Vital Signs
November 2006

"One Medicine" and Translational Research

Dr. Gerhardt G. SchurigDear Friends and Colleagues,
I recently read with interest an article that appeared in the December 2006 edition of Scientific American called "Cancer: Clues from Pet Dogs." The article described some of the important progress that has been made in our understanding of cancer by studying naturally occurring cancer in dogs; and significantly, it suggested a rapidly growing role for dogs in future comparative oncology work.
The article also endorsed the direction, principles and concepts we have been developing for our translational research programs here in the college, which are based upon an increased collaboration between basic and clinical scientists to develop better preventative, diagnostic, and treatment solutions for urgent animal and human health problems.
Many of you are familiar with the historic role veterinary medicine has played in human health through comparative research. It is important that such research promptly and directly solves animal health problems in addition to advancing human health solutions. This can be achieved using our proposed translational medicine approach. Such an approach will arm practicing veterinarians with new methods for improving their patients' health, leading to higher levels of client satisfaction.
We have something that is very unique and important on this campus: caseload. Thousands of animals suffering from an assortment of spontaneous diseases present every year for diagnosis and treatment in our hospitals. New preventative approaches, diagnostic tests, and treatments developed in partnership with basic researchers in the various colleges at Virginia Tech can be applied to our patients to achieve high levels of disease prevention, improved diagnostics and better treatments with more positive outcomes. As these beneficial effects are realized with our own patients and those of our colleagues in private practice, the technologies can be transferred by our allies in human medicine to improve human health approaches. We would be fully collaborating and synergizing with scientists in the Colleges of Engineering, Sciences and Agriculture and Life Sciences on projects that will directly affect animal and human health.
Pharmaceutical companies and other research organizations, recognizing some of the substantial limitations associated with complete reliance upon laboratory rodents through all phases of testing and evaluation, have expressed interest in funding tests of new treatments on sick animals whose owners are interested in the same leading edge medical care that is often extended through clinical trials in human medical centers. This funding, and the concomitant advancement in human health, is often not realized because the numbers of participants are often too small to support the empirical requirements of the study designs. But by exploring additional partnerships, we could increase our access to clinical cases, which could in fact create a critical mass that is sufficient in size to attract large-scale research investment in our translational development programs by pharmaceutical companies.

Gerhardt G. Schurig

House Appropriations Sub-Committee Visits College

Dean Schurig & Dr. Pierson meet with VA House Appropriations Committee Several members of the Higher Education Sub-Committee of the Virginia General Assembly's House Appropriations Committee recently visited the Virginia-Maryland Regional College of Veterinary Medicine as part of a major program at Virginia Tech.
A delegation of Members, and permanent House Appropriations Committee staff-members were greeted by VMRCVM Dean Gerhardt Schurig, who presented introductory remarks on the college and its progress and more detailed remarks about strategies for protecting public health through more effective zoonotic disease control.
Dr. Bill Pierson, associate professor, Department of Large Animal Clinical Sciences (DLACS) and College Biosecurity Officer, then provided a more detailed presentation on Avian Influenza H5N1. Pierson, who had just returned from his fifth trip to Mongolia where he was helping them deal with AI and other problems, then shared information about a Department of Homeland Security (DHS) funded program that is supporting his efforts to develop a grassroots oriented training program to help agricultural producers develop measures to detect and protect themselves from agro-terrorism.
Following those presentations, Jeff Douglas, director of communications and public relations, then led the delegation on a tour of the Veterinary Teaching Hospital, where they heard brief presentations from Dr. Phillip Pickett, associate professor, Department of Small Animal clinical Sciences (DSACS), and Dr. Virginia Buechner-Maxwell, associate professor, DLACS.
This was the largest delegation of Virginia General Assembly officials to visit the college since the Senate Finance Committee convened a meeting at the college in the late 1980's.

Tom Inzana Named Interim Associate Vice President for Research at Virginia Tech

Dr. Tom Inzana Dr. Tom Inzana, the Tyler J. and Frances F. Young Professor of Bacteriology in the Virginia-Maryland Regional College of Veterinary Medicine's Department of Biomedical Sciences and Pathobiology, has joined the administrative team in the Office of the Vice President for Research at Virginia Tech as interim associate vice president for research.
Inzana, who is director of clinical microbiology for the College of Veterinary Medicine's Teaching Hospital, has been at Virginia Tech since 1987, was director of the Center for Molecular Medicine and Infectious Disease (CMMID) for almost five years, and has been an endowed professor since April 2003. His new position, which began October 23, will be a 50 percent commitment.
The Office of the Vice President for Research (OVPR) is filling two leadership positions on an interim basis. The combined positions are responsible for research development, interdisciplinary programs, and research administration and support and are involved in planning and policy. The term of each position is anticipated to be one to two years, or until a permanent full-time appointment is made. The time commitment is anticipated to be 50 to 75 percent or more. "These are important positions on the team that supports the faculty as it furthers the university's discovery and scholarly missions," said Vice President for Research Brad Fenwick.
"I am confident Tom's background and abilities in the life sciences put him in an excellent position to make meaningful contributions on a number of fronts, such as with the university's strategic discovery domain of health, food, and nutrition, as well as with the focus on biomedicine and infectious disease," said Fenwick. "His experiences will also be valuable to this office's emphasis on helping faculty locate appropriate funding and manage projects."
Inzana earned his bachelor and master's degrees from the University of Georgia, his Ph.D. in microbiology from the University of Rochester School of Medicine, and was a post doctoral fellow at the Baylor College of Medicine. He was an assistant professor at Washington State University before joining Virginia Tech's faculty.
His ongoing research support as a lead investigator includes the U.S. Department of Defense for development of a vaccine against and biosensors for rapid detection of Francisella tularensis, the causal agent of tularemia in humans and a potential bioweapon. He also has National Institutes of Health (NIH) support to develop multi-valent F. tularensis/anthrax or plague protein conjugate vaccines. And he is working on sequencing the genome of the Bovine Pathogen Haemophilus somnus, with the support of the National Science Foundation and the U.S. Department of Agriculture Cooperative State Research, Education, and Extension Service (USDA/CSREES), and on a USDA/CSREES-funded study of Haemophilus somnus virulence and colonization.
Inzana has 78 peer-reviewed publications and two patents for vaccines against swine pleuropneumonia, one in commercial use.
His recent honors and service include being elected a fellow in the American Academy of Microbiology, receiving the Pfizer Award for Research Excellence, and serving as a panel member for NSF/USDA Microbial Genome Research Grants, the NIH study section on proposals for Sexually Transmitted Infections and Topical Microbicide Cooperative Research Centers, on the NIH Biodefense and Emerging Infectious Diseases study section on proposals for Regional Centers of Excellence, and the NIH Biodefense and Emerging Infectious Diseases study section on proposals for "Disabling Innate Immune Evasion: New Attenuated Vaccines."

