Companion Quarterly Vol 29 No4 December 2018 by Companion Quarterly

Companion Quarterly â&#x20AC;&#x201C; 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 29, No. 4 | December 2018

VOLUME 29 NO 4 December 2018

Cytopoint: high tech help for itchy dogs

Pathology Corner: lung-digit syndrome in a cat

Allergen-specific immunotherapy in dogs

Conference reports: NAVDF and ANZCVS Science Week

CAV Life Member Profile: Allan Bell

Volume 29 | No. 4 | December 2018 ISSN No. 2463-753X Executive Committee 2018 cav@vets.org.nz

Contents

President

John Munday

Companion Quarterly

Secretary

Paula Short

Treasurer

Simon Clark

Committee Members Simon Clark Nina Field Toni Anns Natalie Lloyd Alison Pickering Becky Murphy

EDITORAL COMMITTEE Sarah Fowler (Editor) Bart Karalus Ian Millward Juliet Matthews Aurore Scordino 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@tvg.co.nz

NZVA website www.nzva.org.nz CAV website www.nzva.org.nz/cav Copyright

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.

Cover photograph

Beagles Tui and Nikau are sure they just heard the word "WALK". Photo courtesy of Mike Gieseg.

highlights

8 CAV Noticeboard 10 What is your diagnosis?

Miriam Bates, Devon Thompson

12 Mange on hedgehogs – it

probably isn’t what you thought Caroline Kriechbaum, Bill Pomroy

14 Cytopoint: high tech help for itchy dogs Debbie Simpson

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.

18 Allergen-specific

immunotherapy in dogs Raewyn Creevey

24 Tail pull injuries in cats Andrew Worth

28 Lung-digit syndrome in a cat John S. Munday, L. Cristina Gans, Susan C. Tomlin

34 CAV Life Member Profile: Allan Bell

36 Conference report: North American Veterinary Dermatology Forum Debbie Simpson

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

2 Editorial 6 CAV activities and meeting

40 Conference report: Highlights

from Science Week Conference Andrew Worth

44 What is your diagnosis? The answers

46 48

Massey News Companion Animal Health Foundation update

50 CPD Record 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 29 No 4 | December 2018

EDITORial

Changes for CAV The only thing in life that is constant is change, and as another year comes to a close I would like to take this opportunity to mention a few changes in the CAV sphere – some that are big and some that are smaller. The first change is the resignation of Mark Ward as CEO of the NZVA. Mark was always very interested in the companion animal side of veterinary practice and was a strong supporter of CAV. While it is a shame to see him leave, it will be interesting to see the direction that his replacement will lead the NZVA in. Closer to home, two key members of the CAV family have decided to pursue other opportunities in the last quarter. Firstly, Rochelle Ferguson, our Operations Manager, has resigned for an exciting new job opportunity. Rochelle joined the CAV Executive Committee officially in October 2013 specifically to undertake the role of secretary. She had undertaken a 3-month handover period with previous secretary Sue Blaikie, along with completing the NZVA Orientation day for new officers, and attending Branch Summit, and several other meetings to ensure a seamless transfer. Due to the increasing workload of the secretary, Rochelle was offered the CAV Operations Manager role in December 2015 after a rigorous recruitment process. To me, referring to Rochelle as our Operations Manager never did her justice. Rochelle did manage the operations of CAV in an extremely efficient way that always ensured that policies were produced on time, accurate advice was promptly given to CAV members as well as companion animal stakeholders, meetings were well organised and ran smoothly, and media enquiries were answered accurately and promptly (including an excellent interview that Rochelle gave on live television despite being understandably terrified!). However, more important than her efficiency and outstanding level of organization, Rochelle had a true passion for improving the lives of small animal veterinarians in New Zealand 2

and improving the lives of companion animals. This passion was obvious as soon as you talked to her about many companion animal issues, but she was especially interested in improving veterinarian wellness and preventing burnout in the profession, ensuring logical dangerous dogs policies were introduced, promoting policies that improved animal welfare, developing and advocating for breeding guidelines that reduced dogs bred in ‘puppy mills’ and dogs being deliberately bred to propagate disabling cosmetic traits. Rochelle also firmly believed in supporting veterinarians by maintaining the current high standards in our profession and she was a firm believer in the value of continuing professional development. She was influential in the highly popular veterinary refresher schemes being offered by CAV, as well as being a strong supporter of the ‘A Week With’ and ‘Educating the Educators’ scholarships. The passion and drive that Rochelle had for companion animals and their vets will certainly be missed within CAV. With Rochelle leaving, Paula Short has agreed to fill the role of CAV secretary until the role of the operations manager can be refined, and a suitable person for this position found. If you contact CAV, Paula will be the person who will help you with your enquiry. Also resigning from a key position on the CAV committee was Aimee Brooker. Aimee joined the committee in 2013 and has been the treasurer since 2014. Due to the time constraints caused by raising a family while working as a companion animal veterinarian in Taranaki, Aimee made the decision to resign from the CAV committee and Simon Clark has agreed to take over as Treasurer. Aimee was the definition of quiet efficiency as treasurer on the committee and both her skills with money as well as her insightful input on a wide range of issues facing companion animal practitioners will be greatly missed. A more minor change is the addition of a new regular column in Companion Quarterly that follows a case from the

initial clinical presentation to the findings in the post-mortem examination. This column provides a good opportunity to illustrate some less common diseases and therefore gives a brief refresher about diseases that may not be seen too often in clinical practice. As a pathologist I also think the column is an important reminder of the value of doing a post-mortem examination. All veterinarians will have animals die unexpectedly; however, the good ones will learn from these cases. A post-mortem examination provides a very valuable opportunity to check the accuracy of diagnosis as well as the efficacy of the treatments used. While doing a post-mortem of an animal isn’t a benefit to the animal that died, it may provide information that greatly benefits your subsequent patients. Performing post-mortem examinations is one of the easiest ways to ensure that you are constantly learning and gaining clinical experience as a veterinarian. Therefore, although I imagine the majority of these cases will be cases that have come through the Massey post-mortem room, other veterinarians are more than welcome to contribute to this column if they have interesting cases that they think will be valuable learning tools for other veterinarians. The first column describes a cat that developed multiple masses over the digits and is on page 28. Finally, a major change which companion animal veterinarians can all enjoy is the change in the law which makes it illegal to dock the tails of puppies and for non-veterinarians to remove front or articulated rear first digits. These changes have been a long time coming and CAV has played a significant role in getting these changes made. Enjoy the rest of 2018 and I hope everybody has a great time over the holiday season. John S. Munday CAV President l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

Industry news With the recent launch of Virbac’s new VEGGIEDENT® formulation, VEGGIEDENT® FR3SH™ Dental Chews, it is important that you are reassured that the high palatability of VEGGIEDENT® has not been affected by the new ingredients. The original formula and FR3SH™ formulation have been compared head to head for both prehension rates and total consumption rates, and the FR3SH™ formulation has been shown to retain the same high levels of palatability as its predecessor to enable preservation of the important bond between pet and pet owner. An independent study1 of VEGGIEDENT® FR3SH™ involved 37 dogs of various sizes and included both male and female dogs. Subjects were offered dental chews appropriate for their body size. Prehension was defined as the act of taking the chew spontaneously into the mouth, independent of whether it was then consumed. Total consumption was defined as the act of eating all the chew. All dog sizes recorded a 100% prehension rate and total consumption rates varied between 87% and 100%. This is comparable with original formula VEGGIEDENT®, so no loss of palatability was observed with the enhanced benefits of FR3SH™ Technology. These excellent prehension and high total consumption rates are comparable with those of other available dental chews. VEGGIEDENT® FR3SH™, has the same benefits as original formula VEGGIEDENT®, but with the added breath freshening benefits of FR3SH™ Technology. FR3SH™ Technology includes natural ingredients added for three new additional actions – cleaning the teeth to reduce oral causes of bad breath, cooling the mouth to freshen the breath, addressing intestinal imbalances to reduce digestive causes of bad breath. All contribute to better preserving the bond between the pet and its owner. The new and exciting VEGGIEDENT® FR3SH™ Dental Chews will become available through your veterinary wholesaler during December. Chaix G, Lloret F. Palatability in dogs of a new vegetable dental chew which helps to reduce plaque and calculus formation and helps to maintain a healthy and fresh breath. Proceedings of ECVD Congress, 2018

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

Working to promote and support companion animal practice in new zealand

CAV activities and meeting highlights

Significant surgical procedures

MPI is progressing proposals for animal welfare regulations relating to significant surgical procedures with a view to new regulations being developed by the end of 2019. The existing regime for significant surgical procedures in the Animal Welfare Act 1999 will be repealed in 2020, and a new criteria for determining whether a procedure is a significant surgical procedure will be brought into force. These regulations are intended to provide greater clarity on what procedures are considered significant and who can perform them. CAV were invited to attend a workshop with MPI to provide external stakeholder feedback on these proposals. This was a valuable opportunity to ensure that veterinarians’ voices are heard amongst a range of other stakeholders. In particular CAV raised concerns regarding dental work being performed by nonvets in conscious animals and further information has been subsequently provided to MPI that supports our opposition to this.

Brachycephalic issues

The Auckland branch of the NZVA hosted a meeting in July with a panel discussion of veterinarians and breeders to air the issues associated with brachycephaly. CAV arranged to have this meeting filmed so that all members could benefit from hearing the discussion. A special E-Cav bulletin focussing on brachycephalic issues was sent out in November with links to this film and several other items related to brachycephalic health. This information is now available on the CAV website (www. nzva.org.nz/cav) in a special section on brachycephalics. Collaboration is vital if we are going to make progress on improving the welfare of brachycephalic breeds. CAV and Dogs

NZ shared the costs of filming and editing this video and we would like to extend our thanks to Dogs NZ and the Auckland Branch for this opportunity.

Requests for veterinary certification

A number of external organizations have developed ‘veterinary certificates’ that clients may bring to veterinarians to complete. These ‘certificates’ have raised some significant concerns by some members as much of the information requested is vague and almost impossible to certify. To protect the profession’s integrity, the Veterinary Council of New Zealand (VCNZ) take matters involving certification very seriously. It is therefore important that a veterinarian does not issue a certificate or sign a letter without being aware of the personal legal responsibility that this carries. CAV are continuing to work with outside organisations to ensure the wording on veterinary certificates doesn’t contain statements that are outside the scope of the veterinary examination. Members should exercise sound judgement when asked to certify an animal and adhere strictly to certifying only what can be objectively determined from their examination, tests and clinical records.

CAV website

To improve the member experience and make information easier to find, CAV have moved the member information from the group pages on the NZVA website to a separate CAV website. This also includes a section for the public that has our policies on general pet ownership topics available in a user friendly format. More information will be regularly added. Do check the website out and keep up-todate with your branch and companion animal topics in New Zealand. You can access the website from www.nzva.org. nz/cav

Workplace Barometer project

As part of our focus on wellbeing CAV has engaged with the Healthy Work Group at Massey University as part of the NZ Workplace Barometer Scheme. Thank you to the 55 members who completed the recent survey. We have received a preliminary report so far and hope to report back to members once the final report has been completed. The scheme is designed to give organisations a way of tracking progress over time, so we may look to repeat this survey in 1–2 years.

NZ Companion Animal Council (NZCAC)

The NZCAC biannual conference was held in Auckland on September 17–18 with the theme “Human Behaviour Change for Animals”. Paula Short represented CAV at this event which was well attended. Keynote speakers from Australia and Canada rounded out some excellent New Zealand speakers.

Executive committee member updates Aimee Brooker has resigned from the committee after serving a 4-year term. Aimee has been a highly valued member of the CAV committee and we thank her in particular for taking on the role of treasurer.

