CONNECTEDYo u r L i n k to V e t e r i n a r Y S P e C i a Lt Y H o S P i ta L | aPr–Jun 2016

SAN DIEGO 10435 Sorrento Valley Rd San Diego, CA 92121 | NORTH COUNTY 2055 Montiel Rd San Marcos, CA 92069 | www.vshsd.com

MEDICAl EvAlUATION Of CONGENITAl HEpATIC DISEASE IN DOGSIN THIS ISSUE:

VSH BLood BankCLiniCaL triaLSuPComing eVentS

For more details about these and other clinical trials, please visit our website at www.vshsd.com.

Please join us in support of the following organizations.

in our CommunitY

Dermatology – Topical Therapy for Acral lick DermatitisWe are recruiting patients for participation in a placebo-controlled clinical trial evaluating the efficacy of a topical steroid-free spray in the treatment of Acral Lick Dermatitis. The lesion should receive no treatment within 2 weeks prior to enrollment. Four visits will be required. All costs will be covered by the study.

Contact the Dermatology Service at derm@vshsd.com

Dermatology – Topical Therapy for “Hot Spots”The Dermatology Service is recruiting patients for participation in a placebo-controlled clinical trial evaluating the efficacy of a topical steroid-free spray in the treatment of acute pyotraumatic dermatitis (“hot spots”). The lesion should receive no treatment prior to enrollment. Two visits will be required. All costs will be covered by the study.

Contact the Dermatology Service at derm@vshsd.com

Dermatology – Blood Samples from felines with History of Allergic Skin DiseaseThe Dermatology Service is recruiting otherwise healthy cats with a history of any allergic skin disease for collection of a blood sample to be used in a study of feline allergy. Patients with manifestations of eosinophilic granuloma complex (indolent or rodent ulcers, eosinophilic plaques, eosinophilic granulomas) can be included. Subjects may not have received oral cyclosporine, oclacitinib, oral prednisone, or short-acting glucocorticoids for 2 weeks prior to their visit, and may not have received long-acting injectable glucocorticoids for 6 weeks prior to their visit.

Contact Dr. Laura Stokking at laura.stokking@vshsd.com

Internal Medicine – Glomerular Disease StudyVSH is participating in a multi-center prospective study evaluating increased dosing of enalapril in dogs with glomerular disease. Client incentives include reduced cost of some initial testing and no cost for scheduled recheck visits and tests.

Contact Dr. Julie Fischer at (760) 466-0600

Internal Medicine – Glucocorticoids and spec cpl studyPatients who will be started on glucocorticoids (minimum dose of 0.5mg/kg/day) and will need to be on them for at least 3 weeks. Patients will receive a spec cPL prior to administration of any glucocorticoids and at least 3 weeks after starting glucocorticoid therapy at no charge.

Contact Drs. Sarah Cocker or Keith Richter at (858) 875-7500

Internal Medicine – feline IBD/GI Small Cell lymphoma Study and proteomics StudyWe are enrolling cats with chronic gastrointestinal disease that are suspected of having either inflammatory bowel disease (IBD) or gastrointestinal small cell lymphoma (GI SC LSA). Endoscopy will be performed and GI biopsies will be obtained for histopathology, immunohistochemistry (IHC) and PCR for antigen receptor rearrangements (PARR). A 3 week follow-up will be required. Blood, urine, and fecal samples will be collected for proteomic analysis at the time of endoscopy and follow-up visit. The cost of the histopathology, IHC and PARR is funded. GI panel is also funded by the proteomic study.

Contact Drs. Betty Chow, Steve Hill or Keith Richter at (858) 875-7500

*NEW* Oncology – Canine Osteosarcoma, post-Amputation, post-Carboplatin ChemotherapyEvaluating a novel therapeutic for dogs with canine osteosarcoma, post-amputation, post-carboplatin chemotherapy. It is acceptable if chemotherapy administration has been done elsewhere.

Contact Dr. Brenda Phillips at (858) 875-7500

Oncology – funded Trial for Dogs with CancerClients enrolling and completing a study evaluating the use of a probiotic along with chemotherapy will receive funding toward doxorubicin chemotherapy. Some breed or patient exclusions may apply.

Contact Dr. Andi Flory at (760) 466-0600 or (858) 875-7500

Continued on back page…

announCementSWe welcome Dr. Matt Cleveland as our newest board-certified surgeon! Some of you might have met him when he was here in 2011 as a specialty surgery intern. He went on to Angell Animal Medical Center for a 3-year residency training program, joining us last fall and successfully passing his boards this March. Dr. Cleveland has had broad surgical training leading to strong clinical interests in orthopedic surgery, including TPLO (Tibial Plateau Leveling Oste-otomy) and TTA (Tibial Tuberosity Advancement) procedures for surgical treatment of cranial cruciate ligament pathology, as well as joint replacement surgeries. Additionally, he has a strong interest in surgical oncology, and minimally invasive procedures including laparoscopy, thoracoscopy, and arthroscopy.

VSH had very good representation at the recent Comparative Gastroenterology Society GutSki meeting in Winter Park, Colorado with 6 attending and 4 presenting abstracts. Drs. Steve Hill, Lauren Cochran (resident), Sarah Cocker (resident) and Christopher Greenwood (intern) presented abstracts at the meeting. The other attendees were Drs. Keith Richter (Meeting Director) and Kate Arnell who are both on the CGS board of directors. Additionally Dr. Greenwood was awarded the intern travel award for this meeting. VSH representation was second only to the Texas A&M GI Lab and we were not far behind them.

10435 Sorrento Valley Rd Suite 100

San Diego, CA 92121

San Diego: 858 875 7500 San Marcos: 760 466 0600

For more information on Continuing Education events, please visit vshsd.com/Veterinarians or contact Ann Ong at (858) 875-7544 or ann.ong@vshsd.com.

TAKE NOTEcURRENT cLINIcAL TRIALs SaVe tHe date

vSH 6th Annual Symposiumapril 17, 2016 8:00 am - 4:30 pm: Symposium Lectures, Sponsor Visits, Lunch 4:30 pm - 5:30 pm: Join us for Happy Hour! University of San Diego Joan B. Kroc Institute for Peace & Justice Multiple Educational Tracks for Veterinarians, Technicians, Practice Management /Front Office Staff!

We’re LiSteningReceiving timely notifications on the status of your patients has been a past concern. We have revamped our internal processes and you should all be receiving discharge information on your patients within 24 hours. If not, please let us know. Timely communication with you is one of our top priorities.

Sunday, May 1 | 1 pm to 5 pm FaCe Foundation’s 6th annual Bags & Baubles Silent auction Fundraiser Private Estate, Rancho Santa Fe

Saturday, May 7 | 7 am to 12 noon San diego Humane Society Walk for animals NTC Park at Liberty Station, San Diego

Saturday, May 21 | 8 am – 1 pm tails on the trails Beneficiaries include tri-City medical’s Pet therapy Program, oceanside Police dept. k-9 unit Mance Buchanon Municipal Park, Oceanside

Sunday, June 5 | 10 am – 4 pm rB alive! Street Fair Rancho Bernardo, CA

Oncology – Quality of life for Cats with GI lymphomaThis is a trial that will lead to the design of a validated quality of life survey tool for cats with GI lymphoma. This will enable the profes-sion to study different interventions that may impact quality of life. Clients will be required to fill out survey information to develop this tool. If you have an UNTREATED cat with GI lymphoma (or suspect GI lymphoma), they are eligible to participate.

