Companion Quarterly Vol 32 No3 September 2021 by Companion Quarterly

Companion Quarterly – Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA

Companion Quarterly

OFFICIAL Newsletter of the Companion Animal veterinarians branch of the nzva Volume 32, No. 3 | September 2021

VOLUME 32 NO 3 September 2021

Serological survey of leptospiral antibodies in unwell dogs in NZ

Survey results: NZ vets’ advice about vaccination and socialisation of puppies

A case of metaldehyde poisoning in a dog

Specialist Profile returns: Internal medicine specialist Tommy Fluen

Life without ACTH: Part 2

Volume 32 | No. 3 | September 2021 ISSN No. 2463-753X Executive Committee 2021 cav@vets.org.nz

Contents

President

Natalie Lloyd

Companion Quarterly

Treasurer

Simon Clark

Committee Members Nina Field Toni Anns Alison Pickering Becky Murphy Sally Aitken Shanaka Sarathchandra Kevanne McGlade

Veterinary Manager (companion animal) Lorelle Barrett

EDITORIAL 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

Tony Leggett NZ Farmlife Media Ltd Agribusiness Centre 8 Weld St, Feilding T 027 4746 093 E tony.leggett@nzfarmlife.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.

highlights

6 CAV Noticeboard 8 News in brief 12 What is your diagnosis?

Emily Ball, Devon Thompson, Tommy Fluen

14 The future of pet groomers in New Zealand

15 Letter to the editor 16 Understanding current veterinary advice about vaccination and socialisation in puppies: a CAV survey Lorelle Barrett

22 Life without ACTH –

24 Serological survey of leptospiral

antibodies in clinically unwell dogs in New Zealand Keara Brownlie

32 “Shake and Bake” – metaldehyde toxicity in a dog Ryan Philips

38 CAV specialist profile: Tommy

Newsletter design and setting

40 What is your diagnosis? The

Disclaimer

42 Massey News 44 Healthy Pets NZ update: Welcome

Penny May T 021-255-1140 E penfriend1163@gmail.com

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.

hypoadrenocorticism Simon Clark

Cover credit

The Lloyd family's beloved Heist

2 Editorial 4 CAV activities and meeting

Fluen

answers

to Spring!

46 CANZ update: Recommend

trainers with confidence: part II

48 Dogs NZ update: Respiratory function grading scheme announcement

50 Obituary – Frazer James Allan 52 Shaggy dog stories Boyd Jones

54 Authors' guidelines

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 32 No 3 | September 2021

EDITORial

Saying goodbye to a companion My editorial for the September issue last year talked about two new feline additions to our household – Heist and Hazel, the precocious Burmese kittens. I talked about the road to providing environmental enrichment in our house for them, discussed the responsible things we had done as new cat owners – of course they were both microchipped and fully insured. They stayed inside at night and we were looking for ways to cat-proof our section (which I have to admit, was not overly easy to do without turning our backyard into something resembling a prison yard). But none of our responsible cat owner measures protected Heist from leaving our house on a Thursday evening a few weeks ago and being hit by a car right outside our front door within his “curfew” hours. The microchip did not help us to track him after he ran off somewhere in panic and to this day has not been found. The insurance policy was of little use when he never made it to a vet clinic for treatment. Statistically, we should have known better. Cats between the age of 7 months and 2 years old, have the highest risk of being involved in a road traffic accident (RTA). For every oneyear increase in age, the odds of an RTA decrease by 16%. Male cats have been found to be 1.9 times more likely to be involved in an RTA than females, and more entire males are involved in RTAs than neutered males (Rochlitz 2003a). The majority of road traffic accidents happen at night (dusk in Heist’s case) and often (in 48% of cases) they occur just outside or very near to the cat’s home – bingo (Rochlitz 2003b). We were able to reduce the risk somewhat through desexing – intact male cats are more likely to be involved in an RTA than those that are neutered. But in all honesty, the only thing that really would have eliminated this risk would have been to keep him indoors. And believe me, we tried, but he was insistent that he “wanted out”. He displayed a few different behavioural 2

Heist. The very thing that we loved about him (that confident and outgoing nature) was the personality trait that put him at risk. To our family, he was one of a kind. Heist put the “companion” in companion animal. He was friendly, vocal and snuggly. My 13-year-old son could pick him up and have cuddles when life as a 13-year-old boy got a bit too much. My 11-year-old daughter could pass him around all five of her BFF’s and he would happily purr and camp out with them while they did, well, whatever 11-year-old girls do. problems, including more than a couple of episodes of inappropriate urination around the house, and so, eventually, we relented. So I am currently reconsidering what makes us as New Zealanders so intent on thinking our cats need outdoor access. As a country, we are a little unique in our approach to cat ownership. Most of us think our cats should be able to go outside. In fact, in a 2010 survey, 95% of NZ cat owners reported their cats have outdoor access (Farnworth et al. 2010). We cite freedom to express normal cat behaviour as one of the main reasons for this decision. On the other hand, we provide advice to our clients on many health issues we know young animals are at risk of developing – the risk of parasitism, disease, poor nutrition, too little or too much exercise and poor socialisation …. But I wonder how much “airtime” we give to the pros and cons, and recognised statistical risk for cats who do go outside compared to their indoor counterparts?

Eventually after shining his light on everyone else in the household he would come and sleep on our bed at night cuddled up by our feet. He was the star feature of Sunday morning sleep-ins and helped my husband tirelessly whenever a computer and keyboard were required…. And he was inseparable from his little sister Hazel. They slept together, ate together, went outside together and played endlessly together. As I turn my attention to her, I wonder how to fill a void of “behavioural enrichment” previously occupied by Heist. So, if you haven’t already, perhaps consider those statistics I have provided in this editorial when talking to your kitten guardians. I am aware that we have so many other important topics to cover in a new kitten or puppy consult but maybe there is room for just a couple of minutes on this avoidable health risk.

Looking at lostpet.co.nz, ours is not an uncommon story. Cats that venture outside often go missing. There are many many people waiting for their cats to turn up after, in some cases, quite extended periods of time (one person has been renewing their monthly listing every month for over two years!).

Rochlitz I. Study of factors that may predispose domestic cats to road traffic accidents: part 1. Veterinary Record 153, 549–53, 2003a Rochlitz I. Study of factors that may predispose domestic cats to road traffic accidents: part 2. Veterinary Record 153, 585–8, 2003b Farnworth MJ, Campbell J, Adams NJ. Public awareness in New Zealand of animal welfare legislation relating to cats. New Zealand Veterinary Journal 58, 213–7, 2010

Honestly, I don’t know if I could do it differently if I had another chance with

Natalie Lloyd, CAV President

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

Working to promote and support companion animal practice in new zealand

CAV activities and meeting highlights

The CAV executive committee met for their annual 2-day strategic planning meeting in mid-August, at the NZVA offices in Wellington. Discussions included key projects for 2022, catching up with members of the national office Senior Leadership Team, and a presentation from Otago Polytechnic School of Veterinary Nursing staff on a proposed clinical coaching programme to facilitate a more structured approach to in-clinic training of veterinary nurses.

Vaccination and socialisation of puppies

A survey was conducted to better understand what advice veterinarians are giving puppy owners about vaccination for parvovirus and appropriate socialisation. The survey was part one of a project to better support veterinarians in this area where it is needed. Check out the summary of findings on page 16 of this issue!

Companion animal dentistry

The NZVA veterinary team re-engaged with MPI on the issue of veterinary nurses no longer being able to perform subgingival scaling, subsequent to changes in the Animal Welfare Act in May of this year. MPI has been asked to create a regulation to allow veterinary nurses to undertake this procedure, with urgency. The CAV committee provided their support to this advocacy, along with other representatives from within the veterinary and veterinary nursing professions.

Qualifications for groomers

Also in conjunction with the NZVA veterinary team, the CAV committee supported a submission to Primary ITO as part of their consultation process for developing an NZQA-approved qualification for pet groomers. As mentioned in last issue’s highlights, the committee also recently met with the National Dog Groomers Association to discuss professional standards for

groomers. See the summary of these discussions and our submission to the Primary ITO on page 14.

Feline immunodeficiency virus in NZ

A successful webinar discussing the current science around FIV in New Zealand was hosted by the CAV committee in early August. The guest speakers were Dr Mark Westman (University of Sydney) and A/Prof Richard Squires (James Cook University and Chair of WSAVA Vaccination Guidelines Group). The evening provided much for participants to consider around prevention and management of FIV in NZ. l

Companion Quarterly – a call for contributions Do you have a clinical case to share, need to tick off a task on your CPD plan or want to earn some pocket money? CQ publishes case studies, clinical updates, reviews etc. on topics that are of interest to companion animal veterinarians. An award of $300 is paid for all published articles, with the chance to win the Best Article of the Issue and Best Article of the Year (thanks to Eyevet Services). Please send your contributions to the Editor at sarah.fowler@gmail.com Microsoft Word format is preferred and photographs/ images are welcome, preferably two megapixels or higher, and sent as a separate attachment (rather than embedded within the Word document).