Operations Manager update

Rochelle Ferguson has resigned from her role as CAV Operations Manager to take on new challenges within the veterinary profession. Rochelle joined the CAV committee in 2013 and served as CAV secretary for 2 years until taking on the inaugural operations manager role in 2016. Rochelle has done an outstanding job in this new position, which saw her take on huge range of work, including engaging widely with the profession and other stakeholders, in addition to the general administration work of the committee. She has left CAV with excellent systems in place to continue her good work and we wish her all the best in her new role. l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

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 School of Veterinary Science at Massey University and VetLearn.

CAV/CAHF Project Grant 2018 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.

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

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

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

WINNER

Article of the Issue

Miriam Bates, Richard Jerram, Benjamin Wernham

“Case report: unusual congenital spinal malformation causing neurologic dysfunction in a young dog" September 2018 | Volume 29 (3) | Pages 36–43

EyeVet Services Limited

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

What is your diagnosis? THE QUESTIONSâ&#x20AC;Ś Dr MIRIAM BATES BVSc (Dist), VSA Zoetis Intern and Dr Devon Thompson BVSc (Dist), MVS (Hon), MANZCVSc, (Radiol), DipECVDI, Registered Specialist Veterinary Radiology

Case history

A 13-year-5-month-old, neutered male, Shih Tzu cross dog presented for straining to defaecate. Physical examination was normal aside from the presence of a large, firm mass involving the left anal sac, which was identified on rectal examination. Apocrine gland adenocarcinoma of the anal sac was diagnosed based on cytology from fine needle aspirates of the mass. In order to stage the disease and formulate an appropriate treatment protocol, the dog underwent an abdominal ultrasound and three-view thoracic radiographs. No structural abnormalities which might suggest the presence of metastasis were detected on abdominal ultrasound. Furthermore, there was no radiographic evidence of thoracic metastasis. However, at the periphery of the field of view on the ventrodorsal projection of the thorax (Figure 1) an abnormality within the left antebrachium was identified. Mediolateral (Figure 2a) and craniocaudal (Figure 2b) views of the left antebrachium were obtained to further characterise this lesion. A single mediolateral radiograph of the right antebrachium was obtained for comparison (Figure 3).

3 1

Questions

1. Describe the radiographic findings of Figures 2a and 2b. 2. What are the differential diagnoses for this lesion? 3. How could you confirm your diagnosis? l

Answers on page 44 Contact: miriam.bates@vsnz.co.nz

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

Clinical Update

Mange on hedgehogs – it probably isn’t what you thought CAROLINE KRIECHBAUM, BVSc, MVM and Prof. BILL POMROY, BVSc(Hons), Dip Vet Clin Stud, PhD A survey of mange on hedgehogs was conducted in 2016 for a Masters of Veterinary Medicine dissertation at Massey University and has been recently published (Kriechbaum et al. 2018). The traditional story has been that hedgehogs can develop mange caused by Caparinia tripilis, a mite specific to hedgehogs. However, a project at Massey University several years ago found a number of hedgehogs had mange caused by Sarcoptes scabiei but there had been no subsequent follow-up. For this present project the prevalence of mites on hedgehogs was determined by examining dead hedgehogs collected from veterinary clinics, rescue centres, members of the public and from road kill, so is clearly not a random sample of hedgehogs. Nevertheless, in total 38 hedgehogs were examined and Sarcoptes was found on 27 (70%) of them whilst Caparinia was found on only 11 (29%). A technique, which sampled the head and ventral abdomen, was used to measure the relative abundance of mites on each animal. Sarcoptes mites were commonly present in large numbers (median 341, min 1, max 5659) whereas Caparinia mites were less numerous (median 3, min 1, max 2397). Of the hedgehogs on which Sarcoptes was found, 78% had obvious mange lesions but there was no statistical relationship between mange severity and numbers of mites seen. Sarcoptes from two different hedgehogs were analysed by PCR to confirm their species identity. When the DNA sequence of the Sarcoptes cox1 gene was compared to that in the NCBI database it did confirm their species identity but it was also apparent that one sequence was most similar to a sequence from a dog-

Contact: cgreig@xtra.co.nz

Photo source: pixabay.com

derived mite and the other to a sequence from a pig-derived mite. It raises the question as to the source of these mites. Sarcoptes has been seen on hedgehogs in Europe so finding them on hedgehogs in New Zealand does not represent a new host record for this mite species. However, early studies on hedgehogs in New Zealand found only Caparinia. There would not appear to have been any new introductions of hedgehogs into New Zealand since the very early 1900s. This is only the second report of Sarcoptes on hedgehogs in New Zealand so it appears hedgehogs have acquired these mites from somewhere in New Zealand and the very limited DNA evidence suggests some genetic diversity in the mites on New Zealand hedgehogs. They would most likely have come from pigs, dogs or humans as these are the three hosts that regularly develop sarcoptic mange in New Zealand. At this point in time there is no DNA test to determine the particular host preference for Sarcoptes so it is just speculation as to their origin. Nevertheless, it would appear that they are currently the dominant mite

on this animal, clearly causing disease in them and possibly influencing the numbers of hedgehogs in New Zealand. It also raises the question whether dogs can get infected from hedgehogs either temporarily or with development of a long-standing sarcoptic mange. Sarcoptes is known to have different genotypes with particular host preferences and infestations on animals other than their preferred host may be only temporary, if they occur at all. We know that humans can get temporary dermatitis when handling dogs with sarcoptic mange and we also know of people who have developed dermatitis from handling hedgehogs with mange (e.g. hedgehog rescue personnel). Further studies are clearly required to answer these questions but in the meantime be careful handling hedgehogs with mange and consider them when examining dogs with mange-type lesions.

Reference

Kriechbaum C, Pomroy W, Gedye K. Sarcoptes scabiei on hedgehogs in New Zealand. Parasitology Research, 117, 693–703, 2018 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

Clinical Update

Cytopoint: high tech help for itchy dogs DEBBIE SIMPSON BVSc

MANZCVS (Small Animal Medicine), FANZCVS (Veterinary Dermatology), Registered Specialist in Veterinary Dermatology

Cytopoint (Zoetis NZ, Auckland, NZ) is the latest hot topic in companion animal dermatology and was a focus of plenty of attention at the recent North American Veterinary Dermatology Forum, which I attended in May 2018. Cytopoint (lokivetmab) is a monoclonal antibody which targets interleukin 31. The label indication is for atopic dermatitis since interleukin 31 has been shown to be a key cytokine inducing itch in atopic dermatitis (Gonzales et al. 2013). Monoclonal antibodies have been used in human medicine for some time, e.g. Humira for the treatment of rheumatoid arthritis and Xolair for the control of asthma. Monoclonal antibodies can bind to a target receptor on a cell surface to block its activation or can bind to soluble targets such as cytokines in the blood to prevent the cytokine activating its receptor. Cytopoint falls into this latter category. It is the first monoclonal antibody to be used in veterinary medicine so truly is a leading-edge treatment for us to be able to offer to our patients. Many countries in the world (including Australia) have not had access to this drug until the last month or two, and many countries still do not have access to it, so we have been lucky here to be amongst the first countries to have it available. The two big advantages of Cytopoint are that it can be used in any age of dog and it is a very safe medication. One reason for this high level of safety is that because Cytopoint is a monoclonal antibody it specifically binds to its target, interleukin 31. Also, it is catabolised Contact: The Skin Vet, Auckland Tel 09 216 6222 E mail: theteam@theskinvet.co.nz

rather than metabolised so there are no contraindications with concurrent diseases, such as kidney or liver compromise. The therapeutic antibodies are degraded within lysosomes and the amino acids are re-used within the body. Unlike Apoquel (oclacitinib) Cytopoint binds to the interleukin 31 itself, rather than to the JAK receptor, so downstream signalling is not affected. There are also no known interactions with other medications or vaccinations, which gives Cytopoint a clear advantage over drugs such as steroids (Study reports No. C362N-US-13-042 and C961R-US-13-051, Zoetis Inc). The Cytopoint label does state that it is not to be used in dogs less than 3 kg bodyweight and Zoetis recommend that any vaccine given at the same time as Cytopoint should be administered at a different injection site. Personally, I don’t recommend giving vaccinations and Cytopoint on the same day, just in case of a reaction to either one. I would rather know which treatment had caused the reaction than have any confusion, however this is an individual choice. As the antibody is caninised, to prevent recognition by the canine immune system, it would be recognised as foreign by the immune system of other species such as cats and horses, so it therefore cannot be used in any species other than dogs. No therapy of course is ever completely safe and there have been some anecdotal reports amongst dermatologists of increased bacterial infections due to inhibition of the immune system with both Cytopoint and Apoquel, and also very rare adverse event reports of immune-mediated disease such as toxic epidermal necrolysis and immune mediated haemolytic anaemia (Michaels et al. 2016). A recent study suggests a mechanism by which this could occur. Hänel and coworkers (2016) showed that IL-31 regulates expression of genes involved in the formation of an intact physical skin barrier and stimulates expression

of antimicrobial peptides. They also showed that the IL-1 cytokine network is a major downstream effector of IL-31 signaling in deregulating the physical skin barrier. Thus, by interfering with IL-31, we will have to consider that low levels of IL-31 promote the antimicrobial barrier, and thus a complete inhibition of IL-31 signaling may be undesirable. Cytopoint is given subcutaneously and has an onset of action of approximately 24 hours. In the USA, it is licensed for use at 2 mg/kg, whereas in New Zealand and Europe it is licensed for use at 1 mg/ kg. At the higher dose, it tends to have a longer duration of action and sometimes a better response (up to 8 weeks vs. up to 4 weeks on average if given at the 1 mg/kg dose). Cytopoint is available in single use vials of 10 mg, 20 mg, 30 mg and 40 mg. There is no preservative, so the entire contents must be used when the vial is opened, or any excess discarded if the practitioner does not want to use it immediately (it is probably not going to be common for anyone to discard it as a higher dose can be used off label). The product should be treated gently, similarly to insulin, i.e. keep it in the main body of the fridge, not the door of the fridge, and don’t subject it to extreme temperatures, or excessive shaking. The recommendation is to store it in a refrigerator at 2–8°C. Freezing will damage the antibody and is likely to render it ineffective, and it should also be protected from light. A recent study addressed the efficacy and safety of Cytopoint compared to ciclosporin (Moyaert et al. 2017). A total of 274 dogs with chronic atopic dermatitis were randomised to two treatment groups, either oral ciclosporin at 5 mg/kg once daily or monthly injectable lokivetmab (Cytopoint) at 1–3.3 mg/kg for 3 months. At the end of 3 months, 81 dogs were enrolled in a continuation phase receiving lokivetmab for an additional 6 months. Lokivetmab was non-inferior to ciclosporin for

