HVTA Update

  • Our goal is to get as many eligible techs grandfathered in as RVTs as possible. So far only 3 have done it! This is the YEAR to get them studying. That way they can take the VTNE in 2020 and beat the 2021 cut-off. Study sessions are on the HVTA website and on the Events tab of our FB Page.
  • We have a FAQ page for anyone who might have questions about grandfathering.
  • Last, we have Clinic/Facility Membership that allows clinics and hospitals to show support for HVTA, post jobs, and we put their clinic name/logo into our newsletter.

Submitted by Sam (Craddock) Geiling, RVT, President, Hawaii Veterinary Technician Association

Rat Lungworm Disease Workshop

The University of Hawai`i at Hilo invites the public to the 6th International Scientific Workshop on Angiostrongylus cantonensis and Angiostrongyliasis (rat lungworm disease), held January 5-8, 2020, at the Hilo Hawaiian Hotel. Dr. Richard Malik (PhD, DVM) of the University of Sydney’s Centre for Veterinary Education will be leading discussion sessions for veterinarians on detection, treatment, and prevention of rat lungworm disease in domestic animals, wildlife, and livestock. There is no fee, but all attendees must register by September 1st at https://hilo.hawaii.edu/conferences/rat-lung-worm-2020/. Case study presentations are also welcome; abstracts due September 1st. For additional information, contact rlwlab@hawaii.edu.

Conference Registration Open

Registration is open for our 66th Annual HVMA Conference, which will be held from November 7-10, 2019 at the Hilton Waikiki Beach Hotel. We are again offering over 80 hours of RACE-approved CE (up to 27 credits for vets and 16 credits for vet techs) and bringing in world-renowned speakers covering a variety of topics including cardiology, oncology, sports medicine, equine medicine, soft tissue surgery, infectious disease, exotics, essential oils, wellness, the opioid crisis, and emergency & critical care.

Our wet lab offerings include orthopedic labs by Brian Beale and Don Hulse, a small diameter endoscopy lab by Carrie Palm and Sean Hulsebosch, dental radiograph positioning and interpretation labs by Kevin Stepaniuk, and a laser lab by Yukiko Kuwahara.

During the conference, we will hold our annual HVMA Hui on Saturday November 9 at 12:00pm during lunch. You do not need to be a conference attendee to come to the meeting. During the meeting, we will provide an update on what the HVMA has been doing this past year as well as overview any important legislative and island news. If you are interested in sharing anything during this time, please email us.

Also on Saturday November 9 from 6-8pm we will be hosting our annual social cocktail party. Tickets to this event are $60 or complimentary with full conference registration.

Register online for early bird pricing by September 15th. Remember to log in to your HVMA online account to register at the reduced member rates. If you have forgotten to renew your membership for 2019, it’s not too late! We hope you and your staff can join us!

Pesticides Rules Change

§4-66-54 of the Hawaii Administrative Rules is being updated by the Hawaii Department of Agriculture Pesticides branch to mandate that “every retailer that sells or distributes pesticide products to the public shall prominently post within ten feet of any pesticide product display or sales area, a warning sign that includes:

  1. Information regarding the proper handling, storage, and disposal of all pesticides sold;
  2. Emergency telephone numbers to call in case of poisoning from the pesticides; and
  3. A statement that use of any pesticide product in a manner inconsistent with its label is prohibited by law.

The warning sign shall be no less than seventeen inches by twenty two inches and contain lettering of sufficient size, no less than sixteen point bold type, which will enable the sign to be read from a distance of six feet under all lighting conditions normally encountered during business hours.”

The rules have not yet been signed as law by the governor but are expected to be signed some time in the May-June timeframe. These rules will affect
retailers that sell pesticides in any form (flea collars, topical medicine, etc.).

Sample signage wording below:

  1. For the proper handling, storage, and disposal of a pesticide product as required by Federal and State law, please refer to its label.
  2. In case of pesticide poisoning, please call the National Poison Control Center at 1-800-222-1222.
  3. It is a violation of Federal and State law to use any pesticide product in a manner inconsistent with its label.

[Pesticide product signage as required by Hawaii Administrative Rules(HAR) 4-66-54(d).]

For more information, please see the Department of Agriculture website.

