Non-surgical Sterilization: Facts to Consider Dr. Amy Fischer, Dr. Bob Weedon

Transcription

1 Non$SurgicalSteriliza1on:FactstoConsider G.#Robert#Weedon,#DVM,#MPH Amy#Fischer,#PhD# ClinicalAssistantProfessor,ShelterMedicine TeachingAssociateandOutreachSpecialist,AnimalSciences UniversityofIllinois UniversityofIllinois ShelterVeterinarian,ChampaignCountyHumaneSociety Mission:''Toexpeditethesuccessfulintroduc1onofmethodstonon$surgicallysterilizedogsandcatsandtosupportthedistribu1onandpromo1onoftheseproductstohumanelycontrolcatanddogpopula1onsworldwide. acc$d.org October 23 26,

2 Priori;es#for#Non>Surgical#Fer;lity#Control## Safeandeffec1ve Permanentorlong$term Deliverableinasingleinjec1onortreatment Approachesfordogsandcats/maleandfemale Documentedeffectsonbehaviorandhealth Affordable Special'thanks'to'our'' Council'of'Stakeholders' October 23 26,

3 Whynonsurgicalsteriliza1oninsteadoftradi1onalspay/neuter? October 23 26,

4 October 23 26,

5 SURGICAL SPAY/NEUTER Tosavemorelives.. we#need#more#op;ons.### October 23 26,

6 Let sexploretheop1ons.! Onthehorizon! Availablenow! Exci1ngannouncement!! Ques1onsanddiscussionwelcomeaswego Thebrain scontrolofreproduc1on October 23 26,

7 Gonadotropin#Releasing#Hormone# GnRH o Masterreproduc1vehormone o Actsdirectlyonthepituitary October 23 26,

8 Gonadotropins# FollicleS1mula1ngHormone,#FSH# LuteinizingHormone,##LH# o Bindtoreceptorsonthegonads Whatdothegonadotropinsdo? MALE ## Spermmatura1on Testosteroneproduc1on October 23 26,

9 Whatdothegonadotropinsdo? MALE ## FEMALE# Coordina1onofestrouscycle/ovula1on Estrogenandprogesteroneproduc1on Nega1ve Feedback Gametes Hormones Testosterone Estrogen Progesterone Spermmatura1on Testosteroneproduc1on Reproduc1veControl Hypothalamus PituitaryGland Gonads GonadotropinReleasing Hormone(GnRH) LuteinizingHormone(LH) FollicleS1mula1ngHormone(FSH) October 23 26,

10 Nega1ve Feedback GnRH Vaccines GnRH Agonists Gametes Hormones Testosterone Estrogen Progesterone Reproduc1veControl Hypothalamus PituitaryGland Gonads GonadotropinReleasing Hormone(GnRH) LuteinizingHormone(LH) FollicleS1mula1ngHormone(FSH) Immunocontracep1on Theuseofananimal'simmunesystemtoprevent successfulreproduc1on # vaccine#technology October 23 26,

11 Slimmyreceivesarabiesvaccine. emc.maricopa.edu Herbodymakesan1bodiesagainst thevirus. Ifexposedtothevirus,circula1ngan1bodiesbindit.Thevirusdoesnotreachitsreceptor. Hey,thanks! Slimmyisnotinfected. October 23 26,

12 SlimmyreceivesaGNRHvaccine. Herbodymakesan1bodiesagainstherown GnRH. WhenherhypothalamusreleasesGnRH, an1bodiesbindit. Slimmyiscontracepted. FSHandLHarenotreleased. Yay! GnRHdoesnotreachitsreceptorsinthe pituitary. GonaCon TM TheU.S.DepartmentofAgriculture swildlifeservice s Na1onalWildlifeResearchCenter(NWRC) GnRHimmunocontracep1vevaccine Deliveredbyinjec1on ApprovedbyEPAin2010forfemaledeer Researchalsoconductedwith: Dogs Cats # October 23 26,

13 Dr.JulieLevyStudy 5$yearstudy 15femalestreated withgonacon 5controlfemales J.K. Levy et al. / Theriogenology 76 (2011) Percent'left'in'study Sham GnRH Months' October 23 26,

14 GnRHAgonists ACC&DisworkingtorealizeGonaCon s poten1alforfree$roamingcats. MimictheeffectofGnRH,anddownregulate( burnout ) thereceptorsinthepituitarygland October 23 26,

