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CompendiumCONTINUING EDUCATION FOR VETERINARIANS®

CompendiumVet.com | Peer Reviewed | Listed in MEDLINE Vol 31(6) June 2009

Compe

ndium

Rated #

1 in O

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for S

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Veter

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Journ

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3 CE Contact Hours

Laparoscopic CryptorchidectomySurgical Views

Adding Behavior ServicesAddi B h i SSSS iUnderstanding Behavior

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CONTINUING EDUCATION FOR VETERINARIANS®

Compendium

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1. 2006 American Association of Feline Practitioners Feline Vaccine Advisory Panel Report. JAVMA, Vol. 229, No. 9, Nov. 1, 2006.

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CompendiumVet.com 249

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Compendium: Continuing Education for Veterinarians®

(ISSN 1940-8307)

PUBLISHED BY

250 CompendiumVet.com


AnesthesiaNora S. Matthews, DVM, DACVATexas A&M University

CardiologyBruce Keene, DVM, MSc, DACVIMNorth Carolina State University

Clinical Chemistry, Hematology, and UrinalysisBetsy Welles, DVM, PhD, DACVPAuburn University

DentistryGary B. Beard, DVM, DAVDCAuburn University

R. Michael Peak, DVM, DAVDCThe Pet Dentist—Tampa Bay Veterinary

DentistryLargo, Florida

Emergency/Critical Care and Respiratory MedicineLesley King, MVB, MRCVS, DACVECC, DACVIMUniversity of Pennsylvania

Endocrinology and Metabolic DisordersMarie E. Kerl, DVM, ACVIM, ACVECCUniversity of Missouri-Columbia

EpidemiologyPhilip H. Kass, DVM, MPVM, MS, PhD, DACVPMUniversity of California, Davis

Exotics AvianThomas N. Tully, Jr, DVM, MS, DABVP (Avian), ECAMSLouisiana State University

ReptilesDouglas R. Mader, MS, DVM, DABVP (DC)Marathon Veterinary HospitalMarathon, Florida

Small MammalsKaren Rosenthal, DVM, MS, DABVP (Avian)University of Pennsylvania

Feline MedicineMichael R. Lappin, DVM, PhD, DACVIM (Internal Medicine)Colorado State University

Margie Scherk, DVM, DABVP (Feline Medicine)Cats Only Veterinary ClinicVancouver, British Columbia

GastroenterologyDebra L. Zoran, DVM, MS, PhD, DACVIM (Internal Medicine)Texas A&M University

Infectious DiseaseDerek P. Burney, PhD, DVMGulf Coast Veterinary SpecialistsHouston, Texas

Internal MedicineDana G. Allen, DVM, MSc, DACVIMOntario Veterinary College

Internal Medicine and Emergency/Critical CareAlison R. Gaynor, DVM, DACVIM (Internal Medicine), DACVECCNorth Grafton, Massachusetts

NephrologyCatherine E. Langston, DVM, ACVIMAnimal Medical CenterNew York, New York

NeurologyCurtis W. Dewey, DVM, MS, DACVIM (Neurology), DACVSCornell University Hospital for Animals

OncologyAnn E. Hohenhaus, DVM, DACVIM (Oncology and Internal Medicine)Animal Medical CenterNew York, New York

Gregory K. Ogilvie, DVM, DACVIM (Internal Medicine, Oncology), DECVIM-CA (Oncology)CVS Angel Care Cancer Center

and Special Care Foundation for Companion Animals

Carlsbad, California

OphthalmologyDavid A. Wilkie, DVM, MS, DACVOThe Ohio State University

ParasitologyByron L. Blagburn, MS, PhD Auburn University

David S. Lindsay, PhDVirginia Polytechnic Institute

and State University

PharmacologyKatrina L. Mealey, DVM, PhD, DACVIM, DACVCPWashington State University

Rehabilitation and Physical TherapyDarryl Millis, MS, DVM, DACVS University of Tennessee

SurgeryPhilipp Mayhew, BVM&S, MRCVS, DACVSColumbia River Veterinary SpecialistsVancouver, Washington

C. Thomas Nelson, DVMAnimal Medical CenterAnniston, Alabama

ToxicologyTina Wismer, DVM, DABVT, DABTASPCA National Animal Poison Control

CenterUrbana, Illinois

EDITORIAL BOARD

Any statements, claims, or product endorsements made in Compendiumare solely the opinions of our authors and advertisers and do not necessarily refl ect the views of the Publisher or Editorial Board.

EDITOR IN CHIEF

Douglass K. Macintire, DVM, MS, DACVIM, DACVECC

Department of Clinical SciencesCollege of Veterinary MedicineAuburn University, AL 36849

June 2009 Vol 31(6)

EXECUTIVE ADVISORY BOARD MEMBERS

BehaviorSharon L. Crowell-Davis, DVM, PhD, DACVBThe University of Georgia

DermatologyCraig E. Griffi n, DVM, DACVDAnimal Dermatology ClinicSan Diego, California

Wayne S. Rosenkrantz, DVM, DACVDAnimal Dermatology ClinicTustin, California

NutritionKathryn E. Michel, DVM, MS, DACVNUniversity of Pennsylvania

SurgeryElizabeth M. Hardie, DVM, PhD, DACVSNorth Carolina State University

Compendium is a refereed journal. Articles published herein have been reviewed by at least two academic experts on the respective topic and by an ABVP practitioner.

AMERICAN BOARD OF VETERINARY PRACTITIONERS (ABVP) REVIEW BOARD

Kurt Blaicher, DVM, DABVP (Canine/Feline)Plainfi eld Animal HospitalPlainfi eld, New JerseyCanine and Feline Medicine

Eric Chafetz, DVM, DABVP (Canine/Feline)Vienna Animal HospitalVienna, VirginiaCanine and Feline Medicine

Henry E. Childers, DVM, DABVP (Canine/Feline)Cranston Animal HospitalCranston, Rhode IslandCanine and Feline Medicine

David E. Harling, DVM, DABVP (Canine/Feline), DACVOReidsville Veterinary HospitalReidsville, North CarolinaCanine and Feline Medi cine,

Ophthalmology

Jeffrey Katuna, DVM, DABVPWellesley-Natick Veterinary

HospitalNatick, MassachusettsCanine and Feline Medicine

Robert J. Neunzig, DVM, DABVP (Canine/Feline)The Pet HospitalBessemer City, North CarolinaCanine and Feline Medicine

CompendiumVet.com | June 2009 | Compendium: Continuing Education for Veterinarians® 251

Canadian News

The government of Canada is invest-ing $2.7 million in the infrastructure

of the University of Saskatchewan’s West ern College of Veterinary Medicine (WCVM). The funding, coming from the Canadian Western Economic Diversi fi ca-tion program, will be used on up grades to the large animal clinic and the diag-nostics laboratory at the college. The upgraded facilities will make the college, province, and country more competitive, according to Minister of State Lynne Yelich. “Investments such as these will lead to new diag-nostic tests that will protect Canada’s livestock industry and the health and safety of Canadians, their families, and communities.”

The construction of a two-story addi-tion and basement will add 3000 m2 of additional space to the diagnostics facil-ity. Once completed, the centre will be a major western Canadian hub for veterinary diagnostics services, ani-mal health research, and specialized training in diagnostic pathology, virol-ogy, bacteriology, immunology, and a range of biomedical sciences. “The expansion of the college’s diagnostics area and the renovation of our large animal clinical services will provide our staff and students with specialized, biosecure facilities where they’ll have access to a full range of new technologies,” says WCVM Dean Dr. Charles Rhodes.

The Canadian Food Inspection Agency and the Atlantic Veterinary College

(AVC) at the University of Prince Edward Island have joined together in a $1.2-million partnership to create the Canadian Regulatory Veterinary Epidemiology Network. This network will link the fi ve Canadian veterinary colleges and enhance animal health expertise by contributing to research and training programs. In addition to strengthening Canada’s animal disease prevention and control efforts, the pro-gram will also help meet national and international demands for animal and veterinary health experts. The initial phase of the project will establish a research chair in regulatory veterinary epidemiology at the AVC as well as related graduate positions. The network will be led by the Centre for Veterinary Epidemiological Research at the AVC, which is considered one of the leading centres for animal health epidemiologic research in the world. “This network will further strengthen

our ability to understand and respond to animal health and zoonotic disease challenges in a world of ever-changing risks,” said Dr. Brian Evans, chief vet-erinary offi cer of Canada.

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WEB CompendiumVet.com

July 16Ontario Veterinary Medical Association: Career Planning for Associate Veterinarians & Potential Practice OwnersOntario Veterinary Medical AssociationMilton, OntarioThis course will present the benefi ts and downsides of owning a practice as well as the practical aspects of practice ownership.Web www.ovma.info/Meetings/

August 8–13World Association for the Advancement of Veterinary Parasitology: 22nd International ConferenceCalgary, AlbertaThis conference will discuss current issues in parasitology. Web waavp.org

September 9Calgary Academy of Veterinary Medicine: OphthalmologyClara Christie Theatre, Health Sciences University of Calgary, AlbertaThis seminar will offer 1.5 hours of scientifi c CE and will be presented by Dr. Cheryl Cullen. Phone 403-863-7160E-mail [email protected] cavm.ab.ca/ce_calendar.html September 15 Toronto Academy of Veterinary Medicine: Update on Clinical GastroenterologyDave and Buster’sToronto, OntarioThis seminar will provide an update on gastrointestinal disorders of cats and dogs, with an emphasis on diagnosis and treatment. It will offer 5.5 CE credits.Phone 800-670-1702Web tavm.org

October 13Toronto Academy of Veterinary Medicine: Early Resuscitation and Stabilization of the Emergency PatientDave and Buster’sToronto, OntarioThis seminar will focus on practical emergency management using case examples. It will offer 5.5 CE credits.Phone 800-670-1702Web tavm.org

October 18Calgary Academy of Veterinary Medicine: HematologyClara Christie Theatre, Health Sciences University of Calgary, AlbertaThis seminar will offer 6 hours of scientifi c CE and be presented by Dr. Marjorie Brooks. Phone 403-863-7160E-mail [email protected] cavm.ab.ca/ce_calendar.html

Coming Events

Canadian Government Invests in Western College of Veterinary Medicine

Animal Health Network Announced

On the Cover This radiograph, obtained by Carol Adams, DVM, of Lone Oak Veterinary Clinic in Visalia, California, is from an 8-year-old cat that weighed 19 lb. The excessive weight placed undue stress on the cat’s skeleton.

Cover image © 2009 Carol Adams, Lone Oak Veterinary Clinic


June 2009 Vol 31(6)

252 Compendium: Continuing Education for Veterinarians®

*2009 PERQ/HCI FOCUS® Veterinary Study of Total Companion Animal Veterinarians, in comparison to ratings for each publi-cation, by that publication’s readers.

Each CE article is accredited for 3 contact hours by Auburn University College of Veterinary Medicine.

Features

Departments254 Letters

256 CompendiumVet.com

257 Editorial: Feline Focus ❯❯ Margie Scherk

294 Product Forum

295 Index to Advertisers

295 Market Showcase

295 Classifi ed Advertising

296 In Memory: Anna Worth

258 Understanding Behavior

Incorporating Behavioral Medicine Into General Practice

❯❯ Lisa Radosta

Learn how—and why—to include basic behavioral medicine into your day-to-day practice.

264 Feline Focus 2008 Feline Retrovirus

Management Guidelines In the debut of this quarterly

series devoted to feline medicine, the American Association of Feline Practitioners shares an abridged version of its most recent guidelines.

274 Surgical Views Laparoscopic and Laparoscopic-Assisted

Cryptorchidectomy in Dogs and Cats ❯❯ Philipp Mayhew

Surgical removal is the standard of care for cryptorchid testicles. Laparoscopy can help reduce incision sizes and postoperative pain in these patients. Watch videos of some aspects of these procedures on CompendiumVet.com.

EEAACE

s NEWSERIES

284 Feline Obesity: Clinical Recognition and Management

❯❯ Debra L. Zoran

Obesity is a common problem in cats that is compounded by most cats’ sedentary lifestyles and many owners’ feeding tech-niques. Recognition of the risk factors for obesity and early education of owners to prevent excessive weight gain are crucial to feline health. Further information on feline obesity is available on CompendiumVet.com.

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1. Reeder CJ, Griffi n CE, Polissar NL, et al. Comparative adrenocortical suppression in dogs with otitis externa following topical otic administration of four different glucocorticoid-containing medications. Vet Therap. 2008;9:111-121.2. Rubin J, Walker RD, Blickenstaff K, Bodies-Jones S, Zhao S., Antimicrobial resistance and genetic characterization of fl uoroquinolone resistance of Pseudomonas aeruginosa isolated from canine infections., Vet microbiol. 2008 Mar 4; [Epub ahead of print] SPAH-MO-96

Mometamax® Malassezia pachydermatis) Pseudomonas P. aeruginosa Enterococcus faecalis, Proteus mirabilis

See Page 254 for Product Information Summary

254 Compendium: Continuing Education for Veterinarians® | June 2009 | CompendiumVet.com

Letters

Understanding

Behavior Feline Hyperesthesia Syndrome*

About This ColumnBehavior problems are a signifi -cant cause of death (euthanasia) in companion animals. While most veterinary practices are necessarily geared toward the medical aspect of care, there are many opportuni-ties to bring behavior awareness into the clinic for the benefi t of the pet, the owner, and ourselves. This column acknowledges the importance of behavior as part of veterinary medicine and speaks practically about using it effectively in daily practice.

❯❯ John Ciribassi, DVM, DACVB Chicagoland Veterinary Behavior ConsultantsCarol Stream, Illinois

*Adapted with permission from John Ciribassi, DVM, and the Veterinary Information Network (VIN).

116 CompendiumVet.com | March 2009

Feline hyperesthesia syndrome (FHS) is known by several names, including rolling skin disease, neurodermatitis, neuritis, psychomotor epilepsy, and pru-

ritic dermatitis of Siamese.1,2 As evidenced by these names and by the use of the term syndrome, FHS is not characterized as having a single etiology. In fact, it is often a diagnosis of exclusion. The differential diagnosis for FHS includes diseases related to the fi elds of dermatology, neurology, and behavior. Only after conditions relating to skin and the nervous system have been ruled out can this condition be labeled a behavior disorder.

SignalmentFHS can occur in cats of any age, but it is commonly seen in cats aged 1 to 5 years. Males and females are equally affected. While all breeds can be affected, Siamese, Burmese, Persian, and Abyssinian cats are more commonly affl icted.3

Clinical SignsAs indicated by the name rolling skin disease, affected cats often show rippling or rolling skin along the lum-bar spine. Palpation of the lumbar musculature may elicit signs of pain. Mydriasis is common during bouts of FHS. Affected cats commonly stare at their tail, then attack the tail and/or fl anks. Biting of the tail base, forelegs, and paws is common. These cats often run wildly around the home, vocalizing at the same time. Normally calm cats may display aggression toward people or other cats in the household, while aggressive cats may display increased affection. The behavior may be induced by pet-ting or stroking the cat’s fur and most commonly occurs in the morning or later in the evening.2

DiagnosisThe differential diagnosis for FHS can be categorized by the type of clinical signs displayed:

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09 K

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FHS can occur in cats of any age, but it is commonly seen in cats aged 1 to 5 years.

QuickNotes

Feline Hyperesthesia SyndromeI read with interest the March 2009 Understanding Behavior article on feline hyperesthesia syndrome (FHS), a poorly understood clinical entity. To me, it is plausible that some cats with clinical signs compatible with FHS may truly experience bouts of breakthrough neuropathic pain leading to allodynia (sensation of pain resulting from non-noxious stimuli, such as a light touch), regardless of whether higher brain func-tions are involved (e.g., displacement behavior).

If this is the case, it could partly explain

why some cats appear to improve with

certain centrally acting therapies, such as

the anticonvulsant gabapentin. This drug

binds to a subunit of the voltage-gated

calcium channels in the dorsal horn and is

commonly used for conditions associated

with neuropathic pain or with chronic

pain when central sensitization is sus-

pected, even though clinical studies are

lacking in veterinary medicine.1 As such,

a clinical response to gabapentin should

not necessarily lead the practitioner to

conclude that the patient was experienc-

ing seizures, as is suggested in this article

(p.118), but may instead be the result of a

true neuropathic pain syndrome respond-

ing to an adjuvant analgesic drug. The

same reasoning could apply to other

drugs, such as tricyclic antidepressants

and selective serotonin reuptake inhibitors,

often considered as fi rst-line therapies in

people with neuropathic pain.2

Louis-Philippe de Lorimier, DVM,

DACVIM (Oncology)

Hôpital Vétérinaire Rive-Sud

Brossard, Québec

Canada

References1. Backonja M, Glanzman RL. Gabapentin dosing for neuropathic pain: evidence from randomized, placebo-controlled clinical trials. Clin Ther 2003;25:81-104.2. Verdu B, Decosterd I, Buclin T, et al. Antidepressants for the treatment of chronic pain. Drugs 2008;68:2611-2632.

The Author’s ReplyThank you for your comments regard-

ing my article on FHS. It is plausible that

at least some cases of FHS are related

to neuropathic pain. As indicated in my

article, some believe that myopathic

disorders can result in the clinical signs

seen with FHS. An underlying neuropa-

thy may certainly account for these signs.

Gabapentin, while often used in treating

seizure disorders, is also well known for

its use in human and veterinary medi-

cine for treating neuropathic pain.1,2 As

a result, it can be diffi cult to distinguish,

in patients responding to treatment with

gabapentin for FHS, whether the response

is managing a seizure disorder centrally or

is exerting peripheral neuropathic effects.

The advantage of initially using pheno-

barbital in managing cases in which sei-

zures are suspected as the etiology is that

phenobarbital would not be expected to

act peripherally. As a result, improvement

with phenobarbital would provide a pre-

sumptive diagnosis of seizure. If pheno-

barbital proves to be ineffective, turning

to gabapentin can help distinguish seizure

from neuropathy. This being said, diagno-

sis by drug trial does not truly provide a

secure diagnosis. Instead, it merely gives

circumstantial evidence of an etiology

based on the assumption of a known and

specifi c mode of action of the drug that is

providing relief of the signs.

Dr. John Ciribassi

Chicagoland Veterinary Behavior

Consultants

Carol Stream, Illinois

References1. Kumar B, Kalita J, Kumar G, Misra UK. Central post-stroke pain: a review of pathophysiology and treatment. Anesth Analg 2009;108(5):1645-1657. 2. Clivatti J, Sakata RK, Issy AM. Review of the use of gabapentin in the control of postoperative pain. Rev Bras Anestesiol 2009;59(1):92-8, 87-92.

What do dogs who take VETORYL® (trilostane) have in common?

Results like these.

Effective treatment for Cushing’s syndrome is now FDA approved.You now have easy access to the most powerful weapon in the fight against canine Cushing’s syndrome. VETORYL Capsules are the only licensed treatment available for both pituitary-dependent and adrenal-dependent hyperadrenocorticism.