Witonsky Exploring EPM

Dr. Sharon Witonsky Equine researchers continue to make progress in unravelling mysteries surrounding Equine Protozoal Myelitis (EPM), a parasitic infection of horses that causes major neurological problems.
Sharon Witonsky, associate professor, Department of Large Animal Clinical Sciences (DLACS), was recently honored with the college's 2006 Pfizer Award for Research Excellence for the research she is conducting in this area.
EPM is caused by an infectious protozoal parasite known as Sarcocystis neurona. Opossums are the known carriers of this organism and horses are believed to contract the disease by grazing on forage contaminated with the opossum feces. The parasite then breeches the blood/brain barrier through unknown mechanisms.
The blood/brain barrier is composed of the blood vessels of the brain. It protects the tissues of the brain from being exposed to anything that might cause harm.
While over 50% of all horses in the United States are believed to be exposed to this disease, only 0.5-1% actually develop clinical signs, and the reason for this selective infection remains unclear, according to Witonksy.
However, the effect of the disease on horses that are afflicted can be devastating. Equine patients can suffer a range of neurologic problems including behavioral changes, ataxia or clumsiness, muscle atrophy, and death. According to Witonsky, part of the current problem is that it can be difficult to determine whether a horse has the disease. In some cases, a horse may not be diagnosed until the disease has entered more severe stages. This late diagnosis may make a 100% recovery much more difficult for the patient.
Luckily, over the past several years, diagnostic tests, treatments and vaccinations for EPM have been developed and Witonsky is attempting to improve upon those.
Witonsky hopes to achieve three main goals with her research. First, she seeks to discover the mechanism by which Sarcocystis neurona is able to travel to the brain and affect the horse. Second, she wants to broaden scientific understanding of the disease process so that more sensitive and more accurate diagnostic tests can be developed. Finally, Witonsky hopes to develop a more effective vaccine to help protect horses from this debilitating disease.
Witonsky and her collaborators are using both equine and murine models to address these issues. Their work with these models has led her and fellow researchers to hypothesize that Sarcocystis neurona crosses the blood brain barrier via infecting leukocytes in the periphery. S. neurona then leaves the leukocytes and infects the brain tissue. However, the mechanism of this transfer is, as of yet, unclear.
Witonsky works both as a clinician in the hospital's equine field service unit and as a research scientist pursuing EPM and other infectious disease research. Witonsky's research is a good example of the VMRCVM's goal of increasing the amount of translational research underway in the college.
Translational research involves strong collaborations between basic and clinical scientists and seeks to rapidly develop solutions for pressing animal and human disease problems. The discoveries which are being made in Witonsky's laboratory are easily transferable to the examining room. Veterinarians are able to take the knowledge gained from Witonsky's research and use it to diagnose and treat horses that are afflicted with EPM.
All of this work has been made possible by a large collaboration with colleagues in a variety of areas. Current collaborators include Dr. David Lindsay, professor, parasitology, Department of Biomedical Sciences and Pathobiology; Dr. Robert Gogal Jr., associate professor, immunology, Edward Via Virginia College of Osteopathic Medicine; Dr. Robert Duncan Jr., associate professor, pathology, Department of Biomedical Sciences and Pathobiology; Dr. Yasuhiro Suzuki, associate professor, molecular immunology, Department of Biomedical Sciences and Pathobiology; Dr. Virginia Buechner-Maxwell, associate professor, Clinical Services / Medicine / Equine and Production Management Medicine, Department of Large Animal Clinical Sciences; Mr. Dan Ward, laboratory supervisor, Laboratory for Study Design and Statistical Sciences; Dr. Frank Andrews, professor, large animal internal medicine, University of Tennessee College of Veterinary Medicine; and Dr. Siobhan Ellison, private practitioner specializing in pathogens.

