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Volume 56 - Veterinary Diagnostics
An International Publication VOLUME 56, 2015 Featured Case: Liza Dadone, VMD Advances in Giraffe Care: Trained Medical Behaviors To watch Dr. Ward’s story, visit vet.abaxis.com/beinspired “ I love Abaxis! I love having the test results there (within minutes) so that I can put the entire picture together for a client... and that way I can more effectively tailor the treatment option for them.” Dr. Heidi Ward Gulfcoast Veterinary | Oncology | Internal Medicine | Sarasota, FL. Abaxis customer It’s not just better diagnostics, it’s a Better way. 800.822.2947 vet.abaxis.com/beinspired #beinspired GLOBAL DIAGNOSTICS Abaxis and VetScan are registered trademarks of Abaxis, Inc. © Abaxis 2015. Learn more about all of our products and services at www.abaxis.com 2 | Vetcom | Volume 56 vetscan@abaxis.com Volume 56 INSIDE VETCOM 26 18 10 14 42 WHAT’S INSIDE 38 06 Abaxis Distributors A comprehensive list of North American Abaxis distributors 09 Coming to a Show Near You Abaxis Tradeshow Schedule 38 Saving Endangered Grey Crowned Cranes in Rwanda By Dr. Olivier Nsenginama 42 Animal Embassy: The Message of the Animals By Dr. Matthias Reinschmidt Dr. David Waugh 46 Vector-borne disease center established, Kansas State University College of Veterinary Medicine $250,000 KSU donation for Vector Borne research 10 Advances in Giraffe Care: Trained Medical Behaviors By Liza Dadone, VMD 14 Adult-onset Demodicosis in a Shih Tzu By Thomas Lewis DVM DACVD Carine Laporte VMD 18 Understanding Radioactive Iodine (I131) Therapy By Gary Norsworthy, DVM, DABVP (Feline) 26 Smokey the Sick Ferret By Karen Rosenthal, DVM 30The Importance of Testing for Ehrlichiosis in Dogs with Persistent Lymphocytosis By Mary Anna Thrall, DVM, MS, DACVP 35 Sometimes it’s More Than Periodontal Disease By Jan Bellows, DVM Volume 56 | Vetcom | 3 GLOBAL DIAGNOSTICS An Abaxis International Publication OUR PROMISE to our customers • Excellent customer service • Giving back • Doing the ‘right thing’ • Respect for all people ABAXIS TODAY Abaxis Editorial Staff & Advisory Board • Entrepreneurial spirit • Building strong relationships • Taking care of our people • Creating value by virtue of world-class products EDITORIAL TEAM Valerie Goodwin-Adams Baerbel Koehler Director, Global Marketing Editor-in-Chief Manager, Wildlife Medicine Abaxis Europe Andrew Rosenfeld, DVM, ACVIM Andrew Ghiringhelli Animal Health Director Medical Editor Graphic Designer Abaxis ADVISORY BOARD Vetcom is also available online at www.abaxis.com. For article reprints and back issues, email us at vetcom@abaxis.com or valeriegoodwin@abaxis.com STA FF & MI SSI ON Printed in the U.S. Deborah Horwitz Sharon Dial DVM ACVB DVM ACVP Gary Norsworthy Steve Levy DVM ABVP (Feline) DVM Heidi Ward Tom Divers DVM ACVIM (Oncology) DVM ACVIM (Equine) Jan Bellows Tom Lewis DVM (Dentistry) DVM ACVD Karen Rosenthal Victoria Lukasik DVM (Exotics) DVM ACVA Kent Adams Dr. Mark Mitchell DVM (Equine General Practice) Abaxis, Inc. Worldwide Headquarters 3240 Whipple Road Union City, CA 94587 Tel 800.822.2947 Fax 510.441.6150 ABAXIS Europe ABAXIS Europe GmbH Bunsenstr. 9-11 64347 Griesheim Germany Tel +49 6155 780 21 0 Fax +49 6155 780 21 111 follow us on Facebook: facebook.com/AbaxisVeterinary 4 | Vetcom | Volume 56 Mary annA Thrall Kendall Harr DVM ACVP DVM, MS ACVP Interested in having your case featured in Vetcom? Send to vetcom@abaxis.com or click vet.abaxis.com/vetcom Words from the Editor of Vetcom Publications Welcome to Vetcom, an Abaxis International Publication, volume #56. Vetcom is read by veterinarians, veterinary technicians and office staff from all over the world, therefore, our issues always have some international news and cases. Vetcom offers readers case studies, practice tips from a clinical perspective as well as educational opportunities and recent news from Abaxis. ON THE CUTTING EDGE O Veterinary and Medical practices around the world benefit from cost efficiencies UR mission at Abaxis is to improve the efficiency of the delivery of care and the quality of life of patients in both the medical and veterinary markets, and we’re proud of the work we do to meet these patient needs. Abaxis’ portable blood analysis systems are used in a broad range of medical specialties in human and veterinary care to provide clinicians with rapid blood constituent measurements. In this issue of Vetcom, multiple scenarios are detailed in Case Studies from the around the world which best describe the global use of our Veterinary product line. Recent news I would like to share is the following Abaxis products received approval from the Center for Veterinary Biologics of the U.S. Department of Agriculture for three rapid diagnostic test kits – VetScan Canine Anaplasma Rapid Test, VetScan Canine Ehrlichia Rapid Test and VetScan Feline FeLV/FIV Rapid Test. We believe that the continuous expansion of our portfolio of rapid diagnostic tests in the veterinary market helps veterinarians achieve greater efficiency and productivity and make the most informed, timely decision about a pet’s health. These single tests, using lateral flow immunoassay technology, aid in the detection of specific diseases, offer cost effective, easy to use, and fast, accurate and easy to read results, while improving patient outcomes and reducing costs for veterinarians. Thank you for your readership and continued participation in Vetcom International Publications. Sincerely, LET TER FR OM T HE EDI TOR Valerie Goodwin-Adams Editor-in-Chief - Vetcom Publications Director, Global Marketing valeriegoodwin@abaxis.com 510-675-6604 Volume 56 | Vetcom | 5 Want to learn more about Abaxis Products and Services? Log onto the Abaxis Veterinary Reference Center at www.abaxis.com/veterinary to view videos on: • • • • VetScan Analyzers Abaxis University VetScan Rapid Tests Abaxis Service and Support VIDEO LEARNING Abaxis is Hiring 1. Multiple positions at corporate headquarters in Union City, CA 2. Field Sales 3. Marketing Professionals 4. Professional Service Veterinarians For more information, go to www.abaxis.com A BAXIS I NFOR MATION AUTHORIZED US ABAXIS DISTRIBUTORS ANIMAL HEALTH INTERNATIONAL, A PATTERSON COMPANY 877-289-9252 CESAR CASTILLO, INC. 7 8 7- 9 9 9 -1 6 1 6 EQUIPMENT OUTREACH, INC. 888-996-9968 FIRST VETERINARY SUPPLY 800-998-4661 HAWAII MEGA-COR, INC. 8 0 0 - 3 6 9 -7 7 1 1 HENRY SCHEIN ANIMAL HEALTH 8 5 5 -724 -3 4 61 MERRITT VETERINARY SUPPLIES, INC. 800-845-0411 MIDWEST VETERINARY SUPPLY 800-328-2975 MWI VETERINARY SUPPLY 800-824-3703 NORTHEAST VETERINARY SUPPLY (NEVSCO) 7 1 7- 52 6 -79 9 0 PATTERSON VETERINARY 8 0 0 - 2 2 5 -7 9 1 1 PENN VETERINARY SUPPLY, INC. 800-233-0210 VICTOR MEDICAL COMPANY 800-888-8908 WESTERN MEDICAL SUPPLY INC. 800-242-4415 CANADIAN DISTRIBUTORS ASSOCIATED VETERINARY PURCHASING 604-856-2146 CDMV 45 0-77 1 -23 68 MIDWEST VETERINARY DISTRIBUTORS 2 04 -23 3 -8 1 5 5 VETERINARY PURCHASING 519-284-137 1 WESTERN DRUG DISTRIBUTION 780-413-2508 *Distributor of Equipment only. No Reagents 6 | Vetcom | Volume 56 LIVE SUMMER & FALL CONTINUING EDUCATION SERIES For more information go to www.abaxisuniversity.com INDUSTRY THOUGHT LEADERS ONLINE CONTINUING EDUCATION (CE) FOR VETERINARIANS, TECHNICIANS AND PRACTICE MANAGEMENT PROFESSIONALS. LEARN LIVE OR ON-DEMAND. YOU CHOOSE. (some of the course offerings listed below) LIVE ONLY Jan Bellows, DVM, DAVDC, DABVP Renal Insufficiency in Cats Dental Anatomy and Nomenclature – Cat Dental Anatomy and Nomenclature – Dog How to Skyrocket Your Dental Practice Andrew Rosenfeld, DVM, DABVP Fluid Therapy and Diagnostic Monitoring of the Patient on IV Fluids Evaluating for Liver Damage and Dysfunction Managing the Acute and Chronic Renal Patient Debra Horwitz, DVM, DACVB Twitching, Itching and Licking: Behavioral Dermatology in Cats Kendal Harr, DVM, MS, DACVP Mineral Metabolism & Pathology - Part I Mineral Metabolism & Pathology - Part II General Quality Assurance ABAXIS UNIVERSITY Committed to Education www.abaxisuniversity.com Abaxis, Inc. – Animal Health 3240 Whipple Road, Union City, CA 94587. Abaxis and VetScan are registered trademarks of Abaxis, Inc. ©2015 Volume 56 | Vetcom | 7 ABAXI S INFOR MATION Gary Norsworthy, DVM, DABVP A FEW OF OUR CUSTOMERS... Veterinary Facilities & Foundations y Facilities Veterinary & Foundations Facilities & Foundations Research Medical/Research Veterinary Facilities & Foundations uariums Zoos/Aquariums Medical/Research Medical/Research es Zoos/Aquariums Universities Veterinary Facilities & Foundations Zoos/Aquariums Veterinary Facilities Facilities & & Foundations Foundations Veterinary Universities A BAXIS I NFOR MATION Medical/Research Medical/Research Medical/Research Zoos/Aquariums Zoos/Aquariums Zoos/Aquariums Universities Universities Universities Universities 8 | Vetcom | Volume 56 The Abaxis Tradeshow Schedule ON THE ROAD CANWEST 10/18 OMVQ 11/20 ONTARIO VMA 01/28 10/13 ACVC 10/08 WILD WEST VET CONFERENCE AAEP 12/06 10/19 MWI EQUINE EVENT 12/04 CVC IN SD 01/17 NAVC 10/19/15 – 10/23/15 MWI EQUINE EVENT Las Vegas, NV 12/06/15 – 12/08/15 AAEP Las Vegas, NV 10/13/15 – 10/15/15 ACVC Atlantic City, NJ 11/20/15 – 11/21/15 OMVQ Quebec City, QC 01/17/16 – 01/20/16 NAVC Orlando, FL 10/18/15 – 10/19/15 CANWEST Banff, AB 12/04/15 – 12/06/15 CVC IN SD San Diego, CA 01/28/16 – 01/30/16 ONTARIO VMA Toronto, ON Volume 56 ABAXI S INFOR MATION 10/08/15 – 10/11/15 WILD WEST VET CONFERENCE Reno, NV | Vetcom | 9 CONTRIBUTING AUTHORS FEATURED CASE Trained Medical Behaviors Featured Case: Contributing Author: Liza Dadone, VMD Director of Animal Health and Conservation | Cheyenne Mountain Zoo T RADITIONALLY, giraffe in human care have been considered to be challenging patients, partly due to their tall stature, unique anatomy, and neophobic nature. However, zookeepers and veterinary staff at Cheyenne Mountain Zoo are challenging these assumptions by incorporating operant conditioning methods for medical behaviors. By using positive reinforcement procedures to shape medical behaviors, we are able to do an increasingly wide range of diagnostics and treatments. This allows our 17 reticulated giraffe to be active participants in their own medical care. 10 | Vetcom | Volume 56 ADVANCES IN GIRAFFE CARE: TRAINED MEDICAL BEHAVIORS Diagnostic Procedures With the help of target training, we perform a wide range of diagnostic procedures on our giraffe. This includes venipuncture for routine CBC/Chem monitoring, ophthalmic exams, trans-abdominal pregnancy ultrasounds, and skull radiographs. Additionally, using a series of trained behaviors and a restricted contact set-up, the entire giraffe herd is trained for voluntary front foot radiographs. Medical Treatments Operant training also facilitates husbandry care and medical treatments. The giraffe get front hoof farrier trims every 6-12 weeks. Annually, they get vaccine booster injections and other injections if needed. After a neck injury to our breeding bull giraffe five years ago, he was trained for range of motion neck exercises, chiropractic adjustments, and cold laser therapy treatments; with these, he’s made a full clinical recovery and has since fathered two calves. Wild Giraffe and Their Silent Crisis In 1998, the IUCN estimated that