Contact Drs. Brenda Phillips or Keith Richter at (858) 875-7500

*NEW* Surgery – post-Operative pain StudyWe are currently enrolling patients in a postoperative pain study looking at liposomal encapsulated bupivacaine. Dogs qualify if they are receiving a total hip replacement, femoral head and neck excision or amputation. The dogs need to be hospitalized for 3 days post procedure and the owners receive $1000 credit to the bill.

Contact Drs. Sean Aiken or Katy Fryer at (858) 875-7500

CLiniCaL triaLS, Cont.

RIchTER scALEHello Friends and Colleagues:

I hope you are all looking forward to Spring and Summer as we are here at VSH.

Some news and reminders: Our 6th Annual Symposium is scheduled for Sunday

April 17th. Despite a record number of registrations, there is still room available

for some last minute veterinarian attendees. The Technician Program has also had

a record number of registrations. The program promises to be outstanding, with a

speaker-wide commitment to the theme of “Clinical Pearls,” so that you can take

home information that you can use immediately. The headline keynote speaker

will be Dr. Mark Kittleson, Professor Emeritus at U.C. Davis. His topics will be

“The Golden Rules for Distinguishing Pulmonary Edema from Chronic Bronchitis in

Small Coughing Dogs with a Heart Murmur” and “Feline Hypertrophic Cardiomyo-

pathy.” In addition to Dr. Kittleson and several other guest speakers, many VSH

specialists will be speaking to round out the multi-track scientific program. There

will also be opportunities for you to socialize with your colleagues and VSH

specialists at the new Happy Hour following the scientific program. All of the top

vendors are also attending for plenty of interaction. The spectacular University of San Diego setting always makes this

a unique event. We have received comments in the past saying, “I wish I could be in 3 places at the same time.” Well,

we are recording two of the Veterinarian Tracks and the Management Track (“the Human Side”) which will be made

available to all attendees.

As painful as it is coming from an internist, I’d like to give a “shout out” to the VSH Surgery Department. The most

important thing I want to highlight, and what I like most about being at VSH, is our team approach. You can send cases

to one of our surgeons, and have your clients get input from neurology, dermatology, ophthalmology, oncology, medi-

cine, or any of our specialties, simultaneously coordinated by us. Our surgeons tackle complicated oncologic surgery and

have seamless integration with our medical and radiation oncologists. They do complicated ureteral surgery and have a

close and collaborative relationship with the U.C. Davis group in our building. Our critical cases are expertly managed by

our anesthesiologist (Dr. Hopkins) and team of critical care specialists. Another unique feature of our Surgery Depart-

ment is that we have board certified surgeons on call for ER cases 24/7/365. We are the leaders of hip replacement

surgery in the Western USA. Also, several of our surgeons have special interests in minimally invasive surgery (arthros-

copy, laparoscopy, and thoracoscopy). This department is definitely cutting edge (excuse the pun)!

My last reminder is that our radiologists, Drs. Sunico and Shanaman, are now set up to perform outpatient ultrasound

examinations (where you maintain the direction of case management) and teleradiology interpretations. Just give either

of them a call to get set up.

By the time you read this, the Padres will already be in first place, lead in every statistical category, be installed as a

heavy betting favorite to win the World Series, and have all the pundits talking about how they greatly underestimated

our talent. Or, maybe my credibility is not as strong as I thought??

Keith Richter, DVM, MSEL Diplomate ACVIM

The two most common types of congenital hepatic disease include portosystemic vascular anomalies (PSVA) and microvascular dysplasia (MVD, now technically termed portal vein hypoplasia without a macroscopic anomaly). The clinical course and treat-ment options differ depending on the underlying disease, and an accurate diagnosis is essential for future management and prognosis. Most affected dogs will have a mildly but variably elevated ALT, and may be symptomatic (variable for PSVA) or asymptomatic (almost always true for MVD, and variable for PSVA). The following tests are commonly utilized to differentiate between these two congenital diseases.

pre- and post-prandial Bile Acids TestBile acids are produced by the liver, secreted into the biliary system, released into the duodenum to help digest fats, then resorbed by the ileum into the portovenous circulation, and re-excreted into bile. This test is easy to perform, and only requires a pre-testing 12-hour fasting period and two blood samples drawn two hours apart. We are most concerned about the post-prandial bile acids result, with dogs having hepatobiliary disease typically showing elevated (>25 umol/L) levels. Normal bile acids concentrations levels do not rule out hepatobiliary disease, although most dogs with PSVA will have markedly elevated post-prandial concentrations (usually >100 umol/L) and dogs with MVD will have mild to moderately elevated concentra-tions. Occasionally, the pre-prandial bile acids levels are higher than the post-prandial levels (this has no diagnostic significance; just go by the highest value); this is likely due to inadequate pre-testing fasting, spontaneous gallbladder contraction, differing gastric emptying or intestinal transit times, or varying cholecys-tokinin release. Results can also be affected by exogenous bile acids, mainly ursodeoxycholic acid (ursodiol), which need to be discontinued for at least 48 hours prior to measure serum bile acids. Finally, Maltese and Maltese mixes may have elevated post-prandial bile acids in the absence of hepatic disease; this is likely due to substances within their blood that interfere with the assay.

Abdominal Ultrasound ExamThe sensitivity of ultrasound exams for differentiating between a PSVA or MVD is largely dependent on the ultrasonographer/machine, however this can be a relatively sensitive test (up to 97% sensitivity in experienced hands). Ultrasound is used to visualize a definitive extra- or intra-hepatic PSVA, as well as assess for microhepatica, decreased hepatic vascularity, renomegaly, nephroliths or cystoliths (most commonly ammonium urate), acquired hepatic shunts, and abdominal effusion. Two ultrasono-

graphic measurements have been shown to help differentiate between a PSVA and MVD; a PV:Ao (portal vein to aorta) ratio ≥ 0.65 is most consistent with an extra-hepatic portosystemic shunt, and a PV:CVC (portal vein to caudal vena cava) ratio ≥ 0.75 helps to rule out an extra-hepatic PSS.

protein C Activity AssayThis assay is now available through Cornell University, and helps to further differentiate between dogs with PSVA and MVD. Protein C is a plasma anticoagulant factor synthesized by the liver, and protein C deficiency can be a marker for hepatic dysfunction. Decreased protein C activity develops in dogs with PSVA and hepatic synthetic failure, and a level < 70% supports a diagnosis of PSVA, whereas activity greater than 70% are more typically seen in dogs with MVD. The protein C level requires 1ml separated citrated plasma and the laboratory cost is $37.50. Samples are run daily Mon-Fri, so the turn-around time is fairly quick.

