SAVMA PHCOC, SAVMA Vet Gazette Submission for Covelo Clinic

Established in 2012, Covelo Clinic strives to improve animal health and welfare in

Covelo, a small town in Mendocino County that struggles with pet overpopulation and access to

veterinary care due to financial and transportation restraints. The clinic provides vaccinations,

preventatives, spay and neuter surgeries, owner education, and other veterinary care. Covelo

Clinic is completely volunteer run, with veterinarians, veterinary students, registered technicians,

and community members coming together to provide care for the animals of Covelo. Partnering

with a local nonprofit organization, Better Options for Neglected Strays (BONES) Pet Rescue,

Covelo Clinic currently conducts 2-3 field clinics each year, serving hundreds of patients in the

span of two days. Most of the clinic equipment is transported from Davis to Covelo, set up on the

first day, and taken down and packed up once the last patient has been seen. This clinic is

completely donation based. Equipment, medications, vaccines, and preventatives are all donated

or purchased with donations from UCD, SAVMA, and the Covelo community.

Every clinic, clients begin lining up 12 hours before the clinic doors are opened in order

to secure a spot for their dogs to be seen. The closest veterinarian to Covelo is over an hour away

and is close to retiring. On top of this, the median yearly income in Covelo in 2019 was 18,730

USD. Some residents of Covelo lack reliable transportation, and the closest veterinarian has

quoted over $800 for house calls, which is an unfeasible financial burden for many people in the

area. Every clinic, residents of Covelo bring cats and dogs with lacerations, embedded foxtails,

eye injuries, masses, and other medical problems that would have otherwise gone untreated. A

lack of access to preventative care combined with a high tick burden in Covelo also leads to a

high incidence of tick-borne diseases such as Lyme disease and anaplasmosis in these animals.

Covelo clinic provides education about tick-borne diseases to owners as well as flea and tick

preventatives for patients in order to decrease this problem. Additionally, due to the lack of a

local veterinarian, the majority of the animals in Covelo were not sterilized prior to the

establishment of this clinic in 2012. Because of this, the Covelo community struggles with pet

overpopulation. BONES Pet Rescue has been rescuing and providing veterinary care for this

struggling pet population since 1998. BONES operates on a very limited budget and is

completely donation and volunteer based. Covelo Clinic strives to lessen the burden both by

decreasing the expansion of the pet population via spay and neuter surgeries as well as providing

BONES with medical advice and support.

Covelo Clinic could not operate without the incredible support from this community,

especially without the support from BONES Pet Rescue. On top of a core group of 16 veterinary

student clinic coordinators, our volunteer team includes roughly 5 veterinarians, 3 veterinary

technicians, 40 veterinary students, and 4 pre-veterinary undergraduates per trip. Clinic

coordinators work intimately with BONES to run the field clinics, and BONES connects the

community to the clinic through advertising and decreasing barriers to access by facilitating

transport. While clinics are running, members of BONES collaborate with clinic coordinators to

intake patients and assist with equipment (eg: oxygen tank refills), creating smooth clinic flow.

Furthermore, to ensure that veterinary students are cognizant of the community’s background

and needs, the BONES founder discusses BONES’ history and mission at the orientation prior to

every clinic. This clinic is dependent on a flourishing partnership with the community of Covelo.

Over the course of a weekend, the clinic performs approximately 100 wellness exams.

During these appointments, veterinary students gather patient histories and perform physical

exams, administer vaccines and dewormers, and for more complicated cases, run diagnostics to

better understand how to effectively treat their patients. Diagnostics performed at Covelo Clinic

include ear cytologies, fine needle aspirates, packed cell volumes, blood smears, skin scrapings,

and more! Perhaps most importantly, students gain invaluable experience communicating

directly with clients to gather patient histories, educate on disease and prevention, and conduct

post-surgical discharges. Over 100 surgeries (spays, neuters, mass removals, and amputations)

are also performed over the weekend. For surgeries, one student monitors anesthesia under the

guidance of a veterinary technician, while another acts as an assistant to the veterinarian

performing the surgery. Veterinary students gain invaluable experience placing catheters and ET

tubes, calculating and administering anesthetic drugs, and recovering patients from anesthesia,

all under the guidance of veterinary professionals. 

Covelo Clinic was established with two goals in mind: improve the health and wellbeing

of the animals in the underserved population of Covelo, and provide veterinary students with

practical experience. It is through generous donations and community support that we hope to

continue to reach these goals!