there were over 140,000 wild giraffe in Africa. In 2012, follow-up population studies indicate that fewer than 80,000 wild giraffe remain. Despite the decline, there has been relatively little global attention surrounding giraffe conservation. Cheyenne Mountain Zoo helps support the Giraffe Conservation Foundation’s conservation fieldwork with our Quarters for Conservation program. For more info about how you can help support giraffe conservation, please see www. cmzoo.org/q4c. Acknowledgments Thanks to the dedicated team at Cheyenne Mountain Zoo: the animal department for their exceptional training: Amy Schilz, Andrea Bryant, Diana Cartier, Jason Bredahl, and Jeremy Dillon; and to our veterinary team for medical care: Dr Eric Klaphake, DeeAnn Wilfong, Harley Thompson, and Erica Veal. Thanks also to farrier Steve Foxworth at the Equine Lameness Prevention Organization for helping provide giraffe foot care. CONTRIBUTING AUTHORS FEATURED CASE Using a restricted contact set-up and extensive safety training protocols, the giraffe herd is trained for voluntary front foot radiographs. Volume 56 | Vetcom | 11 ADVANCES IN GIRAFFE CARE: TRAINED MEDICAL BEHAVIORS Msitu positions for a voluntary phlebotomy. Bloodwork was run on an in-house Abaxis VS2 serum chemistry analyzer and VetScan HM5 CBC machine, and Msitu was given a clean bill of health. Msichana, giraffe, positions for a skull radiograph. CONTRIBUTING AUTHORS FEATURED CASE VetScan VS2 Large Animal Profile Patient ALB g/dL ALP U/L AST U/L BUN mg/dL Ca mg/dL CK U/L GGT U/L Glob g/dL Mg mg/dL Phos mg/dL TP g/dL Msitu 4.1 366 95 17 9.2 433 20 4.9 2.6 6.3 9.0 1.7-4.1 67- 1512 31- 163 7-34 7.1-12.9 90-3144 9-84 1.7-6.8 1.14-3.13 3.2-13.9 4.5-10.0 ISIS Reference Values VetScan HM5 CBC Patient Neut Lymph Mono Eos Baso RBC WBCC 109cells/µL 109cells/µL 109cells/µL 109cells/µL 109cells/µL 109cells/µL 1012cells/µL Msitu 11.53 8.35 ISIS Reference 3.38-21.91 1.58-17.40 Range 12 | Vetcom | Volume 56 2.82 0.11 0.22 0.03 0.46-5.30 61-1110 < 0.953 < 0.570 9.92 Hgb g/dL Hct % PLT 109cells/µL 12.3 36.87 126 5.15-15.44 6.9-15.6 19.6-46.9 94-1041 ADVANCES IN GIRAFFE CARE: TRAINED MEDICAL BEHAVIORS Mshichana, giraffe, positions for hoof care in the outdoor restricted contact paddock. Volume 56 | Vetcom | 13 CONTRIBUTING AUTHORS FEATURED CASE Khalid, bull giraffe, injured his neck five years ago. Part of his treatment includes a physical therapy exercise routine. He is cued to touch his nose to each hip to stretch out his neck muscles. Since starting his treatments, Khalid has made a full clinical recovery. (For more details on this case, see the Journal of Zoo and Wildlife Medicine, 4(1): 181-185, 2013.) Adult-onset Demodicosis in a Shih Tzu Contributing Authors: Thomas Lewis, DVM, DACVD Carine Laporte, VMD Dermatology for Animals D CONTR IBUTI NG AUTH OR S EMODICOSIS, also called “red mange” or “demodectic mange,” is an inflammatory skin disease caused by an overabundance of demodex mites. The most common causative demodex species in dogs is Demodex canis; however, D. injai and D. cornei have also been reported and are seen in practice. Different species can be seen simultaneously in the same patient. Hallmarks of the disease in dogs include alopecia, erythema, comedones, increased keratosebaceous exudate (greasy skin), and folliculitis, which can progress to deep furunculosis. Secondary pyoderma is common. Canine demodicosis has classically been categorized as either juvenile or adult onset, and as either localized or generalized disease. These classifications play a role in determining the underlying cause, as well as the prognosis, of the disease. Though true adult-onset generalized demodicosis is uncommon, it is more serious than juvenile-onset and is more often associated with underlying immunosuppression. Generalized demodicosis is one of the most serious canine skin diseases, with a potentially fatal outcome in the absence of treatment. cannot be documented at the time of diagnosis with demodicosis; however, these dogs should continue to be closely monitored, as malignancy or systemic illness may become obvious in the subsequent weeks to months. While demodicosis is initially diagnosed by skin scraping and cytology, additional diagnostic testing, including hematologic and urologic assessments are important when evaluating these patients. Concurrent disorders recognized in dogs with adult-onset demodicosis include, but are not limited to: hypothyroidism, spontaneous or iatrogenic hypercortisolism, leishmaniasis, malignant neoplasia, and concurrent immunosuppressive therapy. In more than 50% of cases, an underlying disease An 11-year old, female spayed Shih Tzu was presented with a 5-month history of non-seasonal dorsal and pedal draining and crusted lesions that had been unresponsive to enrofloxacin. Similar lesions had occurred 2 years prior and had resolved with an unknown medical therapy. The patient showed no signs of systemic illness apart from mild lethargy and intermittent stranguria. No other animals or people in the household were affected with dermatologic disease. 14 | Vetcom | Volume 56 The case described herein is one of adult-onset generalized demodicosis, deep pyoderma, and furunculosis in which hematologic and urologic evaluations were an important part of the diagnostic workup and patient monitoring. ADULT-ONSET DEMODICOSIS IN A SHIH TZU On presentation, the patient had numerous, thick, yellowblack crusts overlying draining tracts, erosions, and ulcerations along the cranial dorsal trunk and ventral chin. All paws were markedly swollen and had similar draining tracts, erosions, ulcerations, and matting of the hair with hemorrhagic exudate (Image 1). Otoscopic examination revealed bilateral moderate ear canal erythema and ceruminous debris; however, ear canals were normally distensible on palpation. The presentation was consistent with truncal and pedal folliculitis and furunculosis, with bilateral otitis. Image 2 Image 1 Dorsal trunk and pedal hemorrhagic crusting associated with deep furunculosis due to concurrent demodicosis and Staphylococcus pyoderma. Diagnostics A skin scraping of the dorsal crusted area, as well as a pluck of the interdigital hair, revealed numerous (5-10/low power field) D. canis mites (Image 2). Impression cytology of the dorsal trunk draining tracts revealed significant presence of intra- and extracellular coccoid bacteria in a neutrophilic milieu. Dermatophyte culture was obtained and was determined to be negative three weeks later. Cytology of the ceruminous debris revealed D. injai mites within the cerumen but no other microorganisms. Based on these results, a diagnosis of adult-onset demodicosis with a deep pyoderma, otitis and pododermatitis was made. Labwork, including blood chemistry, complete blood count, thyroid evaluation and urinalysis with culture, is an important minimum data base when evaluating a case of adult-onset demodicosis. Diagnostic imaging may also be warranted. Aerobic skin culture was also obtained, given the history of non-response to enrofloxacin. Aerobic culture of the dorsal trunk draining tracts revealed a methicillin-susceptible Staphylococcus pseudintermedius. Urinalysis revealed significant bacteriuria and hematuria with mild proteinuria. Aerobic culture of the urine identified Enterococcus species. Both bacterial species were susceptible to amoxicillinclavulanate. Blood chemistry results revealed a marked hyperproteinemia of 11.2 g/dL (range 5.5-7.5) with marked hyperglobulinemia of 9.6 g/dL (range 2.4-4.0) and moderate hypoalbuminemia of 1.6 g/dL. Albumin to globulin ratio was correspondingly decreased at 0.2 (range 0.7-1.5). The complete blood count was unremarkable and the total T4 was just below the normal range at 0.9 ug/dL (range 1.0 – 4.0ug/dL). Given the concurrent extent of skin disease and the lack of corresponding hematologic and chemistry abnormalities (e.g. hypercholesterolemia, anemia, etc.), the patient was considered euthyroid. Differential diagnoses for the significant serum protein abnormalities included Volume 56 | Vetcom | 15 CONTRI BUT ING AU THOR S The three primary causes of folliculitis in the dog are demodicosis, pyoderma, and dermatophytosis. In some dogs, the three conditions may be present simultaneously. Initial diagnostic testing for these conditions should include skin scraping, dermatophyte culture, and cytology. Demodex canis mites found on skin scraping. ADULT-ONSET DEMODICOSIS IN A SHIH TZU neoplastic versus a severe inflammatory process. It was not suspected that the hypoalbuminemia reflected urinary or gastrointestinal losses given the patient’s clinical appearance, lack of suggestive history, and mild proteinuria on urinalysis. Hypoalbuminemia was attributed to a compensatory response to severe hyperglobulinemia. To further evaluate the hyperglobulinemia, Coccidioidomycosis titers (endemic in the region) were performed and were negative for IgG and IgM. Protein electrophoresis indicated a polyclonal gammopathy. Based on these results, inflammatory processes remained a potential cause for the hyperglobulinemia. The owners elected to perform serial monitoring of globulin levels via chemistry panel over time with treatment of the demodicosis, pyoderma and cystitis. Ivermectin (0.5 mg/kg PO daily) and a 6-week course of oral antibiotic (amoxicillin-clavulanate at 22 mg/kg PO BID) therapy were initiated. Twice weekly bathing with a benzoyl peroxide shampoo was initiated for antibacterial and follicular flushing effects. At the scheduled recheck four weeks after initiating therapy, the patient was significantly improved. The crusting and draining tracts from the trunk and feet had resolved indicating clearing of the deep pyoderma. The ears contained only subtle amounts of ceruminous debris. Multiple skin scrapings, ear cytology and hair plucks revealed one dead adult mite. A urinalysis was normal indicating the cystitis had cleared. Repeating the blood work showed improvement in the hyperproteinemia (9.0 down from 11.2 g/dL) and hyperglobulinemia (7.0 down from 9.6 g/dL) and hypoalbuminemia (2.0 up from 1.6 g/ dL). Examination and blood work after three months of ivermectin therapy revealed normal skin, feet and ears with negative skin scrapings and blood work all within normal levels. This case illustrates the importance of additional laboratory testing in the diagnosis of adult-onset demodicosis. Though this patient had no history of known underlying disease, hematologic and urologic evaluation revealed concurrent urinary tract infection and a marked hyperproteinemia and hyperglobulinemia. Continued monitoring of this patient with serial complete blood counts and chemistry panels constitute an important element of care for these patients and may help to identify an underlying disease in its earlier stages. Figure 3 CONTR IBUTI NG AUTH OR S Figure 1 4 weeks after initiating antibiotic and anti-parasitic therapy, all crusting and deep pyoderma has resolved. Follicular casting and comedones with residual hyperpigmentation are evident. 