Transplenic or Rectal ScintigraphyThese tests involve a nuclear scan that measures radioactive uptake by the heart and liver after the technetium pharmaceutical is given by rectal enema or a splenic injection.

A shunt fraction is calculated after determining the relative uptake. Normal dogs have a shunt fraction <15% (>85% of the blood goes to the liver first rather than the heart), whereas dogs with a PSVA typically have a shunt fraction >65% (<35%of the blood goes to the liver first rather than the heart). Usually only mild sedation at most is required. Nuclear scintigraphy can determine whether or not a PSVA is present with very high sensitivity, though does not provide anatomic detail.

Abdominal CT ScanThis is the most sensitive test for the evaluation of PSVA. It does require anesthesia and is the most costly test to perform, however it can accurately determine if a PSVA is present and elucidate the specific location by providing anatomic detail; this is essential to assess if surgery is an option and for surgical planning.

Hepatic BiopsyUltimately, a liver biopsy is the only means of determining the specific etiology for elevated hepatic enzymes and hepatic function tests when a macroscopic shunt is ruled out. A liver biopsy cannot differentiate between a PSVA and MVD, so the aforementioned tests are always recommended if there is concern for a PSVA.

Transfusion of blood products to dogs and cats plays a crucial role in the practice of emergency and critical care of patients with anemia, thrombocytopenia or coagulopathies. Blood transfusions have commonly been performed with whole blood from dog or cat donors. However with advancing critical care medicine and growing transfu-sion demands, component therapy is becoming more commonplace.

Component therapy is the separation of whole blood, using a specialized centrifuge, into its cellular and plasma components to allow directed replacement of the patient’s needs. Typically, 2-3 products can be created from a single dog or cat donation. For example, red blood cells administered to anemic patients directly restore oxygen carrying capacity without administration of plasma. The plasma from this donation may be administered to another patient with hemorrhage due to anticoagulant rodenticide ingestion. Component therapy reduces the risk of transfusion reactions such as fluid overload and acute immunologic reactions that may result from unnecessary product administration.

Veterinary Specialty Hospital is proud to announce the on-going development of our blood donor program. Since June 2015, we are able to offer component therapy to tailor treatment plans specific to each patient in need of blood product transfusions. This includes the availability of packed red blood cells, fresh frozen plasma, frozen plasma, cryoprecipitate, cryo-poor plasma, platelet rich plasma, platelet concentrate and leukoreduction. Dogs have an estimated 13 blood types that can be tested, however the DEA 1.1 blood type is one most commonly tested as it carries a high likelihood of causing a transfusion reaction. Cats on the other hand have 3 blood types (A, B, AB). With the wide variety of blood types and patient needs, the program is expanding!

Our blood bank relies on the generous donations of volunteers who meet blood donation requirements. The VSH Blood Donor Program is actively seeking dogs and cats to be part of our life-saving team. Donor dogs should be in good overall health, 1-7 years of age, over 55 pounds, and receiving monthly flea, tick and heart worm prevention. Cats should be in good overall health, 1-7 years of age, over 10 pounds, indoor only, and receiving monthly flea prevention. Dog and cat donors should also have a friendly temperament and be current on all recommended vaccines.

Prior to enrollment, potential dog and cat donors receive a full physical exam by our board certified criticalist(s), Dr. Stephanie Istvan or Dr. Jennifer Willey. A complete blood count, chemistry

profile, infectious disease panel in accordance with published guidelines, and blood type will be submitted to the laboratory as part of the screening process. Owners of canine and feline donors must agree to a one-year commitment to the program and be available for scheduled donations every 6 to 8 weeks. In rare instances, donors might be called upon in an emergency situation to provide fresh products such as fresh whole blood, platelet rich plasma, platelet concentrate or type B feline blood products.

At each donation appointment, our donors receive a complete physical exam by a criticalist and red blood cell count while owners have their choice of several compensation options per donation. Pet owners are welcome to schedule an appointment and wait in the lobby for donation completion or drop their pet off for the day. The blood donation process typically takes approximately 45 minutes. Donors receive fluids, treats and lots of love and attention during their donation. After each donation, component products are produced based on patient needs.

If owners are interested in enrolling their pets in the VSH blood donor program to help save lives, please contact blood.donor@ethosvet.com or visit www.vshsd.com for more information.

MEdIcAL EvALUATION Of cONgENITAL hEpATIc dIsEAsE IN dOgsby KAThARINE ARNELL, dvM, dAcvIM

vsh BLOOd BANK: sAvINg LIvEs, ONE dONATION AT A TIMEby sTEphANIE IsTvAN, vMd, dAcvEcc & NIcOLE EdwARds, RvT

Blood Donor, “Motley Crue”

RIchTER scALEHello Friends and Colleagues:

I hope you are all looking forward to Spring and Summer as we are here at VSH.

Some news and reminders: Our 6th Annual Symposium is scheduled for Sunday

April 17th. Despite a record number of registrations, there is still room available

for some last minute veterinarian attendees. The Technician Program has also had

a record number of registrations. The program promises to be outstanding, with a

speaker-wide commitment to the theme of “Clinical Pearls,” so that you can take

home information that you can use immediately. The headline keynote speaker

will be Dr. Mark Kittleson, Professor Emeritus at U.C. Davis. His topics will be

“The Golden Rules for Distinguishing Pulmonary Edema from Chronic Bronchitis in

Small Coughing Dogs with a Heart Murmur” and “Feline Hypertrophic Cardiomyo-

pathy.” In addition to Dr. Kittleson and several other guest speakers, many VSH

specialists will be speaking to round out the multi-track scientific program. There

will also be opportunities for you to socialize with your colleagues and VSH

specialists at the new Happy Hour following the scientific program. All of the top

vendors are also attending for plenty of interaction. The spectacular University of San Diego setting always makes this

a unique event. We have received comments in the past saying, “I wish I could be in 3 places at the same time.” Well,

we are recording two of the Veterinarian Tracks and the Management Track (“the Human Side”) which will be made

available to all attendees.

As painful as it is coming from an internist, I’d like to give a “shout out” to the VSH Surgery Department. The most

important thing I want to highlight, and what I like most about being at VSH, is our team approach. You can send cases

to one of our surgeons, and have your clients get input from neurology, dermatology, ophthalmology, oncology, medi-

cine, or any of our specialties, simultaneously coordinated by us. Our surgeons tackle complicated oncologic surgery and

have seamless integration with our medical and radiation oncologists. They do complicated ureteral surgery and have a

close and collaborative relationship with the U.C. Davis group in our building. Our critical cases are expertly managed by

our anesthesiologist (Dr. Hopkins) and team of critical care specialists. Another unique feature of our Surgery Depart-

ment is that we have board certified surgeons on call for ER cases 24/7/365. We are the leaders of hip replacement

surgery in the Western USA. Also, several of our surgeons have special interests in minimally invasive surgery (arthros-

copy, laparoscopy, and thoracoscopy). This department is definitely cutting edge (excuse the pun)!

