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Filho TG, Rahal SC, Kano WT, Mesquista LR, Mamprim MJ, Silva JP, Agostinho FS. Gait Analysis of Amputee Dogs Using a Pressure-Sensitive Walkway. Vet Comp Orthop Traumatol 2024; 37:189-195. [PMID: 38503301 DOI: 10.1055/s-0044-1779727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE The aim of this study was to perform gait analysis using a pressure-sensitive walkway in dogs submitted to high (total) or low amputation (partial) of one forelimb or hindlimb. STUDY DESIGN A total of 39 dogs met the inclusion criteria. The reasons for the amputations were motor vehicle accidents in 38 dogs and possible limb malformation in 1 dog. The amputee dogs were divided into four groups: G1 (n = 10)-high forelimb; G2 (n = 10)-low forelimb; G3 (n = 9)-high hindlimb; and G4 (n = 10)-low hindlimb. For kinetic evaluation, the dogs were walked across a pressure-sensitive walkway. RESULTS In dogs with forelimb amputation, the percentage of body weight (%BW) distribution on the contralateral forelimb was 50.7% in cases of high amputation and 55.5% in cases of low amputation, while the %BW distribution on the hindlimbs, mainly in the ipsilateral hindlimb, was 27.9% in cases of high amputation and 27.1% in cases of low amputation. In cases of high amputation of the hindlimb, the %BW distribution was 71.5% on the forelimbs and 29.7% on the contralateral hindlimb, while in cases of low amputation, the distribution was mainly for the contralateral hindlimb and ipsilateral forelimb. No statistical difference was noted between the amputation levels, except for the contralateral limb in cases of low and high amputation of the hindlimbs concerning the overload percentage and %BW distribution. CONCLUSION The amputation level of one forelimb did not influence the %BW distribution; however, in the hindlimb, this was higher for the contralateral limb in dogs submitted to high amputation.
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Affiliation(s)
- Túlio G Filho
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Sheila C Rahal
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Washington T Kano
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Luciane R Mesquista
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Maria J Mamprim
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Jeana P Silva
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Felipe S Agostinho
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, SP, Brazil
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2
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Sayag D, Jacques D, Thierry F, Castell Y, Aumann M, Gauthier O, Wavreille V, Tselikas L. Combination of CT-Guided Microwave Ablation and Cementoplasty as a Minimally Invasive Limb-Sparing Approach in a Dog with Appendicular Osteosarcoma. Animals (Basel) 2023; 13:3804. [PMID: 38136841 PMCID: PMC10740973 DOI: 10.3390/ani13243804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/03/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Image-guided microwave ablation and cementoplasty are minimally invasive techniques that have been used as part of a limb-sparing approach in the treatment of appendicular bone tumors in humans. The objective of this case report was to describe the feasibility and result of microwave ablation (MWA) and cementoplasty in a dog with stage-1 osteoblastic appendicular osteosarcoma of the right distal radius. A microwave antenna was inserted in the osteolytic area using computed tomography (CT) guidance. Three ablation cycles of 5 min at 60 watts were performed. Immediately after the MWA procedure, a tricalcium phosphate-based cement was injected through the bone trocar to consolidate the ablated zone. Adjuvant chemotherapy with six sessions of carboplatin was performed, without major complication. Response to the treatment was evaluated according to RECIST criteria every 6 weeks. Twenty-four hours after MWA, the dog was pain-free and had excellent mobility. Based on CT measurements, a reduction of the size of the lytic area was observed at the 2-month and at the 7-month follow-up (from 13% to 25% of the longest diameter), classified as stable disease according to RECIST criteria. The dog died 18 months after the initial diagnosis due to distant metastases.
