Companion Quarterly Vol28 No4 December 2017 by Companion Quarterly

COMPANION QUARTERLY – Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA

Companion Quarterly

OFFICIAL NEWSLETTER OF THE COMPANION ANIMAL VETERINARIANS BRANCH OF THE NZVA Volume 28, No. 4 | December 2017

VOLUME 28 NO 4 DECEMBER 2017

The EPIC study: pimobendan for dogs with preclinical mitral valve disease

Local anaesthetic techniques for ophthalmic surgery

Guidelines for responsible dog breeding

Conference reports: FASAVA and World Veterinary Dental Congress

A week with … specialist surgeon Warrick Bruce

Volume 28 | No. 4 | December 2017 ISSN No. 2463-753X EXECUTIVE COMMITTEE 2017 cav@vets.org.nz

CONTENTS

President

John Munday

Companion Quarterly

Operations Manager Rochelle Ferguson

Treasurer

Aimee Brooker

Committee Members Simon Clark Nina Field Toni Anns Natalie Lloyd Pauline Calvert Paula Short

EDITORAL COMMITTEE Sarah Fowler (Editor) Bart Karalus Crystal Loh Ian Millward Juliet Matthews Simon Clark Shanaka Sarathchandra

Address for submitting copy/ correspondence

Sarah Fowler 66 Callum Brae Drive, Rototuna, Hamilton 3210 T (H) 07 845 7455 | M 027 358 4674 E sarah.fowler@gmail.com

Advertising Manager

Christine Moloney 25 Manchester St, Feilding T 06 323 6161 | F 06 323 6179 E christine.moloney@totallyvets.co.nz

NZVA website www.nzva.org.nz CAV website www.cas.nzva.org.nz

2 Editorial 4 CAV activities and meeting highlights

6 CAV Noticeboard 8 What is your diagnosis? Mark Owen

10 Recent advances in treatment of myxomatous mitral valve disease in dogs Claire Bennett

14 Local anaesthesia for post-

operative pain relief following enucleation in cats and dogs Kellam Bayley

20 Guidelines for responsible dog breeding

28 Conference report – FASAVA Congress 2017 Natalie Lloyd

Cover photograph

36 A week with ... Specialist

The whole of the content of the Companion Quarterly is copyright, The Companion Animal Veterinarians Branch of the NZVA (CAV) and The New Zealand Veterinary Association (NZVA) Inc. A rescue Spanish Galgo stands alert in the courtyard at Scooby Medina, an animal rescue shelter in Medina del Campo, Spain. Taken by Crystal Loh on a volunteer veterinary trip in 2010.

Newsletter design and setting Penny May T 021-255-1140 E penfriend1163@gmail.com

Conference report – World Veterinary Dental Congress 2017 Janine van Dam surgeon, Warrick Bruce Jane Ough

42 Specialist Profile – Michael Hardcastle

44 Book Review – Diagnostic

techniques in veterinary dermatology: a review of two recently published textbooks Duncan Graham

Disclaimer The Companion Quarterly is a non peer reviewed publication. It is published by the Companion Animal Veterinarians Branch of the NZVA (CAV), a branch of the New Zealand Veterinary Association Incorporated (NZVA). The views expressed in the articles and letters do not necessarily represent those of the editorial committee of the Companion Quarterly, the CAV executive, the NZVA, and neither CAV nor the editor endorses any products or services advertised. CAV is not the source of the information reproduced in this publication and has not independently verified the truth of the information. It does not accept legal responsibility for the truth or accuracy of the information contained herein. Neither CAV nor the editor accepts any liability whatsoever for the contents of this publication or for any consequences that may result from the use of any information contained herein or advice given herein. The provision is intended to exclude CAV, NZVA, the editor and the staff from all liability whatsoever, including liability for negligence in the publication or reproduction of the materials set out herein.

48 Massey News 50 What is your diagnosis? The 54

answers

New Zealand Companion Animal Health Foundation Update

55 CPD Record 56 Guidelines for authors

Vets in Stress Programme 24 Hour Freephone Confidential Counselling Service

0508 664 981 Helps you solve personal and work problems, including: Relationship problems Drug and alcohol issues Work issues Change Stress Grief

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

EDITORIAL

Changes at the top While the last three months seems to have passed very quickly there have been some significant changes for companion animal veterinarians in New Zealand. The first big change of course is our new government. While it is currently unclear what changes in our profession may result from the change in government, the inclusion of the Green Party will likely continue the recent move to recognise that cats are not only beloved, valued pets in society, but also a significant ecological problem in this country. I believe that as companion animal veterinarians, it is important to stress this distinction between the two roles of cats in New Zealand and continue working to promote responsible cat ownership. A big change for CAV is that Helen Beattie, our previous president, has been appointed as the Chief Veterinary Officer for the NZVA. Helen did a magnificent job as President of CAV and all of us on the executive committee were extremely sorry to see her go. However, Helenâ&#x20AC;&#x2122;s passion and enthusiasm for the veterinary profession will ensure that we are all well represented by her in her new role. Additionally, having a Chief Veterinary Officer who has such an extensive knowledge and interest in small animal medicine will definitely be beneficial to companion animal veterinarians in the future. Another recent exciting piece of news was the election of Cath Watson to the board of the NZVA. As many of you will remember, Cath performed long and distinguished service to CAV including a very successful period as President. Having someone that has such a good knowledge of issues for companion animal veterinarians serving on the

board is excellent news. Additionally, Cath has been appointed as the Board liaison to CAV and so the committee is looking forward to working closely with Cath to ensure that the issues that are important to CAV members are presented and discussed by the NZVA board. With the departure of Helen, I have assumed the role of President of CAV. To introduce myself, I graduated from Massey in 1994 and worked in a predominantly small animal practice for two years. After this, I completed a PhD at Massey and then travelled to the United States initially to complete my training as a Veterinary Pathologist and then as an academic pathologist. I returned to Massey in 2004 and have worked here as a pathologist since. Although I have been in academia for some years, my interest in companion animals has remained and my research career has focussed on the prevention of cancer in companion animals and on ways to better predict the behavior of cancer in dogs and cats. I have served on the executive committee of CAV for the last three years and I am humbled to serve as president. Needless to say, I am extremely grateful for the contributions and support from the other committee members that include an excellent mix of practicing veterinarians and veterinarians working in industry.

CAV is also interested in dangerous dog policies and believe that using breed to classify dogs as dangerous is a gross oversimplification of the issue which will result in wasted resources and poor outcomes. Other issues that CAV are monitoring include antimicrobial usage and the potential that resistant bacteria could be increasing in New Zealand, ways to maintain wellness in companion animal veterinarians, micro-chipping and vaccination policies, the use of evidencebased medicine, and ways to increase the uptake of pet insurance in New Zealand. While CAV always seems to have a full agenda, I am very conscious that CAV is there to support its members and I am always happy to hear your feedback. If there is an issue that you are interested in that you feel is not being addressed by CAV, please contact me. I welcome your comments and any suggestions regarding ways that CAV can improve the life of companion animals and their veterinarians in New Zealand. Overall, we have seen some big changes in the last quarter. The next year will undoubtedly provide some challenges and opportunities, but CAV will continue to support its members in every way that we can. John S. Munday CAV President l

Along with the support CAV give to continuing professional development through conferences, seminars, wetlabs and scholarships, CAV is currently involved in welfare issues such as promoting responsible breeding of cats and dogs, educating owners to make good choices when obtaining their pets, greyhound racing and humane management of feral and stray cats.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

WORKING TO PROMOTE AND SUPPORT COMPANION ANIMAL PRACTICE IN NEW ZEALAND

CAV activities and meeting highlights

New President

Dr John Munday was elected as the new CAV President, following Helen Beattie resigning to take up the Chief Veterinary Officer position at NZVA. John has been a valuable member of the committee since February 2015. With his vast knowledge of companion animal health and experience in education, the executive committee are looking forward to continuing their contributions to promote and support companion animal practice under his leadership.

Dogs NZ (formerly the NZ Kennel Club)

The Executive Secretary (Peter Dunne) and the Dogs NZ Veterinarian (Becky Murphy) were our guests at the last meeting. We discussed our positions on tail docking and dew claws. While not agreeing on these topics, there remains many more important issues in which we are very aligned. These include responsible dog ownership, our approach to legislation and education on managing dangerous dogs and improving canine health through good breeding practices. Becky outlined the work that Dogs NZ have been doing to improve inherited diseases. This includes the new requirement that Labrador Retrievers litters registered with Dogs NZ must have parents that have been tested for elbow and hip dysplasia, DNA-tested for exercise induced collapse and PRA, as well as holding a current eye certificates. CAV are supportive of their work to introduce mandatory testing and will be working with them to ensure veterinarians are equipped to support the breeders who wish to work on improving their breedâ&#x20AC;&#x2122;s health.

Conformational diseases were also discussed. The current Dogs NZ brachycephalic working group has been disbanded as little progress was being made. A new working group has been proposed. Functional testing and judging were discussed as measures that would assist breeders in selecting healthier brachycephalic breeding stock. Making breeding dogs a regulated activity, with premises subject to inspections was also raised by CAV. It was proposed that CAV and Dogs NZ look to meet again to discuss this idea further.

Canine health and welfare seminar

This seminar was hosted by Dogs NZ in Fielding and supported by CAV. It was open to both breeders and veterinarians, with presentations on pedigree dog health by Kevin Stafford, Kat Crosse and Craig Irving. Becky Murphy, the Dogs NZ veterinarian also presented. A write up of the day is in the December Vetscript and a breeders toolkit has been compiled (available on the CAV website and in this issue of CQ) to support veterinarians working with breeders to improve dog health.

Fireworks

The CAV position on fireworks is to continue to seek a ban of private firework use. CAV will be supporting the NZVA with media work on this topic.

World Small Animal Veterinary Association (WSAVA) dental guidelines

Wellington City Council (WCC) animal policy submission

CAV supported the NZVA submission to the WCC on their cat factsheet and animal policy. WCC are leading the country in their cat management policies by introducing compulsory microchipping and registration on the NZCAR next year. By supporting WCC with their animal policies, it is hoped that their policies will be seen as best practice by other districts and be more widely adopted.

Policy updates

The NZVA euthanasia policy was reviewed and updated. The recommended method for usual circumstances is to euthanase cats and dogs with I/V barbiturate, using prior sedation. The NZVA dewclaw removal for dogs policy was also updated in light of the changes that will occur from October 2018 when the new animal welfare regulations are implemented. The updated policy provides clarity to veterinarians on how to remain compliant with the VCNZ code of professional conduct when approached by owners to remove dewclaws.

CAV membership

CAV membership continued to grow in 2018. We now have 753 veterinary members and 215 student members, and continue to be the largest special interest branch of the NZVA. l

CAV endorsed this comprehensive dental resource. It will be used for a future campaign to raise public awareness of the risks of dental procedures done without anaesthetic by providers such as dog groomers.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

The CAV Noticeboard Hill’s Pet Nutrition/CAV Educating the Educators Scholarship This scholarship provides assistance for veterinary educators to attend advanced level continuing education events outside New Zealand, in exchange for articles, reports and presentations on their area of interest. Through this partnership, we recognise the importance in supporting our leading veterinarians’ participation in international conferences to ensure they remain up to date, and disseminate this knowledge to the wider CAV membership. This scholarship is open to both CAV members and non-members. Successful applicants are

usually specialists in their field but we also support those who have developed advanced skills in a specialist area. If you would like to partner with us to improve the knowledge of NZ veterinarians, then see our website, or contact cav@vets.org.nz for application forms and a list of the terms and conditions. We are very grateful to Hill’s Pet Nutrition as the principle sponsor along with support we receive from the Institute of Veterinary, Animal and Biomedical Sciences and VetLearn.

CAV/CAHF Project Grant 2017 The Companion Animal Health Foundation is a charitable trust that acts as the research funding arm for CAV. Funding applications are invited in March and September for research projects that will enhance companion animal health and welfare. See the CAHF website (www.healthypets.org.nz) to find out how we are supporting projects on elbow dysplasia, bone marrow sampling techniques and FIV

WINNERS

Article of the Issue

Keaton Morgan & Kyle Clarke

prevalence. Any queries on how to make an application or donate contact Rochelle Ferguson (CAV Operations Manager) on cav@vets.org.nz

G SCH RAN OL TS & AR SH Ava IPS ilab CAV le to me mb ers

“The complicated brachycephalics: reducing the morbidity and mortality of elective brachycephalic anaesthesia" September 2017 | Volume 28 (3) | Pages 36–37

EYEVET Services Limited

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

What is your diagnosis? THE QUESTIONSâ&#x20AC;Ś MARK OWEN BVSc DipECVDI FANZCVS A geriatric Labrador Retriever is presented with a 2-day history of vomiting and straining to defaecate. The abdomen appears distended with some discomfort on palpation. Radiographs are performed (Figure 1). 1. What are your radiographic findings? 2. What are your differential diagnoses? 3. How could you confirm these?

Figure 1. (a) Right lateral projection of the caudal thorax and cranial abdomen, (b) right lateral abdominal view and (c) ventrodorsal view of the abdomen of a geriatric Labrador retriever presented for vomiting and straining to defecate.