Established in 2012, Covelo Clinic strives to improve animal health and welfare inCovelo, a small town in Mendocino County that struggles with pet overpopulation and access toveterinary care due to financial and transportation restraints. The clinic provides vaccinations,preventatives, spay and neuter surgeries, owner education, and other veterinary care. CoveloClinic is completely volunteer run, with veterinarians, veterinary students, registered technicians,and community members coming together to provide care for the animals of Covelo. Partneringwith a local nonprofit organization, Better Options for Neglected Strays (BONES) Pet Rescue,Covelo Clinic currently conducts 2-3 field clinics each year, serving hundreds of patients in thespan of two days. Most of the clinic equipment is transported from Davis to Covelo, set up on thefirst day, and taken down and packed up once the last patient has been seen. This clinic iscompletely donation based. Equipment, medications, vaccines, and preventatives are all donatedor purchased with donations from UCD, SAVMA, and the Covelo community.Every clinic, clients begin lining up 12 hours before the clinic doors are opened in orderto secure a spot for their dogs to be seen. The closest veterinarian to Covelo is over an hour awayand is close to retiring. On top of this, the median yearly income in Covelo in 2019 was 18,730USD. Some residents of Covelo lack reliable transportation, and the closest veterinarian hasquoted over $800 for house calls, which is an unfeasible financial burden for many people in thearea. Every clinic, residents of Covelo bring cats and dogs with lacerations, embedded foxtails,eye injuries, masses, and other medical problems that would have otherwise gone untreated. Alack of access to preventative care combined with a high tick burden in Covelo also leads to ahigh incidence of tick-borne diseases such as Lyme disease and anaplasmosis in these animals.Covelo clinic provides education about tick-borne diseases to owners as well as flea and tickpreventatives for patients in order to decrease this problem. Additionally, due to the lack of alocal veterinarian, the majority of the animals in Covelo were not sterilized prior to theestablishment of this clinic in 2012. Because of this, the Covelo community struggles with petoverpopulation. BONES Pet Rescue has been rescuing and providing veterinary care for thisstruggling pet population since 1998. BONES operates on a very limited budget and iscompletely donation and volunteer based. Covelo Clinic strives to lessen the burden both by decreasing the expansion of the pet population via spay and neuter surgeries as well as providingBONES with medical advice and support.Covelo Clinic could not operate without the incredible support from this community,especially without the support from BONES Pet Rescue. On top of a core group of 16 veterinarystudent clinic coordinators, our volunteer team includes roughly 5 veterinarians, 3 veterinarytechnicians, 40 veterinary students, and 4 pre-veterinary undergraduates per trip. Cliniccoordinators work intimately with BONES to run the field clinics, and BONES connects thecommunity to the clinic through advertising and decreasing barriers to access by facilitatingtransport. While clinics are running, members of BONES collaborate with clinic coordinators tointake patients and assist with equipment (eg: oxygen tank refills), creating smooth clinic flow.Furthermore, to ensure that veterinary students are cognizant of the community’s backgroundand needs, the BONES founder discusses BONES’ history and mission at the orientation prior toevery clinic. This clinic is dependent on a flourishing partnership with the community of Covelo.Over the course of a weekend, the clinic performs approximately 100 wellness exams.During these appointments, veterinary students gather patient histories and perform physicalexams, administer vaccines and dewormers, and for more complicated cases, run diagnostics tobetter understand how to effectively treat their patients. Diagnostics performed at Covelo Clinicinclude ear cytologies, fine needle aspirates, packed cell volumes, blood smears, skin scrapings,and more! Perhaps most importantly, students gain invaluable experience communicatingdirectly with clients to gather patient histories, educate on disease and prevention, and conductpost-surgical discharges. Over 100 surgeries (spays, neuters, mass removals, and amputations)are also performed over the weekend. For surgeries, one student monitors anesthesia under theguidance of a veterinary technician, while another acts as an assistant to the veterinarianperforming the surgery. Veterinary students gain invaluable experience placing catheters and ETtubes, calculating and administering anesthetic drugs, and recovering patients from anesthesia,all under the guidance of veterinary professionals. Covelo Clinic was established with two goals in mind: improve the health and wellbeingof the animals in the underserved population of Covelo, and provide veterinary students with practical experience. It is through generous donations and community support that we hope tocontinue to reach these goals!