VETORYL Capsules contain the active ingredienttrilostane, which blocks the excessive production of cortisol. Daily administration of VETORYL can greatly reduce the clinical signs associated with Cushing’s syndrome, enhancing the quality of life for both dog and owner. For more information, visit www.VETORYL.com.

Contact your local veterinary distributor to order VETORYL Capsules today!

ee

(trilostane)

Prior to VETORYL treatment

Following 3 months of treatment

with VETORYL

Following 9 months of treatment with VETORYL

Photographs courtesy of Carlos Melian, DVM, PhD

VETORYL is a trademark of Dechra Ltd. ©2009, Dechra Ltd.NADA 141-291, Approved by FDA

As with all drugs, side effects may occur. In field studies, the most common side effects reported were poor/reduced appetite, vomiting, lethargy, diarrhea, and weakness. Occasionally, more serious side effects, including severe depression, hemorrhagic diarrhea, collapse, hypoadrenocortical crisis, or adrenal necrosis/rupture may occur, and may result in death. VETORYL Capsules are not for use in dogs with primary hepatic or renal disease, or in pregnant dogs. Refer to the prescribing information for complete details or visit www.VETORYL.com.

VTYL0209-01-47122-CPD


CE ARTICLES

❯❯ Renal Secondary Hyperparathyroidism❯❯ Jenefer R. Stillion and Michelle G. Ritt

The parathyroid glands secrete parathyroid hormone (PTH), which is important for main-taining calcium homeostasis. Parathyroid gland hyperplasia and subsequent hyper-parathyroidism can occur secondary to chronic renal failure in dogs, resulting in signifi cant alterations in calcium metabolism. Renal secondary hyperparathyroidism is a complex, multifactorial syndrome that involves changes in circulating levels of calcium, PTH, phosphorus, and 1,25-dihy-

droxycholecalciferol (calcitriol).

WEB-EXCLUSIVE VIDEOS

❯❯ Laparoscopic and Laparoscopic-Assisted Cryptorchidectomy Videos

The June 2009 Surgical Views column, “Laparoscopic and Laporoscopic-Assisted Cryptorchidectomy in Dogs and Cats,” by Dr. Philipp Mayhew, discusses the advantages and disadvantages of these techniques. Three videos, contributed by Dr. Mayhew, demonstrate some of the techniques discussed in this column.

VIDEO 1 demonstrates the manipulation of the normal testicle in a unilaterally cryptorchid dog. By pushing the normal testicle in a cra-nial direction, it is possible to see whether the

normal testicle is located on the right or the left side (in this case the normal testicle is the right testicle). The cryp torchid testicle should be located on the contralateral side.

VIDEO 2 demonstrates use of the vessel-sealing device to seal and section the gubernaculum, spermatic cord, and, fi nally, the vascular pedicle of an abdominally cryptorchid testicle.

If a totally laparoscopic cryptorchidec-tomy is per-formed (VIDEO

3), the testicle can be removed through the subumbilical port. This way, enlargement of the port can be performed through the linea alba rather than the muscular body wall where the instrument ports are located.

❯❯ COMPENDIUM EXTRA, a monthly e-newsletter, provides Web-exclusive articles and news as well as a preview of this month’s journal. Sign up at CompendiumVet.com.

❯❯ E-mail your questions, suggestions, corrections, or letters to the editor:[email protected]

E-NEWSLETTER

CONTACT US

June 2009 Vol 31(6)WEB EXCLUSIVES

256 Compendium

31(6)

on

❯❯ Cryptorchidectomy Video 1



VETORYL® Capsules (trilostane)

30 mg and 60 mg strengthsAdrenocortical suppressant for oral use in dogs only

BRIEF SUMMARY (For Full Prescribing Information,

see package insert.)

CAUTION: Federal (USA) law restricts this drug

to use by or on the order of a licensed veterinarian.

DESCRIPTION: VETORYL is an orally active

synthetic steroid analogue that blocks production

of hormones produced in the adrenal cortex of dogs.

INDICATIONS: VETORYL Capsules are

indicated or the treatment of pituitary-dependent

hyperadrenocorticism in dogs. VETORYL

Capsules are indicated for the treatment

of hyperadrenocorticism due to adrenocortical

tumor in dogs.

CONTRAINDICATIONS: The use of VETORYL

Capsules is contraindicated in dogs that have

demonstrated hypersensitivity to trilostane.

Do not use VETORYL Capsules in animals with

primary hepatic disease or renal insufficiency.

Do not use in pregnant dogs. Studies conducted

with trilostane in laboratory animals have shown

teratogenic effects and early pregnancy loss.

WARNINGS: In case of overdosage,

symptomatic treatment of hypoadrenocorticism with

corticosteroids, mineralocorticoids and intravenous

fluids may be required. Angiotensin-converting

enzyme (ACE) inhibitors should be used with caution

with VETORYL Capsules, as both drugs have

aldosterone-lowering effects which may be additive,

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electrolytes, blood volume and renal perfusion.

Potassium-sparing diuretics (e.g., spironolactone)

should not be used with VETORYL Capsules as

both drugs have the potential to inhibit aldosterone,

increasing the likelihood of hyperkalemia.

HUMAN WARNINGS: Keep out of reach of children.

Not for human use. Wash hands after use. Do not

empty capsule contents and do not attempt to divide

the capsules. Do not handle the capsules if pregnant

or if trying to conceive. Trilostane is associated

with teratogenic effects and early pregnancy loss

in laboratory animals. In the event of accidental

ingestion/overdose, seek medical advice immediately

and take the labeled container with you.

PRECAUTIONS: Hypoadrenocorticism can

develop at any dose of VETORYL Capsules.

A small percentage of dogs may develop

corticosteroid withdrawal syndrome within 10 days

of starting treatment. Mitotane (o,p’-DDD) treatment

will reduce adrenal function. Experience in foreign

markets suggests that when mitotane therapy is

stopped, an interval of at least one month should

elapse before the introduction of VETORYL

Capsules. The use of VETORYL Capsules will not

affect the adrenal tumor itself. Adrenalectomy

should be considered as an option for cases that

are good surgical candidates.

ADVERSE REACTIONS: The most common

adverse reactions reported are poor/reduced

appetite, vomiting, lethargy/dullness, diarrhea,

and weakness. Occasionally, more serious reactions

including severe depression, hemorrhagic diarrhea,

collapse, hypoadrenocortical crisis, or adrenal

necrosis/rupture may occur, and may result in death.

VETORYL is a trademark of

Dechra Ltd. © 2009, Dechra Ltd.

NADA 141-291, Approved by FDA

(trilostane)Distributed by:

Dechra Veterinary Products

7015 College Boulevard, Suite 525

Overland Park, KS 66211

www.VETORYL.com

866-933-2472

Editorial


By now, you know that Compendium is launch-ing several new series this year, and excite-ment is building! So what’s new in the

journal for you and your feline patients? The American Association of Feline Practitioners (AAFP) is partnering with Compendium to shine the spotlight on cats on a quarterly basis in Feline Focus! This series will provide you with pertinent and timely updates in feline medicine, covering a myriad of useful and useable facts to help you help cats in your practice. It will include brief abstracts and conference pearls; how-to articles about approaching specifi c problems in cats, as well as handling and working more peacefully and effectively with the more diffi cult members of this species; and summaries of AAFP guidelines.

Every column will be peer-reviewed by a dip-lomate specialist and approved by a representa-tive of the AAFP. Together, Compendium and the AAFP want to provide more access to informa-tion about feline medicine, brought to you by sources you know you can trust. In this premiere offering of Feline Focus, we are pleased to share with you the 2008 AAFP Feline Retrovirus Management Guidelines. Not excited yet? Let me whet your appetite. For exam-ple, did you know that testing, not vaccination, is

the cornerstone to management and prevention of the spread of FeLV and FIV and that all cats should be tested, especially when they are ill? Vaccination should be considered only in adult cats that are deemed to live in an at-risk environ-ment (i.e., FeLV and FIV vaccines are not core for adult cats). However, FeLV vaccination is now recommended as core for cats younger than 1 year. Do you know what the risk for FeLV or FIV is in your region? In addition to providing recommendations on preventing retrovirus infections, the guidelines are an excellent source of information about caring for retrovirus-positive cats—not only pet cats but also those in cattery, shelter, and rescue situations. Do clients ask you whether fencing is adequate for iso-lation of retrovirus-positive cats from uninfected cats, or what kinds of disinfectant they need to use? Do you know how often a cat with FeLV should be examined and which tests should be conducted at each visit, or what drugs have been shown to be effective in the treatment of FeLV or FIV? If the answers to any of these questions intrigue you, the practical, scientifi cally solid article in this issue should be a useful clinic resource. Welcome to Feline Focus! We look forward to growing a relationship with you based on solid, practical feline facts.

Cheers!Margie

While FIV and FeLV vaccines are not

considered core for adult cats, FeLV is a

core vaccine for cats younger than 1 year.

472 Compendium | June 2009 | CompendiumVet.com

About AAFP

The American Association of Feline Practitioners improves the health and well-being of cats by supporting high stan-dards of practice, continuing education, and scientifi c inves-tigation. Feline Practitioners are veterinary professionals who belong to this association because they are “passionate about the care of cats”!

American Association of Feline Practitioners

203 Towne Centre DriveHillsborough, NJ 08844-4693

phone: 800-874-0498phone: 908-359-9351fax: 908-292-1188

e-mail: [email protected]

Media contact: Valerie Creighton, DVM, ABVP


About AAFP

FELINEPRACTITIONERS

AMERICANASSOCIATION OF

Contributed by:

2008 Feline Retrovirus Management Guidelines*

Members of the Advisory Panel❯❯ Julie Levy, DVM, PhD, DACVIM, Chair❯❯ Cynda Crawford, DVM, PhD

University of Florida

❯❯ Katrin Hartmann, Dr. Med. Vet., Dr. Habil., DECVIN-CALudwig Maximilian University Munich | Munich, Germany

❯❯ Susan Little, DVM, DABVP (feline practice)Winn Feline Foundation | Manasquan, New Jersey

❯❯ Eliza Sundahl, DVM, DABVP (Feline Practice)KC Cat Clinic | Kansas City, Missouri

❯❯ Vicki Thayer, DVM, DABVP (Feline Practice)Purrfect Practice | Lebanon, Oregon

❯❯ Regina Hoffmann-Lehmann, Dr. Med. Vet.,Dr. Habil, FVHUniversity of Zurich | Zurich, Switzerland

Epidemiology Page XXX

Preventing FeLV and FIV Infection Page XXX

Limiting Transmission in the Veterinary Practice Page XXX

Diagnosing FeLV and FIV Page XXX

Managing Positive Cats Page XXX

At a Glance

*This is an abridged version of the full guidelines (Levy JC, Crawford C, Hartmann K, et al. 2008 American Associa-tion of Feline Practitioners’ feline retrovirus management guidelines. J Feline Med Surg 2008;10[3]:300-316), available at Catvets.com from the American Association of Feline Practitioners (AAFP). Adapted with permission of AAFP.

FeLV and FIV are among the most common infectious diseases of cats. Risk factors for infection include male gender, adulthood, and outdoor access, whereas indoor

lifestyle and sterilization are associated with reduced infec-tion rates.1–5

The retroviral status of all cats should be known. Cats may require retrovirus testing at different times in their lives. Here are some general principles for retrovirus testing:

A cat with a confi rmed-positive test result should be diagnosed as having a retroviral infection—not clinical dis-ease. Diseases in cats infected with FeLV or FIV may not necessarily be the result of the retrovirus infection. Cats infected with FeLV or FIV may live for many years.

A decision for euthanasia should never be made solely on the basis of whether the cat is infected. No test is 100% accurate at all times under all conditions.

All test results should be interpreted along with the patient’s health and prior likelihood of infection. All positive results should be confi rmed by another test method. While FeLV and FIV can be life-threatening viruses, proper management can give infected cats longer, healthier lives. The following article refl ects the recommendations of the AAFP on managing these infections.

EpidemiologyThe prevalence of FeLV infection has reportedly decreased during the past 20 years, presumably as a result of implemen-tation of widespread testing programs and development of effective vaccines.1,2,6 In contrast, the prevalence of FIV has not changed since the virus was discovered in 1986.

This report is an abridged version of the Retrovirus Guidelines of the American Association of Feline Practitioners (AAFP) to guide veterinary practitioners who want to optimize the care and management of feline patients. It represents a consensus of current information compiled by the researchers and practitioners on the panel. The guidelines in this report are based on the best research data, clinical experience and technical judgments available at the time of preparation. While the guidelines are as accurate and comprehensive as possible, they are subject to change should new insights become available from additional research or technological updates. The AAFP is a professional organization of practitioners and board-certifi ed specialists who seek to raise the standards of feline medicine and surgery among practitioners.

About These Guidelines

In a study of more than 18,000 cats tested in 2004, 2.3% were positive for FeLV and 2.5% were positive for FIV.1 Infection rates for FeLV and FIV (TABLE 1) varied among subpopula-tions and sources of cats.

Preventing FeLV and FIV InfectionVaccines are available for both retroviruses. Both FeLV and FIV vaccines are non-core. Risk assessment of the individual animal should dictate their use. No vaccine is 100% effec-tive, and repeat testing should be performed as warranted.

FeLV VaccinationThe decision to vaccinate an individual cat against FeLV should be based on the cat’s risk of exposure. Cats that live in a FeLV-negative, indoor environment are at minimal risk. FeLV vaccination is recommended for:

All kittens because the lifestyles of kittens fre-quently change after acquisition and they may subsequently be at risk for FeLV exposure Cats that go outdoors Cats that have direct contact with cats of unknown status or in high-turnover situations

TABLE 1 Risk Factors for FeLV and FIV Seropositivity in 18,038 Cats Tested at Veterinary Clinics and Animal Shelters in North America1

Factor Categories Number of Cats Tested

Number of Cats with Positive Results

for FeLV(%)

Number of Cats with Positive Results

for FIV (%)

Study site Animal shelter 8068 124 (1.5) 141 (17)

Veterinary clinic 9970 285 (2.9) 305 (3.1)

Region West 3737 39 (1.0) 72 (1.9)

Canada 325 8 (2.5) 10 (3.1)

South 6359 144 (2.3) 183 (2.9)

Northeast 3747 107 (2.9) 79 (2.1)

Midwest 3870 111 (2.9) 102 (2.6)

Source Clinic (indoors only) 3613 53 (1.5) 32 (0.9)

Clinic (outdoors access) 6357 232 (3.6) 273 (4.3)

Shelter (relinquished pet) 2809 41 (1.5) 38 (1.4)

Shelter (stray) 4550 71 (1.6) 75 (1.6)

Shelter (feral) 709 12 (1.7) 28 (3.9)

Age Juvenile 9556 131 (1.4) 100 (1.0)

Adult 8482 278 (3.3) 346 (4.1)

Sex Spayed female 2611 45 (1.7) 82 (1.2)

Neutered male 2984 88 (2.9) 127 (4.3)

Sexually intact female 6588 128 (1.9) 44 (1.7)

Sexually intact male 5855 148 (2.5) 193 (3.3)

Health status Healthy 15,312 238 (1.6) 280 (1.8)

Sick 2726 171 (6.3) 166 (6.1)

These guidelines are not exclusive. Other techniques and procedures may be available. The AAFP expressly disclaim any warranties or guarantees, express or implied, and shall not be liable for any damages of any kind in connection with the material, informa-tion, techniques, or procedures set forth in these guidelines.

Disclaimer

The new Feline Focus series begins on page 264.

❯❯ Margie Scherk, DVM, DABVP (Feline Medicine)Vancouver, British Columbia

Feline Focus

Understanding

Behavior

About This SeriesBehavior problems are a signifi -cant cause of death (euthanasia) in companion animals. While most veterinary practices are necessarily geared toward the medical aspect of care, there are many opportuni-ties to bring behavior awareness into the clinic for the benefi t of the pet, the owner, and ourselves. This series acknowledges the importance of behavior as part of veterinary medicine and speaks practically about using it effectively in daily practice.

SERIES EDITOR Sharon Crowell-Davis, DVM, PhD, DACVBThe University of Georgia

258 CompendiumVet.com | June 2009

Incorporating Behavioral Medicine Into General Practice ❯❯ Lisa Radosta, DVM, DACVBa

Florida Veterinary Behavior Service | Royal Palm Beach, Florida

Behavior issues affect almost every aspect of veterinary medicine (BOX 1). The most obvious, such as aggression, fears, and phobias, may be serious enough

to prompt consultation with a behavior specialist. Others, however, may simply be considered “normal,” such as stress during offi ce visits or avoidance of a carrier. Although they may not be dramatic, these behaviors can cause clients to limit the number of nonemergency veterinary visits they make, ultimately affecting a prac-tice’s bottom line. Therefore, providing basic behavioral services, such as social-ization or habituation, can not only help increase revenue in general practices but also improve patient health.

Why Provide Behavioral Services?Many general practices do not offer behavioral services for several reasons. The appointments are assumed to be too time-consuming to be profi table (1½ to 3 hours), and add-on services and products are not obvious to practices. In addition, many veterinarians are not comfortable with treating behavior problems. However, many behavior services can be provided within a 20- to 30-minute appointment, and although adding a new profi t center and retraining employees is a large investment, the return on investing in behavioral services is sizable. Adding these services can not only increase client compliance (e.g., medication administration, scheduling recheck appointments), retention, and satisfaction but also improve your patients’ quality of life and decrease the likelihood of relinquishment. Clients are often embarrassed to share their pet’s behavior problems or their decision to relinquish their pet with their vet-erinarian. You may not know how many patients you lose to behavior problems each year, but behavior problems are the leading cause of relinquishment and euthanasia of dogs and cats.1–3 Offering behav-ioral services is, therefore, a great way to attract and retain clients, reduce stress and euthanasia in your practice, and even make a profi t. By improving a pet’s behavior, you ulti-mately help the pet, the client, and the practice.

Avoidance of cat carrier Stress during veterinary visit Diffi cult handling during veterinary visit Intolerance of regular injections/medication Anxiety during boarding Aggression in the waiting room Lack of compliance with postoperative rest recommendations Resistance to nail trimming Relinquishment of pets for treatable problems

Common Circumstances in Which Behavioral Issues Affect General Practice

BOX 1

B

aDr. Radosta discloses that she has re-ceived fi nancial support from Eli Lilly and Company and Virbac Animal Health.

Providing basic behavioral services can help increase revenue and improve patient health.

QuickNotes

Federal (U.S.A.) law restricts this drug to use by or on the order of a licensed veterinarian. Children should not contact application site for twenty-four (24) hours.

*From a survey of 736 cat owners. Data on fi le.

P08711n

Cats and their owners agree: a topical dewormer beats a pill any day. In fact, nearly 90% of cat

owners prefer topical drops to pills or tablets.* So listen to your cat owners. Choose the only feline

dewormer that treats and controls roundworms, hookworms and tapeworms with the ease and

convenience of a topical application: Profender® Topical Solution.

Cat ownerslisten to their cats.

Listen to your cat owners.


