Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Uncovering Discrepancies in Neonatal Incubator Temperatures: A Theriogenologist's Insight
Imagine the heartbreak of losing a newborn puppy due to a malfunctioning incubator. It's a tragic reality that our guest, Bruce Christensen, a theriogenologist and a veterinarian, has faced and is now dedicated to preventing. We delve into a critical issue - the alarming discrepancy in temperatures between what's set and achieved in neonatal incubators. Bruce shares the findings of his comprehensive research that uncovers how certain incubator models can heat up to fatal temperatures far surpassing the set limit, leading to heartbreaking loss of neonatal animals.
Bruce's expertise doesn't stop at just identifying the problem; he provides a solution by emphasizing the absolute necessity of double-checking incubator temperatures. He takes us through his remarkable journey of overcoming challenges to step into the world of theriogenology. As we navigate the passion-filled pathway he has trodden, you would also discover a personal keepsake that fuels his drive. Make sure not to miss this enlightening episode that can potentially save lives and bring about meaningful change in neonatal care.
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You're listening to Veterinary Vertex, a podcast of the AVMA Journals. In this episode we chat about the discrepancy between set and actual temperatures and neonatal incubators with our guest Bruce Christensen.
Lisa Fortier:Welcome to Veterinary Vertex. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Today, we have Bruce joining us. Bruce, I haven't seen you for about 20 years, but thank you so much for being here with us today.
Bruce Christensen:Yeah, it's a pleasure. Yeah, Lisa was my surgery professor in large animal when I was in vet school and I remember rotating through with her so good memories of that.
Sarah Wright:Small world! Let's dive right in. So, Bruce, your manuscript in JAVMA discusses an investigation that you performed evaluating the discrepancy between set and actual temperatures of neonatal incubators. Can you give our listeners a bit of background on this study?
Bruce Christensen:Well, our veterinary practice specializes in theriogenology, so we perform many c-sections and we see a lot of neonatal patients. Neonatal dogs are particularly fragile. They're unable to maintain their own body temperature through thermogenic mechanisms like shivering and panting and things that more mature dogs are able to do. So when treating and maintaining the neonatal puppies, it's important to keep them in a safe temperature range that allows them to maintain appropriate core body temperature. Too hot, too cold will result in body system failure and death. So the incubators well, they're commonly used in both by both veterinarians and by breeders. We're concerned that some incubators may be malfunctioning and causing either hypothermia or hyperthermia in neonatal puppies.
Sarah Wright:Yeah, it's a really important topic and something I guess I had never even thought about. I remember using these incubators during my internship and, you know, just kind of trust the setting you don't really think to check. So thank you so much for bringing this to our attention and sharing this information with our listeners too.
Bruce Christensen:Yeah.
Sarah Wright:So what were some of the important findings from this study?
Bruce Christensen:Well, we tested five models of incubators from two separate companies who manufactured incubators for use with neonatal puppies and kittens, so they were designed for animal use. We set the incubators to temperatures between 85 and 90 degrees Fahrenheit, which is a common both of those are common settings. That range is a common range for us to use in our clinic. And then, every 10 minutes, we measured the internal temperatures using independent tools. We used a thermocouple and an infrared sensor and we found that three of these models, all from the same company, frequently heated up to temperatures above the set temperature on the incubator, sometimes far above and into ranges that were incompatible with normal life functions. So, in other words, they were creating environments where neonates would become hyperthermic.
Lisa Fortier:That's crazy, Bruce, especially that they're all from the same company. How did you observe this? What sparked your interest? In doing this Did you have some cases that you were like what's the heck's going on here?
Bruce Christensen:Well, we've been using a couple of the incubators for a number of months, even probably a little more than a year, with great success. We had very nice success. And then we had a case. We got a new incubator from the same company and we had an unfortunate case the first time we used it at our clinic, where three neonatal puppies died from hyperthermia when the incubator, which was set to 90 degrees Fahrenheit, malfunctioned and rose to temperatures above 109 degrees Fahrenheit. And we weren't even sure how high it actually reached, because at the time the only secondary way we had to measure was a transrectal thermometer and they maxed out at 109 degrees Fahrenheit and it just showed greater than H on the thermometer when we tested on the puppies that had died.
Lisa Fortier:Wow, that's really tragic. Does the company know about this now?
Bruce Christensen:Yeah, they know about it. Yes, it became, unfortunately, but predictably, it became a legal issue, and so that was something that we struggled with with them and with the clients, trying to find a reasonable solution in a very tragic situation.
Lisa Fortier:Yeah, very, very sad. And then that's one part of it, right, and you're a busy clinician. It's really hard and congratulations as a clinician to do this research and write this manuscript. I mean, the puppy death is really unfortunate and the suffering of the clients, but what inspired you to go to the next step and bring it as a manuscript?