16 | Vetcom | Volume 56 Abaxis announces ABAXIS VETERINARY CONSULTING Exclusive to Abaxis customers Preventive Care for ALL life stages. The Abaxis Veterinary Consulting Group is an established group of veterinarians and veterinary technicians with business acumen whose goal is to optimize your preventive care for all life stages. The complimentary program consists of: • • • • Staff training from AVC Veterinarians A dedicated concierge team to help monitor your success Personalized forms and client education handouts On-site diagnostics to help initiate and oversee the program in your practice It’s not just better diagnostics, it’s a Better way. 800.822.2947 www.abaxis.com AVC@abaxis.com GLOBAL DIAGNOSTICS Abaxis and VetScan are registered trademarks of Abaxis, Inc. © Abaxis 2015. Learn more about all of our products and services at www.abaxis.com Volume 56 | Vetcom | 17 CONTR IBUTI NG AUTH OR S UNDERSTANDING RADIOACTIVE 131 IODINE (I ) THERAPY H Contributing Author: Gary D. Norsworthy, DVM, DABVP (Feline) Alamo Feline Health Center | San Antonio, Texas YPERTHYROIDISM is considered the most common endocrine disease of the older cat. It has been estimated that approximately 10% of cats over 10 years of age are or will be affected. The disease begins as an adenoma of one or both of the thyroid lobes. Over several years the adenoma may transform to adenocarcinoma. Treatment of the latter is much more intense and often not successful; therefore, it is highly desirable to rid the cat of the adenoma. There are four treatments in two categories. Treatments in the “Control” category are the administration of methimazole or y/d, an iodine restricted diet. Treatments in the “Cure” category are thyroidectomy and radioactive iodine (radioiodine or I131) therapy. The obvious advantage for using a Cure approach is the avoidance of thyroid adenocarcinoma. Each treatment approach has pros and cons. The approach with the most pros and the least cons is I131 therapy. Although its availability is somewhat limited, it can rid the cat of the benign tumor without destruction of the normal thyroid tissue or the parathyroid gland. When dosed properly, I131 therapy will cure the disease without resulting in any further treatment of the cat for thyroid disease, either hypo- or hyper-. Since 2004 my practice, Alamo Feline Health Center, has treated over 500 hyperthyroid cats with I131. During that time many questions have arisen regarding this treatment modality. Below are the questions we have received and the answers. Note that radiation laws vary from state to state so some of the legal aspects of these answers may not apply to all states. 18 | Vetcom | Volume 56 UNDERSTANDING RADIOACTIVE IODINE (I 131 ) THERAPY 1. What is the cost? The treatment cost is usually based on the dose of I131 that is administered. Cats diagnosed early get a smaller dose so their treatment cost averages $1000-1500, which includes isotope administration and the required hospitalization until discharge. Cats with advanced disease require a higher dose; however, it is very unusual for the higher doses to cost more than $2000. In addition to the actual treatment cost, there is usually an examination/referral exam fee of $75.00-150.00 and the cost of any needed pretreatment tests. The latter may be several hundred dollars depending on the facility and the tests performed. Some cats require sedation for safe I131 administration. There will be a charge for sedation; the cost will depend on the drug and the route of administration. 2. How is the dose determined? There is not a precise way to determine the dose of I131 for any given cat. Formerly, in the U.K., every cat received the same dose. However, notable treatment failures forced U.K. veterinarians to re-examine their dosing protocol. Despite the absence of a precise method, satisfactory dosing techniques do exist. Rather than basing dosage on the size of a cat, it is based on the size of the tumor. The size of the tumor can be estimated in several ways. Thyroid palpation can be used in most cats. After many years of practice, we have developed a sizing system that works well. More precise size determination may be made with a technetium scan, not available at all treatment facilities. For best results, we use a combination of palpation and total T4 (TT4) levels to determine tumor size and are correct over 99% of the time. In order to attain this level of accuracy, we need an exact TT4 value. 3. What pre-treatment laboratory tests are needed? In addition to a total T4 (or fT4), we need to be sure the kidney function is normal or nearly normal. High thyroxine levels increase heart rate and blood pressure with resulting increased perfusion of the kidneys. This process results in temporarily lowered creatinine (especially) and BUN values. Note that the higher the TT4 or fT4 the more the kidney values are lowered. Therefore, we need to have the renal values at the time of diagnosis and any values since. 4. If the cat’s renal values increase above normal after treatment, what are the consequences? If the one month post-treatment values are in late IRIS Stage 2 or early IRIS Stage 3 (creatinine = 2.9-4.0 mg/dl) range, there are great options to control renal disease and slow the progression of age-induced renal deterioration. However, these cats need support quickly. If the creatinine rises to 4.0 mg/dl or greater, more aggressive therapy is needed, but this is still feasible. Note that after treating over 500 cats, we have only had 4 cats (0.8%) in the latter category. 5. What about the Methimazole Test? The “Methimazole Test” has been employed to determine what level of renal function is likely to be present after treatment with I131. Methimazole is given until the TT4 is normal (about 2-4 weeks), and then the TT4 is rechecked. We will treat cats with I131 with or without a methimazole test. If one is performed, the cat needs to be off the drug for at least 5 days before I131 treatment. 6. Ordering the Isotope: By law, we are not permitted to store I131 on our premises. When it is delivered to us, we must pay for it, and it must be given to a cat. We cannot store it for future use or return it. Therefore, we do not order it until our patients are physically in the building. 7. How long does a cat need to be hospitalized? Our patients are generally treated on Mondays. Their release is governed by state rules which mandate we perform a scan to determine when the level of radioactivity is safe. Most cats are then cleared for release on Thursdays or Fridays; however, if the results of the scan are not appropriate, they stay until they are. It is very unusual for discharge clearance to go past Saturday, but I131 excretion is largely dose related. The higher the dose, the longer the isolation period must be. NOTE: The answer to this question varies from state to state. Volume 56 | Vetcom | 19 CONTRI BUT ING AU THOR S This is a test that comforts many people – veterinarians and owners alike. It gives us an understanding of what the kidneys are likely to do after I131 treatment. However, Dr. Mark Peterson, the guru of hyperthyroidism, is of the opinion that it is rarely needed. His perspective is that if hyperthyroidism exists, it needs to be treated or else it will be fatal. If the kidney values increase after treatment, renal disease can be addressed with diet, electrolyte correction, SC fluids, etc. UNDERSTANDING RADIOACTIVE IODINE (I 131 ) THERAPY The safe level is not all the way down to zero. If the owner is concerned about the minuscule amount of residual radioactivity, we are happy to board the cat until it reaches zero. The additional stay is charged as a boarding fee only; there is no charge for further scanning. The radioactivity is principally eliminated through the urine and the stool. If the cat does not eat while it is here, the elimination is slower and the stay prolonged. Therefore, we request that owners bring a few days of the cat’s favorite food in order to encourage the cat to eat, and thus expedite the elimination process. 8. Can my clients bring bedding or toys for their cats to have during the treatment time? Yes. However, State regulations prohibit them from being returned. NOTE: The answer to this question varies from state to state. 9. My patient’s liver enzymes are elevated. Should I perform more diagnostics or treat for liver disease? Elevation of liver enzymes (LEs), especially ALT, is expected in cats with hyperthyroidism. It is the result of prolonged TT4 elevation. The LEs will return to normal 4-6 weeks after treatment. That said, it is possible for a cat to have two concurrent diseases which elevate LEs. If you are concerned about a dual diagnosis, a liver biopsy is indicated. We can do that if you are not comfortable doing so. We generally perform a fine needle biopsy with a 22 gauge needle guided by ultrasound. However, we cannot do a liver biopsy the same day as I131 treatment due to the turnaround time required by the veterinary pathology laboratory. 10. Are there side effects? No. When the proper adenoma dose is given the effects of I131 are limited to hyperactive thyroid cells; other body cells, including normal thyroid cells, are not affected in any way. If the adenocarcinoma dose is given (5-10X adenoma) normal thyroid cells are killed, the cat becomes hypothyroid; however, no other body cells are adversely affected. CONTR IBUTI NG AUTH OR S 11. Can clients visit their cats? No. The State regulations prohibit this. 12. Is it permissible to administer medications for other diseases? State law prohibits us from handling these cats for the first 24 hours after treatment. If doing without medications for that period of time is life-threatening, we should not treat the cat. Although limited contact is permitted after the first 24 hours, we can then administer oral or injectable medications. NOTE: The answer to this question varies from state to state. 13. What post-treatment care is needed at home? There are state-mandated rules the owner is expected to follow when the cat returns home. These release criteria are listed for your clients. NOTE: The answer to this question varies from state to state. 14. Will this cat be a danger to my other pets at home? No. The I131 treated cat does not need to be separated from other cats or use a different litter box. Dogs that eat cat stools are also not at-risk. 15. I am not sure of the diagnosis. Should I confirm it with a free T4? The fT4 is said to be more sensitive than the TT4 for hyperthyroidism. However, in some situations it is not specific. A study published 20 | Vetcom | Volume 56 UNDERSTANDING RADIOACTIVE IODINE (I 131 ) THERAPY in JAVMA (June 15, 1996) showed that cats with non-thyroidal illnesses frequently have a decreased TT4 and an increased fT4. Therefore, this test must be used with care. Our preferred test for clarifying confusing cases is the T3 Suppression Test. It is described in The Feline Patient, eds. 3 and 4 or other standard textbooks. 16. What follow-up is needed after treatment? One month after treatment, the cat needs to have its TT4 and renal values determined. These tests are usually performed by the referring veterinarian, which is our preference. If any values are abnormal, the treating veterinarian should be contacted for recommendations. 