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

The CAV Noticeboard Hill’s Pet Nutrition and CAV present: Educating the Educators Scholarship Applications are now open for the Hills/CAV Educating the Educators Scholarship. This scholarship provides assistance for veterinary educators to attend advanced level continuing education events, in exchange for articles, reports and presentations on their area of interest. While we typically provide support for events held outside NZ, applications will currently be considered for assistance to attend virtual events. Through this partnership, we recognise the importance of supporting our leading veterinarians’ participation in international conferences, to ensure they remain up to date, and able to disseminate this knowledge to the wider CAV membership.

The scholarship is open to both CAV members and nonmembers. Successful applicants are usually specialists in their field, but we also support those who have developed advanced skills in an area of special interest. There are two funding rounds each year, in March and September. We gratefully acknowledge Hill’s Pet Nutrition as the principle sponsor, along with the support we receive from the School of Veterinary Sciences at Massey University. The closing date for this application round is 31 October. For more information, check out the CPD section of the CAV website (https://www.nzva.org.nz/branches/cav/ scholarships/), or email Lorelle Barrett at cav@vets.org.nz.

Healthy Pets NZ Project Grant 2021 Healthy Pets NZ is a charitable trust that acts as the research funding arm for CAV. Funding applications are invited in March and September for research projects that will enhance companion animal health and welfare. See the Healthy Pets NZ website (www. healthypets.org.nz) to find out how we

WINNER

Article of the Issue

Hannah Cleary &

are supporting projects on analgesia for ovariohysterectomy, treatment of squamous cell carcinoma and FIV prevalence. Any queries on how to make an application or donate please email healthypetsnz@gmail.com.

"What is your diagnosis? Urachal diverticulum" June 2021 | Volume 32(2) | Pages 10, 34–6

Devon Thompson EyeVet Services Limited

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

News in Brief

Professor Boyd Jones receives Honorary Life Membership of the NZVA CAV are very proud to report that last June, a CAV Life Member, Professor Emeritus Boyd Jones was awarded life membership of the NZVA. The following is excerpted from Lotte Cantley’s nomination proposal.

Professor Jones is widely regarded by the veterinary profession in New Zealand as the ‘father of companion animal medicine’. He has the enormous respect of veterinarians both nationally and internationally. As well as his academic and scholarly achievements, he has served the profession through extensive involvement with the NZVA, the Australian and New Zealand College of Veterinary Scientists (ANZCVS) and the VCNZ. Boyd gained his BVSc in 1967 as one of first cohort of students that graduated from Massey University. In 1974 he attained membership of the Australian College of Veterinary Scientists (now the ANZCVS) in canine medicine, followed by fellowship of the ANZCVS in 1984. He is also a diplomate of the American College of Veterinary Internal Medicine a fellow of the Royal College of Veterinary Surgeons, and a diplomate of the European College of Veterinary Internal Medicine. Boyd has had a long and prestigious career at Massey University where he has taught undergraduate, clinical and postgraduate students for 22 years. He has had a major influence on the career development of many veterinarians in New Zealand, and was prominent in raising the profile of veterinary science on a national and global stage. In 1996, he moved to the University of Dublin, where he was Chair of Small Animal Clinical Studies and then Dean of Veterinary Medicine. He returned to Massey University in 2009 as Emeritus Professor, where his mentorship and support have been greatly valued. Although officially retiring in 2013, he has continued to mentor postgraduate students and to support the profession. Professor Jones has also had a long association and involvement with the NZVA. He was a founding member, in1973, of the Small Animal Society, later renamed the Companion Animal Society (CAS) and then the Companion Animal Veterinarians (CAV) branch of the NZVA. He served many years on the CAS executive committee and in 1994 he received the CAS Annual Service Award. Soon after this was he was honoured with life membership of the CAS in recognition of his service. He was editor of the CAS Newsletter (now Companion Quarterly) for many years. He continues to support the publication as a prolific author providing valuable continuing professional development resources for companion animal veterinarians in New Zealand. Boyd has also contributed significantly to the New Zealand Veterinary Journal (NZVJ) as both a board member and later chair of the board from

2015–2020. Professor Jones helped organise and contributed to multiple NZVA conferences over several decades, as well as consulting on education programmes. He was instrumental in the founding of the Companion Animal Health Foundation (now Healthy Pets NZ), to help fund research into companion animal health matters; and the Centre for Service and Working Dog Health. In his association with the ANZCVS, he has been variously an examiner, mentor and supervisor for candidates, as well as board member and president. In 2019 he received the ANZCVS College Oration award, which gives recognition to a veterinarian in Australia or New Zealand who has made a major contribution to veterinary science, especially contributions that have a global and lasting impact. Boyd was chairman of the VCNZ from 1995–1996, as well as chairing multiple committees for this organisation. In 2015 Professor Jones was awarded Officer New Zealand Order of Merit for services to veterinary science. His achievements exceed the criteria for Honorary Life Membership of the NZVA and he would be an extremely deserving recipient of this honour.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

Purina Pro Plan Veterinary Diets Webinar Series

A series of recorded webinars are available FREE (for both members and non-members) on the NZVA Online Learning platform VetScholar for a limited time. Nestlé Purina® PetCare’s advanced, therapeutic nutrition has been established by decades of research involving over 500 scientists globally and is backed by a team including veterinarians, behaviourists and nutritionists. l

I love dogs with epilepsy and here is how I manage them – Dr Holger Volk l Clinical research experiences with probiotics – Dr Mike Lappin l Water intake in cats: how much water should a healthy cat drink? – Dr Linda Fleeman Register your interest to gain access via the NZVA website. [https://www.nzva.org.nz/g/event-manager/ViewEvent/489]

Photo by Tuyen Vo on Unsplash

CAV President Natalie Lloyd joins the WSAVA Congress Steering Committee The role of the steering committee is to guide and strategically develop the annual WSAVA World Congress. It means New Zealand will have an opportunity to help shape the internationally well respected WSAVA conference. Natalie is very excited about this new role: “It's a huge honour to be part of a group whose purpose is to shape the incredible event that is the WSAVA Congress. Having attended one of these events in person and another virtually, I have experienced first-hand how comprehensive the content is. As part of my research for this role, I discovered that the Congress Steering Committee helps to provide companion animal veterinarians from other countries continuing education opportunities, and I am very excited about that aspect of the job. We are so lucky in NZ to be able to access high quality CPD. We don't realise how difficult this is for vets in many countries, where companion animal veterinary work is still developing in the face of more established primary industry roles.” Natalie will keep CAV members informed about the activities of the committee in upcoming issues of CQ and/or e-CAV. The 2021 Global WSAVA Congress will be held virtually on 13–15 November.

2021 WSAVA Global Community Congress

You are invited to attend the virtual WSAVA Global Community Congress, from 13–15 November 2021. WSAVA 2021 will be a unique world Congress, focusing on the work you do – the WSAVA members and worldwide community. Together we can work towards unified standards of care and a global voice, aimed at advancing the health and welfare of companion animals worldwide. We would also like to encourage all professionals who hold recent research findings to submit an abstract to have a chance to present their work internationally. Knowledge is what keeps us strong and sharing it with the world is crucial for moving forward.

Dates for your calendar: l

Abstract submission deadline: 1 August 2021 Early registration deadline: 12 October 2021 l WSAVA Global Community Congress: 13–15 November 2021 For more information about the Congress, program and abstract submission, visit the WSAVA 2021 website at wsava2021.com l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

What is your diagnosis? THE QUESTIONS… Dr Emily Ball, BVSc (Dist), Zoetis Intern at Veterinary Specialists Auckland 2021; Dr Devon Thompson, BVSc (Dist), MVS (Hon), MANZCVSc (Radiol), DipECVDI, Registered Specialist Veterinary Radiology; Dr Tommy Fluen, BSc, MSc, DVM, ANZCVS Fellow, Registered Specialist Small Animal Internal Medicine

Case history

A 10-year-old, entire male Bull Mastiff presented to the referring clinic with a 2-day history of haematuria, mild lethargy, and ongoing weight loss. On presentation, the dog was cachectic with mild caudal abdominal pain; physical exam was otherwise unremarkable. A complete blood count revealed no abnormalities. Serum biochemistry revealed a marked increase in alkaline phosphatase (956 IU/L; reference range 1–87 IU/L), mild hypochloraemia (100 mmol/L; reference range 106–117 mmol/L), mild hypercholesterolaemia (12.1 mmol/L; reference range 3.27–9.82) and mild hyperamylasaemia (2882 IU/L; reference range 0–1074 IU/L). Urinalysis was performed on a freecatch urine sample and revealed a urine specific gravity of 1.030 (reference range 1.015–1.045), urine pH 8.0 (reference range 6.0–7.5), urine blood 3+ and urine protein 3+. Urine glucose was negative. Urine sediment showed moderate numbers of magnesium ammonium phosphate (struvite) crystals, numerous red blood cells (reference range 1.1

Figure 1. Survey right lateral abdominal radiograph of a 10-year-old Bull Mastiff that presented with a 2-day history of haematuria and mild lethargy, and ongoing weight loss.