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Affiliation(s)
- David Sayag
- ONCOnseil, Unité D’expertise en Oncologie Vétérinaire, 31200 Toulouse, France
| | - David Jacques
- Clinique Vétérinaire Occitanie, 31200 Toulouse, France
| | | | | | - Marcel Aumann
- Unité Medecine Interne, Urgences et Soins Intensifs, École Nationale Vétérinaire de Toulouse, 31300 Toulouse, France
| | - Olivier Gauthier
- Unité de Chirurgie, Anesthésie, ONIRIS—École Nationale Vétérinaire de Nantes, 44300 Nantes, France;
| | - Vincent Wavreille
- Vetspecialistes, Service de Chirurgie, 1218 Grand-Saconnex, Switzerland;
| | - Lambros Tselikas
- Service de Radiologie Interventionnelle, Gustave Roussy Cancer Campus, 94805 Villejuif, France;
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3
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Rigas K, Tanis JB, Morello E, Polton G, Marconato L, Carroll M, Ciriano Cerda E, Ramos S, Baker C, Finotello R. The Prognostic Role of Preoperative Hematological and Inflammatory Indices in Canine Appendicular Osteosarcoma. Vet Sci 2023; 10:495. [PMID: 37624282 PMCID: PMC10459974 DOI: 10.3390/vetsci10080495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Hematological indices play a prognostic role in human osteosarcoma (OSA), but data are limited in dogs. The aim of this retrospective multicentric cohort study was to investigate the prognostic significance of pre-operative hematological/inflammatory indices in a cohort of client-owned dogs with appendicular OSA receiving standardized treatment. Cut-offs associated with progression-free survival (PFS) for pre-operative hematological values/ratios were established using the minimal p-value approach. Historical prognostic factors were also assessed. Statistical analyses were performed for the whole population and after the exclusion of sighthounds. Fifty-nine dogs were included (13 were sighthounds). Multivariable analysis revealed that a low neutrophil count (<4.37 × 109/L, HR0.28, CI 95% 0.13-0.61, p = 0.001), a high red blood cell count (≥7.91, HR3.5, CI 95% 1.56-7.9, p = 0.002), and a proximal humerus location (HR3.0, CI 95% 1.48-6.1, p = 0.002) were associated with shorter PFS. In the sighthound-only population, only OSA location was significantly associated with PFS in univariable analysis. When sighthounds were excluded, a low neutrophil count, a low monocyte count, and a proximal humerus location were associated with shorter PFS, in multivariable analysis. Neutrophil count and possibly monocyte and red blood cell counts can be useful prognostic markers in canine OSA treated with amputation and adjuvant carboplatin. However, not all indices are appropriate in sighthounds.
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Affiliation(s)
- Konstantinos Rigas
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston CH64 7TE, UK; (K.R.); (R.F.)
- Southfields Veterinary Specialists, Basildon SS14 3AP, UK
| | - Jean-Benoit Tanis
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston CH64 7TE, UK; (K.R.); (R.F.)
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool L7 8TX, UK
| | - Emanuela Morello
- Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy
| | - Gerry Polton
- North Downs Specialist Referrals, Bletchingley RH1 4QP, UK
| | - Laura Marconato
- Department of Veterinary Medical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Marlon Carroll
- Department of Veterinary Sciences, University of Turin, 10095 Grugliasco, Italy
| | | | - Sofia Ramos
- North Downs Specialist Referrals, Bletchingley RH1 4QP, UK
| | - Charlotte Baker
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston CH64 7TE, UK; (K.R.); (R.F.)
| | - Riccardo Finotello
- Department of Small Animal Clinical Sciences, Institute of Veterinary Science, University of Liverpool, Neston CH64 7TE, UK; (K.R.); (R.F.)
- Department of Veterinary Medicine, University of Bari, 70010 Valenzano, Italy
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4
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Altwal J, Martin TW, Thamm DH, Séguin B. Configuration of pathologic fractures in dogs with osteosarcoma following stereotactic body radiation therapy: A retrospective analysis. Vet Comp Oncol 2023; 21:131-137. [PMID: 36633386 DOI: 10.1111/vco.12877] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 01/13/2023]
Abstract
For some cases of canine appendicular osteosarcoma (OSA), limb-sparing treatment options are often desired, one of which is stereotactic body radiation therapy (SBRT). A major complication of SBRT is fracture of the irradiated bone at the site of treatment. The present study evaluated 127 appendicular OSA sites in 122 dogs treated with SBRT to identify the most common pathologic fracture locations and configurations. A total of 50 tumours experienced a pathologic fracture, and 38 had imaging sufficient to identify fracture configuration. The distal tibia was more likely to develop a fracture than other sites. Multiple types of fracture configuration (transverse, oblique, spiral and comminuted) were observed. The distal radius was significantly more likely to develop a transverse fracture than other sites. Documentation of fracture location and configuration leads to the identification of the forces contributing to fracture occurrence, since each configuration is a result of different forces acting on each affected bone. Such knowledge is imperative for the development of new approaches to diminish the occurrence of pathologic fractures.