17. How often does hypothyroidism occur after I131 treatment? It is not unusual for the TT4 to be subnormal at one month post-treatment. When a thyroid tumor is active, negative feedback stops TSH production causing normal thyroid cells to become dormant. When the thyroid tumor is destroyed by I131 treatment, it may take more than one month for the dormant thyroid cells to rebound. This is called “transient hypothyroidism.” If the TT4 is subnormal at one month posttreatment, repeat it four to six weeks later. “Persistent hypothyroidism” following treatment is dose related and occurs less than 1% of the time in the cats we treat. 18. I understand that a thyroid (technetium) scan can differentiate a thyroid adenoma from a thyroid adenocarcinoma. Is that correct? No. Thyroid disease begins as a thyroid adenoma. Over time, the benign adenoma may transform to a malignant thyroid adenocarcinoma. It is frequently stated that 2% of hyperthyroid cats have malignancy, but it should be noted that these are the cats with advanced disease. Therefore, a cat with early or mid-range thyroid disease is extremely unlikely to have adenocarcinoma. A thyroid scan can determine the number of thyroid masses and their sizes and give a suggestion of differentiation. However, a histological diagnosis can only be made by a pathologist with a microscope. If malignancy is suspected, a thyroid biopsy is the only way to accurately differentiate thyroid adenoma from thyroid adenocarcinoma. 19. Does treatment with methimazole or y/d prevent the transformation from adenoma to adenocarcinoma? No. Neither of these treatment modalities destroys the thyroid tumor. Over time, the tumor gets larger requiring higher doses of methimazole to control the disease. We do not know the long-term success rate and long-term side effects of y/d. Dr. Mark Peterson reported on a large number of cats on methimazole for four years. He found the incidence of malignancy to be about 20%. Only destroying the benign tumor can prevent its change to adenocarcinoma. CONTRI BUT ING AU THOR S 20. Can thyroid adenocarcinoma be treated successfully? Possibly. The size of the tumor and the extent of metastasis are the major determinants in success and survival. In order to have a realistic chance of remission, the dose of I131 is increased about 5-10 fold. Some survive 1-2 years and have quality life for most of that time. However, this very high dose of I131 will kill normal thyroid tissue leaving the cat persistently hypothyroid. These cats need thyroid replacement hormone therapy for the remainder of their lives. The poor response rate for thyroid adenocarcinoma means that cure (not just control) during the stage of adenoma is highly desirable. Radioactive iodine has the ability to do this. Volume 56 | Vetcom | 21 Rapid Tests S I N G U L A R LY BETTER PROVIDING THE FLEXIBILITY YOU NEED The Abaxis VetScan Canine Ehrlichia Rapid Test! For the qualitative detection of antibodies of E. canis, E. chaffeensis, and/or E. ewingii in canines Single Tests for Vector-Borne and Fecal Diseases VetScan Rapid Tests — Singles The VetScan Rapid Test portfolio gives you more of what you want and less of what you don’t want from a single, rapid test — more options, more confidence, less hassle, less waiting. VetScan Rapid Tests deliver exactly what you’ve come to know from Abaxis. The perfect balance of price and performance. Fast, accurate, easy and affordable — It’s a singularly better approach to rapids. It’s not just better diagnostics, it’s a better way. 800.822.2947 vet.abaxis.com/rapids GLOBAL DIAGNOSTICS Abaxis and VetScan are registered trademarks of Abaxis, Inc. © Abaxis 2015. Learn more about all of our products and services at www.abaxis.com 22 | Vetcom | Volume 56 vetscan@abaxis.com Performance of the Abaxis VetScan® Canine Ehrlichia Rapid Test Steven Levy, VMD Andrew J. Rosenfeld, DVM ABVP Introduction The genus Ehrlichia consists of tick-transmitted gramnegative obligate intracellular bacteria from the order Rickettsia and family Anaplasmataceae that primarily infect leukocytes.1 The three most relevant species found in dogs at this time are E. canis, E. chaffeensis, and E. ewingii, with E. chaffeensis having significance as a human pathogen.2 The vector for E. canis is the brown dog tick (Rhipicephalus sanguineus) which has worldwide distribution throughout tropical and temperate climates, including all of the United States except Alaska. The vector for E. ewingii is the Lone Star Tick (Amblyomma americanum) which is found from Texas, Oklahoma, Kansas, Missouri and Iowa in the Midwest and eastward to the Atlantic coast. The primary vector for E. chaffeensis is the Lone Star Tick as well, but the organism is also found in the American dog tick (Dermacentor variabilis).3 Clinical signs of E. canis infection range from non-specific (depression, lethargy, anorexia, weight loss), to red/purple subcutaneous bleeding, nose bleeds, ocular signs (retinal hemorrhage/ Inflammation), and / or neuromuscular signs (e.g. seizures, balance issues, or pain). Diagnosis of canine ehrlichiosis can be made by the observation of infected morulae in macrophages in blood smears or monocytes in tissue aspirates or impression smears.4 With E. chaffeensis infection, clinical signs are similar to, but often less apparent, than those of dogs infected with E. canis. Thrombocytopenia is common, but other observations, including identification of morulae, are not routinely observed.5 With E. ewingii, infection can be mild or unapparent, however symptomatic, infected dogs display signs of fever, lethargy, anorexia, polyarthritis, vomiting, diarrhea, and / or neurologic signs.6 After infection with Ehrlichia species organisms an acute, subacute or chronic infection can occur. The acute phase can last from 1 to 4 weeks. Most dogs that are treated appropriately with antibiotics during the acute phase will recover. Dogs that are either untreated or inappropriately treated may clinically recover, but then enter the subclinical phase for months to years. Dogs that are persistently infected may spontaneously recover or develop severe chronic disease. Dogs in acute phases are often antibody negative while dogs in subacute and chronic phases are generally antibody positive. In chronic disease, the bone marrow is typically infected resulting in pancytopenia. The severity of chronic ehrlichiosis can vary in severity from mild to lifethreatening.7 Materials and Methods Four hundred twenty-six samples were obtained from private practices, humane societies and laboratories. The overall sensitivity and specificity of the VetScan® Test were determined versus commercially available immunofluorescence assay (IFA). Results Of the 426 samples tested in this study, 214 were found to be negative and 212 samples were positive by IFA. The sensitivity and specificity are calculated below. VetScan Canine Ehrlichia Rapid Test Negative VetScan Canine Ehrlichia Rapid Test Positive IFA Negative 207 7 IFA Positive 14 198 Results Sensitivity = 93.4% (95% CI: 88.9 - 96.2%) Specificity = 96.7% (95% CI: 93.1 - 98.6%) There were 14 samples which were positive by IFA but negative on the VetScan Ehrlichia Rapid Test. However 8 of those 14 were confirmed as negative when tested on a commercially available kit and ELISA. These are likely false positives on IFA. Taking this into consideration the actual sensitivity of the VetScan Ehrlichia Rapid Test is 97%.8 From a subset of these positive samples, species identification was accomplished by using a combination of commercially available IFA reagents for E. canis and E. chaffeensis, commercially available Ehrlichia antibody test kits, and Abaxis proprietary ELISA tests. Of these, 45 were found to be positive for E. canis, 40 for E. chaffeensis, and 47 for E. ewingii. Volume 56 | Vetcom | 23 Results for E. canis Results VetScan Canine Ehrlichia Rapid Test Negative VetScan Canine Ehrlichia Rapid Test Positive 1 44 All criteria positive for E. canis Sensitivity for E. canis = 97.7% (95% CI: 88.2 - 99.9%) Recent developments in laboratory methodology and the corresponding in-clinic VetScan Canine Ehrlichia Rapid Test offer a cost-effective and time-saving option. The VetScan Canine Ehrlichia Rapid Test is both a sensitive and specific test for the detection of antibodies to three Ehrlichia species. Conclusions This study demonstrates that the VetScan Canine Ehrlichia Rapid Test is a reliable, cost effective and time saving point of care assay to detect the presence of antibodies against E. canis, E. chaffeensis, and E. ewingii species affecting dogs, allowing for the effective diagnosis and treatment of infected patients. Results for E. chaffeensis Results VetScan Canine Ehrlichia Rapid Test Negative VetScan Canine Ehrlichia Rapid Test Positive 2 38 All criteria positive for E. chaffeensis Bibliography 1 Little, S.E. (2010). Ehrlichiosis and anaplasmosis in dogs and cats. Vet Clin North Am Small Anim Pract., 40(6), 1121-40. 2 Berrada, Z.L., & Telford, S.R. 3rd. (2009). Burden of tick-borne infections on American companion animals. Top Companion Anim Med., 24(4), 175-81. 3, 5, 6 4 Foglia Manzillo, V., Cappiello, S., & Oliva, G. (2006). Tick-transmitted diseases in dogs: clinicopathological findings. Parassitologia, 48(1-2), 135-6. 4 Harrus, S., & Wane, T. (2011). Diagnosis of canine monocytotropic ehrlichiosis (Ehrlichia canis): an overview. Vet J. 187(3), 292-6. 7 Sainz, A., Roura, X., Miro, G., Estrada-Pena, A., Kohn, B., Harrus, S., & Solano-Gallego, L. (2015). Guidelines for veterinary practitioners on canine ehrlichiosis and anaplasmosis in Europe. Parasites & Vectors, 8:75. 8 Walker et al. (2014). Serology of Tick-Borne Diseases in Dogs. Cambridge HealthTech Institute Conference “Targeting Tick-Borne Diseases.” Boston. Oct 28-29. Poster presentation. For a copy of the poster handout, go to: www.abaxis.com Sensitivity for E. chaffeensis = 95.0% (95% CI: 83.1 - 99.4%) Results for E. ewingii Results VetScan Canine Ehrlichia Rapid Test Negative VetScan Canine Ehrlichia Rapid Test Positive 1 46 All criteria positive for E. ewingii Green, Craig, E. (2012). Infectious Diseases of the Dog and Cat 4th Edition. Athens, Ga: Elsevier, 227-259. Sensitivity for E. ewingii = 97.9% (95% CI: 88.7 - 99.9%) Discussion In general, Canine Ehrlichia infection (or Ehrlichiosis) is not only evaluated in sick patients, but also evaluated to identify asymptomatic chronically infected canines in endemic regions. Diagnosis of Ehrlichiosis is based upon history, tick infestation, hematologic abnormalities and serologic findings. Polymerase Chain reaction (PCR testing) has also been used to determine infection and monitor response to medications. The VetScan Canine Ehrlichia Rapid Test is ideally suited to detect antibodies to all three species of Ehrlichia, and is labeled for all three species. Information on how Ehrlichia species were identified is available at Abaxis, Inc. Abaxis and VetScan are registered trademarks of Abaxis, Inc. © Abaxis 2015 24 | Vetcom | Volume 56 888-4281 Rev. A “ The fact that Abaxis Chemistry is utilized on the human side says a lot about the company and the Quality of their product.” Erica Kent Director of Operations | Newman Veterinary Centers | Daytona, FL. Abaxis customer To watch NVC’s story, visit vet.abaxis.com/beinspired It’s not just better diagnostics, it’s a Better way. 800.822.2947 vet.abaxis.com/beinspired vetscan@abaxis.com #beinspired GLOBAL DIAGNOSTICS Abaxis