My last reminder is that our radiologists, Drs. Sunico and Shanaman, are now set up to perform outpatient ultrasound

examinations (where you maintain the direction of case management) and teleradiology interpretations. Just give either

of them a call to get set up.

By the time you read this, the Padres will already be in first place, lead in every statistical category, be installed as a

heavy betting favorite to win the World Series, and have all the pundits talking about how they greatly underestimated

our talent. Or, maybe my credibility is not as strong as I thought??

Keith Richter, DVM, MSEL Diplomate ACVIM

The two most common types of congenital hepatic disease include portosystemic vascular anomalies (PSVA) and microvascular dysplasia (MVD, now technically termed portal vein hypoplasia without a macroscopic anomaly). The clinical course and treat-ment options differ depending on the underlying disease, and an accurate diagnosis is essential for future management and prognosis. Most affected dogs will have a mildly but variably elevated ALT, and may be symptomatic (variable for PSVA) or asymptomatic (almost always true for MVD, and variable for PSVA). The following tests are commonly utilized to differentiate between these two congenital diseases.

pre- and post-prandial Bile Acids TestBile acids are produced by the liver, secreted into the biliary system, released into the duodenum to help digest fats, then resorbed by the ileum into the portovenous circulation, and re-excreted into bile. This test is easy to perform, and only requires a pre-testing 12-hour fasting period and two blood samples drawn two hours apart. We are most concerned about the post-prandial bile acids result, with dogs having hepatobiliary disease typically showing elevated (>25 umol/L) levels. Normal bile acids concentrations levels do not rule out hepatobiliary disease, although most dogs with PSVA will have markedly elevated post-prandial concentrations (usually >100 umol/L) and dogs with MVD will have mild to moderately elevated concentra-tions. Occasionally, the pre-prandial bile acids levels are higher than the post-prandial levels (this has no diagnostic significance; just go by the highest value); this is likely due to inadequate pre-testing fasting, spontaneous gallbladder contraction, differing gastric emptying or intestinal transit times, or varying cholecys-tokinin release. Results can also be affected by exogenous bile acids, mainly ursodeoxycholic acid (ursodiol), which need to be discontinued for at least 48 hours prior to measure serum bile acids. Finally, Maltese and Maltese mixes may have elevated post-prandial bile acids in the absence of hepatic disease; this is likely due to substances within their blood that interfere with the assay.

Abdominal Ultrasound ExamThe sensitivity of ultrasound exams for differentiating between a PSVA or MVD is largely dependent on the ultrasonographer/machine, however this can be a relatively sensitive test (up to 97% sensitivity in experienced hands). Ultrasound is used to visualize a definitive extra- or intra-hepatic PSVA, as well as assess for microhepatica, decreased hepatic vascularity, renomegaly, nephroliths or cystoliths (most commonly ammonium urate), acquired hepatic shunts, and abdominal effusion. Two ultrasono-

graphic measurements have been shown to help differentiate between a PSVA and MVD; a PV:Ao (portal vein to aorta) ratio ≥ 0.65 is most consistent with an extra-hepatic portosystemic shunt, and a PV:CVC (portal vein to caudal vena cava) ratio ≥ 0.75 helps to rule out an extra-hepatic PSS.

protein C Activity AssayThis assay is now available through Cornell University, and helps to further differentiate between dogs with PSVA and MVD. Protein C is a plasma anticoagulant factor synthesized by the liver, and protein C deficiency can be a marker for hepatic dysfunction. Decreased protein C activity develops in dogs with PSVA and hepatic synthetic failure, and a level < 70% supports a diagnosis of PSVA, whereas activity greater than 70% are more typically seen in dogs with MVD. The protein C level requires 1ml separated citrated plasma and the laboratory cost is $37.50. Samples are run daily Mon-Fri, so the turn-around time is fairly quick.

Transplenic or Rectal ScintigraphyThese tests involve a nuclear scan that measures radioactive uptake by the heart and liver after the technetium pharmaceutical is given by rectal enema or a splenic injection.

A shunt fraction is calculated after determining the relative uptake. Normal dogs have a shunt fraction <15% (>85% of the blood goes to the liver first rather than the heart), whereas dogs with a PSVA typically have a shunt fraction >65% (<35%of the blood goes to the liver first rather than the heart). Usually only mild sedation at most is required. Nuclear scintigraphy can determine whether or not a PSVA is present with very high sensitivity, though does not provide anatomic detail.

Abdominal CT ScanThis is the most sensitive test for the evaluation of PSVA. It does require anesthesia and is the most costly test to perform, however it can accurately determine if a PSVA is present and elucidate the specific location by providing anatomic detail; this is essential to assess if surgery is an option and for surgical planning.

Hepatic BiopsyUltimately, a liver biopsy is the only means of determining the specific etiology for elevated hepatic enzymes and hepatic function tests when a macroscopic shunt is ruled out. A liver biopsy cannot differentiate between a PSVA and MVD, so the aforementioned tests are always recommended if there is concern for a PSVA.

Transfusion of blood products to dogs and cats plays a crucial role in the practice of emergency and critical care of patients with anemia, thrombocytopenia or coagulopathies. Blood transfusions have commonly been performed with whole blood from dog or cat donors. However with advancing critical care medicine and growing transfu-sion demands, component therapy is becoming more commonplace.

Component therapy is the separation of whole blood, using a specialized centrifuge, into its cellular and plasma components to allow directed replacement of the patient’s needs. Typically, 2-3 products can be created from a single dog or cat donation. For example, red blood cells administered to anemic patients directly restore oxygen carrying capacity without administration of plasma. The plasma from this donation may be administered to another patient with hemorrhage due to anticoagulant rodenticide ingestion. Component therapy reduces the risk of transfusion reactions such as fluid overload and acute immunologic reactions that may result from unnecessary product administration.

Veterinary Specialty Hospital is proud to announce the on-going development of our blood donor program. Since June 2015, we are able to offer component therapy to tailor treatment plans specific to each patient in need of blood product transfusions. This includes the availability of packed red blood cells, fresh frozen plasma, frozen plasma, cryoprecipitate, cryo-poor plasma, platelet rich plasma, platelet concentrate and leukoreduction. Dogs have an estimated 13 blood types that can be tested, however the DEA 1.1 blood type is one most commonly tested as it carries a high likelihood of causing a transfusion reaction. Cats on the other hand have 3 blood types (A, B, AB). With the wide variety of blood types and patient needs, the program is expanding!

Our blood bank relies on the generous donations of volunteers who meet blood donation requirements. The VSH Blood Donor Program is actively seeking dogs and cats to be part of our life-saving team. Donor dogs should be in good overall health, 1-7 years of age, over 55 pounds, and receiving monthly flea, tick and heart worm prevention. Cats should be in good overall health, 1-7 years of age, over 10 pounds, indoor only, and receiving monthly flea prevention. Dog and cat donors should also have a friendly temperament and be current on all recommended vaccines.

