CONNECTED UPDATE ON THE SCIENCE ACTIVITIES OF VSH AND ETHOS VSH BLOOD DONOR PROGRAM OPHTHALMOLOGY SERVICE IS BACK CLINICAL TRIALS UPCOMING EVENTS

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1 CONNECTED YOUR LINK TO VETERINARY SPECIALTY HOSPITAL JUL SEP 2017 UPDATE ON THE SCIENCE ACTIVITIES OF VSH AND ETHOS IN THIS ISSUE: VSH BLOOD DONOR PROGRAM OPHTHALMOLOGY SERVICE IS BACK CLINICAL TRIALS UPCOMING EVENTS SAN DIEGO Sorrento Valley Rd San Diego, CA NORTH COUNTY 2055 Montiel Rd San Marcos, CA

PIKE S PEAK In the summer, the days were long, stretching into each other.

Sarah Dessen, Along for the Ride Summer has arrived and we re in the thick of it. For the Pike family, the quote above sums up summer perfectly.

For my wife and I, we become professional chauffeurs during the summer and I could not be happier to see our kids exposed to all that summer in San Diego has to offer.

Rob has a Master of Business Administration and a professional career with a focus on excellence in customer service.

Rob has a hands-on approach that is welcoming and inviting.

family. On the clinical front, VSH is extremely honored to welcome the return of ophthalmology with the addition of Dr. Emily Moeller.

Emily s motivation to return to VSH is driven by her desire to join a collaborative multispecialty team. Dr.

We are privileged to have Emily on our team. Our radiology service is also expanding with Dr. Georgette Shields also joining our team.

2 PIKE S PEAK In the summer, the days were long, stretching into each other. Out of school, everything was on pause and yet happening at the same time, this collection of weeks when anything was possible. Sarah Dessen, Along for the Ride Summer has arrived and we re in the thick of it. For the Pike family, the quote above sums up summer perfectly. With our 12 and 14 year old kids at home, they set the schedule and we set the rules at least that s what I like to believe. For my wife and I, we become professional chauffeurs during the summer and I could not be happier to see our kids exposed to all that summer in San Diego has to offer. On the VSH front, summer also brings welcome transition. Our new hospital director, Rob Green, has comfortably embraced his new role. Rob has a Master of Business Administration and a professional career with a focus on excellence in customer service. Rob will leverage his customer service talents to improve the entire experience for your clients and their four-legged family friends. Rob has a hands-on approach that is welcoming and inviting. He is committed to the success of our entire healthcare team and he acknowledges that the success of VSH begins and ends with how we treat you, your clients and their family. On the clinical front, VSH is extremely honored to welcome the return of ophthalmology with the addition of Dr. Emily Moeller. Emily is a San Diego native and previous VSH intern. She returns to VSH with 5 plus years of board-certified experience in a busy ophthalmology practice in Arizona. Emily s motivation to return to VSH is driven by her desire to join a collaborative multispecialty team. Dr. Moeller will provide a 5 day per week service in Sorrento Valley and will build an ophthalmology team that is accessible and approachable. We are privileged to have Emily on our team. Our radiology service is also expanding with Dr. Georgette Shields also joining our team. Georgette recently completed her radiology residency at Colorado State University and is a North County San Diego native who is eager to return to San Diego. Georgette has a clinical interest and research experience in advanced musculoskeletal imaging that will complement our surgery orthopedic service. There are a few other notable additions to the VSH team. Drs. Delamaide, Flory, Fryer and Cleveland have added to their families with the addition of newborns. We send a collective congrats and best wishes to each of them. We trust you enjoy the summer with family and friends. We extend a warm welcome your way and thank you for your support as the VSH family continues to grow. Sincerely, Fred Pike, DVM, DACVS Medical Director