260 Compendium

Understanding

BehaviorWhere to BeginPlanning for New ServicesFirst, decide which levels of care your practice can provide. Examples include prepurchase counseling, doggie day care, preventive medicine, behavior modifi cation for simple or major problems, basic obedience classes, behavioral consultation for major problems, and referral to a behavior specialist. Next, decide how you will del-egate the responsibilities to your team. Your role as the veterinar-ian is to diagnose the problem and write a treatment plan. Just as you would not ask a technician to make the treatment plan for a dog with acute pancreatitis, you should not turn the responsibility to diagnose and treat behavior problems over to a technician. So, what will the technician’s role be? Will he or she implement the treatment plan for you or be responsible for phone follow-up and follow-up appoint-ments? What will the receptionist’s role be? All members of the prac-tice should be on board with the plan for it to be effective. Next, think about how you will train your staff. Some resources for education are textbooks, continuing education courses, and professional organizations (BOX 2). Contact your nearest board-certifi ed veterinary behaviorist and ask which text-books and conferences he or she recommends or whether he or she would be willing to talk to your staff to get the ball rolling. Finally, consider how to make behavioral services simple and acces-sible for clients. Easy-to-understand client handouts explaining the diagnosis and treatment should be used to help keep appoint-ments to a reasonable length of time. Handouts can be written by staff and edited by the veterinar-ian, or prewritten handouts can be found in a number of textbooks (BOX 2). Handouts can also be inte-


Understanding

Behavior

Behavioral medicine can be a profi t cen-ter for primary care practices.

QuickNotes

grated into a computer-generated discharge sheet so that all client instructions are in the same place. The number of handouts and the topics to be covered will depend on the services offered at the prac-tice. Also, decide which behavior-related products the practice will carry, as this will be an important part of completely integrating behavior services.

Integrating New Services Into the Practice

For any service to be a successful practice builder, it must be inte-grated into the practice, from the receptionist to the veterinarian. From the moment that clients enter the waiting room, they should be aware that you provide behavioral services. Signs unique to the practice or supplied by toy manufac-turers or pharmaceutical companies are one way of achieving this goal. The receptionist should men-tion the addition of behavioral services to the prac-tice when clients book appointments and should give each arriving client a short behavior checklist (BOX 3) to be fi lled out while waiting. The client can then give the completed form to the technician at the beginning of the visit. Using a form is the most effi cient way of collecting information about a pet’s

behavior at each appointment. By incorporating behavioral issues into routine wellness visits, you foster the idea that behavior is just another aspect of the patient to be examined. Similarly, the practice should support the message that behav-ioral problems should be treated as promptly as medical illnesses. For example, when you write a medical treatment plan, the practice pharmacy dispenses the necessary medications (e.g., an antibiotic for superfi cial pyo-derma). Although other phar-macies may dispense the same

medication at a lower price, dispensing from the practice pharmacy allows clients to begin treatment immediately and conveniently. Behavior cases are no different. Behavioral supplies (e.g., food toys, collars, clickers) should be displayed prominently in the lobby. Although clients can pur-chase these products elsewhere at a later time, they are more likely to initially purchase them from the vet-erinarian at the time of the appoint-ment because the product is unique to the veterinarian’s offi ce (e.g., Blue Kong) or was “prescribed” as part of the treatment plan.

What to OfferPrepurchase CounselingPrepurchase counseling helps owners avoid prob-lems of incompatibility by suggesting a pet that matches their lifestyle. These appointments typi-cally take 20 to 30 minutes and can be conducted by a veterinary technician. Technicians can educate themselves by using Internet resources (e.g., akc.org, iams.com, purina.com), attending continu-ing education classes, and familiarizing themselves with breed handbooks. Before the appointment, the owner fi lls out a 1- to 2-page questionnaire list-ing his or her expectations for a pet (e.g., groom-ing, exercise, energy level). The technician should consider the owner’s ability to exercise the pet, the amount of time available for training, the presence of children in the household, grooming require-ments, and the owner’s travel/work schedule. The client should be sent home with a summary of rec-ommendations, which can be as simple as a list of breeds with the suitable candidates checked off.

Textbooks

Horwitz D, Mills D, Heath S, eds. BSAVA Manual of Canine and Feline Behavioural Medicine. Gloucester, England: BSAVA; 2002.

Landsberg G, Ackerman L, Hunthausen W. Handbook of Behavior Problems of the Dog and Cat. Philadelphia: Elsevier; 2003.

Organizations

American College of Veterinary Behaviorists: www.dacvb.org

American Veterinary Society of Animal Behavior: www.avsabonline.org

Society of Veterinary Behavior Technicians: www.svbt.org

ResourcesBOX 2


Understanding

BehaviorDoggie Day CareIn today’s busy society, many owners do not have the time to adequately exercise their dogs, which can contribute to several behavior problems. By instituting a doggie day care program, your prac-tice can offer your clients several benefi ts. To clients who pick up their dog after a long day of work, the most obvious benefi t will be the dog’s reduced need for activity. This aspect of the service will build cli-ent loyalty and encourage clients to continue to use the day care. Another benefi t of a good doggie day care program is screening for common infectious diseases and aggression (via a questionnaire), which should be required for all dogs before they are per-mitted to participate. Doggie day care requires a signifi cant commit-ment of space and dedicated staff. A medium-to-large room or yard is necessary. Outdoor yards should have secured fencing of adequate height to contain large dogs. Agility equipment, beds, crates, and toys can also be provided. Ideally, there should be at least three separate areas for small dogs, large

dogs, and older dogs. Dogs should be rotated between rest and play in appropriate groups, depending on their play style. All interactions should be supervised by at least one person for every four or fi ve dogs. Upgrades such as baths and viewing by webcam can also be offered.

Preventive MedicineVeterinarians practice preventive medicine every day, but behavioral advice is frequently left out. Puppies and kittens have sensitive periods for socialization in which a relatively small amount of effort can have a very large effect. Unfortunately, if their experi-ences during these periods are stressful, or if they are not exposed to new people and situations dur-ing this time, they often become fearful or anxious. Fears and anxieties are the most common causes of behavior problems, including aggression, in animals. Therefore, each new puppy or kitten appointment should include counseling about socialization and habituation. In addition, the practice can offer in-house socialization/habituation services, kitten and puppy classes, obedience classes, and counseling services for life/schedule changes. In-house socialization/habituation services for puppies and kittens reduce clients’ time commit-ment to this type of training. Instead, clients bring their pets to the clinic, where habituation to star-tling noises (e.g., thunderstorms, fi reworks), house-

training, crate training, and socialization to people and other animals can be conducted. While this may seem like a large task, it requires little more time and commitment than boarding patients. Crate training and housetraining of dogs include walk-ing them on a schedule and teaching them that the crate is a fun place to be. Socialization to people takes roughly 5 to 10 minutes, three times a day. Clients who are in your clinic waiting for their own pets can help by playing with puppies and kittens in a clean, safe area, adding to socialization with-out placing a drain on the practice. However, these services require a separate puppy/kitten area that is kept clean and free of any pets with infectious dis-eases, and owners of pets with infectious diseases should not participate. Clients may want to complete the socialization of their pet themselves but not know how to do so. In these cases, the veterinarian can customize a plan, based on the pet’s strengths and weaknesses, for the client to implement at home. Appointments gener-ally last 20 to 30 minutes. The client should leave the appointment with a summary and a handout on which the appropriate recommendations are checked off. Puppy and kitten socialization classes are vitally important in preventing behavioral disorders.4 Because the classes should be limited in size and the patients are small, there is no need for a large space. During these classes, pets are socialized to people and other pets, habituated to sounds and handling, and taught to tolerate nail trims and tooth brushing. Finally, they are taught basic obedience behaviors. These positive-reinforcement classes can be taught by a veterinarian or a member of the staff. Puppies and kittens should be enrolled when they are as close to 8 weeks of age as possible to offer the greatest benefi t to the pet and client.

Understanding

Behavior

Have your pet’s elimination habits changed since his/her last appointment? Has your pet growled at or bitten someone since his/her last appointment? Has your pet had an increase in anxiety or fear since his/her last appointment? Has your pet’s personality changed since his/her last appointment? Are any of your pet’s behaviors of concern to you?

Waiting-Room Behavior ChecklistBOX 3

Behavioral issues affect almost every aspect of veterinary medicine.

QuickNotes


Understanding

Behavior

Obedience classes can be offered at the clinic. A member of the staff can teach the class, or the clinic can partner with a dog trainer. Such classes can be a good way to supplement income, increase employee job satisfaction and retention, and intro-duce new clients to your practice. However, these classes should be undertaken with care because the practice may be legally responsible for the advice given. Regardless of who you employ to teach obe-dience or puppy classes, observe them teaching fi rst. Ask them what methods they use and how much experience they have. Lay down guidelines for pos-itive-reinforcement training in writing so that there is no confusion about what is permitted. Counseling services can help clients transition their pets in circumstances such as moving, marriage, loss of a family member (animal or human), or arrival of a baby. Even the best pet can become agitated by major life changes. Appointments generally last 20 to 30 minutes. As with a medical appointment, the tech-nician takes the history and presents the case to the veterinarian. The veterinarian examines the pet and makes an assessment and a treatment plan. After pre-senting the plan to the client, the technician teaches the client how to implement it and sends him or her home with an appropriate handout.

Basic Behavior Modifi cation Basic behavior modifi cation appointments last 20 to 30 minutes and are conducted either by the techni-cian after the veterinarian has examined the pet or as

a standard part of treating a medical disorder. Some examples are muzzle training for veterinarian-aggres-sive dogs, behavior modifi cation for cats that will not enter their carriers, and counterconditioning for pets that do not tolerate medication administration. When topical, oral, or injectable medications are prescribed, the client should be asked if he or she will be able to administer the medication for the duration of the treatment plan. If the answer is “no,” a behavior modi-fi cation appointment should be recommended.

Problem Behavior ReferralsAppointments for problem behaviors typically last 1½ to 3 hours. Most general practices choose not to offer these appointments because of their length and profi tability compared with other services. If this is the case in your practice, you can offer an initial 30-minute consult preceding a referral to a board-certifi ed veterinary behaviorist. These visits include a physical examination, screening laboratory tests (e.g., complete blood count, serum chemistry pro-fi le, thyroxine, urinalysis), and a short list of fi ve to 10 safety recommendations specifi c to the case (e.g., avoidance of provocative situations, discontinuation of physical corrections or confrontational interac-tions). By offering this service, you ensure that the patient has had a recent medical workup before it goes to the behavior specialist and that this income stays in your practice. In addition, screening tests may help identify, and allow you to start treatment for, an underlying medical disorder that may be con-tributing to the behavior problem.

ConclusionThere are many ways to integrate behavioral medi-cine into the general veterinary practice. Change is never easy or comfortable, but by adding behav-ioral services to your practice, you can improve your patients’ quality of life; increase patient, client, and employee retention; and positively affect your prac-tice’s bottom line.

References1. Patronek FJ, Glickman LT, Beck AM, et al. Risk factors for relinquishment of dogs to an animal shelter. JAVMA 1996;209:572-581.2. Patronek GJ, Glickman LT, Beck AM, et al. Risk factors for relinquishment of cats to an ani-mal shelter. JAVMA 1996;209:582-598.3. Salman MD, Hutchinson J, Ruch-Gallie R, et al. Behavioral reasons for relinquishment of dogs and cats to 12 shelters. J Appl Anim Welf Sci 2000;3(2): 93-106. 4. Duxbury MM, Jackson JA, Line SW, Anderson RK. Evaluation of association between retention in the home and attendance at puppy socialization classes. JAVMA 2003;223:62-66.

TO LEARN MORE

For a sample waiting room

questionnaire, please visit

fl vetbehavior.com.

264 Compendium | June 2009 | CompendiumVet.com

2008 Feline Retrovirus Management Guidelines*

Members of the Advisory Panel❯❯ Julie Levy, DVM, PhD, DACVIM, Chair❯❯ Cynda Crawford, DVM, PhD

University of Florida

❯❯ Katrin Hartmann, Dr. Med. Vet., Dr. Habil., DECVIN-CALudwig Maximilian University Munich | Munich, Germany

❯❯ Regina Hoffmann-Lehmann, Dr. Med. Vet., Dr. Habil, FVHUniversity of Zurich | Zurich, Switzerland

❯❯ Susan Little, DVM, DABVP (Feline Practice)Winn Feline Foundation | Manasquan, New Jersey

❯❯ Eliza Sundahl, DVM, DABVP (Feline Practice)KC Cat Clinic | Kansas City, Missouri

❯❯ Vicki Thayer, DVM, DABVP (Feline Practice)Purrfect Practice | Lebanon, Oregon

Epidemiology Page 265

Preventing FeLV and FIV Infection Page 265

Limiting Transmission in the Veterinary Practice Page 268

Diagnosing FeLV and FIV Page 269

Managing Positive Cats Page 270

At a Glance

*This is an abridged version of the full guidelines (Levy JC, Crawford C, Hartmann K, et al. 2008 American Associa-tion of Feline Practitioners’ feline retrovirus management guidelines. J Feline Med Surg 2008;10[3]:300-316) available at catvets.com from the American Association of Feline Practitioners (AAFP). Adapted with permission from AAFP.

FeLV and FIV are among the most common infectious diseases of cats. Risk factors for infection include male gender, adulthood, and outdoor access, whereas indoor

lifestyle and sterilization are associated with reduced infec-tion rates.1–5

The retroviral status of all cats should be known. Cats may require retrovirus testing at different times in their lives. Here are some general principles for retrovirus testing:

A cat with a confi rmed-positive test result should be diagnosed as having a retroviral infection—not clinical dis-ease. Diseases in cats infected with FeLV or FIV may not necessarily be the result of the retrovirus infection. Cats infected with FeLV or FIV may live for many years.

A decision for euthanasia should never be made solely on the basis of whether the cat is infected.No test is 100% accurate at all times under all conditions.

All test results should be interpreted along with the patient’s health and prior likelihood of infection. All positive results should be confi rmed by another test method.

While FeLV and FIV can be life-threatening viruses, proper management can give infected cats longer, healthier lives. The following article refl ects the recommendations of the AAFP on managing these infections.

This report represents a consensus of current information compiled by the researchers and practitioners on the panel.These guidelines are based on the best research data, clinical experience and technical judgments available at the time of preparation. While the guidelines are as accurate and comprehensive as possible, they are subject to change should new insights become available from additional research or technological updates. The American Association of Feline Practitioners is a professional organization of practitioners and board-certifi ed specialists who seek to raise the standards of feline medicine and surgery among practitioners.

About These Guidelines

MORE ON THE WEB

Compendium grants permission to

reproduce this article for educational purposes. A downloadable version of this article is available on CompendiumVet.com.

About AAFP

The American Association of Feline Practitioners improves the health and well-being of cats by supporting high stan-dards of practice, continuing education, and scientifi c inves-tigation. Feline Practitioners are veterinary professionals who belong to this association because they are “passionate about the care of cats”!

American Association of Feline Practitioners

203 Towne Centre DriveHillsborough, NJ 08844-4693

phone: 800-874-0498phone: 908-359-9351fax: 908-292-1188

e-mail: [email protected]

Media contact: Valerie Creighton, DVM, DABVP


About AAFP

FELINEPRACTITIONERS

AMERICANASSOCIATION OF

Contributed by

EpidemiologyThe prevalence of FeLV infection has report-edly decreased during the past 20 years, pre-sumably as a result of implementation of widespread testing programs and develop-ment of effective vaccines.1,2,6 In contrast, the prevalence of FIV has not changed since the virus was discovered in 1986. In a study of more than 18,000 cats tested in 2004, 2.3% were positive for FeLV and 2.5% were positive for FIV.1 Infection rates for FeLV and FIV (TABLE 1) varied among subpopula-tions and sources of cats.

Preventing FeLV and FIV InfectionVaccines are available for both retroviruses. Both FeLV and FIV vaccines are non-core. Risk assess-ment of the individual animal should dictate their use. No vaccine is 100% effective, and repeat testing should be performed as warranted.

FeLV VaccinationThe decision to vaccinate an individual cat against FeLV should be based on the cat’s risk of exposure. Cats that live in an FeLV-negative, indoor environment are at minimal risk. FeLV vaccination is recommended for:

All kittens because the lifestyles of kittens frequently change after acquisition, and kittens may subsequently be at risk for FeLV exposure Cats that go outdoorsCats that have direct contact with cats of

un known status or in high-turnover situations such as foster homes or other group housingCats that live with FeLV-positive cats

Because suffi cient protection is not induced in all vaccinates, vaccination against FeLV does not diminish the importance of testing cats to identify and isolate those that are viremic. In

TABLE 1 Risk Factors for FeLV and FIV Seropositivity in 18,038 Cats Tested at Veterinary Clinics and Animal Shelters in North America1

Factor Categories Number of Cats Tested

Number of Cats With Positive Results

for FeLV (%)

Number of Cats With Positive Results

for FIV (%)

Study site Animal shelter 8068 124 (1.5) 141 (1.7)

Veterinary clinic 9970 285 (2.9) 305 (3.1)

Region West 3737 39 (1.0) 72 (1.9)

Canada 325 8 (2.5) 10 (3.1)

South 6359 144 (2.3) 183 (2.9)

Northeast 3747 107 (2.9) 79 (2.1)

Midwest 3870 111 (2.9) 102 (2.6)

Source Clinic (indoors only) 3613 53 (1.5) 32 (0.9)

Clinic (outdoors access) 6357 232 (3.6) 273 (4.3)

Shelter (relinquished pet) 2809 41 (1.5) 38 (1.4)

Shelter (stray) 4550 71 (1.6) 75 (1.6)

Shelter (feral) 709 12 (1.7) 28 (3.9)

Age Juvenile 9556 131 (1.4) 100 (1.0)

Adult 8482 278 (3.3) 346 (4.1)

Sex Spayed female 2611 45 (1.7) 44 (1.7)

Neutered male 2984 88 (2.9) 127 (4.3)

Sexually intact female 6588 128 (1.9) 82 (1.2)

Sexually intact male 5855 148 (2.5) 193 (3.3)

Health status Healthy 15,312 238 (1.6) 280 (1.8)

Sick 2726 171 (6.3) 166 (6.1)

These guidelines are not exclusive. Other techniques and procedures may be available. The AAFP expressly disclaims any warranties or guarantees, express or implied, and shall not be liable for any damages of any kind in connection with the material, informa-tion, techniques, or procedures set forth in these guidelines.

Disclaimer


addition, cats should be tested for FeLV infec-tion before initial vaccination and whenever the possibility exists that they have been exposed to FeLV since they were last tested. Administering FeLV vaccines to cats confi rmed to be FeLV infected is of no value.

FIV VaccinationThe decision to vaccinate a cat for FIV is com-plicated. FIV vaccines may be considered for cats with lifestyles that put them at high risk for infection, such as outdoor cats that fi ght or cats living with FIV-infected cats. Because FIV infection is more often spread by unfriendly exchanges (usually biting), cats in households with a stable social structure are at lower risk for acquiring FIV infection.