DEI Highlight Series

As this summer vacation comes to an end, we are excited to continue our Diversity, Equity, and Inclusion (DEI) Highlight Series, by introducing you all to the work of the National Association for Black Veterinarians (NABV). Driven by their mission to “ADVOCATE, provide SUPPORT, and cultivate an inclusive COMMUNITY for blacks in veterinary medicine…,” the NABV Conference held at The Ohio State University this past June was a physical manifestation of just that! 

Dr. Stara Robertson, DACLAM (NABV Executive Board, President, left), Darius Statham (NABV Executive Board, Student Representative and Louisiana State University School of Veterinary Medicine ‘23, right), and Brittany Carter-Stewart (NABV Executive Board, Student Representative and The Ohio State University College of Veterinary Medicine ‘23, center) walk us through what this Conference is and why it is so important. 

Motivation, and Impact: 

Lack of representation is still a persistent issue in the profession. Recent statistics revealed that the demographic makeup of black professionals within veterinary medicine has decreased to 1.5% and has constantly fluctuated between this 1-2% range for decades. One of our goals is to create a pipeline to help correct this. This conference allows for the black community, and allies, from all stages and areas of veterinary medicine to congregate under one roof to network and build more interpersonal connections with one another.  With the NABV conference, we wanted to create a safe space to network, socialize, and learn. We hoped to facilitate students having access to mentorship and summer jobs/internship opportunities.

Scope of the conference: 

There were about 100-150 attendees total. We had 40-45 speakers including 3 panel discussions and our two keynote speakers; Tim Wise and Dr. James Moore. We also hosted an outreach activity at a local shelter as our conference lab. Hotel lodging was probably the main unexpected challenge we faced with planning this conference. We underestimated the total number of attendees and essentially ran out of space. We had to do some research on neighboring hotels and were able to accommodate our participants. 

Adding in Action to Allyship:  

Challenges that have been historically prevalent within this profession and many others include microaggressions, prejudice, or blatant racism. There have already been so many discussions covering this over the years, so I promise to not get onto my soapbox about it. However, I do encourage people seeking information to educate themselves with the resources still available on several different platforms. I also have noticed more individuals seeking insight and/or education from their black colleagues. Even though this is greatly appreciated, one must also consider the amount of time and energy that is required to educate and facilitate change for those within the black community.

 Allyship becomes a key component by serving as a buffer for all of this whether that is speaking up, educating, or providing spaces for belonging. There are some instances where individuals outside of the black community truly cannot understand our perspectives due to the cultural disconnect. In these situations, an ally outside of the black community may have a more relatable take on the exact same point that is more palatable. True allyship also includes being able to identify and speak up against microaggressions and prejudices when they notice them; regardless of whether that person is present or not. Regarding creating a sense of belonging, this can be accomplished by setting a welcoming and inviting tone in a given space. This involves not asking assumptive, stereotypical questions or bombarding someone with conversations on race. Just take time to truly get to know someone for who they are as an individual, not their race. This shows that you’re intentional about creating a genuine bond with a person, and not just reaching out because of obligation or guilt.

My recommendation is always to be an active participant with events hosted by the NABV. The best way to keep up with current events is to join this organization as an ally. If you are a student enrolled in an institution with an established student NABV chapter, we encourage you to join those organizations as well. This is an all-inclusive organization for individuals that would like to support our mission and goals for the upliftment of the black community. Even if you simply want to learn and gain more understanding about what is happening and why organizations like these are crucial, becoming a member shows that you at least want to support and opens up that safe space for dialogue with your colleagues.

Looking to the Future: 

In the future we hope to create more student chapters at pre-veterinary and veterinary school level. We would like to expand our network of sponsors to provide more scholarships for our students. Currently, we are working to provide more mentorship opportunities for individuals interested in pursuing careers within the field. We also plan to have more events for our members throughout the year and more outreach activities for community engagement.

Resources: 

A few resources that we currently have available include NABV directory listed on our website https://nabv.bausper.com/, the BlackDVMNetwork, and the Tuskegee Alumni Association. We always encourage those within the black veterinarian community to reach out to one another for networking purposes and to build a genuine rapport with one another. For prospective students interested in more information, we recommend reaching out to animal science departments and other established veterinary organizations for more insight. Also, feel free to reach out to members of the executive board either individually or at info@NABVonline.org any time if you have any questions or concerns.