Contact: NZRadVet, M: 0274503327

Answers on page 48

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

CLINICAL UPDATE

Recent advances in treatment of myxomatous mitral valve disease in dogs Claire Bennett is a Technical Services Veterinarian with Boehringer Ingelheim

CLAIRE BENNETT BVSc Myxomatous mitral valve disease (MMVD) is the most common heart disease in dogs and is characterised by a long preclinical period often spanning years (Borgarelli et al. 2012). During this period, the severity of the disease progresses from mild myxomatous lesions, mild mitral regurgitation, and normal heart size, to severe valve lesions, severe mitral regurgitation, and enlarged cardiac size. Ultimately, many dogs with MMVD will develop signs of congestive heart failure (CHF). The median survival time for dogs that develop CHF is typically less than a year (Häggström et al. 2008). This article reviews the EPIC study (Evaluation of Pimobendan In dogs with Cardiomegaly caused by preclinical mitral valve disease), the first trial to test whether the preclinical period in dogs with MMVD (at stage B2, see Table 1) can be significantly extended by pharmacological management (Boswood et al. 2016). The American College of Veterinary Internal Medicine consensus classification system for canine chronic valvular heart disease is displayed in the following table. Table 1. The American College of Veterinary Internal Medicine (ACVIM) consensus classification system for canine chronic valvular heart disease (Atkins et al. 2009). Stage A B1 B2 C D

Severity of signs High risk individuals (e.g. Cavalier King Charles Spaniel) with no structural cardiac abnormality or murmur. Structural cardiac abnormality but no clinical signs and no cardiac enlargement Structural cardiac abnormality and cardiac enlargement but no clinical signs Past or current clinical signs of heart failure Clinical signs of heart failure refractory to standard treatment

Pimobendan is classified as an inodilator, that is, it has both positive inotropic (increases myocardial contractility) and peripheral vasodilatory properties. These effects are due to inhibition of phosphodiesterase III and increased sensitivity of cardiac myofibrils to intracellular calcium. The rationale for use of pimobendan in dogs with MMVD is to counteract reduced left ventricular contractility which is suspected to occur as MMVD worsens (Borgarelli et al. 2007). In addition, pimobendan acts to reduce systemic and pulmonary vascular Contact: claire.bennett.ext@boehringer.com

resistance, which mediates a decrease in cardiac size. A reduction in cardiac size is presumed to be the underlying reason for increased survival times in pimobendan dogs with CHF secondary to MMVD (Häggström et al. 2013). This principal was used in the design of the EPIC study to investigate whether dogs with stage B2 heart disease (i.e. those with no clinical signs of CHF) could also benefit from pimobendan treatment. There has previously been no consensus regarding the effectiveness of medical treatment in dogs with stage B2 MMVD. The EPIC study was published in the Journal of Veterinary Internal Medicine in 2016 (Boswood et al. 2016). The five-year study began in 2010 and involved 36 centres in 11 countries across four continents. The study population included 360 client-owned dogs of a variety of breeds weighing between 4–15 kg. The number of dogs and duration of the study meant the sum of days the dogs spent in the trial well exceeded 200,000 days, making it the largest clinical trial ever conducted in small animal cardiovascular medicine. The EPIC study was designed, controlled and evaluated independently by a group of eminent veterinary cardiology specialists. The lead investigators had full access to the study results and the right to independently publish the results, regardless of the clinical trial outcome. The study was funded by Boehringer Ingelheim and one of the 36 authors was an employee of this company. The objective of the trial was to study whether longterm administration of pimobendan to dogs with stage B2 myxomatous mitral valve disease delays the onset of signs of CHF, cardiac related death or euthanasia. All CHF endpoints were independently verified through examination of radiographs by at least two members of the investigating committee. Dogs that fulfilled a number of inclusion criteria were recruited into the EPIC trial, as outlined below: • ≥6 years old • 4.1–15 kg • Preclinical MVD as determined by: - Systolic heart murmur with maximal intensity over the mitral valve area (≥ grade 3/6) - Echocardiographic evidence of MMVD - Radiographic and echocardiographic evidence of cardiomegaly

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

The recruited dogs were randomised into two groups, one group of 180 dogs received 0.5 mg/kg/day pimobendan as a divided dose and the group of 180 dogs received a placebo. Dogs were excluded from the study if they were pregnant or lactating or had a history of any current or previous pulmonary oedema, tachyarrhythmia or cardiac disease other than MMVD. Dogs could not receive any cardiovascular medication other than pimobendan or placebo during the trial. The primary endpoint for the study was either the development of left-sided CHF or death presumed to be cardiac in origin. Secondary endpoints were defined to capture any increase in other unexpected cardiac presentations or mortality as a result of treating with pimobendan. The study was terminated early in March 2015 after the interim analysis demonstrated a clear benefit in favour of the administration of pimobendan to dogs with preclinical MMVD. Dogs in the pimobendan group experienced a significantly prolonged preclinical period and longer overall survival time, in comparison to the placebo group (Figure 1). The estimated median time to the primary endpoint was 1228 days in the pimobendan group and 766 days in the placebo group. The risk of developing CHF was reduced by approximately 1/3 and the risk reduction due to pimobendan treatment was constant regardless of the degree of cardiomegaly. There were no statistically significant differences in adverse event occurrence between the pimobendan and placebo groups.

Figure 1. Median time to the development of left-sided congestive heart failure or death due to cardiac causes, in a study of dogs with stage B2 myxomatous mitral valve disease treated with either 0.5 mg/kg/day pimobendan (n=180) or placebo (n=180).

The results of the secondary endpoint analysis demonstrated that the extension in clinical sign-free time was not offset by any reduction in overall survival or the occurrence of any other unexpected clinical presentation. Results were analysed with predefined multivariate statistical analysis which took into account 32 different variables which may have differed between the individuals within the study to ensure that there were no significant differences between the dogs in the two treatment groups. This provides assurance that the benefits for treated dogs were not due to any potential differences between the dogs.

The results demonstrate that administering pimobendan to dogs with stage B2 MMVD is safe and well tolerated. Prolongation of the preclinical period by approximately 15 months represents a benefit of significant clinical importance. Regular health checks and screening of at-risk dogs with thoracic radiographs to measure vertebral heart score (Buchanan and Bucheler 1995) and/or echocardiography is important to identify stage B2 patients. Early diagnosis means these dogs can benefit as early as possible from an effective treatment. The EPIC study is the first trial showing that the preclinical period in dogs with stage B2 MMVD can be significantly prolonged by pharmacological management. However the conclusions of this study are only relevant to dogs with cardiac enlargement secondary to preclinical MMVD as no dogs without cardiac enlargement were recruited into the study. Treatment with pimobendan for all dogs with a heart murmur compatible with the presence of MMVD is not justified on the basis of the findings of the EPIC study.

References

Atkins C, Bonagura J, Ettinger S, Fox P, Gordon S, Häggström J, Hamlin R, Keene B, Luis-Fuentes V, and Stepien R. Guidelines for the diagnosis and treatment of canine chronic valvular heart disease. Journal of Veterinary Internal Medicine 23, 1142–50, 2009 Borgarelli M, Tarducci A, Zanatta R, Häggström J. Decreased systolic function and inadequate hypertrophy in large and small breed dogs with chronic mitral valve insufficiency. Journal of Veterinary Internal Medicine 21, 61–7, 2007 Borgarelli M, Crosara S, Lamb K, Savarino P, La Rosa G, Tarducci A, Häggström J. Survival characteristics and prognostic variables of dogs with preclinical chronic degenerative mitral valve disease attributable to myxomatous degeneration. Journal of Veterinary Internal Medicine 26, 69–75, 2012 Boswood A , Häggström J, Gordon SG, Wess G, Stepien RL, Oyama MA, Keene BW, Bonagura J, MacDonald KA, Patteson M et al. Effect of pimobendan in dogs with preclinical myxomatous mitral valve disease and cardiomegaly: the EPIC Study – a randomized clinical trial. Journal of Veterinary Internal Medicine 30, 1765–79, 2016 Buchanan JW and Bucheler J. Vertebral scale system to measure canine heart size in radiographs. Journal of the American Veterinary Medical Association 206, 194–9, 1995 Häggström J, Boswood A, O'Grady M, Jöns O, Smith S, Swift S, Borgarelli M, Gavaghan B, Kresken JG, Patteson M et al. Effect of pimobendan or benazepril hydrochloride on survival times in dogs with congestive heart failure caused by naturally occurring myxomatous mitral valve disease: the QUEST study. Journal of Veterinary Internal Medicine 22, 1124–35, 2008 Häggström J, Boswood A, O'Grady M, Jöns O, Smith S, Swift S, Borgarelli M, Gavaghan B, Kresken JG, Patteson M, et al. Longitudinal analysis of quality of life, clinical, radiographic, echocardiographic, and laboratory variables in dogs with myxomatous mitral valve disease receiving pimobendan or benazepril: the QUEST study. Journal of Veterinary Internal Medicine 27, 1441–51, 2013 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

FEATURE ARTICLE

Local anaesthesia for post-operative pain relief following enucleation in cats and dogs This article was written as part of the requirements for receiving the Hill’s Pet Nutrition/CAV Educating the Educators Scholarship

KELLAM BAYLEY, BVSc,

MVSc(dist), CertVOpthal

Introduction

Post-operative analgesia is vitally important to maintain animal welfare following any surgery. Enucleation is the most invasive and painful ocular procedure performed by veterinarians and special consideration must be given to analgesia following this procedure. There are a variety of systemic analgesia techniques that exert their effect throughout the body and which may be a useful part of pain management after enucleation. However this article will focus on local anaesthesia options available to promote post-operative analgesia following enucleation, along with the pros and cons of each technique.

Pain physiology and analgesic mechanisms Providing optimal analgesia is particularly important for veterinary species due to an animal’s inability to effectively communicate the extent of their pain. Pain not only impacts the basic welfare of an animal, but may contribute negatively to the overall recovery of the patient. Pain is a stressor and therefore can be detrimental to the cardiorespiratory, metabolic and immune systems and inhibit wound healing (Carroll 1998). An understanding of the basic pain pathways is useful when planning an effective analgesic protocol for patients. The pain experience can be divided into four components; transduction by the nociceptors, transmission of the stimuli Contact: Kellam.bayley@gmail.com

via sensory neurons, modulation of the signal in the spinal cord and subcortex, and conscious perception in the somatosensory cortex. The progress of a noxious stimulus along the pain pathway is as follows. Peripheral polymodal nociceptors are stimulated and the impulse is transmitted along the axons of c and Aó sensory fibres to neural cell bodies located in the dorsal horn of the spinal cord and brain stem. Here the impulse undergoes processing with influence from modulatory interneurons and descending inhibitory neurons. Second order ascending neurons project the impulse towards the brain where they synapse in the thalamic region before the impulse moves through other areas of the brain (including the limbic system) on its way to the somatosensory cortex where pain is consciously perceived (McMahon et al. 2013).

sites: peripheral nociceptors; sensory inflow via neurons; and the central nervous system (Woolf and Chong 1993). The use of multiple different analgesic drugs (i.e. multimodal analgesia) impacts these different regions of the pain pathway, which results in summation of the analgesic effects. The actions of different classes of analgesic drugs are summarised in Table 1 (Carroll 1998; McMahon et al. 2013). Analgesia should be used pre-emptively in surgical patients as this prevents central sensitisation occurring during surgery. It is important to be aware that most general anaesthetic agents only prevent the conscious perception of pain but do not prevent activation of the pain pathway. These drugs therefore do not prevent development of central sensitisation, which may negatively impact post-operative pain control.

If the pain pathway is activated unchecked, peripheral and/or central sensitisation can develop. Peripheral sensitisation results when tissue injury during surgery leads to release of inflammatory cytokines that increase the sensitivity of nociceptors in the surgical region. In contrast, central sensitisation occurs when untreated peripheral sensory neuron activity drives central spinal systems that amplify and prolong the incoming sensory messages (Woolf and Chong 1993; McMahon et al. 2013). We should aim to prevent of both of these types of sensitisation from occurring as they intensify and prolong the pain experienced.