15 Deslorelin/Suprelorin VIRBAC,formerlyPeptechAnimalHealth $GnRHagonist $Deliveredbyimplant $ApprovedinAustralia,NewZealandandEUformaledogs $FDA$indexedproducttotreatadrenaltumorsinferrets $Researchalsoconductedwith Femaledogs Male/femalecats # DogswithNoNames October 23 26,

16 Chemicalsteriliza1on Currentapproachesareformales Zincgluconateneutralizedbyarginine Zeuterin Gametes Hormones Testosterone Estrogen Progesterone Calciumchloride Theuseofchemicalcompoundswhichdestroyand/orrender ineffec1veessen1alcomponent(s)ofthereproduc1vesystem Reproduc1veControl Hypothalamus PituitaryGland Gonads GonadotropinReleasing Hormone(GnRH) LuteinizingHormone(LH) FollicleS1mula1ngHormone(FSH) Nega1ve Feedback Zinc Gluconate October 23 26,

17 NewYorkTimes December'2,'2013' NewStridesin Spayingand Neutering WhyDoWeNeuterDogs? October 23 26,

18 WhyDoWeNeuterDogs? Commonbeliefs: 1. It shealthierforthedog. 2. Tochangebehavior. 3. Tocontrolreproduc1on. Agenda! ZeuterinIntroduc1on! Efficacyandsafety! FDAapprovalresearch! Expectedreac1ons! Trea1ngadversereac1ons October 23 26,

19 Agenda! Longtermeffects! Behavioralissues! Administra1onprotocol! Iden1fica1onofzincneutereddogs ACC&D#Resources# October 23 26,

20 Zeuterin TM ZincGluconateNeutralizedbyArginineistheonlyFDAapprovednon$surgicalsterilantformaledogs Asingle,virtuallypainlessinjec1ontoneuteramaledog,permanently CourtesyArkSciences Zeuterin TM Highlights Maledogs3$10monthsofage(olderpending) One$1meInjec1onintoeachtes1cle Safe&Effec1ve PermanentandIrreversible ReducesTestosterone CourtesyArkSciences October 23 26,

21 Efficacy#! Provensafeandeffec1ve! 99.6%Efficacy! FDAclinicaltrial:223/224dogs age3to10months CourtesyArkSciences How#do#we#know#Zeuterin#is#permanent?# InChapter7: HistopathologicEvalua1onoftheTes1sinToxicologic Tes1ngandRiskAssessment, ofthetextbook,histological'and' histopathological'evaluabon'of'the'tesbs,theauthorsdiscussthehistologicevalua1onofthetes1sasanimportantcomponentofmanyregulatoryagencytestprotocols.theysay, Histopathologicevidencemayrevealdisrup1onintes1cular1ssue,par1cularlyintheseminiferousepithelia,andmaybeusedasthebasisforregulatoryac1on. Russell,etal sted.CacheRiverPress,St.Louis,MO October 23 26,

22 How#do#we#know#Zeuterin#is#permanent?# EndPointsforHistopathologicExamina1onoftheSeminiferousEpithelium: Presenceofdegenera1ng,sloughedand/orinfiltra1ngcells Absenceofatubularlumen Absenceofelongatedsperma1ds Heightofgerminalepithelium Tubulediameter Numberofsperma1ds/tubularcrosssec1on Russell,etal sted.CacheRiverPress,St.Louis,MO Epididymisfromuntreated dog(100x) EpididymisfromZeuterin treateddog(100x) At30dayspost$injec1on HowdoweknowZeuterinispermanent? CourtesyArkSciences October 23 26,

23 Epididymisfromuntreated dog(100x) EpididymisfromZeuterin treateddog(100x) At24monthspost$injec1on HowdoweknowZeuterinispermanent? CourtesyArkSciences Tes1clefromuntreateddog (100x) Tes1clefromZeuterin treateddog(100x) At24monthspost$injec1on HowdoweknowZeuterinispermanent? CourtesyArkSciences October 23 26,