<5/high power field) and moderate numbers of white blood cells (5–10/high power field; reference range <5/high power field). No bacteria were seen on sediment exam. A single right lateral abdominal radiograph was obtained as part of the initial work up (Figure 1).

Questions

1. What are the radiographic findings? 2. What is the radiographic diagnosis? 3. What would be the next diagnostic step?

Answers on page 40

Contact: intern.emily@vsnz.co.nz

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

CAV update

The future of pet groomers in New Zealand The CAV committee and the NZVA veterinary team have recently been involved in several discussions about the future of the New Zealand pet grooming industry. We thought it would be useful for members to know about these discussions and what our advice has been to date. As mentioned in the CAV committee highlights in June, discussions were recently had with a representative of the National Dog Groomers Association of New Zealand (NDGA) about the role of groomers as part of an animal’s ongoing care. The NDGA is very keen to work alongside the NZVA in educating the public about responsible pet guardianship, and to ensure high standards of care are provided by their member groomers to animals under their care. Following this meeting, a summary document was provided to the NDGA by the committee that detailed advice about specific procedures groomers might undertake on animals. Subsequent to this conversation, the NZVA veterinary team was contacted by other veterinary colleagues who have been involved in discussions with Primary ITO about developing an NZQA-recognised qualification for pet groomers in NZ. Soon after this, Primary ITO opened the consultation process on the proposed qualification, to which the CAV committee/NZVA made a combined submission. The same advice given to the NDGA about specific procedures was provided as part of this submission. The following is the advice developed by the CAV committee:

Dental hygiene

Based on the criteria laid out in Section 16 of the Animal Welfare Act 1999, both sub-gingival scaling and extraction of teeth are veterinary-only procedures. There is no regulation in place to allow for non-veterinarians to undertake these procedures, therefore any groomer performing these procedures would be in breach of the Animal Welfare Act and liable for prosecution. We are aware that many groomers offer non-anaesthesia dentals (NAD) as part of their services. For clarity, we consider NAD to be the removal of tartar/calculus from the tooth crown of a conscious animal. The World Small Animal Veterinary Association (WSAVA) has stated non-anaesthesia dentistry represent a major animal welfare concern for the following reasons:

Ramiro Pianarosa for Unsplash

A comprehensive evaluation of dental pathology or meaningful subgingival treatment is not possible without proper anaesthesia. l The procedure is a cosmetic one only. The level of dental calculus is not an accurate indicator of dental disease – clients may therefore delay seeking appropriate treatment based on the animal having clean crowns. This may result in the animal being left with persistent infection, inflammation and pain. l The stress or discomfort incurred during non-anaesthetic dental procedures cannot be justified from either a medical or ethical standpoint.

Contact: cav@vets.org.nz

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

As such, WSAVA strongly objects to the practice of veterinary dentistry without appropriate anaesthesia. NZVA/CAV are also aligned in this view. Further points to note on groomers undertaking NAD: l There is personal risk (e.g. being

bitten) for the operator when performing NAD. l Scaling of the tooth crown only is unlikely to meet the criteria of a significant surgical procedure, however it should be noted that Section 15(4) of the Act clearly states that non-significant surgical procedures must not result in the animal being subjected to unreasonable or unnecessary pain or distress. It is our view that groomers’ dental hygiene activities should be limited to recognising healthy vs. unhealthy tissues/ teeth, and basic cleaning techniques (e.g. finger brushing with appropriate equipment and animal handling).

Expression of anal glands

Routine expression of anal glands at every groom is not indicated. Some animals will never have issues with emptying of anal glands, others will require frequent intervention.

Anal glands can be emptied by groomers when the animal shows signs of discomfort, such as: l

Scooting (frequently dragging its bottom along the ground) l Frequent licking around or near the anus However, it should be noted that these signs are not unique to anal gland issues alone. These signs can also be exhibited by an animal suffering from other disorders such as perineal dermatitis. When expressing anal glands, apply gentle pressure externally from behind the gland [acknowledged that this technique may differ from that used by veterinary staff]. Indications to discontinue the procedure include: l The animal shows signs of discomfort

or pain with only gentle pressure applied l There is external evidence of draining sinus tracts around the anus l The expressed material appears to contain blood or pus These issues suggest conditions such as anal gland abscesses or tumours are present. Clients should be advised to

seek veterinary assessment in these instances.

Ear plucking

It is now recognised that routinely plucking dogs’ ears is not a necessity. Plucking causes pain, and results in inflammation and in some cases infection. The exception may be when a dog suffers from chronic ear problems, to allow improved air circulation through the ear. In these instances, a veterinarian should determine the need for plucking. It is preferable to sedate these animals to avoid pain (these ears are often already sore) and ensure an appropriate amount of plucking. Trimming of ear hair can be safely undertaken by groomers as part of a routine groom.

Claws

Similar to the nail bed in humans, dog and cat claws have the ‘quick’ running in the centre of them. The quick contains nerves and blood vessels. If claws are cut too short, the quick may also be cut through leading to pain and bleeding. Exposure of the quick can also predispose to infection in the claw or the surrounding tissue bed. l

Letter to the Editor Dear Editor, I read the letter from Keara Brownlie in the latest edition of Companion Quarterly with much interest. As she discusses, there seems to be much debate and uncertainty around both whether or not FIV infection causes disease in New Zealand and the efficacy of the Fel-O-Vax vaccine to protect against FIV infection. However, I was struck by the passage that states that “a follow-up field efficacy study is desperately needed to provide further information for vets in NZ. While we await this follow up information, it is suggested that Fel-O-Vax FIV should still

be offered”. Shouldn’t we expect that Zoetis is able to provide information about efficacy before the release and promotion of this vaccine? Repeated vaccination is not without cost, both financial for clients, but also due to the increased risk of injection-site sarcomas due to repeated use of an inactivated-virus vaccine. It appears that two studies (one in Australia and one in New Zealand) have now reported no statistically different rates of FIV infection in vaccinated cats compared to unvaccinated cats. There are no field studies from other countries and, as Fel-O-Vax is now only being sold in

New Zealand, Australia, and Japan, field studies from elsewhere are unlikely. Veterinary science is an evidence-based profession and there is currently no evidence that Fel-O-Vax protects cats in New Zealand from infection with FIV. I sincerely hope that any research that Zoetis is currently performing to prove their vaccine is effective is published and made available to veterinarians soon. Without this evidence, it is difficult to see how veterinarians are able to recommend a seemingly ineffective vaccine to their clients. Regards, David Smith

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

CAV update

Understanding current veterinary advice about vaccination and socialisation in puppies: a CAV survey Lorelle Barrett,

NZVA Veterinary Manager (Companion Animals)

In late 2020, representatives from Companion Animals NZ approached the CAV committee about anecdotal reports that the messaging from veterinarians to puppy owners regarding vaccination and socialisation was highly variable. The concern was that inconsistencies in messaging was leading to confusion amongst puppy owners about the right thing to do for their puppy. The CAV committee and CANZ agreed to work together in 2021 to better understand the advice veterinarians are currently providing their puppy owners, and to assist with resources if veterinarians thought they were needed. The first step was to undertake a survey of NZVA members asking them to tell us about the advice they are currently providing to puppy owners. The online survey was run via SurveyMonkey for 6 weeks during May and June of this year and was open to all NZVA members. Notification of the survey occurred in e-CAV, Vet News emails, and on the NZVA member Facebook page. A summary of findings follows:

Jametlene Reskp for Unsplash

Demographics

The survey was completed by 113 veterinarians. Figure 1 shows the distribution of respondents’ geographical location and practitioner type (companion animal veterinarian in companion animal only practice, companion animal veterinarian in

Figure 1. Demographics of responding veterinarians (n = 113) by region and practitioner type. CA = companion animal veterinarian in companion animal only practice; CAM = companion animal veterinarian in mixed animal practice; M = mixed animal veterinarian.

Contact: cav@vets.org.nz

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

mixed animal practice, mixed animal veterinarian). The median year of graduation was 2001 (range 1976–2020).

Parvovirus risk and vaccination recommendations

Respondents were asked to estimate their local risk of parvovirus on a sliding scale from 1–100%. Figure 2 presents the mean estimated parvovirus risk for each region of New Zealand, as indicated by respondents from that region. Respondents were also asked the following: l Typical age recommended for starting

primary vaccinations. l Typical age recommended for finishing primary vaccinations. l Time interval between completing primary vaccinations and unrestricted access to the outside world. Figure 3 presents a summary of respondents’ recommendations for each of these questions. Eight weeks of age was the most recommended age for starting primary vaccinations (63.7% of respondents). Those who selected ‘Other’ for starting recommendations typically recommended the first vaccination between 6–8 weeks of age, and this was often associated with litters of puppies being presented by breeders for first vaccination prior to going to new owners. The most recommended age for finishing primary vaccinations was 16 weeks. There was some variation in recommendations occurring in the ‘Other’ category. These included: l

Finishing at 12 weeks for low-risk puppies vs. 16 weeks for high-risk (e.g. black and tan breeds) l Finishing age was dictated by starting age of vaccination, e.g. 8/12/16 week programme ī 6/10/14 week programme Recommendations for the time interval between the last primary vaccination and unrestricted access to the outside world were mixed. The most common recommendation was to wait 1 week after the last vaccination (51.3% of respondents), followed by 2 weeks (28.3%). The most common recommendation stated in the ‘Other’ category was to wait 10 days following

Figure 2. Mean estimated parvovirus risk (1–100%) by region, as indicated by veterinarians from that region (n = 113).