Show Horse Returns to Competition after Undergoing New Surgical Procedure at the Marion duPont Scott Equine Medical Center

Sporty and owner Laura Whitford Laura Whitford of Shadow Fox Farm in Haymarket, Virginia, has been showing horses since the age of 11. But it wasn't until the night that she first saw her horse, Aragonas, a.k.a. Sporty, in March of 2002 that she truly felt that she had met her ideal competition partner.
"You know how it is when you fall in love? When it's a perfect match? The first time that I saw him, I just knew he was the right one for me. He was my little sports car," said Whitford.
Sporty, an Oldenburg by Argentinus and out of Saskia who had been bred in Germany and was brought to the states two years prior by a woman in the Atlanta, Georgia area, was purchased by Whitford that night.
Unfortunately, only two short weeks after she brought her dream horse home, she noticed that something was terribly wrong.
"I had only had him a short time when we became aware of the injury," said Whitford. "There was no incident that we can trace unless it happened in shipping. You never know with these injuries."
Whitford brought Sporty to see Dr. Kent Allen of Virginia Equine Imaging on March 20, 2002, who diagnosed the horse with proximal suspensory desmitis of the hind limbs, a common injury in athletic horses which results in a sudden onset of lameness.
According to Allen, proximal suspensory cases of the hind limbs are always significant injuries. Although the cause of this particular injury is unknown, Allen said that these injuries are usually athletic ones incurred when, during a workout, the horse hyper-extends its hind limbs.
"We told Laura that this would be a difficult problem to recover from, but that there were both medical and surgical treatments available for it," said Allen. "If a case is a candidate for medical, we usually try the non-invasive procedures first."
Dr. Allen treated Sporty with shock wave therapy, and prescribed first resting and then walking the horse. On April 18, 2002, Sporty was found to be sound during his exam and seemed to have responded well to the therapy. However, in May 2002, he re-entered lameness.
"For rehabilitation, we keep the horse at a walk and steadily progress," said Allen. "He was in that process when he became lame again."
Having exhausted the available medical options, Allen referred Whitford to Dr. Nat White of the Marion duPont Scott Equine Medical Center in Leesburg, Virginia, for surgery.
White, a world-renowned equine surgeon and director of the center, conducted a lameness exam on July 2, 2002, and diagnosed Sporty as having Grade 1.5 Lameness. At the time, White was conducting a study on the results of a new surgical procedure called proximal suspensory desmoplasty that he had engineered for treating proximal suspensory desmitis. White recommended Sporty as a candidate for this innovative new technique which consisted of ultrasound guided splitting of the ligament and scoring the bone.
"We had a number of horses that had gone sound after this surgery," said White. "These are horses that had had relapse injuries or had experienced months of lameness and had not responded to shockwave treatment."
White advised Whitford that Sporty's chances for recovery were approximately 80%. The study later concluded that 85% of the participating horses were able to return to full work after undergoing the surgery and rehabilitation.
"The chronicity of Sporty's condition left this as a last resort for curing this problem," said White.
On December 18, 2002, White performed a successful proximal suspensory desmoplasty on the horse. Sporty was released from the hospital on December 19, 2002, with strict instructions for a controlled rehabilitation that included gradually increasing exercise.
"It requires a month of absolute stall rest after the surgery and then an increasing exercise routine," said White. "First at hand walking, then walking under saddle and then walking at a trot under saddle over four to six months. The level of exercise is determined by the sequential ultrasound examinations of the ligaments after surgery."
During a two and a half year rehabilitation period, Whitford worked slowly and carefully to bring Sporty back to top athletic condition. Her patience and dedication were rewarded when Sporty competed in his first post-surgery competition, the VADA/NOVA Summer Breed Show in Leesburg, Virginia, on June 9, 2005.
"That was a scary one," said Whitford. "He was a bit shaky but we were glad to be there."
Now, almost four years after White performed his surgery, Whitford is enjoying competing with her perfect partner more than ever.
"He is in great condition," said Whitford of Sporty who is currently under the care of Dr. Paul Anikis of Piedmont Equine Practice in Marshall, Virginia. "We do keep him maintained well. I still really manage the turnout situation so he doesn't get hurt again."
The two were High Score Champions at the Fourth level at the VADA/NOVA Autumn II show on November 19, 2005, in Leesburg, Virginia, and placed third and fourth in Prix St. George at the Potomac Valley Dressage Association's Calvert Chapter Dressage Schooling Show in Hughesville, Maryland, on September 17, 2006.
"Sporty is very fit and is getting ready for the championship show next week," said Whitford in regard to the VADA CBLM Championships taking place in Lexington, Virginia, from October 19 through 22, 2006.
White points to Whitford's perseverance as an essential ingredient in Sporty's remarkable recovery.
"Laura was persistent and she did everything that we asked her to do," said White. "That includes the fact that when we told her she needed more time for recovery, she was willing to take the time."
If Whitford were able to give advice to other owners whose horses suffer potentially devastating injuries, it would be to have faith.
"It takes a lot of rest and rehabilitation work but you have to be patient," said Whitford. "You have to be committed to going through the process. Don't push the horse too fast after the surgery and don't give up."

Pet Portraits with Santa

Pets with Santa Looking for a new twist on an old tradition? Why not grace this year's Christmas card for family and friends with a picture of your beloved pet?
You can have your pet professionally photographed with Santa Claus on Saturday, December 2 from 9 a.m. to 3 p.m. at the Virginia-Maryland Regional College of Veterinary Medicine at Virginia Tech.
Packages of portraits are being offered and details will be available on-site. Cats, dogs and exotics (no reptiles) are all welcome. All pets must be on a leash or contained and should be well-behaved.
Photographs will be taken in the College's Classroom 125, which is located on the east side of the veterinary college complex. Signs will direct visitors to the event.
The program is being presented by the college's Omega Tau Sigma service fraternity, a veterinary student organization that provides a variety of community services.