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Affiliation(s)
- Johnny Altwal
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Tiffany Wormhoudt Martin
- Flint Animal Cancer Center and Department of Environmental and Radiological Health Science, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Douglas H Thamm
- Flint Animal Cancer Center and Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Bernard Séguin
- Flint Animal Cancer Center and Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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5
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Norquest CJ, Maitz CA, Keys DA, Moore M, Bryan JN, Ehling TJ, Lattimer JC, Flesner BK. Fracture rate and time to fracture in dogs with appendicular osteosarcoma receiving finely fractionated compared to coarsely fractionated radiation therapy: A single institution study. Vet Med Sci 2022; 8:1013-1024. [PMID: 35263506 PMCID: PMC9122396 DOI: 10.1002/vms3.782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Radiation therapy (RT) is used for local pain alleviation in dogs with appendicular osteosarcoma (OS), especially among dogs that are poor surgical candidates for amputation. However, many historical reports of fractionated protocols lack time to fracture and fracture rates. OBJECTIVES The primary objectives of this retrospective study were to determine fracture rate and time to fracture of dogs receiving RT (coarse or fine fractionated) for appendicular OS. Secondary objectives were to evaluate tolerability and disease outcome measures. METHODS Fifty-one dogs that received RT as part of treatment for appendicular OS were available for evaluation. Forty-five received coarse fractionation (C-RT, 8 or 6 Gy per fraction protocols [C-RT8 or C-RT6]) while the remaining six received fine fractionation (F-RT). RESULTS The overall pathologic fracture rate was 37%. Pathologic fracture rate was significantly higher for dogs that received F-RT (5/6, 83%) compared to dogs that received C-RT (12/40, 30%, p = 0.021). In the 17 dogs that fractured, the overall median time to fracture was 57 days. For all dogs, the median progression free interval (PFI) and median overall survival time (OST) were 90 and 140 days, respectively. In a very small cohort of dogs (n = 7) treated with zoledronate and RT, fracture rate was 0% and extended survival times were noted. CONCLUSIONS In conclusion, C-RT is recommended over F-RT due to lower risk of pathologic fracture and similar PFI. Prospective evaluation of combined C-RT and zoledronate, especially for dogs with poor surgical candidacy, is warranted for the treatment of canine appendicular osteosarcoma.
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Affiliation(s)
| | | | | | - Melanie Moore
- Veterinary Health CenterUniversity of MissouriColumbiaMissouri
| | | | - Tara J. Ehling
- Veterinary Health Center at WentzvilleUniversity of MissouriWentzvilleMissouri
| | | | - Brian K. Flesner
- Veterinary Health CenterUniversity of MissouriColumbiaMissouri
- School of Veterinary MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvania
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6
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Magidenko SR, Peterson NW, Pisano G, Buote NJ. Analysis of patient outcome and owner satisfaction with double limb amputations: 14 dogs and four cats. J Am Vet Med Assoc 2022; 260:884-891. [PMID: 35333746 DOI: 10.2460/javma.21.04.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the indications for, complications of, and surgical outcomes of dogs and cats that were treated with double limb amputations. ANIMALS 14 dogs and 4 cats that underwent double limb amputations. PROCEDURES Data collected retrospectively included patient-specific (species, age, weight, breed, sex, existing comorbidities) and amputation-specific (indication for amputation, full or partial limb amputation, associated complications, need for revision surgeries) variables. Owner satisfaction scores were also collected. RESULTS The most common indication for double amputations was trauma (12/18) patients. Eleven patients had both amputations performed simultaneously. Nine patients had double partial limb amputations versus full limb amputations. Twelve patients underwent bilateral pelvic limb amputations, 4 underwent bilateral thoracic limb amputations, and 2 had 1 pelvic and 1 contralateral thoracic limb amputated. Five patients had reported complications over the course of the follow-up period, and complications for 3 patients were considered major. Revision surgery was reported for 2 animals. Owner satisfaction scores were reported as very satisfied/excellent (14/18), mildly satisfied (3/18), and strongly dissatisfied (1/18). Median time to follow-up was 450 days (range, 85 to 4,380 days). CLINICAL RELEVANCE Double limb amputation may be a viable alternative to advanced limb-sparing procedures or humane euthanasia based on the owner satisfaction data and the relatively low rate of major complications in this study. Future studies should clarify patient selection criteria and differences in function between surgical types.