Figure 3. Summary of recommendations made by veterinarians (n = 113) for the age to start primary vaccinations in puppies (‘Recommended start age’), the age to finish primary vaccinations (‘Recommended finish age’), and the time interval to wait before allowing unrestricted access to the outside world (‘Recommended wait time after last vaccination’).

the last primary vaccination. However, a number of respondents also reported that they recommend limited access to the outside world after the 12-week vaccination for increased socialisation opportunities.

Socialisation recommendations

Respondents were asked about the types of socialisation activities they recommended that puppy owners undertake. A yes-or-no response was sought for whether they recommended puppy classes, and a free-text entry was offered when asking about additional socialisation activities. The free text responses were then reviewed and

theme categories were created based on the descriptions provided. The final additional socialisation categories were: l

‘Safe’ dogs: dogs that were vaccinated and on properties with no known parvovirus risk. l Car rides: taking puppy in the car when family is going out and about. l Carried in public: carrying puppy (in arms/carrier/pushchair etc.) out in public but not allowing them onto the ground. l Walked in public: e.g. on neighbourhood pavements, the beach at low tide, but generally avoiding areas with high dog traffic levels.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

Sights and sounds: exposure to everyday noises/sights, e.g. vacuum cleaners, noisy vehicles, hand-held objects such as umbrellas. l New people: meeting people outside of the immediate family, e.g. extended family, friends, children, the elderly etc. l Vet clinic visits: visits with no interventions/procedures performed, just positive interactions with veterinary staff. l Nothing else: no other socialisation activities recommended above puppy classes. Figure 4 presents the percentage of respondents that recommended different types of activities. The most recommended activities were puppy classes (96%) and interactions with safe dogs (86%). The most common reason for respondents not recommending puppy classes was a lack of local availability. Those that did not recommend anything beyond puppy classes considered that puppy classes provided sufficient socialisation opportunities. Respondents that recommended walking in public all came from regions where the mean percentage of parvovirus risk was considered to be less than 50%.

Figure 4. Types of socialisation activity recommended by veterinarians (n = 113). ‘Safe dogs’ = allowing contact with vaccinated dogs on properties with no known parvovirus risk; ‘Car rides’ = taking puppy in the car when family is going out and about; ‘Carried in public’ = carrying puppy (in arms/carrier/pushchair etc.) out in public but not allowing them onto the ground; ‘Walked in public’ = e.g. on neighbourhood pavements, the beach at low tide, but generally avoiding areas with high dog traffic levels; ‘Sights and sounds’ = exposure to everyday noises/sights, e.g. vacuum cleaners, noisy vehicles, hand-held objects such as umbrellas; ‘New people’ = meeting people outside of the immediate family, e.g. extended family, friends, children, the elderly etc.; ‘Vet clinic visits’ = visits with no interventions/ procedures performed, just positive interactions with veterinary staff; ‘Nothing else’ = no other socialisation activities recommended above puppy classes.

Confidence discussing risks

Respondents were asked to rate their confidence on a 5-point scale (from ‘Extremely confident’ to ‘Not at all confident’) for discussing with puppy owners the local risk of parvovirus and prevention strategies, and appropriate socialisation vs the local parvovirus risk. Figure 5 presents the level of confidence that respondents indicated for each question, stratified by practitioner type. Companion animal veterinarians tended to rate themselves as extremely confident or very confident when discussing both issues, whereas mixed animal veterinarians tended to rate themselves as either very confident or somewhat confident. There was no correlation between the mean percentage of regional parvovirus risk and respondents’ confidence in discussing either the local parvovirus risk (correlation coefficient = 0.07), or appropriate socialisation vs. local parvovirus risk (correlation coefficient =

Figure 5. Confidence of veterinarians (n =113) when discussing the local risk of parvovirus exposure and prevention strategies with puppy owners (‘Confidence discussing parvo risk’), and when discussing appropriate socialisation vs the local parvovirus risk (‘Confidence discussing socialisation vs parvo risk’). CA = companion animal veterinarian in companion animal only practice; CAM = companion animal veterinarian in mixed animal practice; M = mixed animal veterinarian.

0.00). Confidence discussing the local parvovirus risk was strongly correlated with confidence discussing appropriate socialisation vs. local parvovirus risk (correlation coefficient = 0.81).

Provision of resources

Respondents were asked to rank the usefulness of possible resources about puppy socialisation. Table 1 summarises

the percentage of respondents that ranked each possible resource as either Very useful, Somewhat useful, Neutral, Somewhat unuseful, or Not at all useful.

Commentary on survey findings

The data on vaccination recommendations indicates that there

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

is good alignment within the surveyed respondents on when vaccinations should commence in puppies. However, there are some disparities with the recommended age of finishing a primary vaccination course, and recommendations for how long to wait after the last vaccination before unrestricted access to the outside world should occur. Although the level of confidence discussing appropriate socialisation was generally high amongst respondents, the data on recommended socialisation activities indicates that there is scope for veterinary teams to broaden their discussions with puppy owners about what appropriate socialisation can include. Positive exposure to a wide variety of experiences is a cornerstone of growing happy, confident dogs. Provision of resources such as client handouts or socialisation checklists may aid both veterinarians and clients in future discussions about puppy socialisation.

Table 1. Responding veterinarians’ (n = 113) assessment of the usefulness of possible resources about on puppy socialisation. Results are the percentage of respondents. Very useful Somewhat useful

Printable client handouts Printable posters for clinic Owner checklist of socialisation activities CPD for vets/nurses about puppy socialisation Educational articles about puppy socialisation

Neutral

Somewhat unuseful

Not at all useful

69 32 60

22 36 24

23 27 13

1 3 3

0 2 1

201

It is interesting to note that the advice to take puppies out walking in public prior to completion of their primary vaccination course comes from practitioners who rate their local risk of parvovirus as less than 50%. This may provide some insight into the anecdotal reports that puppy owners are receiving conflicting advice from veterinarians about whether it is appropriate to take the puppy into the outside world. There is unlikely to be a one-size-fits all answer to this, as the types of socialisation activities that can be safely undertaken by owners may vary based on the local risk of parvovirus. Veterinarians therefore need to help puppy owners understand the breadth of socialisation activities that can be safely undertaken relative to the risk of local parvovirus exposure, and that the advice provided for that owner’s situation may differ to advice given to their family/friends/colleagues because of variations in parvovirus risk.

Coming up next issue

Nima Naseri for Unsplash

A review of the current science on parvovirus vaccination and immunity in puppies. l Redefining what socialisation in puppies means. l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

CLINICAL update

Life without ACTH – hypoadrenocorticism Simon Clark is an associate at the Hamilton Small Animal Veterinary Centre (HSAVC) and a member of the CAV Executive Committee. Here he describes how adrenal diseases in companion animals have been diagnosed and managed in his clinic since Synacthen became unavailable, reducing the use of the ACTH stimulation test. This second of two articles discusses the options for diagnosis and monitoring of hypoadrenocorticism in dogs and cats without Synacthen.

Simon Clark , BVSc, MVM The ACTH stimulation test measures the adrenal gland’s response to an I/V injection of ACTH (Adrenocorticotropic hormone). ACTH is no longer extracted from cadavers, and a synthetic ACTH product is commercially available for human use, called Synacthen (SynACTH-en). Synacthen (Tetracosactide hexaacetate) is not a brand, but more akin to a nickname for an active ingredient. There are many different products containing Synacthen as the active ingredient. Some of these are licensed for human use in New Zealand, some are not. None are licensed for veterinary use in New Zealand. Synacthen became unavailable for purchase a few years ago because the only brands stocked by New Zealand distributors were listed under Section 29 of the Medicines Act (see Box 1). When this occurred, veterinarians at HSAVC divided up what they had into small aliquots and froze them. Even though some Synacthen products are licensed for human use, and so available for discretionary veterinary use, this availability is intermittent and unpredictable. I discussed how to diagnose hyperadrenocorticism and hypoadrenocorticism and how to monitor my patients with Sandra

Box 1: Section 29

Section 29 medicines are human medicines that are non-consented. These medicines don't have a current product registration with MedSafe (similar to a veterinary medicine being registered with ACVM), so according to Section 29 of the Medicines Act 1981 they can still be sold to and used by registered medical practitioners, but they cannot be sold to or used by anyone who isn't a registered medical practitioner (i.e. veterinarians). The Medicines Act is overseen by the Ministry of Health (MoH), and is therefore outside of the jurisdiction of MPI’s ACVM group. The Act went under review in 2019, and NZVA/VCNZ made a combined submission that addressed the animal welfare impacts of veterinarians not having access to Section 29 medicines. The MoH is still in the review process. Medications that fall under Section 29 may be imported by veterinarians through a Special Circumstances Approval process via MPI. The information can be found at: https://www.mpi.govt.nz/processing/agricultural-compounds-and-vet-medicines/veterinarymedicines/getting-a-veterinary-medicine-authorised/authorisation-of-veterinary-medicines-underspecial-circumstances/. MPI only issues the approval, they do not help facilitate the importation process. Some veterinary wholesalers may be able to assist with importation of products, on a case-by-case basis.