Marion duPont Scott Equine Medical Center Announces 2006-07 "Tuesday Talks" Schedule

Tuesday Talks The Marion duPont Scott Equine Medical Center has announced its 2006-07 "Tuesday Talks" schedule. This series of lectures is designed to provide veterinarians, horse owners, and horse professionals with valuable insight and practical advice related to a wide-array of equine healthcare topics.
The 2006-07 "Tuesday Talks" schedule is as follows:
  • "Equine Neurological Issues Over the Life Course" - Tuesday, December 5, 2006, by Martin O. Furr, DVM, Ph.D., Diplomate ACVIM, Adelaide C. Riggs Chair in Equine Medicine, Marion duPont Scott Equine Medical Center
  • "Acupuncture and Pain Relief for Horses" - January 16, 2007, by Alison A. Smith, DVM, Diplomate ACVA, Clinical Assistant Professor in Anesthesia, Marion duPont Scott Equine Medical Center
  • "New Treatments for Equine Tumors" - February 13, 2007, Kenneth E Sullins, DVM, MS, Diplomate ACVS, Professor of Equine Surgery, Marion duPont Scott Equine Medical Center
  • "Detecting and Treating Lameness" - March 6, 2007, Nathaniel A. White, II, DVM, MS, Diplomate ACVS, Jean Ellen Shehan Professor and Director, Marion duPont Scott Equine Medical Center
All "Tuesday Talk" lectures will be held at 7:00 pm in the Marion duPont Scott Equine Medical Center's library. No fee is charged for attending, but seating is limited and pre-registration is required. To register, e-mail Amy Troppmann at or call (703) 771-6843.

Demand Grows for College's Gastrointestinal Endoscopy Courses

Dr. Leib performs an Endoscopy Demand for the VMRCVM's continuing education courses in gastrointestinal endoscopy continues to grow.
Registration for the upcoming "Intermediate Gastrointestinal Endoscopy for Internal Medicine Residents" course scheduled for December 4-5, 2006 is at capacity, according to Dr. Michael Leib, the C. R. Roberts Professor of Veterinary Clinical Medicine.
Leib, an internationally recognized expert in veterinary gastroenterology, said registrants for the course are coming from three different universities and two private veterinary specialty practices.
The course was initially going to be limited to six to eight veterinarians but in response to the demand officials raised the enrollment to nine.
Endoscopy involves the oral or rectal introduction of a fiberoptic camera into the patient's body. It enables a clinician to visually examine and gather biopsy samples of internal body structures for more detailed laboratory analysis. It is also useful for removing gastrointestinal foreign bodies.
The course, which is designed for first year internal medicine residents, includes eight hours of lecture on all aspects of feline and canine endoscopy and two four-hour laboratory exercises.

VMRCVM Signs MOU to Support Animal Emergency Program; SART Program Established

SART Program Members College officials have signed a Memorandum of Understanding (MOU) with several state and non-state agencies that are developing animal evacuation and management protocols in the event of a natural or deliberately induced disaster.
The MOU formalizes some of the roles and responsibilities that the agencies and organizations will play in the evacuation and management of animal populations in the event of an emergency.
Agencies signing the MOU include the Virginia Veterinary Medical Association (VVMA), the VMRCVM, the Virginia Federation of Humane Societies (VFHS), the Virginia Department of Agriculture and Consumer Services (VDACS) and the Virginia Department of Emergency Management (VDEM).
The devastating hurricanes of the 2005 season that demolished vast coastal regions of the southern coast of the United States and caused a major national emergency focused the need and the urgency for refining emergency companion and agricultural animal management and evacuation plans.
In another important development that will improve emergency animal management and evacuation procedures, a Virginia State Animal Response Team (SART) has been created. The SART program is the culmination of work that has been underway for about three years by a group known as the Virginia Disaster Animal Care and Control Committee (VDACCC). Chaired by Peggy Allen of the Virginia Federation of Humane Societies, the group has conducted a great deal of work that has led to the establishment of the SART program.
The VDACCC included representatives from the Virginia Department of Health, the Virginia Department of Emergency Management, the Virginia Department of Agriculture and Consumer Services, the Virginia Association of Licensed Veterinary Technicians, the Virginia Veterinary Medical Association, the Virginia Department of Environmental Quality, the Virginia Department of Game and Inland Fisheries and other organizations.
In April 2004, the group heard a presentation on the National State Animal Response Team (SART) model. Participating organizations were asked to pool resources designed to win a matching grant offered by PetSmart Charities, Inc., which would have supported the development of a fully detailed Virginia SART program. The Virginia program was not funded in 2005, but in 2006, a $20,000 matching grant was awarded by PetSmart.
The VMRCVM is represented on the SART program by Dr. Bill Pierson, professor, Department of Large Animal Clinical Sciences, who was elected to their board of directors during a November 15 meeting. The group also discussed plans to hold a major Virginia SART Summit in 2007.

