The tick came back the very next day....

He just wouldn’t stay away.

 Continuing on the weather-related theme from the last post, aka you know you’re getting old when, you:

cat came back.jpg

1) chat about the weather constantly, and

2) mis-reference Fred Penner sung songs.

However, just like the yellow cat in ‘The cat came back’ song, the driving or drizzling rain outside is a ‘Meow’ call of return- in this case of spring. Somewhat less desirable than the thought of spring (and similar to the wails of the reluctant cat-owner in the song), temperatures at and rising above 4’Celsius also mean that ticks have ‘come back’ from their winter nap and are actively seeking a blood meal.

Tick on grass.jpg

This spring, in order to help with the concerns related to tick surge in Canada, there are a few new groups (of humans) forming with specific goals related to obtaining information on and educating about the rise of ticks in (and across ) Canada, tick risk and related disease.

Here’s three of these newer websites and a brief summary of their goals:

Canadian Lyme Disease Research Network:  

Goal to reduce Lyme disease impact on Canadians by uniting various groups (patients, researchers, etc.) in research activities.

The Canadian Pet Tick Survey from Pets and Ticks:  

Performing tick identification (& testing) on ticks found attached to companion animals in order to provide information on tick risk in Canada.

Tick Talk for Pet-owners from The Canadian Veterinary Medical Association (CVMA):

An educational website directed at pet-owners to provide information on ticks and tick risks.

 There are a number of different ways to obtain information related to risk and disease, and sometimes it seems that a focus on working together (i.e. all groups communicating) for key health care goals gets a bit lost in the effort to info-gather.

It’s great to see collaboration between veterinarians, vets and pet-owners, and also between vets and those who focus on the 2 legged (i.e. human health care workers-researchers). Working together seems essential (at least IMHO) to provide a One Health perspective, and drive awareness of potential outcomes of tick bites and the consequent need for prevention for all of us- dogs, humans, other mammals and cats…whether you agree with that ear-worm of a song or not.

 

 

 

Winter turns to Spring turns to...Ticks

EFNIC9Pq.jpg

The whimsy of weather keeps every Canadian connected with (and frequently at the mercy of) nature. And, while the country is currently getting a blast of chill, we’re also entering the ‘end of February’ slide to spring-summer steam.

Lobster.jpg

So, whether you’re dreaming of prepping your garden, getting ready for bird-watching or anticipating the start of lobster season (Oops- that’d be me!), be aware that the incoming warmth also feels good to creepy crawlies, i.e. ticks. Temperatures above 4’Celsius mean tick bites and the consequent need for tick bite prevention- for you and your 4 footed family members.

If ticks do bite and attach, it's pretty important to remove them, identify (ID) them AND test them for potential pathogens. Tick testing provides awareness of what’s ‘out there’ and enables a One Health approach to education on risk, disease and prevention for animals as well as people. Since Canada’s public health monitoring of ticks on companion animal program has been discontinued, a gap has needed to be filled. As such, tick identification (& testing) on ticks found attached to companion animals will be starting again this spring. This ID and testing will be performed as a collaborative approach through Canadian veterinary clinics nationally and coordinated through the the Canadian Pet Tick Survey on www.petsandticks.com.

Additional information can be found on the Canadian Pet Tick Survey and this latest blog posted by lead researcher Dr. Katie Clow:

https://www.petsandticks.com/news/calling-all-veterinary-clinics-join-the-canadian-pet-tick-survey

Similar to the Canadian K9 Lifetime Study (UPDATE), these types of studies can only be performed through dedicated veterinary clinic and pet-owner involvement. Having a mutual goal of improving health (for the 4 and 2 legged) Canadians across the country is a wonderful thing !

 

 

 

 

Finger on the ‘pulse’ of dog diets & DCM

Heart of the Matter: V-day edition: 2019

Perfectly ‘pulsed’, heart-themed and evidence-based, comes another publication on the topic of dog diet, taurine and the potential association of both with dilated cardiomyopathy (DCM):

Vday Spots.jpg

Similar to previously posted about (original post here, Nov 2018 update here. Dec 2018 update here) articles on this palpitating subject, there are solid reasons for anyone with an interest in educating themselves on dog diet to take the time to read beyond this pub’s abstract.