Bruce Christensen:Well, this, of course, concerned all of us, and I spoke with a number of other theriogenologists about our case. I was, frankly, I was worried that I wasn't practicing the standard of care in how we were monitoring and maintaining the neonates, and so I reached out to colleagues and asked them what their protocols were for monitoring post-c-section neonates and found that many of us were just trusting incubators to function properly without secondary safeguards. And then I had a couple of veterinarians communicate with me and a few breeders share with me that they also had lost puppies to hyperthermia in a similar way to our case through incubator use, and so I felt like this was clearly a problem that wasn't just isolated to this one crazy, tragic case at my clinic and felt like somebody needed to look into this issue in a controlled manner and get the word out. So I felt like the standard of care needed to be raised.
Lisa Fortier:Yeah, that's really very sad. I think the whole manuscript is surprising, like Sarah said, and you and all of us were just trusting that somebody at the manufacturer was doing QC. I'm sure you have many, but what is the most surprising finding from your manuscript?
Bruce Christensen:We were surprised how much higher some of our independent temperature readings were from the set temperature. As I mentioned during the case, we could just say that it was more than 109 degrees Fahrenheit, which in and of itself is awful. But when we started using the independent measures that do measure temperatures much higher than that so a thermocouple or an infrared sensor we were surprised at how high some of the temperatures reached. Sometimes they were more than 20 degrees Fahrenheit higher than what the set temperature was.
Sarah Wright:It's a pretty big discrepancy. So again, just thank you for sharing this with us and for getting that information out there. I think this is going to be really important for clinicians to read and to also listen to.
Bruce Christensen:Yeah, it is important to think about that. 20 degrees more. If you have it set at 90 or 95, then that puts it up around 115 or higher. That may be a temperature even for adult dogs. We're here in California and we've had summers like the last summer, a couple summers where outside temperatures have reached those temperatures 115 degrees Fahrenheit and when that's the case the recommendation is bring your dogs inside, don't leave them outside when it's 115 degrees outside, and those are adult animals that should be able to control their own temperatures through panting and shivering. Imagine a neonate that doesn't have any of that and is completely reliant on its environment. So anything above 104 to 106 is where we start. Well, above 106 is where we really start to see organ failure.
Sarah Wright:Yeah, I was just starting to think about all those heat stroke cases that you'd see in the late summer months when it's really hot out, and those are tragic too. So just all around, again, good information to bring to our clinicians. So, bruce, therogenology is your wheelhouse. How did your advanced training prepare you to write this manuscript?
Bruce Christensen:Well, I had really excellent mentors during my residency and master's program at the University of Florida who encouraged me to submit cases and research projects for publications. So I submitted a number of case reports and primary research cases during my training as a resident and a master's student and then over the years I've had time spent as a faculty member at Iowa State University and UC Davis and so in those capacities I was encouraged to and expected to continue to research and publish both case reports and primary research. So I've also had the experience of mentoring students and interns and residents who have also had cases and research to publish. So that background has been very helpful to me as a private practitioner to still feel like I can and should remain active in that realm of our profession.
Sarah Wright:Great to hear that mentorship has really carried through, even in the current stage of your career. So this next set of questions is pretty important for our listeners. First one is dealing with a veterinarian. So what is one piece of information the veterinarian should know before discussing this topic with the client?
Bruce Christensen:Well, I think it's important for veterinarians that in their practice, they begin utilizing independent tools to double check incubator temperatures, having an additional thermometer, a thermocouple, an infrared sensor all inexpensive and easy to use. It's worth having a couple different ways to do it, since they measure temperature in different ways and measure different aspects of the environment. So we definitely do that in our practice. Now, I think that all practices treating neonates should employ those safeguards.
Sarah Wright:Yeah, some really great advice, Thank you. This next question is on the other side of the relationship, so on the client side. What is one piece of information the client should know about this topic?
Bruce Christensen:Well, I think that veterinarians should be advising their breeder clients to do the same thing, because some breeders who are full in dedicated to breeding have purchased incubators and are using them with their own litters at home. So I think they need to be aware of this potential problem. We saw it with hyperthermia, but it could malfunction and break and you could have hypothermia, and either case would be bad. So having a secondary way to monitor the temperature for clients as well, and not just trust what the set temperature says, is important for them to understand.
Lisa Fortier:That makes sense, Bruce. I like the way you rounded that out, to say clearly these are arriving to you with not a great temperature control, but something could go wrong a year later. So just to have that double check, because if it's not functioning then you're in the off. I mean, I guess I don't know enough about incubators and all their electrical cords and everything, but I could imagine it would lose temperature, not gain. But you never know. This is a good quality check.