College Hosts 23rd Annual Awards Presentation

Dr. Otto Lanz (left) Several faculty members were recognized for excellence in teaching and more than $500,000 in scholarship awards were presented to 162 students during the Virginia-Maryland Regional College of Veterinary Medicine's recent 23rd Annual College Awards Program.
The Carl J. Norden Distinguished Teacher Award was presented to Dr. Otto Lanz, associate professor, Department of Small Animal Clinical Sciences. Sponsored by Pfizer Animal Health, this national award honors faculty members who have displayed outstanding teaching ability.
Lanz received his D.V.M. in 1992 from Auburn University. Prior to joining the faculty in 1998 as an assistant professor, he was a resident in small animal surgery at the University of Florida. He has also been in private practice. Dr. Lanz's research interests are reconstructive surgery and neurosurgery. He is board certified by the American College of Veterinary Surgeons.
Dr. Kurt Zimmerman, assistant professor, Department of Biomedical Sciences and Pathobiology, was awarded the College Teaching Award and a Virginia Tech Certificate of Teaching Excellence. That award honors a faculty member who has made exceptional contributions to the college's instructional program.
Dr. Kurt Zimmerman (right) Zimmerman is an assistant professor of pathology and informatics in the Department of Biomedical Sciences and Pathobiology. He received his D.V.M. from Purdue University and his Ph.D. in veterinary medical science/medical informatics from Virginia Tech. Prior to joining the faculty of VMRCVM in 2004, he was an informatics research fellow for the National Library of Medicine at VMRCVM. Zimmerman's research interests include medical expert systems, medical knowledge representation, knowledge discovery and machine learning algorithms, medical decision-making, and diagnostic pathology. Dr. Zimmerman is board certified as a diplomate with the American College of Veterinary Pathologists.
Three Bayer Animal Health Faculty Recognition Awards, which recognize faculty commitment to teaching and the impact that good teaching has on the careers of the veterinarians they train, were also presented.
The Class of 2009 Bayer Animal Health Faculty Recogntion Award was presented to Dr. Bonnie Smith, associate professor, Department of Biomedical Sciences and Pathobiology.
Smith is an associate professor of anatomy, embryology, and physiology in the Department of Biomedical Sciences and Pathobiology. She received her D.V.M. and her Ph.D. in veterinary anatomy with a minor in human anatomy from The Ohio State University. Before joining the faculty of VMRCVM in 1991, Smith was a visiting assistant professor at North Carolina State University's College of Veterinary Medicine. Her research interests are classical morphology, functional morphology, and teratology.
The Class of 2008 Bayer Animal Health Faculty Recognition Awards was presented to Dr. Zimmerman.
The Class of 2007 Bayer Animal Health Faculty Recognition Awards was presented to Dr. Lanz.
The student scholarships presented have been funded by a variety of individuals and organizations that seek to promote excellence in the college's academic programs and provide educational opportunities for deserving students. They are awarded to students on the basis of academic performance, leadership, and need.

Pandemic Flu Conference Held for Colleges, Universities

Pandemic Flu Conference Pandemic Flu and how it might affect Virginia's higher education community was the business of the day as about 120 representatives from colleges and universities recently convened at the University of Richmond to discuss planning and preparedness.
Sponsored by the College Communicator's Association, the informational meeting featured experts from the medical, risk management, and emergency management fields and principally concerned the need to plan well for the worst-case scenario, even if it does not occur.
Dr. Lynne Dean, medical director at UR and a member of the Virginia Department of Health's Pandemic Influenza Advisory Committee, provided an overview of the threat and current government preparedness strategies.
After opening her talk with the statement that influenza is the "king killer" of the more than 1500 microbes that cause infectious diseases, she detailed the recent history of the present Avian Influenza H5N1 strain, which was initially identified in Hong Kong in 1997. By 2003, cases were being seen in Asia and by 2006 human cases were being seen in Eurasia, parts of Europe and Africa.
AI H5N1 is a zoonotic disease, which means it affects people and animals. Significantly, the people who have been infected with the current strain have had direct contact with infected birds, their carcasses and/or waste products. Right now, there is no evidence that the virus has mutated in a way that supports direct aerosol-based human-to-human transmission. That has happened in the past, and it could happen again, but so far it has not.
Yet the onset of Sudden Acute Respiratory System (SARS) disease episode a few years ago demonstrates how quickly infectious disease can spread around the planet in the age of global airline travel. Within 24 hours it had spread to five countries. Within a couple months it had spread to 30 countries on five continents.
The present strain of H5N1 that is circulating is highly pathogenic - or virulent. By September 25, 2006, the virus had killed 146 of the 249 people who had come down with the disease. Clinical features of the disease include cough, headache, fever, body aches and in some cases diarrhea. Severe respiratory disease soon sets in. Essentially what kills victims is their own immune systems. Victims basically drown as a result of a "cytokine storm" that floods the lungs (cytokines are immune system front-liners).
Hence, the disease does not present the greatest threat to the elderly, the young, the sick and the infirm who have compromised immune systems; it presents the greatest threat to young, healthy individuals with strong immune systems (college age and young adults).
The medical community generally believes that there have been about 10 major pandemics over the past 300 years, according to Dr. Dean. These include events in 1918, 1957, 1968 and a scare in 1976 (swine flu) that never really emerged. By far and away, the worst of these was the so-called "Spanish Flu" of 1918 which is said to have killed more people than any World War and is believed to have killed anywhere from 40 to 100 million worldwide in the early 20th century.
The United States currently operates the world's best public health system, and since 9/11 it has been shored up quite substantially, according to Dr. Dean. On the negative side, because of changes associated with managed care and bottom lines, our nation might be hard pressed to handle the "surge" associated with a pandemic. Our hospitals stay at about 80% occupancy, she said. We have about 105,000 ventilators in this country, of which 100,000 or so are typically in use during flu season.
How would we react if it hits? Experts generally believe that if all the wrong things happen and we get a highly infectious mutant, then it would hit in two or three big waves over a 12 to 18 month period. Absent the invention of a vaccine between now and then, or the development of more specifically effective anti-vitals, then the best strategies for dealing with it would be surveillance, social distancing, travel restrictions, isolations and quarantines.
The World Health Organization presently characterizes the pandemic threat alert level at stage three. Federal and state government agencies are stock-piling the anti-viral agents that are believed to be somewhat effective, researchers are urgently attempting to develop a vaccine, emergency management protocols are being developed and everybody is hoping that the virus does not mutate into the microbe that is feared.
Some of the implications that a possible pandemic has for colleges and universities were spelled out by University of Richmond Director of Safety & Risk Management John Sheffield, who also serves on the Virginia Department of Health's Pandemic Influenza Advisory Committee. Sheffield had just returned from a national meeting of university risk managers and safety people in Texas, and he said H5N1 discussions dominated the conference.
Basically, Sheffield said that colleges and universities have to reckon with some unique conditions because they are generally very open institutions with highly concentrated residential communities of individuals that would be highly susceptible to severe disease.
One of the big questions facing colleges and universities would be the issue of when to close, according to Sheffield. When the first human-to-human transmission is documented? When the first human case occurs in this country? With the first case diagnosed in this state? If universities and colleges are closed, will we pay faculty and staff salaries? Will student tuition be reimbursed? How will these be financed and accomplished? How will the people who cannot leave the university be cared for?
Experts estimate that 30% of college students will become ill, Sheffield said, and of those 40% will require hospitalization and two to three percent will die. University staffing will be down 40 to 60% and supply line issues will drastically affect shipments of food and supplies in to the university.
Sheffield quoted Dr. John Agwunobi, assistant secretary of the Department of Health and Human Services, as saying: "We hope it will not happen but hope is not a strategy."
Sheffield said that conventional government planning for Virginia predicts 1 million becoming sick, 24,000 requiring hospitalization, and 6,300 deaths.
In the event it does present in the worst possible scenario, all places of public assembly would be closed: schools, churches, shopping malls, public transportation systems, etc.; basically all large public gatherings would be prohibited.
Even if universities were able to make their closing decisions early enough to get people home to wait it out, international students and others would still require university housing. That would present major challenges with regard to food, shelter, and energy production and distribution, given the staffing shortages that are expected. Colleges and universities would also have to develop temporary morgue facilities as well, he said.
During a subsequent presentation, Virginia Department of Emergency Services' Division Director of Field Services Gordon Barwell reminded the audience that all emergencies are local and made the point that because of unique ways in which colleges and universities are structured in Virginia, they would not be classified under the same emergency management protocols and directives that towns, cities and counties are, which has implications for how they would make closing decisions.
An official with the Virginia Department of Education also discussed how the public school systems would be affected and the implications that would have for public health and the workforce (dual income families could not work as usual if children were not in school). Virginia has about 1.2 million students in 134 different school divisions. There are 1,957 school buildings in the state and only 1,057 school nurses.