Honolulu Street Dog Coalition

The Street Dog Coalition is a Colorado-based nonprofit founded by veterinarian Jon Geller whose mission is to provide free veterinary care and related services to pets of people affected by homelessness. Dr. Geller began providing care through street clinics in Ft. Collins in 2015 and has since expanded to mentor and provide supplies to licensed, volunteer veterinarians willing to lead clinics in their communities. The Street Dog Coalition partnered with the AVMA in July for a clinic at the Denver convention in July, read more about it here.

The Honolulu Street Dog Coalition clinics are led by Aleisha Swartz, DVM, and have started providing veterinary care such as vaccinations, parasite control and treatment of minor medical concerns at the new Punawai Rest Stop in Iwilei. The facility was built by the City and County of Honolulu and is a pet-friendly hygiene center where people can do laundry, take showers, receive mail and access social services.

The number of pets belonging to people affected by homelessness is unknown but is estimated to be approximately 10%. For the first time the 2019 Hawaii Homeless Point in Time Count survey asked people if they had pets; this information should be available in the spring.

If you are interested in more information on how to support this effort, volunteering at the Honolulu Clinics, or starting a clinic on a neighbor island, contact Aleisha at honolulu@thestreetdogcoalition.org. Support staff are welcome to volunteer. For more information about The Street Dog Coalition visit their website.

Rat Lungworm Disease in Hawaii

In November and December 2018, two young dogs in the Honolulu area were diagnosed with Rat Lungworm Disease, caused by Angiostrongylus cantonensis. Both puppies presented with spinal hyperesthesia, hindlimb weakness, and proprioceptive ataxia. One dog had peripheral eosinophilia; all other hematology and serum biochemistry tests were unremarkable. Plain radiographs and computed tomography scans (with/without) contrast were performed but did not reveal a cause for the neurologic signs. Cerebrospinal fluid analysis in both patients revealed eosinophilic pleocytosis and real-time PCR testing for Angiostrongylus cantonensis on CSF was positive in both dogs, confirming a diagnosis of neural angiostrongylisias; PCR testing for other canine neural pathogens was negative.

Both dogs responded rapidly to treatment with corticosteroids and recovered clinically within 2 weeks. Neither dog was observed ingesting a snail or slug, but both dogs had environmental access to them. Dr. Richard Malik (University of Sydney) spoke on this topic in May 2018 and recommends treating with corticosteroids (up to 6 weeks), +/- anthelmintics (if early infection when the larvae are still small and not yet in the CNS), and pain medication or other symptomatic care as needed. He also recommends antibiotics to address the issue of translocated bacteria carried by migrating larvae.

If you have any suspected cases or have questions regarding diagnosing, treating, or preventing rat lungworm infection in dogs or other animals, please call Dr. Jenee Odani (Extension Veterinarian) at 808-956-3847 or email jsodani@hawaii.edu. She is especially interested in conducting post mortem testing on suspected cases.

Submitted by:
Jenee S. Odani, DVM, DACVP
Associate Specialist: Veterinary Extension
Pre-Veterinary Medicine Program Advisor
College of Tropical Agriculture and Human Resources/HNFAS
University of Hawaii

Hawaii Veterinary Emergency Response

HVMA is working with the Hawaii Emergency Management Agency (HI-EMA) to support local and state disaster preparedness pertaining to animals. Would you be interested in volunteering in the event of an emergency? Would you be interested in being part of the working group developing a set of guidelines for animal care and treatment and considering the formation of a Veterinary Medical Reserve Corps or Companion Animal Response Team? Please help us gauge member interest by taking our survey below.

Feline Fix by Five Campaign

Why the change in recommended age of sterilization of cats?

Philip A. Bushby, DVM, MS, DACVS

In June of 2017, the AVMA formally endorsed the consensus document put forth by the Veterinary Task Force on Feline Sterilization for Age of Spay and Neuter Surgery, which recommends cats not intended for breeding be gonadectomized by five months of age. This joined endorsements from other veterinary medical and cat breeding associations including the
American Association of Feline Practitioners, Association of Shelter Veterinarians, American Animal Hospital Association, Winn Foundation, Catalyst Council, Cat Fancier’s Association and The International Cat Association. Feline Fix by Five (FFF) is a campaign promoted by the
Marian’s Dream Foundation to share this recommendation that has garnered such broad support. FFF was born out of awareness that cats can be reproductively active by 4 to 5 months of age, yet most veterinarians recommend spay/neuter of cats at 6 months of age or older. The
result of this mismatch between age at which cats can become pregnant and the recommended age of sterilization is demonstrated any time one walks into a local animal shelter.