and VetScan are registered trademarks of Abaxis, Inc. © Abaxis 2015. Learn more about all of our products and services at www.abaxis.com Volume 56 | Vetcom | 25 SMOKEY SICK FERRET THE Contributing Author: Karen Rosenthal, DVM, MS Dean | School of Veterinary Medicine ST. MATTHEW’S UNIVERSITY P. O. Box 32330, Grand Cayman KY1-1209 Cayman Islands, B. W. I. CONTR IBUTI NG AUTH OR S “S MOKEY,” a five-year-old male neutered ferret, is brought to your hospital for a physical examination. Although your associate saw this ferret only three months ago for a yearly check-up, since then, the owner says that “Smokey” has become slightly less active. That is why “Smokey” is here to see you today. At his appointment three months ago “Smokey” had no unusual physical examination findings and the owners had no complaints about anything out of the ordinary at home with “Smokey.” There are no other pets in the house and “Smokey” was acquired from a local pet store as a kit and has no health issues his entire life. Usually, “Smokey” spends the day in his large cage that has a litter pan, a hammock, and a hide box. When the owners come home, “Smokey” is allowed out to run around the “ferret-proof” living room with supervision. From talking with the owners, it becomes apparent that “Smokey” is not acting like his normal-self. When the owners come home, instead of bounding out of his cage, “Smokey” stays in his hammock or takes a look around at the open door, and decides to stay inside his enclosure. Not content to let him sleep in the cage, once they are home, “Smokey’s” owners pick him up out of his enclosure, put him on the living room floor and start playing with him. After a few minutes, he seems to perk up a little, especially now that they are coaxing him to run around by offering him some ferret treats. They report that he does seem more energetic after he eats, but he is less interested in eating his food compared to when he used to finish his dinner quickly. To further encourage “Smokey” to eat, they have started giving him a little bit of meat-based baby food in jars as a way to get him to eat more of his dry food. 26 | Vetcom | Volume 56 Your physical examination of “Smokey” is fairly normal except for a couple of unusual findings that you discuss with the owners. When you place “Smokey” on the carpeting to watch him walk, he does seem less active than your associate reported a few months ago. Also, you can hear a grade II heart murmur on the left side of his thorax. You tell “Smokey’s” owners that you are not exactly sure what is wrong but in an older ferret that is less active, insulinoma disease has to be high on your rule out list. Likewise, heart disease is known to occur in older ferrets and there is a heart murmur present now. Finally, you remind them that there may be other causes then those two you just listed that are responsible for “Smokey’s” condition and murmurs are not always associated with serious or clinical heart disease in a ferret. Therefore, you recommend a CBC and biochemistry profile along with whole body radiographs. “Smokey’s” owners agree to the plan SMOKEY THE SICK FERRET and they leave him with you for the day. Radiographs are taken and the blood work is sent off to a laboratory. The radiographs show an enlarged heart silhouette and some pleural effusion. An echocardiogram confirms that heart disease, specifically dilated cardiomyopathy, is present and “Smokey” is in the early stages of heart failure. He is started on appropriate medications for the dilated cardiomyopathy and associated pleural effusion. We also let the owners know that at this point, we are not sure if the heart disease is the only reason for the weakness “Smokey” was exhibiting at home since we do not have the blood tests back yet. We tell the owners we have a bit of a dilemma. We could start him on prednisone for a presumptive insulinoma since he has the signs and signalment for an insulinoma, but you are concerned about the potential effect prednisone might have on pre-load for his heart. Since “Smokey’s” laboratory results will not be back until tomorrow, you decide to send “Smokey” home on just his heart medications and will call the owners with the results and update any medications at that time. The results come back late the next day and the CBC is normal. The biochemistry panel has only one abnormal result. The blood glucose concentration is reported to be 40 mg/dl. The laboratory reports the normal range to be between 85 and 150 and so 40 mg/dl appears to be very low. Here is the dilemma- if “Smokey’s blood glucose is truly 40 mg/dl, then he needs surgery to debulk the disease in his pancreas and/or medication to combat the low glucose. Both forms of treatment have serious implications to a ferret with heart failure. Ferrets acclimate to the hypoglycemia, therefore, owners may miss the subtle signs at the start of this disease. So when the laboratory reports a blood glucose concentration of 40 mg/dl, is it not unusual that the ferret did not appear sicker- both at home and in your office due to this ability to acclimate to the hypoglycemia. But now we have a treatment dilemma. If the blood glucose concentration is 40 mg/dl, then treatment must be started. Both diazoxide and prednisone are reported to increase pre-load which is something that we would try to avoid in a ferret with heart failure. Plus, with a 40 mg/dl concentration, it is likely we would need to start at the higher end of the dose of these medications, potentially increasing the risk of improperly effecting pre-load. Surgery, on a ferret with heart failure, will make this ferret a more challenging anesthetic patient. Neither choice for treatment brings a smile to your face! The questions are, is insulinoma treatment necessary and would having an Abaxis Vetscan have improved your care of this patient? “Would having an Abaxis Vetscan have improved your care of this patient?” The answer is yes for two reasons. Let’s first answer the question- “would having an Abaxis Vetscan have improved your care of this patient?” The answer is yes for two reasons. First, we recommend ferrets over the age of three visit the veterinarian twice a year and at each visit, have a biochemistry panel performed. Since insulinoma disease is so common in ferrets over the age of three, you can pick up early insulinoma disease during a visit, just by running a biochemistry panel. This disease is so insidious that the blood glucose concentration can be low for weeks or months before the owners notice a problem. If an in-house biochemistry panel had been performed three months ago when Volume 56 | Vetcom | 27 CONTRI BUT ING AU THOR S Insulinoma is a common disease in pet ferrets. The incident rate is unknown but it is not an exaggeration to state that probably at least 50% of pet ferrets will develop this disease, if they live long enough. Insulinoma may be present for months before owners notice a change in their ferret’s behavior. The changes are due to hypoglycemia. Signs of disease include varying amounts of lethargy, drooling, difficulty to wake from sleep, and ataxia. It is believed the disease is due to malignant beta cells in the pancreas that will eventually spread to the liver and lymph nodes. It can take months to years before these malignant cells spread from the pancreas to other organs and during that time, ferrets can have a decent quality of life with the proper treatment. There are both surgical and medical approaches to treatment for insulinoma disease in ferrets. Surgical treatment involves removing the masses in the pancreas, usually via a partial pancreatectomy. Surgery is a debulking procedure rather than removal of the entire malignant tumor. If there is spread of this disease beyond the pancreas, surgical treatment is not advised. Medical treatment is aimed at increasing the blood glucose concentration. Two of the most commonly used medications are prednisone and diazoxide. Medical treatment controls the signs of this disease (which are due to the hypoglycemia) but will not prevent eventual metastasis of the malignant cells. As the disease progresses, increases in the amount of medication given is necessary to fight the hypoglycemia. Once the ferret develops resistant to the highest doses of the medications, only a surgical approach will alleviate the signs of disease. Neither surgery nor medications will cure this disease but surgery can provide a longer survival time. SMOKEY THE SICK FERRET CONTR IBUTI NG AUTH OR S “Smokey” visited for a health check, it is possible the diagnosis of an insulinoma could have been made at that time. That would have been before the cardiac disease and he would have been a better candidate for anesthesia and surgery. Now there is a suspicion of a diagnosis of insulinoma but “Smokey” is in heart failure. An early diagnosis three months ago would have put “Smokey” at much less risk for a poor anesthetic outcome than he is now if he has an insulinoma and if surgery is performed. The second reason that having an Abaxis Vetscan would have improved care is because there is doubt that the 40 mg/dl truly represents what the blood glucose concentration was at the time of venipuncture. Since the sample was not spun down, whole blood was sent to the laboratory, and the sample was run at least 24 hours after venipuncture, there is a good chance the value is artifactual. A blood glucose of 40 mg/dl would require medical treatment at a high dose of medication that could negatively affect treatment of his heart failure or surgery with anesthesia for the debulking procedure. 