Prior to enrollment, potential dog and cat donors receive a full physical exam by our board certified criticalist(s), Dr. Stephanie Istvan or Dr. Jennifer Willey. A complete blood count, chemistry

profile, infectious disease panel in accordance with published guidelines, and blood type will be submitted to the laboratory as part of the screening process. Owners of canine and feline donors must agree to a one-year commitment to the program and be available for scheduled donations every 6 to 8 weeks. In rare instances, donors might be called upon in an emergency situation to provide fresh products such as fresh whole blood, platelet rich plasma, platelet concentrate or type B feline blood products.

At each donation appointment, our donors receive a complete physical exam by a criticalist and red blood cell count while owners have their choice of several compensation options per donation. Pet owners are welcome to schedule an appointment and wait in the lobby for donation completion or drop their pet off for the day. The blood donation process typically takes approximately 45 minutes. Donors receive fluids, treats and lots of love and attention during their donation. After each donation, component products are produced based on patient needs.

If owners are interested in enrolling their pets in the VSH blood donor program to help save lives, please contact blood.donor@ethosvet.com or visit www.vshsd.com for more information.

MEdIcAL EvALUATION Of cONgENITAL hEpATIc dIsEAsE IN dOgsby KAThARINE ARNELL, dvM, dAcvIM

vsh BLOOd BANK: sAvINg LIvEs, ONE dONATION AT A TIMEby sTEphANIE IsTvAN, vMd, dAcvEcc & NIcOLE EdwARds, RvT

Blood Donor, “Motley Crue”

RIchTER scALEHello Friends and Colleagues:

I hope you are all looking forward to Spring and Summer as we are here at VSH.

Some news and reminders: Our 6th Annual Symposium is scheduled for Sunday

April 17th. Despite a record number of registrations, there is still room available

for some last minute veterinarian attendees. The Technician Program has also had

a record number of registrations. The program promises to be outstanding, with a

speaker-wide commitment to the theme of “Clinical Pearls,” so that you can take

home information that you can use immediately. The headline keynote speaker

will be Dr. Mark Kittleson, Professor Emeritus at U.C. Davis. His topics will be

“The Golden Rules for Distinguishing Pulmonary Edema from Chronic Bronchitis in

Small Coughing Dogs with a Heart Murmur” and “Feline Hypertrophic Cardiomyo-

pathy.” In addition to Dr. Kittleson and several other guest speakers, many VSH

specialists will be speaking to round out the multi-track scientific program. There

will also be opportunities for you to socialize with your colleagues and VSH

specialists at the new Happy Hour following the scientific program. All of the top

vendors are also attending for plenty of interaction. The spectacular University of San Diego setting always makes this

a unique event. We have received comments in the past saying, “I wish I could be in 3 places at the same time.” Well,

we are recording two of the Veterinarian Tracks and the Management Track (“the Human Side”) which will be made

available to all attendees.

As painful as it is coming from an internist, I’d like to give a “shout out” to the VSH Surgery Department. The most

important thing I want to highlight, and what I like most about being at VSH, is our team approach. You can send cases

to one of our surgeons, and have your clients get input from neurology, dermatology, ophthalmology, oncology, medi-

cine, or any of our specialties, simultaneously coordinated by us. Our surgeons tackle complicated oncologic surgery and

have seamless integration with our medical and radiation oncologists. They do complicated ureteral surgery and have a

close and collaborative relationship with the U.C. Davis group in our building. Our critical cases are expertly managed by

our anesthesiologist (Dr. Hopkins) and team of critical care specialists. Another unique feature of our Surgery Depart-

ment is that we have board certified surgeons on call for ER cases 24/7/365. We are the leaders of hip replacement

surgery in the Western USA. Also, several of our surgeons have special interests in minimally invasive surgery (arthros-

copy, laparoscopy, and thoracoscopy). This department is definitely cutting edge (excuse the pun)!

My last reminder is that our radiologists, Drs. Sunico and Shanaman, are now set up to perform outpatient ultrasound

examinations (where you maintain the direction of case management) and teleradiology interpretations. Just give either

of them a call to get set up.

By the time you read this, the Padres will already be in first place, lead in every statistical category, be installed as a

heavy betting favorite to win the World Series, and have all the pundits talking about how they greatly underestimated

our talent. Or, maybe my credibility is not as strong as I thought??

Keith Richter, DVM, MSEL Diplomate ACVIM

The two most common types of congenital hepatic disease include portosystemic vascular anomalies (PSVA) and microvascular dysplasia (MVD, now technically termed portal vein hypoplasia without a macroscopic anomaly). The clinical course and treat-ment options differ depending on the underlying disease, and an accurate diagnosis is essential for future management and prognosis. Most affected dogs will have a mildly but variably elevated ALT, and may be symptomatic (variable for PSVA) or asymptomatic (almost always true for MVD, and variable for PSVA). The following tests are commonly utilized to differentiate between these two congenital diseases.

pre- and post-prandial Bile Acids TestBile acids are produced by the liver, secreted into the biliary system, released into the duodenum to help digest fats, then resorbed by the ileum into the portovenous circulation, and re-excreted into bile. This test is easy to perform, and only requires a pre-testing 12-hour fasting period and two blood samples drawn two hours apart. We are most concerned about the post-prandial bile acids result, with dogs having hepatobiliary disease typically showing elevated (>25 umol/L) levels. Normal bile acids concentrations levels do not rule out hepatobiliary disease, although most dogs with PSVA will have markedly elevated post-prandial concentrations (usually >100 umol/L) and dogs with MVD will have mild to moderately elevated concentra-tions. Occasionally, the pre-prandial bile acids levels are higher than the post-prandial levels (this has no diagnostic significance; just go by the highest value); this is likely due to inadequate pre-testing fasting, spontaneous gallbladder contraction, differing gastric emptying or intestinal transit times, or varying cholecys-tokinin release. Results can also be affected by exogenous bile acids, mainly ursodeoxycholic acid (ursodiol), which need to be discontinued for at least 48 hours prior to measure serum bile acids. Finally, Maltese and Maltese mixes may have elevated post-prandial bile acids in the absence of hepatic disease; this is likely due to substances within their blood that interfere with the assay.

Abdominal Ultrasound ExamThe sensitivity of ultrasound exams for differentiating between a PSVA or MVD is largely dependent on the ultrasonographer/machine, however this can be a relatively sensitive test (up to 97% sensitivity in experienced hands). Ultrasound is used to visualize a definitive extra- or intra-hepatic PSVA, as well as assess for microhepatica, decreased hepatic vascularity, renomegaly, nephroliths or cystoliths (most commonly ammonium urate), acquired hepatic shunts, and abdominal effusion. Two ultrasono-

graphic measurements have been shown to help differentiate between a PSVA and MVD; a PV:Ao (portal vein to aorta) ratio ≥ 0.65 is most consistent with an extra-hepatic portosystemic shunt, and a PV:CVC (portal vein to caudal vena cava) ratio ≥ 0.75 helps to rule out an extra-hepatic PSS.

protein C Activity AssayThis assay is now available through Cornell University, and helps to further differentiate between dogs with PSVA and MVD. Protein C is a plasma anticoagulant factor synthesized by the liver, and protein C deficiency can be a marker for hepatic dysfunction. Decreased protein C activity develops in dogs with PSVA and hepatic synthetic failure, and a level < 70% supports a diagnosis of PSVA, whereas activity greater than 70% are more typically seen in dogs with MVD. The protein C level requires 1ml separated citrated plasma and the laboratory cost is $37.50. Samples are run daily Mon-Fri, so the turn-around time is fairly quick.