Forsyth, a clinical pathologist at SVS Laboratories and reviewed the 4th Edition of Canine and Feline Endocrinology (Feldman et al. 2015). Based on these sources I have been adopting new tests, and have found the options for diagnosing hyperadrenocorticism faster, easier and cheaper, and therefore much more convenient for the client than the tests using Synacthen. The ACTH stimulation test remains the gold standard for diagnosing hypoadrenocorticism. As hypoadrenocorticism is less common than hyperadrenocorticism, avoiding the use of Synachten on patients suspected of hyperadrenocorticism, as discussed in the first of these two articles, will save our reserves for diagnosing hypoadrenocorticism.

Summary of hypoadrenocorticism

The cortex of the adrenal gland produces three classes of hormones. Glucocorticoids (cortisol), mineralocorticoids (aldosterone) and androgens. Naturally occurring adrenocortical insufficiency in the dog has been recognised since the 1950s. The disease was first recognised in cats in the 1980s and has been much less researched leading to limited understanding of the disease in this species. Therefore, the following discussion will focus on diagnosis and monitoring in dogs. There are a variety of causes of hypoadrenocorticism including tumours, infections, autoimmune disease, and

Contact: Simonthevet@gmail.com

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

Monitoring

Addisonian crisis

are also present (i.e., hyponatraemia and hyperkalaemia). If the disease originates in the pituitary gland (i.e. secondary hypoadrenocorticism), only glucocorticoid function will be affected. Mineralocorticoid secretion is usually preserved. In about 30% of patients with primary hypoadrenocorticism electrolyte concentrations are normal – this is referred to as “atypical” hypoadrenocorticism.

Summary

Diagnosis of hypoadrenocorticism

A study of 123 dogs with clinical signs suspicious of hypoadrenocorticism (110 with non-adrenal disease and 13 with hypoadrenocorticism) showed that a cut-off for basal cortisol concentration (i.e. unstimulated by Synacthen) of 55 nmol/L was 100% sensitive for hypoadrenocorticism (Lennon et al. 2007). It is important to understand that while basal cortisol is helpful in ruling out hypoadrenocorticism, it is not adequate to confirm the diagnosis since some healthy dogs with a normal pituitary-adrenal axis have low basal cortisol concentrations.

genetic disorders. Interested readers are encouraged to learn more (see Feldman et al. 2015). Disease originating in the adrenal gland is referred to as primary hypoadrenocorticism, and disease originating in the pituitary gland is referred to as secondary hypoadrenocorticism.

Addisonian crisis is where a patient is severely hyperkalaemic, and coma and death are direly imminent. Rapid recognition and treatment of this syndrome are necessary to save the patient. A classic component of presentation is signs of hypotension and poor perfusion (weak pulses, slow capillary refill time, low blood pressure) but with normal or reduced heart rate instead of the expected tachycardia that is usually seen with shock.

Clinical presentation

Glucocorticoid deficiency leads to hypotension, hypoglycaemia, anorexia, vomiting, diarrhoea, muscle weakness, and inability to maintain vascular tone and endothelial integrity. Mineralocorticoid deficiency, which was discovered in humans in the 1930s and is the most life-threatening part of hypoadrenocorticism, leads to hyponatraemia, hyperkalaemia, hypochloraemia and metabolic acidosis. Naturesis and consequent loss of the renal medullary concentration gradient leads to polyuria and compensatory polydipsia. Some patients present in Addisonian crisis before they are diagnosed with hypoadrenocorticism.

Basal cortisol assay

Low cortisol concentration in the serum of a stressed dog is highly suspicious of glucocorticoid deficiency. Low aldosterone concentration is assumed to also be present if matching electrolyte abnormalities

Urinary cortisol:creatinine ratio

Recent conference proceedings have discussed how UCCR can be used to diagnose hypoadrenocorticism. One article (Rowland et al. 2018) claimed that a cut-off ratio of <3 was 100% sensitive and 100% specific. Further study will verify this claim, but this finding makes UCCR a much better option for investigating hypoadrenocorticism than basal cortisol.

ACTH stimulation test

This test remains the gold standard for diagnosing hypoadrenocorticism, and if stocks of Synachthen are low or intermittently available to veterinary practitioners, this product should be frozen and saved for investigating suspected hypoadrenocorticism patients and not wasted on suspected hyperadrenocorticism patients. It should certainly not be wasted on monitoring hyperadrenocorticism patients where a pre-trilostane cortisol assay is just as effective, faster and less expensive.

As it is the mineralocorticoid deficiency that makes most hypoadrenocorticism patients unwell, and most are maintained only mineralocorticoid supplementation (e.g. fludrocortisone acetate), monitoring usually consists only of measuring the electrolytes sodium and potassium. There is no value in repeating ACTH stimulation tests.

Hypoadrenocorticism is much less common than hyperadrenocorticism, but it is often on our differential list for a wide variety of presentations. Starting with a UCCR for patients suspected of hypoadrenocorticism is a good early, inexpensive way to rule hypoadrenocorticism in or out, the same as it is for our patients suspected of hyperadrenocorticism. If the UCCR is low, then proceeding to an ACTH stimulation test is the gold standard diagnostic test. Monitoring of patients under treatment is by biannual electrolyte assay. Saving the Synacthen that we can store frozen, divided into aliquots of one diagnostic dose, for diagnosing hyperadrenocorticism is the best option to care for our patients.

References

Feldman EC, Nelson RW, Reusch CE, Scott-Moncrieff JC, Behrend EN (Eds.) Canine and Feline Endocrinology (4th edtn.). Elsevier, St. Louis, MO, USA, 2015 Lennon EM, Boyle TE, Hutchins RG, Friedenthal A, Correa MT, Bissett SA, ... & Birkenheuer AJ. (2007). Use of basal serum or plasma cortisol concentrations to rule out a diagnosis of hypoadrenocorticism in dogs: 123 cases (2000–2005). Journal of the American Veterinary Medical Association, 231(3), 413–416. Rowland A, Birkenheuer AJ, Mamo L, Lunn KF. (2018). Comparison of Urine Cortisol:Creatinine Ratio and Basal Cortisol for the Diagnosis of Canine Hypoadrenocorticism. ACVIM 2018 l

As at the time of printing CAV have become aware that Synacthen is now available from Provet.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

Study REPORT

Serological survey of leptospiral antibodies in clinically unwell dogs in New Zealand Keara Brownlie BVSc, Companion Animal Veterinary Advisor, Zoetis

Aim

To investigate the prevalence of immunoglobulin M (IgM) positive antibody response to leptospirosis in clinically unwell dogs in New Zealand

Introduction

Leptospirosis is a spirochaete bacterial disease which affects all mammals worldwide. It is also considered one of the most common zoonotic diseases to affect humans globally with potentially fatal consequences (Levett 2001). Infected and carrier animals, including dogs, will shed leptospires in their urine. In this way, infection can spread to other species including humans. Dogs are recognised as a significant reservoir for human infection in tropical countries, but, although it has a temperate climate, cases have been attributed to contact with dogs in New Zealand (NZ) (Sanhueza et al. 2012; Thompson 2012). Due to relatively high rates of infection in humans (ESR 2019), considerable effort has been made to reduce the risk of human infection through staff education and livestock vaccination in high-risk agricultural industries such as dairy farming and abattoirs in NZ. Despite this, relatively little attention has been paid to the role of dogs in the infection cycle for leptospirosis in NZ. There are over 250 pathogenic serovars of Leptospira interrogans and borgpeterensii, in addition to nonpathogenic serovars of Leptospira biflexa. L. borgpeterensii serovars

Balcanica, Hardjo, Ballum, Taravossi and L. interrogans serovars Pomona and Copenhageni which are known to be endemic in the livestock, rodent and possum populations of NZ (Hathaway et al. 1981). Of those present in NZ, Copenhageni, Hardjo, Ballum and Pomona have been recognised internationally as causing disease in dogs (Miller et al. 2007). Antibodies to all of these serovars have been identified in dogs in NZ (O'Keefe et al. 2002). A 2013 survey of 655 samples submitted to veterinary laboratories established that serovar Copenhageni was found most commonly (10.3% of included dogs), with serovars Hardjo, Pomona and Ballum identified less commonly (3.5%, 1.1%, 0.8% respectively) (Harland et al. 2013b). The agricultural compounds and veterinary medicines (ACVM) register lists two leptospiral vaccines licensed for dogs in New Zealand, Leptoguard (Zoetis NZ, Auckland NZ) and Nobivac Lepto (MSD Animal Health, Upper Hutt, NZ). Both these vaccines contain inactivated Icterohaemorrhagiae which stimulates active immunity to both Icterohaemorrhagiae and Copenhageni serovars (Schoone 1989). The most recent serological survey of leptospiral antibodies in dogs in New Zealand concluded that there was no significant difference in the prevalence of positive leptospiral titres between dogs in the North and South Islands. However, there was uneven geographical distribution of samples submitted (Harland et al. 2013b). A recent survey on vaccination policies for dogs across New Zealand showed that 90/96 (94% )of responding veterinarians in the upper North Island often or always recommended vaccination of dogs against leptospirosis. In comparison,