24 HowdoweknowZeuterinispermanent? Does#the#tes;s#have#the#capacity#to#reverse#fibrosis?## Attheendof24months,thehistopathologyofthetes1s,theheadoftheepididymis,thebodyoftheepididymisandthetailoftheepididymiswereperformedtoanalyzethepresenceorabsenceoffunc1oningspermproducingcellsandseminiferoustubules.Thehistopathologyshowedthatnonormalseminiferoustubulesexistedandonlyfibro1cornonfunc1onalseminiferoustubuleswerepresentthroughoutthetes1s. Itshouldbenotedthatunfortunately,orinthiscasefortunately,thebodydoesnotreversefibrosisandthereisnoknowntreatmenttorecoverthefibro1cseminiferoustubulesofthetes1s,whichrenderstheanimalpermanentlysterile aclaimthatthefdahasapprovedbasedontheevidencepresented. Urologist,Co$InventorofZeuterin MinWang,MD CourtesyArkSciences HowdoweknowZeuterinissafe? "Inthelasttwelvemonths,ArkSciencesveterinariansandmorethanahundredotherveterinarianstrainedbythemhaveZincNeutered1,000+dogsintheUS.EachveterinarianwastrainedusingArk'snewlydesigned,hands$ontrainingprotocol.Preliminaryobserva1onsareconsistentwiththeUSFDAclinicalstudy$$dogsthatneededanymedicalawen1onaxertheprocedurewerefoundtobeabout1.1%ofthetotal.Ratesofulcera1onobservedare1in200whenprotocolisfollowed(orwhendevia1onsareunknown)and1in100ifoneincludescasesofknownmajorprotocoldevia1ons(forexample,injec1ngfromtheoppositesideofthetes1cle). ArkSciencesCompanyStatement Atotalofninecasesofscrotalulcera1onreportedwereresolvedsafelyeitherviasurgeryormedicalmanagementwithan1bio1csatthediscre1onoftheveterinarian.Arkreceivedreportsoftwoapparentallergicreac1onsthatmayormaynothavebeenunrelatedtoZeuterinbutwereresolvedsafelyandquickly.Sta1s1csonminorreac1onsthatdidnotneedanymedicalmanagementhavenotbeencompiled." CourtesyArkSciences October 23 26,

25 ResearchBehindFDAApproval! Twelveyearsofscien1ficresearch! Dosagedetermina1onstudy! AnimalSafetyStudy! ClinicalTrial224dogs3$10monthsold! Follow$upofdogsinoriginalstudy Local Reactions No. of Dogs (n = 270) Percent (%) Systemic Reactions No. of Dogs (n = 270) Percent (%) Scrotal Pain* % Neutrophilia % Scrotal Irritation 3 1.1% Vomiting** % Biting and Licking 2 0.7% Anorexia % Scrotal Swelling 2 0.7% Lethargy 6 2.2% Scrotal Irritation/Dermatitis 2 0.7% Diarrhea 5 1.9% Scrotal Ulceration 1 0.4% Leukocytosis 2 0.7% Scrotal Infection 1 0.4% Dry Scrotal Skin 1 0.4% Scrotal Bruising 1 0.4% Preputial Swelling 1 0.4% Scrotal Sore 1 0.4% CourtesyArkSciences AdverseReac1onsObservedDuringFDATrial CourtesyArkSciences * No NSAIDs were used and most scrotal pain was reported on the first two days after injection. ** Vomiting was most commonly seen on the day of the injection, between 1 minute and 4 hours postinjection October 23 26,

26 Trea1ngAdverseReac1ons! Only 1.1% of the 270 dogs in FDA Clinical Trial neededanyfollowupmedicalawen1on:! ScrotalIrrita1on:Applyan1$inflammatory/an1bio1c ointment,possiblee$collar,2$3days! ScrotalUlcera1on:An1bio1cs,Salinesoaks,E$collar, 1$2weeks! Tes1cleabscess/infec1on:An1bio1cs,E$collar,1$2 weeks ZeuterinTrainingManual,ArkSciences ExpectedReac1ons! Injec1ontechniqueiscri1caltopreventadverse reac1ons! Normalreac1onsinclude:! Generallynon$painfulswellingfor24$48hours! Listlessnessforthefirst24hours! Mayormaynotvomitduringthefirst24hours! Shouldreturntonormalcywithin24hours ZeuterinTrainingManual,ArkSciences October 23 26,