Table 1. The effect of different analgesic drugs on the pain pathway

Pain should be continually anticipated and pre-empted with therapy for as long as the abnormal afferent barrage of nerve stimulation from the wound and surrounding site continues (Woolf and Chong 1993). This is achieved by using analgesic techniques targeted at three

Drug class Non-steroidal antiinflammatory drugs

Local anaesthetic agents

Opioids, alpha-2 agonists, dissociative drugs, gabapentin,

General anaesthesic agents

Effect on the pain pathway Reduction of inflammation and peripheral sensitisation at the surgical site so reduces transduction of pain signal by nociceptors Prevents transmission of nerve impulses along the sensory nerves Alters activity of modulatory interneurons and endogenous analgesic pathways in the central nervous system Induces a state of unconsciousness preventing the behavioural and emotional responses we consider to be characteristic of pain

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

Local anaesthesia for postoperative pain

Local anaesthesia combined with general anaesthesia results in less post-operative pain than systemic analgesia combined with general anaesthesia. Some studies indicate that local anaesthesia appears to be a more effective analgesic when given pre-operatively compared to postoperatively. Theoretically, the local anaesthesia blocks any nociceptive transmission from the surgical trauma and prevents central sensitisation. However studies do not show such clear benefit for pre-operative local anaesthesia. This may relate to the fact that surgical tissue damage causes two phases of sensory input; from the surgical trauma itself and then secondarily from the tissue inflammatory reaction during wound healing (Woolf and Chong 1993). Therefore, a single pre-emptive local anaesthetic treatment may not be sufficient to eliminate postoperative pain as it does not address this second phase. Studies on the benefits of regional anaesthesia as an adjunct for post-operative pain relief in dogs have shown mixed results with some showing a benefit, while others did not detect a difference when compared to a systemic opioid (Conzemius et al. 1994; Buback et al. 1996). All local anaesthetics share a similar mode of action by reversibly binding to sodium channels in neuronal axons. This blocks sodium influx to the axon and prevents conduction of an action potential in both motor and sensory neuron. The key attributes of lidocaine

and bupivicaine as local anaesthetics are summarised in Table 2 (Mauger and Craig 1994; Becker and Reed 2006; Ramsey 2011). As local anaesthetics may also affect cardiac and central nervous system function, the maximal recommended systemic dose should not be exceeded. This dosing restriction is not as important for a splash block technique as most of the solution runs out of the orbit before wound closure and is not retained within the animal.

Local orbital anaesthesia techniques

Four different techniques may be used to achieve localised globe and orbital anaesthesia. Retrobulbar injection, peribulbar injection and sub-Tenon’s anaesthesia are all administered before beginning surgery, while the splash block is performed following removal of the globe and prior to wound closure. For the pre-operative techniques, the target region for local anaesthetic infusion is within the cone formed by the extraocular musculature, termed the intraconal region. This space contains the sensory nerve branches from cranial nerve V (trigeminal) that are sensory for the globe, therefore blocking these nerves are of primary importance. Some nerves sensory to the orbit are outside of the extraocular muscle cone (termed extraconal) and these are blocked by diffusion of the local anaesthetic. The extraocular muscle cone provides an incomplete barrier, therefore a sufficient volume of local anaesthetic can diffuse between the intraconal and extraconal

Table 2. Summary of effects of lidocaine and bupivicaine Drug Lidocaine Bupivicaine

Maximal systemic dose 4 mg/kg 1–2 mg/kg (use lower end of dose range for cats)

Time to onset 2–10 min. 2.5–30 min.

Duration of motor Duration of nerve blockade analgesia 35–136 min. Potentially several hours 2–12 hours Potentially 1–2 days

Table 3. Advantages and disadvantages of the different orbital local anaesthesia techniques Technique Retrobulbar

Peribulbar

Sub-Tenon’s

Splash block 16

Advantages Pre-operative. Intraconal anaesthesia if placement is accurate

Disadvantages Sharp needle. Thus risk of penetration of globe, optic nerve or other important structures Pre-operative. Needle insertion away Sharp needle. Placement is extraconal. from important structures, therefore Thus large infusion volume required to should be safer than retrobulbar. diffuse into intraconal space. Pre-operative. Intraconal. Blunt technique Technically more difficult so minimal risk of damage to important structures. Technically very simple Applied post-surgically.

regions (Johnson 1995). These techniques all have their pros and cons, which are summarised in Table 3. Retrobulbar injections (intraconal) are the most commonly used orbital anaesthesia technique in veterinary ophthalmology. The most recently described technique for retrobulbar injection in dogs is an inferiotemporal palpebral technique (Accola et al. 2006). This technique involved using a 22 ga, 1.5-inch spinal needle with a 20° bend at the midpoint. The needle is positioned at the inferior orbital rim and inserted perpendicularly through the inferior lid at the junction of its middle and temporal thirds. The needle is advanced until a slight popping sound is detected, indicating piercing of the orbital fascia. The needle is then directed dorsonasally towards the apex of the orbit and advanced 1–2 cm; then 2 mL of 2% lidocaine is injected. Complications from retrobulbar injections are sparsely referenced in the veterinary literature, however extrapolation from human studies indicates a potential risk for a range of complications such as brain stem anaesthesia, globe penetration, peribulbar haemorrhage and choroidal haemorrhage. However, given that in the veterinary literature there is a single well described case of brain-stem anaesthesia in a cat following retrobulbar injection (Oliver and Bradbrook 2013), it is likely that the likelihood of these complications is low. Despite this, many clinicians are reluctant to use retrobulbar anaesthesia for veterinary ophthalmic surgery. The ‘blind’ nature of the technique whereby a sharp needle is passed through tissue, potentially causing unseen damage, appears to be off-putting for many clinicians. Peribulbar (extraconal) injection involves using a short fine needle to inject local anaesthetic into the orbit. This technique was developed to help avoid the risks associated with retrobulbar injection. Because needle insertion is limited to 25 mm, the risk of traumatising intraorbital structures is lower. Peribulbar injections have only been described in the veterinary literature as a pre-operative block before enucleation in cats (Shilo-Benjamini et al. 2014). In these studies, the effects of peribulbar injection were first assessed in cat cadavers, then later in live cats where the effects were compared to a retrobulbar injection. The peribulbar injection was performed with a 25 ga, 3/8

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

inch needle inserted trans-palpebrally adjacent to the dorsomedial orbital wall with 3 mL of solution. The peribulbar block technique was shown to be more effective in distributing injectate into the intraconal region than the retrobulbar technique and provided equivalent post-injection corneal anaesthesia. There was a significant, but transient, increase in intraocular pressure after peribulbar injection and the authors suggested that this may restrict its usage to cats that do not have glaucoma and or those not at risk of corneal perforation (Shilo-Benjamini et al. 2014). There is no published data on the rate of complications following peribulbar injection in animals. Sub-Tenon’s anaesthesia is a technique where local anaesthetic solution is infused into the intraconal region via a blunt cannula. After surgically disinfecting the globe and conjunctiva, a small incision is made in the bulbar conjunctiva and Tenon’s capsule is dissected through to the level of sclera. A blunt, curved cannula is then inserted so the tip sits posterior to the globe equator, and 3–5 mL of local anaesthetic is infused into the subTenon's space (Canavan et al. 2003). The rationale for this development of this anaesthetic technique was to avoid the risk of retrobulbar haemorrhage, globe perforation, optic nerve damage, and brain stem anaesthesia, while still providing prolonged and reliable anaesthesia. Studies of sub-Tenon's anaesthesia for cataract surgery in dogs found it effectively caused globe and orbital anaesthesia (Ahn et al. 2013). SubTenon’s anaesthesia with bupivicaine has also been shown to be effective in producing globe and orbital anaesthesia and provided good post-operative pain control following enucleation in dogs (Bayley 2016). Orbital anaesthesia can also be achieved using a splash block technique following enucleation. Once the globe is removed, local anaesthetic is instilled into the orbit and/or over swabs placed to provide haemostatic compression prior to closure. This technique is quick and easy, however as the local anaesthetic is placed after the globe has been removed, it does not provide improved intraoperative analgesia. Bupivicaine is commonly used for this block due to its long duration of action and in the author’s experience appears to be

Photo courtesy of the author

effective, despite its reported slow onset of action. This is possibly due to the orbital shape promoting retention of the bupivicaine after it is instilled, providing the required contact time for the drug to take effect. Studies have recently been published comparing splash block anaesthesia to retrobulbar injection for post-enucleation analgesia in dogs (Ploog et al. 2014; Chow et al. 2015). These studies showed no significant difference in post-operative pain scoring between the two treatments and that the splash block technique was simple to perform. A study performed by the author also showed that splash block anaesthesia was effective in providing post-operative analgesia following enucleation in dogs (Bayley 2016).

Conclusion

Pre-emptive multimodal analgesia is the most effective way to prevent postoperative pain in our veterinary patients. Due to the profound blocking effects on pain pathways, local anaesthesia forms a valuable component of multimodal analgesia. While the pre-operative injections techniques may be a little daunting, it is quite exciting that a ‘splash block’ technique provides effective postenucleation pain relief. As this approach is technically simple, it can be easily used in practice to promote post-operative analgesia.

References

Accola PJ, Bentley E, Smith LJ, Forrest LJ, Baumel CA, Murphy CJ. Development of a retrobulbar injection technique for ocular surgery and analgesia in dogs. Journal of the American Veterinary Medical Association 229, 220–5, 2006 Ahn J, Jeong M, Lee E, Kim S, Park S, Park S, Kang S, Lee I, Seo K. Effects of peribulbar anesthesia (subTenon injection of a local anesthetic)

on akinesia of extraocular muscles, mydriasis, and intraoperative and postoperative analgesia in dogs undergoing phacoemulsification. American Journal of Veterinary Research 74, 1126–32, 2013 Bayley KD. The applications of sub-Tenon's anaesthesia for canine ophthalmic surgery. MVSc thesis. Massey University, Palmerston North, NZ, 2016 Becker DE, Reed KL. Essentials of local anesthetic pharmacology. Anesthesia progress 53, 98–108, 2006 Buback JL, Boothe HW, Carroll GL, Green RW. Comparison of three methods for relief of pain after ear canal ablation in dogs. Veterinary Surgery 25, 380–5, 1996 Canavan KS, Dark A, Garrioch MA. Sub-Tenon's administration of local anaesthetic: a review of the technique. British Journal of Anaesthesia 90, 787, 2003 Carroll G. Small Animal Pain Management. American Animal Hospital Association Press, Lakewood, CO, USA, 1998 Chow D, Wong M, Westermeyer H. Comparison of two bupivacaine delivery methods to control postoperative pain after enucleation in dogs. Veterinary Ophthalmology 18, 422–8, 2015 Conzemius MG, Brockman DJ, King LG, Perkowski SZ. Analgesia in dogs after intercostal thoracotomy: a clinical-trial comparing intravenous buprenorphine and interpleural bupivicaine. Veterinary Surgery 23, 291–8, 1994 Johnson RW. Anatomy for ophthalmic anaesthesia. British Journal of Anaesthesia 75, 80–7, 1995 Mauger T, Craig E. Havener's Ocular Pharmacology (6th Edtn). Mosby, St Louis, MO, USA, 1994 McMahon S, Koltzenburg M, Tracey I, Turk DC. Wall & Melzack's Textbook of Pain. Elsevier Health Sciences UK, 2013 Oliver JAC, Bradbrook CA. Suspected brainstem anesthesia following retrobulbar block in a cat. Veterinary Ophthalmology 16, 225–8, 2013 Ploog CL, Swinger RL, Spade J, Quandt KM, Mitchell MA. Use of lidocainebupivacaine-infused absorbable gelatin hemostatic sponges versus lidocainebupivacaine retrobulbar injections for postoperative analgesia following eye enucleation in dogs. Journal of the American Veterinary Medical Association 244, 57–62, 2014 Ramsey I. Small Animal Formulary (7th Edtn). British Small Animal Veterinary Association, Quedgeley, Gloucester, UK, 2011 Shilo-Benjamini Y, Pascoe PJ, Maggs DJ, Pypendop BH, Johnson EG, Kass PH, Wisner ER. Comparison of peribulbar and retrobulbar regional anesthesia with bupivacaine in cats. American Journal of Veterinary Research 75, 1029–39, 2014 Woolf CJ, Chong MS. Preemptive analgesia treating postoperative pain by preventing the establishment of central sensitisation. Anesthesia and Analgesia 77, 362–79, 1993 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

FEATURE ARTICLE

Guidelines for responsible dog breeding CAV Responsible Breeding Committee Breeders are feeling the heat over welfare issues associated with selective breeding. They have been criticised by the government in the National Animal Welfare Advisory Committee report, demonised on social media and some have even found themselves in the disputes tribunal facing claims for veterinary bills incurred by purchasers of their puppies. Veterinarians must be ready to support those breeders who wish to improve their dog’s welfare through responsible breeding practices. The following is a quick reference to assist veterinarians advising breeders on responsible practices. Further information is available in the Dog Breeding Toolkit available on the CAV website (www. nzva.nz/cavmembers).

A) Selecting dogs for breeding

Dog breeders of both pedigree and crossbred dogs are required under minimum standard 7 in the New Zealand Animals (Dogs) Code of Welfare (2010) to ensure that “all reasonable efforts are made to ensure that the genetic makeup of both sire and dam will not result in an increase in the frequency or severity of known inherited disorders.” Breeders should understand the health issues to which their breed, or breeds (in the case of crossbred dogs) are prone and take all reasonable steps to eliminate or minimise these issues. Breeders that have not taken this responsibility seriously are at risk for dispute tribunal claims from puppy purchasers should the progeny require corrective veterinary care due to preventable inherited diseases.

Veterinarians who would like assistance providing genetic counselling can contact the Dogs NZ veterinarian Becky Murphy (caninehealth@dogsnz.co.nz). Becky is happy to discuss the testing results to assist with breeding selection decisions for Dogs NZ members.