28 | Vetcom | Volume 56 In fact, “Smokey” ended up the evening before he was to come back for a recheck at an emergency hospital due to his tail being stepped on as he was more active than he has been in weeks and was running around in the living room. The emergency clinic ran a vetscan rotor and to everyone’s surprise, his blood glucose was 80 mg/dl! What caused the difference? The whole blood was run immediately and the result was unaffected by transport, time and most importantly, blood cells lowering the blood glucose concentration. In the end, “Smokey” had a normal blood glucose concentration and did not have an insulinoma. His treatment for heart failure greatly improved his quality of life but unnecessary surgery and medication were avoided because a precise measurement of his blood glucose via the Vetscan was performed. To watch Dr. Kamiya’s story, visit vet.abaxis.com/beinspired “Having the Rapid Tests has changed the game. Being able to quickly run the test & get your results — that has been a tremendous benefit to our medical center.” Dr. Cristie Kamiya CONTRI BUT ING AU THOR S Humane Society Silicon Valley | Milpitas, CA. Abaxis customer It’s not just better diagnostics, it’s a Better way. 800.822.2947 vet.abaxis.com/beinspired vetscan@abaxis.com #beinspired GLOBAL DIAGNOSTICS Abaxis and VetScan are registered trademarks of Abaxis, Inc. © Abaxis 2015. Learn more about all of our products and services at www.abaxis.com Volume 56 | Vetcom | 29 THE IMPORTANCE OF TESTING FOR EHRLICHIOSIS IN DOGS WITH PERSISTENT LYMPHOCYTOSIS Contributing Authors: Mary Anna Thrall, DVM, MS, DACVP Diana Scorpio, DVM, MS, DACLAM Ross University School of Veterinary Medicine Basseterre, St. Kitts, West Indies INTRODUCTION esting for monocytic ehrlichiosis is warranted in dogs with unexplained persistent lymphocytosis, T particularly in endemic areas. The list of causes of persistent lymphocytosis in dogs is quite short and includes leukemia, canine ehrlichiosis, and rarely, hypoadrenocorticism. Canine ehrlichiosis is endemic in St. Kitts, West Indies, and persistent lymphocytosis in affected dogs is quite common. The following case presentations are examples of dogs with canine ehrlichiosis and persistent lymphocytosis. CASE 1: SWIGGLES CONTR IBUTI NG AUTH OR S Swiggles, a male dog infested with ticks and assumed to be approximately three years of age, was presented to the Ross University School of Veterinary Medicine (RUSVM) community clinic for testing for ehrlichiosis, and was PCR positive. Complete blood counts were performed over a three-month period (Table 1). Abnormalities on 11/20 included leukocytosis due to lymphocytosis, and eosinophilia. The apparent thrombocytopenia on that day is erroneous due to platelet clumping, as can be observed on the platelet histogram (Figure 1). Large granular lymphocytes were observed (Figure 2). The manual differential count performed that day was also erroneous due to neutrophil agglutination likely due to hyperproteinemia and subsequent uneven distribution of leukocytes in the counting area of the blood film. Doxycycline therapy (10 mg/kg sid) was initiated on 1/26/15 and was continued for 28 days. A biochemical profile using the Abaxis Vet Scan VS2 was performed on 1/30/15. The only abnormalities noted were total protein of 9.6 g/dl (reference interval is 5.4-8.2) and globulin concentration of 6.2 g/dl (reference interval is 2.3-5.2). Biochemical profile was repeated on 2/27/15 revealing total protein of 8.2 g/dl and globulin concentration of 4.7g/dl, both within the reference interval. Table 1. Swiggles’ complete blood counts (Abnormalities are bolded) 11/20/14^ 1/30/15^2/13/15^2/27/15Ref Interval PCV (%)3044434437-55 MCV (fl) 5555595960-77 Total Protein (g/dl) 9.511.19.58.86.0-8.0 TNCC* (x 103µl) 19.5 11.38.18.56.0-17.0 Segmented neuts(x 103µl) 9.0 4.11.22.53.0-12.0 Lymphocytes(x 103µl) 9.55.55.04.41.0-4.8 Monocytes(x 103µl) 0.10.60.30.30.2-1.5 Eosinophils(x 103µl) 0.91.11.61.30-0.8 Platelets(x 103µl) 57.5**257280268200-500 ^Technician observations re blood film exam: Rouleaux present (due to increased globulin); numerous large granular lymphocytes present; neutrophil agglutination present * Total nucleated cell count (White blood cell count or WBC) ** Platelet count is erroneously low due to platelet clumping (observed on blood film) 30 | Vetcom | Volume 56 THE IMPORTANCE OF TESTING FOR EHRLICHIOSIS IN DOGS WITH PERSISTENT LYMPHOCYTOSIS Figure 1 CONTRI BUT ING AU THOR S Figure 2 Volume 56 | Vetcom | 31 THE IMPORTANCE OF TESTING FOR EHRLICHIOSIS IN DOGS WITH PERSISTENT LYMPHOCYTOSIS CASE 2: SURPRISE Surprise, an intact female dog assumed to be approximately three years of age was presented to the RUSVM community clinic for testing for ehrlichiosis and was PCR positive. Complete blood counts were performed over a one-month period (Table 2). Abnormalities include lymphocytosis, increased total protein, and on 2/18/15, one day after she had aborted a dead puppy, increased band neutrophils (Table 2). Doxycycline therapy (10 mg/kg sid) was initiated on 1/30/15 and was continued for 28 days. A biochemical profile was performed on 1/30/15. The only abnormalities noted were total protein of 9.7 g/dl and globulin concentration of 7.2 g/dl. The biochemical profile was repeated on 2/27/15, and both the total protein and globulin continued to be above the reference interval (9.7 g/dl and 6.7 g/dl, respectively). Table 2. Surprise’s complete blood counts 1/30/15^2/6/15^ 2/18/152/27/15^Ref Interval PCV (%) 3334344137-55 MCV (fl) 5761626260-77 Total Protein (g/dl) 11.1109.1106.0-8.0 TNCC* (x 103µl) 15.215.523.513.26.0-17.0 Segmented neuts(x 103µl) 5.95.915.17.03.0-12.0 Band Neutrophils (x 103µl) --3.8**-0-0.3 Lymphocytes(x 103µl) 7.87.63.15.31.0-4.8 Monocytes(x 103µl) 0.90.51.60.80.2-1.5 Eosinophils(x 103µl) 0.61.6-0.10-0.8 Platelets(x 103µl) 304248197325200-500 CONTR IBUTI NG AUTH OR S ^Technician observations re blood film exam: Rouleaux present (due to increased globulin); numerous large granular lymphocytes present * Total nucleated cell count (White blood cell count or WBC) ** Neutrophils and band neutrophils exhibited marked toxic change CASE 3: WHISKEY Whiskey, a male dog assumed to be approximately three years of age, was presented to the Ross University School of Veterinary Medicine (RUSVM) community clinic for testing for ehrlichiosis and was PCR positive. Complete blood counts were performed over a three-month period (Table 3). Abnormalities on 11/20/14 included lymphocytosis and eosinophilia. The apparent thrombocytopenia is erroneous due to platelet clumping. Large granular lymphocytes were 32 | Vetcom | Volume 56 observed. Doxycycline therapy (10 mg/kg sid) was initiated on 1/26/15 and continued for 28 days. A biochemical profile using the Abaxis Vet Scan VS2 was performed on 1/30/15. The only abnormalities noted were total protein of 11.3 g/ dl (reference interval, 5.4-8.2) and globulin concentration of 8.7 g/dl (reference interval, 2.3-5.2). Biochemical profile was repeated on 2/27/15 revealing a total protein of 10.5 g/ dl and globulin concentration of 7.7g/dl. THE IMPORTANCE OF TESTING FOR EHRLICHIOSIS IN DOGS WITH PERSISTENT LYMPHOCYTOSIS Table 3. Whiskey’s complete blood counts 11/20/14^1/23/15^2/13/15^2/27/15^Ref Interval PCV (%) 2331283337-55 MCV (fl) 5759626360-77 Total Protein (g/dl) 1011.511.110.66.0-8.0 TNCC* (x 103µl) 9.813.011.612.96.0-17.0 Segmented neuts(x 103µl) 3.02.92.84.53.0-12.0 Lymphocytes(x 103µl) 5.38.14.96.21.0-4.8 Monocytes(x 103µl) 0.30.90.70.60.2-1.5 Eosinophils(x 103µl)1.31.20.31.50-0.8 Platelets(x 103µl) 18**58**98**91200-500 ^Technician observations re blood film exam: Rouleaux present (due to increased globulin); many large granular lymphocytes present * Total nucleated cell count (White blood cell count or WBC) **Electronic platelet count erroneously low due to platelet clumping (observed on the blood film) DISCUSSION Testing for ehrlichiosis is warranted in dogs with unexplained persistent lymphocytosis. However, in areas not endemic for ehrlichiosis, a neoplastic lymphoproliferative disorder is the most common cause of persistent lymphocytosis. Lymphoid leukemia may be seen with chronic lymphocytic leukemia (CLL), acute lymphoblastic leukemia (ALL), and lymphoma with circulating neoplastic cells (stage V lymphoma). Unlike ALL and stage V lymphoma, lymphocytes in dogs with CLL usually appear mature and normal. The diagnosis of CLL can sometime be made based on the magnitude of the lymphocytosis, since a lymphocyte concentration of greater than 35,000/µl would almost certainly be due to leukemia. In patients with a lymphocytosis of lesser magnitude, ehrlichiosis can be eliminated as a differential based on testing, and CLL can be confirmed using either immunophenotyping by flow cytometry or by clonality testing using the PCR for antigen rearrangement assay (PARR) (Avery et al, 2007). Volume 56 | Vetcom | 33 CONTRI BUT ING AU THOR S Canine monocytic ehrlichiosis, first reported in 1935, is caused by Ehrlichia canis, a small, coccoid, gram-negative bacterium transmitted by Rhipocephalus sanguineus, a ubiquitous tick. Clinical signs and lesions of canine ehrlichiosis are related to the infection and immune response produced by the host. It is known from small studies that dogs with ehrlichiosis have increased numbers of circulating large granular lymphocytes and a higher lymphocyte concentration than normal dogs (Lorente et al, 2008). Although chronic infectious disease of all types is often listed as a differential for lymphocytosis in dogs, a review of the literature suggests that with the exception of Ehrlichia canis infection, lymphocytosis is not a feature of canine chronic infectious disease (Avery et al, 2007). Numerous studies have shown that naturally occurring E. canis infection can result in lymphocytosis with values up to 17,000 lymphocytes/µL (Kuehn et al, 1985; Codner et al, 1986; Weiser et al, 1991; Frank et al, 1999; Heeb et al, 2003), although not all case series describe lymphocytosis (Breitschwerdt et al, 1998). Anecdotal reports and the experience of some clinicians and clinical pathologists suggest that lymphocyte counts up to 30,000 cells/µL are possible in E canis infection. The lymphocyte response usually consists of an increased percentage of cells with a large granular lymphocyte (LGL) phenotype (McDonough et al, 2000; Lorente et al, 2008), which were shown to be CD8+ T cells. Therefore, an important differential for lymphocytosis in dogs is E. canis infection, but the frequency with which E. canis is associated with lymphocytosis is not known. The lymphocytosis may persist for several months, even after treatment. THE IMPORTANCE OF TESTING FOR EHRLICHIOSIS IN DOGS WITH PERSISTENT LYMPHOCYTOSIS hese cases also emphasize the importance of blood film examination. For example, the thrombocytopenia reported on T three of Whiskey’s CBCs and the first CBC performed on Swiggles were erroneous due to platelet clumping, which was observed on the blood film. Another example is Surprise’s CBC performed on 2/18/15. The presence of band neutrophils detected on the manual differential count were important in diagnosing significant inflammation, but they were not detected by the electronic cell counter, as band neutrophils cannot be differentiated from segmented neutrophils. On the other hand, the instrument may be reporting more reliable differential counts than can be obtained by a manual count if neutrophil agglutination is present, as was seen on Swiggles’ blood films on numerous occasions. References Avery AC, Avery PR. Determining the significance of persistent lymphocytosis. Vet Clin Small Anim. 2007;37: 267–282. Breitschwerdt EB, Hegarty BC, Hancock SI. Sequential evaluation of dogs naturally infected with Ehrlichia canis, Ehrlichia chaffeensis, Ehrlichia equi, Ehrlichia ewingii, or Bartonella vinsonii. J Clin Microbiol 1998;36:2645–51. Codner EC, Farris-Smith LL. Characterization of the subclinical phase of ehrlichiosis in dogs. J Am Vet Med Assoc 1986;189:47–50. Frank JR, Breitschwerdt EB. A retrospective study of ehrlichiosis in 62 dogs from North Carolina and Virginia. J Vet Intern Med 1999;13:194–201. Heeb HL, Wilkerson MJ, Chun R, et al. Large granular lymphocytosis, lymphocyte subset inversion, thrombocytopenia, dysproteinemia, and positive Ehrlichia serology in a dog. J Am Anim Hosp Assoc 2003;39:379–84. Kuehn NF, Gaunt SD. Clinical and hematologic findings in canine ehrlichiosis. J AmVet Med Assoc 1985;186:355–8. Lorente C, Sainz A, and Tesouro MA. Immunophenotype of Dogs with Subclinical Ehrlichiosis. Animal Biodiversity and Emerging Diseases: Ann. N.Y. Acad. Sci. 2008;1149:114–117. McDonough SP, Moore PF. Clinical, hematologic, and immunophenotypic characterization of canine large granular lymphocytosis. Vet Pathol 2000;37:637–46. CONTR IBUTI NG AUTH OR S Weiser MG, Thrall MA, Fulton R, et al. Granular lymphocytosis and hyperproteinemia in dogs with chronic ehrlichiosis. J Am Anim Hosp Assoc 1991;27:84–8. 