Animal shelters are generally overrun with kittens, the vast majority of which are the result of unplanned and unexpected pregnancies of young cats. A survey conducted in the State of Massachusetts revealed surprising results. While many people believe that pet-overpopulation is the result of pets that are left intact for their entire life, the opposite is true. Cats that were eventually spayed accounted for 87% of all litters born. [1]

Cat owners who are unsure of when to have their cat sterilized or simply wait until 6 months of age or later are faced with the dilemma of what to do with an unexpected litter of kittens. Too often those kittens are relinquished to local shelters and too often those kittens are euthanized. The problem was not that the owners refused to spay or neuter their pet; it was that they didn’t have it done in time.

Esther Mechler of the Marian’s Dream Foundation, who initiated the FFF campaign, has stated that “the number of births prevented – simply by changing the recommended age for spay/neuter of cats from 6 months to between 4 and 5 months – could reduce the numbers of shelter intakes enough to balance the number of potential adopters with available cats and
kittens. We could end the overpopulation of cats by this one simple change.” [2]

As a profession, we need to recognize that there is, at present, no scientifically sound basis for waiting until 6 months of age or older to sterilize cats and no contraindications for spay/neuter at 4 to 5 months of age. Anesthetic concerns about juvenile surgery voiced in the 60s and 70s
are no longer valid. There are many anesthetic drugs and protocols in use today that are safe in cats as young as 6 weeks of age. Old fears that castration of juvenile male cats would predispose to urinary obstruction were disproven in the 90’s. [3]

There are numerous known health benefits for spay/neuter in cats, in addition to the population management benefits, and there is “no evidence to suggest that pediatric gonadectomy by 5 months of age is linked to any
increased risk of disease.” [4] A survey conducted in 2000 of veterinarians who were, at that time, spaying and neutering cats under 5 months of age, confirmed that the surgeries were easier, faster, and had fewer complications than spay/neuter of cats at 6 months of age or older. [5]

So, what should the practicing veterinarian do to make this change? Simply add one more appointment to your standard kitten wellness protocols. Make no changes in current vaccination and parasite control recommendations except add an appointment for spay/neuter two to three weeks after the last kitten vaccination. Owner compliance will be increased,
surgeries will be easier, and, in time, local shelters will not be overrun with kittens.

For more information on Feline Fix by Five go to http://www.felinefixbyfive

For more information on the AVMA’s position on spay neuter go to
http://www.avma.org/spayneuter

1. Manning MM & Rowan AN, Companion animal demographics and sterilization status: Results from a survey in four Massachusetts towns. Anthrozoos 5 (3).
2. Esther Mechler, Personal Communication, October 25, 2017.
3. Stubbs WP Scrugges SL, et al BMS. Prepubertal gonadectomy in the domestic feline: Effects on skeletal, physical and behavioral development. Vet Surg. 1993;22.
4. Dale S. When to Spay/Neuter Cats? Vet Consensus Says Fix by Five Months. Vet Pract News. 2016.
5. Land TDVM, Wall SDVM. Survey of the Coalition of Spay/Neuter Veterinarians. J Am Vet Med Assoc. 2000;216(5).

The Use of Drugs in Food Animal Species

Christie Balcomb, BVSc, DACVIM
YourVet Maui
1476 S. Kihei Rd, Kihei, HI 96753
(808) 879-5777
Email: Christie@yourvetmaui.com

The use of medications in food-producing animals can have some challenges, as current demographics seem to be shifting for more people to have livestock as pets and other food-producing animals that are treated more as companion animals than in the past. Livestock are being kept as pets in more urban settings and will likely be seen by veterinarians that treat solely companion animals. Some owners are more willing to pursue medical and surgical treatment for these animals such as backyard chickens or pet goats. However, the Federal Drug Administration (FDA) designates “food animals” as any species that are raised and used for food production or consumption by humans. The species considered to be Major food animal species include: Cattle, Swine, Chickens and Turkeys. Minor species include sheep, goats, camelids, aquaculture species and honeybees, and rabbits. There are several important regulatory distinctions made between Major and Minor food animal species.