Bruce Christensen:Right.
Lisa Fortier:In order to get to where you are, Bruce, we'd like to ask this question of like, pretty much everybody on the podcast, we learn a lot about this. Where did your resilience, determination, inspiration come to get to where you are in life and encourage you to keep doing research?
Bruce Christensen:Well, that's changed with each step of my career. There have been different touchstones along the way that have continued to inspire me, from as early as when I was in high school, reaching out to another veterinarian who I'd read about in a magazine and wrote to him and said, gee, I want to do what you're doing. And he took the time to write back to me. This was back in the 80s, before you could just whip off an email to somebody, had to sit down and actually write, stick it in an envelope, send it off in the post. And this veterinarian didn't know me from Adam, but he took the time to sit down and write a very nice letter back to this high school kid that had a question and give me some really good advice about how I should continue through my college career to progress towards being a vet. And then I had great professors in undergrad. I had great professors in vet school, particular ones each time that took a special interest in me and responded to my enthusiasm. And then, as I finished vet school and headed into my residency I've already mentioned that I had good mentors in my residency. I really did and they, all of them, really gave me the personal attention that a resident should get to help me develop into the professional that I am today, and then, I would say, most recently, as a professional out in the workforce.
Bruce Christensen:I think that my AKC and Sport Breeder clients are the inspiration to me, because they get a reputation for being a little bit on the crazy side and my response is well, that may be true, but aren't we all a little bit crazy about something?
Bruce Christensen:You know, some passion in our life?
Bruce Christensen:I'm a birdwatcher and I've learned I can't talk to other people who aren't birdwatchers about birds because their eyes glaze over and they lose interest very quickly because I'm a little bit of a nerd when it comes to that and people would say that I am a little crazy to do some of the things I do to see a little brown bird sometimes.
Bruce Christensen:And these breeders are definitely a bit crazy about their breed, but it really is just a passion for their dogs and their number one goal is to produce healthy puppies that will contribute positively to their breed. None of these breeders that are in the show rings and doing active things with their dogs, whether it's field trials or agility or whatever. Their goal isn't to make money off of these dogs. They love the breed and they want to have healthy puppies and on a selfish side but a worthy selfish side they want to have their kennel, have a good reputation for producing dogs that are a good representation of whatever breed of dog that is, and that includes being healthy, not having conditions that are debilitating. So for me it's a pleasure to partner with them in creating healthy, functional puppies.
Lisa Fortier:I like saying, like you have to pick your right passion, or to find your buddy to hang out with at a cocktail party. Yeah, when you get, it's good to be passionate about what you do.
Lisa Fortier:And I agree with you, the sport breeders that I know, and the dog breeders they would be equally as devastated by this sort of tragedy, in their role too. One of the funny things that we like to ask here we always get some great answers is what is the oldest or the most interesting thing either on your desk or in your desk drawer?
Bruce Christensen:I actually have a ring of keys that I got from my great grandfather when I was a kid. He used to just keep keys, even after they were no longer useful to him, on this ring, and a number of them are skeleton keys, so I thought that was cool when I was a kid and he gave them to me and I just kept them around. I like to wonder what they might have opened, because it could have been anything.
Lisa Fortier:What's your favorite thing to think of that? It might have opened the dungeon where the birds are.
Bruce Christensen:Oh man, I guess I just think of old barns with a room in the back that could have had a dungeon. I mean, who knows what could have been a dungeon? I just recently went to London with my daughter and we went to the London dungeon and you don't open those doors with anything but a skeleton key. That's true.
Lisa Fortier:Very cool.
Sarah Wright:Have you seen the Netflix show Lock and Key?
Bruce Christensen:I have not.
Sarah Wright:You should definitely watch it. It's pretty interesting. It's more on the fictional side of things, but it focuses around a different set of keys and no one knows what they go to. They have to solve mysteries and find clues to figure it out.
Bruce Christensen:Oh, cool, that's on my watch list. There you go, thanks.
Sarah Wright:Yeah, of course. Thank you again for joining us today on the Veterinary Vertex podcast. We're just so happy to have you here to show us important information with our listeners, and thank you also for contributing this important information to JAVMA.
Bruce Christensen:It was a pleasure. I'm glad I was able to do it and glad it was accepted.
Sarah Wright:I'm Sarah Wright with Lisa Fortier. We want to thank each of you for joining us on this episode of the Veterinary Vertex podcast. We love sharing cutting-edge veterinary research with you and we want to hear from you. Be sure to leave us a rating and review on Apple podcasts or whatever platform you listen to.