Inherited diseases

Conformational diseases

Dogs New Zealand (Dogs NZ) have a list of recommended health tests for each breed they register available on their website (www.dogsnz.org.nz). The tests include DNA sampling, cardiac and eye certification, along with orthopaedic assessments, radiographs and blood testing. To support veterinarians involved in health testing breeding dogs, CAV have compiled a veterinarian's guide to DogsNZ health tests. This is available in the CAV resources section of our website (www.nzva.org.nz/cavmembers) as part of the dog breeding toolkit under "selecting parents". Interpreting test results and providing genetic counselling: In general, it is not advised to breed animals that have: • genetic disorders associated with diseases with high heritability that are detrimental to the animal’s health and welfare • diseases with low heritability but which severely compromise an animal’s health and welfare. Contact: rochelle.ferguson@vets.org.nz or comment on the CAV members-only discussion forum on the CAV website

Source: Melissa Leigh Wilson

These diseases are related to exaggerated features such as brachycephaly, miniature and giant dogs, large eyes, long ears, excessive skin folds, long backs and hairlessness. Assessment of these features are subjective, making breeding guidelines much more difficult for everyone to agree on. The following suggestions are put forward to guide veterinarians and breeders: • All breeding dogs should be able to walk and breathe easily, as well as manage their own feeding and toileting. • Avoid breeding from dogs that have required corrective surgery or intensive management for diseases that compromise welfare. Examples include stenotic nares or elongated palate corrections, cryptorchids, severe malocclusion, spinal problems, severe skin disease, hip dysplasia, elbow dysplasia or patella luxation corrections. • Avoid breeding from dogs that have required repeat Caesarean sections. • Assess all brachycephalic breeding dogs by examining them after performing a fast 3-minute walk. Attempt to breed only from those that score a grade 0 on the BOAS Functional Grading System. Grade 0 dogs will not have any audible

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

respiratory noise or inspiratory effort after the walk, and will also not exhibit cyanosis, dyspnoea or syncope. More information on functional grading of brachycephalics is available on the Cambridge Veterinary School website (www.vet.cam.ac.uk) under their BOAS research group tab. • Select only those dogs with more moderate, lower risk conformations for breeding. Altering breed standards to support this approach is recommended so lower risk conformations are not penalised in the show ring (Packer et al. 2015). • Judicious out-crossing to increase health and phenotypic diversity (Packer et al. 2015).

Temperament

Only dogs of favourable temperament should be used for breeding.

Genetic diversity

To avoid risks of genetic diseases being uncovered, it is desirable that mating pairs are unrelated. Health concerns are held for breeds that have small genetic pools. If a breeder is unable to breed using an unrelated pair of dogs, it is suggested that they use the least closely related dogs available and dogs that are closer than two generations should not be used.

General health of the female breeding dog All dogs to be mated should be in fully grown and in good physical condition.

B) Managing the breeding female dog

There is little scientific evidence available on which to base recommendations for maximum numbers of litters a dog should have, how often they should be mated, or when breeding should commence or finish. We do however know the following: • Fertility is highest when a female dog is younger (Hollinshead 2012). • Older dogs experience uterine inertia more commonly than younger dogs (Forsberg and Persson, 2007). • Unmated cycles create a hormonal environment that predisposes female dogs to pyometra (Krekeler and Hollinshead 2014). Given this, CAV suggest the following as a guide to managing breeding in the female dog: 22

1. Begin mating early Once the female breeding dog is physically and mentally mature, begin mating as early as possible after the first season. This is to capitalise on her peak fertility and general health. Being young both lowers the risk of uterine inertia and the requirement for medical interventions at whelping. It is understood that in some circumstances, early breeding is not desirable e.g. performance dogs who may need time to prove their worth before being selected to enter a breeding programme or pre-breeding selection health tests that require a dog to be a certain age before they are performed.

2. Avoid breeding female dogs over six years of age Increasing age is linked to reduced fertility, with lower pregnancy rates and litter sizes seen in older dogs. As dogs age uterine inertia that requires medical interventions at whelping is seen more often. Older female dogs may also have increased rates of other medical conditions that increase the risk of complications during pregnancy and at whelping. It is for these reasons that retiring female dogs from breeding programmes once they reach six years of age is encouraged.

3. Limit each female dog to three litters The maximum number of litters a female dog should have, in order to maintain her own health and welfare has not been determined. However, CAV recommends a limit of three litters per dog. This allows for breeders to produce a suitable daughter in which to continue the breed line and reduces the welfare impacts on individual breeding female dogs associated with producing multiple litters.

4. Avoid unmated cycles where possible

posed by empty cycles, predisposing to uterine disease. This recommendation for back-to-back matings is only made with the caveat that each female dog is limited to a maximum of three litters before being de-sexed and retired from the breeding programme. “Back to back matings’ got a bad reputation because it was abused by puppy mill breeders. By setting a limit of three litters per female dog, ‘back-to-back matings’ should not be seen as controversial but beneficial to the reproductive health of a female dog. This is just about education… or re-education. The aim of this recommendation is to achieve not only the best welfare, but the best reproductive performance of a breeding female dog.

5. De-sex after final litter whelped When the female breeding dog has had her final planned litter, it is recommended that she is desexed to avoid the risks associated with unmated cycles causing pyometra (Ross 2014). Note that if a female dog's final litter is delivered by Caesarean section, it is not recommended to spay her then unless there is an emergency situation. This is due to the increased risk of complications arising from ovariohysterectomy when carried out at the time of Caesarean section.

6. Avoid repeated Caesarean sections There are negative welfare impacts associated with dogs that routinely require Caesarean sections. CAV encourages breeders whose dogs routinely require Caesarean sections, to limit the number of Caesarean sections that each female dog experiences to less than three. Other measures breeders may take (such as selecting for smaller heads and wider pelvises) that reduce the dependence on Caesarean section to maintain the breed are to be encouraged.

The risk of developing uterine disease increases when female dogs experience heat cycles without being pregnant. Canine physiology is such that the hormonal environment created after a non-pregnant cycle predisposes the uterus to develop pyometra. To avoid this risk, back-to-back matings could be considered.

7. Aim to improve the breeding female dog's chances of being rehomed

The decision on whether to mate on consecutive cycles is made in consideration of the female dogs physical condition, her age, and the risks

C) Artificial insemination

By commencing breeding at an early age, and limiting the number of litters to three or less, the dog will be retired from breeding, while still relatively young. improve her chances of being rehomed if that is what the breeder plans.

Ethics

A breeder should select the mating pairs so that the genetic make-up of both sire

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

What to feed pregnant dogs

and dam will not result in an increase in the frequency or severity of known inherited disorders. Breeders should also manage their breeding stock to minimise the negative welfare impacts associated with pregnancy and whelping. Veterinarians that are concerned a planned mating will compromise the welfare of the female dog or the resultant progeny, are under no obligation to perform artificial insemination.

Technique

Veterinarians involved in supporting breeders with their programmes must be conversant with artificial insemination (AI) techniques, the types of semen used for AI, and have a good understanding of how to monitor a female breeding dog's oestrous cycle to ensure optimum timing of the procedure.

Trans-cervical insemination

This advanced procedure was pioneered by a New Zealander, Dr. Marion Wilson and is now used worldwide. It is available at a steadily increasing number of clinics throughout New Zealand. This technique allows for intra-uterine insemination with frozen semen without the need for invasive surgery under general anaesthetic. The success rates are comparable to that achieved with intra-uterine insemination techniques (Pretzer et al. 2006; Hollinshead and Hanlon 2017). Breeders should be encouraged to use this technique to improve their breeding female dog's welfare by avoiding multiple anaesthetics and surgery.

Blood testing

Relaxin is produced by the placenta and if present indicates pregnancy. It may also be present in the case of an abortion or in the post-partum period, so can give a false positive in these cases. It gives no information on fetal health. For these reasons diagnosis of pregnancy by ultrasonographic examination is preferred over relaxin measurement. Progesterone is elevated after ovulation, during pregnancy and in pseudopregnancy so cannot be used to confirm a pregnancy. However, pregnancy can be ruled out if levels are low.

E) Nutrition in the breeding female dog Optimal feeding of the mother during pregnancy will result in puppies that have good reserves and are more resilient (Fontaine 2012).

Prior to mating

Fertility and parturition complications are associated with body condition scores that are both too low and too high. To avoid these, the breeding female dog should be in an optimal body condition score when mated.

D) Pregnancy diagnosis

First 6 weeks of pregnancy

This is the most reliable and informative method of pregnancy diagnosis, however the accuracy is dependent on the operator. It may be attempted at day 20–22 of gestation but is most reliable after day 25. It can provide information not only on pregnancy, but also fetal viability, and indications of litter size and distribution.

Weeks 6–9 of pregnancy

Ultrasound

Palpation

This is most reliably performed around day 30 (mid-gestation).

Radiography

Skeletal ossification occurs from around day 45 of gestation. It is optimally seen on a radiograph after day 55.

Source: Raewyn Mullan

It is recommended to feed the dog normally in the first 6 weeks of pregnancy. The majority of growth of the fetuses occurs after the sixth week. After the sixth week, increase the energy intake by 10% every week until parturition. An exception would be for a dog that had a singleton litter; in this case a smaller increase each week (e.g. 3–4%) is more appropriate. As the increasing size of the uterus puts pressure on the stomach, food will need to be divided into smaller meals and given more frequently to allow the mother to meet her daily energy intake.

The food chosen must contain good quality protein, have adequate calcium and be energy dense. Consideration can be given to supplementing with folic acid, omega-3 fatty acids and antioxidants although there is little evidence to support the benefits of doing so. Calcium should not be supplemented above normal intake levels in pregnant dogs as it interferes with metabolic pathways that regulate blood calcium levels. This can result in eclampsia during lactation, and may also contribute to uterine inertia.

Lactation

The energy requirement for lactation is huge. To avoid weight loss at this time, free feeding of an energy dense food that is highly digestible and contains good quality protein is recommended. Exceptions to this recommendation may be needed in cases where the litter size is small (1–2 puppies).

Weaning

The mother should be moved back to a more regular feeding schedule once weaning commences, usually when the puppies are 4–4.5 weeks of age.

References

Fontaine E. Food intake and nutrition during pregnancy, lactation and weaning in the dam and offspring. Reproduction in Domestic Animals, 47, 326–30, 2012 Forsberg, C, Persson, G. A survey of dystocia in the boxer breed. Acta Veterinaria Scandinavica, 49, 8, 2007 Hollinshead FK. Multivariable statistical analysis of reproductive performance in the bitch (abstract). International Congress on Animal Reproduction, 2012 Hollinshead, F, Hanlon D. (2017). Factors affecting the reproductive performance of bitches: a prospective cohort study involving 1203 inseminations with fresh and frozen semen. Theriogenology 101, 62–72, 2017 Krekeler N, Hollinshead F. Pyometra. In: Monnet E (Ed.), Small Animal Soft Tissue Surgery. Pp. 623–634. John Wiley & Sons Ltd. Hoboken NJ, USA, 2014 Packer R, Hendricks A, Tivers, M, Burn C. Impact of facial conformation on canine health: airway disease. PLoS ONE, 10, e0137496, 2015 Pretzer S, Lillich R, Althouse G. Single, transcervical insemination using frozenthawed semen in the Greyhound: a case series study. Theriogenology, 65, 1029–36, 2006 Ross, LH. A restrospective study of bitches with pyometra, medically treated with aglepristone. Theriogenology, 82, 1281–1286, 2014 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

CONFERENCE REPORT

FASAVA Congress 2017 Gold Coast, Australia, August 10–12 2017

NATALIE LLOYD, BVSc There is no better time to attend a conference on the Gold Coast than the depths of a Wellington winter and so with remarkably little persuasion, I packed my bags and headed off to Surfers Paradise for the 2017 FASAVA Congress in August. Both the technical programme and the social events looked amazing. While registering on Day One, I realised I was not the only NZ vet to be impressed, as there were a lot of fellow kiwis picking up their “kit”, looking for some quality CPD offerings as well as a few rays of sunshine. The programme was vast and included eight different streams over four days for veterinarians and veterinary nurses. Some of the topics covered were dentistry, oncology, neurology, urogenital, critical care, ophthalmology, feline medicine, surgery, exotics and imaging. The social programme included a visit into the “outback” for the Australiana Night and a fantastic Gala the night before the conference closed. The outback visit was highly entertaining and comical. Although the Kiwis in the room were initially a bit “ho hum” about watching a shearing display on what seemed like very co-operative sheep, our host managed to make everyone in the room laugh with his sense of humour and an entertaining use of the wool he retrieved from said sheep. Dinner, drinks and dancing followed with a good show on the dance floor from the attendees. The Gala was a whole different event; black tie and cocktail dresses. The event opened with a fantastic display of acrobatics which got everyone seated and stunned into silence, marvelling at the flexibility one human can display! There was a prizegiving ceremony, including a welcome to the new ASAV president, Dr Mark Kelman, and thanks to the outgoing Contact: natalielloyd72@gmail.com

president, Dr Geeta Saini, for all her hard work, including the work done on putting such a great conference together. A beautiful dinner and then, you guessed it, more dancing! It was a fantastic conference with quality speakers, I had a hard time picking which stream to attend over the entire 4 days as there was so many great lectures. Here are a few snippets I picked up:

Critical care

Possibly my favourite lecture of the conference was a highly entertaining lecture by Dez Hughes from the University of Melbourne about the Emergency Approach to the Blocked Cat. An early point made was that when presented with a critically ill patient, consider what is going to kill them first. In the case of a blocked cat, that is life threatening hyperkalaemia, so in Dez’s words “Get off that penis!” He suggests that the first measure is ALWAYS ALWAYS ALWAYS to place an IV catheter, get IV fluids running, check electrolytes and TP/PCV, and ideally, get an ECG trace running. Always try to stabilise these cats before unblocking and consider aggressive fluid therapy. He likened a blocked cat to an “empty bucket with a hole in the bottom”, they are hypovolaemic and hyperkalaemic in a lot of cases and fluids are necessary. His choice of fluids is a balanced electrolyte solution at shock rates with constant checking and rechecking for the effects of fluid loading. DO NOT USE HYPOTONIC SALINE. Once fluid therapy has started, treat the hyperkalemia with either calcium gluconate at 50–100 mg/kg; IV insulin (0.25–0.5 iu/kg) and dextrose (2 g per unit of insulin); or sodium bicarbonate. His choice of sedation for these patients is an opiate/benzodiazepine or benzodiazepine/ketamine combo to avoid inducing hypotension. Then attention can be given to the blocked urethra. Twist the tip of the penis like a

straw to try to break up any obstruction in the distal end, then, if this does not relieve the obstruction, place a urinary catheter. His preference is to use a 5.5 inch openended Kendall Sovereign Sterile Tom Cat catheter to unblock the urethra, then to place a Kendall Sovereign Sterile Feeding Tube and Urethral Catheter to be left in place. Although these can be fiddly, they are much less likely to induce urethral damage during placement (he felt that this is more likely with rigid plastic catheters or the silicon ones with an indwelling stylet) and are much better tolerated by the cats when left in place for a day or two post-obstruction. Fully drain the bladder and flush repeatedly, suture the catheter in place and attach to a closed collection system. Always place an Elizabethan collar! Leave in place for a day or two until the urine is clear and continue IVFT in the postobstruction period until the cat is eating well and urinating normally.

Oncology

After using the support of the lovely Angela Frimburger and Tony Moore of Vet Oncology Consultants for years for our chemotherapy cases, it was awesome to attend some of Tony’s lectures and meet the man himself. He spoke on a few oncology topics, but here are a few useful snippets from the lymphoma lectures…

Canine lymphoma

The best chemotherapy protocols will be designed based on the exact type of lymphoma we are dealing with. Early immunophenotyping is recommended to determine if it is T- (terrible) or B- (better) cell lymphoma. Then ideally stain for CD markers to determine subsets of either B- or T-cell lymphoma. Consider taking a biopsy of an enlarged node for histopathology in the staging process of lymphoma. Histopathology allows morphological evaluation of the specimen that is not possible with cytology, and can allow the pathologist to grade the

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

likely to develop multi-drug resistance. These cells express high levels of the MDR 1 transporter which may export traditional chemotherapy agents such as vincristine and doxorubicin out of cells. HGTCL tends to be more common in young dogs such as Boxers, Golden Retrievers and the Spitz. Interestingly, 30% of human T-cell lymphoma cases are refractory to treatment also. L-asparaginase is a useful addition to HGTCL treatment protocols as it is an alkylating agent and these do not tend to be affected by MDR 1.

Feline lymphoma

Lymphoma can be difficult to treat in cats due to lack of prognostic factors. Extranodal involvement is common, while nodes can be affected too. The heterogenous nature of the disease in cats makes prognosis difficult to determine. Anatomic categorisation and staging are separate classifications but the best prognostic system for cats takes into account both of these factors. The site can have a marked effect on the progress of the disease, as does the severity. Immunophenotype has a marked impact on the classification and severity of the disease and should always be done when staging cats with lymphoma (along with histological grading). There is not a lot of information about the contribution of immunophenotype to severity of disease as immunophenotyping is not routinely done, but it could make a big impact on our ability to determine prognosis. For example it is hypothesised that most nasal lymphoma is B-cell derived, and that is why these cats have the best prognosis of all extranodal lymphoma patients, but more immunophenotyping information will determine if this is in fact the case.

Surgery for GI lymphoma can not only improve a catâ&#x20AC;&#x2122;s clinical condition prior to starting chemotherapy but is also vital for determining the type of disease present. Risk rates of dehiscence are lower than you might think and post-surgery, GI lymphoma patients are often feeling better, eating better, and make overall better candidates for chemotherapy. Radiation therapy can be very effective, either as a first line therapy, or in conjunction with chemotherapy and or surgery. It causes rapid reduction in tumour volume as it kills lymphocytes without them having to divide. It is a good option therefore, for those cats with respiratory difficulty due to mediastinal lymphoma. There can be concern about radiation therapy causing damage to kidneys and other organs, but the doses used to treat lymphoma should be low enough that this is not the case. Access to this treatment option is its major impediment. The most common side effect of radiation is hair loss, which is not usually permanent. Special care must be taken of the eyes however, particularly when radiating nasal lymphoma, if they get irradiated, cataracts can develop post-treatment

Dentistry (a) Performers at the opening ceremony, (b) the Australiana night show and (c) the author getting some beach time. Photographs courtesy of

the author.

lymphoma and measure other prognostic factors such as mitotic rate. High grade T-cell lymphoma (HGTCL) tends to be harder to treat than B-cell, possibly because the cells involved in HGTCL are more

A full programme with some incredibly entertaining speakers. A variety of extraction techniques were discussed and (hotly) debated! Do you prefer the buccal or lingual approach to removal of mandibular canines? Some good recommendations around essential pieces of equipment were made (keep a look out for a Zator 1.3SXS 503, a narrow feline luxator. This tool is meant to make extracting even the dreaded mandibular canine a breezeâ&#x20AC;Ś well, easier anyway). As expected dental radiography was strongly endorsed, and as a convert, it was reassuring that the dollars we spent in our practice,

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

and the blood, sweat and tears taken to get familiar with taking good radiographic images, has our clinic on the road to implementing best practice in the dental field. An entertaining talk by Loic Legendre focussed on design of good mucoperiosteal flaps. The flaps we make in the tooth extraction process should be large, never under tension, and with knots lying on bone as opposed to across the defect being closed. They are an art, a beautiful thing, and the design of them should relieve tension for both the gum and the operator (!)

Cardiorespiratory

Fiona Meyers Campbell spoke on feline hypertension, heart disease and hyperthyroidism. Hypertrophic cardiomyopathy is the most common type of cardiomyopathy seen in cats (60% of CM cases). Heart murmurs in cats are very common (approx. 1/3 of cats examined will have a heart murmur). Most murmurs are dynamic so will increase in intensity along with increasing sympathetic tone. Listening to a cat’s heart for a while may result in a murmur becoming much quieter or disappearing all together. Murmurs can be innocent: dynamic right ventricular outflow tract obstruction (DRVOTO) is the main cause of innocent murmurs. Murmurs secondary to structural heart disease are associated with systolic anterior motion of the mitral valve (SAM) or HCM. DRVOTO and SAM are both dynamic and clinically indistinguishable. Up to 30% of cats presenting with clinical signs attributable to heart disease do not have a murmur at all. Hyperthyroid cats presenting with a murmur may have EITHER structural heart disease or DRVOTO so it is important not to jump to conclusions about heart function in these patients. Heart disease does not pose a risk for hypertension or hyperthyroidism. Hypertension in cats is rarely a primary disease, so hypertensive cats should always be screened for underlying causes (most commonly hyperthyroidism and renal disease). Hypertension should be confirmed following a couple of visits and those visits should be SOLELY to assess the cat’s BP. Poor techniques can significantly affect the measurement. “White Coat

Syndrome” has been seen to elevate a cat’s BP by up to 75 mmHg over the normal level! Patients getting a BP check should not wait in the waiting room, but rather consider transferring them to a quiet room, away from the barking dogs and ringing phones, and an average of 5–7 measurements should be calculated.

Ophthalmology

I first saw David Maggs who authored Slatter’s Fundamentals of Veterinary Ophthalmology at WSAVA in Auckland in 2013. He is a very entertaining speaker who makes a complicated topic straightforward. His lecture on “Pearls of the Ophthalmic exam” detailed how to perform a thorough ophthalmic exam. Examine the eyes in a room with a dim ambient light, use a bright light and magnification to examine the eye, the patient and doctor should always be at eye level (consider how many of us try to examine a dog’s eyes from a standing position with the dog on the ground). Then work in an orderly fashion: from the outside of the eye inwards, and from the superficial structures to the deeper ones. The following techniques are vital for a good ocular exam: • Retroillumination focal light source held close to the examiners eye, directed over the bridge of the patient’s nose and held at arm’s length. Most useful for pupils and the transparent ocular media (tear film, cornea, aqueous, lens and vitreous). Can help to differentiate between nuclear sclerosis and cataracts, and also can be used in examination of the fundus • Focal illumination for examination of the anterior chamber (direct the light source towards the eye at a different angle from that which the observer is viewing from) • Tonometry measures intraoccular pressure and is essential for differentiation of glaucoma and uveitis, the two main vison-threatening conditions presenting as a “red eye” • Aqueous flare (for uveitis) is easier to look for after pupils have been dilated.

Feline idiopathic cystitis

This is a common but frustrating disease to manage. Understanding the aetiology of this disease is at the core of treating it effectively. The condition involves an uncoupling of the normal hypothalamic/ pituitary/adrenal axis and the sympathetic nervous system. Affected cats often have an altered response to stress. It is a complex interaction between the urogenital, neurological and endocrine system. Management involves multimodal environmental modification and client education, particularly with regard to litter tray hygiene.

Feline hyperthyroidism

Andrea referred particularly to trying to focus on curing the disease (RI131 therapy or surgery) rather than managing it medically with daily dose control. In one study, cats who had their disease cured had a median survival time twice that (4 years after diagnosis) of those who had their disease managed daily (median survival of 2 years). Daily dosing with antithyroid medication does nothing to manage the underlying disease and makes control of thyroxine synthesis more challenging as time goes on. One study showed that cats on medical treatment had an increase in the prevalence of thyroid tumours, intrathoracic thyroid masses and thyroid carcinomas. TT4 may not be an overly reliable way to measure the degree of control over the disease (suppression by concurrent disease and/ or lack of close monitoring) providing more rationale for consideration of “curative”measures to treat this disease. Oh so many other great topics: Dennis Chew talking on treating chronic renal disease (manage hyperphosphataemia and proteinuria aggressively, consider calcitriol); Allevyn dressings are the dressing of choice for most types of wound management; always consider the prevalence of a disease in light of specificity and sensitivity testing, and some gems on urinalysis, imaging, critical care, skin cytology….. But then maybe you should consider attending yourself next time! I highly recommend it! l

Feline medicine

I attended two fantastic lectures by Andrea Harvey on very common feline diseases encountered daily in practice.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

CONFERENCE REPORT

World Veterinary Dental Congress 2017 at FASAVA Congress, Gold Coast, Australia, August 2017 This article was written as part of the requirements for receiving the Hill’s Pet Nutrition/CAV Educating the Educators Scholarship

JANINE VAN DAM, BVSc

MANZCVS (Dentistry and Oral Surgery)

The Federation of Asian Small Animal Veterinary Associations (FASAVA) Congress was held this year in The Convention Centre, Broadbeach, Surfers Paradise. With eight streams of small animal and exotic lectures running simultaneously over the four days, there were certainly excellent learning opportunities for every delegate who attended. My interest is small animal dentistry, and as the World Veterinary Dental Congress was hosted by the FSAVA Congress, I was very excited to have the opportunity to listen and learn from the world class dental specialists who had been invited to share their knowledge.

My adventure began with a bleeping alarm at 4 am, followed by a three-hour delay at the airport due to a thick layer of fog which had nestled over Christchurch. I landed in Brisbane in a pleasant 27°C heat, a stark contrast from the 2°C chill in Christchurch when I left, booked a shuttle, and 40 minutes later, arrived at the hotel. The beauty of arriving a day early was that I had a free afternoon for a run along the beach and a plunge in the ocean, and I was able to attend the Welcome Dinner and Drinks. It was interesting chatting to the international delegates; a colleague from India, a lady from Japan who had studied in Melbourne, a bunch of Aussies, a couple of Kiwis, then unfortunately a rather intoxicated He-Who-Shall-Not-BeNamed, who deposited himself opposite me and stated loudly that “the problem

with the veterinary profession is your lot – the women”. While I was tempted to wash his mouth out with chlorhexidine then bond his incisors together with a flowable composite, I elected instead to take it all with a grain of plaque and let that wonderful problem solver, Time, sort him out. Time tends to favour the more youthful, especially those with an open mind-set. By Friday morning my room mates had arrived and we started the day with a delicious breakfast and entertaining presentation by the dentistry guru, Dr. Brook Niemic. He spoke about periodontal disease, interspersed with an engaging story about performing a root canal on a jaguar in a jungle in South America. He had some interesting facts to share, such as that in the United States, only 14% of recommended dental

The author and colleagues participate in the early morning Dermcare Scrub Run along Main Beach, Surfers Paradise.