Current FIV antibody tests cannot dis-tinguish vaccinated cats from infected cats. Clients should be informed that vacci-nated cats will have positive FIV test results, and the decision to vaccinate should be reached only after careful consideration of this implication. If the decision falls in favor of vaccination, cats should test negative immediately before vaccination. A permanently placed identifi cation micro-chip and collar are recommended for all cats to increase the chance of returning lost cats to their owners. Microchip databases can also record FIV vaccination histories. This infor-mation can be used by animal shelters to help assess the significance of positive FIV test results when screening cats before adoption.

The retroviral status of all cats should be known because the serious health consequences of infection infl uence patient manage-ment both in illness and wellness care.

QuickNotes

General Recommendations for Testing for and Controlling Transmission of FeLV and FIV in Shelters and Breeding Catteries

Testing As for pet cats, it is ideal for all cats in shelters and catteries to be tested for FeLV and FIV.*

Testing at admission is optional for singly housed cats.

Testing is highly recommended for group-housed cats.

If not performed before adoption, testing should be recommended to the new owner before exposure to other cats.

Testing should be repeated 60 days af-ter the initial test and annually for cats kept in long-term group housing. Each cat should be individually tested. Testing representative kittens in a litter or colony and extrapolating results to other cats in the group is unreliable. Procedures such as pooling mul-

tiple samples for use in a single test reduce test sensitivity and should not be performed.

Foster families and adopters should have their own resident cats tested before fostering or adopting a new cat.

Testing is optional in feral cat trap–neuter–return programs.

Controlling Transmission FeLV vaccination is optional for singly housed cats.

FeLV vaccination is highly recom-mended for all cats housed in groups and for foster cats and permanent residents in foster homes.

Cats should test negative before vac-cination.

In catteries that follow testing guide-lines and maintain retrovirus-negative

status, vaccination against FeLV and FIV is not necessary.

Vaccination is not 100% effective and should never be used in place of a test-and-segregate program.

In contrast to feline panleukopenia, herpesvirus, and calicivirus vaccines, the value of a single FeLV vaccine for feral cats has not been determined. Therefore, FeLV vaccination is not rec-ommended for feral cat trap–neuter–return programs if program resources are needed for higher priorities. FIV vaccination is not recommended for use in shelters or feral cats.Strict adherence to universal precau-tions is required to prevent iatrogenic transmission of retroviruses in the shelter environment via contaminated equipment and secretions.

*Currently, no test can distinguish FIV antibodies induced by infection from those induced by vaccination. Therefore, shelters have the diffi cult task of determining the true infection status of stray cats that are admitted without medical histories and that test positive for FIV antibodies. If the cat is microchipped, the history of FIV vaccination may be recorded in an accessible database. However, even if cats are known to have been vaccinated against FIV, determining whether they are also infected is not usually possible. This is a challenge for shelters for which no solution currently exists.

BOX 1

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FIGURE 2 FeLV

FeLV antigen positive

FeLV IFA positive

All positive results should be confi rmed.

Consider FeLV infected and start appropriate management program.

Negative screening test results are highly reliable. However, if results are negative but recent infection cannot be ruled out, testing should be repeated a minimum of 30 days after the last potential exposure.

Discordant results may be due to the stage of infection, the variability of host responses, or technical problems with testing. It is not usually possible to determine the true FeLV infection status of cats with persistently discordant test results.

FeLV antigen negative

FeLV IFA negative

Antigen test

Retest immediately with IFA.

If resolving is desired, retest in 60 days using antigen and IFA.

IFA test

Limiting Transmission in the Veterinary PracticeRetroviruses are unstable outside their host animals and can be quickly inactivated by detergents and routine disinfectants.7–11 Simple precautions and routine cleaning procedures prevent transmission of these agents in veteri-nary hospitals. As a guide:

All infected patients should be housed in individual cages when hospitalized and not in isolation/contagious wards where they may be exposed to infectious agents.Hospital staff should wash their hands

between patients and after cleaning cages. Because FeLV and FIV can be transmitted in

blood transfusions, donors should be tested before donating. A real-time polymerase chain reaction (PCR) test for FeLV is recommended for blood donors because proviral elements in seronegative cats with regressive FeLV in fection may cause infection in transfusion recipients. Retroviruses can

be quickly inac-tivated by deter-gents and routine disinfectants.

QuickNotes

FeLV and FIV Diseases

Although many FeLV-/FIV-infected cats experience prolonged survival, retroviral infections can be associated with:

Anemia Secondary and opportunistic infections Neoplasia Chronic infl ammatory conditions Ocular disorders Hematologic disorders

Specifi c diseases associated with very high rate of infection:

Cutaneous abscesses (FeLV: 8.8%, FIV: 12.7%)12

Oral infl ammation (FeLV: 7.3%, FIV: 7.9%)a

aBellows J, Lachtara JL. Feline retroviruses and oral disease [unpublished]. Reported in: Veterinary Medicine, “Spotlight on Research”; 2006.

BOX 2

FeLV test interpretation algorithm—all cats. IFA = immunofl uorescence assay

FIGURE 1


Dental and surgical instruments, endotracheal tubes, and other items potentially contami-nated with body fl uids should be thoroughly cleaned and sterilized between uses. Fluid lines, multidose medication containers,

and food can become contaminated with body fl uids (especially blood or saliva) and should not be shared among patients.

Recommendations on testing for and control-ling transmission of FeLV and FIV in shelters and catteries are listed in BOX 1.

Diagnosing FeLV and FIVThe retroviral status of all cats should be known because the serious health consequences of infection infl uence patient management both in illness and wellness care. Failure to identify infected cats may lead to inadvertent exposure and transmission to uninfected cats. Misdiagnosis of infection in uninfected cats may lead to inap-propriate changes in lifestyle or even euthanasia.

Cats should be tested when they are:

Sick, regardless of age, despite previ-ous negative test results or previous vac-cination. FeLV and FIV are associated with a wide variety of health disorders4,5 (BOX 2).

Identifi cation of retroviral infection as a com-plicating factor can assist in the development of optimal management plans.About to be adopted or brought into a

new household, regardless of age. Even if no other cats are present in the household, testing will protect future cats that may join the family as well as neighborhood cats, should the pet escape or be allowed outside.At risk of exposure, even if their most

recent test was negative. As an example, a 2008 study12 showed that more than 19% of cats with cutaneous abscesses were FIV or FeLV positive at the time of presentation. Because of delay in seroconversion after initial infection, these cats should also be retested (a

ELISA and other immunochromato-graphic tests are the preferred screening tests for FeLV and FIV.

QuickNotes

FIV test interpretation algorithm—all cats.

FIGURE 2 FIV

FIV antibody positive

FIV antibody positive FIV antibody positiveFIV antibody negative FIV antibody negative

All positive results should be confi rmed.Cats vaccinated with a whole-virus vaccine will test antibody positive.

If positive after kitten reaches 6 months of age, consider FIV infected.

Consider FIV infected and continue appropriate management program.

Note: False-positive results will exist in vaccinated cats.

If negative at any interval, consider free of infection and begin a wellness program.

Consider free of infection and begin a wellness program.

Negative screening test results are highly reliable. However, if results are negative but recent infection cannot be ruled out, testing should be repeated a minimum of 60 days after the last potential exposure.

FIV antibody negative

Antibody test

Retest with another antibody test.

<6 Months of age >6 Months of age

Retest at 60-day intervals Retest immediately with different test


minimum of 30 days after the last potential FeLV exposure and 60 days after potential FIV exposure). Of “unknown” viral status. Infected cats

can remain asymptomatic for years, during which time they may serve as hidden sources of infection to other cats in the household.About to be vaccinated against FeLV or

FIV. These vaccines should not be administered to cats that are already infected. Vaccination does not affect the carrier state, the capacity to infect other cats, or the development of dis-ease in cats with preexisting infection.

Diagnosis of FeLVSoluble-antigen tests are preferred for initial screening (FIGURE 1). These include ELISA and other immunochromatographic tests. While screening tests detect the presence of free antigen in the circulating blood, the immu-nofl uorescence assay (IFA) tests for the presence of antigen within infected white blood cells and platelets. Positive results from tests that detect free antigen may be refl ective of the transient period of antigenemia associated with regres-sive infections. Positive results from tests that detect cell-associated antigen, such as the IFA, are likely to be refl ective of progressive infec-tions. Tests that use saliva and tears yield an unacceptably high percentage of inaccurate results, and their use is not recommended.13

Although there are no published assessments of diagnostic accuracy of PCR testing for FeLV, the test is offered by a number of commercial laboratories. Recent studies14,15 using real-time PCR have shown that 5% to 10% of cats with negative results on soluble antigen tests were positive for FeLV provirus by PCR (regressive infection).

Diagnosis of FIVFIV produces a persistent, lifelong infection, so detection of antibodies in peripheral blood has been judged suffi cient for routine diagnos-tic screening if the cat has not been previously vaccinated against FIV and has not acquired FIV antibodies in colostrum16,17 (FIGURE 2). ELISA and other immunochromatographic tests are the preferred screening tests. Confi r-mation of positive screening tests should include a different method or at least an antibody test

from a different manufacturer.18,19 Western blot tests have been the recommended confi rma-tion tests in the past, but they were found to be less sensitive and specifi c than in-clinic screen-ing tests in one study.17

Vaccination of cats against FIV induces anti-FIV antibodies that cannot be distinguished from natural infection. These antibodies per-sist for at least 1 year and can be transferred in colostrum to kittens. While PCR assays may help distinguish cats infected with FIV from cats vaccinated against FIV, one study found marked variability in diagnostic accuracy among commercial laboratories.20

* * *

Negative results for either FeLV or FIV are much more reliable than positive results because of the low prevalence of infec-tion in most cat populations. Positive test results should be confi rmed, especially in asymptomatic and low-risk cats. No test is 100% accurate all the time, under all con-ditions. In cat populations with a low prevalence (e.g., <1%), more than half of the cats that test positive are likely to be uninfected.21 Kittens may be tested for FeLV and FIV at any age. Most kittens test negative, indicat-ing no infection. Antibody tests for FIV can detect antibodies passed in colostrum from an infected or vaccinated mother, which can be mistaken for infection in the kitten. Kittens that test positive for FIV antibodies should be retested every 60 days up to 6 months of age. If the kitten becomes seronegative, it most likely is not infected. If results of tests performed after 6 months of age are still con-fi rmed positive, these kittens should be con-sidered infected. FeLV vaccinations will not induce positive test results. FIV vaccinations will induce positive test results.

Managing Positive CatsBoth FeLV-infected and FIV-infected cats can live for many years and may succumb at older ages to causes unrelated to their retrovirus infections. In recent studies,22 the median sur-vival after diagnosis of FeLV-infected cats was 2.4 years; for FIV-infected cats, it was 4.9 years.

Both FeLV-infected and FIV-infected cats can live for many years.

QuickNotes

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Thus, a decision for treatment or for euthana-sia should never be based solely on the pres-ence of a retrovirus infection.

Managing Healthy Positive CatsExaminations should be performed at least twice a year. At each visit:

Update medical history. Monitor for any signs of weight loss.Perform a thorough physical examination; pay

close attention to the lymph nodes, eyes, and oral cavity.Conduct a complete blood count, biochemi-

cal analysis, urinalysis, and fecal examination at least once a year. FeLV-positive cats may need a complete blood count twice a year.Spay or neuter intact cats.Control internal and external parasites. Vaccinate as lifestyle indicates. Most retrovirus-

infected cats mount adequate immune responses when vaccinated, and there is no need to modify standard vaccination intervals.23 There is controversy about the use of inactivated versus modifi ed-live vaccines. Cur rent recommendations are to use inac-tivated vaccine products due to the theoretical risk of a modifi ed-live product regaining its pathogenic-ity in cats with compromised immune systems.

Infected queens should not be bred and should be spayed if their condition is suf-ficiently stable to permit them to undergo surgery.

Managing Clinically Ill Positive CatsPrompt and accurate diagnosis is essential to allow early therapeutic intervention and a suc-cessful treatment outcome. Therefore, inten-sive diagnostic testing should proceed early in the course of illness for infected cats. Many cats infected with FeLV or FIV respond as well as their uninfected counterparts to appro-priate medications and treatment strategies, although a longer or more aggressive course of treatment may be needed. Few attempts have been made to evaluate antiviral drugs, immunomodulators, or alter-native therapies in large controlled studies of naturally infected cats. To date, no treatment has been shown to reverse well-established retrovirus infection in cats. Clients with a healthy or ill retrovirus-positive cat may be frightened by the initial diagnosis. It is important to alleviate these fears when appropriate and offer encouraging advice on the proper care and management of the cat (BOX 3).

Advice for Owners of Infected Cats

Limiting Transmission at Home Confi ne—Infected cats should be confi ned indoors so they do not pose a risk of infection to other cats and so they are protected against infectious hazards in the environment.

Isolate—The best method of preventing spread to other cats in the household is to isolate the infected cat from interacting with its housemates. Isolation in a separate room is recommended, but a simple screen or chain-link barrier is adequate. Generally, FeLV transmission is low in households with stable social structures where housemates do not fi ght, but FeLV can still be transmitted via friendly interactions.

Don’t Introduce—If separation is not possible, no new cats should be introduced in the house-hold to reduce the risk of territorial aggression.

If owners choose not to separate retrovirus-infected housemates from their other cats, the uninfected cats should be considered for vaccination. Vaccinated cats should be isolated from infected cats for at least 2 months after the vaccine series.

Managing Positive Cats Watch closely for behavioral changes in the cat. Feed a nutritionally balanced diet. Avoid raw diets because of the risk of food-borne bacte-rial and parasitic infections.

BOX 3


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References 1. Levy JK, Scott HM, Lachtara JL, Crawford PC. Seroprevalence of feline leukemia virus and feline immunodefi ciency virus infection among cats in North America and risk factors for seropositivity. JAVMA 2006;228:371-376.2. O’Connor TP Jr, Tonelli QJ, Scarlett JM. Report of the National FeLV/FIV Awareness Project. JAVMA 1991;199:1348-1353.3. Levy JK, Crawford PC. Feline leukemia virus. In: Ettinger SJ, Feldman EC, eds. Textbook of Veterinary Internal Medicine. 6th ed. Philadelphia: WB Saunders; 2005:653-659.4. Hoover EA, Mullins JI. Feline leukemia virus infection and diseases. JAV-MA 1991;199:1287-1297.5. Levy JK. Feline immunodeficiency virus update. In: Bonagura J, ed. Current Veteri-nary Therapy XIII. Philadelphia: WB Saunders; 2000:284-288. 6. Moore GE, Ward MP, Dhariwal J, Al E. Use of a primary care veterinary medical database for surveillance of syndromes and diseases in dogs and cats. J Vet Intern Med 2004;18:386.7. Francis DP, Essex M, Gayzagian D. Feline leukemia virus: survival under home and laboratory conditions. J Clin Microbiol 1979;9:154-156.8. van Engelenburg FA, Terpstra FG, Schuitemaker H, Moorer WR. The virucidal spectrum of a high concentration alcohol mixture. J Hosp Infect 2002;51:121-125.9. Moorer WR. Antiviral activity of alcohol for surface disinfection. Int J Dent Hyg 2003;1:138-142.10. Kramer A, Schwebke I, Kampf G. How long do nosocomial pathogens per-sist on inanimate surfaces? A systematic review. BMC Infect Dis 2006;6:130.11. Terpstra FG, Van Den Blink AE, Bos LM, et al. Resistance of surface-dried virus to common disinfection procedures. J Hosp Infect 2007;66:332-338.12. Goldkamp CE, Levy JK, Edinboro CH, Lachtara JL. Seroprevalences of feline leukemia virus and feline immunodefi ciency virus in cats with abscesses or bite wounds and rate of veterinarian compliance with current guidelines for retrovi-

rus testing. JAVMA 2008;232:1152-1158.13. Panel report on the colloquium on feline leukemia virus/feline immunodefi -ciency virus: tests and vaccination. JAVMA 1991;199:1273-1277.14. Hofmann-Lehmann R, Huder JB, Gruber S, et al. Feline leukemia provi-rus load during the course of experimental infection and in naturally infected cats. J Gen Virol 2001;82:1589-1596.15. Gomes-Keller MA, Go¨nczi E, Tandon R, et al. Detection of feline leu-kemia virus RNA in saliva from naturally infected cats and correlation of PCR results with those of current diagnostic methods. J Clin Microbiol 2006;44:916-922.16. Hartmann K. Feline immunodefi ciency virus infection: an overview. Vet J 1998;155:123-137.17. Levy JK, Crawford PC, Slater MR. Effect of vaccination against fe-line immunodefi ciency virus on results of serologic testing in cats. JAVMA 2004;225:1558-1561.18. Barr MC. FIV, FeLV, and FIPV: interpretation and misinterpretation of sero-logical test results. Semin Vet Med Surg Small Anim 1996;11:144-153.19. Hartmann K, Werner RM, Egberink H, Jarrett O. Comparison of six in-house tests for the rapid diagnosis of feline immunodefi ciency and feline leu-kemia virus infections. Vet Rec 2001;149:317-320.20. Bienzle D, Reggeti F, Wen X, et al. The variability of serological and molecular diagnosis of feline immunodefi ciency virus infection. Can Vet J 2004;45:753-757.21. Jacobson RH. How well do serodiagnostic tests predict the infection or disease status of cats? JAVMA 1991;199:1343-1347.22. Levy JK, Lorentzen L, Shields J, Lewis H. Long-term outcome of cats with natural FeLV and FIV infection. In: 8th Int Feline Retrovirus Res Symp 2006.23. Richards JR, Elston TH, Ford RB, et al. The 2006 American Associa-tion of Feline Practitioners Feline Vaccine Advisory Panel Report. JAVMA 2006;229:1405-1441.


❯❯ Philipp Mayhew, BVM&S, MRCVS, DACVSColumbia River Veterinary SpecialistsVancouver, Washington

Abstract: There are many applications for laparoscopy in small animal surgery. A relatively simple one is abdominal cryptorchid castration. Laparoscopic examination of the peritoneal cavity can both aid in the diagnosis of abdominal cryptorchidism and allow treatment using either a totally laparo-scopic or a laparoscopic-assisted technique. Minimally invasive cryptorchid castration obviates the need for “open” celiotomy and may thereby reduce postoperative discomfort and wound-related complications in these patients.

Advantages Page 275

Disadvantages Page 275

Preoperative Assessment

Page 275

Instrumentation Page 276

Surgical Techniques Page 278

At a Glance

Laparoscopic and Laparoscopic-Assisted Cryptorchidectomy in Dogs and Cats

In collaboration with the American College of Veterinary Surgeons

During embryonic development in male dogs and cats, contraction of the gubernaculum causes progres-

sive migration of the testes from a location just caudal to the kidney to their normal position in the scrotum.1 This migration is typically complete by 2 months of age but can take place as late as 6 months of age in some breeds.1 The cause of cryptorchidism has not been completely elucidated but is likely multifactorial.1 Migration of the testis can cease at any time, with the result that one or both testes can remain in the perito-neal cavity, within the inguinal rings, or in

the inguinal area cranial to the scrotum. Owners should be advised that there are several impor-tant reasons to castrate a cryptorchid pet. First, cryp-torchidism is thought to be a sex-linked autosomal recessive trait in dogs. Further breeding could lead to propagation of this undesirable trait. Second, cryptorchid testes are prone to several pathologic states.