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

pruritus reduction on Day 28. No abnormal health events associated with lokivetmab were observed during the initial 3-month phase (142 dogs) or during the subsequent 6-month phase (81 dogs). Efficacy may depend on how prevalent interleukin 31 is in that individual dog at that particular stage of their atopic disease. While monoclonal antibodies may have close to 100% efficacy in simple diseases with only one target, atopic dermatitis is a complex inflammatory disease with multiple pathways involved. The chronicity and severity of skin lesions can vary and other confounding factors such as pyoderma may be involved. Many dogs have a component of food allergy as part of their disease and may have other flare factors such as flea bite hypersensitivity playing a role. Sometimes practitioners or owners are disappointed with efficacy or confused about why the duration of action may vary. Clearly, we need to be sure of our diagnosis of atopic dermatitis to begin with. This is achieved by ruling out or quantifying other diseases such as flea allergy and food allergy, and also identifying and managing other contributing factors such as bacterial or yeast overgrowth, intertrigo, superficial bacterial pyoderma and barrier dysfunction. Once we are sure that atopic dermatitis is the primary disease we are trying to control with Cytopoint, we also need to be aware that in the initial stages of disease different cytokines are prevalent compared to later stages of disease. There may also be differences in levels of interleukin 31 in an individual dog at different times of the year if their disease is seasonal, for example when pine trees are pollinating (if the dog is allergic to pine pollen). In these cases, it might be expected that Cytopoint would be less effective or last for a shorter duration of time during periods of high allergen challenge. Some dogs may simply produce less interleukin 31 than others, just as some atopic dogs do not produce as much allergen-specific IgE as others, and in these dogs Cytopoint may be less effective. In rare cases dogs may truly mount an allergic reaction against the caninised antibody – this phenomenon has also been reported in human medicine

in association with monoclonal antibody treatment, but the incidence seems higher in human medicine, at approximately 5–15%. In these rare cases the immune system may neutralise the antibody, leading to reduced or absent efficacy of the therapeutic antibody. A recent study reported that this occurred in 2.5% of dogs (Michaels et al. 2016). The titres of anti-lokivetmab antibodies were increased in these dogs on Day 42 of the study and average serum lokivetmab concentrations were 90% lower than in the remaining treated animals. It should be mentioned that the gold standard treatment for canine atopic dermatitis is still allergen-specific immunotherapy (if this is possible for the client and dog) as this is the only treatment which can alter the body’s immune responses and immunotherapy is still the safest overall treatment available for atopic dermatitis. A big advantage of Cytopoint is that it does not seem to interfere with intradermal skin testing, therefore it is not necessary to withdraw this drug before referral for intradermal skin testing. One concept that emerged at the conference was that using Cytopoint need not be an all or nothing treatment plan – some clients with cost concerns may use glucocorticoids as their primary drug, but perhaps occasional use of Cytopoint every few months may allow steroid sparing, and therefore reduce the risk of side effects in these patients. Dogs in the initial stages of immunotherapy may benefit from Cytopoint to control their immediate pruritus while the immunotherapy is building efficacy. It isn’t necessary to schedule repeat doses of Cytopoint exactly every 4 weeks, as some dogs may get a shorter or longer duration of action from the treatment or may have seasonal pruritus. It is potentially preferable to allow the Cytopoint to run out and touch base with the client again after 4–5 weeks to see if the itch levels are indeed rising again and only repeat the Cytopoint if the itch has returned. This will give the client confidence that their pet is not being over-treated. Dispensing an alternative oral treatment such as prednisone or Apoquel to be used in the interim before returning for another Cytopoint injection means the client has access to short-term treatment if needed and appropriate.

In summary, Cytopoint is a great new option to be able to offer our clients and patients and used appropriately, with good management of client expectations, it should improve the quality of life of many atopic dogs. My attendance at the conference was partially funded by a scholarship generously provided by Hill’s Pet Nutrition and the Companion Animal Veterinarians Branch of the New Zealand Veterinary Association. My thanks go to them for allowing me the opportunity to participate in this cutting-edge conference which means I am able to bring the latest information back to New Zealand to share.

References

Gonzales AJ, Humphrey WR, Messamore JE, Fleck TJ, Fici GJ, Shelly JA, Teel JF, Bammert GF, Dunham SA, Fuller TE, McCall RB. Interleukin-31: its role in canine pruritus and naturally occurring canine atopic dermatitis. Veterinary Dermatology 24, 48–53, 2013 Hänel KH, Pfaff CM, Cornelissen C, Amann PM, Marquardt Y, Czaja K, Kim A, Lüscher B, Baron JM. Control of the physical and antimicrobial skin barrier by an IL-31–IL-1 signaling network. The Journal of Immunology 4, 1402943, 2016 Michels GM, Walsh KF, Kryda KA, Mahabir SP, Walters RR, Hoevers JD, Martinon OM. A blinded, randomised placebo-controlled trial of the safety of lokivetmab (ZTS-00103289), a caninised anti-canine IL-31 monoclonal antibody in client owned dogs with atopic dermatitis. Veterinary Dermatology 27, 505–e135, 2016 Moyaert H, Van Brussel L, Borowski S, Escalada M, Mahabir SP, Walters RR, Stegemann MR. A blinded, randomised clinical trial evaluating the efficacy and safety of lokivetmab compared to ciclosporin in client owned dogs with atopic dermatitis. Veterinary Dermatology 28, 593–603, 2017 l

This article was written as part of the requirements for receiving the Hill's Pet Nutrition/CAV Educating the Educators scholarship.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

Feature article

Allergen-specific immunotherapy in dogs Dr RAEWYN CREEVEY, BVSc.

During my time spent with Dr Debbie Simpson at The Skin Vet as part of the CAV “A week with…” Scholarship I saw many atopic dogs at various stages of immunotherapy and this prompted me to investigate the use of allergen-specific immunotherapy (ASIT) for the treatment for atopy in dogs.

Favrot’s atopy checklist Age of onset: 3 years or less Dog lives mostly indoors Glucocorticoid responsive pruritis Alesional pruritus at first Affected front feet Affected pinnae Unaffected ear margins Unaffected dorsolumbar areas (unless concurrent flea allergy is present).

Allergen-specific immunotherapy is a treatment for atopic dermatitis (AD) which involves the administration of repeated doses of allergens in the form of a vaccine, in an effort to desensitise the atopic patient to the environmental allergens to which they are allergic. The allergens included in the vaccine are based on either intradermal testing (IDT) or serum IgE tests, or both. It is the only treatment that currently has the ability to alter the course of the disease and was first described as a treatment in human medicine, over 100 years ago, for people suffering from hayfever.

diet with a novel protein source, for a duration of 6–8 weeks, with NO other foods being fed and an appropriate rechallenge once completed, is necessary to rule out food allergy as IDT and serum IgE tests have found to be of no use in this regard (Mueller and Tsohalis 2002, Mueller and Olivry 2017). Note that IDT and serum IgE tests are NOT considered useful as screening tests for the diagnosis of atopy and should only be undertaken with the specific intention of subsequently starting the dog on ASIT.

Atopic dermatitis is defined as “a genetically predisposed inflammatory and pruritic allergic skin disease with characteristic clinical features. It is associated most commonly with IgE antibodies to environmental allergens”(Hensel et al. 2015) and is a diagnosis of exclusion. To help practitioners diagnose canine atopy a checklist of criteria has been developed by Favrot et al. (2010). Fulfilment of 5 of 8 of these criteria (see Box 1) has a sensitivity of 85% and specificity of 79% which means that, when using this method alone, 20% of dogs will still be misdiagnosed.

Thus, it is really important to have an in-depth conversation with the owners before beginning this process, as ASIT requires a strong commitment to giving injections regularly to their dog, likely for the rest of its life (although some dogs do successfully stop immunotherapy and maintain remission after several years of treatment). Intermittent skin flare ups still occur and these will require medical treatment however the flare ups when on immunotherapy are usually much less severe and less frequent than if the dog is not on immunotherapy. ASIT is not a quick fix so it is really important not to create unrealistic owner expectations from the outset!

Ruling out other causes of pruritis such as ectoparasites, infections (caused by bacteria and Malassezia), and food allergy, improves the accuracy of diagnosis of AD. A food elimination Contact: silverdale@vethospital.co.nz

Box 1

ASIT is considered an appropriate choice of therapy for those atopic dogs who are:

• preferably young and therefore do not have chronic skin changes (though it can help older dogs with chronic skin changes),

• having seasonal or non-seasonal

pruritis and are unable to avoid the allergen they are allergic to,

• spending 6 or more months of the

year on medication to control their atopic disease,

• taking medications but these are

ineffective in controlling the disease,

• experiencing, or likely to experience, side effects from anti-pruritic medications that are intolerable.

Allergy testing

Studies show that efficacy of treatment with vaccines derived from IDT is similar to those derived from IgE serum tests when managed by a veterinary dermatologist; however serum IgE tests have a higher incidence of false positive results (Park et al. 2000). Most dermatologists consider IDT as the gold standard as it tests the organ of interest i.e. the skin. Many will use both tests but this increases the cost. Several types of serum IgE tests are available and although these are more accessible to the general practitioner, there is a lack of agreement with results between laboratories so due diligence is required when selecting which company to use (Plant et al. 2014). In the case of both IDT and serum IgE tests, it is very important that medications that may confound the results are stopped at an appropriate time prior to the testing (see Table 1). This can be difficult if the dog is severely pruritic but if the owner is interested in skin testing there is no need to withdraw medications prior to referral as plans can be made at the initial referral appointment as to how to get to testing and manage pruritus simultaneously. Intradermal testing works by causing IgE antibodies on mast cells in the skin to release inflammatory mediators when exposed to the allergen, resulting in a

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

wheal and flare reaction (Type 1 hypersensitivity). The “library” of allergens used by the dermatologist is comprised of pollens from various trees, weeds and grasses known to be of local significance plus allergens from insects (house fly, cockroach, moth, dust and storage mites), Malassezia and moulds, and is assembled using knowledge from other veterinary dermatologists and human allergists, allergy centres, medical schools etc. The specific library of antigens used does vary between specialists. Table 1. Appropriate withdrawal times of medication prior to intradermal and IgE serum testing 3 (From Mueller and Tsohalis 1998) Drug Depot corticosteroids Oral corticosteroids

Topical corticosteroidsa Antihistamines, fluoxetine, clomipramine, acepromazine Cyclosporin Oclacitinib (Apoquel) Lokivetmab (Cytopoint)

Intradermal tests IgE serum tests 6–12 weeks 3–5 weeks 4 weeks None if used for <3 weeks, otherwise 4 weeks 1–2 weeks None 1–2 weeks

None

None 2 days

None None

Unknownb

Includes medications used topically in the ears and eyes. Likely that no withdrawl time is necessary, but no studies have been done (T. Anns, Zoetis NZ, pers. comm.)

The dog is sedated for the procedure using intravenous medetomidine. Opioids should not be used as they can trigger mast cells to release histamine resulting in inflammation which may interfer with interpretation of the test (Vogelnest et al. 2000). Note that propofol has been shown to increase the rate of positive reactions (Graham et al. 2003). A patch of skin approximately 15 cm x 10 cm is clipped on the lateral thorax. The sites for injection (approximately 50) are marked in a grid fashion with a whiteboard marker and numbered allergens are injected (0.05 – 0.1 mL) intradermally at these sites (Figure 1). The first and last two injections are the positive and negative controls (histamine and saline respectively). All are read within 5–20 minutes and are graded using a scale of 0 (saline) to 4 (histamine) dependent on the size of the wheal, erythema and turgidity of the reaction (Figure 2). This requires expertise and experience as it is both subjective and dynamic. A grade of 2 or higher is considered significant. When completed, the test site is smeared with corticosteroid cream (mometasone furoate; Elocon, MSD Animal Health, Auckland, NZ) to reduce irritation and the dog is given atipamezole to reverse the sedation. A cold pack can be applied to the site at home if it is still itchy. The results are then reviewed to determine which allergens to include in a vaccine. Again the “artform” of ASIT comes into play as the dermatologist prioritises which allergens will be included in the vaccine. Dr. Debbie Simpson uses approximately 10 allergens per vaccine. These are chosen by severity of reaction and seasonal pollination matching the patient’s flare seasonality; cross-reactivity between allergens is also taken into account. Debbie will usually try to include at least one allergen from each category in which a reaction occurs (trees, insects etc.) and if there are few or no reactions on the IDT she will perform a serum IgE test (Allercept Allergy Test; Heska, CO, USA) as well, so as to elucidate further allergens for inclusion in the vaccine. Atopic cats are usually tested using both IDT and serum IgE tests. 20

Figure 1. Exciting times as I get to participate in my first intradermal test

Figure 2. Reading the intradermal test

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

ASIT – the nuts and bolts

Immunotherapy is very safe with no health contraindications. Unlike most other anti-pruritic medications it is not immunosuppressive. Once the allergens for the vaccine are decided upon, the dermatologist makes up the brew (green topped vial, see Figure 3) taking into account the relative allergen concentrations (as pre-determined by the allergen manufacturer). An aliquot is then taken from this and diluted with saline to make the silver topped vial. This is repeated again to create the blue vial which has the lowest concentration of allergens.

over time, so when the new green top vial is ordered owners are instructed to give a half dose to lessen the likelihood of an adverse reaction. Cost of this process will vary between dermatologists however it is typically in the region of $1,800–$2,800 for the initial consultation, cytology, sedation, intradermal testing, serum IgE test, 9 months of immunotherapy, plus other initial medications e.g. antibiotics, topical medications, Cytopoint etc. Ongoing costs of ASIT are approximately $100/month plus any medications required for flare-ups and secondary infections. Efficacy, defined as ≥50% improvement in clinical signs, has been reported as 50–100% in dogs in several uncontrolled studies (Griffin and Hillier 2007). Owners are warned that it generally takes 6–8 months to see an improvement. Debbie reports a success rate of up to 80–90% but counsels owners that 10–20% of dogs show insufficient improvement to warrant continuing therapy after 12 months. After 12 months the dog is reassessed and a decision is made whether to continue the immunotherapy. If the dog is doing well, the frequency of injections may be reduced to 4-, 5- or even 6-weekly which also reduces the cost. Typically, injections are required life-long unless remission occurs (occasionally dogs will stop therapy after 3–4 years).