27 Painreceptorsareconsideredtobepresentinthetunicaetes1sanditwouldseemreasonabletosupposethat,asinothersolidorgans,theacutepainexperiencedintes1cularinjuryisdueinparttostretchingofthecapsule. The'TesBs,'Volume'1,'Development,'Anatomy,'and'Physiology.AcademicPress,NewYorkand London,1970;p.80$81Chapter2,Subchapter5.Hodson,N.NervesoftheTes1s,Epididymis, andscrotum. HowdoweknowZeuterinispainless? CourtesyArkSciences LongTermEffects! 30six$montholddogstreatedwithZeuterinwere followedfor2years! 2yearsofrou1neobserva1onsandclinicalevalua1ons! Permanentreduc1onofcircula1ngtestosteroneof 41$52%! 24monthspostinjec1on$necropsyconcludedallvital organsnormal! Epididymides,tes1clesandprostatehadallreducedin size CourtesyArkSciences October 23 26,

28 WhyDoWeNeuterDogs? Commonbeliefs: 1. It shealthierforthedog. 2. Tochangebehavior. 3. Tocontrolreproduc1on. WhyDoWeNeuterDogs? Isithealthierforthedogs? Neuteringdogs:Effectsonjointdisordersandcancersin goldenretrievers(g.delariva,b.hart,etal.ucdavis) Testosterone,boneandosteoporosis(SPTuck James Cook University) Canineprostatecarcinoma:Epidemiologicalevidenceof anincreasedriskincastrateddogs(e.teske,e.naan,etal. UtrechtUniversity) October 23 26,

29 Benefits Condition Incidence Substantial morbidity? Specific breeds at risk? Testicular neoplasms 0.9% No No BPH or prostatitis 75% 80% by 6 years of age No No Detriments Complications of surgery 6.1% No No Prostatic neoplasms 0.2% 0.6% Yes No TCC 1.0% No Yes* Osteosarcoma 0.2% Yes Yes Hemangiosarcoma 0.2% Yes Yes CCL rupture 1.8% Yes Yes Obesity 2.8% No YesII Diabetes mellitus 0.5% No Yes LongTermEffects ZincNeuteringsparesthetestosteroneproducingfunc1onofLeydigcells, keepingthecri1calendocrine systemintact. Withoutspermatogenesis,thetestosteroneproduc1ongoesdownby41$52% Testosteroneproduc1onremainsavailableforothermetabolicfunc1onsofthedog CourtesyArkSciences LongTermEffectsofSurgicalNeuteringShowBenefitsandDetriments (Source: Determining the optimal age for gonadectomy of dogs and cats, Margaret V. Root Kustritz, DVM, PhD, DACT) * Airedale Terrier, Beagle, Collie, Scottish Terrier, Shetland Sheepdog, West Highland, White Terrier, and Wire Fox Terrier. Doberman Pinscher, Great Dane, Irish Setter, Irish Wolfhound, Rottweiler, and Saint Bernard. Boxer, English Setter, German Shepherd Dog, Golden Retriever, Great Dane, Labrador Retriever,Pointer, Poodle, and Siberian Husky. Akita, American Staffordshire Terrier, Chesapeake Bay Retriever, German Shepherd Dog, Golden Retriever, Labrador Retriever, Mastiff, Neapolitan Mastiff, Newfoundland, Poodle, and Saint Bernard. II Beagle, Cairn Terrier, Cavalier King Charles Spaniel, Cocker Spaniel, Dachshund, Labrador Retriever. Airedale Terrier, Cocker Spaniel, Dachshund, Doberman Pinscher, Golden Retriever, Irish Setter, Miniature Schnauzer, Pomeranian, and Shetland Sheepdog. JAVMA,Vol231,No.11,December1,2007 October 23 26,

30 WhyDoWeNeuterDogs? Commonbeliefs: 1. It shealthierforthedog. 2. Tochangebehavior. 3. Tocontrolreproduc1on. # Behavior#changes#may#be#observed#aSer#zinc#neutering:## DoesZeuterin ChangeBehavior? Myobserva1onasanAnimalCaretakerforthedogsisthatthemaledogstreatedwithZincGluconatearemuchcalmerthanascomparedtotheintactmaledogs. FDAClinicalTrial,ProgenyTes1ngandSexualBehaviorStudy Maxstoppedurinemarkingandnowsitsonmylap DeeAnn,DogOwner Tankstoppeddiggingthegardenandbecamecuddly Kari,DogOwner CourtesyArkSciences October 23 26,

31 # The#FDA#behavior#posi;on#statement:# DoesZeuterin ChangeBehavior? Aswithsurgicalcastra1on,secondarymalecharacteris1cs (roaming,marking,aggression,ormoun1ng)maybe displayed. CourtesyArkSciences WhatDoWeReally Knowaboutthe BehavioralEffectsof SurgicalNeuteringin Dogs? CourtesyDr.JamesSerpell October 23 26,