3 UPDATE ON THE SCIENCE ACTIVITIES OF VSH AND ETHOS by KEITH RICHTER, DVM, MSEL, DIPLOMATE ACVIM, CHIEF APPLIED SCIENCES OFFICER Hello Everybody! Here is an update on what I have been doing for the last year or so, as well as some interesting developments in the science activities of VSH and Ethos. One of the most exciting components that distinguish VSH and Ethos from other veterinary hospital groups is our focus on Science. In this area, I work with the Ethos Chief Science Officer, Dr. Chand Khanna. Dr. Khanna is a world renowned veterinary oncologist who spent much of his career at the NIH, in addition to being an active clinician. We are creating some exciting relationships with research institutes, academic centers, and biotech, for the purpose of addressing unmet needs in veterinary medicine. Our science efforts consist of three distinct areas: Ethos Diagnostic Science (STAT Veterinary Laboratory, our reference lab and histopathology service) Ethos Discovery (our non-profit organization for medical innovation) Ethos Therapeutics (placeholder for future potential drug discoveries) Ethos Diagnostic Science Most of you are familiar with the VSH reference lab. Originally begun as STAT Veterinary Lab, the addition of the histopathology service under the direction of Dr. EJ Ehrhart furthers this growth and the need for new branding as Ethos Diagnostic Science to encompass all this service has to offer. Dr. Ehrhart is a luminary pathologist known for his work in oncologic pathology. Ethos Discovery Ethos Discovery is a completely separate and brand new 501(c)3 nonprofit organization. Its entire focus is to deliver innovations that will improve the outcome of pets and humans afflicted with complex medical problems. These efforts will begin in the area of oncology, but will deliver innovations to all fields of medicine and surgery. Starting with a look at unmet clinical needs and partnering with academic and non-profit institutes and commercial partners, this will lead to the development of novel diagnostic tests and therapeutics. Conducting clinical trials throughout our hospital network allows us to collect the necessary data and completely sets Ethos apart from other specialty groups. Additionally, Ethos Discovery will offer this information free of charge and without restriction to parties interested in commercialization for human health. In-so-doing, the work of Ethos Discovery will develop and deliver scientific innovations to both humans and pets. The Hemangiosarcoma Trial: CHAMP-1 We are very excited to begin our science efforts with an incredible and unique study of hemangiosarcoma (HSA). The CHAMP-1 (Canine Hemangiosarcoma Sampling Program, Biomarker Development and Precision Medicine) study will be our first clinical trial involving all the Ethos hospitals. The hope is that from this study, we will be able to create a new blood test and treatment options for this deadly aggressive cancer. Imagine a liquid biopsy test to aid in the diagnosis and prognosis of this disease, using blood samples alone! We are collaborating with the Translational Genomics Research Institute (TGen), a world leader in genomic research, for many aspects of this trial. There are 5 main goals of the trial: 1. To begin a focused molecular and genomic characterization of canine splenic HSA; 2. To determine the potential value of Precision Medicine in this disease by assessing the variability in potential drug treatments that may target genomic variants of canine HSA from a large cohort of dogs; 3. To describe the tumor and cell free tumor DNA molecular alterations present in the blood of patients during a clinical course of progression in a large cohort of dogs with HSA; 4. To describe the outcome of dogs with HSA treated with targeted therapies as recommended through genomic screening and drug matching (i.e., Precision Medicine), and to compare these outcomes with historical controls as a means to propose a prospective placebo-controlled study; 5. To develop canine hemangiosarcoma cell lines from the splenic tumors and develop novel in vitro and in vivo models of canine hemangiosarcoma that will fuel future studies into the biology and therapy of this disease. More details on this study will follow in a separate communication. I am thankful that my career has evolved in a way to allow me to pursue these passions. I am especially grateful to you, my friends and colleagues, for supporting VSH and these efforts, thus making this possible!

4 OPHTHALMOLOGY SERVICE RETURNS TO SORRENTO VALLEY We are proud to welcome Emily Moeller, DVM, DACVO to VSH! Dr. Moeller is a San Diego native and previous VSH intern. She returns to VSH with 5 plus years of board-certified experience in a busy ophthalmology practice in Arizona. Her motivation to return to VSH is driven by her desire to join a collaborative multispecialty team. The most advanced diagnostic modalities including electroetinography, ocular ultrasonography, CT and MR Offering Comprehensive Treatment Capabilities: Phacoemulsification for cataracts Laser treatment for glaucoma and iris tumors Medical and surgical management of eye, eyelid and orbital disease with microsurgical capabilities Eye certification examinations Appointments 5 days a week, Monday-Friday Please give us a call at if you would like to schedule an appointment or consultation. VSH BLOOD DONOR PROGRAM Transfusion of blood products to dogs and cats plays a crucial role in the practice of emergency and critical care of patients with anemia, thrombocytopenia or other bleeding disorders. Blood transfusions have commonly been performed with whole blood from canine or feline donors. However, with advancing medicine and growing transfusion demands, component therapy is becoming more commonplace. The Veterinary Specialty Hospital blood donor program is actively looking for canine and feline donor members. Donor dogs should be in good overall health, 1-7 years of age, over 55 pounds, and receiving monthly flea, tick and heartworm prevention. Donor cats should be in good overall health, 1-7 years of age, over 10 pounds, indoor only, and receiving monthly flea prevention. Canine and feline donors should also have a friendly temperament, current on all recommended vaccines and free of chronic disease. When a new donor meets these requirements, a full physical exam will be performed by specialists Dr. Stephanie Istvan or Dr. Lisa Bazzle. Then, screening lab work would be submitted. Upon approval, the new donor will be enrolled in the program to donate every 6-8 weeks and provided compensation for each donation. After each donation, component products are produced at Veterinary Specialty Hospital based on present patient and supply needs. Both our Sorrento Valley and North County locations are concurrently carrying canine Dea 1 negative and positive red blood cells, fresh frozen plasma, cryoprecipitate, cryo-poor plasma, platelet rich plasma and feline type A and B packed red blood cells, fresh frozen plasma.