“Food-producing animals” are animal species or classes that are used to create a food or food by-product that does not require slaughter, such as milk (also used to make cheese and butter), eggs and honey.1

It is important to note that the FDA does not recognize the owner’s intended purpose of the animal, such as companion miniature pigs versus commercial pig breeds, and all fall under the classification as a Major food animal species. So, even if the animal is considered by the owner as a pet, rather than a production animal, the government regulations and restrictions still apply. Unfortunately, veterinarians cannot always guarantee the outcome and disposition of an animal for the rest of its life.

Extralabel drug use (ELDU) is allowed under the American Medicinal Drug Use Clarification Act (AMDUCA) of 1994, as long as certain requirements are met, including the existence of a valid Veterinary Client Patient Relationship (VCPR). 2-4

Extralabel use is defined as the use or intended use of a drug that is not in accordance with the approved labeling in regards to:

  1. Species
  2. Indication
  3. Dose rate
  4. Dose frequency
  5. Route of administration

For ELDU in Food Animal Species, the following requirements must be met:

  1. There is no approved animal drug labeled for use for that species, indication, dose rate and concentration. [An approved human drug must not be used in extralabel fashion if an approved animal drug exists that can be used in an extralabel fashion]
  2. There must be a diagnosis based on evaluation of the condition suspected
  3. Establish an appropriately extended withdrawal time prior to sale or consumption of milk, eggs, meat or edible products
  4. Maintain records to identify the treated individual
  5. Take precautions to ensure that the established extended withdrawal times are met to prevent any violative residues are found in products to enter the food chain

As clinicians, we are often faced with challenges, as many of the species that we treat are not listed on the label of many veterinary medications, and thus we need to use drugs in an extralabel fashion.  As such, we are also very dependent on scientific data and utilizing the Food Animal Residue Avoidance Database (FARAD) is an essential tool to ensure that we are following the appropriate requirements of ELDU as defined by AMDUCA.

FARAD is a USDA-funded university-based consortium that is overseen and operated by faculty and staff within the Colleges of Veterinary Medicine at the University of California-Davis, the University of Florida, Kansas State University, North Carolina State University and Virginia-Maryland College of Veterinary Medicine. FARAD is a great resource for veterinary practitioners to provide guidance and advice to avoid violative residues in animal products intended for human consumption. The program provides a hotline for requests, as well as online submission of withdrawal times, and a wealth of information on the use of medications in both major and minor use species.  It is highly recommended for any extralabel drug use in a food animal or food-producing animal species to submit a request for appropriate withdrawals to avoid violative residues. For example, the labeled dose rate of procaine penicillin is considered now to be subtherapeutic, and thus it is common for clinicians to use much higher dose rates or frequency of administration, and thus the withdrawal times can extremely prolonged compared to what is listed on the label.5 Current updates on prohibited and restricted drugs used in food animals can be found on their website: http://www.farad.org/prohibited-and-restricted-drugs.html.

The purpose behind many of the major and minor designations and regulations is to protect public health and food safety. Drugs and drug classes that have been prohibited for use in these species have been found to cause potential disease or harm to humans through exposure, or do not have an acceptable analytical method established. Other restricted drugs include classes of antimicrobials that are considered important for human health, and extralabel use of these medications may put the public at risk if antimicrobial resistance develops. In the next few years, it is likely that these regulations will grow to include other antimicrobial classes, or restrict their use further in an attempt to slow the tide of antimicrobial resistance in bacteria.

Violations of these regulations could end up with a consequence of drug residues in food products, which may have health implications for the humans consuming these products. Any products sold to the product could be considered a liability issue due to sale of an adulterated product into the human food chain.6 For those food animals considered as pets, administration of a prohibited antimicrobial may result in transmission of bacteria with resistance to that microbial to the rest of the flock or to the owners, themselves. Other options of antimicrobials with similar spectrum of activity may be available to use in ELDU, rather than these prohibited drugs.