Photos courtesy of the Author.

Contact: janine@petdentistry.co.nz

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

procedures actually get performed. I studied for my membership exams from his textbooks so I couldn’t pass up the opportunity to say “hello”. He was surprisingly friendly and asked me questions about New Zealand, the Christchurch earthquakes and the ongoing rebuild. I only attended the Dental stream and it was fantastic. The lecturers, many of whom were Diplomates of the American Veterinary Dental College, have written the current dentistry textbooks, were interesting to listen to and presented their information with many photos and cases studies. They were always willing to answer questions. I especially enjoyed listening to the entertaining French Canadian Dr Loic Legendre, who had an infectious enthusiasm for oral surgery and cislak luxators. The lectures were interspersed with morning tea, lunch and afternoon tea, with all the food included in the

conference fee. This gave ample time for eating and drinking cups of coffee while chatting with other delegates and visiting the stands in the exhibition hall. At 6.30 am on Sunday morning I lined up with a stream of colleagues for the Dermcare Scrub Run. This was a 5 km run (or 2.5 km walk) along the beach as the sun rose slowly in the sky. A breakfast of croiossants, muesli, fruit and water followed and for some of us, a well-deserved splash in the waves. It was well organised and a nice opportunity to get out and enjoy Surfers’ outside the Convention Centre. All participants were given a medal and a scrub top. It was well worth the effort! Each evening we ate at one of the many local restaurants with colleagues (there was quite a large contingent from New Zealand), and on the final night we ate and socialised with a mixed group of about thirty delegates and some of the dental specialists. I was pleasantly

surprised at how down to earth the specialists were – and how keen they all seemed to be to visit New Zealand. Although the conference officially finished on Monday, I stayed for the extra Dental Symposium, a more relaxed and informal day with case studies presented and practical advice shared. As I write this on the surprisingly punctual Jetstar flight back home, I feel like the conference was both a holiday with friends and an incredible learning experience. I would like to thank my room mates for making the trip so much fun and I encourage everyone to attend such a conference. The collegiality and atmosphere of belonging to such an interesting group of people is very inspiring. I would also like to thank Hill’s Pet Nutrition, CAV, Vetlearn and the Institute of Veterinary, Animal and Biomedical Science at Massey University, for contributing to the costs involved with attending this conference. l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

A WEEK WITH ...

… Specialist surgeon, Warrick Bruce at VetSOS, Hamilton This article was written as part of the requirements for receiving the RxVet/CAV A Week With… Grant

JANE OUGH, BVSc, Companion Animal Veterinarian Take home message – apply for the RxVet/CAV "A Week With….." scholarship NOW! Whatever stage of your career, it gives you a fantastic mental refresh about your work.

Sunday

Well, I’m 56, it’s been a long time since I was a student, most of my class mates are planning their exit strategy and here I am still on my re-entry trajectory! I arrived the day before in Hamilton. Not a town I am familiar with apart from the bad jokes. Straight to the Airbnb by the river, chosen mainly for it’s walking distance to VetSOS. Turns out it is also a minute from the lovely riverside walkway and “Browsers” – a very cool secondhand book store. I have walked the route to VetSOS and it takes 9 minutes, so I shall allow 15. I have my clothes laid out ready to go for tomorrow. Did I say I am a little bit nervous? I emailed the VetSOS nurses last week and they have kindly forwarded the week’s surgery list so I have been able to do a bit of preparatory reading, but as they pointed out, anything could happen. What will tomorrow bring?!

Contact: South Wairarapa Veterinary Services 3–8 High Street Carterton, Wairarapa. Jane. ough@swvets.co.nz

The author (centre) gets to grips with the suction device while assisting VetSOS surgeon Warrick Bruce with a TTO surgery on a very large labrador. Note the excised medial meniscus sitting in the scalpel blade holder (yellow box). These plastic trays are cheap and prevent the surgeon and nurses getting injured by scalpel blades laying around and also prevent contamination of the scalpel when they are placed on the table and inadvertently penetrate the table drape. Photo courtesy of the author.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

Monday

And it’s pouring! Hadn't really planned for that, I’m so used to driving to work. Donna, my host, comes to the rescue with two umbrellas to choose from… and a kind offer of a lift which I turn down as I need to walk myself into calmness. The rain stops as I step out the door and 9 minutes later I am at VetSOS. The friendly receptionists find the nurse who will induct me and suddenly all my fears evaporate and I am back on familiar ground, in a vet clinic surrounded by the usual cast of friendly hardworking people. Warrick Bruce (aka WOK – everyone seems to have a nickname here) arrives and giving me a big grin, crushes my hand – that man could out shake Trump. The morning is spent shadowing Dr B. consulting, following up on recent surgeries and arranging new ones. Dr B. does a beautiful job talking a young couple through their options for CCL repair. Even though they had come in primed by their referring veterinarian for a TTO, he took the time to fully explain the condition, the predisposing factors, the treatment options and the likely long-term outcomes. I was even more impressed when he said afterwards, he does it so often he wished he could just show people a video. My phone was busy photographing good ideas around the clinic and I sampled a wide variety of paperwork; post-op handouts, admit forms, you name it, to read over and pick the eyes out of later. Dr B. threatened to confiscate my phone, but possibly worse, and not sure if he was joking, said he would wear his Borat mankini for the photo for this article.

Watched pre-operative radiographs to help with planning for a total hip replacement (THR) in a cat (a Maine Coone), the first cat to have a THR done in New Zealand. But not the smallest patient to receive one; Dr B. has already done a THR on the smallest patient in the world so far, a 2.5 kg Chinese Crested dog. Had a quick look at a joint sample: “Well Jane, is this joint infected?” which made me feel about 18 again; ridiculous! So, look and think – Oh! No effusion… strongly staining proteinacoeus background… monocytes present but no PMN… No! This is not a septic joint! Yes! I can do this. Watched a couple of minor surgeries in the afternoon. Sterile technique here is a step up from ours with scrubs, hats, masks and shoe covers mandatory before entering theatre. Great to see diathermy and suction in action. All owners are asked to bathe their dogs the day before coming in for surgery. Keen to try this with some of our farming clients! Top tip of the day: purse string suture round the anus of all dogs prior to surgery. No more intra-op faecal bombs! Looking forward to tomorrow already. I’m keen to see the TTO master at work.

Tuesday

So today it was the Goldilocks of TTOs: small (12 kg), medium (a 40 kg dog who should have been 25 kg) and large (a healthy 35 kg). While I am proficient at TTAs in dogs over 15 kg, I can now see why the TTO is such a useful procedure – a quick and (in the hands of the master) easy adjustment to correct the tibial torsion in the medium sized dog with genu varum and risk of medial patella

luxation. This was not a leg I would have been confident doing a TTA on. Use your tissue clamps to peg your gelpies in place! Genius! Suction! Great to see inside a stifle that was suctioned – menisci and cruciate ligaments glistening. And diathermy. What can I say? I want one. Didn’t help when Dr B. said that without it, it’s butchery not surgery. Saw Ioban dressing being used by the pros. Now I feel confident to try our free sample that has been languishing. Intra-articular pain relief is given (bupivicaine) but no epidural or incisional block. The three TTOs today all looked very relaxed when they recovered. And all these years I have been religiously doing seven loops in my Scottish knot (is it Edinburgh or Glasgow?). Here I see that three is enough! No post-op pressure bandages used here – just ice therapy for the first 24 hours. Then I watched removal of the external fixator from a dog in which a proximal tibial/fibula fracture had been repaired with trianglated ESF. 20-day post-op check up on a fox terrier with hinged external fixator (H-ESF). She had been run over by a farm ute and sustained an open fracture of medial malleolus of the left hock with valgus hock instability and contamination of the wound. After wound debridement and lavage, the malleolar fracture had been stabilised with two 1.5 mm lag screws. The talocrural joint had been lavaged and closed. The rest of the closure was routine, however the wound was not

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

completely closed to avoid excessive tension. The articulated ESF was applied to the medial aspect of the limb. At the 20-day check, the dog was looking very comfortable, the H-ESF was stable and all pin tracts were sealed. Dr B. designed these hinges and has them made up locally as he found the commercially available ones problematic. Certainly we have to use a lot of tape around ours to prevent them failing with use. Pestered Dr B. about the nitty gritty of applying external fixators. His take home point was ALWAYS pre-drill your holes and, yes, you can put your pins through a primary incision. So good to be able to ask all these burning questions and get an emphatic answer! The staff here are very helpful and happy to pull up old radiographs, find information sheets, loan me scrubs, help me into my sterile gown ...

Wednesday

A few morning consults, arranging surgeries, checking a grossly effused stifle with radiographs and arhtrocentesis for any signs of sepsis or neoplasia. It looked like a quiet day on the books, but Dr B. seems very keen that I dust off the few remaining brain cells and pull out records on all the repairs he has done using transarticular H-ESF and… write a journal-worthy report! OK, so this is a bit of a challenge, but is does dovetail neatly with my obligation to write up something for Companion Quarterly as part of this "A Week With…." scholarship. It is also something I have a particular interest in, as we see a lot of working dogs with MCL damage and we have recently started repairing them with H-ESF. The advantage of no implant long term seems a good one in working dogs. Going back through all the cases is fascinating and the nurses are so helpful finding the relevant archived radiographs. It’s very interesting to read the wide range of conditions the H-ESF has been used on here, to support affected hinge-type joints (mostly hock and elbow) while healing. I was very interested to find out that, here at VetSOS, the hinge is, in most cases, active from day one. I have routinely fixed

the apparatus with a crossbar to create an A-frame for 4 weeks then removed the crossbar so the hinge operated for the final 2 weeks. Here a Robert Jones bandage is applied for 7 days postoperatively. This guy is organized – a flicker of enthusiasm from me and he is hauling out neatly filed articles on the subject (and for good measure one about the thermodynamic differences between pre-drilling your ESF holes and not) and giving me great advice about how to approach this challenge – namely to figure out which journal I aim to get my article published in, and get my referencing sorted the way that publication likes it from the get go.

Thursday

A couple of consults, then a full-on day of surgery. A client brought in one of the fattest Labradors I, and everyone else at the clinic, had every seen; 55 kg and probably, given size of her head, she should have weighed 25 kg. What a surprise, she had CCL and meniscal disease so she ended up having the fourth TTO operation I saw this week! A dog with presumed neck pain was admitted for cervical radiographs. The ones by the referring vet weren't up to standard which gave me pause for thought: good positioning is so critical. Here, they have a wide range of props from sandbags to rolls of cotton wool to 4-litre flagons filled with sand, foam neck braces, foam wedges, you name it, and the results speak for themselves – perfect alignment achieved. I watched a mini hemilaminectomy procedure to decompress the right L2-3 nerve root. I think it’ll be a while before I attempt anything like that! Then, more to my taste, a nice mid-shaft oblique tibial fracture in a 9-monthold Jack Russell cross. I got the “you are a gardener not a carpenter” chat when I suggested an IM pin and two lag screws. This is what I am here for, to do better, so from now on I will aim for nurturing biological healing rather than an impressive multi-implant post-op radiograph! Observed Dr B.s elegant solution for this fracture, creating a curved and sledge-tipped IM pin, then

with the aid of image intensification, stabilizing the tibia with it, the sledge tip encouraged the pin to veer away from the cortex rather than drive through and the curve ensured great contact with the cortices and rotational instabilty was eliminated. Nifty. The fourth TTO of the week was a great opportunity to have a good look inside another stifle. The fat lab had a couple of tears in her medial meniscus, so that was deftly removed, and I got to play with the suction device… what a difference that makes (have I said that before!?). I was submitted to the local tradition of having to tell a joke in surgery. I warned them I am hopeless at joke telling so to make up for my miserable attempt (a joke Dr B. already knew and told better) I got to perform my tour de force: The Ballad of Tooting Bec Common, a wonderfully silly poem written by a schoolmate that is etched upon my heart having had to learn it to recite at the school prize giving. It is not easy to do the theatrical gestures and remain sterile! The lovely nurses showed me the Veterinary Instrumentation catalogue – I’ll be ordering one of those! Dr Bruce plans on spending the day writing reports tomorrow, I am, of course, hoping a juicy emergency fracture repair will come in but if not I will take up his offer of access to his reference material and progress this hinged transarticular ESF study.