Testicular tumors develop much more fre-quently in cryptorchid testes than in scrotal testes. In one study, the risk of tumor devel-opment in cryptorchid testes was 13.6 times the risk in scrotal testes.2 Inguinally retained testes appear to be at even higher risk of developing neoplasia than abdominally retained testes.3 The risk of testicular torsion is also increased for cryptorchid testes, with torsed testes often being neoplastic.4 If, on physical examination, one or both testes are not present inguinally or scrotally, the missing testis is most likely within the peritoneal cavity. Palpation should be per-formed carefully because cryptorchid testes are often smaller than descended testes and can be diffi cult to fi nd. Traditionally, abdom-inal testes have been removed through either a ventral midline celiotomy or a paraprepu-tial laparotomy.5 Totally laparoscopic or laparoscopic-assisted techniques now exist, allowing removal of intraabdominal testes through much smaller incisions. Neoplastic cryptorchid testes can also be removed laparoscopically, although if the tumor is very large, open surgery may remain more practical.

TO LEARN MORE

For a description of

conventional surgical

approaches to cryptorchid

testes, see the June 2008

article “Cryptorchidism,”

available at

CompendiumVet.com.

ryptorchidism is one of the most com-mon congenital defects seen in small ani-mal practice. In dogs, the reported

prevalence of cryptorchidism ranges from 0.8%to 10%.1 The defect is a sex-linked autosomalrecessive trait that is common in certain breeds,2

such as Chihuahuas, miniature schnauzers,Pomeranians, poodles, Shetland sheepdogs, andYorkshire terriers. Smaller breeds are 2.7 timesmore likely to be cryptorchid than larger breeds.3

In cats, one study found Persians to be predis-posed to cryptorchidism.4 Due to the thermalsuppression of sperm production, bilaterallycryptorchid animals are sterile, while unilaterallycryptorchid animals are usually fertile.5 Unde-scended testes are 13.6 times more likely todevelop neoplasia (Figure 1) than normal testesand are at increased risk of torsion.6,7

Undescended testes vary in their anatomic posi-tion. They may be located in the prescrotal area,inguinal region, or abdominal cavity. In a study of

240 cryptorchid dogs and 50cryptorchid cats, retained testeswere most commonly found inthe right inguinal region indogs and in the left or rightinguinal region in cats.8 Locat-ing an ectopic testis can be dif-

ficult in some animals. A thorough and systematicapproach to patient evaluation is necessary to effi-ciently find and remove the abnormal testis.Although surgery for removal of cryptorchidtestes is well described in the veterinary literature,approaches to diagnosis and localization of ectopictestes have not been extensively described. Thislack, coupled with the increasing number of ani-mals that present with an unknown neutering his-tory (e.g., rescue animals), emphasizes the need fora discussion of a thorough clinical approach tocryptorchidism.This article describes a systematic approach

to the diagnosis and surgical treatment of cryp-torchidism in dogs and cats, including the inte-gration of the history; physical examination;blood tests, including hormone assays; anddiagnostic imaging to make a definitiveanatomic diagnosis. Various options for surgicalremoval of the retained testis are also described.

DIAGNOSISHistoryMost authors agree that if one or both testes

are not present in the scrotum by 2 months ofage, the animal is cryptorchid.2 It is highlyunlikely that the testes will descend into thescrotum after this age. The clinical signs of

June 2008 325 COMPENDIUM

CryptorchidismStephen J. Birchard, DVM,MS,DACVS

Michael Nappier, DVM

The Ohio State University

C

ABSTRACT:Cryptorchidism is a common clinical problem in dogs and cats. Retained testes can

be unilateral or bilateral, are usually small and atrophied, and vary in location.These factors make

diagnosis and surgical removal challenging in some animals. Diagnosis is confirmed using a variety of

modalities, including diagnostic imaging in difficult cases. Surgical removal of the affected and normal

testes is the treatment of choice.The surgical approach and technique used depend on the location

of the retained testis.

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AdvantagesA minimally invasive approach to abdomi-nal cryptorchid testis removal reduces tissue trauma and is likely to reduce postoperative pain and wound healing complications com-pared with open laparotomy. If localization of a cryptorchid testis is challenging, laparo-scopic examination of the caudal peritoneal cavity and the entrance to the inguinal rings provides excellent visualization and can help to rule out the diagnosis of abdominal cryptorchid-ism. This may help to minimize iatrogenic dam-age to surrounding structures, which has been attributed in some cases to inadequate visual-ization when small paramedian laparotomies are performed. Such damage includes inad-vertent prostatectomy and ureteral or urethral trauma.6–8

DisadvantagesThe principal disadvantage of laparoscopy is the need for specialized equipment and the associ-ated costs. Adequate training is also necessary to perform laparoscopic procedures and to use the equipment appropriately. Although surgi-cal time can initially be longer than that for an open procedure, with experience, laparoscopic cryptorchidectomy is likely to become as effi -cient, if not faster than, its open counterpart.

Preoperative AssessmentA careful history should be taken for any male cat or dog in which two testes cannot be pal-pated in the inguinal area to ensure that one or both testes have not been removed previ-ously. Generally, a male dog or cat in which one or both testes are absent from the scrotum at 6 months of age is classified as cryptorchid because scrotal migration of a testis after this time is extremely unlikely.1 It is important to assess the inguinal area carefully with the animal under heavy sedation or general anes-thesia so as not to miss the presence of an inguinal testis. If one testis is present scrotally and one abdominally, it is also helpful to iden-tify whether the right or left testis is present

within the peritoneal cavity. This can be done by gentle manipulation of the scrotal testis in a cranial direction, which will usually reveal the side on which it is located. If no inguinal testes are palpated, it can be assumed that the missing testes are in either the inguinal canal (which is uncommon) or the abdomen. Abdominal ultrasound can be used to confi rm the presence of abdominal or inguinal canal testes in most cases. If doubt still remains about the presence or absence of tes-tes, a human chorionic gonadotropin stimulation test can be performed to confi rm the presence of testicular tis-sue.5 For this test, serum samples are

Generally, a male dog or cat in which one or both testes are absent from the scrotum at 6 months of age is classifi ed as cryp-torchid because scrotal migration of a testis after this time is extremely unlikely.

QuickNotes

SURGICAL VIDEO

To see a video of manipulation to

identify which testis is cryptorchid,

visit CompendiumVet.com.

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It is with great pleasure that I announce the new partnership of the American College of Veterinary Surgeons (ACVS) with Compendium in the

“Surgical Views” series. The expertise and experi-ence of the ACVS Diplomates will add greatly to the value of the series.

Elizabeth M. Hardie, DVM, PhD, DACVSNorth Carolina State University

The ACVS is proud to enter into this new coop-erative venture with Compendium and series edi-tor Elizabeth Hardie. The ACVS is well known as a world leader in developing innovative surgical procedures and disease research, yet continuing education is also one of the pillars of the College. In addition to presenting at our yearly sympo-sium, ACVS Diplomates host and produce much of the continuing education in veterinary surgery in the United States. Now, with this collaboration, we are expanding our education outreach to a new venue. The ACVS hopes you will enjoy and profi t from our Diplomates’ contributions to this distinct continuing education effort.

Larry R. Bramlage, DVM, MS, DACVSChair, ACVS Board of Regents

To locate a Diplomate, ACVS has an online directory that includes practice setting, species emphasis, and research interests (acvs.org/VeterinaryProfessionals/FindaSurgeon).


collected before and 2 hours after administra-tion of human chorionic gonadotropin (50 IU/kg IM) and submitted for testosterone assay. Unilateral or bilateral monorchidism is very rare; therefore, it is most likely that abdomi-nal testes are present,7,9 making exploration of the peritoneal cavity a reasonable next step. Typically, exploration is accomplished via open surgery through a ventral midline celiotomy or a paramedian laparotomy.5 In cats, a standard ventral midline laparotomy that must usually extend caudally to the pubis is performed.

Laparoscopic examination of the caudal abdomen is a minimally invasive modality for confi rming the presence or absence of abdom-inal testes, and laparoscopic or laparoscopic-assisted techniques have been described for removal of abdominally cryptorchid testes.

InstrumentationAs well as the basic components of an endo-scopic tower,10 other equipment required to perform laparoscopic and laparoscopic-assisted cryptorchidectomy includes a laparoscope, two or three trocar–cannula assemblies, and lap-aroscopic surgical instruments. The most com-monly used laparoscope size is 5 or 10 mm, and the most common lens angles are 0° and 30°. Trocar–cannula assemblies can be disposable or reusable and are usually 6 mm in diameter to fi t 5-mm instrumentation. Typically, sterilizable, reusable cannulas are more cost-effective than single-use devices for veterinary use. Instruments essential for laparoscopic cryp-torchi dectomy include a blunt probe for tissue manipulation and Kelly or Babcock forceps for grasping the testis, spermatic cord, and guber naculum. For hemostasis during totally laparo scopic cryptorchidectomy, either a ves-sel-sealing device (e.g., Ligasure [Valleylab Inc., Boulder, CO], Enseal [Ethicon Endosurgery, Cincinnati, OH], Harmonic Scalpel [Ethicon Endo surgery, Cincinnati, OH]) can be used. If these devices are not available, hemostasis can be achieved using either hemostatic clips dispensed by a laparoscopic clip applier or extracorporeal suturing. A knot pusher is used

Laparoscopic examination of the caudal abdomen is a minimally invasive modal-ity for confi rming the presence or absence of abdomi-nal testes.

QuickNotes

TO LEARN MORE

Basic laparoscopic equipment and the Hasson

and Veress needle techniques are described in

the August 2008 article, “Canine Laparoscopic

and Laparoscopic-Assisted

Ovariohysterectomy and

Ovariectomy,” available at

CompendiumVet.com.

A video demonstrating

the Hasson technique

is also available at

CompendiumVet.com.

In many cases, the cryptorchid testis is readily visible during initial visualization of the

peritoneal cavity. In this case, the testis can be

seen on the right side, lateral to the descending

colon and bladder.

FIGURE 2

Port position for a totally laparoscopic approach for abdominal cryp-torchidectomy in a dog. The subumbilical telescope port is placed fi rst, followed

by two paramedian instrument ports.

FIGURE 1

©2008 Fort Dodge Animal Health, a division of Wyeth.

1. Michael P. Ward, et al. Prevalence of and risk factors for leptospirosis among dogs in the United States and Canada: 677 cases (1970-1998). JAVMA, Vol. 220, No. 1, January 1, 2002.2. George E. Moore, et al. Canine Leptospirosis, United States, 2002-2004. Emerging Infectious Diseases, www.cdc.gov/ncidod/eid/vol12no03/05-0809.htm. Vol. 12, No. 3, March 2006.3. Michael P. Ward, et al. Evaluation of environmental risk factors for leptospirosis in dogs: 36 cases (1997-2002). JAVMA, Vol. 225, No. 1, July 1, 2004.

Whether dogs live in a condo or in the backyard, more of them than ever are at risk for leptospirosis – a deadly, zoonotic disease spread by rats, raccoons, squirrels and other wildlife.1,2,3

Protect your patients with LeptoVax™. Its unique subunit purification process is designed to reduce cellular debris for enhanced safety. And with six convenient combinations to choose from, LeptoVax easily accommodates your canine patients and protocols. Contact your Fort Dodge Animal Health representative. Because, wild as it seems, chances are lepto is in your neighborhood, too.

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to place extracorporeal sutures. If a testicular tumor is suspected, resection and placement into a specimen retrieval bag before removal from the peritoneal cavity is advised to avoid port site metastasis.

Surgical TechniquesPatient Preparation and PositioningDogs and cats with cryptorchid testes should be positioned in dorsal recumbency on the surgical table. The inguinal area should be thoroughly palpated again to rule out an ingui-nally located testis and prevent unnecessary laparotomy or laparoscopy. The entire ventral abdomen from the scrotum to the xiphoid pro-cess and laterally to the midabdominal level should be aseptically prepared, as the possibil-ity of conversion to an open approach should always be anticipated with any laparoscopic procedure. After initiating the pneumoperito-neum, place the animal in a 20° to 30° “head down” (Trendelenburg) position to allow cau-dal peritoneal organs to move cranially, thus improving visualization of the area. In some

cases, it may also be benefi cial to tilt the animal laterally to better visualize one or both testes.

Port PositionLaparoscopic-assisted cryptorchidectomy can be performed using a two-port tech-nique. A telescope port is established in a subumbilical location, using either the Hasson technique or a Veress needle tech-nique. These techniques were described in an earlier Surgical Views article.10

Once the telescope port has been established, an instrument port can be established using a 5- or 10-mm trocar–cannula assembly under direct visualization in a paramedian location (lateral to the prepuce in dogs; in the left or right caudal quadrant of the abdomen in cats) on the right or left side, depending on which testis is located in the abdomen. Every effort should be made to avoid iatrogenic damage to the caudal superfi -cial epigastric vessels during cannula placement. In most bilaterally cryptorchid animals, the side that the instrument port is placed on is not criti-cal because both testes will still be retrievable from the same port.9

A totally laparoscopic technique is usually performed using a three-port technique. A two-port technique can be used if an oper-ating laparoscope with a working channel is used. A camera port should be placed in a sub-umbilical position. Two more instrument ports are established in paramedian (lateral to the prepuce) positions on both sides of the pre-puce in dogs (FIGURE 1) and in a triangulating position around the caudal abdomen in cats.

Exploration of the Caudal Peritoneal CavityIn many cases, after establishment of a pneumo-peritoneum, the abdominal testis can be seen immediately on entering the peritoneal cavity with the laparoscope (FIGURE 2). However, if confusion exists, the area of the internal ingui-nal ring should be visualized. If the spermatic cord and vascular pedicle of the testis are seen entering the ring, the testis is in an extraperito-

The possibility of conversion to an open approach should always be anticipated with any laparoscopic procedure.

QuickNotes

SURGICAL VIDEO

To see a video of the use of a

vessel-sealing device to seal

and section the gubernaculum,

spermatic cord, and vascular

pedicle, visit

CompendiumVet.com.

Only the gubernaculum (no vascular pedicle or spermatic cord) can be seen entering the

inguinal ring in this dog. This confi rms that the tes-

tis is within the abdomen, and a thorough examina-

tion of the caudal peritoneal cavity should reveal

its location.

FIGURE 4

The spermatic cord and vascular pedicle of the testis can be seen entering the inguinal ring

in this dog. This fi nding confi rms that the testis is

located extraperitoneally.

FIGURE 3


neal location, either within the inguinal canal or (more likely) in an inguinal location (FIGURE

3). The surgeon should reevaluate the ingui-nal area if no testis was palpated in that loca-tion previously. If only the gubernaculum is seen entering the inguinal ring, the testis is located within the peritoneal cavity, and fur-ther inspection of the caudal abdomen usually locates it. Gentle traction can also be placed on the gubernaculum to help in localization (FIGURE 4). In some cases, the testis is obscured by the bladder or other surrounding structures.

Laparoscopic-Assisted CryptorchidectomyThe laparoscopic-assisted cryptorchidectomy technique provides a rapid, simple way to recover an abdominal testis and ligate the vas-cular pedicle and spermatic cord outside the abdominal cavity, thereby obviating the need for intracorporeal ligation techniques.9 In this technique, laparoscopic Kelly or Babcock for-ceps are placed through the instrument port to grasp the testis or the spermatic cord. At this point, it is helpful to evacuate the pneu-moperitoneum to decrease tension during elevation of the testis. Enlarge the port inci-sion by separating the parallel fi bers of the rectus abdominus just enough to remove the

testis from the peritoneal cavity. Once the tes-tis has been exteriorized, clamp and double ligate the spermatic cord and vascular pedicle before sectioning. It is important to ensure that ligated pedicles are not bleeding and do not become caught in the subcutaneous fat or muscular tissue of the body wall as they are returned to the peritoneal cavity. If both testes are in the peritoneal cavity, they can usually be recovered through the same port incision. To locate the second tes-tis, reestablish the pneumoperitoneum. If the instrument port was enlarged to recover the fi rst testis, use a larger cannula, hold a moist-ened sponge around the cannula, or place a temporary purse-string suture around the cannula to prevent leakage of carbon dioxide during reinsertion of the cannula. The second testis can then be withdrawn and ligated in the same manner as the fi rst. If the second tes-tis cannot be advanced to the port site, estab-lish a third port on the opposite side of the prepuce (FIGURE 1) and follow the above steps to withdraw the second testis, although in my experience, this is unlikely to be necessary. The port site incision(s) should then be closed, making sure that the ventral sheath of the rec-tus abdominus is adequately sutured to prevent herniation of abdominal contents, which can occur through defects as small as 5 mm. After closure of the instrument port incisions and before closure of the telescope port, it is advis-able to briefl y reestablish the pneumoperito-neum and reinsert the telescope to ensure that good hemostasis has been maintained. Finally, remove the telescope, thoroughly purge the pneumoperitoneum from the peritoneal cavity, and close the telescope portal routinely.

Totally Laparoscopic CryptorchidectomyIn the totally laparoscopic cryptorchidectomy technique, the vascular supply and spermatic cord are ligated within the peritoneal cavity before the testis is removed from the abdomen. If the testis is directly visible, it can be grasped with laparoscopic Kelly or Babcock forceps and elevated (FIGURE 5), allowing the vascular pedicle and spermatic cord to be moved away from surrounding structures in readiness for ligation. A vessel-sealing device can be placed into the second instrument port, and the guber-

If both testes are in the peritoneal cavity, they can usu-ally be recovered through the same port incision.

QuickNotes

Clinical Pearls

Laparoscopic examination of the caudal peritoneal cavity can be very helpful in localizing cryptorchid testes and can prevent an unnecessary celiotomy.

Laparoscopic-assisted abdominal cryptorchidectomy is a simple, rapid technique that does not require specialized equipment beyond the basic laparoscopic instrumentation.

In many cases, neoplastic cryp-torchid testes can be removed using a laparoscopic technique. If the testis is ≥8 cm in diameter or has signifi cant adhesions to surrounding structures, it may be more practical to perform a ventral midline celiotomy.


naculum, spermatic cord, and vascular pedicle sealed and subsequently sectioned. The vascular pedicle can be substantial in large dogs, and care should be taken to ensure adequate hemostasis. The Ligasure and Enseal devices are both indicated to seal vessels up to 7 mm in diameter, and I have used them to seal the pampiniform plexus effectively. However, it is suggested that the vascular pedicle be double sealed—once proximally and once distally—before sectioning (FIGURE 6). If a vessel-seal-ing device is not available, hemostasis can be achieved using hemostatic clips delivered via a laparoscopic clip applier. Although 5-mm lap-aroscopic clip appliers are available, medium or large clips are generally delivered in a 10-mm clip applier. To reduce costs associated with the use of expensive single-use dispos-able clip appliers, multifi re sterilizable clip appliers that can be loaded with cartridges of clips are available (M/L-10, Microline Pentax, Beverly, MA). Another alternative for achieving hemostasis of the pedicle is the placement of extracorpo-real ligatures. To place extracorporeal sutures,

pass a piece of suture material through one cannula and around the pedicles. Withdraw the suture through the same cannula, tie a modifi ed Roeder knot outside the peritoneal cavity, push the knot into place through the cannula, and tighten it around the pedicle using a laparoscopic knot pusher.11 Although this is the least expensive technique (it does not require any expensive

disposable equipment), it is likely to be the most time-consuming because these sutures are tedious to place; however, a rapid learn-ing curve has been seen in studies that used extracorporeal suturing.12

When laparoscopic cryptorchidectomy is performed, the testis must be withdrawn through one of the ports. One of the para-preputial ports can be used for this purpose, or the telescope can be replaced into one of the instrument ports and the testis withdrawn through the subumbilical port. If the subumbili-cal port is used, any enlargement of the port incision will be through the linea alba, resulting in less muscular trauma and therefore possibly less postoperative pain than if a paramedian instrument port is enlarged. After laparoscopic cryptorchidectomy, it is not necessary to rees-tablish the pneumoperitoneum because the pedicles are inspected for hemostasis immedi-ately after they have been sealed or ligated and sectioned. After the testis has been removed, all remaining ports can be closed routinely.