5 IN OUR COMMUNITY Please join us in support of the following organizations. Sunday, July 30 6:30 am to 11:30 am Live Well San Diego in Partnership with the SD Blood Bank Waterfront Park Saturday, October 21 8 am to 12 pm Canine Companions DogFest Walk n Roll NTC Park, Liberty Station Sunday, August pm to 6 pm Cardiff Dog Days of Summer Encinitas Community Park (new location) Sunday, December 3 9 am to 3 pm Doggie Street Festival NTC Park, Liberty Station TAKE NOTE CURRENT CLINICAL TRIALS *NEW* Dermatology Clinical Trial for Atopic Dogs Dr. Laura Stokking is enrolling canine patients in a new clinical trial for atopic dogs. Patients cannot have had any long-acting treatments for allergy, such as glucocorticoid injections or Cytopoint. Food allergy should have been ruled out prior to enrollment. Contact Drs. Laura Stokking or Wendy Terry at (858) *NEW* Emergency & Critical Care Novel Rattlesnake Antivenom We are currently enrolling dogs that have been bitten (or suspected to have been bitten) by a rattlesnake for treatment with a novel antivenom. Enrolled dogs will receive free bloodwork on presentation (CBC, chemistry, coagulation panel) and trial antivenom at no cost to the client. Patients are required to return for a 24 hour post-antivenom administration recheck and free bloodwork (CBC, chemistry, coagulation panel). Owners must commit to the 24 hour recheck as well as use of their pet s photos and/or videos for research and publication purposes. Patients are now being enrolled at Sorrento Valley, and North County enrollment begins August 14. Contact Dr. Erica O Donnell or Nicole Edwards, RVT at (858) Internal Medicine Canine Bile Acid Diarrhea and Microbial Dysbiosis Study We are enrolling dogs with signs of inflammatory bowel disease, with or without histopathologic evidence, that are on current standard therapies (prednisone, diet) but continue to have diarrhea. A GI panel and fecal analysis for bile acid concertation and enteropathogens, along with a dysbiosis index will be performed through the GI Lab at Texas A&M. Dogs with a non-gi disease to explain their signs will be excluded. Patients will be randomly assigned into a placebo or cholestyramine group. Owners will be asked to grade their dog s feces daily. Dogs will be re-evaluated at 3, 6, and 16 weeks post induction of therapies. At these rechecks, a fecal sample will be collected and submitted for a fecal bile acid analysis and microbial evaluation. All study related expenses will be funded. Cost to initial diagnosis of a chronic enteropathy will be covered by clients. Contact Drs. John Gil or Steve Hill at (858) Internal Medicine Clinical Trial for Diabetic Dogs VSH is participating in an exciting new clinical trial using a novel stem cell therapy to resolve diabetes mellitus in dogs! Dogs must weigh 5 to 12 kg, and be free of significant other systemic illnesses, on insulin (preferably Vetsulin), and at least partially controlled. Owners must be willing to perform glucose curves at home (with training), and to reliably bring the dog in for follow-up visits over 3 years. All study-associated costs are covered for the study duration (labs, procedures, insulin, glucometer, exams, etc.), including the initial screening visit, so we encourage any potential candidates to come in for formal screening with Drs. Loy Son, Gil, or Fischer. Visit website for additional details or call (858) Internal Medicine Feline IBD/GI Small Cell Lymphoma Study and Proteomics Study We are enrolling cats with chronic gastrointestinal disease that are suspected of having either inflammatory bowel disease (IBD) or gastrointestinal small cell lymphoma (GI SC LSA). Endoscopy will be performed and GI biopsies will be obtained for histopathology, immunohistochemistry (IHC) and PCR for antigen receptor rearrangements (PARR). A 3 week follow-up will be required. Blood, urine, and fecal samples will be collected for proteomic analysis at the time of endoscopy and follow-up visit. The cost of the histopathology, IHC and PARR is funded. GI panel is also funded by the proteomic study. Contact Drs. Betty Chow, Steve Hill or Keith Richter at (858) Internal Medicine Glucocorticoids and spec cpl study Patients who will be started on glucocorticoids (minimum dose of 0.5mg/kg/day) and will need to be on them for at least 3 weeks. Patients will receive a spec cpl prior to administration of any glucocorticoids and at least 3 weeks after starting glucocorticoid therapy at no charge. Patients are being enrolled in North County and Sorrento Valley. Contact Drs. Sarah Cocker or Keith Richter at (858) Oncology Canine Osteosarcoma Canine osteosarcoma, fully funded trial evaluating a novel immunotherapy procedure. Either Sorrento Valley or San Marcos hospitals. A pre-amputation consult is required but a pre-consult histologic/cytologic diagnosis is not necessary. Contact Dr. Brenda Phillips at , or Dr. Andi Flory at continued on back page