Special Thanks: 

We would like to thank the entire executive board for helping to organize this amazing conference. There was a lot of time and thought that went into planning every aspect of this event, so we want each of you to know how much you are appreciated for the hard work. We also want to send a special shoutout to each and every one of our sponsors for this event. None of this would have been possible without your contributions, and we lookforward to seeing you all again next year!

IVEC Student Highlight

SAVMA IVEC would like to highlight Lindsay Hopper, a fourth-year student at the University of Tennessee CVM who was awarded the IVEC Scholarship. 

“My experience in Belize has shaped how I view veterinary medicine and all the individuals involved in animal care. While in Belize, I was able to work with the dedicated keepers at the Belize Zoo and learn from them about the incredible animals they care for. Our group was composed of veterinarians and veterinary students from the University of Tennessee. We were able to provide care for over 40 animals including jaguars, jaguarundis, howler monkeys, tapir, coatimundi, kinkajou, peccary, toucan, and more. We performed physical exams, annual wellness treatments, spays, dental cleanings with extractions, root canals and more. Some of my favorite experiences were participating in a howler monkey spay, performing a physical exam on a jaguar, and assisting in a dental on a jaguar.

This experience also allowed me to gain experience providing veterinary care with limited resources. We were able to provide care to so many animals, despite not having all the resources and technology that we are used to in a university setting. This is important to me because I plan on volunteering my time in the future to organizations in the US and abroad that provide veterinary care in underserved communities.

Being able to care for the amazing creatures at the Belize Zoo is an experience that will stay with me forever.”

Student Case Study

Erosive Polyarthritis in a Porcupine

Submitted by Rose Olsasky, Iowa State University

A juvenile (approximately 5 month old) female intact porcupine presented to the Wildlife Rehabilitation Center of Minnesota (WRC) following acute onset of lameness.  She was initially in the care of a different rehabilitation facility beginning at a few weeks old.  She was apparently healthy until 1 month ago when she began showing signs of lameness.  It was at this point that she was transferred to WRC. 

On physical exam, the porcupine was bright, alert, responsive, and had a normal appetite.  She walked with a stilted gait and there was concern for her favoring her left front leg.  A thorough orthopedic exam was difficult to perform without sedation.  It was unclear if she was just reactive to palpation versus spinal or long bone pain.  The remainder of her physical exam was within normal limits.  A CBC was ran but bloodwork was unremarkable.  The working differential diagnoses for her case included infectious (tick-borne), trauma, inflammatory (septic process), and degenerative/congenital. 

The porcupine was preemptively started on trimethoprim /sulfamethoxazole (TMPS) and doxycycline due to the concern for infectious and tick borne disease, such as Lyme.  There is no information about the validity of using the canine 4DX snap test for porcupines.  Additional diagnostics to rule out infectious causes would include a PCR tick panel but that was not pursued.  While rodents, including porcupines, are known reservoirs of Borrelia burgdorferi, they are typically not clinically affected1.  There are no specific reports of porcupines developing signs of infection that we see in our small animal patients such as shifting leg lameness or joint pain. However, there may be other infectious haemoparasites yet to be discovered in these wild rodents.  For example, a novel haemotropic Mycoplasma was recently identified in the orange-spined hairy dwarf porcupine but clinical effects of the organism remain unknown2.

Due to the fact that the porcupine appeared painful, she was started on pain medication (gabapentin). She had no history of trauma but her discomfort was difficult to localize.  After a couple days acclimating in hospital, she was sedated and radiographs were taken. There are few porcupine radiology reference images which makes interpretation difficult.  There were no overt abnormalities except possibly increased joint spaces which may be an entrapment due to her juvenile skeleton. Previous trauma was ruled out by the lack of fractures or soft tissue swelling [see the adjacent images]. Under sedation, a more thorough exam was performed and again, there were no obvious abnormalities. Radiographs were repeated a couple weeks later with similar images.

Through her stay, the porcupine was bright, alert, and responsive in hospital. She was eating well and appeared otherwise healthy.  Another issue developed while she was with WRC where she became acclimated to humans.  She would approach and greet people when they approached her enclosure, which makes re-release difficult.  Her ambulation also remained static or worsened slightly through the weeks.  Her front left leg was supinated and she seemed to have decreased range of motion.  She had difficulty climbing and porcupines need to be able to do so in the wild to find food3.  Due to lack of therapeutic response and poor long-term prognosis, humane euthanasia was elected. 