52/66 (79%) of responding veterinarians in the South Island rarely or never recommended leptospirosis vaccination (Cave et al. 2016). This is in line with the anecdotal experience of Zoetis representatives speaking to veterinarians across New Zealand. There is a common perception that leptospirosis is diagnosed infrequently in dogs residing south of Lake Taupo and even more rarely in dogs south of Nelson. Anecdotally it is for this reason that veterinarians rarely consider testing unwell dogs for leptospirosis south of Nelson. Additionally, few veterinarians recommend vaccination against leptospirosis for dogs residing south of Taupo. Despite this, Zoetis representatives typically receive one to two reports of confirmed leptospirosis in dogs residing south of Nelson every year. The presenting signs of leptospirosis in dogs include pyrexia, anorexia, lethargy, vomiting, anaemia, uveitis, abortion, pulmonary haemorrhage and signs of renal and/or hepatic failure. Dogs can present with only mild, non-specific clinical signs such as fever, anorexia, depression and abdominal pain. Historically, diagnosis of leptospirosis in dogs has been considered challenging. For these reasons, dogs presenting with nonspecific clinical signs may be unlikely to be tested for leptospirosis and could be misdiagnosed, further perpetuating the perception that leptospirosis does not commonly affect dogs in Southern New Zealand. It is considered likely that leptospirosis is under-diagnosed in both working and pet dogs in NZ (Harland 2013a), particularly in regions where leptospirosis in dogs is considered rare, and where it may not feature on the differential diagnosis list for some

Contact: Keara.brownlie@zoetis.com

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

veterinarians. In the past, diagnosis of leptospirosis has been considered challenging by many veterinarians and it has been necessary to send samples to an external laboratory for analysis. This may also have contributed to lower rates of diagnosis. A new point-of-care lateral flow assay for diagnosis of leptospirosis (WITNESS Lepto) is now available in NZ. The WITNESS Lepto test detects the primary immune response (IgM) that develops within 1 week of exposure to any canine leptospire (Greene 2006) with 98% sensitivity, 100% specificity (Kodjo et al. 2016); (Troia et al. 2018) and 100% positive predictive value (Gloor et al. 2017). IgM antibodies detected by the WITNESS Lepto test predominate in the primary immune response and do not generally persist much beyond resolution of clinical signs. The availability of a reliable in-clinic test kit for leptospirosis facilitates easy, prompt diagnosis (or rule-out) of this disease. It is anticipated that the affordability of the WITNESS Lepto test will also reduce the number of canine leptospirosis diagnoses which are successfully treated with empirical antibiotic treatment for example due to pyrexia) but remain undiagnosed due to lack of owner funds. Other in-clinic tests are available in NZ such as the Idexx SNAP test which detects IgG. In one challenge study, seroconversion was detected using the WITNESS Lepto test by day 10 in all 32 affected dogs included in the study (Lizer et al. 2018). In contrast the Idexx SNAP test detected seroconversion in 3/32 dogs during the 2 weeks postchallenge. WITNESS Lepto has greater detection rates of canine leptospirosis on day 7 (87.5%) than traditional microscopic agglutination testing (MAT; 65.6%) (Lizer et al. 2017). Earlier detection of canine leptospirosis is particularly important to confirm the need for barrier nursing of these high-needs patients due to the potential zoonotic risk. The Idexx SNAP test has been reported to return positive results up to 12 months after vaccination against leptospirosis (Curtis et al. 2015). Vaccinal antibodies are also known to interfere with laboratory MAT testing. Vaccine interference is less likely with IgM-based WITNESS Lepto tests, as IgM does not persist for as long

as IgG after vaccination. On evaluation of WITNESS Lepto in recently vaccinated, healthy animals 110/110 samples tested negative when tested 21 or more days after vaccination (Data on file).

ongoing clinical signs. This was only appropriate if the results of the initial WITNESS Lepto test was negative and clinical signs had been present for <14 days at initial testing.

The availability of a new, reliable in-clinic test for rapid diagnosis of leptospirosis in dogs, combined with the ongoing disparity between vaccination practices and leptospirosis reports across New Zealand precipitated this study. We aimed to estimate the prevalence of leptospirosis among sick dogs presenting to veterinary clinics across New Zealand using the WITNESS Lepto test, with its superior sensitivity and specificity and lack of interference by IgG. Our objective was to determine the proportion of sick dogs presenting to veterinary clinics that yield a positive result to the WITNESS Lepto test.

Concurrent treatments were allowed, and animals were managed as deemed appropriate by the attending veterinarian in conjunction with the dog’s owner. Veterinarians were requested to complete the online questionnaire at the provided link for all tests completed. Testing procedure was to follow the instructions provided for WITNESS Lepto test. The sample collected could be whole blood (with EDTA), serum or plasma and samples should always have been collected with a sterile needle and syringe. Blood samples could be taken from unwell dogs as part of a diagnostic work up and specifically for this study, or from blood drawn for other clinical reasons such as for a serum biochemistry panel. Clinics were requested to contact Zoetis to report positive test results so that follow-up testing of acute and convalescent phase plasma by MAT testing at an external laboratory could be performed for dogs testing positive for serovars Copenhageni, Hardjo, Pomona, Ballum and Tarassovi (funded by Zoetis). Data were collected into Microsoft Excel spreadsheet and descriptive statistics presented. Continuous variables were categorised so that all variables could be described as proportions. Confidence intervals were calculated for the outcome variable.

Methods

The study was approved by the Kaiawhina Animal Ethics Committee of the Estendart Research Centre, approval number AEC 010/19. A cross-sectional survey of unwell dogs presenting to veterinary clinics across New Zealand was conducted between July 2019 and January 2021. Zoetis representatives across New Zealand were provided with brief training on the study design, WITNESS Lepto test kits and study protocol summaries to be distributed free of charge to interested clinics. To be included in the study, participating veterinary clinics confirmed they were willing to follow study protocol, particularly around inclusion criteria and the completion of a brief, online questionnaire on the included animal’s clinical history and test results. Only unwell dogs showing clinical signs compatible with leptospirosis infection were eligible for inclusion in this study. To be eligible, dogs were required to have displayed at least one of the following clinical signs in the 14 days prior to sampling: anorexia, lethargy, pyrexia, vomiting, signs of renal and/or hepatic failure, anaemia, uveitis, abortion and pulmonary haemorrhage. Dogs that received a leptospirosis vaccination within 3 weeks of blood sampling were excluded. Dogs could be retested 7–10 days after the initial test if there were

Results

Five hundred WITNESS Lepto test kits were distributed to >50 veterinary clinics throughout New Zealand. In total, completed questionnaires for 105 dogs were received during the study period. There was a relatively even distribution of ages from 8 weeks to 18 years of age and 56% of dogs tested were female. A variety of breeds were represented and 24% of dogs had worked with livestock or wildlife in their lifetime. Unfortunately no responses were received from the Gisborne, Wellington, Tasman, Nelson and Marlborough regions (Figure 1). Dogs residing in both urban (51%) and Rural (49%) environments were represented. Of the dogs included, 58% had never received a vaccination against

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

leptospirosis: 30/61 dogs in the North Island had been vaccinated but only 1/44 dogs in the South Island had received a vaccine. Of the respondents, 91% (99/105) described the WITNESS Lepto test as being easy or very easy to use. In total, five positive cases (4.8% of samples) were identified and 3/5 of the dogs who tested positive for IgM antibodies using the WITNESS Lepto test had worked with livestock or wildlife and 4/5 would be considered as a working breed. One positive case was identified in each of the Hawke’s Bay, Bay of Plenty, Taranaki, Auckland and the Waikato. Three of the positive cases had never received a vaccination against leptospirosis. Three of these cases were identified during the summer months (November and December) and interestingly pyrexia was not listed as a clinical sign in any positive case. All positive cases presented with clinical signs of lethargy and renal and/ or hepatic failure. 4/5 positive cases presented with anorexia, and 3/5 with vomiting. Interestingly, pyrexia was not reported as a clinical sign for any positive dog. The clinical signs reported overall give an indication of clinical signs which prompt vets to test for leptospirosis in dogs. Lethargy and anorexia were identified as clinical signs in 91% and 83% of reports received, respectively, regardless of test outcome. Vomiting (54%) and pyrexia (38%) were also commonly reported alongside 36% of dogs showing signs of renal failure and 48% showing signs of hepatic failure, this is also regardless of test outcome. Follow-up MAT testing was conducted on 2/5 positive cases. The three remaining positive cases were lost to follow-up due to incompleteness. In one case, a two-fold increase in titre in acute and convalescent phase samples for Pomona and Copenhageni was supportive, though not confirmatory, that one of these serovars was the infecting serovar. For the other case, a four-fold increase in titre against Copenhageni, and two-fold increase in titre against Hardjo was supportive, though not confirmatory that Copenhageni was the infecting serovar. Overall, 5/105 (4.8%, 95% CI=1.6–10.8%) dogs were positive using the WITNESS

Figure 1. Region of New Zealand where dog selected for testing using WITNESS Lepto test kit resides

Lepto test. For dogs in the study from the South Island, based on 0/44 positive cases identified, the upper one-sided 95% exact confidence limit for the prevalence is 6.6%. For the North Island, based on 5/61 (8.2%) positive cases identified, the upper one-sided 95% exact confidence limit for the prevalence is 16.5%.