Transplenic or Rectal ScintigraphyThese tests involve a nuclear scan that measures radioactive uptake by the heart and liver after the technetium pharmaceutical is given by rectal enema or a splenic injection.

A shunt fraction is calculated after determining the relative uptake. Normal dogs have a shunt fraction <15% (>85% of the blood goes to the liver first rather than the heart), whereas dogs with a PSVA typically have a shunt fraction >65% (<35%of the blood goes to the liver first rather than the heart). Usually only mild sedation at most is required. Nuclear scintigraphy can determine whether or not a PSVA is present with very high sensitivity, though does not provide anatomic detail.

Abdominal CT ScanThis is the most sensitive test for the evaluation of PSVA. It does require anesthesia and is the most costly test to perform, however it can accurately determine if a PSVA is present and elucidate the specific location by providing anatomic detail; this is essential to assess if surgery is an option and for surgical planning.

Hepatic BiopsyUltimately, a liver biopsy is the only means of determining the specific etiology for elevated hepatic enzymes and hepatic function tests when a macroscopic shunt is ruled out. A liver biopsy cannot differentiate between a PSVA and MVD, so the aforementioned tests are always recommended if there is concern for a PSVA.

Transfusion of blood products to dogs and cats plays a crucial role in the practice of emergency and critical care of patients with anemia, thrombocytopenia or coagulopathies. Blood transfusions have commonly been performed with whole blood from dog or cat donors. However with advancing critical care medicine and growing transfu-sion demands, component therapy is becoming more commonplace.

Component therapy is the separation of whole blood, using a specialized centrifuge, into its cellular and plasma components to allow directed replacement of the patient’s needs. Typically, 2-3 products can be created from a single dog or cat donation. For example, red blood cells administered to anemic patients directly restore oxygen carrying capacity without administration of plasma. The plasma from this donation may be administered to another patient with hemorrhage due to anticoagulant rodenticide ingestion. Component therapy reduces the risk of transfusion reactions such as fluid overload and acute immunologic reactions that may result from unnecessary product administration.

Veterinary Specialty Hospital is proud to announce the on-going development of our blood donor program. Since June 2015, we are able to offer component therapy to tailor treatment plans specific to each patient in need of blood product transfusions. This includes the availability of packed red blood cells, fresh frozen plasma, frozen plasma, cryoprecipitate, cryo-poor plasma, platelet rich plasma, platelet concentrate and leukoreduction. Dogs have an estimated 13 blood types that can be tested, however the DEA 1.1 blood type is one most commonly tested as it carries a high likelihood of causing a transfusion reaction. Cats on the other hand have 3 blood types (A, B, AB). With the wide variety of blood types and patient needs, the program is expanding!

Our blood bank relies on the generous donations of volunteers who meet blood donation requirements. The VSH Blood Donor Program is actively seeking dogs and cats to be part of our life-saving team. Donor dogs should be in good overall health, 1-7 years of age, over 55 pounds, and receiving monthly flea, tick and heart worm prevention. Cats should be in good overall health, 1-7 years of age, over 10 pounds, indoor only, and receiving monthly flea prevention. Dog and cat donors should also have a friendly temperament and be current on all recommended vaccines.

Prior to enrollment, potential dog and cat donors receive a full physical exam by our board certified criticalist(s), Dr. Stephanie Istvan or Dr. Jennifer Willey. A complete blood count, chemistry

profile, infectious disease panel in accordance with published guidelines, and blood type will be submitted to the laboratory as part of the screening process. Owners of canine and feline donors must agree to a one-year commitment to the program and be available for scheduled donations every 6 to 8 weeks. In rare instances, donors might be called upon in an emergency situation to provide fresh products such as fresh whole blood, platelet rich plasma, platelet concentrate or type B feline blood products.

At each donation appointment, our donors receive a complete physical exam by a criticalist and red blood cell count while owners have their choice of several compensation options per donation. Pet owners are welcome to schedule an appointment and wait in the lobby for donation completion or drop their pet off for the day. The blood donation process typically takes approximately 45 minutes. Donors receive fluids, treats and lots of love and attention during their donation. After each donation, component products are produced based on patient needs.

If owners are interested in enrolling their pets in the VSH blood donor program to help save lives, please contact blood.donor@ethosvet.com or visit www.vshsd.com for more information.

MEdIcAL EvALUATION Of cONgENITAL hEpATIc dIsEAsE IN dOgsby KAThARINE ARNELL, dvM, dAcvIM

vsh BLOOd BANK: sAvINg LIvEs, ONE dONATION AT A TIMEby sTEphANIE IsTvAN, vMd, dAcvEcc & NIcOLE EdwARds, RvT

Blood Donor, “Motley Crue”

CONNECTEDYo u r L i n k to V e t e r i n a r Y S P e C i a Lt Y H o S P i ta L | aPr–Jun 2016

SAN DIEGO 10435 Sorrento Valley Rd San Diego, CA 92121 | NORTH COUNTY 2055 Montiel Rd San Marcos, CA 92069 | www.vshsd.com

MEDICAl EvAlUATION Of CONGENITAl HEpATIC DISEASE IN DOGSIN THIS ISSUE:

VSH BLood BankCLiniCaL triaLSuPComing eVentS

For more details about these and other clinical trials, please visit our website at www.vshsd.com.

Please join us in support of the following organizations.

in our CommunitY

Dermatology – Topical Therapy for Acral lick DermatitisWe are recruiting patients for participation in a placebo-controlled clinical trial evaluating the efficacy of a topical steroid-free spray in the treatment of Acral Lick Dermatitis. The lesion should receive no treatment within 2 weeks prior to enrollment. Four visits will be required. All costs will be covered by the study.

Contact the Dermatology Service at derm@vshsd.com

Dermatology – Topical Therapy for “Hot Spots”The Dermatology Service is recruiting patients for participation in a placebo-controlled clinical trial evaluating the efficacy of a topical steroid-free spray in the treatment of acute pyotraumatic dermatitis (“hot spots”). The lesion should receive no treatment prior to enrollment. Two visits will be required. All costs will be covered by the study.

Contact the Dermatology Service at derm@vshsd.com

Dermatology – Blood Samples from felines with History of Allergic Skin DiseaseThe Dermatology Service is recruiting otherwise healthy cats with a history of any allergic skin disease for collection of a blood sample to be used in a study of feline allergy. Patients with manifestations of eosinophilic granuloma complex (indolent or rodent ulcers, eosinophilic plaques, eosinophilic granulomas) can be included. Subjects may not have received oral cyclosporine, oclacitinib, oral prednisone, or short-acting glucocorticoids for 2 weeks prior to their visit, and may not have received long-acting injectable glucocorticoids for 6 weeks prior to their visit.