Any hospitalized patient that is euthanized receives a necropsy.  On gross exam, there were no obvious lesions. Her internal structures including heart, gastrointestinal tract, and abdominal organs appeared normal.  The only lesions were found in her joints.  When excising into the joint (both stifles and both cubital joints), there was copious amounts of suppurative effusion present (image to the left).  There was also evidence of articular erosions on all the joint surfaces with ranges of severity (see image on the right).  The total protein of the effusion was 7.0g/dL.  The synovial fluid was evaluated under the microscope and numerous nucleated cells were identified.  Majority of the effusion was made up of neutrophils as well as a decent amount of plasma cells. There was no bacteria noted on cytology.  An in-house culture was started but the results are not known at the time of this paper.

  

 There is not a lot of research or data on porcupine diseases.  Most of the conclusions from this report will be extrapolated from other rodents and small animal medicine cases.  Based on necropsy results, this porcupine had an erosive polyarthritis.  There are currently no published case reports of polyarthritis in porcupines.  Differentials for erosive polyarthritis include non-inflammatory (trauma, degenerative disease, gout), sepsis, infectious inflammation (Ehrlichia, Lyme, fungal), or immune-mediated (idiopathic, rheumatoid arthritis).  Based on fluid analysis, a non-inflammatory process was ruled out due to the elevated total protein.  Although culture results are not completed, the absence of a fever, normal white cell count, lack of systemic illness, and lack of bacteria seen on cytology helps to rule out sepsis.  As aforementioned, the lack of response to doxycycline makes tick-borne disease unlikely as well.  The last potential cause is immune-mediated.  In dogs, immune-mediated polyarthritis is caused by accumulation of immune complexes leading to chemotaxis of neutrophils into the joint5.  There are a number of different inciting causes including idiopathic, secondary to infection (non-joint), secondary to GI illness, or secondary to neoplasia.  There is no similar immune-mediated polyarthritis documented in rodents, however, mice have been experimentally used as a model for rheumatoid arthritis.  This can be done through intra-articular antigen-induction, collagen-induction, or transgenic mice lacking interleukin-336,7.  The mice in these experiments are meant to mimic the human disease and there is little literature on natural occurring rodent arthritis.  It remains unclear what the underlying etiology is for this porcupine’s polyarthritis.

In reviewing the case, arthrocentesis and fluid analysis would have been a useful antemortem diagnostic.  However, retrospectively knowing the results would not have changed the prognosis or end decision to euthanize.  Something else that could have been done is immunosuppressive medications or glucocorticoid therapy to treat an immune-mediated process.  Based on the author’s research, this is the first documented case of a non-septic erosive polyarthritis in a porcupine. Given the multifocal nature and extent of the lesions, humane euthanasia was ultimately the best choice in this case.

References

1. Radolf, Justin D et al. “Of ticks, mice and men: understanding the dual-host lifestyle of Lyme disease spirochaetes.” Nature reviews. Microbiology vol. 10,2. 9 Jan 2012; 87-99.

2. Valente JDM, Saldanha A, Martini R, Lange RR, Baggio RA, Martins TF, Dos Santos LP, de Sousa RS, Vieira TSWJ, Vieira RFC. 'Candidatus Mycoplasma haemosphiggurus' a novel haemoplasma species in orange-spined hairy dwarf porcupines (Sphiggurus villosus) from Southern Brazil. Transbound Emerg Dis. 2021 May;68(3):1054-1061. 

3. Uldis R. The North American Porcupine. 2nd ed. Comstock publishing associates: Cornell University Press, 2009; 218-222. 

4. MacWilliams PS, Friedrichs KR. Laboratory evaluation and interpretation of synovial fluid. Vet Clin North Am Small Anim Pract 2003;33:153-178.

5. Rondeau MP, Walton RM, Bissett S, et al. Suppurative, nonseptic polyarthropathy in dogs. J Vet Intern Med 2005;19:654-662.

6. Williams, R O. “Rodent models of arthritis: relevance for human disease.” Clinical and experimental immunology vol. 114,3. 1998; 330-2. 

7. Talabot-Ayer, D., Martin, P., Seemayer, C.A., et al. Immune-mediated experimental arthritis in IL-33 deficient mice. CYTOKINE 2014; 69, 68-74

Foot in Mouth Disease

Submitted by Heidi Free, Kansas State University