Resection of Neoplastic or Torsed Cryptorchid Testes

Cryptorchid testes are predisposed to neopla-sia and torsion, both of which are indications for surgical excision.1–4 Whether a laparoscopic approach is feasible in these situations depends on several variables. If the testis is very large (8 to 10 cm), a laparoscopic approach may be less practical because a large incision will be required to retrieve the testis after its pedicles have been ligated. A second potential problem

The vascular pedicle can be substantial in large dogs, and care should be taken to ensure ade-quate hemostasis.

QuickNotes

SURGICAL VIDEO

To see a video of testis

removal through the

subumbilical port, visit

CompendiumVet.com.

The testis is elevated for totally laparo-scopic cryptorchidectomy to allow better

access to the vascular pedicle and spermatic cord

during intracorporeal ligation of these structures.

FIGURE 5

The vascular pedicle after sectioning using the vessel-sealing device. The pedicle has been

sealed in two different locations approximately 1 cm

apart to ensure good hemostasis.

FIGURE 6

June 2009 | Compendium: Continuing Education for Veterinarians® 281

is the presence of adhesions to other struc-tures, specifi cally the bladder, ureters, prostate, and lower gastrointestinal tract. If the surgeon has any concern about the involvement of these structures or encounters technical diffi -culties while dissecting adhesions, conversion to an open approach should be considered. However, laparoscopic resection of a neoplas-tic testis has been reported in the veterinary

literature.13 In my experience, most neoplastic abdominally cryptorchid testes remain small and mobile enough to be resected laparoscopi-cally in a manner similar to those described above for removal of nonneoplastic testes. If a testis is suspected to be neoplastic, it should be placed in a specimen retrieval bag before being pulled through the instrument port to reduce the possibility of port-site metastasis.

References1. Romagnoli SE. Canine cryptorchidism. Vet Clin North Am Small Anim Pract 1991;21:533-544.2. Hayes HM, Pendergrass TW. Canine testicular tumors: epide-miological features of 410 dogs. Int J Cancer 1976;18:482-487.3. Reif JS, Maguire TG, Kenney RM, et al. A cohort study of canine testicular neoplasia. JAVMA 1979;175:719-723.4. Pearson H, Kelly DF. Testicular torsion in the dog: a review of 13 cases. Vet Rec 1975;97:200-204.5. Birchard SJ, Nappier M. Cryptorchidism. Compend Contin Educ Pract Vet 2008;30:325-336.6. Bellah JR, Spencer CP, Salmeri KR. Hemiprostatic urethral avul-sion during cryptorchid orchiectomy in a dog. JAAHA 1989;25:553-556.7. Millis DL, Hauptman JG, Johnson CA. Cryptorchidism and monorchidism in cats: 25 cases (1980-1989). JAVMA 1992;200: 1128-1130.8. Schultz KS, Waldron DR, Smith MM. Inadvertant prostatecto-

my as a complication of cryptorchidectomy in four dogs. JAAHA 1996;32:211-214.9. Miller NA, Van Lue SJ, Rawlings CA. Use of laparoscopic-as-sisted cryptorchidectomy in dogs and cats. JAVMA 2004;224:875-878.10. Gower S, Mayhew PD. Canine laparoscopic and laparoscopic-assisted ovariohysterectomy and ovariectomy. Compend Contin Educ Pract Vet 2008;30:430-440.11. Stoloff DR. Laparoscopic suturing and knot tying techniques. In: Freeman LJ, ed. Veterinary Endosurgery. St. Louis: Mosby; 1999:85.12. Mayhew PD, Brown DC. Comparison of three techniques for ovarian pedicle hemostasis during laparoscopic-assisted ovari-ohysterectomy. Vet Surg 2007;36:541-547.13. Pena FJ, Anel L, Dominguez JC, et al. Laparoscopic surgery in a clinical case of seminoma in a cryptorchid dog. Vet Rec 1998;142:671-672.

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Factors to Consider When Choosing Kitten Vaccines

for adult cats, the AAFP stronglyrecommends vaccinating kittens againstthis disease. In an experimental study,susceptibility to FeLV decreased withage, but young kittens were mostvulnerable.6 Persistent viremia occurredwith 100% of cats infected with FeLV asnewborns, 85% of cats exposed between2 weeks and 2 months of age, and 15%of cats infected at 4 months to 1 year ofage.6 Even though owners may claim akitten is a strictly indoor pet, kittens canescape or owners may eventually allowthem outdoors.

Choosing the Right VaccinesSome vaccine components, such aspreservatives, adjuvants, or pH, cancontribute to local inflammation.2

Chronic inflammation has beenimplicated as a potential factor in thedevelopment of vaccine-associatedsarcomas (VAS).7 Although the precisecause of VAS is not known, the AAFPFeline Vaccine Advisory Panel suggestsusing less inflammatory productswhenever possible.5

Most products today are killed,modified-live virus (MLV), or recombinantcanarypox-vectored vaccines. Killed virusvaccines generally require an adjuvant tobolster the immune response. Most MLVand recombinant feline vaccines, on theother hand, are capable of stimulating an effective immune response without

Sponsored by an educational grant from Merial © 2009 Merial Limited, Duluth, GA. All rights reserved.® VET JET is a registered trademark of Merial.

At no time are cats at greater risk fordisease than in the first few months oflife.1 That’s why it’s important to vaccinatekittens early to induce immunity beforethey are exposed to pathogens.

“Maternal antibodies can block the kitten’s ability to respond to a vaccine,”2

according to Alice Wolf, DVM, DACVIM,DABVP, emeritus/adjunct professor at Texas A&M University College ofVeterinary Medicine and chief medicalconsultant for the VeterinaryInformation Network. “Every kitten hasa different level of maternal antibodies—even kittens from the same litter—andthese antibodies can persist for differentperiods of time.” Some kittens have verylow or no maternal antibodies at 6 weeks

Quick Course

of age.3 Studies have also shown thatmaternal antibody interference maypersist beyond 14 weeks of age.2–4

To compensate for variations inmaternal immunity, initial kittenvaccinations should begin at 6 to 8weeks of age and continue at 3- to 4-week intervals until the kitten is at least 16 weeks of age.5 Practitioners areencouraged to consult the 2006American Association of FelinePractitioners (AAFP) feline vaccinationguidelines for complete vaccinerecommendations.

The Case for FeLV VaccinationAlthough vaccination for feline leukemiavirus (FeLV) is considered noncore

POSTINJECTION LUMPS: THE 3-2-1 RULEMost postvaccination lumpsusually resolve within a few weeks.However, lumps that persist for morethan 3 months after the injection, are larger than 2 cm in diameter, or continue to increase in size 1 month after injection should beinvestigated.5 In these cases, a biopsy and chest radiographs can help determine the diagnosis andprognosis. Cats with vaccine-associatedsarcomas require aggressive treatment,and, if possible, injectable vaccinesshould be discontinued in the future in these cats.5

Merial_QC_KittenVaccine_PV0609.qxp:Layout 1 5/28/09 8:34 AM Page 282

adjuvants. The canarypox-vectoredrecombinant vaccines, for example,stimulate protective immunity and reduce the potential risks associated with an adjuvant.

Another way to potentially reduceinflammation at the injection site is withthe needle-free VET JET® transdermaldelivery system. Compared withconventional needles and syringes, thissystem disperses a smaller volume ofvaccine (0.25 ml) into the tissue througha tiny orifice (about the diameter of a 36-gauge needle).

Discussing Vaccine Issueswith ClientsOwners should be instructed to monitortheir kittens for signs of possible vaccinereactions. “The most common reactionis a mild malaise or fever that may lastfor 24 hours,” explains Dr. Wolf. “That’ssimply the immune system respondingto the vaccine.”

Mild swelling at the vaccine site mayalso occur and generally resolves within

This information has not been peer reviewed and does not necessarily reflect the opinions of, nor constitute or imply endorsement or recommendation by, the Publisher or Editorial Board. The Publisher is not responsible for any data, opinions, or statements provided herein.

VAC08PBKITTENVACQCR

a few weeks. However, a lump thatpersists or grows can be a sign of VAS.Although the risk of VAS is relatively low (approximately one to two cases per10,000 vaccinated cats8,9), the probabilitythat a kitten will be exposed to apotentially fatal disease is considerablyhigher.10

Still, vaccines are important, even forindoor kittens. “It’s possible for owners to track the panleukopenia virus into thehouse,” according to Dr. Wolf, “andwhile less likely, owners can bringrespiratory viruses home on theirclothing.”11 Kittens may also be exposedto sick cats through porch screens orwhen boarded, groomed, or travelingwith their owners. “Certainly, all kittensneed to receive their core vaccines,” saysDr. Wolf.

REFERENCES1. Richards J, Rodan I: Feline vaccination guide-

lines. Vet Clin North Am Small Anim Pract(31)3:455−472, 2001.

2. Greene CE, Schultz RD: Immunophylaxis, inGreene CE (ed): Infectious Diseases of the Dogand Cat, ed. 3. St. Louis, Saunders Elsevier,

2006, pp. 1069–1119.

3. Dawson S, Willoughby K, Gaskell R, et al: Afield trial to assess the effect of vaccinationagainst feline herpesvirus, feline calicivirus andfeline panleukopenia virus in 6-week-old kit-tens. J Feline Med Surg 3:17–21, 2001.

4. Reese MJ, Patterson EV, Tucker SJ, et al: Theeffect of anesthesia and surgery on serologicalresponses to vaccination in kittens. JAVMA233(1):116–121, 2008.

5. AAFP Advisory Panel: The 2006 AmericanAssociation of Feline Practitioners Feline Vaccine Advisory Panel Report. JAVMA9(1):1405–1441, 2006.

6. Hoover EA, Olsen RG, Hardy WD Jr, et al: Felineleukemia virus infection: Age-related variation inresponse of cats to experimental infection. J NatlCancer Inst 57:365–369, 1976.

7. Macy DW, Hendrick MJ: The potential role ofinflammation in the development of postvacci-nal sarcomas in cats. Vet Clin North Am 26(1):103–108, 1996.

8. Kass PH, Barnes WG Jr, Spangler WL, et al:Epidemiologic evidence for a causal relationbetween fibrosarcoma and tumorgenesis incats. JAVMA 203:396–405, 1993.

9. Esplin DG, McGill LD, Meininger AC, et al: Postvaccination sarcomas in cats. JAVMA202:1245–1247, 1993.

10. Tizard IR: The uses of vaccines, in VeterinaryImmunology: An Introduction, St. Louis, Saun-ders Elsevier, 2009, pp. 270−285.

11. Gaskell RM, Dawson S, Radford A: Feline respira-tory disease, in Greene CE (ed): Infectious Dis-eases of the Dog and Cat, ed. 3. St. Louis,Saunders Elsevier, 2006, pp. 145−154.

Vaccine Initial Dosea Booster Intervals Considerations

Core Vaccines

Feline panleukopeniavirus (FPV)

As early as 6 weeks of age Every 3 to 4 weeks

Feline herpesvirus-1(FHV-1)


Feline calicivirus(FCV)


Rabies As early as 8 weeks of ageor 12 to 16 weeks of age

Single dose in the first year;follow state or local statutes

Recommended Vaccine

Feline leukemia virus(FeLV)

As early as 8 weeks of age

One booster 3 to 4weeks later

Kittens should test negativefor FeLV before vaccination

aDepends on the vaccine.

Primary Kitten Vaccine Series5

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Feline Obesity: Clinical Recognition and Management

Depending on the study cited, the number of obese or overweight cats in Western societies ranges

from 15% to 35%, with practitioners estimat-ing even higher numbers in some areas.1–5 A body weight of greater than 20% over the ideal weight of the animal is generally accepted as obese for cats, which means that a 4-kg (9-lb) cat that gains 1 kg (2 lb) is considered obese. Obesity in cats not only is a cosmetic problem but also increases the risk of development of diabetes6 and hepatic lipidosis7 and is associated with increased incidences of many other condi-tions, such as lower urinary tract disease and osteoarthritis.8 Presuming that obesity in cats is similar to that in dogs and humans, this condition will also shorten the life span of affected cats.8–11 Considering the number of cats already affected and the great diffi culty in getting a 12-kg (25-lb) cat to weigh 4.5 kg (10 lb) again, it is clear that the situation demands veterinarians’ full attention.

Preventing ObesityThe commonly stated reason for devel-opment of obesity is that an animal is consuming more energy than it is expending.12 This energy imbalance can be due to excessive dietary intake of calo-ries or a reduction in energy expenditure. However, obesity is not just a simple mat-ter of intake or output. Many other fac-tors that can infl uence or control appetite, metabolism, and homeostasis, including genetic predisposition, sex, neuter status, and hormonal disturbances, may play sig-nifi cant roles in the development of obe-sity.5,8,12 As a result, it is important to make a concentrated effort to recognize risk fac-tors, monitor young and middle-aged cats carefully to detect excess weight gain early, promote the importance of obesity pre-vention and the health benefi ts of weight control from the fi rst veterinary visit, and be actively involved in body assessment (weight and body condition score [BCS]) of all cats at every visit. In other words,

❯❯ Debra L. Zoran, DVM, MS, PhD, DACVIMa

Texas A&M University

Preventing Obesity Page 284

Steps in a Weight-Loss Program for an Obese Cat

Page 286

Clinical Evaluation of Obese Cats

Page 287

Methods of Assessing Body Condition

Page 288

Obesity and Diet Page 289

Creating a Treatment Plan Page 291

At a Glance

Abstract: Obesity is one of the most common clinical problems in cats presenting to veterinary practitioners. Because it is a risk factor for other conditions, such as diabetes mellitus and hepatic lipidosis, it not only increases the morbidity of affected cats but may also shorten their life span. In cats, a body weight of greater than 20% over the ideal weight of the animal is generally accepted as obese. The goal of this article is to help all members of the health care team understand how to prevent the development of obesity in young cats and, when confronted with an obese adult cat, how to develop a safe and effective weight-loss program.

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aDr. Zoran discloses that she has received fi nancial support from Nestlé Purina Petcare and Pfi zer Animal Health.

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obesity prevention must start early, and the veterinary team is essential to recognition, early intervention, and success. There is now ample evidence that neutering is an important risk factor for obesity in male and female cats.13–19 For some time, it has been recognized that many cats have signifi cant weight gain after neutering or during their ado-lescent years, but most clinicians believed this was due entirely to the type or amount of food fed. However, several recent studies13–18 have shown that multiple hormonal changes that sig-nifi cantly affect feline metabolism immediately follow removal of the gonads.a These changes affect food intake and energy metabolism and result in an increase in body fat mass that is almost inevitable unless appropriate measures to limit intake are taken immediately.14–19

Controlling Food IntakeBecause gonadectomy is now recognized as a risk factor for obesity,13–18 the key factor for pre-vention of obesity in neutered animals appears to be careful control of intake immediately after neutering (e.g., no free-choice feeding) and close monitoring of body weight and BCS to allow adjustments in intake if needed.14,16,18 As a rule of thumb, intake recommendations based on commercial food labels should be reduced by 30% for neutered animals to account for the hormonal changes resulting in reduced energy needs.14,16,18 Several studies have evaluated the role of different amounts of dietary components (e.g., fat, carbohydrates) in the development of obesity after neutering, but the key factors that result in increase in body weight are gonadec-tomy and free-choice access to food.17,19 Free-choice access to dry food is not an appropriate method of feeding for many cats—particularly indoor, neutered, inactive cats—for many rea-sons (BOX 1). The most important with regard to obesity is the risk of overfeeding (or overeating), which even in very small amounts can exceed appropriate caloric intake and result in weight gain. Further, due to the feline preference (and, when eating small meals such as mice, physi-ologic need) for eating multiple meals a day, it is best to provide cats’ caloric requirements in two to four meals/day.20

Even when owners measure the amount of food they give their cats, feeding recommen-dations based on the label recommendations for a particular food or traditional maintenance energy calculations are likely to result in sig-nifi cant overfeeding. These recommendations are based on feeding trials in intact, young, active cats—not neutered, indoor (sedentary) cats—and as a result, they are approximately 30% higher than most housecats need. While the appropriate number of calories proposed in the veterinary literature for the maintenance energy requirement in cats ranges from 20 to 100 kcal metabolizable energy (ME)/kg/day, multiple papers have suggested that 70(BW

kg)0.75

represents the resting energy requirement and 94 to 125(BW

kg)0.75 the accepted range for the

maintenance energy requirement for cats. However, in 2006, the National Research Council recommended maintenance amounts of 130(BW

kg)0.40 for obese cats and 100(BW)0.67

for lean cats,21 and several recent studies of neu-tered cats have shown that feeding cats typical maintenance amounts of food results in weight and (more importantly) fat mass gain.22 Kienzle and colleagues23 analyzed the caloric needs in Obesity is a com-

mon, serious medi-cal problem in cats.

QuickNotes

aFor an overview of some of the metabolic changes related to obesity, see the companion article on CompendiumVet.com.

Free-Choice Feeding and Feline Health

BOX 1

Free-choice feeding of dry food affects overall feline health in many ways, including:

Inadequate water intake, which can lead to an increased risk of constipation and urolithsa,b

Learned preference for dry food, which may make it diffi cult to change to a therapeutic canned dietc

Inability of owners to monitor the amount of food being eaten, which may lead them to miss subtle signs of illnessd

aSeefeldt SL, Chapman TE. Body content and turnover in cats fed dry and canned rations. Am J Vet Res 1979;40:183-185.bFinco DR, Adams DD, Crowell WA, et al. Food and water intake and urine composition in cats: infl uence of continuous versus periodic feeding. Am J Vet Res 1986;47:1638-1642.cHorowitz D, Soulard Y, Junien-Castagna A. The feeding behavior of the cat. In: Pibot P, Biourge V, Elliott D, eds. Encyclopedia of Feline Clinical Nutrition. Aniwa SAS, Aimargues, France; 2008:339-378.dHoupt KA. Feeding and drinking behavior problems. Vet Clin North Am Small Anim Pract 1991;21:281-298.