In conclusion, as veterinarians that may practice on both companion and production animals, it can be challenging to adhere to FDA regulations for certain medications, such as the prohibition of any ELDU of fluoroquinolone antibiotics in any food animal species. It can also be uncomfortable to mention the term “food animal” species to a client who has a sanctuary for farm animals that will not be entering the food chain, and some clients may be offended. However, as part of the ELDU requirements, keeping records with some acknowledgement of withdrawal times for food products must be written. It may be more palatable to clients if there is a written statement about the FDA requirements based on species, but understanding that this animal is considered a pet. Finally, FARAD can be an extremely useful resource in case of determining withdrawal periods in case of historical administration, or pre-emptive research to provide the best estimate based on scientific literature. The FARAD digest publications have useful summaries of ELDU in backyard poultry, small ruminants and other species.6-10 FARAD is not a regulatory or governing body, but a program to help support veterinarians maintain public health and food safety.

FARAD Contact Info
Website: www.farad.org
Hotline: 1-888-873-2723

Please also feel free to contact Extension Veterinarian Jenee Odani to discuss any issues: jsodani@hawaii.edu or (808) 956-3847.

Drug or drug class Special considerations
Antiviral drugs – adamantane and neuraminidase inhibitors Prohibited ELDU in all poultry
Cephalosporins Except for cephapirin, any ELDU in MAJOR species (cattle, swine, chickens, turkeys) is prohibited. ELDU in MINOR use species is permitted.
Chloramphenicol Any use is prohibited in food animals
Clenbuterol Any use is prohibited in food animals
Diethylsilbesterol (DES) Any use is prohibited in food animals
Fluoroquinolones ELDU is prohibited in all food animal species (MAJOR and MINOR)
Gentian Violet Any use is prohibited in food animals
Glycopeptides Any use is prohibited in food animals (e.g. vancomycin)
Indexed drugs 11 Some use permitted in MINOR species
Medicated feeds Any ELDU prohibited – Veterinary Feed Directive 2017
Nitrofurans Any use is prohibited in food animals (e.g. topical use of nitrofurazone)
Nitroimidazoles Any use is prohibited in food animals (e.g. metronidazole)
Phenylbutazone Prohibited in dairy cattle >20 months
Sulfonamides * Use in milking sheep and goats is discouraged; Prohibited in dairy cattle >20 months, except for approved labeled use
Table adapted from FARAD http://www.farad.org/prohibited-and-restricted-drugs.html, updated 7/16/2018

 

References:

  1. FARAD. Available at www.farad.org. Accessed on 9/30/2018.
  2. US FDA. Animal Medicinal Drug Use and Clarification Act (AMDUCA) 1994. Available at: https://www.fda.gov/animalveterinary/guidancecomplianceenforcement/actsrulesregulations/ucm085377.htm. Accessed on 9/30/2018
  3. Extralabel drug use in animals. 21 CFR 530.
  4. AVMA. VCPR. Available at: https://www.avma.org/KB/Resources/Reference/Pages/VCPR.aspx. Accessed 9/30/2018.
  5. DeDonder KD, Gehring R, Baynes RE et al. Effects of new sampling protocols on procaine penicillin G withdrawal intervals for cattle. JAVMA 2013, 243:10, 1408-1412.
  6. Marmulak T, Tell LA, Gehring R et al. Egg residue considerations during treatment of backyard poultry. JAVMA 2015, 247:12, 1388-1395
  7. Webb A, Baynes RE, Craigmill AL et al. Drugs approved for small ruminants. JAVMA 2004, 2224:4; 520-523
  8. Baynes RE, Payne M, Martin-Jimenez T et al. Extralabel use of ivermectin and moxidectin in food animals. JAVMA 2000, 217:5, 668-671
  9. Riveiere JE, Tell LA, Baynes RE et al. Guide to FARAD resources: historical and future perspectives. JAVMA 2017, 250: 10, 1131-1139
  10. Davis JL, Smith GW, Baynes RE et al. Update on drugs prohibited from extralabel use in food animals. JAVMA 2009, 235:5, 528-534
  11. US FDA. Index of legally marketed unapproved new animal drugs for minor species. https://www.fda.gov/AnimalVeterinary/DevelopmentApprovalProcess/MinorUseMinorSpecies/ucm125452.htm. Accessed 9/30/2018.