34 | Vetcom | Volume 56 Sometimes IT’S MORE THAN Periodontal Disease Contributing Author: Jan Bellows, DVM A On presentation the dog appeared to be thin with a body condition score of 3/9, well hydrated, had a normal respiratory rate with a temperature of 102.6. Her heart and lungs asculted normally. The systolic and diastolic blood pressure readings were normal. Palpation of her abdomen gave the impression of hepatomegaly. There was evidence of halitosis and moderate periodontal disease. There were also areas of petechial hemorrhage on the skin and gingiva. The owner was informed that before dental care could be provided to care for the periodontal disease and oral malodor we would need to access the dog’s health status. A hematology and chemical profile were analyzed with our in house Abaxis VS2 and HMT, a 4 DX vector born diseases profile, fecal, urinalysis, chest and abdomen images were also performed. Initial in house results revealed a non-regenerative slight anemia, and a marked thrombocytopenia which was confirmed with a visual Volume 56 | Vetcom | 35 CONTRI BUT ING AU THOR S N 11-year-old Shih Tzu dog living in the Bahamas was referred to ALL PETS DENTAL in Weston, Florida for dental care. Her owners complained that after eating a bone on the beach a week before presentation, the dog had not “acting like herself” , had breath odor like dead fish, and began to bleed from the left nostril. The dog was current on core vaccines and prevented against fleas, ticks, and heartworm disease. According to their local veterinarian other than slight anemia, and mild hepatic and renal laboratory elevations, the dog’s problem was probably due to advanced periodontal disease. SOMETIMES IT’S MORE THAN PERIODONTAL DISEASE stained slide examination. The profile results also revealed elevated hepatic enzyme activity, hypoalbuminemia, moderately elevated BUN, creatinine, and phosphorus levels. 4Dx test was negative as was testing for gastrointestinal ova and parasites. A urinalysis revealed a low specific gravity of 1.014 with 3+ protein and 3+ blood. Bacteria, casts or crystals were not noted in the urine. A urine protein creatinine ratio was sent out to assess the extent of the proteinuria as was a urine culture. Thoracic and abdominal imaging revealed moderate hepatomegaly and moderate to marked soft tissue opacities in the caudodorsal lung lobes. The radiologist felt the opacities were consistent with bronchopneumonia or thromboembolic disease. A summary of the dog’s abnormal examination findings at the time included: • Thin • Petechial hemorrhages • Halitosis • Hepatomegaly • Periodontal disease • Left nostril epistaxis A summary of the abnormal laboratory results at the time included: • Mild non-regenerative anemia • Low urine specific gravity • Marked thrombocytopenia • Suspect proteinuria • Azotemia • Hematuria • Hyperphosphotemia A tentative diagnosis was renal / hepatic disease as the dog’s major problems. Further laboratory testing included urine protein/creatinine ratio to assess the extent of proteinuria, leptospirosis and tick serology evaluation, and a coagulation profile. 36 | Vetcom | Volume 56 A coagulation profile was sent to the reference lab which revealed an elevated D-Dimer @ 774 ng/ml (normal <250 ng/ml ), and a fibrinogen @ 824 MG/DL (normal < 256 MG/DL). The prothrombin level was within the normal range of 7.0 seconds, the partial thromboplastin (PTT) was slightly elevated at 25.2 seconds (10.6-16.8 seconds). The tick serology showed positive PCR results for Ehrlichia spp. The PCR was negative for leptospirosis. SOMETIMES IT’S MORE THAN PERIODONTAL DISEASE We felt the life limiting problem in this patient was persistent epistaxis and needed to know if it was due to neoplasia vs. potentially treatable thrombocytopenia from ehrlichiosis. The dog was sedated for nasal imaging, which revealed abnormal opacification nasal turbinate destruction consistent with rhinitis, hemorrhage or neoplasia. Nasal swabs were also acquired and cytologically examined which were consistent with rhinitis. The next day the urine protein creatinine ratio came back as 8.1 (normal <2.0) consistent with significant proteinuria. Due to the multiple organ system involvement (renal, hepatic, respiratory, dental, and hematologic) with a guarded prognosis for long term success the owner opted to euthanize the dog. A necropsy was not performed. The degree of periodontal disease observed on the nasal films was minimal but the dog’s fish breath halitosis was marked. It could be surmised that the chronic bleeding due to thrombocytopenia from the ehrlichiosis was responsible. Volume 56 | Vetcom | 37 RWANDA SAVING ENDANGERED GREY CROWNED CRANES IN RWANDA T Contributing Author: Dr. Olivier Nsenginama HE Grey Crowned Crane (Balearica regulorum) is the only species of crane in Rwanda and a spectacular and iconic species in the country’s diverse natural landscape. Sadly however, they face increasing threats to their habitat and a growing illegal trade. Rwanda is a country challenged with population growth and poverty which often results in a huge competition for resources. Much of the natural marshy habitat of the cranes has been taken over by agricultural activities and a lack of conservation awareness within communities readily results in the poaching of cranes, chicks and eggs even though it is illegal to do so. ON LOC ATION RWANDA Grey Crowned Cranes are often kept domestically by hotels and wealthy families who are unaware of the environmental consequences of doing so. In captivity, the cranes are usually stressed, malnourished, have broken wings to prevent them flying and cannot breed. As a result, the population of Grey Crowned Cranes has dramatically fallen by 80% over the past 45 years; with less than 500 living in the wild in Rwanda today. In 2012 the International Union for Conservation of Nature (IUCN) raised the threat listing for the crane to “endangered”, highlighting the need for immediate action. 38 | Vetcom | Volume 56 RWANDA This project has been designed to reverse the trend in illegal trade and boost the wild populations of Grey Crowned Cranes in Rwanda. It adopts a holistic approach, to tackle the problem from all angles to ensure the impact is long-term and sustainable. The first step was to launch a national media campaign in collaboration with the Rwanda Development Board to raise awareness amongst the general public about the Grey Crowned Crane and its endangered status and the laws that exist to protect it. This led to a nationwide amnesty calling for people to register any cranes they have in captivity so that we could issue every captive crane in the country with a unique identifying leg band. A national database was set up to provide a baseline of the extent of the illegal trade and will allow us to more easily prosecute people who are found with newly poached cranes. So far 130 captive cranes have been registered, mainly in Kigali city but it is expected that with further media campaigns, this number will exceed 200. The second step was to work with local communities around the marshland where the biggest population of Grey Crowned Cranes live. Engaging and educating them to understand the importance of protecting the habitat of the cranes will ensure that the problem of illegal trade is tackled from the source. We provided training to local leaders and security officials and will work with local school children, setting up conservation clubs to inspire the future generation of conservationists. We also plan to work with poachers to support them in finding alternative means of income and to volunteer as rangers in the region to report any illegal activities. continue ON LOCATION RWAN DA Volume 56 | Vetcom | 39 RWANDA Dr. Nsengimana using the VetScan VS2. ON LOC ATION RWANDA Captive Crane with the registration leg band. Photo credit: Thierry Grobert Rolex In addition, we recently moved 40 Grey Crowned Cranes from captivity back to the wild. We had assessed all the captive cranes and selected those that were most likely to do well in the wild to be rehabilitated and reintroduced. This is a momentous achievement and one of the first of its kind. We built a purpose made quarantine facility and during the quarantine period, the cranes underwent a complete physical exam and samples were collected to test for different diseases. One crucial component of medical diagnosis of disease is the clinical chemistry and we could not have conducted this without the support of ABAXIS. ABAXIS donated The Avian/Reptilian Profiles Plus for the VetScan VS2 analyzer. These rotors are specific to avian species and provide 12 blood parameters. Looking at the blood chemistry results of every crane is very important as it gives an indication of the overall health of the crane and the Wild Crane in Akagera National Park. Photo credit: Thierry Grobert Rolex 40 | Vetcom | Volume 56 RWANDA function of specific organs. The blood chemistry results, alongside haematology, physical examination and disease test results enabled us to make a detailed assessment of every crane. Through this, we could ensure they were completely healthy before their reintroduction as well as avoiding the risk of introducing a new disease to the wild that could be a threat to other birds or animals. All blood chemistry analysis we carried out using the VetScan VS2 analyzer donated for use by the Gorilla Doctors in Rwanda. One of the first reintroduced cranes had chicks! Photo credit: Sarah Hall - Akagera Management Company Team members processing samples from the cranes during health checks. For more information on the project please contact Dr. Olivier Nsengimana at nsengolivier@gmail.com or follow our the progress of the project at www.facebook.com/cranesrwanda Dr. Nsengimana talking to students who study near Rugezi Marshland about cranes. ON LOCATION RWAN DA Once all the cranes were clear of disease and the quarantine period was complete, they were moved to the release site at Akagera National Park. The rehabilitation facility gives the cranes time to relearn or remember behaviours such as foraging that they will need to survive in the wild, as well as re-grow feathers that were cut in captivity. During this time, the cranes are supplemented with food but this is slowly reduced to encourage them to look for their own food and become less reliant on people. As we monitor the cranes closely in the rehabilitation facility, we are assessing how they are adapting to their new environment. The facility has no roof so when the cranes are ready and able to fly again, they are free to return to the wild. We hope to take another group of Grey Crowned Cranes back to the wild in the near future and hope that one day, we will see flocks of cranes flying overhead as we used to do years ago. Previous captive cranes in the quarantine facility. Volume 56 | Vetcom | 41 SPAIN Animal Embassy the Message of the Animals Contributing Authors: Dr. Matthias Reinschmidt, Zoological Director, Loro Parque Fundación Dr. David Waugh, Director, Loro Parque Fundación ON LOCAT ION SPA IN L ORO Parque was voted in 2015 the best zoo in Europe and the second best in the world (by Trip Advisor, the largest Internet portal for attractions). This is not only a wonderful appreciation of the work done in Loro Parque for the animals and visitors, but also an incentive to continue along the same path. The transparency shown in hundreds of TV documentaries for many years, where the audience can look behind the scenes of Loro Parque, is what we want to share now with all visitors in our latest project. Therefore, a completely new part of the park with more than 2,200 square meters has been developed. 