Figure 3. Three vials make up the initial ASIT kit; two induction (blue and silver caps) vials and one maintenance vial (green cap).

A variety of different protocols (dose, volume and frequency) are recommended by dermatologists but as yet no one protocol has been found to be superior (Colombo et al. 2005). Debbie uses an induction phase of twice weekly S/C injections for 8 weeks starting with the blue vial, moving on to the silver and then green vial which means both the dose given and the allergen concentration increase with each successive dose. Owners are trained to give the S/C injections and given a dosing schedule to adhere to. They are then asked to record any redness or pruritis which occurs and also to note the medications that the dog is taking at the time and any bathing that is being done. A recheck is scheduled for after 8 weeks of treatment. Anaphylaxis is uncommon but owners are warned of this possibility and asked to monitor their dog for 30–60 minutes after injections and to give injections during normal business hours (or be prepared to go to an after-hours veterinarian if a reaction occurs). After 8 weeks injections are continued using only the green (maintenance concentration) vial and the dosage frequency is reduced to one injection of 1 mL every 3 weeks. After 6 months Debbie will check the patient to tweak the dose and frequency if needed. A dog that experiences an increase in pruritis after the injection is given or is becoming itchy a few days prior to the next injection is a sign that the dose or frequency of injection may need adjustment. The vaccine is stable for 1 year when refrigerated, however may lose potency

For dogs or owners who do not cope well with injections it is possible to give immunotherapy sublingually (SLIT) but this requires the vaccine to be given every day and thus increases the cost. There are also protocols for “rush” immunotherapy where the dog is hospitalised and given multiple doses of allergen over the day in an effort to hasten management. Regardless of the protocol used, most dogs on ASIT will require concurrent multimodal treatment for flare ups especially during the first 6 months. Debbie uses regular injections of Cytopoint (Lokivetmab; Zoetis NZ, Auckland, NZ) in her patients plus owners usually have a supply of Apoquel (Oclacitinib; Zoetis NZ) or glucocorticoids to use as required and topical medications. Skin barrier function is optimised by the use of bathing and essential fatty acid supplementation. Monitoring and treating for secondary bacterial or Malassezia infection is essential for patient comfort. In conclusion, ASIT is the gold standard treatment for atopic dermatitis where there has been careful allergen selection and cases are well managed. It is safe and efficacious. Owners need to be committed to giving the therapy as directed, using other modes of treatment concurrently especially in the first few months of starting ASIT and following through with regular checks. Thank you to Dr. Debbie Simpson and staff of The Skin Vet, Dr Toni Anns (Zoetis NZ Ltd), and my colleagues at Veterinary Hospital Group for their help in the preparation of this article.

References

Colombo S, Hill PB, Shaw DJ, Thoday KL. Effectiveness of low dose immunotherapy in the treatment of canine atopic dermatitis: a prospective, double-blinded, clinical study. Veterinary Dermatology 16, 162–70, 2005 Favrot C, Steffan J, Seewald W, Picco F. A prospective study on the clinical features of chronic canine atopic dermatitis and its diagnosis. Veterinary Dermatology 21, 23–31, 2010

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

Graham L, Torres S, Jessen C, Horne K, Hendrix P. Effects of propofol‐induced sedation on intradermal test reactions in dogs with atopic dermatitis. Veterinary Dermatology 14, 167–76, 2003 Griffin C, Hillier A. The ACVD task force on canine atopic dermatitis (XXIV): allergen-specific immunotherapy. Veterinary Immunology and Immunopathology 81, 289–304, 2001 Hensel P, Santoro D, Favrot C, Hill P, Griffin C. Canine atopic dermatitis: detailed guidelines for diagnosis and allergen identification. BMC Veterinary Research 11, 196, 2015 Veterinary Dermatology 9, 167–71, 2002 Mueller R, Tsohalis J. Evaluation of serum allergen‐specific IgE for the diagnosis of food adverse reactions in the dog. Veterinary Dermatology 9, 167–72, 1998 Mueller R, Olivry T. Critically appraised topic on adverse food reactions of companion animals (4): can we diagnose adverse food reactions in dogs and cats with in vivo or in vitro tests? BMC Veterinary Research 13, 275, 2017 Park SJ, Ohya F, Yamashita K, Nishifuji K, Iwasaki T. Comparison of response to immunotherapy by intradermal skin test and antigen-specific IgE in canine atopy. Veterinary Medical Science 62, 983–8, 2000 Plant JD, Neradelik MB, Polissar N, Fadok VA, Scott BA. Agreement between allergen-specific IgE assays and ensuing immunotherapy recommendations from four commercial laboratories in the USA. Veterinary Dermatology 25, 15-e6, 2014 Vogelnest U, Mueller R, Dart C. The suitability of medetomidine sedation for intradermal skin testing in dogs. Veterinary Dermatology 2000, 285–90, 2000

Useful sources

Barnard N. Investigating the pruritic dog on a shoestring. Proceedings of British Small Animal Veterinary Congress 2017. https://www.vin.com/ members/cms/project/defaultadv1. aspx?id=7904641&pid=17890&, 2017 Bond R. Allergy tests for skin disease. Proceedings of British Small Animal Veterinary Congress 2011. https://www.vin.com/ members/cms/project/defaultadv1. aspx?id=4823162&pid=11328&, 2011 De Boer DJ. Therapeutic approaches to CAD. Proceedings of WSAVA Congress 2016. https://www.vin.com/ members/cms/project/defaultadv1. aspx?id=8250191&pid=19840&, 2016 Fadok V. Allergy testing and immunotherapy, medical FAQs https://www.vin.com/members/ cms/project/defaultadv1. aspx?id=5661890&pid=11200&, 2017 Gortel K. Diagnostic techniques in dermatology: how to get the most from your work-up. Proceedings of the Ontario Veterinary Medical Association 2016. https://www.vin.com/ members/cms/project/defaultadv1. aspx?id=7126898&pid=13293&, 2016 Hillier A. Getting the most out of allergen immunotherapy. Proceedings of Western Veterinary Conference 2004 https://www.vin.com/ members/cms/project/defaultadv1. aspx?id=3849368&pid=11170&, 2004 Hillier A, DeBoer D. The ACVD task force on canine atopic dermatitis (XVII): intradermal testing. Veterinary Immunology and Immunopathology 81, 289–304, 2001

Lewis T. Allergy specific immunotherapy: how to maximise results. Proceedings of Wild West Veterinary Conference 2017. https://www.vin.com/ members/cms/project/defaultadv1. aspx?id=8216473&pid=19026&, 2017 International Committee on Allergic Diseases of Animals. http://www.icada. org/publications.html; http://www.icada. org/resources.html Olivry T, Deboer D, Favrot C, Jackson H, Mueller R, Nuttall T, Prélaud P. Treatment of canine atopic dermatitis: 2010 clinical practice guidelines from the International Task Force on Canine Atopic Dermatitis. Veterinary Dermatology 21, 233–48, 2010 Rosenkratz W. Atopic disease – the test. Proceedings of the Western Veterinary Conference 2002. https://www.vin.com/ members/cms/project/defaultadv1. aspx?id=3844362&pid=11136&, 2002 l

This article was written as part of the requirements for receiving the RxVET/CAV "A week with ..." scholarship.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

Feature article

Tail pull injuries in cats ANDREW WORTH, BVSc, PGDipVCS, FANZCVS, PhD. Registered Specialist in Small Animal Surgery Tail pull injury is principally a feline phenomenon. In a tail pull injury the cat will present with a flaccid tail with or without more significant neurological dysfunction. The pathogenesis of the condition is thought to be the result of a near miss road traffic accident. The cat narrowly avoids being run-over, but the tail is caught under the tire and there is a sudden deceleration. The cat’s momentum produces a severe pulling force on the tail leading to sacrocaudal luxation. Cats that have a sacral fracture and a fracture luxation of the tail are more likely to have suffered a blow rather than a tail pull and therefore may have fewer neural deficits. In a sacrocaudal luxation generated by a tail pull, the tail muscles tear and the caudal nerves are unprotected from the stretching injury. Depending of the severity of the pulling there can be varying degrees of injury to the S1-3 nerves of the cauda equina, probably by stretching or avulsion of the nerve roots. Sacrocaudal luxation is a severe injury if there is resultant anal sphincter and bladder dysfunction. A pet with permanent faecal and urinary incontinence may not be an acceptable pet and these patients are often euthanized. It is important that the clinician understands this presentation and the known prognostic indicators for recovery. A flaccid tail should be the signal to perform a thorough neurological examination. However, these cats are victims of significant trauma so concurrent injuries are common and should be triaged. Smeak and Olmstead (1985) found that 84% of cats with sacrocaudal luxation had other injuries, most commonly pelvic and femoral fractures, and thoracic and abdominal injuries. Once the cat is stabilised and any life-threatening injuries are dealt with, attention turns to the neurological status and establishing the extent of the injury. Neurological examination must include assessment of tail tone (flaccid) and sensation (absent below the injury site) as well as anal tone and bladder palpation (tone of the bladder itself and ease of expression). A severe injury is indicated when there is absence of tail tone and sensation, lack of anal tone and a LMN bladder, which is big but not tense and is easily expressed. In contrast, if a cat’s injuries are restricted to the sacrocaudal luxation itself, without neurological dysfunction the prognosis for a return to normal pelvic limb function is usually excellent if other pelvic injuries are addressed. Prognosis for return of normal urinary function in cats with

Contact: Massey University Veterinary Teaching Hospital, Private Bag 11222, Palmerston North 4442

Photo credit: Sarah Fowler

sacrococcygeal injuries is good if an anal reflex and perineal sensation are intact at the time of initial presentation. A prospective study by Tatton and others (2009) followed 21 cats with sacrocaudal or proximal intercaudal luxation from initial presentation and compared the proportion of cats with and without tail sensation that recovered normal urination. The 11 cats with tail sensation showed control of urination within 3 days (mean 1.9, min 1, max 3 days). But only 6/10 cats without tail sensation regained urinary control within the 30-day study period (mean 2·6, min 1, max 7 days). Testing tail base sensation was specific with a 100% positive predictive value. However, the test exhibited poor sensitivity (11/17; 64·7%) and negative predictive value (4/10; 40%). In those cases, in which followup was available, 8/9 cats with tail base pain sensation, but only 1/7 cats without tail base pain sensation, recovered tail function.