VMRCVM/Banfield New River Valley Clinic Proposal

The VMRCVM has been engaged in discussions with Banfield regarding the joint administration of a clinical facility that Banfield plans to construct adjacent to the New River Valley Mall in Christiansburg, Virginia. The following FAQ document contains detailed information about the proposal being considered.


November 9, 2006

What's going on with the VMRCVM and Banfield?
The VMRCVM and Banfield - the Pet Hospital are in the preliminary stage of discussions regarding the joint operation of a new hospital to be constructed in the New River Valley Mall area of Christiansburg, Virginia. The hospital would serve as a Community Practice training center for VMRCVM DVM students, it would serve as an after hours emergency center for the area, it would provide primary clinical veterinary care for clients, and it could provide "capacity" for some specialty procedures that the Veterinary Teaching Hospital cannot accommodate on a timely basis.
What is Banfield?
Banfield - the Pet Hospital is a Portland, Oregon based corporation that presently operates about 565 veterinary hospitals in communities around the country. They are expanding and plan to open 80-100 new clinics a year for the next several years. Banfield hospitals operate on a wellness/preventive care clinical model with prescriptive procedures and protocols and see thousands of cases per day.
What exactly is being considered?
The project will involve the joint operation of an animal hospital to be constructed near the New River Valley Mall. The hospital will provide primary care services for an area client base and function as an emergency center that will serve area animal owners and relieve local private practices and the college's Veterinary Teaching Hospital from having to address after-hours emergency caseload demands.
What is the status of the project?
At this point, college and university officials are still developing an agreement that will define and structure a joint operating relationship of the new hospital facility near the New River Valley Mall. University administrative officials must ultimately approve any agreement regarding this collaboration. If an agreement is reached, the Virginia Tech Foundation would likely establish a sub-corporation that would in turn franchise the hospital. Banfield has agreed to make significant monetary concessions to the college and university with regard to their standard franchising relationship. Following the presentation of preliminary information regarding physical plant needs associated with a collaborative facility, Banfield has developed plans for a facility that would accommodate the special needs of the college's educational programs, an emergency center, and special procedures from the Veterinary Teaching Hospital's referral back-log.
How did this idea get started?
In October 2005, VMRCVM Dean Gerhardt Schurig attended a meeting for veterinary college deans that Banfield hosted in Portland, Oregon that was designed to explore ways for Banfield to develop cooperative programs with veterinary academia. During this meeting, Dean Schurig invited Banfield CEO Dr. Scott Campbell to visit the college. Dr. Campbell later contacted the college and indicated that he would like to visit, which he did in May 2006. Dr. Campbell and other executives met with members of the college's Executive Board and Dr. Campbell made two general presentations on Banfield before faculty, staff and student audiences. During those presentations, Dr. Campbell stated that the company was interested in establishing formal relationships with several colleges of veterinary medicine. During the visit, it became apparent to college officials (and was subsequently confirmed) that Banfield was already committed to building a Banfield Hospital in the New River Valley Mall area as a complement to the planned construction of a new PetSmart retail store. Dr. Campbell asked the college if it was interested in discussing some form of collaborative relationship with the project. VMRCVM faculty and administrators have subsequently met with Banfield in Portland on several occasions.
Will this create a more competitive practice environment for local practitioners?
It is possible that the introduction of more service capacity may introduce some competitive pressures in the immediate area in the short term. But it is important to realize that Banfield made the decision to move into the New River Valley regardless of their involvement with the VMRCVM and will open a hospital with or without the college's cooperation. The Veterinary Teaching Hospital has always been open for local clients seeking primary animal care providing they live within a 35-mile radius of the hospital. The college has always been sensitive about competitive issues with private practitioners in the area and has worked through organizations like the VMRCVM/VVMA Liaison Committee to develop mutually beneficial practices. Looking back over the past 25 years, a number of successful veterinary practices have developed within 20 miles of the college, suggesting that a growing critical mass of veterinary capacity actually increases awareness and demand.
What's in it for the VMRCVM?
The Veterinary Teaching Hospital caseload includes secondary and tertiary referral cases, which does not provide our students with optimal exposure to the everyday activities of routine veterinary care. In response to practitioner requests that we provide better training in this area, the VMRCVM administration has been working to create a "stand-alone" "Community Practice" clerkship for fourth year DVM students for over 10 years. This rotation is scheduled to be removed from its current involvement with Small Animal Medicine and begin as a "stand-alone" core clerkship in May 2007 for all VMRCVM DVM students. In addition to the traditional learning experience of routine veterinary cases, the rotation will also address non-technical areas identified to be deficient in new graduates: productivity, business management and personal attributes. The existing structure of clerkships does not adequately address these non-technical skills and the current hospital environment is not ideally suited to support this instruction. The introduction of the Banfield opportunity offers a way to address this need. College officials have also been working with local practitioners to support the development of an emergency clinic that could serve the region. The introduction of the Banfield opportunity also addresses this need.