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colony cats and reported that neutered females required 100(BW

kg)0.40 and neutered males

required 120(BWkg

)0.40 to maintain ideal body condition. In two other feeding studies,24,b inves-tigators determined that neutered cats consum-ing more than 50 to 60(BW

kg)0.67 gained weight

and underwent a change in BCS from ideal to obese in just 3 months. In simple terms, an intake of 30% less than maintenance requirements means that most average-sized, indoor, neutered cats weighing 4 to 5 kg (9 to 11 lb) need to eat less than 200 kcal/day, and many may need even less than 180 kcal/day to maintain lean body condition (BOX 2). This is a signifi cantly smaller amount of food than is often recommended and represents a critical change in feeding recommendations

for cats—one that will be extremely diffi cult to achieve in cats being fed a calorie-dense (high-fat) food or allowed free access to dry food.

Increasing ExerciseLike many people, indoor cats are sedentary, which has detrimental effects on their physiologic and psychologic health and well-being. Therefore, increasing activity and energy expenditure are very important aspects of weight management in indoor cats. However, it is not easy to induce cats to exercise. Lifestyle alteration is, then, one of the most important additions to any program of obesity prevention or management.25

Exercise is a key factor in health for several reasons: (1) it helps maintain and strengthen lean muscle tissues, (2) it promotes cardiovas-cular health, (3) it provides mental stimula-tion and improves overall quality of life, (4) it increases energy expenditure and fat oxida-Indoor, neutered

cats are at greatest risk of becoming obese if their intake is not carefully lim-ited soon after they achieve adult size.

QuickNotes

Steps in a Weight-Loss Program for an Obese Cat19,23,38,a

BOX 2

1. Determine ideal body weight: Set a target goal for weight loss.

A record of the cat’s ideal weight at an earlier age is the most accurate guide.

If you have no previous record of ideal weight, you must estimate an ideal from the current weight. This can be done by using the body condition score (BCS): On a 9-point scale, each point above a 5 represents a 10% to 15% increase in body weight (BW).

Using this approach, a cat weighing 10 kg (22 lb) and having a BCS of 9/9 is 40% to 60% above its ideal weight. Using an equation with both BW and the percentage over BCS can provide an estimate of ideal BW:

If the cat is considered to be 40% above its ideal weight, the ideal BW is calculated as follows:

If the cat is considered to be 60% above its ideal weight, the ideal BW would be 6.25 kg (13.75 lb).

2. Determine the amount to feed: Energy allocation.

If possible, determine how much the cat is currently consuming. This may be diffi cult if the cat is being fed free-choice or lives in a multicat household without careful observation of intake.

If the amount is known, an intake reduction of 20% to 40% from the calculated maintenance requirements for a cat of ideal body condition is a good starting point for weight loss. The diet fed should contain >45% metabolizable energy of protein and be low in fat.

The current National Research Council recommendations for maintenance require-ments in lean and obese cats are as follows:

Lean cat: 100 kcal(BW)0.67 or 60 kcal/kg/day. For a 4-kg cat, this equals 240 kcal/day (4 kg × 60 kcal/kg/day = 240 kcal/day). Note that many indoor, neutered cats, even if they are lean, need 20% to 30% less than this amount, or less than 200 kcal/day.

× current weightIdeal BW = 100% (normal BCS)

100% + % above normal BCS

100%140%

= 7.1 kg (15 lb)× 10 kg

bBauer JE. Texas A&M University. Personal communication. 2009.

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Play and activity are essential compo-nents of a healthy feline lifestyle and are necessary for indoor cats to increase their muscle mass and reduce their risk of obesity.

QuickNotes

tion, and (5) it increases the metabolic rate.26 If feasible, protected outdoor activity should be encouraged, as it is a great stimulus for play or exercise activity. Cats that are unable to engage in outdoor hunting or play behavior need other opportunities to fulfi ll their physiologic needs for climbing, balancing, scratching, and exer-cise.25,27,28 These requirements can be met in many ways and can be tailored to the cat and its situation. Toys may work well for some cats, cat trees or play stations are excellent for oth-ers, and some cats respond well to interactive toys that reward them with food. Clients do not need to turn mice loose in their house to encourage activity or play, but they do have to engage their cats to create play opportunities. The most important message about exercise that veterinarians should give cat owners is that play and activity are essential components of a healthy feline lifestyle and are necessary

for indoor cats to increase their muscle mass and reduce their risk of obesity.

Clinical Evaluation of Obese CatsThe fi rst step in identifying and correcting obe-sity is recognizing it. Obviously, it is not diffi -cult to recognize a severely obese animal, but the veterinarian’s goal is to recognize changes in body weight and condition early so that cor-rections in diet, intake, and exercise can be ini-tiated to prevent progression to obesity, with all of its associated hormonal changes and comorbid conditions. For assessment purposes, body composition is typically separated into fat mass and fat-free mass (FFM). The FFM is the largest, heaviest portion and includes protein (muscle mass), minerals (bones), and water (intracellular and extracellular). Measuring or assessing the FFM provides essential information about an animal’s

Obese cat: 130 kcal(BW)0.40 or 37 kcal/kg/day. For an 8-kg cat, this equals 296 kcal/day (8 kg × 37 kcal/kg/day = 296 kcal/day).

However, to achieve weight loss in an obese cat, its intake must be decreased to 60% of the maintenance requirements: 0.60 × 296 = 178 kcal/day. In practice, this can be rounded up to 180 kcal/day.

Some obese cats may need to consume as little as 20 to 30 kcal/kg/day to achieve weight loss. This amount of food is very small, and the greatest concern is to maintain adequate protein intake.

3. Monitor the weight-loss program and make adjustments.

The goal of weight loss is 1% to 2% of BW per week. At this rate, the cat is less likely to lose lean muscle mass or develop hepatic lipidosis.

Typically, cats lose weight more quickly at the start of the program, but metabolic and physiologic responses to weight loss result in signifi cant slowing or even cessation of weight loss over a short period of time. Thus, monitoring progress and making adjustments

are essential to continued success.

Adjustments in the weight-loss program are based on results. If the cat is not losing weight at a rate of 1% per week, the amount of food intake should be decreased by 5% to 10%.

Weight loss should be monitored frequently (every 2 to 4 weeks) and, to avoid discrep-ancies, always using the same scale.

Other recommended monitoring tools in-clude BCS, morphometric measurements, and photographs.

As with any chronic disease, weight management requires a good veterinarian–client–patient relationship to achieve optimal care and results.

It may be helpful to give owners an estimated time line for weight loss so that they have realistic expectations for results. In general, for a cat to have a 30% decrease in BW, it takes approximately 12 months if the cat is losing 0.5%/week, 7 months if the cat is losing 1%/week, or 4 months if the cat is losing 2%/week.

aHashimoto M, Funaba M, Abe M, et al. Dietary protein levels affect water intake and urinary excretion of magnesium and phosphorus, in laboratory cats. Exp Anim 1995;44:29-35.

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Clinicians should familiarize them-selves with at least one of the clinical techniques for assessment of body composition and use it daily.

QuickNotes

metabolic and physiologic status.29 Cats in thin body condition with loss of muscle mass are known to have higher morbidity and mortality and should be evaluated to determine the cause of the loss.30 By contrast, obesity is the accumu-lation of body fat or an increase in the fat mass. In most cats, obesity represents an increase in fat mass that causes increases in body weight and changes in body composition. Measurement of body weight is the simplest technique for determining increased fat mass. However, there are two main concerns with using only body weight monitoring: (1) mea-surement of body weight alone does not dis-tinguish the loss of FFM from the loss of fat mass, and (2) scales are notoriously inaccurate or variable—measurements made on different scales can vary signifi cantly. When weighing cats, it is important to use a reliable, well-maintained scale intended for small animals (pediatric scales are excellent) and to use the same scale for all weight tracking to minimize variability and maximize accuracy. However, to better assess body condition, most nutritionists recommend that techniques for specifi c assess-ment of fat mass be incorporated in the physi-cal examination in addition to measuring body weight. In general, the techniques available to clinical practitioners (BOX 3) are easy to use, require no special instrumentation, and can

be performed on an awake cat. They include BCS, morphometric measurements, and body mass index (BMI).29 Tools used in clinical or basic research also exist; detailed informa-tion on these techniques has been published elsewhere.8,29,31

Body Condition Scoring BCS is perhaps the most widely accepted and well-known technique for assessing increased fat mass.31–33 The two most common scoring systems are the 5-point system (in which a score of 3 is ideal) and the 9-point system (in which 5 is considered ideal).8,32 However, because half points are often used in the 5-point system, resulting in a total of 9 catego-ries, the systems are essentially identical, and clinical use is based on preference. One disadvantage of using BCS to assess fat mass is that physical palpation cannot dis-tinguish loss of FFM from gain of fat mass. So although BCS can provide a subjective assess-ment of an increase or decrease in fat mass in obese patients, it is not helpful in overall body condition assessment of FFM. For example, a cat with diabetes may be obese but have also lost muscle mass due to the lack of insulin result-ing in muscle wasting. Simple assessment of BCS by palpation cannot accurately distinguish these changes. Another disadvantage of BCS is its lack of repeatability in inexperienced observ-ers. However, for estimating body fat mass in a clinical setting, BCS is an important tool. It provides owners with tangible information about their pets and, when used repeatedly so that familiarity and comfort are achieved, can provide highly reproducible results.8,32,33

Morphometry and Body Mass IndexMorphometric measurements and determina-tion of BMI are also easy to use in a clinical setting; however, they are less well known and require more time. Morphometric analysis uses measured parameters to provide an estimate of body composition. The simplest measurements are dimensional evaluations, whereby a tape measure is used to obtain specifi c dimensions of the animal. In general, length measurements of the head, thorax, and limbs correlate well with lean body mass,34 while circumference measurements (truncal/ribcage) correlate with fat mass.35 By using a measurement of lean body mass (leg index) with a measurement of

Methods of Assessing Body Condition8

BOX 3

Clinically useful methods Serial body weight Body condition score Morphometric measurements Bioelectric impedance Body mass index

Research methods Dual energy x-ray absorptiometry (DEXA) Dilution/isotope techniques Ultrasonography, computed tomography, or magnetic resonance imaging Electrical conductance Chemical analysis Neutron activation analysis

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fat mass (ribcage circumference) in the follow-ing equation, BMI can be predicted28:

In this equation, the ribcage circumference is measured at the ninth cranial rib, and the leg index is the distance from the patella to the calcaneal tuber of one hindlimb.36 Other morphometric measurements of body composition use specifi c tools to assess fat composition, such as ultrasonography (this tech nique has not been validated in cats) or bioelectric impedance analysis (BIA). In BIA, the conductance of an applied electric current in the patient is measured and used to calculate body composition.29,35,37 Because body fl uids and electrolytes are responsible for the highest conductance and adipose tissue is dehydrated, increased adipose tissue results in lower con-ductance and greater impedance.29 Although several BIA systems exist, none are widely available, and there are few reports of their use in cats. BIA can be affected by electrode position, hydration status, consumption of food or water, physical activity, conductance of the examination table, and other variables.37 Thus, further evaluation of this technique is needed before it can be recommended for routine use in the assessment of fat mass in cats.

* * * Clinicians should familiarize themselves with at least one of the clinical techniques for assess-ment of body composition and use it daily so that it becomes not only a normal part of every physical examination but also a more reliable and repeatable tool for assessing fat mass. Routine use of BCS also shows clients that their veterinarian considers body condition assess-ment to be an important part of their cat’s physical examination and health evaluation. Perception is reality: owners need to know that obesity is important not only from what veteri-narians say but also from what we do.

Obesity and DietDiet must be considered in any prevention or treatment plan for feline obesity. Unlike most domestic species, cats are true carnivores. They must consume animal fl esh and fat to meet their nutritional needs, or their diets must be supple-mented appropriately with the necessary amino

acids and fatty acids that they are unable to synthesize from other food sources as omnivo-

rous species do.38 The most commonly used foods for cats are dry, extruded diets. These

foods meet the minimum requirements of the National Research Council and are nutritionally complete and balanced, readily available, easy to use and store, and quite palatable. However, they bear little resemblance to a diet of a natu-ral carnivore. Therefore, the distinctive nutri-ent requirements of cats should be taken into account when designing a weight-loss or main-tenance diet.

ProteinAs obligate carnivores, cats use protein as an energy source even when other energy sources such as fat or carbohydrates are available.38 However, most researchers have focused on fat and carbohydrate energy sources as having the primary roles in the prevention and man-agement of obesity. While it is critically impor-tant to reduce caloric intake in cats to achieve successful weight loss, this approach has over-looked the important role of protein in feline metabolism. Hoenig and colleagues39 showed that cats consuming high-protein diets (>45% ME) had increased energy metabolism, higher fat oxidation, and improved glucose tolerance, while cats consuming high-carbohydrate diets had lower energy metabolism, required fewer calories to meet their needs, and gained fat mass. Others40–43 have also shown that in obese cats, diets containing high levels of protein result in greater loss of fat mass and improved preservation of muscle mass. This is important because muscle mass is a major determinant of metabolism. Muscle mass loss provokes a

“starvation” response as the body seeks to pre-serve itself either through energy metabolism changes or increased intake. Therefore, loss of muscle mass increases the likelihood of weight regain, and, particularly in cats, maintaining muscle mass may be a key to successful weight loss.44 Research has shown that even cats con-suming protein at 45% ME lost some muscle mass during diet restriction. This fi nding sug-gests that >45% ME of protein may be needed during weight loss due to the severe restric-tion of intake necessary to achieve reduction in calories and loss of weight.40,41

Successful weight loss in cats requires preservation of lean muscle tissue and concurrent loss of fat mass, which is best achieved using high-protein (>45% ME), low-energy diets.

QuickNotes

Feline BMI (% fat) = 1.5 (ribcage circumference [cm] – leg index measurement [cm])

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Obese cats appear to adapt to lower-protein, higher-carbohydrate diets; however, obese cats on high-protein diets have not only improved insulin sensitivity but also greater energy and fat metabolism, resulting in great loss of fat mass during calorie restriction and weight loss.39 Increased protein intake may be particularly important in cats after weight loss, as research also shows that energy expendi-ture remains decreased.44 In summary, high protein levels are essen-tial for preservation of lean body mass dur-ing calorie restriction and weight loss in obese cats and are important for increasing insulin sensitivity, thereby preventing further devel-opment of glucose intolerance. In addition, high-protein diets (>45% protein ME) allow a more optimum metabolic status in lean cats.

CarbohydratesWhile protein is a very important component of the feline diet, it is only one part. Carbohydrates serve two major purposes: as an energy source (simple carbohydrates, such as starches) or as dietary fi ber (complex carbohydrates). The role of fi ber is discussed in a separate section below. Carbohydrates are a major part of most dry and some canned commercial feline and canine diets due to issues of processing, preservation, and cost. The digestibility and glycemic index of dietary car-bohydrate varies by source: highly digestible car-bohydrates include cooked white rice and potato; less digestible sources include complex grains (e.g., barley, wheat, whole corn). Carbohydrates in high-quality commercial pet foods are generally highly digestible and provide a readily available energy source. If the pet is active and needs energy, car-bohydrates are used effi ciently; however, if the pet is sedentary, any carbohydrates that are not used for energy are stored as fat. The amount and type of carbohydrate in the feline diet are of considerable importance for several reasons: (1) cats’ ability to handle dietary carbohydrate loads are very different from those of omnivores38,45 (BOX 4); (2) because cats use protein for energy, even when excess energy is available in their diet, sedentary indoor cats often do not use the carbohydrate energy pres-ent in a diet38,46; and (3) high-carbohydrate diets result in a reduced resting energy metabolism, so cats must consume less food to maintain appropriate body weight.39 However, cats are not unable to use carbohy-

drates; on the contrary, they can digest, absorb, and use them quite well. Nevertheless, the type of carbohydrate is important, as there are signif-icant differences in glycemia, postprandial glu-cose levels, insulin secretion, and food intake between normal-weight and obese cats.47,48

FatThe role of dietary fat is also very important in feline obesity, as fat provides the greatest amount of energy per gram of diet. As a result, there are a number of commercially available low-fat feline diets for calorie control. Further, several recent studies show that controlling calories from fat in weight-loss programs is essential to achieving successful weight loss.19,21 Nevertheless, dietary fat has many roles in metabolism beyond being a power-ful source of energy, and there are key differ-ences in feline requirements for fat that must be considered when choosing a diet. As carnivores, cats require additional sup-plementation of fatty acids (especially arachi-donic acid) and fat-soluble vitamins in their diet that normally would come from the fat stores of prey. Also, fat is a major palatabil-ity enhancer, and cats often reject diets with too little fat or in which the fat is oxidized.

Major Metabolic/Anatomic Differences in Feline Carbohydrate Handling Compared With Omnivoresa

BOX 4

Lack of a sweet taste receptor and gene for sweet taste Lack of salivary amylase (enzyme that initiates digestion of starches) Low levels (5% to 10%) of intestinal amylase and intestinal disaccharidases Minimally functioning levels of hepatic glucokinase (inducible enzyme that affects glucose uptake) Minimally functioning levels of hepatic glycogen synthetase (enzyme that converts glucose to glycogen) Lack of fructokinase and ability to metabolize fructose sugars

aZoran DL. The unique nutritional needs of the cat. In: Ettinger S, Feldman E, eds. Textbook of Veterinary Internal Medicine. 7th ed. 2009, in press.

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However, while reducing fat is an important method of controlling calories in feline diets, there are no studies in cats showing the ideal amount of fat in the diet. And as with protein and carbohydrates, it is essential to consider the whole: diets for weight loss in cats should ideally be higher in protein (at least >45% ME), lower in fat (to control calories) but contain-ing enough essential fatty acids to meet feline requirements, and lower in carbohydrates (to prevent reduction in energy metabolism and conversion of excess carbohydrate to fat).

FiberThe fi nal dietary component to consider in weight-loss diets is fi ber. Most weight-loss diets add insoluble or mixed sources of fi ber, such as cellulose or beet pulp. Dietary fi bers have been used in weight-loss diets for many years because of their ability to dilute calories and provide bulk to the diet so that larger volumes of food can be eaten during energy restriction. Fiber aids in glycemic and weight control by promoting slow, sustained absorption of glu-cose (and other nutrients) from the gastroin-testinal tract and by increasing the speed of passage of food through the small intestine. However, this effect, while benefi cial for weight loss, results in reduced digestibility of protein49

and may have other untoward effects, such as increased fecal volume, constipation, food refusal, and dry skin.50 As a result, many own-ers and cats do not tolerate diets with moder-ate to high levels of dietary fi ber (>15% dry matter). No studies demonstrate an optimum amount or type of dietary fi ber for use in cat foods for any purpose; however, a moderate amount (5% to 12% dry matter) of mixed fi ber may be best.50

If a moderate- to high-fi ber diet is cho-sen, the effects on protein digestibility must be considered and an appropriate amount of protein added to the food to prevent a reduc-tion in protein availability. As with any dietary strategy, increased fi ber in the diet should not be considered a “cure-all” for weight loss, but it can be included as part of the overall approach to controlling caloric intake.