Management of tail pull injuries – let nature do her thing

The main considerations are the cat’s level of pain and regular bladder expression to prevent over stretching. Typically, expression of an LMN bladder is easily performed and owners can be taught to maintain these cats at home. Some might prefer a cystostomy tube to be placed. As function returns, the sphincter tone will improve which can hamper efforts to express the bladder and require either pharmacological intervention (to relax the sphincter) or a urinary diversion. Recurrence of sphincter tone is normally an encouraging sign though management can become more difficult. Cats should be maintained on a low residue diet with the addition of lactulose if there is any constipation. Development of megacolon is a rare but reported sequelae to a tail pull injury. The prognosis for return of tail function is poor in cats with no deep pain perception at the tail base and/or perineum due to a sacrocaudal luxation. In these circumstances clinicians often offer tail amputation. The advantages of amputating the tail

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

can include reduction in pain when the tail is manipulated and prevention of further injury to the caudal nerve roots due to the weight of the hanging tail or it getting caught in something. The disadvantages of amputation include the need for anaesthesia and the cost (given the uncertain prognosis for return of urinary function at this stage). In addition, it is possible that tail function may return (Davies and Walmsley 2012). Based on a study of 51 cats (Smeak and Olmstead 1985), if normal urination returned, it did so between 2–30 days (mean 13 days). Every cat that could not urinate normally within 1 month remained incontinent during the 2–36 month follow-up period. Tail function may take several months or longer to improve. In the same study, tail function returned to its full extent between 7–150 days (mean 31 days). Surgical alignment of the sacrocaudal luxation has been described using sutures between the sacral spine and the dorsal spinal process of Cd1. In a study by Bernasconi (2002) the pre- and post-operative clinical, neurological and radiological findings in 16 operated

animals (13 cats and 3 dogs) were compared with findings in 17 (13 cats and four dogs) conservatively treated animals. There was a reduction in tail hyperesthesia and a higher number of animals recovered tail function in the surgically treated cohort. The authors suggested that surgical stabilisation of caudal sacral fractures or sacrococcygeal fractures/luxations carries an improved prognosis over conservative management chiefly in reducing hyperesthesia. The suturing technique has been recently evaluated by Caraty et al. (2018). Fifteen cats were included in this retrospective study, all of which had lost voluntary motor function in the tail and eight of which were urinary incontinent. After surgery, 11 cats recovered voluntary tail function and pain sensation within 14–90 days (mean 39 days). Five of the eight previously incontinent cats recovered urinary continence within a month of surgery. As noted by the authors, a comparison study is required to determine whether these results are superior to conservative management.

References

Bernasconi C, Grundmann S, Montavon P. Simple techniques for the internal stabilisation of fractures and luxations in the sacrococcygeal region in cats and dogs. European Journal of Companion Animal Practice 12, 139–45, 2002 Davies E, Walmsley G. Management of tail pull injuries in cats. In Practice 34, 27–33, 2012 Smeak D, Omlstead M. Fracture/luxations of the sacrococcygeal area in the cat: a retrospective study of 51 cases. Veterinary Surgery 14, 319–24, 1985 Tatton B, Jeffery N, Holmes M. Predicting recovery of urination control in cats after sacrocaudal injury: a prospective study. Journal of Small Animal Practice 50, 593–6, 2009 Caraty J, Hassoun R, Meheust P. Primary stabilisation for tail avulsion in 15 cats. Journal of Small Animal Practice 59, 22–6, 2018 l

This article was written as part of the requirements for receiving the Hill's Pet Nutrition/CAV Educating the Educators scholarship.

Hope for persistent bacterial infections Bacterial persisters are thought to be a significant cause of chronic or relapsing bacterial infections. "Persisters" resist antibiotic treatment by entering a dormant state in which they become metabolically inactive. So hope is on the horizon for those recurrent pyoderma dogs with the discovery that a novel retenoid (teenagers with scarring acne know about these) kills persisters. Further, it is thought that the use of this retenoid may reduce the length of antibiotic treatment in this type of patient. Experimentally it killed MRSA by distorting the lipid bilayer of the cell membrane. We wait and hope! References available on request l

Contact: Allan Bell, Dermvetonline, dermvet.bell@xtra. co.nz

Photo credit: Pina Fratamico, USDA (via Wikicommons)

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

Pathology corner

Lung-digit syndrome in a cat JOHN S. MUNDAY BVSc, PhD, Dipl ACVP, L. CRISTINA GANS BVSc, and SUSAN C. TOMLIN BSc, BVSc

Case history

A 9-year-old female spayed domestic short-haired cat presented with a 3-day history of right hind limb lameness. Examination revealed possible swelling in the gastrocnemius and quadriceps area; however, when the hair in the region was clipped no bite wounds were found. Radiography of the hind legs from the pelvis to the hocks showed no significant findings. The cat was treated with antibiotics and 0.05 mg/ kg meloxicam orally for 6 days. The treatment resulted in only transient improvement. She was represented 17 days after the initial presentation. The cat was reported to have been licking the toe of the fourth digit of the right hind foot and the claw had been displaced. Additionally, the cat was thought to be lethargic. Examination at this time revealed that the second and fourth digits of the right hind limb were swollen and inflamed with some skin ulceration. The third digit of the right fore limb was also swollen but to a lesser degree. Radiographs of the right hind paw revealed the presence of lytic lesions within the distal phalanx of digit II and IV. The lytic lesions were surrounded by moderate swelling within the soft tissues. The right hind digit II was amputated at the distal interphalangeal joint and submitted for aerobic culture and histology. Thoracic radiographs were not obtained at this visit. The cat was discharged with additional antibiotics and analgesia whilst awaiting culture and histology results. Contact: j.munday@massey.ac.nz, School of Veterinary Science, Massey University, Palmerston North

Figure 1. Examination of the lungs revealed a large firm mass within the caudal lobe (white arrow). Smaller masses were also scattered throughout both lungs (black arrows).

The aerobic culture was negative, but the histology confirmed the presence of neoplastic cells within the osteolytic lesion. These cells were determined to be epithelial and an adenocarcinoma or a squamous cell carcinoma were considered to be most likely. Due to the likely presence of neoplasia involving multiple digits in this cat, the possibility of a metastatic bronchogenic neoplasm was considered. The cat was still eating, but she seemed reluctant to stand and walk and, as her owners felt that she was in pain, they elected euthanasia around a month after her initial presentation to Massey. At no time did the cat show any clinical evidence of respiratory disease.

Gross findings

Examination of the right hind limb revealed swelling and crusting close to the nail bed of digit IV. Similar changes were visible involving digit III of the right forelimb. Examination of the lungs revealed a firm multinodular 5 x 3.5 cm mass on the caudal aspect of the right

caudal lung lobe (Figure 1). Similar smaller masses were also scattered throughout both lungs. A 1 x 1 cm firm mass was also visible within the jejunum. Incision of the mass revealed that the majority of the mass was associated with the serosal surface and there was no evidence that of mucosal involvement by the mass.

Histology

Examination of sections of lung, digits, and intestine all contained proliferations of cells contained in poorly-defined glands (Figures 2a, b). The cells contained significant anaplasia with approximately 1 mitosis visible/ high powered field. Small amounts of basophilic material was variably present within the lumen of some neoplastic glands and occasional lining epithelial cells had visible cilia. Surprisingly, examination of the heart revealed the presence of numerous scattered metastatic foci containing similar epithelial cells arranged in poorly-formed glands (Figure 2c).

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

Figure 2. Photomicrographs of histological sections taken from the (a) digit, (b) lung and (c) myocardium of cat 9-year-old domestic shorthair cat. Sections from the digit reveal numerous poorly-formed glandular acini lined by poorly-differentiated epithelial cells (arrows). Hair follicles within the sections are indicated with an asterisk. Sections from the lung reveal an anaplastic population of epithelial cells forming glands. Small quantities of basophilic material is visible in small numbers of glands. This material is consistent with mucus that would normally be produced by bronchiolar epithelium. A similar population of neoplastic cells are visible within sections of myocardium.

Diagnosis

Pulmonary adenocarcinoma with intrapulmonary metastases as well as metastases to multiple digits, the jejunum, and heart.

Discussion

Presentation of cats due to disorders of the digits or nails is not uncommon in practice. While most of these are inflammatory diseases that may be predisposed to by the cats not fully wearing their nails, it is estimated that as many as 1 in 8 cases of digit and nail disease in cats are due to neoplasia (Goldfinch and Argyle 2012). Which neoplasms are most common involving the digits of cats is currently controversial with some studies revealing that squamous cell carcinomas were most common and others reporting that metastases from an underlying lung neoplasm to be the most common carcinoma affecting the digits of cats (Van der linde-Sipman and van de Ingh 2000; Wobeser etÂ al. 2007). Regardless, it appears most appropriate to consider the possibility of an underlying lung neoplasm in any cat that develops a carcinoma of the digits. The likelihood that the neoplasm is a metastasis is greatly increased when, as in the present case, multiple digits are involved. Lung neoplasia is rare in cats and represent around 0.7% of feline necropsy accessions (Wilson 2017). Adenocarcinomas are reported to be the most common primary neoplasm type in cats and currently no cause is known for the feline neoplasms (Wilson 2017). As with lung neoplasms in other species, intrathoracic metastases are most common. However, feline pulmonary adenocarcinomas (and less commonly other feline lung cancer types) can develop an unusual pattern

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

of metastases. The digits appear to be the most common abnormal location for lung neoplasm metastasis and this pattern of spread has been referred to as the ‘feline lung-digit syndrome’ (Goldfinch and Argyle 2012). Other ‘abnormal’ locations that feline pulmonary adenocarcinomas have been reported to metastasize to include the skin, eyes, skeletal muscle, bone, and a most of the thoracic and abdominal organs. This pattern of spread is hypothesized to be due to infiltration of the neoplasm into the aorta and direct dissemination as aortic emboli (Wobeser et al. 2007).5 As in the present case, affected cats can present due to clinical signs of metastatic disease rather than due to the primary lung neoplasm. Certainly, the presence of a primary lung neoplasm cannot be excluded simply because the cat is not showing signs of respiratory disease. The prognosis for cats with primary lung neoplasia is very poor with survival times generally around 2 months (Gottfried et al. 2000). Most cats undergo

euthanasia due to severe persistent lameness, anorexia or lethargy. There is no cure for these neoplasms and care should be aimed at preserving quality of life for as long as possible. Just a reminder that the Massey postmortem service is always looking for cases to use as teaching material for the final year veterinary students. We can only accept whole animals for teaching purposes. The necropsy will be done immediately if the case is submitted while the final year students are having their necropsy rotations. However, if the case is submitted outside of our final year teaching times (end of October to end of February plus scattered weeks in June and July), the case will be frozen and then the necropsy will be done when teaching of fifth year students resumes. Due to the value of such material for teaching, there is no charge for a routine gross necropsy and histology and a detailed post-mortem report will be issued generally within 10 days of the necropsy. Please e-mail Fernanda at F.Castillo-Alcala@massey. ac.nz for more detail.

References

Goldfinch N, Argyle DJ. Feline lung-digit syndrome: unusual metastatic patterns of primary lung tumours in cats. Journal of Feline Medicine and Surgery 14, 202–8, 2012 Gottfried SD, Popovitch CA, Goldschmidt MH, Schelling C. Metastatic digital carcinoma in the cat: a retrospective study of 36 cats (1992– 1998). Journal of the American Animal Hospital Association 36, 501–9, 2000 van der Linde-Sipman JS, van den Ingh TS. Primary and metastatic carcinomas in the digits of cats. The Veterinary Quarterly 22, 141–5, 2000 Wilson DW. Tumors of the respiratory tract. In: Meuton DJ (Ed). Tumors in Domestic Animals. 5th Edtn. Pp. 467–498. John Wiley and Sons, Inc. 2017 Wobeser BK, Kidney BA, Powers BE, Withrow SJ, Mayer MN, Spinato MT, Allen AL. Diagnoses and clinical outcomes associated with surgically amputated feline digits submitted to multiple veterinary diagnostic laboratories. Veterinary Pathology, 44, 362–5, 2007 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

CAV Life Member Profile

Allan Bell

BVSc MANZCVS FANZCVS, Veterinary Dermatologist CAV Life Member Profile is a new regular feature in which we profile the special folks who have been awarded life membership of CAV for their significant and valued input into the practice of companion animal medicine in New Zealand

In this issue Nina Field talks to Allan Bell who has played a significant role in the New Zealand veterinary profession since the beginning of his long and active career, which started as a member of the first class of veterinarians graduating from Massey in 1967.