What's in it for Banfield?
Banfield's expansion plans are constrained by the veterinary profession's inability to produce enough graduates to meet the market demand of corporate veterinary medicine. The growing shortage of graduates is well-documented. According to the National Bureau of Labor Statistics there will be 28,000 openings for veterinarians in the year 2012. Banfield is interested in developing awareness of their career opportunities and relationships with veterinary students who might wish to pursue veterinary medical careers with the corporation. Banfield has also reached a point in the growth of the corporation where it is logical to form more productive relationships with veterinary academia and other allied constituencies within the veterinary medical profession.
Will all VMRCVM students become trained in the Banfield "method"?
Specifics regarding how students will be trained in the new facility are still being considered by the faculty. It is important to stress that the College will not relinquish the academic integrity of the educational experience for our students in order to establish a cooperative agreement with Banfield. All VMRCVM students will be required to rotate through the Community Practice clerkship, whether the clerkship is housed in the Veterinary Teaching Hospital or at the New River Valley hospital. Our students would be able to become familiar with Banfield's diagnostic and therapeutic protocols during this clerkship experience and become exposed to how this corporation believes primary care veterinary medicine should be practiced, just as our students learn other methods from practitioners when they engage in private practice clerkships. The college believes that corporate veterinary medicine is a model that will continue to grow and become a part of how veterinary clinical care is delivered in the future. Exposure to this model of clinical care is part of our goal of producing broadly educated students.
Will VMRCVM students still conduct private practice clerkships?
The new Community Practice clerkship is being substituted for the current Small Animal Medicine clerkship for all students. Students in all tracks in the current curriculum will still have an opportunity to select elective private practice clerkships. The Community Practice clerkship will not replace these elective opportunities, no matter where the Community Practice clerkship is based. The college has always valued the educational opportunities extended to our fourth-year DVM students by private practitioners in Virginia and Maryland.
What are some of the other reasons the college is considering this?
The VMRCVM, like all of higher education, is facing increased needs and diminishing financial support. Projected private and public support will not fully support programmatic growth; and yet, at least $60 million in physical plant expansions must be financed over the next ten years in order to meet instructional needs and the expansion of the college's research, extension, outreach and service enterprise. As conceived, the collaboration with Banfield will produce a revenue positive situation for the college. Importantly, the relationship with Banfield may also advance the development of the college's Translational Medicine Programs. Banfield hospitals see an estimated 75,000 cases per week. This rich source of medical records data managed by Banfield's DataSavant subsidiary is considered to be the largest database of veterinary medical records and animal health information world-wide. Access to this information, as well as access to samples and cases from the vast hospital network, could have a transformative effect on the college's growing Translational Research programs and ultimately create some funding opportunities. Other professional development and enhancement opportunities might arise in the future, ranging from increased instructional capacity to new research initiatives and product developments. The facility might also provide opportunities for some VMRCVM faculty to offer specialty level care, which would create better service for referring DVM's and clients and assist the college in faculty recruitment activities and retention.
How come we haven't heard anything about this before?
The VMRCVM values the mutually beneficial relationships that it maintains with the organized veterinary medical community. We enjoy a productive and ongoing dialogue with the VVMA and the MVMA about issues affecting the profession and work together on numerous programs designed to shape public policy in a way that best serves society and our profession. Our philosophy of communication with stakeholder groups is based upon transparency, engagement and reciprocity. However, as detailed above, the college has not been in a position to share much information about this opportunity because much remains in a state of flux. This is an innovative proposal that involves a great deal of creativity, mutual consideration, and compromise from each party. The college did share general information about the concept during a meeting with the VVMA Southwest District in July and is interested in sharing facts as they become available so that everyone interested in this possible venture can understand as much as possible. As always, the college welcomes practitioner input on this and other issues that surface as it considers future opportunities for growth and development.
How will this benefit veterinary medicine in Virginia and Maryland?
The college has always worked closely with the organized veterinary medical community on programs designed to promote the development of the profession of veterinary medicine in a way that ultimately elevates the quality of care that the profession is able to deliver to the people and animals of Virginia. The college and university will only enter into any agreement that will support the successful execution of its mission in the future, which is predicated on service to the people and animals in the states it serves. Our goal is to develop our instructional, clinical, research and service programs in a way that ultimately enhances the practice environment for private practitioners.