32 Whatdoesthescience tellus? CourtesyDr.JamesSerpell Variableseffectallbehavior: BreedSpecific AgeofSteriliza1on Environment Training CourtesyDr.JamesSerpell October 23 26,

33 (Quotes from websites of veterinary clinics, humane societies, trainers & animal shelters) Spaying and neutering makes pets better, more affectionate companions. Unsterilized animals often exhibit more behavior and temperament problems than do those who have been spayed or neutered. Female dogs, like males, have an increased risk of aggression if left intact. Unneutered dogs are often more aggressive and territorial (urine marking, fighting), but these traits should not be confused with loyalty and protection of their home and family. Altered pets are less aggressive toward other dogs and cats, are less likely to urine mark and wander, and generally have better personalities. %#Decrease# %#No#change# %#Increase# Sexual#Moun;ng# 41%# 58%# 1%# Roaming# 40%# 58%# 2%# Inter>male# Aggression# # Aggression#to# familiar#people# Aggression#to# unfamiliar#people# # 57%# # 9%# # 22%# # 39%# # 87%# # 74%# # 4%# # 4%# # 4%# Urina;ng#inside# 69%# 31%# 0%# WhatWeThinkWeKnow CourtesyDr.JamesSerpell OriginalEvidence But Maarschalkerweerd et al Vet. Record, 140: N=122. Quasi$randomsamplederivedfromveterinaryclinicrecordsofmaledogscastratedinprevious6$12months. Mostdogscastratedforbehaviorproblems (expecta1oneffects). Nocontrolgroup(unsterilized);nowaytodetermineifreportedeffectswereduetosurgery. Retrospec1vephonesurvey;ownerswereaskedtorememberdog sbehaviorpriortosurgeryandcomparewithpost$surgicalbehavior. Ownersgiventhreechoices:Behavior increased;behaviorstayedthesame; behaviordecreased. CourtesyDr.JamesSerpell October 23 26,

34 OriginalEvidence(summarized) Neuteringhassomeposi1veeffectson sexualmoun1ng,roaming,urine$marking, andaggressiondirectedtowardother (intact)maledogs. Butithasminor negligibleeffectsonall otheraspectsofbehavior. CourtesyDr.JamesSerpell MoreRecentStudy Useddatacollectedviaavalidatedonlinesurvey(C$BARQ )tocomparethereportedincidenceofbehavioralproblemsamongspayed/neuteredversusintactdogs vs. CourtesyDr.JamesSerpell October 23 26,

35 Dogdirected Aggression/Fear FEMALE MALE Ownerdirected Aggression *** *** *** ** FEMALE MALE Bonferronicorrectedpvalue: Mann$WhitneyUtest CourtesyDr.JamesSerpell INTACT SPAYED/NEUTERED ***p'< **p'<0.001 n=247 n=672 n=276 n=542 n=283 n=766 n=353 n=638 SPAYED/NEUTEREDDOGSAREMOREAGGRESSIVETOWARD PEOPLEANDOTHERDOGS Touch Sensitivity * * Nonsocial Fear * * FEMALE MALE FEMALE MALE INTACT SPAYED/NEUTERED n=277 n=716 n=351 n=597 n=267 n=709 n=328 n=603 SPAYED/NEUTEREDDOGSAREMOREFEARFULAND SENSITIVETOHANDLING CourtesyDr.JamesSerpell * p < MannWhitney U test October 23 26,

36 BehaviorConclusions Zeuterin#Administra;on# Surgicalneuteringmayreducespecificmalehormone$ dependentbehaviors(e.g.sexualmoun1ng,roaming, urine$marking,andaggressiondirectedtowardother (intact)males)indogsthathavealreadylearnedthese behaviors. Surgicalspay/neutermayincreaseotherundesirablebehaviors(e.g.owner$directedaggression,touchsensi1vity,fearfulness,etc.)inotherwisebehaviorallynormaldogs. Defini1veconclusionswillrequireprospec1ve,controlled studies. CourtesyDr.JamesSerpell Measurethetes1cularwidth Gentlycleanseanddisinfectthescrotum CourtesyDr.BrendaGriffin October 23 26,

