1. Farm and Field Investigation and Case Management Tools Dr. Locke Karriker, DVM Food Supply Veterinary Medicine Department of Veterinary Diagnostic and Production Animal Medicine Iowa State University College of Veterinary Medicine VDPAM 310

2. Objectives Decrease anxiety Increase proficiency Positive experiences early Get past learning the ‘process’ and on to learning the medicine

3. Attitude Teamwork Investigative Professionally (and politely) skeptical Simplify Prioritize Confidence

4. Table of Contents Objectives Overview Specific tools Preparation for visit Meeting the “manager” Facility evaluation Documentation

5. Table of Contents Objectives Overview of the process Preparation for visit Meeting the “manager” Facility evaluation Documentation Start as discrete tedious steps but become compressed and abbreviated with clinical experience and familiarity with client

6. When you get to clinical courses: Review the syllabus first!! The syllabus describes course expectations that are relevant to farm visits. Note emphasis on confidentiality of information, limitations on video and audio capture, and conduct expectations. The WebCt module has examples (generated by your classmates in previous rotations) of the product that you will generate with your visit: a PPT presentation of case to the class and instructors a case report a client communication letter

7. Farm Field Investigation Tree

8. Preparation….Step 1 Review background material (if available) Size of farm Type of production system Major concern Previous diagnostic reports

9. Preparation….Step 2 Contact the farm manager Schedule time for farm visit Elicit directions to the farm Discuss biosecurity protocols for the farm # of visitors in group, required clothing, shower facilities, downtime requirements Chief complaint/concern

10. Preparation….Step 3 Contact the veterinarian associated with the farm Availability during scheduled farm visit Dissemination of results/reports Ask for expansion on case details

11. Preparation….Step 4 Research clients chief concern Useful resources: Pork gateway (hyperlink)hyperlink Swine Disease Manual (hyperlink) Record benchmarks (hyperlink)hyperlink The pig site (hyperlink)hyperlink AASV Information CD (hyperlink)hyperlink

12. Preparation….Step 5 Develop a “game plan” Locate supplies needed Boots, coveralls, bleeding supplies (including sharps container), necropsy kit, camera (disinfect, charge battery, download previous pictures), garbage bag for dirty equipment, clean transportation, +/- ventilation equipment Generate a check-off list of information to gather Print off production benchmarks

13. Meeting the “manager” Introductions Define what position the contact holds (site manager, field manager, hourly employee, contract operator, owner, etc.) Define students role in the investigation Structure of meeting Outline visit structure and report timeline Outline “manager” objectives Outline how pigs are marketed (negotiated vs contracted)

14. Meeting the “manager” Go over production records, diagnostic reports, pigflow Diagram the layout of the farm Detail pig flow (source, number, facilities, biosecurity, etc.) Historical disease concerns (ex. PRRSV, Circovirus, previous respiratory outbreaks, etc.) List any abnormalities or trends (detailed list) List “manager” concerns List things to look for/check during the walk through Take pictures of record boards if necessary

15. Facility evaluation - outside Assess cleanliness/maintenance of facilities Weeds, junk, equipment, feed spills, ventilation fans, feed bins, etc. Assess biosecurity of the site Fence, signs, visitor log, parking designation, entrance protocols, security of facility entrances

16. Facility evaluation - outside Assess rodent/insect infestation and control measures More information: NPB rodent control, NPB rodent control 2NPB rodent controlNPB rodent control 2

17. Facility evaluation - outside Feed storage Well maintained bins, periodically cleaned, no moldy feed present, no feed spills present, feed is available, etc.

18. Facility evaluation - inside Evaluate feed, water and air Quality of feed, availability, maintenance of delivery equipment Type of watering system, functionality General comfort of air quality (high odor, stuffiness, noticeable drafts at animal level)

19. Facility evaluation - inside Evaluate environment Assess stocking density (standards) Appropriate temperatures for production stage

20. Facility evaluation - inside Assess biosecurity Boot baths, hoses, boot change, etc. Assess overall cleanliness of facility Manure removed from aisles, AI supplies or other trash thrown away, medicine properly stored after use How are facilities cleaned between groups Cleanliness of pigs

21. Facility evaluation - inside Assess presence of noticeable hazards to the pigs Sharp edges, exposed wires, protruding gate rods, etc. Assess equipment Teeth clippers, scalpel blades, etc. Working order, cleanliness

22. Facility evaluation - inside Pharmaceutical storage area Are products well labeled? Are directions for use posted? Are open bottles dated and refrigerated? Any expired antibiotics/vaccines present? Any illegal or extra-label products present? Are products for human consumption stored in the same place? Is the refrigerator at an appropriate temperature? Is there an appropriate sharps container?

23. Facility evaluation - Personnel While inspecting the facility, evaluate the manager and/or employees capabilities Knowledge of protocols Training Knowledge of equipment (ventilation system especially) How well does employee information match what you see

24. Facility evaluation - Personnel “Show me how” versus “Explain how” Open ended questions – NOT “yes/no”

25. Facility evaluation - Pigs Assess sick pens and pulling “accuracy” How many sick pigs/pen are present (pigs that should have been pulled prior to visit) How many pigs/pen pulled daily Are pigs treated when they are pulled Is supplemental feeding utilized Note abnormal characteristics Rough hair, gaunt pigs, tail biting, thumpers, skin lesions, joint problems, neurologic signs, etc.

26. Facility evaluation - Pigs Diagnostic testing Collect blood samples Perform necropsies on mortalities – assess trends Find acute clinical pigs for dx work

27. Follow-up Summarize findings and generate report Submit report to both producer and owner/veterinarian

28. Specific Examples

29. Marco Case Report

30. More barrows died than gilts for every cause except: Heat Stroke/Stress, Ileitis, and Fighting

32. GF-Study: Weight Data by cause $ $

33. Relative Risk Risk in the exposed group versus the risk in the unexposed group: RR = (a/a+b)/(c/c+d) Introduction to Veterinary Epidemiology, Houe et al Chapter 7 Measures of Association and Effect p.95

34. Pigs with any lung lesion were 2.23 times as likely to have an ulcer or hyperkeratosis as pigs that did not have any lung lesions. **LUNG EDEMA PIGS WERE EXCLUDED REGARDLESS OF ULCER STATUS Relationship of lung lesions to hyperkeratosis or ulcers** Relative Risk

35. PCV2 Associated Finisher Mortality October 1, 2005

36. Iowa State University College of Veterinary Medicine Food Supply Veterinary Services Nursery and finisher mortality uncoupled….

37. Data represents cumulative mortality by week of placement for an average of 67,814 pigs placed per week (a total of 12,681,394 pigs on the graph) through peak of outbreak in southeastern U.S.

38. Mature gilts in acclimation barn Very little coughing Very lethargic Anorexic No coughing No vomiting Many with fevers

39. Mature gilts in acclimation barn

42. Diagnostic Results 30/30 sows positive for PRRS on ELISA 0/30 sows positive for TGEv on differential ELISA, no piglet tissues positive –22/30 sows positive for PRCV 24/24 gilt nasal swabs positive for influenza – H3 strain

43. Sow lactation triage plan

44. Necropsy Checklist

45. QUESTIONS???