6 10435 Sorrento Valley Rd Suite 100 San Diego, CA San Diego: San Marcos: ANNOUNCEMENTS Our recently finished 3rd year Internal Medicine Resident, Dr. Stephanie Dong, as well our 2 residents from last year, Dr. Sarah Cocker (currently on staff as an internist) and Dr. Lauren Cochran all passed their Internal Medicine Certifying exam! In addition, Dr. Betty Chow our current 3rd year Internal Medicine resident passed her qualifying exam. Congratulations to you all we are truly proud of you! Dr. Keith Richter was on the ACVIM Consensus panel for Chronic Hepatitis in Dogs that was presented at the ACVIM Forum in June. Every month, the operations team at VSH recognizes someone from our staff who excels above and beyond their duties. Victoria Palmer was one of the recent recipients. Here s what was said about her: Victoria has taken it upon herself to expand her knowledge in advanced imaging and has obtained an understanding of the equipment and protocols that sets her apart from her peers. She is simultaneously working on her RVT and jumping into MRI certification courses. She is always positive and jumps in to help ER and all other departments when she sees them struggling. She is not just an Imaging tech as she is willing to help out in any area of the hospital if they need help. She hates being idle and is always looking for ways to improve the hospital. She is amazing. WE RE LISTENING Please welcome our new client concierge Alissa! She will help ensure that your client s experience is exceptional throughout the appointment process in partnership with the medical, client care and call center teams. Alissa serves as the primary, non-medical communication conduit and coordinator between departments to ensure a seamless interdepartmental visit and provides fluid information of next steps in the appointment process. She comes to us with previous customer service and hospitality experience. We are excited to have her as part of the VSH team! SAVE THE DATE CE Dinner & Program for Veterinarians Antimicrobial Selection to Combat Resistance: Dead Bugs Don t Mutate Guest lecturer: Shelley C. Rankin, PhD Associate Professor of Microbiology, Clinician Educator, University of Pennsylvania, School of Veterinary Medicine Feline Ophthalmology Essentials Emily Moeller, DVM, DACVO August 8, :00-9:00 pm Sorrento Valley Facility: Live Program and Dinner San Marcos Facility: Video Conferencing and Dinner Webinar also available CE Dinner & Program for Internists* Esophageal Disorder in Dogs - From Bench-top to Cage-side Stanley L. Marks, BVSc, PhD, DACVIM (Internal Medicine, Oncology), DACVN Professor of Internal Medicine, University of California, Davis September 19, :00-9:00 pm Sorrento Valley Facility: Live Program and Dinner Webinar also available * Internists, Residents, Interns and interested Veterinarians welcome. CLINICAL TRIALS CONT. Oncology Lymphoma Trials We are now enrolling eligible canine participants with peripheral lymph node lymphoma in a new study to evaluate the benefit of corticosteroids. To be eligible to participate in the trial, a lymphoma diagnosis has to be confirmed or must be highly suspected and chemotherapy treatment declined. Eligible dogs cannot have received any steroids before enrollment. The study provides FREE palliative prednisone. Contact Oncology Services at (858) or (760) *NEW* Surgery Tarsal Replacement Surgery Clinical trial on tarsal replacement surgery. Dogs greater than 30kg with end stage osteoarthritis of the Tarsus. Contact Dr. Josh Jackson at (858) For more details about these and other clinical trials, please visit our website at

CE West June 1-3, 2018 Wine Country Inn, Palisade, CO

CE West June 1-3, 2018 Wine Country Inn, Palisade, CO Tips and Tricks of the Trade: Practical Dermatology and Ophthalmology for the General Practitioner AGENDA Friday, June 1 5:00 6:00 PM Registration