Choosing a Weight-Loss DietHealthy weight loss requires loss of adipose tissue along with maintenance of lean body mass, which is an important arbiter of basal

energy metabolism. Ideally, weight-loss diets should contain protein levels >45% ME and be low in fat and carbohydrates. The number of dry diet choices that meet this profi le is extremely small, primarily because most high-protein, low-carbohydrate dry foods are for-mulated as either diabetic or kitten diets and thus contain a large number of calories due to a high fat content. For example, a typical dry diabetic or kitten food contains 500 to 600 kcal/cup of food. As a result, it is extremely diffi cult to feed an appropriate amount to a cat that requires weight loss, which, in an obese cat, may be as low as 130 to 150 kcal/day. In this scenario, the amount of the high-calorie diabetic dry food fed at a meal will be small (<1/8 cup twice daily)—likely too small to achieve any sense of “fullness” and result-ing in annoying begging behavior that makes owner compliance with feeding recommenda-tions very diffi cult. This point cannot be overstated: too many calories of any kind, including protein calories, will cause weight gain or failure to lose weight. Thus, at this time, the best commercial diets for achieving a high-protein, low-carbohydrate, low- to moderate-fat profi le that can provide reasonable portion sizes are canned cat foods. For example, a typical diabetic (high-protein/low-carbohydrate) canned diet contains 165 to 190 kcal/5.5-oz can. Thus, when the target for caloric intake is 180 kcal or less, it can be easier to achieve the high protein necessary to pre-serve muscle mass in a portion-controlled diet with these foods. However, canned foods can also be high in carbohydrate or low in protein or have poor-quality ingredients, resulting in ineffective or unhealthy weight loss. One size does not fi t all in cat foods, and careful read-ing of the label can help determine the protein, carbohydrate, and fat levels, which is the start of the process.

Creating a Treatment PlanSuccessful weight loss in an obese cat requires patience, setting goals, frequent monitoring and readjustment of strategy, and an under-standing that reversing obesity is a challenge similar to the management of any chronic medical condition. Persistence and diligence are essential. The key is to set a target calorie intake, weigh the cat monthly, and adjust the amount of food based on weight loss. While

Weight loss in obese cats is dif-fi cult and requires appropriate dietary intervention to pre-serve muscle mass, careful control of intake, and frequent monitoring to make adjustments as needed.

QuickNotes

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References1. Scarlett JM, Donoghue S, Saidle S, et al. Overweight cats: prevention and risk factors. Int J Obes 1994;18:522-528.2. Armstrong PJ, Lund EM. Changes in body condition and energy balance with aging. Vet Clin Nutr 1996;3:83-87.3. Lund EM, Armstrong PJ, Kirk CA, et al. Health status and population characteristics of dogs and cats examined at private veterinary practices in the United States. JAVMA 1999;214:1336-1341.4. Robertson ID. The infl uence of diet and other fac-tors on owner perceived obesity in privately owned cats from metropolitan Perth, Western Australia. Prev Vet Med 1999;40:75-85.5. Diez M, Nguyen P. The epidemiology of canine and feline obesity. Waltham Focus 2006;16:2-8.6. Prahl A, Guptill L, Glickman NW, et al. Time trends and risk factors for diabetes mellitus in cats presented to veteri-nary teaching hospitals. J Feline Med Surg 2007;9:351-358.7. Biourge VC, Massat B, Groff JM, et al. Effects of pro-tein, lipid, or carbohydrate supplementation on hepatic lipid accumulation during rapid weight loss in obese cats. Am J Vet Res 1994;55:1406-1415. 8. German AJ. The growing problem of obesity in dogs and cats. J Nutr 2006;136:1940S-1946S.9. Kealy RD, Lawler Dr, Ballam JM, et al. Effects of diet restriction on life span and age–related changes in dogs. JAVMA 2002;220:1315-1320.10. Staiger H, Häring HU. Adipocytokines: fat derived humoral mediators of metabolic homeostasis. Exp Clin Endocrinol Diabetes 2005;113:67-79.

11. Wisse BE. The infl ammatory syndrome: the role of adi-pose tissue cytokines in metabolic disorders linked to obe-sity. J Am Soc Nephrol 2004;15:2792-2800.12. Lafl amme DP. Understanding and managing obesity. Vet Clin North Am Small Anim Pract 2006;36:1283-1295. 13. Fettman MJ, Stanton CA, Banks LL, et al. Effects of neutering on body weight, metabolic rate, and glucose in-tolerance of domestic cats. Res Vet Sci 1997;62:131-136.14. Martin L, Siliart B, Dumon H, et al. Leptin, body fat con-tent and energy expenditure in intact and gonadectomized adult cats: a preliminary study. J Anim Phys Anim Nutr2001;85:195-199.15. Harper EJ, Stack DM, Watson TDG, et al. Effects of feeding regimen on body weight, composition, and con-dition score in cats following ovariohysterectomy. J Small Anim Pract 2001;42:433-438.16. Hoenig M, Ferguson DC. Effects of neutering on hor-monal concentrations and energy requirements in male and female cats. Am J Vet Res 2002;63:634-639.17. Nguyen PG, Dumon HJ, Siliart B, et al. Effects of dietary fat and energy on body weight and composition after go-nadectomy in cats. Am J Vet Res 2004;65:1708-1713.18. Martin LJM, Siliart B, Dumon HJ, et al. Spontaneous hormonal variations in male cats following gonadectomy. J Feline Med Surg 2006;8:309-314. 19. Backus RC, Cave NJ, Keister DH. Gonadectomy and high dietary fat but not high dietary carbohydrate induce gains in body weight and fat of domestic cats. Br J Nutr2007;98:641-650.

20. Beata CA. Feline behavior: can nutrition really make the difference. Royal Canin Feline Symp 2007:30-33.21. National Research Council. Nutrient Requirements of Dogs and Cats. Washington, DC: National Academy Press; 2006.22. Hill RC. Challenges in measuring energy expenditure in companion animals: a clinician’s perspective. J Nutr2006;136:1967S-1972S.23. Kienzle E, Edstadtler-Pietsch G, Rudnick R. Retrospec-tive study on the energy requirements of adult colony cats. J Nutr 2006;136:1973S-1975S.24. Belsito KR, Vester BM, Keel T, et al. Impact of ovariohys-terectomy and food intake on body composition, physical activity, and adipose gene expression in cats. J Anim Sci2009;87:594-602.25. Buffi ngton CAT. Dry food and risk of disease in cats. Can Vet J 2008;49:561-563.26. Patterson CM, Levin BE. Role of exercise in the cen-tral regulation of energy homeostasis and in prevention of obesity. Neuroendocrinology 2008;87:65-70.27. Indoor cat needs. The Indoor Cat Initiative. Accessed May 2009 at vet.ohio-state.edu/ 747.htm. 28. Roudebush P, Schoenherr WD, Delaney SJ. An evi-dence based review of the use of therapeutic foods, own-er education, exercise, and drugs for the management of obese and overweight pets. JAVMA 2008;233:717-725.29. German AJ, Martin L. Feline obesity: epidemiology, pathophysiology, and management. In: Pibot P, Biourge V, Elliott D, eds. Encyclopedia of Feline Clinical Nutrition. Aim-

the most appropriate rate of weight loss is debated, most sources agree that a goal of 1% weight loss per week or 3% to 4% per month is a safe target.8,12,29 If, during periods of moni-toring, this goal is not being achieved, calories must be reduced by 5% to 10% and the effects of the new amount monitored. To achieve loss of fat mass, the weight-loss program must consider the cat’s body condition at the start of weight loss, the degree of calorie restriction required, the desired rate of weight loss, and the cat’s environment and ability to increase exercise.29 BOX 2 provides a step-by-step overview of the process. Although this strat-egy is relatively straightforward (reduce energy intake), it requires patience; careful, long-term monitoring; encouragement and support for the owner; and frequent assessment and readjust-ment to meet the needs of the cat.

ConclusionThe key to obesity prevention (or cor-rection) is balancing the energy intake/energy expenditure equation. Because obesity is incredibly diffi cult to reverse in adult cats and, in many cases, requires lifelong management because of changes in energy metabolism and hormone status, prevention is an essential goal. All neu-

tered cats are at risk for becoming obese due to the changes in their hormonal balance that affect appetite, energy balance, and fat metab-olism. Because of these changes, food intake must be carefully restricted following gonadec-tomy in all cats, and free-choice feeding of dry foods should be strongly discouraged. In indoor cats, for which exercise is reduced by the nature of their lifestyle, energy restric-tion also becomes paramount to preventing or correcting obesity. Energy restriction can be achieved by low-fat, high-fi ber diets, but many of these diets are not high enough in protein to preserve muscle and thus result in loss of mus-cle mass, unhealthy weight loss, and a strong tendency to regain weight. High-protein, low-carbohydrate, low-fat diets are ideal for weight loss in cats because they preserve muscle mass while restricting energy sources to induce fat loss. However, portion control is ultimately the key to controlling energy intake and is most easily achieved by feeding canned food with a protein content of >45% ME and a carbohydrate content of <10% ME. The key to any success-ful weight-loss program is patience, persistence, frequent and careful monitoring and assessment, and readjustment of the caloric intake and diet as needed to achieve fat loss and preserve lean muscle tissue.

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Feline Obesity


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argues, France: Aniwa SAS; 2008:4-43.30. Scarlett JM, Donoghue S. Associations between body condition and disease in cats. JAVMA 1998;212:1725-1731.31. German AJ, Holden SL, Moxham G, et al. A simple, re-liable tool for owners to assess the body condition of their dog or cat. J Nutr 2006;136:2031S-2033S. 32. Lafl amme DP. Development and validation of a body condition score system for cats: a clinical tool. Feline Pract 1997;25:13-18.33. Burkholder WJ. Use of body condition scores in the clinical assessment of the provision of optimal nutrition. JAVMA 2000;217:650-654.34. Hawthorne A, Butterwick RB. Predicting the body composition of cats: development of a zoometric mea-surement for estimation of percentage body fat in cats [abstract]. J Vet Intern Med 2000;14:365.35. Burkholder WJ. Precision and practicality of methods assessing body composition of dogs and cats. Compend Contin Educ Pract Vet 2001;23:1-10. 36. Elliott D. Is my cat fat? Proc Nestle Purina Nutr Forum2007:28-32.37. Stone RA, Berghoff N, Steiner J. The use of a bioelec-tric impedance device in lean and obese dogs to estimate body fat percentage. Vet Ther in press, 2009.

38. Morris JG. Idiosyncratic nutrient requirements of cats appear to be diet-induced evolutionary adaptations. Nutr Res Rev 2002;15:153-168.39. Hoenig M, Thomaseth K, Waldron M, et al. Insulin sensitivity, fat distribution, and adipocytokine response to different diets in lean and obese cats before and af-ter weight loss. Am J Physiol Regul Integr Comp Physiol2007;292:R227-R234.40. Lafl amme DP, Hannah SS. Increased dietary protein promotes fat loss and reduces loss of lean body mass during weight loss in cats. Intern J Appl Res Vet Med2005;3:62-68.41. German AJ, Holden S, Bissot T, et al. Changes in body composition during weight loss in obese client owned cats: loss of lean tissue mass correlates with overall percentage of weight loss. J Feline Med Surg 2008;10:452-459. 42. Szabo J, Ibraham WH, Sunvold GD, et al. Infl uence of dietary protein and lipid on weight loss in obese ovari-ohysterectomized cats. J Vet Med Res 2000;61:559-565.43. Michel KE, Bader A, Shofer PS, et al. Impact of time lim-ited feeding and dietary carbohydrate content on weight loss in group housed cats. J Feline Med Surg 2005;7:349-355.44. Villaverde D, Ramsey JJ, Green AS, et al. Energy re-striction results in a mass-adjusted decrease in energy

expenditure in cats that is maintained after weight regain. J Nutr 2008;138:856-860.45. Cave NJ, Monro JA, Bridges JP. Dietary variables that predict the glycemic responses to food in cats [abstract]. Proc Nestle Purina Forum 2007:73.46. Morris JG, Rogers QR. Metabolic basis for some of the nutritional peculiarities of the cat. J Small Anim Pract1982;23:599-613. 47. Bouchard GF, Sunvold GD. Effect of dietary carbohy-drate source on post prandial plasma glucose and insulin concentrations in cats. In: Reinhert GA, Carey DP, eds. Re-cent Advances in Canine and Feline Nutrition, Iams Nutri-tion Symposium. Wilmington, OH: Orange Frazier Press; 2000:91-105. 48. Appleton DJ, Rand JS, Priest J, et al. Dietary car-bohydrate source affects glucose control, insulin se-cretion, and food intake in overweight cats. Nutr Res2004;24:447-467.49. De-Oliveira LD, Carciolfi AC, Oliveira MCC, et al. Ef-fects of six carbohydrate sources on diet digestibility and postprandial glucose and insulin responses in cats. J Anim Sci 2008;86:2237-2246. 50. Kirk CA. High protein, low carbohydrate diets: are they for all cats? Royal Canin Feline Symp 2007:4-7.

1. A cat with an ideal weight of ____lb and an actual weight of ____lb would meet the cur-rently accepted defi nition of obese.

a. 9; 9.9 b. 7; 8.2 c. 11; 13.5 d. 14; 16.4

2. Cats digest carbohydrates differently from omnivores because they

a. have high levels of intestinal amylase. b. lack salivary amylase. c. have increased function of hepatic

glucokinase. d. have high levels of fructokinase.

3. Which feeding approach is most likely to lead to healthy weight loss?

a. meal feeding of high-carbohydrate dry food only

b. free-choice feeding of high-carbohydrate canned food only

c. free-choice feeding of high-protein dry food only

d. meal feeding of high-protein canned food only

4. Risk factors for obesity in cats include a. appetite and energy changes caused by

hormonal imbalances after neutering. b. a sedentary, indoor lifestyle. c. overfeeding. d. all of the above

5. Successful weight loss in obese cats is characterized by all of the following except

a. preservation of lean muscle mass by feeding a high-protein diet.

b. loss of fat mass at a rate of 1% to 2% per week.

c. control of caloric intake by meal feeding and portion control.

d. activity restriction.

6. Which condition has not been associated with obesity in cats?

a. hepatic lipidosis b. hypertrophic cardiomyopathy c. diabetes mellitus d. osteoarthritis

7. Which clinical method of evaluating body fat mass in cats is most likely to be affected by technical issues?

a. BCS b. morphometric measurement c. BIA d. BMI

8. In neutered cats, energy intake recommen-dations on commercial food labels must be decreased by approximately ________ to prevent the development of obesity.

a. 20% b. 25% c. 30% d. 35%

9. Which statement regarding label recom-mendations for feeding cats is true?

a. They are based on twice the mainte-nance energy requirement.

b. They are based on the needs of intact, active cats.

c. Pet food manufacturers overestimate energy needs to avoid underfeeding cats.

d. They are based on the needs of neu-tered cats.

10. Weight-loss diets for obese cats should contain _______ ME of protein to promote fat loss and prevent loss of muscle mass.

a. >30% b. >35% c. >40% d. >45%

3 CECREDITS CE TEST 1 This article qualifi es for 3 contact hours of continuing education credit from the Auburn University College of Veterinary

Medicine. Subscribers may take individual CE tests online and get real-time scores at CompendiumVet.com. Those who wish to apply this credit to fulfi ll state relicensure requirements should consult their respective state authorities regarding the applicability of this program.

Product Forum


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Client ServicesLifelearn has launched ClientEd Online, a new Web-based client education service at lifelearncliented.com. ClientEd automatically organizes a practice’s client education articles online for easy acces-sibility. ClientEd is compatible with Macs and PCs, is accessible at any time, and offers three different library series.Lifelearn, Inc. | 800-375-7994 | www.lifelearncliented.com

The product information presented here is provided by the manufacturers and does not refl ect endorsement by Compendium.

Digital RadiographyQuantum Medical Imaging has partnered with Agfa Healthcare to release the CR30-Oracle vet-erinary system. The CR30-Oracle can perform multiple functions, including image acquisition, processing, and distribution. With the veterinary confi guration, the system has a custom splash screen, has all veteri-nary DICOM attributes, and excludes all human exam trees.Quantum Medical Imaging | 631-567-5800 | www.quantumvet.net

Topical Flea ProtectionSummit VetPharm has released Vectra for Dogs and Puppies, a topical, monthly fl ea control product. This newest addition to the Vectra line contains dinote-furan and pyriproxyfen combined in a single-dose product. Vectra for Dogs and Puppies can be used on dogs as young as 8 weeks and provides protection against all stages of fl eas. Summit VetPharm | 800-999-0297 | www.summitvetpharm.com

IV Line Tracing LabelsEPS’ customizable line tracing labels help prevent medical errors by making it easy to label and trace IV lines. With one label on the IV infusion container and another on the end of the tubing, IV lines can be quickly located and identifi ed. The customizable labels are available for laser or thermal printers and can be designed using MILT 3.0 software.EPS, Inc. | 800-523-8966 | www.medidose.com

Feline Herpes TreatmentEnisyl-F Lysine treats are formulated to help regulate signs of feline herpesvirus infection and lessen the frequency of fl are-ups. The treats contain L-lysine, which has been shown to lessen the severity of signs and reduce viral shedding associated with herpesvirus infection. Designed to be palatable, the treats can be administered routinely or during active fl are-ups.Vétoquinol | 800-267-5707 | www.vetoquinolusa.com

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296 Compendium: Continuing Education for Veterinarians® | June 2009

In Memory

Anna Elizabeth Worth, VMD, an outstanding leader and talented veterinarian, passed away on Saturday, May 16, following a long and valiant battle with cancer. She was 55 years old.

“It is with heavy hearts and deep sadness that we say goodbye to such a compassionate and talented individual,” said John Albers, DVM, execu-tive director of AAHA. “AAHA will forever be indebted to Anna’s unwav-ering devotion and leadership to the association and to our profession.” A 1978 graduate of the University of Pennsylvania School of Veterinary Medicine, Worth, with her husband, served as a director and owner of West Mountain Animal Hospital, an AAHA-accredited practice in Shaftsbury, Vermont, for more than 25 years. Worth was AAHA president from 2008 to 2009 and had served on the association’s board of directors since 2002. She was also heavily involved in other aspects of the association. Worth was instrumental in the creation of the AAHA Helping Pets Fund. Worth had an active interest in animal welfare and was a past presi-dent of the Society for Veterinary Medical Ethics, as well as past chair to the Vermont Animal Cruelty Task Force, the Vermont Animal Welfare Committee, and the Euthanasia Board for Animals. The Massachusetts Society for the Prevention of Cruelty to Animals presented her with the Veterinarian of the Year Award in 1992. She was also active in her state association and within her local community. Worth is survived by her husband, Bob Bergman, VMD; son, Bo Bergman, DVM, his wife, Megan, and their newborn daughter, Anna Frasier; and daughter, Sarah M. Bergman. In lieu of fl owers, contributions in memory of Anna Worth can be made to the AAHA Helping Pets Fund online at www.aahahelpingpets.org or to the Southwestern Vermont Regional Cancer Center.

Adapted with permission from AAHA.

Anna WorthPast President of AAHA

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