Perhaps the top 3 being,

1) Representative author list, i.e. vet boarded nutritionists, PhD nutritionists, industry and academia,

2) Once again learning that there is a lot we (and the ‘experts’) don’t know about animal nutrition and that these needs may vary between dogs, and

3) That pet-food should be manufactured by people who have been educated on (and understand) ingredient components, e.g. pulses (peas, lentils, chickpeas, etc.) and requirements for nutrient balances in diets fed long-term, i.e. what the vast majority of pet-owners do and as typically advised by their veterinary team.

Once again, I was thrilled to see a group of folks collaborate to try and identify nutritional concerns related to keeping animals (dogs mainly) safe. This included the article tackling topics and raising questions like, ‘What might processing do to nutrients?’, along with providing recommendations (and aid) for formulating dog foods with specific ingredients, e.g. novel ingredients, higher fibre, and closing their discussion with a helpful review and effective referencing of recent publications on the topic of DCM and dog diet.

The researchers concluded with a heart-felt statement regarding dog diet manufacture accountability,

“It is the responsibility of animal nutritionists to formulate balanced diets for dogs, and other animals, by looking beyond the goal of meeting AAFCO recommendations or satisfying unsubstantiated market trends.”

The statement above, combined with the article’s call for action and mini-plan towards learning what dogs might need nutritionally, i.e. “ Greater awareness of amino acid (AA) balance is crucial for ensuring that AA requirements are met for dogs consuming static diets.”, made my wish for veterinary nutrition awareness and start to the Year of The Pig complete.

Year of the Pig.jpg

Why Preventive Care is Necessary (Prevalence review)

Dear Canadian Veterinary Community, Ask, and you will receive. Here are the prevalence and ‘change over time’ numbers you requested …or the reply to why preventive care is needed, i.e. not a conspiracy.

There are many reasons why I adore the country in which I have gainful employment …Psst! Don’t tell anyone that providing me with a paying gig may not’ve been wise. And, near the tippy top of that ‘I love Canada’ list would be: “The Canadian Veterinary Community”. The following publication was driven not by my love of epidemiology (…and lo’ ye shall know them (clinicians) by their dislike of EPI…), but by my desire to give a ‘lil something back to the people who make up this very special community.

Tick alert sign.jpg

Over the past number of years, there have been an increasing number of veterinary teams in Canada who told us they were seeing more. More what? More ticks, more test positive dogs, more Lyme disease, more clients asking about Lyme and other tick-borne diseases, and more of other things related to vector-borne bug exposure and disease. In order to put some numbers to these concerns of ‘more’, and help vet teams do their jobs, we wanted to figure out if these jitters were valid (granted-we were pretty confident they were legit), and if so provide this information in a journal article that was freely available to all vet teams and their clientele.

So, we went to work to try and do exactly that.

Here is the end result of that effort- it definitely was not a solo venture- and I’m grateful to everyone who encouraged me to get it done. The publication establishes prevalence of a few common vector-borne (tick and mosquito) pathogens in Canada, how that has changed over a recent chunk of time, and frequency of co-infections, i.e. how often a given dog may be exposed to more than one of these pathogens.

We hope it helps you with our twin veterinary goals- keeping animals and their people safe!

 

Lyme Disease (LD) in Ontario: S.O.S.

backronym.png

A backronym is a group of words used as the explanation for an acronym. Hmmm…I suspect I’ve gone about that backwards. My apologies, as what I should have begun with is the explanation for an acronym, i.e. a word or name that is actually an abbreviation of letters (typically the first letters of the various words, common examples being HBC (hit by car) or LD (Lyme disease, lethal dose, let’s dance or lame duck).

A classic backronym example might be SOS, which many think equals ‘Save our souls’ and in fact is based on the desire to have a simply identified Morse code. Another being SPAM, i.e. commonly believed to mean ‘something posing as meat’, which now a days is more likely to mean an e-message nobody wants. 

Where is she going with this you might wonder? And quite rightfully so as it’s a segue way into one of my ‘love to hate because it’s entirely preventable’ topics, i.e. LD (purposely not defined so feel free to pick an LD used above).

I’ve never understood lack of movement towards prevention because of the ‘I’m waiting for the paper’ philosophy…this seems similar to creating backronyms for acronyms. In the case of Lyme disease, we know there has been a rapid expansion in tick ranges in Canada, we know these ticks carry pathogens that can cause illness in dogs and waiting to actively work towards tick prevention makes as much sense as a belief in backronyms.

Lyme tick warning.jpg

A recent article was published on LD (which here means Lyme disease) emergence in Ontario, Canada between 2010 to 2016. The paper showcases the fairly common-sense conclusion that increased ticks equals increased human Lyme disease, and that reported disease is rising over time (i.e. more cases each year) with the highest number of Ontario human Lyme cases in 2015 & 2016. 