Discussion

The results of this study align with previously published work and anecdotal evidence on the prevalence of leptospirosis in dogs in NZ. O’Keefe et al. (2002) detected antibodies to leptospiral antigen in 14.2% of 466 samples from a serum bank of apparently healthy dogs in the lower North Island. Harland et al. (2013) detected antibodies to leptospiral antigen in 10.3% of 655 samples submitted to external veterinary laboratories from the lower North Island and South Island of NZ. Although the overall proportion of sick dogs testing positive (4.8%) for leptospirosis in this study is lower than that reported in previous studies (O'Keefe et al. 2002; Harland et al. 2013b), if the proportion of unwell dogs that were positive for leptospirosis is representative of NZ dogs as a whole, then this would suggest that there may be a large number of canine leptospirosis cases occurring annually. When comparing the prevalence of a positive test result between the North and South Islands, the precision, and

hence confidence intervals, of our estimates were likely limited by sample size. However, the estimated prevalence among unwell dogs presented to veterinary clinics with signs consistent with leptospirosis was <16.5% (95% upper one sided CI) in the North Island and less than 6.6% (95% upper one sided CI) for dogs residing in the South Island in this study. It is unclear why the prevalence was lower in our study than previous studies, but the sampled population likely contributes to this difference. We enrolled dogs that presented with any one of the applicable clinical signs and provided in house test kits to use free of charge. This lower prevalence is not likely to be due to reduced rates of disease, but more likely due to the broader sample set achieved in this study where vets were encouraged to test any dog that presented with any one of the applicable clinical signs and provided with in house test kits to use free of charge. This included mild and non-specific clinical signs such as anorexia and lethargy. Harland et al. 2013 relied on MAT testing of conveniencebased samples submitted to Massey University Teaching Hospital and NZVP for other diagnostic purposes. The increased cost and time involved in the process of submitting to an external veterinary laboratory means it is likely samples are only submitted where there is suspicion of serious illness. IgM

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

antibodies detected by the WITNESS Lepto test predominate in the primary immune response and do not generally persist much beyond resolution of clinical signs. In contrast MAT titres will persist and may give false positive results after vaccination or exposure (Schuller et al. 2015). As the Harland 2013 study looked for evidence of historic exposure (IgG) rather than recent active infection (IgM) in this study, this could also help account for the higher proportion of dogs with positive MAT titres to Leptospira spp. in the Harland 2013 survey. Multiple overseas studies have indicated the proportion of dogs with serological evidence of exposure to leptospirosis is higher than the proportion of dogs with confirmed cases of leptospirosis (Ellis 2010; Rojas et al. 2010; Sykes et al. 2011). This would suggest that subclinical infections are common, or that veterinarians are not diagnosing mild cases of leptospirosis. It was felt that providing in-house test kits free of charge and encouraging veterinarians to test any dog that presented with any clinical sign consistent with leptospirosis would provide a larger sample in this study. Leptospirosis in NZ dogs is typically associated with acute renal and/or hepatic failure. Less than 50% of respondent veterinarians reported clinical signs and/or diagnostic results consistent with renal failure (36%) or hepatic failure (48%). The majority of respondents reported less specific clinical signs such as anorexia (83%), lethargy (91%), vomiting (54%) or pyrexia (38%). This suggests that veterinarians may be considering leptospirosis as a differential diagnosis in dogs that present with vague clinical signs as well as those with typical clinical signs of renal and/ hepatic failure. However, it is likely that this may have been encouraged by the provision and promotion of WITNESS Lepto test kits for the purposes of this study. Previous studies of Leptospira spp. infection in NZ dogs have considered MAT titres >96 as positive for leptospirosis. Harland et al. (2013b) considered the infecting serovar to be that generating the highest titre and that co-infection had occurred if there were two serovars with equally

high titres. However, the authors also noted that the interpretation of MAT testing for canine leptospirosis can be challenging. Generally, a single titre >1:800 in an unvaccinated dog with classic signs of canine leptospirosis is considered valid for a presumptive diagnosis of leptospirosis, although higher titres, ≥1:3200, are considered by some investigators to be a more reliable threshold for a positive test. It is possible that the lower cut points used to define a positive result in previous NZ surveys could contribute to the higher prevalence identified in these surveys. Because a single MAT may fail to detect antibodies in the early phase of disease or may give false positive results after vaccination or exposure in enzootic areas (Barr et al. 2005), the authors of the Consensus Statement of the American College of Veterinary Internal Medicine and of the European Consensus Statement on Leptospirosis in Dogs and Cats recommend paired serologic testing. A 4-fold change in MAT convalescent titre compared with the baseline titre is consistent with active infection (Goldstein 2010; Sykes et al. 2011; Schuller et al. 2015). Interpretation of the MAT is further complicated by the high degree of cross-reaction that occurs between the different serogroups, especially in acute phase samples (Greenlee et al. 2005). Dogs often have similar titres to all serovars of an individual serogroup and at the same time, higher titres to a serogroup unrelated to the infecting serogroup (Levett 2001). This crossreactivity in the acute phase, followed by relative serogroup-specificity in the convalescent phase, results from the detection in the MAT of both IgM and IgG antibodies and the presence of several common antigens among leptospires (Schuller et al. 2015). Additionally, both the MAT and the ELISA that detects canine IgG suffer from the same limitations; namely, they may not detect antibodies early in the course of infection but do detect their presence as a result of vaccination (Schuller et al. 2015). This may also have impacted the results of previous NZ surveys. Despite widespread use of the MAT for the diagnosis of leptospirosis in dogs, investigators have noted that the test lacks the degree of sensitivity,

specificity, and repeatability expected of a reference standard test (Midence et al. 2012). Serovar cross reactivity has been observed even when dogs have been experimentally infected with a single known serovar (including Copenhageni and Pomona) (Lizer et al. 2018). The US ACVIM and European Consensus Statements on leptospirosis in dogs both highlight that determination of infecting serovar by MAT testing is flawed due to the high levels of cross reactivity between serovars as well as serogroups (Sykes et al. 2011; Schuller et al. 2015). Anecdotally there has been an increase in awareness of leptospirosis in the South Island of New Zealand due to ongoing reports of sporadic leptospirosis cases in this region. Interestingly, no results were received from the Upper South Island region, despite anecdotal reports of increasing vaccination against and prevalence of canine leptospirosis in this region. Despite the finding of Harland et al. in 2013 that there was no statistically significant difference in prevalence of leptospirosis between the North and South Island, anecdotal reports suggest that there has been no increase in vaccination rates against leptospirosis in the South Island. In this survey, 58% of dogs had never been vaccinated against leptospirosis; 30/61 (49%) dogs in the North Island had been vaccinated but only 1/44 (2%) dogs in the South Island were reported to have received a vaccine. This suggests a need for ongoing promotion of awareness among owners and veterinarians of the importance of maintaining vaccination against this potentially fatal disease. It is recognised that the addition of a licensed canine leptospirosis vaccine providing cross protection against a broad range of serovars (e.g. Hardjo and Pomona) would be useful in NZ, although Harland et al. (2013) and O’Keefe (2002) both identified Copenhageni as the most common serovar. During the study period of this report, Zoetis received anecdotal reports of two cases of leptospirosis in dogs from suburban Christchurch. 4/5 WITNESS Lepto test positive dogs identified in this survey were reported as residing in a rural setting. 3/5 dogs had worked with livestock or wildlife and 4/5 were