Contact Dr. Laura Stokking at laura.stokking@vshsd.com

Internal Medicine – Glomerular Disease StudyVSH is participating in a multi-center prospective study evaluating increased dosing of enalapril in dogs with glomerular disease. Client incentives include reduced cost of some initial testing and no cost for scheduled recheck visits and tests.

Contact Dr. Julie Fischer at (760) 466-0600

Internal Medicine – Glucocorticoids and spec cpl studyPatients who will be started on glucocorticoids (minimum dose of 0.5mg/kg/day) and will need to be on them for at least 3 weeks. Patients will receive a spec cPL prior to administration of any glucocorticoids and at least 3 weeks after starting glucocorticoid therapy at no charge.

Contact Drs. Sarah Cocker or Keith Richter at (858) 875-7500

Internal Medicine – feline IBD/GI Small Cell lymphoma Study and proteomics StudyWe are enrolling cats with chronic gastrointestinal disease that are suspected of having either inflammatory bowel disease (IBD) or gastrointestinal small cell lymphoma (GI SC LSA). Endoscopy will be performed and GI biopsies will be obtained for histopathology, immunohistochemistry (IHC) and PCR for antigen receptor rearrangements (PARR). A 3 week follow-up will be required. Blood, urine, and fecal samples will be collected for proteomic analysis at the time of endoscopy and follow-up visit. The cost of the histopathology, IHC and PARR is funded. GI panel is also funded by the proteomic study.

Contact Drs. Betty Chow, Steve Hill or Keith Richter at (858) 875-7500

*NEW* Oncology – Canine Osteosarcoma, post-Amputation, post-Carboplatin ChemotherapyEvaluating a novel therapeutic for dogs with canine osteosarcoma, post-amputation, post-carboplatin chemotherapy. It is acceptable if chemotherapy administration has been done elsewhere.

Contact Dr. Brenda Phillips at (858) 875-7500

Oncology – funded Trial for Dogs with CancerClients enrolling and completing a study evaluating the use of a probiotic along with chemotherapy will receive funding toward doxorubicin chemotherapy. Some breed or patient exclusions may apply.

Contact Dr. Andi Flory at (760) 466-0600 or (858) 875-7500

Continued on back page…

announCementSWe welcome Dr. Matt Cleveland as our newest board-certified surgeon! Some of you might have met him when he was here in 2011 as a specialty surgery intern. He went on to Angell Animal Medical Center for a 3-year residency training program, joining us last fall and successfully passing his boards this March. Dr. Cleveland has had broad surgical training leading to strong clinical interests in orthopedic surgery, including TPLO (Tibial Plateau Leveling Oste-otomy) and TTA (Tibial Tuberosity Advancement) procedures for surgical treatment of cranial cruciate ligament pathology, as well as joint replacement surgeries. Additionally, he has a strong interest in surgical oncology, and minimally invasive procedures including laparoscopy, thoracoscopy, and arthroscopy.

VSH had very good representation at the recent Comparative Gastroenterology Society GutSki meeting in Winter Park, Colorado with 6 attending and 4 presenting abstracts. Drs. Steve Hill, Lauren Cochran (resident), Sarah Cocker (resident) and Christopher Greenwood (intern) presented abstracts at the meeting. The other attendees were Drs. Keith Richter (Meeting Director) and Kate Arnell who are both on the CGS board of directors. Additionally Dr. Greenwood was awarded the intern travel award for this meeting. VSH representation was second only to the Texas A&M GI Lab and we were not far behind them.

10435 Sorrento Valley Rd Suite 100

San Diego, CA 92121

San Diego: 858 875 7500 San Marcos: 760 466 0600

For more information on Continuing Education events, please visit vshsd.com/Veterinarians or contact Ann Ong at (858) 875-7544 or ann.ong@vshsd.com.

TAKE NOTEcURRENT cLINIcAL TRIALs SaVe tHe date

vSH 6th Annual Symposiumapril 17, 2016 8:00 am - 4:30 pm: Symposium Lectures, Sponsor Visits, Lunch 4:30 pm - 5:30 pm: Join us for Happy Hour! University of San Diego Joan B. Kroc Institute for Peace & Justice Multiple Educational Tracks for Veterinarians, Technicians, Practice Management /Front Office Staff!

We’re LiSteningReceiving timely notifications on the status of your patients has been a past concern. We have revamped our internal processes and you should all be receiving discharge information on your patients within 24 hours. If not, please let us know. Timely communication with you is one of our top priorities.

Sunday, May 1 | 1 pm to 5 pm FaCe Foundation’s 6th annual Bags & Baubles Silent auction Fundraiser Private Estate, Rancho Santa Fe

Saturday, May 7 | 7 am to 12 noon San diego Humane Society Walk for animals NTC Park at Liberty Station, San Diego

Saturday, May 21 | 8 am – 1 pm tails on the trails Beneficiaries include tri-City medical’s Pet therapy Program, oceanside Police dept. k-9 unit Mance Buchanon Municipal Park, Oceanside

Sunday, June 5 | 10 am – 4 pm rB alive! Street Fair Rancho Bernardo, CA

Oncology – Quality of life for Cats with GI lymphomaThis is a trial that will lead to the design of a validated quality of life survey tool for cats with GI lymphoma. This will enable the profes-sion to study different interventions that may impact quality of life. Clients will be required to fill out survey information to develop this tool. If you have an UNTREATED cat with GI lymphoma (or suspect GI lymphoma), they are eligible to participate.

Contact Drs. Brenda Phillips or Keith Richter at (858) 875-7500

*NEW* Surgery – post-Operative pain StudyWe are currently enrolling patients in a postoperative pain study looking at liposomal encapsulated bupivacaine. Dogs qualify if they are receiving a total hip replacement, femoral head and neck excision or amputation. The dogs need to be hospitalized for 3 days post procedure and the owners receive $1000 credit to the bill.

Contact Drs. Sean Aiken or Katy Fryer at (858) 875-7500

CLiniCaL triaLS, Cont.

CONNECTEDYo u r L i n k to V e t e r i n a r Y S P e C i a Lt Y H o S P i ta L | aPr–Jun 2016

SAN DIEGO 10435 Sorrento Valley Rd San Diego, CA 92121 | NORTH COUNTY 2055 Montiel Rd San Marcos, CA 92069 | www.vshsd.com

MEDICAl EvAlUATION Of CONGENITAl HEpATIC DISEASE IN DOGSIN THIS ISSUE:

VSH BLood BankCLiniCaL triaLSuPComing eVentS

For more details about these and other clinical trials, please visit our website at www.vshsd.com.

Please join us in support of the following organizations.

in our CommunitY

Dermatology – Topical Therapy for Acral lick DermatitisWe are recruiting patients for participation in a placebo-controlled clinical trial evaluating the efficacy of a topical steroid-free spray in the treatment of Acral Lick Dermatitis. The lesion should receive no treatment within 2 weeks prior to enrollment. Four visits will be required. All costs will be covered by the study.