42 | Vetcom | Volume 56 SPAIN In this area themed as an African village, visitors have the opportunity, in different pavilions separated by glass panels, to observe the employees directly in their daily work without disturbing them. We want to show how much love and dedication with which our animals are cared for, but also how much expertise and effort is needed for such a large animal population, to meet all the needs of the creatures entrusted to us. We also want to promote respect for animals and the environment among our visitors, to address our commitment for the preservation of the planet and nature for future generations. So, in this new part of the park visitors connect with the animal species and nature conservation in a wonderfully clear and easily comprehensible manner. Continuing the tour, visitors pass in front of two huge artificial, but completely realistic African baobabs, which in the base of one is a large aviary for Grey parrots (Psittacus erithacus). Like the group of Blue-headed macaws (Primolius couloni) in a second aviary, these parrots are regularly integrated into the research programmes of the Max Planck Institute and otherwise live in this beautiful aviary. On-site diagnostic laboratory - Abaxis, Inc. In the following pavilion are the Loro Parque laboratories, which give visitors the chance to see with how much technical equipment the two biologists are working with daily to manage the essential routine tests of a zoo like Loro Parque. Thus every day, sometimes several times, in all pools and ponds at the orcas, dolphins, sea lions, the aquarium and the lakes water samples are taken, which are immediately analyzed and evaluated. Furthermore, many virus tests for parrots, such as Circovirus and Polyomavirus, are also done here. Volume 56 | Vetcom | 43 ON LOC ATION SPA IN In a tour through “Animal Embassy”, the first African pavilion encountered houses the Baby Station for parrots. Here visitors can experience through the glass panes how our nurses lovingly feed the newly hatched parrot chicks. They can even see their growing stages and how they finally perch in a large aviary where they become slowly independent by starting to fly and, step by step, to eat alone and become independent from the feeding syringe. On average three hundred young parrots are reared by hand here every year, and especially in endangered parrot species this is an important method to maintain and increase the populations. The second pavilion is dedicated to research. To this end, there is collaboration between Loro Parque the renowned German Max Planck Institute. From a darkened room, visitors can observe behavioural experiments with different species of parrots. The birds are not disturbed, because the examination rooms are designed so that viewers can see inside, but the birds in the rooms cannot see the audience. The main objective of the research is to examine in more detail the cognitive abilities of parrots because, as with crows, parrots are among the most intelligent bird species and many researchers put them on the same level of intelligence as dogs, dolphins or even apes. The Director of the international research team is Princess Auguste von Bayern, who has a doctorate in biology and internationally known in science circles for her pioneering research on New Caledonian crows. Thus, Animal Embassy offers a unique opportunity to learn more about our parrots and simultaneously therefore the Zoo supports an important area of research. ON LOCAT ION SPA IN SPAIN This is followed by three grouped pavilions where, with four visible rooms, the clinic of Loro Parque is located. Here, visitors also have the opportunity to see live, and separated only by glass panels, the treatments and even the operating theatres and to see with how much effort the three-member veterinary team and technicians work to help the animals. Visitors can see the X-ray room and diagnostic work taking place in the clinic’s laboratory next door. This is where the blood analyses take place, and where the professional cooperation with Abaxis is most in evidence. Abaxis has for fourteen years partnered with Loro Parque and the Loro Parque Fundacion to provide an out-standing service and first-class cooperation. This has included the constant use of an array of Abaxis blood analyzers, as well as rotors, for in-house diagnostics, the net result being a much better understanding of the health of the animal collection, and consequent improvements in welfare and conservation, in particular for the parrots. With the analyzers on view at close range, the visitors can appreciate the extent of partnership between Loro Parque and Abaxis. This professional relationship between the two parties has recently extended into fundamental research, including to establish blood profiles of parrot chicks as they grow and develop, and to map the changes that take place in the profiles over time. The tour concludes in the largest pavilion, where Loro Parque Fundación (LPF) is presented. On a video wall, visitors can select each one of the 36 current protection projects for endangered species by using one of eight front-mounted tablets. The 30 to 40 second videos are in English, Spanish or German and present the most important things about the projects that are initiated and supported by LPF. In its 20 years of existence, LPF has invested almost US$ 16 million in 109 different projects. As a result, in more than two thirds of the projects, the populations of endangered species are increasing again, an effect most clearly seen in the IUCN Red List. Now, nine species of parrots that have been supported by LPF in conservation projects in the field have been down-listed in their threat category due to the positive population figures, for example, the Yellow-eared Parrot (Ognorhynchus icterotis) and the Lear’s Macaw (Anodorhynchus leari) from the category “Critically Endangered” to “Endangered.” In the LPF pavilion the employees are available to answer any questions. The most relevant is that 100% of the membership fees and donations flows to the conservation projects. Since Loro Parque has committed to pay all maintenance costs of LPF, such as salaries, maintenance, care of animals, etc., LPF has the possibility to invest all donations directly for protection programmes. This is an important motivation for visitors to become members or make donations to the LPF as a result of experiencing Animal Embassy. Animal Embassy has a lower level, reserved for the staff. Here the Baby Station, the Max Planck research centre, the clinic and the Loro Parque Fundación have their spacious administration and service areas. The LPF library is equipped as a conference room for visitors, students or student groups of up to 40 participants. Also from Animal Embassy, videoconferences directly into the classrooms of schools are regularly conducted. This is an innovative way by which the educational department of LPF brings the animals, their needs and the need to protect them, closer to children and young people, because it is precisely the children in whom the basics for a sustainable understanding of nature have to be laid. 44 | Vetcom | Volume 56 SPAIN L Founder: Wolfgang Kiessling, President, Loro Parque Fundación Website: www.loroparque-fundacion.org Photos: Loro Parque Fundación Facebook: www.facebook.com/loroparquefundacion Email: lpf@loroparque-fundacion.org Volume 56 | Vetcom | 45 ON LOC ATION SPA IN iving every day close to wildlife definitely inspires a love of nature. In this sense, the most important goal of Loro Parque with this new facility is that the animals of the park are the ambassadors of their own species, raising the awareness of the visitors to support their conservation in their natural habitats – the Message of the Animals VECTOR-BORNE DISEASE CENTER ESTABLISHED Kansas State University College of Veterinary Medicine 250,000 KSU Donation for Vector-Borne Research A $250,000 gift from diagnostics company Abaxis to the Kansas State University College of Veterinary Medicine has helped establish the new Center of Excellence for Vector-Borne Disease. The center, publicly launched April 8, is an interdisciplinary research center with a mission to combat vector-borne diseases, focusing on pathogenesis, surveillance, and disease prevention. Roman Ganta, PhD, professor of diagnostic medicine and pathobiology, is director of the center. “This gift will, in part, allow us to promote the advancement of knowledge on vector-borne diseases of importance to companion and agricultural animals and humans, including the diseases caused by Ehrlichia, Anaplasma, Rickettsia, and Borrelia species,” he said. The center’s goals are to develop programs to prepare future generations of scientists with expertise on vector-borne diseases, offer continuing education workshop, and develop resources, such as repository to maintain culture stocks of vector-borne pathogens. The center also hopes to establish a tick-rearing facility. The center plans to develop a network to build research programs that promote collaborations among Kansas State University faculty who have shared interests as well as faculty and researchers at other academic institutions and industry in the U.S. and foreign countries. “We have followed the excellent work of Dr. Ganta and his group in their pursuit of understanding vector-borne diseases-including the pathogen’s evasion mechanisms and hosts’ response to these infections. His group brings together molecular biology, immunology, animal models, and cell culture systems to pursue its goals,” said Dr. Dennis Bleile, Senior Director of Research and Development at Abaxis. 46 | Vetcom | Volume 56 To watch Dr. Work’s story, visit vet.abaxis.com/beinspired “ We chose the Abaxis Line of Products because we need reliable and cost effective diagnostic equipment for our busy practice.” Dr. Lauren Work Peninsula Equine Medical Center | Menlo Park, CA. Abaxis customer It’s not just better diagnostics, it’s a Better way. 800.822.2947 vet.abaxis.com/beinspired vetscan@abaxis.com #beinspired GLOBAL DIAGNOSTICS Abaxis and VetScan are registered trademarks of Abaxis, Inc. © Abaxis 2015. Learn more about all of our products and services at www.abaxis.com Volume 56 | Vetcom | 47 To watch Dr. Casuccio’s story, visit vet.abaxis.com/beinspired “What I really like about Abaxis is that they’re a step above in Quality, and the customer service is extraordinary.” Dr. Alex Casuccio Scottsdale Animal Healthcare | Scottsdale, AZ. Abaxis customer It’s not just better diagnostics, it’s a Better way. 800.822.2947 vet.abaxis.com/beinspired vetscan@abaxis.com #beinspired GLOBAL DIAGNOSTICS Abaxis and VetScan are registered trademarks of Abaxis, Inc. © Abaxis 2015. Learn more about all of our products and services at www.abaxis.com 888-9300 Rev. AP