Friday

Sadly, no juicy fractures have come in overnight but a great opportunity to read up on the cases I have seen, follow up the xray series and make use of the vast archive of reference material here. What a pleasure to have uninterrupted time to do this. It’s been a great week – a treat to be a student again. I have come away with lots of practical ideas for improving our practice, a better sense of connection with research work that is ongoing and a sense of belonging to a community where knowledge is generously shared. Oh, and did I mention the suction device? l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

INDUSTRY NEWS

Virbac Update: Alizin®, Milpro® and Pyoderm®-S Alizin® prior to C-sections

During the 20 International Congress of the European Veterinary Society for Small Animal Reproduction in Vienna, Austria this June an oral presentation was made. It described a study into the use of Alizin®i prior to elective Caesarean section in 74 bitches at risk of dystociaii. The study was specifically looking at neonatal survival rates and was a follow-up on a similar studyiii to confirm the previous results with a larger sample and observing for a longer period. None of the bitches were at full term as demonstrated by plasma progesterone. Administering Alizin® was intended to lower progesterone levels and mimic the drop at the end of pregnancy. The Alizin® was administered at 5–15 mg/kg the afternoon before surgery, with surgery undertaken the next morning. Lactation was present in 81% of the dogs on the morning of surgery. th

435 puppies were delivered. 41 puppies died in the first two weeks of life (mortality rate of 9.43%, or loss of 0.5 puppies per litter at 60 days gestation, 0.7 at 61 days, and 0.4 at 62 days). This compares very favourably with mortality rates published by Moon et al.,iv of around 20% for all kinds of C-sections, and even worse in emergency C-sections.

Milpro® in pregnant and lactating bitches

At the European Veterinary Conference Voorjaarsdagenv in Amsterdam, The Netherlands in April this year, Virbac presented a poster vi. This summarised a study undertaken to evaluate the tolerance of Milpro®vii in 15 pregnant bitches and their new born puppies. The bitches received normal doses of Milpro® every 2 weeks during pregnancy, and the puppies received Milpro® every 2 weeks from 2 weeks of age. The pregnancies were monitored by ultrasound examination on weeks 5, 7 and 9 of gestation. These examinations recorded inner chorionic cavity diameter, biparietal diameter and foetal heart rate. Length of pregnancy was also recorded. The pregnant bitches had blood drawn for CBC and biochemistry monitoring during gestation and lactation. The bitches were examined 2 and 4 weeks after parturition. The puppies were examined on the day of parturition and then at 2 weeks intervals up to weaning at 8 weeks of age. All measured parameters were normal. Puppy survival rate was normal (mortality 11%). The authors concluded that Milpro® every other week is safe for pregnant and lactating bitches and for puppies from 2 weeks of age.

3% Chlorhexidine for Malassezia

With the launch of Virbac’s Skin Innovative Science (SIS) shampoos this year there has been a lot of discussion about the use of Pyoderm®-S for yeast over-growth. Pyoderm®-S is not being reformulated, but it became clear that there was a lot of misunderstanding of what Pyoderm®-S is and what it can do. The biggest misunderstanding is that 3% chlorhexidine shampoo is, in fact, anti-fungal and will manage yeast overgrowth very effectively. This was demonstrated in a poster presentedviii at the 19th Annual Congress of the European College and Society of Veterinary Dermatology in Tenerife, Spain. This effect had been previously strongly demonstrated in vitro, and this was the first investigation of this effect in vivo.

Twenty-eight dogs were included in the study. They were shampooed twice weekly for three weeks and assessed for pruritus, excoriations, erythema, exudation, keratoseborrhoeic disorder and the total extent of affected body surface. Malassezia population was scored on cytological examination of impression smears and tape preparations from selected sites. All scores and total clinical score decreased over the study period with high statistical significance (p<0.0001). The Malassezia population was reduced by more than 97% with 26 dogs reaching a zero Malassezia population score. This study demonstrated that Pyoderm®-S was well tolerated and highly effective in the control of elevated Malassezia populations, as well as associated skin lesions and pruritus. The efficacy of Pyoderm®-S is not limited to the antibacterial activity of chlorhexidine. When dealing with pruritic dermatitis, especially allergic dermatitis, secondary infections from overgrowth of commensal bacteria and yeast can severely complicate the case and contribute to a substantial part of the clinical signs. Epi-Soothe® with added SIS was launched in August, and Allermyl® a new shampoo with SIS focused on Canine Atopic Dermatitis was launched in June. Sebazole® will be replaced with Sebolytic® later this year – this new formulation includes SIS. Alizin® is a Registered Veterinary Medicine. Available only under Veterinary Authorisation. Registered Pursuant to the ACVM Act 1997. ACVM No. A7957 ii Roos, J., Niewiadomska, Z., Furthner, E., Borges, P., Mir, F., Nudelmann, N., Maenhoudt, C., Fontbonne, A. (2017). Neonatal puppy survival after elective caesarean section in the bitch using aglepristone as a primer: 74 cases. 20th International Congress of the European Veterinary Society for Small Animal Reproduction (EVSSAR), Vienna 2017 Reproduction and Paediatrics in Dogs, Cats and Small Companion Animals Abstract Book. Oral Abstract ID: 213 iii Levy, X., Fontaine, E., Segalini, V., & Fontbonne, A. (2009). Elective Caesarean Operation in the Bitch Using Aglepristone Before the Pre‐Partum Decline in Peripheral Progesterone Concentration. Reproduction in domestic animals, 44(s2), 182184. iv Moon, P. F., Erb, H. N., Ludders, J. W., Gleed, R. D., & Pascoe, P. J. (2000). Perioperative risk factors for puppies delivered by caesarean section in the United States and Canada. Journal of the American Animal Hospital Association, 36(4), 359-368. v Dutch for Spring Days vi Navarro, C., Kowalska, W., Niżański, E. (2017) Evaluation of the tolerance of a combination of Milbemycin Oxime and Praziquantel in breeding, lactating bitches and in new-born puppies. European Veterinary Conference Voorjaarsdagen. http://www.voorjaarsdagen.eu/conference-info/europeanveterinary-conference-voorjaarsdagen/proceedings/category/186posters-companion-animals-2017 vii Milpro® is a Registered Veterinary Medicine. Registered Pursuant to the ACVM Act 1997. ACVM Nos. A11304, A11305 and A11306. viii Jasmin, P., Schroeder, H., Briggs, M., Last, R., & Sanquer, A. (2003). Assessment of the efficacy of a 3% chlorhexidine shampoo in the control of elevated cutaneous Malassezia populations and associated clinical signs (Malassezia dermatitis) in dogs. In Proceedings of the 19th Annual Congress of the ESVD ECVD, Tenerife (Vol. 170). i

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

CAV SPECIALIST PROFILE

Michael Hardcastle

BVSc, MVStds (Hons), Diplomate ACVP The Specialist Profile is a regular feature that aims to provide an insight into the path New Zealand veterinarians have taken to achieve specialisation.

THIS ISSUE TONI ANNS TALKS TO MICHAEL HARDCASTLE, A REGISTERED VETERINARY SPECIALIST IN ANATOMIC PATHOLOGY, WHO WORKS FOR GRIBBLES VETERINARY IN AUCKLAND.

What is your specialty, and how many years have you been practicing as a registered specialist? My specialty is veterinary anatomical pathology. I became a registered specialist in December 2013, and have just celebrated my fifth anniversary of starting work at Gribbles Veterinary Auckland after passing the Board Exam of the American College of Veterinary Pathologists in 2012.

Where did you obtain your veterinary degree, and did you move directly into a residency from there? I graduated from Massey in 1999 with a BVSc. I went into small animal practice, and spent 10 years working in various clinics in New Zealand and the UK before specialising.

What drove you to specialise, and why did you choose anatomical pathology?

The aspect of practice I most enjoyed was working up the complicated and interesting cases; I was less interested in treatment or surgery, and I least enjoyed the sales and marketing side of veterinary business. I was looking for a new direction and after considering a few different options, my interest in pathology was stimulated when I saw an advertisement for a Masterate Scholarship in Pathology at Massey. It was the proverbial “light bulb appearing over your head” moment, and I couldn’t understand why I hadn’t thought of it before. I began to spend afternoons visiting the pathologists at Gribbles Auckland (at that time, Keith

Photo courtesy of Michael Hardcastle

McSporran, Cathy Harvey, Jon Meyer and Catherine Williamson) and looking at cases with them. I felt very at home in the laboratory environment and they encouraged me to apply for residencies. I like clinical pathology but I was more interested in anatomical pathology because it seemed like a more visual, hands-on and less arcane discipline.

Explain the process you took to become a registered specialist

I decided to spend 2 weeks at Massey working alongside the pathologists and residents in post mortem rounds, slide conferences and case discussions. This was inspiring, and I was then able to start applying for residencies with some more substantive evidence of interest in pathology on my CV. (There is no “matching program” or internship required for pathology; if you want to study somewhere you generally write to them and ask nicely.) I also sat the GRE examination for graduate entry into United States colleges, and completed a VetScholar

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

course in clinical pathology. Another Masterate Scholarship to study at Massey became available, and I spent two years there as a resident working in post mortems, studying and completing a project on the expression of phosphatonins by canine soft tissue sarcomas. I gained an MVStds in Pathology with Honours, and then spent one year as a Visiting Scholar at Auburn University in Alabama performing similar tasks before sitting the ACVP board examination in 2012. This was the intellectual equivalent of an “Iron man”, and the culmination of 3 years of very hard work, with study every night and every weekend in the last year.

What do you like most about your job?

I get to see everyone else’s “interesting cases”, and I love the intellectual stimulation of helping to investigate and diagnose these. I like the fact that a diagnosis can usually be reached more often than I found in clinical practice, although we don’t always make a diagnosis even after a post mortem! I have the opportunity to discover new things, and have written several articles during my time at Gribbles (some are waiting to be published…). I also enjoy the fact that my specialty encompasses production animals, equine and exotics; this gives the job variety.

What is the worst part of your job?

The post mortems that are “not so fresh” are an issue, but on a more serious note I am occasionally called upon to provide expert witness testimony in cases of cruelty or neglect. These cases are invariably unpleasant, and I have felt physically sick after reviewing one case.

What is the most challenging part of your job?

Meeting turnaround times and enjoying the “interesting cases” without getting bogged down. I know that veterinarians need their results quickly, and that is always my first concern. I also find that I sometimes need to manage expectations around the type of results that can be achieved from a post mortem or a histology case; there is a lot we don’t know or can’t test for, and many cases that are difficult to classify.

What advice would you give to someone thinking of specialisation?

I would strongly encourage them to think carefully about their personal strengths, weaknesses and interests before pursuing a specialty, to make sure they are a good match. I would then encourage them to spend time alongside specialists in their chosen field to get a “taste” for the career, and also to start building a track record of genuine interest in their CV. If the placement is successful, those contacts may then be useful referees for applications to internships or residencies.

What do you think about vets specialising later in their careers, after a significant period of time in general practice?

As an example of this myself, I think that those specialising later in life bring useful experience and clinical know-how to their fields. This can make it easier for them to relate to practitioners and their approach may be more practical, since they know how cases are usually handled. It is definitely worth it if the new direction suits you and your family will support you while you are studying! The downside is that it is incredibly difficult to specialise later in your career; you are often competing with straight-A students specialising directly from veterinary school, with CV’s containing undergraduate experiences such as externships and clubs oriented around the specialty. A seasoned veterinarian may be seen as a more unknown quantity by those receiving applications.

Do you think NZ needs more specialists, and if yes, in what areas? I’m not sure, although I understand that there are some gaps in certain areas. I would encourage anyone interested in pathology to make some enquiries to find out about how to get into the field; we need a steady stream of enthusiastic new pathologists, especially those who know about NZ production animal systems since they are quite different to the rest of the world.

What are your passions outside of work?