Lyme disease isn’t going away. And that’s because Ixodes scapularis ticks that carry the agent of Lyme disease (Borrelia burgdorferi), along with potential other pathogens, are here to stay. And for those who feel comfortable heading for a hike (or into their own backyard) without appropriate tick prevention, I hope a read of this blog & CDC’s article is interpreted as my S.O.S. call for you (and your dog) to make choices to stay safe from LD, particularly as temperatures drop into this tick LD (let’s dance) zone.

 

 

 

 

 

 

 

 

 

 

 

Slàinte & step 2 towards veterinary spectrum of care

 Picking up from the previous post on veterinary spectrum of care,

here is my attempt at summarizing a few of the article’s proposed action initiatives. These appeared (at least to me) to focus on:

1) Awareness,

2) Education,

3) Research, and

4) Communication, in order to try to improve access to care for animal owners and also overcome barriers that prevent veterinary interventions to these across a wide spectrum of health care needs.

1.     Awareness of the concept of spectrum of care

This makes sense…as I suspect many DVMs & clinic staff members just don’t know that this is a rising concern, or if they do they feel powerless to do much about it or otherwise unable to prioritize and dedicate time towards it.

2.     Education on:

a.     Existing clinical guidelines available for animal health conditions (e.g. Antimicrobial use guidelines such as,  https://onlinelibrary.wiley.com/doi/pdf/10.1111/jvim.14627)

b.     How to critically evaluate these, e.g. Evidence-based practice and use of things like the Appraisal of Guidelines for Research and Evaluation II (AGREE II)

c.     Development and the practice of skills to quickly assess these guidelines for approaches along this spectrum and ideally reduce dollar resources spent on ineffective tests or treatments.

Tools to help DVMs with this offbeat ‘what’s the evidence’ way of thinking, might include websites such as, Choosing wisely

or bestbets for vets.

It’s also critical to keep in mind that ‘evidence’ can come in many forms and levels, and although sometimes all we have is clinical experience as our form of evidence…this (IMHO) should not be discounted.  The key is to recognize and be transparent about this (e.g. lowest level of evidence ) and not be satisfied to settle with this for the future. There is much value (again- at least for me) in sorting out where we are (baseline) and looking towards what we need or would help.

3.     Research!!!!

As in ‘do research’, and do it in (or for) the vet primary care or general practice setting. This will hopefully aid veterinarians faced with these issues, i.e. those that are actually in private practice, aka the hardworking DVMs in the field. This style of research should also focus on the outcomes that we think matter most to the majority of pets and owners (e.g., quality of life, cost). Even if we don’t have all (or very many) of the needed answers for spectrum of care, once again that shouldn’t translate into ‘it’s no use to try’. 

4.     Communication

Much the same thing here…as in ‘communicate’, and do so with all involved groups to figure out what is needed and what is do-able. This type of stuff really does ‘take a village’ and that means, pet-owners, DVMs, clinical staff, baby vets (such as my students here at AVC ), folks in the animal health industry, practice owners, etc. should all get involved to problem-solve.

The bottom-line is, if ‘we’ think this is important stuff for our animals and the profession, then let’s trip the light fantastic and get started bringing these efforts into veterinary curriculums and hopefully from there into clinical practice and to animal-owners. In terms of New Year’s resolutions (for 2019), I think I’ve got a much better shot at this one than 5 minutes of daily meditation.

New Years Resolution.jpeg

Slàinte & steps towards veterinary spectrum of care

Christmas lights.jpg

The holidays can be a whirlwind of lights, colour, joy and in my house kids (& dogs) amped up on Santa-induced excitement and treats. There is no other time of year quite like it. However, there is a dark side to the holidays, and as every vet clinic staff member knows (especially those on emergency duty like I just was)…the season can be cold, bleak, and/or simply sad for many- whether 4 footed or two. For some, the diminished dazzle of the season can be related to economic and/or emotional concerns (i.e. sadness, depression, anxiety, or compassion fatigue), and this can be true for animal owners as well as vet teams

In the veterinary profession we are taking baby steps towards recognizing the challenges related to rising economic concerns (i.e. increasing veterinary costs), and the snowball effect that lack of coin has (especially at this time of year) on reducing pet visits to veterinary clinics. This down-sizing (and decrease in dollars available to spend by animal owners) has considerable impact on animal welfare. The most extreme example of which being an increase in decisions to end a dog, horse, or kitty’s life on the basis of financial factors.