37 Zeuterin#Administra;on# Passtheneedlefromthecranialaspectofthetes1cle,justventraltotheheadof theepididymis Posi1ontheneedlealongthelongaxisofthetes1cleinthecenterofthetes1cular parenchyma CourtesyDr.BrendaGriffin Injec1ontechniquemodified strictadherencetoprotocolisimportanttominimizepoten1aladversereac1ons Three28gaugeneedles,½to1inchlength 1needletodrawsolu1on 2needlestoinject Timedinjec1on(slow) Zeuterin#vs.#Neutersol# What#has#changed?# October 23 26,

38 Zeuterin#vs.#Neutersol# What#has#changed?# Injec1ontechniquemodified strictadherencetoprotocolisimportanttominimizepoten1aladversereac1ons Donotaspiratepriortoinjec1ng Waitwhendoneinjec1ngpriortowithdrawal Donotmassagethetes1clesaxerinjec1ng video October 23 26,

39 HowDoWeIden1fyaZincNeuteredDog? Microchipping MicrochiptrackingcompanieswillrecordtheZinc Neuteredstatusofdog Tawooing A Z tawoobetweenthegenitalsandinnerthighis thestandardsignforzincneutering UniqueCollarTag Everydogisgivenauniqueiden1fica1onnumbercollartagwiththewebsiteaddresstoverifyneuteringstatus CourtesyArkSciences Zeuterin TM inshelters Humaneorganiza1onsthroughoutthe UnitedStatescan tsurgicallysterilizehomelesscatsanddogsfastenoughtocontroltheirnumbers,anddevelopingcountrieswithdangerousferaldogpopula1ons suchaschinaandindia fareevenworse. September2009issueofScience, Acureforeuthanasia? October 23 26,

40 ZeuterinTraininginUnitedStates CourtesyArkSciences! Asampleofloca1onsusingZeuterinaxer training:! Texas:WichitaFalls,Dallas,McAllen! Oregon:Bend,Portland! California:SFSPCA,SanJoseAnimalCare! Florida:FortLauderdale! NorthCarolina:SNAP$NC,Raleigh! Kansas:Spay/NeuterKansasCity ZeuterinUseintheUnitedStates CourtesyArkSciences October 23 26,

41 CourtesyArkSciences ChangingPercep1on ChangingPercep1on WhenIwasinvetschool,Iwastold,"Halfofwhatyoulearnherewillturnouttobewrong.Butnooneknowswhichhalf." Sotrue!Oneofthethingswemayhavegowenwrongwasinlookingatthehealthimpactsofneutering. Dr Marty Becker America s Veterinarian October 23 26,

42 TheEvolu1onofNeutering CourtesyArkSciences Zinc#Gluconate#Neutralized#by#L>Arginine#is# the#only#fda#approved#non>surgical#sterilant# Asingle,virtuallypainlessinjec1onintoeachtes1clewillsterilizeamaledog,permanently. October 23 26,

43 WhyDoWeNeuterDogs? Commonbeliefs: 1. It shealthierforthedog. 2. Tochangebehavior. 3. Tocontrolreproduc1on. Thegreatnessofana1onanditsmoralprogresscanbejudgedbythewayitsanimalsaretreated. MahatmaGandhi October 23 26,

44 Time'for'our'exciBng'announcement!' Congratulations to the Prizes for Pioneers Zeuterin Contest Winners! Animal Balance (Bend, OR); Animal Care Foundation (Fresno, CA), Loving All Animals* (Palm Desert, CA), People Assisting Animal Control (Corpus Christi, TX), Portland Animal Welfare Team* (Portland, OR), Sula Foundation* (New Orleans, LA), Wellness on Wheelz (McAllen, TX) Many thanks to our contest sponsors: October 23 26,

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49 Congratulations to the Prizes for Pioneers Zeuterin Contest Winners! Animal Balance (Bend, OR); Animal Care Foundation (Fresno, CA), Loving All Animals* (Palm Desert, CA), People Assisting Animal Control (Corpus Christi, TX), Portland Animal Welfare Team* (Portland, OR), Sula Foundation* (New Orleans, LA), Wellness on Wheelz (McAllen, TX) Many thanks to our contest sponsors: Thank'you'for'exploring'the' opbons'with'us. Formoreinforma1on:acc$d.org October 23 26,

50 Pleasevisitusat Freedownloadat Booth #204 October 23 26,

51 Whos1llhasques1ons? October 23 26,