Contact the Dermatology Service at derm@vshsd.com

Dermatology – Topical Therapy for “Hot Spots”The Dermatology Service is recruiting patients for participation in a placebo-controlled clinical trial evaluating the efficacy of a topical steroid-free spray in the treatment of acute pyotraumatic dermatitis (“hot spots”). The lesion should receive no treatment prior to enrollment. Two visits will be required. All costs will be covered by the study.

Contact the Dermatology Service at derm@vshsd.com

Dermatology – Blood Samples from felines with History of Allergic Skin DiseaseThe Dermatology Service is recruiting otherwise healthy cats with a history of any allergic skin disease for collection of a blood sample to be used in a study of feline allergy. Patients with manifestations of eosinophilic granuloma complex (indolent or rodent ulcers, eosinophilic plaques, eosinophilic granulomas) can be included. Subjects may not have received oral cyclosporine, oclacitinib, oral prednisone, or short-acting glucocorticoids for 2 weeks prior to their visit, and may not have received long-acting injectable glucocorticoids for 6 weeks prior to their visit.

Contact Dr. Laura Stokking at laura.stokking@vshsd.com

Internal Medicine – Glomerular Disease StudyVSH is participating in a multi-center prospective study evaluating increased dosing of enalapril in dogs with glomerular disease. Client incentives include reduced cost of some initial testing and no cost for scheduled recheck visits and tests.

Contact Dr. Julie Fischer at (760) 466-0600

Internal Medicine – Glucocorticoids and spec cpl studyPatients who will be started on glucocorticoids (minimum dose of 0.5mg/kg/day) and will need to be on them for at least 3 weeks. Patients will receive a spec cPL prior to administration of any glucocorticoids and at least 3 weeks after starting glucocorticoid therapy at no charge.

Contact Drs. Sarah Cocker or Keith Richter at (858) 875-7500

Internal Medicine – feline IBD/GI Small Cell lymphoma Study and proteomics StudyWe are enrolling cats with chronic gastrointestinal disease that are suspected of having either inflammatory bowel disease (IBD) or gastrointestinal small cell lymphoma (GI SC LSA). Endoscopy will be performed and GI biopsies will be obtained for histopathology, immunohistochemistry (IHC) and PCR for antigen receptor rearrangements (PARR). A 3 week follow-up will be required. Blood, urine, and fecal samples will be collected for proteomic analysis at the time of endoscopy and follow-up visit. The cost of the histopathology, IHC and PARR is funded. GI panel is also funded by the proteomic study.

Contact Drs. Betty Chow, Steve Hill or Keith Richter at (858) 875-7500

*NEW* Oncology – Canine Osteosarcoma, post-Amputation, post-Carboplatin ChemotherapyEvaluating a novel therapeutic for dogs with canine osteosarcoma, post-amputation, post-carboplatin chemotherapy. It is acceptable if chemotherapy administration has been done elsewhere.

Contact Dr. Brenda Phillips at (858) 875-7500

Oncology – funded Trial for Dogs with CancerClients enrolling and completing a study evaluating the use of a probiotic along with chemotherapy will receive funding toward doxorubicin chemotherapy. Some breed or patient exclusions may apply.

Contact Dr. Andi Flory at (760) 466-0600 or (858) 875-7500

Continued on back page…

announCementSWe welcome Dr. Matt Cleveland as our newest board-certified surgeon! Some of you might have met him when he was here in 2011 as a specialty surgery intern. He went on to Angell Animal Medical Center for a 3-year residency training program, joining us last fall and successfully passing his boards this March. Dr. Cleveland has had broad surgical training leading to strong clinical interests in orthopedic surgery, including TPLO (Tibial Plateau Leveling Oste-otomy) and TTA (Tibial Tuberosity Advancement) procedures for surgical treatment of cranial cruciate ligament pathology, as well as joint replacement surgeries. Additionally, he has a strong interest in surgical oncology, and minimally invasive procedures including laparoscopy, thoracoscopy, and arthroscopy.

VSH had very good representation at the recent Comparative Gastroenterology Society GutSki meeting in Winter Park, Colorado with 6 attending and 4 presenting abstracts. Drs. Steve Hill, Lauren Cochran (resident), Sarah Cocker (resident) and Christopher Greenwood (intern) presented abstracts at the meeting. The other attendees were Drs. Keith Richter (Meeting Director) and Kate Arnell who are both on the CGS board of directors. Additionally Dr. Greenwood was awarded the intern travel award for this meeting. VSH representation was second only to the Texas A&M GI Lab and we were not far behind them.

10435 Sorrento Valley Rd Suite 100

San Diego, CA 92121

San Diego: 858 875 7500 San Marcos: 760 466 0600

For more information on Continuing Education events, please visit vshsd.com/Veterinarians or contact Ann Ong at (858) 875-7544 or ann.ong@vshsd.com.

TAKE NOTEcURRENT cLINIcAL TRIALs SaVe tHe date

vSH 6th Annual Symposiumapril 17, 2016 8:00 am - 4:30 pm: Symposium Lectures, Sponsor Visits, Lunch 4:30 pm - 5:30 pm: Join us for Happy Hour! University of San Diego Joan B. Kroc Institute for Peace & Justice Multiple Educational Tracks for Veterinarians, Technicians, Practice Management /Front Office Staff!

We’re LiSteningReceiving timely notifications on the status of your patients has been a past concern. We have revamped our internal processes and you should all be receiving discharge information on your patients within 24 hours. If not, please let us know. Timely communication with you is one of our top priorities.

Sunday, May 1 | 1 pm to 5 pm FaCe Foundation’s 6th annual Bags & Baubles Silent auction Fundraiser Private Estate, Rancho Santa Fe

Saturday, May 7 | 7 am to 12 noon San diego Humane Society Walk for animals NTC Park at Liberty Station, San Diego

Saturday, May 21 | 8 am – 1 pm tails on the trails Beneficiaries include tri-City medical’s Pet therapy Program, oceanside Police dept. k-9 unit Mance Buchanon Municipal Park, Oceanside

Sunday, June 5 | 10 am – 4 pm rB alive! Street Fair Rancho Bernardo, CA

Oncology – Quality of life for Cats with GI lymphomaThis is a trial that will lead to the design of a validated quality of life survey tool for cats with GI lymphoma. This will enable the profes-sion to study different interventions that may impact quality of life. Clients will be required to fill out survey information to develop this tool. If you have an UNTREATED cat with GI lymphoma (or suspect GI lymphoma), they are eligible to participate.

Contact Drs. Brenda Phillips or Keith Richter at (858) 875-7500

*NEW* Surgery – post-Operative pain StudyWe are currently enrolling patients in a postoperative pain study looking at liposomal encapsulated bupivacaine. Dogs qualify if they are receiving a total hip replacement, femoral head and neck excision or amputation. The dogs need to be hospitalized for 3 days post procedure and the owners receive $1000 credit to the bill.

Contact Drs. Sean Aiken or Katy Fryer at (858) 875-7500

CLiniCaL triaLS, Cont.