Can you comment on the differences in training from when you trained to what we have today?

I can’t really answer that as I am not familiar with current training. When I trained there were 21 students in the 4th and 5th year so we had a great staff:student ratio and the staff made the course work exciting. The facilities we had were quite limited relative to today.

Can you give us an outline of your career and areas of special interest?

I was in companion animal practise for 16 years with a few good equine cases. I started in Christchurch as an employee and in 1971 moved to Auckland where I started my own practice on the North Shore. I then went deer farming in 1983, while continuing to work part-time, developing my allergy testing and being the family cook! I offered dermatology referrals from 1990, obtained my MANZCVS canine medicine in 1981 and FANZCVS Dermatology in 1995 with subsequent specialist registration. My residency training with the Australian College of Veterinary Scientists was supervised by Ken Mason out of Brisbane. I met a lot of helpful people at my first AAVD meeting in St Louis (MO, USA). My first block of time was at the University of Wisconsin-Madison. This was a wonderful experience and went very well, resulting in opportunities at other North American universities where I broadened my experience. These included a stint at Ohio State University majoring in keratinisation disorders of dogs and University of California-Davis where I was lucky enough to learn from Tony Stannard, the foremost equine dermatologist at the time. I also managed to see a few exotic small animal cases at Davis. These were sometimes flown in (one of the permanent resident’s jobs was to drive to Sacramento to meet the aeroplane). Personal contact with the clinicians involved, as well as recommendations from peers, facilitated these parts 34

Photo courtesy of Allan Bell

of my residency, as did my attendance and participation at American Academy Veterinary Dermatology meetings (now ‘Forums’). From 2014 onwards, I have been a dermatology consultant and involved in research, leading a small group of university molecular biologists and a veterinary pathologist. I am the instigator and ideas person and while I have learned a lot I would not pretend to have suddenly developed the sophisticated skills of my colleagues. Presently my interests are; Staphylococcus pseudintermedius in relation to canine atopic dermatitis and the prospect of a pyoderma-preventing vaccine against S. pseudintermedius.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

What would you say are some of your career highlights?

Getting published whilst still in general practice (on an outbreak of Ollulanus tricuspis in a cat colony). I also published some papers on recurrent furunculosis of German Shepherd dogs and follicular mucinosis during my dermatology training. I was thrilled to be an invited speaker at the 1999 WSAVA conference in Lyon, covering deep pyoderma. My greatest disappointment was failing to persuade MPI (and the people who could pressure MPI) to place border controls to, at least, delay the importing of antibiotic-resistant S. pseudintermedius. We have now imported those international strains and my failure as a lobbyist still hurts.

What are your interests and passions outside of work? My family (wife Cheryll, two daughters (lawyers) and four grandchildren), equestrian sports – now retired, cricket, again retired but I’m still active in yachting. Another passion of mine is conservation – Cheryll and I covenanted a block of regenerating bush with the QE2 trust in the 1980’s.

What advice would you give to veterinarians today, both new grads and more experienced vets? I think graduating just marked the point in my career where I get paid to learn. I remain a student.

What has been the challenging aspects to your career?

Being a husband, father and son (my mum died just a couple of years ago aged 101) as well as looking after myself and doing my work. Balance was not always achieved but Cheryll, my partner and wife, always offered strong support.

How has your veterinary career created value in your life?

I’ve gained huge value from being a veterinarian. I’ve met great people, both clients and colleagues, and animals. I could manage another two or three lifetimes as a veterinarian but each with a different career path such as large animal practice, microbiology and molecular biology.

Has there been significant other people that have influenced your career?

There have been so many, but special mention must go to Dr Mayo with whom I spent 3–4 days as an AgSc student doing large animal practise in Whangarei. I knew after this exactly what I wanted to do and changed from AgSc to BVSc as soon as I could! Also Boyd Jones; a flatmate, colleague and friend who opened doors for me in the USA and enabled me to start my ‘geriatric’ residency. Peter Davies was my first employee who freshened up my basic science and with whom I shared a place in a cricket team. Cheryll; a special person, partner and colleague who wrangled the teenage family and deer while I was away doing my dermatology training. Fergus Oliver, an Auckland human dermatologist who got me excited about dermatopathology. He was always interested in the comparative aspects of both clinical and pathological dermatology, and he co-authored my follicular mucinosis paper.

Do you think the New Zealand veterinary training is the best if can be? What improvements could be made? What do we do well?

I don’t know enough about the current training to comment specifically. However it seems that great effort has been made to accommodate the vast increase in knowledge of the last 50 years. It may seem cynical, but I think that ‘experience’ should not be accepted uncritically. I always told my students that experience can be just making the same mistakes repeatedly. Diagnosis by algorithms is often quite accurate but expensive and inefficient. It also predisposes to the use of robots or technicians rather than clinicians. Allan has lots of tales to tell but says that when he starts to write them down it reads like skiting, or worse part of an obituary!!! 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 29 No 4 | December 2018

Conference Report

North American Veterinary Dermatology Forum Maui, Hawaii, USA, May 2018

DEBBIE SIMPSON BVSc, MANZCVS (Small Animal Medicine), FANZCVS (Veterinary Dermatology), Registered Specialist in Veterinary Dermatology This year the North American Veterinary Dermatology Forum was held in Maui, Hawaii, and perhaps unsurprisingly was one of the best attended dermatology conferences I have been to for a few years! The US meeting normally attracts around 500 delegates. Maui was a beautiful location; the main conference venue was in Wailea, on the south west of the island which was very peaceful. The entire area was covered in beautiful rich green tropical plants and Hawaiian flowers and the rolling lawns of the hotel led straight to the ocean, complete with turtles which could be seen from the beachfront path every morning. The beachfront path extended for several kilometres each direction from the conference hotel and was well utilised by many determined lycra-clad fitness devotees each day (and myself as the odd one out wandering along drinking a salted caramel Hawaiian half and half latte and admiring the view). I was amazed at the number of huge villas right on the beachfront which were obviously owned by the rich and famous and closed up for the majority of the year while they were not in residence. There were plenty of non-academic activities (other than power walking in lycra) ranging from golf to kayaking to snorkelling to hiking to helicopter tours for those not attending the conference, Contact: The Skin Vet, Auckland Tel 09 216 6222 E mail: theteam@theskinvet.co.nz

Photo courtesy of the author

and perhaps some of those who should have been attending the conference but werenâ&#x20AC;&#x2122;t! The volcano on the Big Island erupted during the conference. This resulted in evacuation of over 2,000 people on the Big Island and many homes were destroyed but luckily was far enough away not to disrupt us and no deaths resulted from the eruption.

in the epidermis, pemphigoid diseases, auto-immune blistering skin diseases and the hair follicle. There were some excellent speakers, with Keith Linder and Petra Bizikova from North Carolina State University providing the bulk of the veterinary content. The human medicine speaker was Michael Kasperkiewicz from Schleswig Holstein in Germany.

There were two main streams, a scientific stream with more academic topics, and a concurrent session with more practical topics. The scientific stream covered mostly structural and immune-mediated diseases including epidermal cornification, old dog erythema multiforme, barrier dysfunction, mechanisms of cell death

The highlight of the scientific stream for me was Petra Bizikovaâ&#x20AC;&#x2122;s lecture on pemphigus, as her approach was a novel one which I found very helpful. She began with identifying the immune pathway and cells responsible for the pathogenesis of the disease, then broke down the treatment of the disease into how each drug affected each cell type.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

The take home messages from the canine pemphigus lecture were that there is a variable response to treatment, with disease control reached in about 50% of dogs. The time to disease control ranges from 1.5–29 months, with the average time to disease control with steroid monotherapy being 7 months and steroids plus azathioprine being 12 months. Petra also referenced a paper she coauthored recently (Oral glucocorticoid pulse therapy for induction of treatment of canine pemphigus foliaceus – a comparative study. Veterinary Dermatology 25, 354–8, 2015) detailing high dose pulse therapy with steroids, in which median time to disease control was 7 weeks. I have tried this protocol in several canine patients now and found it very effective. This protocol does not seem to work well in cats, so is not recommended at this time. Her recommendations are to: - Start reducing the dose of steroids as soon as the end of the consolidation phase is reached. - Try the high dose glucocorticoid pulse therapy if possible. - Use steroid sparing agents if needed to rapidly achieve disease control or if steroids cannot safely control the disease without unacceptable side effects. Between 2–22% of dogs with pemphigus foliaceus (PF) were able to achieve complete remission off any drug therapy – this is a question I find I am often asked by owners, so it is nice to have these figures at hand. Petra mentioned two studies relevant to prognosis in canine PF, one from the University of Pennsylvania, in which 60% of the 43 dogs in the study died during the study period (1994–2004). Of these, 92% died in the first year of treatment, due to low quality of life, side effects of treatment or inability to reach complete remission. The other study from North Carolina State University covering the period 1993–2003, included 39 dogs with PF, of which 39% died during the study period, mainly due to side effects associated with treatment. The concurrent sessions covered modern flea control, hyperbaric oxygen

The Kiwi contingent enjoying the North American Veterinary Dermatology Forum in Photo courtesy of the author Hawaii.

therapy, surgical lasers, compounded medications, analgesia, corticosteroids, viral skin diseases, the ecology and control of ticks, video otoscopy, feline dermatoses affecting the digits and equine dermatology. One interesting fact that emerged from the equine session was that a few brave equine practitioners have used Apoquel (oclacitinib) in horses with good results (this is obviously an off label use). So far numbers are very few, so perhaps keep in touch with Zoetis for further developments or news of upcoming studies and research! There were also a number of excellent breakfast meetings covering a variety of topics from Cytopoint to video otoscopy to flea control, which were also very well attended – places were limited to around 20 delegates per breakfast meeting and you had to get in fast to get a seat. These were more informal sessions in which there was a lot of participation from the delegates, sharing questions and clinical experiences with each other.

There was a great Kiwi contingent at the meeting, which was lovely to see. I think in all around nine NZ delegates attended which must rate pretty highly for number of attendees per head of population. Next year the American dermatology conference will be held in Austin, Texas from April 10th–13th 2019, a city known for its cowboy hats, TexMex food and live music, so if these things in conjunction with dermatology CPD appeal to you, then book your flights! l

This article was written as part of the requirements for receiving the Hill's Pet Nutrition/CAV Educating the Educators scholarship.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

Conference Report

Highlights from Science Week Conference Gold Coast, Australia, 5–7 July 2018

Andrew Worth, BVSc, PGDipVCS, FANZCVS, PhD. Registered Specialist in Small Animal Surgery This year’s Science Week was attended by record numbers of veterinarians. In fact, registrations had to be limited. As a result, next year the college has decided to move the meeting from the QT Hotel which has been the college’s second home for many years, up to Broadbeach to the Star Hotel and Conference Centre, which can better cater for the increasing numbers. The obvious appeal of this meeting is the broad variety of CPD on offer, from all the diverse chapters, as well as the higher level (i.e. advanced practitioner) at which it is pitched. The radiology chapter had invited radiologist Dr Chris Ober from the University of Minnesota and Dr Ronaldo da Costa from Ohio State University. Dr da Costa is a neurologist/neurosurgeon with a research interest in wobbler disease. Prior to the main conference there was a neuro-imaging day at which both speakers presented on several topics highlighting the importance of advance imaging. In the main surgery programme, the focus was on intervertebral disc disease, pain syndromes, caudal cervical myelopathy, degenerative lumbosacral stenosis and brain tumours. The following are some of the key points:

Contact: Massey University Veterinary Teaching Hospital, Private Bag 11222, Palmerston North 4442

The utility of spinal radiography (i.e. not advanced imaging)

• As a rapid screening tool for obvious

bony abnormalities. • A minimum of two views (e.g. lateral and ventrodorsal) is required. • Correct patient positioning and elimination of patient movement requires sedation for diagnostic survey spinal radiographs. Dr da Costa showed numerous examples where lesions were missed or erroneously reported due to malpositioning. • Obvious osseous tumors, advanced discospondylitis, displaced fractures or luxations, and congenital vertebral anomalies (e.g. hemivertebrae) may be identified. • However, the sensitivity of spinal radiographs for fractures and luxations is only 75%. • Plain radiographic signs of intervertebral disc disease include collapsed disc spaces, decreased size of the intervertebral foraminae, narrowing of the articular joint space or mineralised disc material within the vertebral canal or intervertebral foraminae.