Moving forward into 2019 and onward, there is a strong need for veterinarians who are prepared to assess, communicate, and deliver approaches to animal owners which include healthcare options along the spectrum of care, i.e. a range from lower cost to those regarded as ‘gold standard’ (+/- more expensive). Whether options that vary in cost also vary in effectiveness may be an open, yet undetermined (and potentially controversial) question…In other words does the ‘gold standard’ treatment really have a better outcome for the patient and owner? …And although it pains my clinician brain to think it, that is exactly the type of question that ties into a rising need for (and application of) evidence based-medicine and the day-to-day use of this in clinical practice, i.e. a vet clinic near you (and me). Other question examples could include, ‘What is the evidence for promoting one diagnostic test or treatment over another?’ and do we (i.e. you, me, ‘the experts’…whomever those people are) consider that evidence ‘good?’.

A recent publication sought to raise awareness of this need for veterinary spectrum of care. Additionally, the commentary didn’t just ‘chit chat’ about need….but proposed action initiatives to try to improve access to care for animal owners and also overcome barriers that prevent veterinary interventions to these across a wide spectrum of health care needs.

Unsurprisingly (at least to me), the bulk of these ideas centred on:

1) Awareness,

2) Education,

3) Research, and

4) Communication.

Because it’s the holidays, (aka my noggin’ is full of egg vs. brainpower), I’ll take a 24 h break (and another thoughtful read of the article) before making an attempt at summarizing a few of this fresh new group’s target areas for veterinarians & the profession.

The Heart of the Matter: Update December 2018

Day 13 on my ‘veterinary publications advent calendar’ opened to reveal something much more nutritionally dense than chocolate…a peer-reviewed (and free-access!) article on dog diet, taurine and the potential association of both with heart disease (dilated cardiomyopathy-DCM)) in 24 DCM diagnosed golden retrievers.

Golden retriever.jpg

The study began with a total of 40 (no doubt super cutie) goldens, with 16 dogs subsequently excluded for the usual reasons clinical research is challenging, e.g. not up to ‘snuff echocardiogram (heart ultrasound) results, incomplete diet histories, etc. Importantly, the publication also contained one year follow-up on 16 of these dogs.

Dog diet was clearly identified, and somewhat unexpectedly (& pleasantly) a complete (i.e. treats, supplements, etc.) diet history was available on the dogs. The study team also performed a diet ‘deep-dive’ review of nutritional parameters (i.e. calories, ingredient deck, fibre composition), feeding trial information (yes they did one or nope-they did not) and/or whether formulated to meet AAFCO (or nope-they did not). Additional nutritional information included whether diets were marketed by manufacturers as grain-free and if diets listed legumes (i.e. beans, chickpeas, lentils, peas, pea protein or fibre) within the first five label ingredients.

There are many reasons to give the article a read, but one (or someone trying to avoid excess rambling) could attempt to re-phrase the heart of the matter as:

In the study, dogs (16) diagnosed with DCM and available to follow-up had…”Significant improvement in echocardiographic parameters and normalization of whole blood taurine concentrations from baseline (close to when the dog was diagnosed) to follow-up visits after implementing a diet change and supplementation with taurine +/- L-carnitine…This occurred by a median of 8 months in all but one dog (15 of 16).”

The researchers identified other nutritional tidbits on this golden grouping. Two of the more interesting, (to me at least), being that: 1) many (most) dogs were eating less than their predicted diet intake needs (based on metabolic energy requirements (MER), and 2) that a clear association with diet meat protein (type of meat) was not found…stay tuned on the ‘baa baa humbug’ aspect of that one.

As I said in November, it seems that we all agree that:

a) nutrition is uber-important,

b) obtainment of a complete diet history needs to occur at every veterinary visits, and

c) we still have an awful lot to learn about pet food, taurine, K9 heart and overall health & nutrition.

However, it’s wonderful (possibly Christmas miracle category) to see such a large group of researchers collaborating to try and identify concerns towards keeping dogs safe- and maybe even learning more about what they might (or might not) need nutritionally. And that (i.e. collaboration and raised nutrition awareness) sums up what I’d asked Santa to ‘veterinary gift’ me with in 2018.

My veterinary wish list looks a bit different for 2019...but more on that (and hopefully a cup or two of spiked cider) in the New Year.

 

2019 happy new year.jpg