My passion is first and foremost my family, followed by quiet pursuits such as reading although I also enjoy road biking. I used to do triathlons, and I want to get back into that someday soon! l

Allan Bell Dermvet-online Consultancy service by a Registered Specialist in Veterinary Dermatology (for veterinarians in the South Island and from Wellington as far north as Lake Taupo) For cases where referral is difficult but help is required. Contact dermvet.bell@xtra.co.nz for cost estimates and protocol

Allan Bell BVSc MACVSc (canine med) FACVSc (dermatology)

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

BOOK REVIEW

Diagnostic techniques in veterinary dermatology: a review of two recently published textbooks DUNCAN GRAHAM BVSc,

BSc (Hons)

DUNCAN IS A VETERINARIAN WITH AN INTEREST IN VETERINARY DERMATOLOGY. HE SEES REFERRALS IN WELLINGTON, NELSON AND DUNEDIN ON A REGULAR VISIT. FOR MORE INFORMATION VISIT HIS WEBSITE WWW. ANIMALDERMATOLOGY. CO.NZ

duncan@animaldermatology.co.nz

For some time there has been a noticeable gap in the dermatology literature: all of the descriptions of diagnostic techniques have been contained in textbooks. This has meant that detailed descriptions of commonly utilised procedures have not been readily available. Furthermore, some of the finer points of certain diagnostic tests, i.e. difficulties of implementation or interpretation, have not been discussed. Two recent texts have gone some way in correcting this situation. The first text is Diagnostic Techniques in Veterinary Dermatology by Ariane Neuber and Tim Nuttall, two eminent European dermatologists working in Chiltern and Edinburgh respectively (are we able to call Britain ‘Europe’ anymore?), published by Wiley Blackwell in 2017. The authors say, in their introduction, that their aim “is to provide an illustrated, step-by-step guide” to help the practitioner “select, perform and interpret clinical tests and procedures for a range of presentations.” I agree whole heartedly with their statement that “some of the most common reasons for poor management of skin conditions involve the inappropriate use of diagnostic tests, suboptimal execution of test procedures, inadequate sample choice and misinterpretation of results.” This applies to all of us; I’ve been seeing only dermatology cases for 16 years and I learned plenty from this text. There are very good chapters on hair plucks and trichograms, allergy testing, endocrine and metabolic skin disease, and otoscopy and examination of the ear. The detail is good, and basically every diagnostic test that you might want to do or order for a dermatology

case is covered. There is a very good introduction to histopathology, including how to take a good biopsy. I really wanted to give this text a whole hearted, 100% endorsement. It does fill a much neglected but sorely needed niche. As I said above, the only discussion of dermatological diagnostic techniques in companion animals has been in textbooks and thus limited by space, or in hard-to-get journals (such as in Veterinary Clinics of North America: Small Animal Practice) without good photographs. With dermatology you need photographs. Lots of them. This text does well with the quantity of photographs, though perhaps the quality is not so good. More importantly the book suffers from the same problem that many lectures/ lecturers suffer from: they don’t stick their necks out, and give you insider information. Some lecturers don’t stick their necks out on paper, but in sotto voce during the lecture or in the discussion, they will release, like reluctant oysters, the pearls, those precious gems that make the lecture worth attending. It seems to me that an extended discussion of diagnostic techniques in dermatology, which is a very circumscribed subject, would be an ideal moment to present a pearl on every page. Unfortunately, although this book does give you pearls, it misses some obvious ones. For example, it says that there are breed differences in thyroid levels, but it does not say which breeds run high, and which run low. That would be good to know. It says that TSH testing has a very low sensitivity, but it still supports

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

assessing TSH levels as part of the initial screening test, while failing to mention measuring cholesterol, which is much cheaper and has the same sensitivity. However the authors do tell you what breeds are prone to thyroiditis. This lets you know when you might have a higher index of suspicion concerning interference by circulating thyroid antibodies. I would call this a pearl. A big gap to me, a real missed opportunity, in the otherwise excellent section on histopathology, is that the authors emphasise the importance of biopsy site selection but do not tell you where to sample when you suspect certain diseases. There should be a table with lesion and distribution, tentative disease, and then where to biopsy. For example; site: nasal planum; lesion: depigmentation; differential diagnoses: pemphigus foliaceus, discoid lupus erythematosus, mucocutaneous pyoderma; pre-treatment: antibiotics for 10 days; site selection: biopsy with 4 mm punch grey rather than white areas of depigmentation. Similarly, site: flank; lesion: alopecia; differential diagnoses: hypothyroidism, canine cyclical flank alopoecia, alopecia X; signalment/pretreatment: breed predilections; biopsy: area of most complete hair loss, avoid biopsying the junctional areas between normal coat and alopecic skin. Or even more importantly, site: foot; lesion: multiple sloughing nails on multiple feet; differential diagnoses: infection, bacterial or fungal, symmetrical lupoid onychodystrophy (SLOD), nail dystrophy; signalment/pre-treatment: certain breeds predisposed to SLOD (Rottweilers…..); biopsy: don’t bother, especially don’t bother sending in sloughed nail. A sloughed nail is non-diagnostic, a pain in the ass for the histopathologist, and expensive for the owner. Do cytology and/or culture instead. Some dermatologists recommend amputating a dew claw or a third phalanx or even using a biopsy punch to take a lengthwise or longitudinal section of the nail to obtain a sample of the growing point. In the classical presentation of SLOD I would question whether this was necessary. This question is discussed in the text. Every disease has a “best” diagnostic presentation, the area or stage of lesion that is most likely to exhibit its

own unique differentiating features and therefore more likely to give a firm diagnosis based on histopathology. This is the benefit of a textbook like Skin Diseases of the Dog and Cat by Gross, Ihrke, Walder and Affolter – for every disease, they tell you which area or lesion to biopsy as well as what the histopath will read like. With pemphigus you want sheets of acantholtytic cells, so biopsy pustules or bullous pustules. If they aren’t available, choose heavy crusts and include the crusts in the sample. My last small quibble has to do with that largest section of the book: cytology. It should have been even larger with better photos. Cytology is such an easy, useful, non-invasive and inexpensive test to do, I feel more should have been done with this chapter. Which leads nicely to the book that I am reviewing next. However, before we start on the other book, let’s talk about the some of the many good aspects of the chapter on cytology. There are plenty of pearls. The authors very rightly point out that you do not need to make a final diagnosis in every case. “A partial interpretation, for instance differentiating an inflammatory from a neoplastic cell can still be valuable.” In the cytology section on acantholtytic cells, the text gives us three pearls in a row: When you have a presentation consistent with pemphigus foliaceus (numerous acantholtytic cells) you should be aware that both bacterial pyoderma and dermatophyte infection can produce acantholytic cells. So first, check the neutrophils for signs of degeneration, and/or intracellular bacteria, second, if possible pre-treat with antibiotics and third and even more importantly, always submit a fungal culture at the time of biopsy, because, while the lesions of dermatophyte infection and pemphigus foliaceus are so similar both macroscopically and histopathologically, the treatments are markedly different. I particularly liked the section on the identification of bacteria on cytology. The authors do a good job discussing what you will see with bacterial overgrowth syndrome versus superficial and deep pyoderma. The pearls are there in the discussion of things that can mimic bacteria cytologically. They

also describe (the only time I’ve seen it mentioned apart from lectures) the significance of Simonsiella, a gliding, nonpathogenic bacteria commonly found in oral cavities. Their presence in other areas is an indicator of licking, therefore associated with pruritus. All in all, a valuable, inexpensive resource for anyone starting off on their adventure with veterinary dermatology, and will be useful to those of us partway along the road. The next text that I would like to discuss briefly is another first of its kind: a whole text devoted to Canine and Feline Skin Cytology, written by Francesco Albanese and published by Springer, also in 2017. I ordered this book on-line and it was printed to order. The production values seem to me to be of a very high quality: heavy glossy paper, well bound, the photographs, both macroscopic and microscopic, are excellent. Since it was written by a pathologist, there is a very nice comparison, for many of the diseases, of what you see cytologically with what you see on histopathology.

The book starts with two excellent chapters. The first is on the morphology and function of skin cells, with good photographs of their microscopic appearance. The second chapter is on techniques of sampling, preparation and staining of cytological specimens, with a good discussion of the different techniques.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

The next chapter goes through the cytology of canine and feline nonneoplastic skin diseases, disease by disease, and the photographs of lesions and diseases are better than great. Dr Albanese is obviously a keen photographer. A useful way of approaching the description of the diseases is that they are categorised according to the lesions that you will sample: papule, nodular papule, pustules, scales, erosions, ulcers, plaques and nodules. The final two chapters are on the cytology of skin tumours, and an interesting chapter on cutaneous metastasis from non-primary skin tumours. In other words, the skin manifestation of non-skin tumours, covering diseases like lung-digit syndrome, mammary carcinoma, internal haemangiosarcoma and other rarer cutaneous metastases. Do I have any criticisms? Well, the cytology photographs should have an

indication of what magnification was used. It is obvious to an experienced cytologist/pathologist but I think for newcomers to veterinary cytology, it would be helpful to know: this is what I would see at 40x, and this under 100x. The text is short on practitioner tips but they are there. For example, blackcoated cats are predisposed to mosquito bite hypersensitivity. I think somewhere it would have been useful to discuss the pitfalls that beginning cytologists might make: interpreting pollen grains as micro-organisms, and bacterial as melanin granules, and so on. In this respect the text Diagnostic techniques in Veterinary Dermatology reviewed above is more useful to the beginning cytologist. I think the major lack is a chapter on the normal and abnormal cytology of areas of the body, especially ears, but also feet (there is no mention of pollen grains), muzzle (there is no mention of Simonsiella), and the peri-anal area (what

is normal and what is abnormal). Ears in particular are such an important part of our everyday cytology it would be nice to have more detail so that we can get more out of our ear cytology. It would be good to have some pictures of otic aspergillosis, for example. Diagnostic techniques in Veterinary Dermatology has an excellent chapter on ears, with a section on sample collection, and the interpretation of otic cytology. On the positive side, this is the first text that I have seen that has a detailed description and photographs of candidiasis. The text describes how Candida albicans differs from Malassezia, and shows what it looks like cytologically. Again, another very useful book for anyone interested in veterinary dermatology and especially the techniques used to help make diagnoses. It is such a fascinating subject. l

Massey News We are proud to announce that staff criticalist, Ivayla Yozova has passed her boards for the American College of American Veterinary Emergency and Critical Care and is now a Diplomate in this college. She joins Janelle Wierenga as a second specialist in our Massey University Pet Emergency Centre (MUPEC). MUPECâ&#x20AC;&#x2122;s caseload continues to grow and intensify, and Ivayla adds significant talent to the team. Congratulations, Ivayla! l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

What is your diagnosis? THE ANSWERS… 1. Radiographic findings

The cardiac silhouette and the pulmonary vasculature are small suggestive of hypovolaemia. On the abdominal portion of these radiographs there is severe distention of the proximal colon with gas and formed faecal material. There is an irregular mineral opacity seen at the pelvic inlet region on the lateral and ventrodorsal projections which appears to be a foreign body within the colon. The colonic lumen appears to be narrowed at the level of L4 on both the lateral and ventrodorsal views (Figure 2; red arrows). The position of the ileocecocolic junction is difficult to establish definitively, though is thought to be on the left side of the abdomen (Figure 2; black arrow). The remaining intra-abdominal structures are difficult to fully discern due to the severity of the distention of the colon however no definitive abnormalities are noted. There is marked spondylosis deformans and some articular process degenerative joint disease.

Conclusions

• Decreased cardiovascular size consistent with hypovolaemia. • Distension of the proximal colon with firm formed faecal material suggestive of constipation • Mineralised foreign material at the pelvic inlet • Focal narrowing of the colon within the midportion of the descending colon. • Suspect malpositioning of the colon with the ileocecocolic region on the left side.

2. Differential diagnoses

The focal narrowing of the colon in conjunction with cecal displacement is most consistent with a colonic torsion. Other possibilities such as a colonic-colonic intussusception, obstructive intestinal wall mass, or other causes of stricture are thought less likely. The size of the mineralised body suggests that this is unlikely to be of clinical significance.

3. How would you confirm your suspicions?

Performing a barium enema is a useful method to establish the exact position of the colon within the abdomen and to confirm the focal region of narrowing. This was performed in this patient (Figure 3). The distal descending colon is filled with barium contrast medium, and in the midabdomen, the orad aspect of the mid-descending colon tapers and twists to a short constricted segment which tracks into the right abdomen and abruptly expands. The rest of the proximal descending colon and the

b Figure 2. The same radiographs as Figure 1 with arrows indicating focal narrowing of the descending colon (red arrows) and the abnormal position of the ileocecocolic region (black arrow).

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 4 | December 2017

Discussion

Colonic torsion is an uncommon occurrence in canine patients, though has been associated with a high mortality without early surgical intervention. With torsion the vascular supply to the cecum and proximal portions of the colon are severely compromised which can lead to ischaemia, and necrosis of the affected segments. This can lead to peritonitis, endotoxaemia and ultimately circulatory collapse. Published studies indicate that this condition is more common in large breed dogs, with some earlier studies showing that German Shepherds were more predisposed, though later studies have not supported this. Cases have also been reported in Labrador Retrievers, Great Danes, Bull Mastiffs and also an Irish water Spaniel. Previous gastropexy (either prophylactic or associated with a gastric dilatation-volvulus) appears to be a predisposing factor from entrapment around the gastropexy site. Many patients diagnosed with a colonic torsion also have had a history of other gastrointestinal disease such as exocrine pancreatic insufficiency (EPI), or lymphoplasmacytic enteritis. Colopexy to the left abdominal wall is typically performed to prevent recurrence which has been reported to occur. The usefulness of performing a barium enema is highlighted in this study. With the increased availability of ultrasound, such techniques are used less frequently and are often overlooked. With intestinal obstructive disease a common problem in small animal patients, the use of contrast techniques can be useful to help differentiate dilated small and large intestine and their respective positions and to confirm an obstruction. If perforation is of concern then iodinated-based agents are recommended. Negative contrast studies (e.g. pneumocolon) are also useful to determine whether suspected foreign material is present within the large or small intestine. The diagnosis was confirmed in this patient following the barium enema, though it was suspected by recognising firstly the focal narrowing of the descending colon and that the ileocecocolic region appeared to be on the left side of the abdomen. Colonic torsion should be considered in any large breed dog that presents with a history of gastrointestinal signs, an acute onset of clinical signs, and radiographic changes suggesting abnormal dilation of large intestinal segments. Figure 3. Right lateral (a) and ventrodorsal (b) radiographic views after administration of a barium enema, confirming the presence of focal narrowing (arrows) of the descending colon.

entire transverse colon are within the right cranial abdomen, appearing stacked and severely dilated with gas and formed faecal material. The cecum is suspected to be within the left abdomen. Several of the small intestinal loops are mildly gas distended and contain ingesta but are otherwise within normal limits. No abnormalities of the stomach are seen. Peritoneal serosal detail is appropriate.