Intervertebral disk disease

• The Hansen classification for

intervertebral disc disease has been expanded from the original description of type I (extrusion of calcified nucleus pulposus) and type II (protrusion of the dorsal annulus) to include type III, or traumatic disc herniation (low-volume/ high-velocity form of herniation that is typically markedly contusive but non-compressive in nature). This type III herniation appears to occur most commonly in older,

chondrodystrophic breeds, but can be seen in any dog. A fourth type has been recently reported and termed hydrated nucleus pulposus extrusion. There are still few reports on this last form (also known as a discal cyst), but it seems to affect primarily the cervical spine. • The Dachshund is by far the most commonly affected breed (mostly type I) in countries where it is popular, and IVDD typically occurs in dogs older than 2 years of age. The notable exception is the French Bulldog, which can be affected between 1 and 2 years of age. • Non-surgical management is still recommended for dogs with suspected type I cervical or thoracolumbar disc extrusions with mild to no neurologic deficits (i.e. first episode of neck or back pain). Successful non-surgical management requires STRICT cage confinement for 3–4 weeks to allow the annulus fibrosus to heal. In patients that are non-ambulatory, or plegic, emergency surgery is recommended. The surgical procedure of choice for cervical disc extrusions is usually a ventral slot procedure and for thoracolumbar disc extrusions, either hemilaminectomy, minihemilaminectomy or pediculectomy. Fenestration of degenerative adjacent discs in the thoracolumbar region is recommended by Dr da Costa as a prophylactic measure. • Type II disk disease should be initially managed medically with restricted activity (but not cage confinement) and anti-inflammatory drugs. Most patients seem to improve and stabilise. With refractory pain and worsening neurological signs, surgical intervention is indicated.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

Decompression of the spinal cord can be performed via hemilaminectomy but removal of protruded annulus from beneath the cord is problematic and can lead to iatrogenic worsening of the neurological status. A more lateral approach is now favoured, which allows removal of vertebral bone from beneath the cord – a lateral corpetectomy. • Neurological grade is still the most important determinant of prognosis with a recovery rate of approximately 95% for dogs that still have deep pain perception treated with decompressive surgery. The recovery rate of dogs with absent deep pain perception is approximately 50% (40–65% in the literature).

Neurogenic lameness

• Neurogenic lameness should be

suspected in an animal with lameness in which no orthopaedic cause can be identified. Neurogenic muscle atrophy is usually present. • In a lame dog, neurological signs that are highly suggestive of nervous system disease are ataxia, weakness, postural reaction deficits and obvious spinal pain. • However, the majority of patients with neurogenic lameness do not present with clear neurological signs and are challenging to diagnose.

Surfers Paradise.

• Clinical signs suggestive of neurogenic

involvement are: severe muscle atrophy, Horner’s syndrome (miosis, ptosis, third eyelid protrusion and enophthalmus), decreased or absent cutaneous trunci (formerly panniculus) reflex, decreased muscle tone and spinal reflexes (lower motor neuron signs), signs of weakness/hypertonicity in the ipsilateral pelvic limb in cases of lameness involving a thoracic limb, and pain on spinal, axillary or limb palpation/manipulation. • Clinical signs that may be seen and are highly suggestive of neurogenic involvement are monoparesis or monoplegia and self-mutilation. It is important to emphasize that any dog with chronic lameness is expected to develop some degree of muscle atrophy from disuse alone. However, neurogenic muscle atrophy is almost always much more profound. • Differential diagnosis for neurogenic lameness include: malignant peripheral nerve sheath tumour (PNST), intervertebral disk disease, spinal neoplasia, brachial plexus avulsion, traumatic neuropathy, degenerative lumbosacral stenosis, cervical spondylomyelopathy and diskospondylitis. • Ancillary tests used to aid the diagnosis of neurogenic lameness include:

Survey radiographs (look for evidence of intervertebral disk disease, osteolytic/ osteoproliferative lesions, and an enlarged intervertebral foramen in cases of proximal PNST). u Axillary ultrasonography (US) is simple though insensitive. If a mass is identified, US-guided fine needle aspiration biopsy should be attempted. US only identifies neoplasms at or below the level of the brachial/lumbosacral plexus therefore cannot rule out proximal tumours. u Myelography – will only establish a definitive diagnosis if the disease causes compression of the subarachnoid space surrounding the spinal cord. u Contrast computed tomography (CT) and magnetic resonance imaging (MRI) allow visualization of the vertebral canal, plexus area and distal nerve regions. • Malignant PNST are locally invasive but rarely metastasise. The treatment of choice for malignant PNST is surgical resection that traditionally has involved limb amputation with or without an approach to the spinal cord. However, post-operative local recurrence is common (up to 72% of cases). A limb-sparing technique with limited local tumour resection u

Photo credit: Australia and New Zealand College of Veterinary Scientists.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

has been recently reported, with long-term survival if complete resection is achieved. Post-operatory chemotherapy protocol (metronomic cyclophosphamide and piroxicam) can significantly delay tumour recurrence in dogs with incompletely resected soft tissue sarcomas, including malignant PNST. Local radiation therapy has also been shown to yield long survival times. • Lateral intervertebral disk protrusion and extrusion can cause neurogenic lameness. Most commonly reported in the cervicothoracic (C4-5, C5-6, C6C7, C7-T1) or lumbosacral (L4-5, L5-6, L-6-7) intumescences. u Lameness is associated with spinal pain, so-called “nerve root signature”. u Dogs may vocalise with movement and pain may be elicited by limb or spinal manipulation. u Diagnosis requires CT or MRI as standard myelography is often unrewarding. u There are surgical and medical treatment options. • Brachial plexus avulsion (BPA) is a common sequel of major traumas, usually traffic accidents. u The majority of dogs have avulsion of all roots of the brachial plexus.

The second most common type of avulsion involves only the caudal roots u In both instances, dogs present with thoracic limb monoparesis or monoplegia. Other signs commonly seen are analgesia of the limb and absence of flexor reflex. Horner’s syndrome and unilateral absence of the cutaneous trunci reflex are seen in approximately 70% of cases. u Diagnosis of BPA is based on a history of trauma and electrodiagnostic abnormalities. CT and MRI may delineate the areas of avulsion. Unfortunately, the only specific treatment is reimplantation of the avulsed nerve roots and it has only been done experimentally in dogs. Physical therapy and limb protection are recommended for at least 2–3 months. • Spinal neoplasms can be extradural, intradural/extramedullary or intramedullary. The former (e.g. osteosarcoma, chondrosarcoma) are the most common. The osseous proliferation associated with some of these tumours can cause nerve root compression or entrapment, and lead to lameness. u

Feline spinal disease – key points

• Progressive monoparesis (“lameness”)

in cats; think tumour mainly lymphoma • Acute monoparesis; think trauma or vascular (aortic thromboembolism or fibrocartilaginous embolic myelopathy(FCEM)) • Cats have several peculiarities, so consider the signalment • Young cats – inflammatory disease or lymphoma • Older cats – IVDD, neoplasia, ischemic myelopathies (FCEM) • Any age – trauma I would like to thank the sponsors of the Educating the Educators fund (Hill’s Pet Nutrition and the Companion Animal Veterinarians Branch of the NZVA) for providing funding to support my attendance at Science Week 2018. l

This article was written as part of the requirements for receiving the Hill's Pet Nutrition/CAV Educating the Educators scholarship.

Imidacloprid, pet products and bees

In the September issue of Companion Quarterly (page 22), Dr Allan Bell expressed his honestly held opinion that “imidacloprid originating from companion animal use may be an unquantified risk to bees especially in cities”. Dr Bell and Companion Quarterly wish to make it clear that that statement is Dr Bell’s opinion and not that of the Editor of Companion Quarterly or the Executive of the Companion Animal Veterinarians of the NZVA. Companion Quarterly has not undertaken the necessary research to form its own view on this particular issue.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

What is your diagnosis? THE ANSWERS… 1. On the mediolateral projection (Figure 2), within the cranial cortex of the ulna at the level of the radioulnar interosseous ligament (proximal-tomid diaphysis), there is a prominent radiolucent concavity with a thin sclerotic rim which is associated with a small spur of new bone at its distal extent. There is mild thinning and irregularity of the opposing caudal radial cortex with overlying smooth new bone formation. On the craniocaudal projection (Figure 3) these changes result in a welldemarcated ovoid radiolucency surrounded by a thin rim of sclerosis. 2. Differential diagnoses include: a. Radioulnar ischaemic necrosis (RUIN) b. Interosseous enthesopathy c. Bone cyst Neoplasia (primary or secondary) and osteomyelitis are not included as differential diagnoses for this lesion (see below for explanation). 3. Advanced imaging with computed tomography (CT) and/or core biopsies may help characterise this lesion, however in most cases are unlikely to be required.

Diagnosis

This report describes a case of RUIN which was detected as an incidental finding during staging for an apocrine gland adenocarcinoma of the anal sac. RUIN is a benign condition characterised by lytic lesions within the radial and/or ulnar cortex at the level of the interosseous ligament and enthesophytosis of this ligament.