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Affiliation(s)
- Steven R Magidenko
- Hospital for Animals, Small Animal Surgery Section, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - Nathan W Peterson
- Hospital for Animals, Emergency and Critical Care Section, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - Guido Pisano
- Centro Veterinario Pisani, Carli, Chiodo Luni Mare, Luni SP, Italy
| | - Nicole J Buote
- Hospital for Animals, Small Animal Surgery Section, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
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7
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Sterman A, Butler JR, Chambers A, Dickson R, Dornbusch J, Mickelson M, Selmic L, Scharf V, Schlag A, Skinner O, Vinayak A, Janssens BW. Post-operative complications following apocrine gland anal sac adenocarcinoma resection in dogs. Vet Comp Oncol 2021; 19:743-749. [PMID: 34173318 DOI: 10.1111/vco.12748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 02/02/2023]
Abstract
Describe the complications associated with surgical resection of primary apocrine gland anal sac adenocarcinoma (AGASACA) tumours study design multi-institutional retrospective cross-sectional cohort study Animals Client owned dogs with spontaneous disease using the Clavien-Dindo classification system, post-operative events were assigned and described. Logistic regression analysis was used to analyse for risk factors for a significant association with complications. One hundred sixty-one dogs were included in the analysis. The post-operative sequelae, complication, and failure to cure rates specific to the anal sac site was 14%, 17% and 1%, respectively. The majority (68%) of complications were grade II or higher, therefore requiring some form of intervention. Intra-operative complications were identified in 11 cases (7%) with anorectal wall perforation being most common. An intra-operative complication was significantly associated with post-operative complications (p < 0.001; OR 7.4) while anorectal wall perforation was the only significant risk factor on regression analysis (p < 0.001; OR 19). Surgical site infection was identified in 20 of 161 (12%) of cases. Local recurrence (LR) occurred in 18% of cases at a median of 374 days (95% CI: 318-430). The only risk factor significantly associated with LR was the presence of vascular or lymphatic invasion (p = 0.008; OR 3). Post-operative complications were relatively infrequent but the risk was significantly increased when there was an intraoperative complication during resection of a primary AGASACA tumour. This study provides information for the clinician regarding risk factors for post-operative complications.
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Affiliation(s)
- Allyson Sterman
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA.,Department of Veterinary Clinical Sciences, Purdue University College of Veterinary Medicine, West Lafayette, Indiana, USA
| | - J Ryan Butler
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Aidan Chambers
- Department of Small Animal Surgery, University of Missouri, Columbia, Missouri, USA
| | - Rachel Dickson
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Josephine Dornbusch
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Megan Mickelson
- Department of Small Animal Surgery, University of Missouri, Columbia, Missouri, USA.,Department of Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Laura Selmic
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Valerie Scharf
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | - Ariel Schlag
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Owen Skinner
- Department of Small Animal Surgery, University of Missouri, Columbia, Missouri, USA
| | - Arathi Vinayak
- Department of Surgery, VCA West Coast Specialty and Emergency Animal Hospital, Fountain Valley, California, USA
| | - Brandan Wustefeld Janssens
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, Texas, USA.,Flint Animal Cancer Center and Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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8
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Martin TW, Griffin L, Custis J, Ryan SD, Lafferty M, Boss MK, Regan D, Rao S, Leary D, Withrow SJ, LaRue SM. Outcome and prognosis for canine appendicular osteosarcoma treated with stereotactic body radiation therapy in 123 dogs. Vet Comp Oncol 2021; 19:284-294. [PMID: 33403752 DOI: 10.1111/vco.12674] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 12/29/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022]
Abstract
Canine appendicular osteosarcoma is commonly treated with limb amputation; however, limb-sparing options are frequently desired or necessary for a subset of patients. We evaluated 123 patients and 130 sites treated with stereotactic body radiation therapy (SBRT). Eighty-two out of 98 dogs (84%) had maximum lameness improvement at a median of 3 weeks for a median of 6 months duration. Histopathologic evaluation of available samples from amputation or necropsy revealed >80% tumor necrosis in 50% of limbs consistent with local disease control. Of evaluable patients, 41% fractured and 21% pursued an amputation after treatment. Fine needle aspirate (n = 52) and needle core biopsy (n = 28) did not result in increased fracture risk compared to those without tumor sampling (n = 50). Median survival time (MST) was 233 days and time to first event was 143 days. Gross tumor volume and planned target volume were significantly inversely associated with survival and tumor location was significantly associated with survival. Dogs with salvage amputation had a significantly longer MST compared to those without (346 vs 202 days; P = .04). The presence of metastatic disease at the time of treatment in 15 dogs did not significantly impact survival time (200 vs 237 days without metastasis; P = .58). Skin side effects correlated significantly with dose with 33% of patients with acute grade 3 effects developing consequential late grade 3 effects. While SBRT improves lameness in most patients, further investigation is needed to identify candidates with minimal early fracture risk prior to initiating therapy.
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Affiliation(s)
- Tiffany Wormhoudt Martin
- Department of Environment and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Lynn Griffin
- Department of Environment and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - James Custis
- Department of Radiation Oncology, VCA Animal Diagnostic Clinic, Dallas, Texas, USA
| | - Stewart D Ryan
- Veterinary Clinical Sciences, The University of Melbourne, Victoria, Australia
| | - Mary Lafferty
- Department of Clinical Science, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Mary-Keara Boss
- Department of Environment and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Daniel Regan
- Department of Microbiology, Immunology, and Pathology College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Sangeeta Rao
- Department of Clinical Science, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Del Leary
- Department of Environment and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Stephen J Withrow
- Department of Clinical Science, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Susan M LaRue
- Department of Environment and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA
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