By Dr. Michael Leib, DACVIM
C.R. Roberts Professor of Small Animal Medicine, Internal Medicine
Department of Small Animal Clinical Sciences

Greenies® Causing Esophageal Obstructions in Dogs

Dr. Leib is interviewed by CNN Greenies® are tooth-brush shaped, molded or plastinated, dental chew treats manufactured for dogs. They have been reported to reduce tartar and plaque accumulation, gingivitis, and halitosis, and have the acceptance of the Veterinary Oral Health Council. They are thought to be the most popular dog treat sold in the United States. According to the manufacturer's website more than 300 million have been purchased recently. The major ingredients are processed wheat gluten, glycerin, and powered cellulose fiber. They contain chlorophyll, which helps to improve breath odor, and a natural proprietary flavor, which makes them taste good. There are similar oral health products for dogs available on the market. These products are green, may contain chlorophyll, may be tooth-brush shaped, and can be molded or compressed.
The author endoscopically removed one from the esophagus of a Yorkshire terrier in August 2004. In June of 2005, during the American College of Veterinary Internal Medicine (ACVIM) Special Interest Group GI Endoscopy: What's your diagnosis?, esophageal foreign body obstruction with Greenies® was discussed; particularly that they were difficult to endoscopically remove. Reports of small bowel obstructions also surfaced. The author conducted two informal surveys of the small animal listserv of the ACVIM, and additional cases were identified. This apparent rise in the number of cases with foreign body obstruction, probably reflected the popularity of Greenies® as a dental chew / treat. The true incidence of Greenies® esophageal obstructions per treat consumed, compared to other esophageal foreign bodies (rawhides, "pig ears", and bones etc.) is not known. However, A Veterinary Information Network survey identified more cases of esophageal obstruction due to Greenies® than meat bones, or rawhide chews. Because of the potential severity of this problem, the author decided to collect data from these cases for publication. Internists that responded to the informal ACVIM listserv surveys were asked to fill out a worksheet. At the time of this writing, data collection is still in progress.
Esophageal obstruction with a Greenie® was reported by Cohn, el. al. in 2003 in the AAHA journal. In December 2005 a lawsuit was filed in New York by owners of a dachshund that died of an intestinal obstruction with a Greenie®. Media attention increased all over the United States. The author was interviewed by CNN for a prime time story about Greenies® that aired on the Paula Zahn show. Several other lawsuits have been filed. The manufacturer has reported on their website and in media interviews that most adverse effects of Greenies® could be avoided if the appropriate size chew was used, if owners observed their dogs while they chewed Greenies®, and if Greenies® were not given to dogs that "gulped." One media report indicated that the manufacturer had received only 8 complaints in the previous 8 years. Greenies® have recently been sold to a pet food manufacturer and the product has been reformulated to reduce the possibility of esophageal or intestinal obstruction (discussed later).
At the time of this writing, the author has collected data from 25 cases of esophageal obstruction with Greenies®. Most cases were seen after March of 2003. The median age was 5 years and the median weight was 4.1 kg. There were only 2 large dogs and no medium sized dogs. Common clinical signs included gagging, regurgitation, vomiting, and anorexia. In most cases, survey radiographs identified a soft tissue density within the esophagus or were suspicious of one. Most of the Greenies® were located in the distal esophagus. Successful endoscopic removal was difficult and infrequent. Many Greenies® were pushed into the stomach. Thoracotomy was necessary when the esophagus was perforated or if the Greenie® could not be pushed into the stomach. Moderate to severe esophageal lesions were seen endoscopically, including perforation, ulceration, and necrosis in most cases. About 50% of the cases recovered without major complications. Approximately 30% died (The VIN survey reported approximately 20% mortality). Esophageal strictures developed in approximately 20% of dogs. Compared to other esophageal foreign bodies reported in the veterinary literature and the author's experience, it appears that Greenies® are harder to endoscopically remove, cause more severe esophageal damage, are associated with a higher mortality rate, and result in more esophageal strictures. Further data is necessary to evaluate the incidence of small bowel obstructions and to further characterize esophageal obstruction with Greenies®.
Greenies® have been reformulated to improve their safety. The new formulation still promotes canine oral health. The new product is much more soluble than the previous product; it should break down into smaller and softer pieces if swallowed. Biometric research that evaluated the biting forces of the canine jaw was used to optimize the hardness of the new product. In addition, surface shape and contour alterations were included to encourage complete chewing of the Greenie®. Hopefully, these changes will reduce the chances that the dog will swallow large pieces, and will reduce the possibility of esophageal or intestinal obstruction with the pieces ingested.

Mike Leib, DVM, MS, DACVIM: Internal Medicine, VMRCVM, Blacksburg, VA