Treatment and outcome

With no evidence of distant metastasis, the dog underwent surgical excision of the anal sac mass followed by an adjuvant carboplatin chemotherapy protocol. Treatment of the RUIN was not necessary as the dog did not have any clinical signs attributable to this lesion. 44

Discussion

The radius and ulna are united by the short, strong interosseous ligament. This ligament arises from a rough area on the middle third of the radius medial to the interosseous crest and inserts on a slightly raised area on the cranial aspect of the body of the ulna (Miller et al. 1964). Enthesophyte formation, which is new bone at the site of attachment of a tendon or ligament, is not uncommonly seen radiographically within the interosseous space of clinically normal dogs (Schmid et al. 2016), however radioulnar ischaemic necrosis (RUIN), a condition characterised by cortical osteolysis within the radius and/ or ulna at the level of the interosseous ligament is rare. RUIN is considered benign and is typically clinically silent, however, it is important to be aware of this condition, so it is not mistaken for a more aggressive lesion such as a primary bone tumour (Deffontaines et al. 2016; Schmid et al. 2016), metastatic disease or osteomyelitis. The aetiology of RUIN is poorly understood. It has been proposed that the primary lesion is caused by disruption of blood flow which leads to ischaemic necrosis of the bone (Schmid et al. 2016). The largest nutrient artery of the ulna is located immediately proximal to the attachment point of the interosseous ligament (Miller et al. 1964) and it is therefore hypothesised that thromboembolic disease, compression or traumatic disruption of this vessel could result in RUIN. Enthesophytosis is thought to occur as a response to stress on the interosseous ligament, similar to the principle of osteophytosis of synovial joints as a response to instability (Deffontaines et al. 2016; Schmid et al. 2016). Bone lesions are categorised on the number of bones involved, site of bone involvement, and behavior of the lesion based on the radiographic

pattern of bone lysis, type of periosteal bone formation, and the transition between normal and abnormal bone. In general, benign lesions have focal or geographic patterns of lysis with welldefined margins, smooth or lamellar new bone formation, and a distinct zone of transition (Thrall, 2013). Lesions seen with RUIN typically have benign characteristics such as well-defined/ geographic regions of osteolysis, a fine sclerotic rim and smooth osseous proliferation of the ulna extending towards the radius (or vice versa) at the level of the interosseous ligament (Deffontaines et al. 2016; Schmid et al. 2016). Conversely, aggressive lesions such as those seen with osteomyelitis, primary bone tumors, and neoplastic metastasis generally have moth-eaten or permeative patterns of lysis, spiculated, sunburst, or amorphous new bone formation, and an indistinct zone of transition (Thrall, 2013). RUIN lesions are cortical, diaphyseal and often polyostotic, involving the ipsilateral radius and ulna, and occasionally the contralateral limb (Schmid et al. 2016; Deffontaines et al. 2016). In contrast, primary bone tumors in dogs are typically monostotic, metaphyseal and medullary in location (Tobias et al. 2012). Neoplastic metastases to the bone are typically polyostotic, metaphyseal, and have a predilection for the axial skeleton, although they may occur within the diaphyses of the long bones of the appendicular skeleton. While osteomyelitis may be polyostotic and located within the medullary cavity of long bones following haematogenous bacterial translocation, this is a rare presentation and it more commonly seen following a penetrating injury with changes occurring within both cortical and medullary components of the adjacent bone (Schmid et al. 2016; Thrall, 2013). The CT appearance of RUIN has recently been described (Deffontaines et al. 2016)

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

and as expected had a benign inactive appearance, however it is the authors’ opinion that in most cases CT would be an unnecessary expense. Biopsy would help to exclude a neoplastic or infectious process if there were any doubts based on radiography alone. Histopathology of a RUIN lesion would be expected to show normal bone adjacent to areas of empty osteocytic lacunae and amorphous eosinophilic material, which is consistent with ischaemic necrosis of the bone (Schmid et al. 2016). RUIN is often an occult disease process and does not require treatment. If clinically indicated by lameness or pain on direct palpation of the site, empiric therapy for RUIN involves physiotherapy, rest, and treatment with non-steroidal anti-inflammatory drugs (NSAIDs). Cases which do not respond to medical management may require surgical intervention. The goal of surgery is to

decrease contact between the radius and ulna in the affected region. This may be achieved through curettage of the proliferative lesion, or by ulnar ostectomy (Deffontaines et al. 2016).

Conclusion

Radioulnar ischaemic necrosis (RUIN) is a rarely reported condition which produces bony lesions at the attachment of the interosseous ligament. RUIN is considered benign and is typically clinically silent, therefore, it is important that it is not mistaken for an aggressive bony lesion. RUIN may be distinguished from neoplastic and inflammatory processes of the bone by its radiographically benign appearance, diaphyseal and cortical location, as well as its potential to be polyostotic. Most clinically affected animals respond to medical management alone, but surgery may be indicated for refractory cases.

References

Deffontaines J, Lussier B, Bolliger C, Bédard A, Doré M, Blevins W. Chronic desmitis and enthesophytosis of the radio-ulnar interosseous ligament in a dog. Canadian Veterinary Journal, 57, 487–91, 2016 Miller M, Christensen G, Evans H. Anatomy of the Dog. W.B. Saunders Company, Philedelphia, PA, USA, 1964 Schmid L, Klang A, Katic N, Ansón A, Gumpenberger M, Kneissl S. Imaging diagnosis – Radiology and computed tomography of radioulnar ischemic necrosis in a Jack Russell Terrier. Veterinary Radiology and Ultrasound 59, 1–5, 2016 Thrall DE. Textbook of Veterinary Radiology (6th Edtn). Elsevier, St Louis, MO, USA, 2013 Tobias KM, Johnston SA (eds). Veterinary Surgery: Small Animal. Elsevier, St Louis, MO, USA, 2012 l

Did you know?........... You can access useful articles from the New Zealand Veterinary Journal, grouped by subject from the NZVA Resource page? Go to http://www.nzva.org.nz/?page=resourcecentre, then click on ‘Our Publications’ and select ‘Browse selected papers in the article collections’ under New Zealand Veterinary Journal. There you’ll find a series of collections covering a variety of topics of particular interest to veterinary clinicians including Companion Animals. Each topic contains review articles, scientific articles and clinical communications that have been published in the NZVJ, mostly since 2010. Just select a topic and you will find the title of the articles with a direct link for downloading the paper from SciQuest.

Would you like to see your pet on the cover of Companion Quarterly? We now have a new cover photo for each issue of Companion Quarterly. This means we are always on the lookout for suitable photos. Photos selected for the cover must be landscape orientation (or able to be cropped to this), crisp and well focused, and of high resolution (at least 300 DPI). They must also be well composed and interesting. Please send any suitable images to the Editor (sarah.fowler@ gmail.com). If however you have a favourite snap of your fur-family that’s not quite up to cover standards, please send that in too: photos that are not selected for the cover may be printed on the back inside cover.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

Massey News It’s hard to believe but another year is almost to a close and by the time this article is in print the 2018 BVSc 5 class will have sat their finals and will be heading out into the world. This year there seem to be plenty of job vacancies and students were confirming contracts in large numbers in the second semester. We wish them well. Next year is the last of the smaller (96 capped) class size, with the 2019 BVSc 4th year class likely to number 128. Stalled building plans are being revisited and staff are having to innovate and develop their teaching to suit the increased numbers, day-one skills requirements and the industry desire for graduates with greater ability to communicate and emotional intelligence.

People

Head of School, Jon Huxley, is ushering in changes in the management of the faculty that will align academics in groupings dependent on their primary role (clinician/teacher versus researcher/ teacher). Massey University is currently recruiting to fill two senior posts to head these organizational units. There are also changes to the MUVTH hospital director role with a change from a hospital director and assistant director, to a separate Companion Animal/Wildlife and Farm Services/Equine Hospital directors. Malcolm Jack has completed his residency programme in small animal surgery and will leave Massey for England’s pastures green in the new-year. It has been a pleasure to

have Malcolm in our team and he will be much missed. Many of our patron’s clients have benefited from his committed care of their pets over the last 4 years. He moves into clinical referral practice but we hope that his relaxed and approachable persona is not lost to academia permanently. The vacant fourth surgical faculty position is being advertised, and the service continues to become busier and busier. Interviews are running at pace for open positions in nursing and internal medicine. Theresa Hardisty, formerly our head nurse in the Companion Animal Hospital, has rejoined the imaging department. Our team of radiographers has a large teaching role in the BVT and BVSc programme as well as a heavy clinical load supporting the various clinical services. Wendy Baltzer attended the 2018 Agility Dog National Championships, held in Feilding. Wendy has rapidly established a consultancy in Agility dogs due to her background with these dogs in the US and as a Diplomat of the American College of Veterinary Sports Medicine.

Visit by Cindy Otto

The third biennial Working Dog Centre Research Colloquium was held on October 16th 2018 and was a huge success. Featuring researchers from the WDC, as well as our guest, Dr Cindy Otto, the day stimulated excellent interchanges amongst delegates. Dr Otto, an associate professor at the University of Pennsylvania inspired us with her work monitoring the health

of USAR dogs used at the World Trade Center following the 9/11 disaster. We look forward to a mutually beneficial relationship with the Penn Vet Working Dog Center. Cindy spent 10 days as our guest and gave several presentations on her work and met with many internal and external groups in a fabulous exchange of information and enthusiasm.

Upcoming events on the CPD calendar: save these dates Massey University Small Animal Hospital Patron’s Day – Friday December 7th

Our annual day of CPD for our patrons will once again occur at the end of the year. This is free to all those practices that refer cases and open to all other veterinarians for a small fee. This is our chance to give something back and introduce new staff as well as network with our colleagues. We hope to see you there. Hip dysplasia: improving patient outcomes CPD day – Saturday December 8th Timed to coincide with Patrons Day and in association with the NZVA, this competitively priced CPD day is designed to update practitioners on the current methods of management and the latest information on pathogenesis, diagnosis, the influence of environmental and genetic factors, as well as current treatment modalities. www.nzva.org.nz/ events l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

Companion Animal Health Foundation update To lead the advancement of companion animal health and wellbeing in New Zealand

Cath Watson, CAHF Chair Our brainstorm session in August was very successful, with a huge thank you to Lottie Cantley, Leanne Fecser, Simon Clark and Campbell Johnston for coming along to help with some outside perspective too. There were three big outcomes. This first was to update our vision and mission:

Vision:

To lead the advancement of companion animal health and wellbeing in New Zealand.

Mission:

We support the generation and distribution of knowledge about companion animal health and wellbeing in New Zealand. We will achieve this through educating the public around advancements in veterinary medicine, providing support for projects investigating companion animal health, and informing veterinary professionals about industry developments. The second was the decision to rebrand to a friendlier name ‘Healthy Pets NZ’ to encompass all the objectives of the trust, not just the projects funded so far. This will result in a more user friendly website, improved marketing material and engagement on social media platforms to help raise our profile. The third was the decision to employ a communications manager with specific objectives to manage and deliver targeted communications and sponsorship activities that take Healthy

Photo credit: Brenda Halliwell

Pets NZ to a new level by increasing awareness, promoting activities, increasing funding, and expanding the trust’s influence through education and research. We hope to have this position filled by the new year, ready for our 21st birthday. Finally, a huge thank you to our recent donors. CAV continues to support us with an annual grant of $10,000, Boyd Jones has made another generous

donation, and Phillip Hyndman very kindly donated his Companion Quarterly article award to us. These donations allow us to continue to support important projects into companion animal issues in New Zealand. A number of projects currently underway should be completed in the next few months, with new applications under consideration at present, so there should be plenty to report on in the next quarter! l

Contact: www.cahf.org.nz

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

CPD RECORD

Read articles from Companion Quarterly 29(4) December 2018 Date of Activity: ………………………… Activity description Read articles in the September 2018 issue of Companion Quarterly (tick those that apply) o What is Your Diagnosis (Miriam Bates and Devon Thompson) o Mange on hedgehogs – it probably isn’t what you thought (Caroline Kriechbaum and Bill Pomroy) o Cytopoint: high tech help for itchy dogs (Debbie Simpson) o Allergen-specific immunotherapy in dogs (Raewyn Creevey) o Lung-digit syndrome in a cat (John Munday et al.) o CAV Life Member profile (Allan Bell and Nina Field) o Conference report: North American Veterinary Dermatology Forum (Debbie Simpson) o Conference report: highlights from ANZCVS Science Week (Andrew Worth) o Tail pull injuries in cats (Andrew Worth) o ………………………………………………………………………………………………………… o ………………………………………………………………………………………………………… o ………………………………………………………………………………………………………… Activity type: Category: Self-directed activity Self-Directed Activity Type: Updating knowledge or preparatory reading/research Hours claimed: VCNZ Points (0.5 per hour reading): Reflective record: Actual learning outcomes and the impact on your practice What did you teach or learn from this activity? ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................

How do you think this will impact on your practice? ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ 50

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 29 No 4 | December 2018

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Companion Quarterly â&#x20AC;&#x201C; 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 29, No. 4 | December 2018

VOLUME 29 NO 4 December 2018

Cytopoint: high tech help for itchy dogs

Pathology Corner: lung-digit syndrome in a cat

Allergen-specific immunotherapy in dogs

Conference reports: NAVDF and ANZCVS Science Week

CAV Life Member Profile: Allan Bell