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

classed as working breeds. This differs from the findings of Harland et al. (2013) which concluded that small breeds (considered less likely to be working dogs) did not have a lower prevalence of Copenhageni titres than other breeds. It is likely that this difference is due to the small sample size included in this current study, and possible selection bias of veterinarians selecting dogs considered higher risk for leptospirosis for inclusion in this survey. Although the Ministry of Internal Affairs lists 574,349 dogs registered on the national dog database in 2020, according to Companion Animal NZ 2020 survey data there are a total of 851,000 dogs in NZ and 44% of these live rurally (Anonymous 2020). It has been estimated that there are 200,000 working dogs in NZ (O'Connell et al. 2019), which is equivalent to the proportion of working dogs represented in the survey (24%). Exposure to Leptospira spp. organisms is considered common in dogs in New Zealand (O'Keefe et al. 2002; Harland et al. 2013b), with zoonotic potential and possibly fatal consequences. As recommended by the WSAVA vaccination guidelines group, vaccination should be recommended on a risk/benefit basis. Risk factors for leptospirosis in dogs in New Zealand include access to livestock, wildlife and water courses. (Policy 2017) Due to the non-specific nature of presenting clinical signs, veterinarians are encouraged to keep leptospirosis on their differential list, regardless of geographic location. The zoonotic potential of canine leptospirosis and potential for rapid progression of clinical disease, combined with the poor performance of other available tests for leptospirosis early in the course of clinical disease, make the WITNESS Lepto IgM test a useful addition to diagnostic tests available for diagnosis of leptospirosis in NZ. The availability of reliable, simple, non-serovar specific, in-clinic lateral flow assays should facilitate faster diagnosis of leptospirosis in dogs and allow the disease to be ruled out cost effectively in dogs with vague clinical signs. The use of in-clinic tests combined with information from local pathologists, will also allow veterinarians to develop deeper

understanding of the prevalence of leptospirosis in their specific regions on which to base vaccine recommendations. This study provides updated information on the prevalence of leptospirosis among sick dogs presenting to veterinary clinics across New Zealand. The overall prevalence of 4.8% among sampled dogs highlights the importance of continued awareness of leptospirosis in dogs in New Zealand. Vets should consider using the WITNESS Lepto test for dogs presenting with vague clinical signs as well as more typical clinical signs associated with hepatic and renal failure. Although no cases of leptospirosis were identified in the South Island as part of this study, ongoing sporadic reports of confirmed cases in the South Island from laboratories suggest that vets should keep leptospirosis on their differential diagnosis list and consider recommending vaccination following risk/benefit analysis. Further studies on the prevalence and epidemiology of leptospirosis in New Zealand would improve our understanding of the potential zoonotic risk, successful case treatment and provision of advice on vaccination for dogs across NZ.

Oliver Young of VetSouth, Gore holds the iSTAT handheld blood analyser they received as the randomly selected winner of the prize draw for clinics who completed the online survey.

Acknowledgements

This study could not have been undertaken without the support of all the veterinarians across New Zealand who completed this survey, thank you for your time. Thanks also to the team at Zoetis who assisted extensively with test distribution, clinic education, study design and review.

References

Anonymous. Companion Animals New Zealand. Auckland, New Zealand, 2020 Barr SC, McDonough PL, ScipioniBall RL, Starr JK. Serologic responses of dogs given a commercial vaccine against Leptospira interrogans serovar pomona and Leptospira kirschneri serovar grippotyphosa. American Journal of Veterinary Research 66, 1780–4, 2005 Cave NJ, Jackson R, Bridges JP. Policies for the vaccination of cats and dogs in New Zealand veterinary practices. New Zealand Veterinary Journal 64, 145–53, 2016 Curtis, Stillman M, Lappin. Performance of a recombinant LipL 32-based rapid in-clinic ELISA (SNAP Lepto) for the detection of antibodies against Leptospira in dogs. International Journal of Applied Research in Veterinary Medicine 13, 182–9, 2015 Ellis WA. Control of canine leptospirosis in Europe: time for a change? Veterinary Record 167, 602–5, 2010 ESR. Annual Notifiable Disease Tables by age, sex, ethnic group 2019. Institute of Environmental Science Research (ESR) Report, 2019 Gloor CI, Schweighauser A, Francey T, Rodriguez-Campos S, Vidondo B, Bigler B, Schuller S. Diagnostic value of two commercial chromatographic "patient-side" tests in the diagnosis of acute canine leptospirosis. Journal of Small Animal Practice 58, 154–61, 2017 Goldstein RE. Canine leptospirosis. Veterinary Clinics of North America: Small Animal Practice 40, 1091–101, 2010 Greene. Leptospirosis. In: Infectious Diseases of the Dog and Cat. 3rd ed, 403–5, Saunders Elsevier, Philadelphia, PA, USA, 2006 Greenlee JJ, Alt DP, Bolin CA, Zuerner RL, Andreasen CB. Experimental canine leptospirosis caused by Leptospira interrogans serovars pomona and bratislava. Am Journal of Veterinary Research 66, 1816–22, 2005 Harland A. Disease under-diagnosed in NZ working and pet dogs. VetScript 26, 19–20, 2013a Harland AL, Cave NJ, Jones BR, Benschop J, Donald JJ, Midwinter AC, Squires RA, Collins-Emerson JM. A serological survey of leptospiral antibodies in dogs in New Zealand. New Zealand Veterinary Journal 61, 98–106, 2013b

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Hathaway S, Blackmore D, Marshall R. Leptospirosis in free-living species in New Zealand [Wildlife]. Journal of Wildlife Diseases 17, 1981 Kodjo A, Calleja C, Loenser M, Lin D, Lizer J. A Rapid In-Clinic Test Detects Acute Leptospirosis in Dogs with High Sensitivity and Specificity. Biomedical Research International 2016, 3760191, 2016 Levett PN. Leptospirosis. Clinical Microbiology Reviews, 296–326, 2001 Lizer J, Velineni S, Weber A, Krecic M, Meeus P. Evaluation of 3 Serological Tests for Early Detection Of Leptospiraspecific Antibodies in Experimentally Infected Dogs. J Veterinary Internal Medicine 32, 201–7, 2018 Lizer J, Grahlmann M, Hapke H, Velineni S, Lin D, Kohn B. Evaluation of a rapid IgM detection test for diagnosis of acute leptospirosis in dogs. Vet Rec 180, 517, 2017 Midence JN, Leutenegger CM, Chandler AM, Goldstein RE. Effects of recent Leptospira vaccination on whole blood real-time PCR testing in healthy client-owned dogs. J Vet Intern Med 26, 149–52, 2012 Miller R, Ross S, Sullivan N, Perkins N. Clinical and epidemiological features of canine leptospirosis in North Queensland. Australian Veterinary Journal 85, 13–9, 2007

O'Connell A, Scott I, Cogger N, Jones BR, Hill KE. Parasitic Nematode and Protozoa Status of Working Sheepdogs on the North Island of New Zealand. Animals (Basel) 9, 2019 O'Keefe J, Jenner J, Sandifer N, Antony A, Williamson N. A serosurvey for antibodies toLeptospirain dogs in the lower North Island of New Zealand. New Zealand Veterinary Journal 50, 23–5, 2002 Policy NZVA. Vaccine use in New Zealand Cats and Dogs. In: (Ed. NZVA CAVbot). p 16. 2017 Rojas P, Monahan AM, Schuller S, Miller IS, Markey BK, Nally JE. Detection and quantification of leptospires in urine of dogs: a maintenance host for the zoonotic disease leptospirosis. Eur J Clin Microbiol Infect Dis 29, 1305–9, 2010 Sanhueza J, Heuer C, Wilson P, Benschop J, Collins-Emerson J, Dreyfus A, Sanhueza J. Update of multispecies leptospirosis in new Zealand. Proceedings of the Deer Branch of the New Zealand Veterinary Association, 93–9, 2012

Schoone GJ. An immunoprotective monoclonal antibody directed against Leptospira interrogans serovar copenhageni. Journal of General Microbiology 135, 73–8, 1989 Schuller S, Francey T, Hartmann K, Hugonnard M, Kohn B, Nally JE, Sykes J. European consensus statement on leptospirosis in dogs and cats. J Small Anim Pract 56, 159–79, 2015 Study Report No. D866R-US-14-015. Zoetis Inc, Data on file Sykes JE, Hartmann K, Lunn KF, Moore GE, Stoddard RA, Goldstein RE. 2010 ACVIM small animal consensus statement on leptospirosis: diagnosis, epidemiology, treatment, and prevention. J Vet Intern Med 25, 1–13, 2011 Thompson J. Leptospirosis in dogs in New Zealand. Vetscript 25, 811–, 2012 Troia R, Balboni A, Zamagni S, Frigo S, Magna L, Perissinotto L, Battilani M, Dondi F. Prospective evaluation of rapid point-of-care tests for the diagnosis of acute leptospirosis in dogs. Vet J 237, 37–42, 2018 l

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 32 No 3 | September 2021

case study

“Shake and Bake” – metaldehyde toxicity in a dog Ryan Philips, BVSc

Introduction

Poisoning of companion animals are commonplace in general practice. Often the clinical signs seen may not guide the clinician to any specific treatment option, and as a result a generic approach to toxin decontamination is taken (Tinson and Cook 2020). Since the toxin ingested is often not known, management and prognosis can be hard to define for the client. Many toxins affect the central nervous system with clinical signs ranging from mild ataxia to severe status epilepticus. Metaldehyde (the active ingredient in a variety of slug and snail bait products), is a toxin that can cause severe neurological signs. Together, these signs are often termed ‘shake and bake syndrome’ due to severe seizure and tremor-like activity and severe hyperthermia (Castle et al. 2017). This case report will describe the management and outcome of a case of metaldehyde toxicity in a dog, and some potential novel approaches to the treatment of this toxicity in a general practice setting.

Case history

A 2-year-old, neutered male Husky, weighing 40 kg, was presented for status epilepticus, severe muscle fasciculations and hypersalivation. Approximately 2 hours before arriving to the clinic, the owners believed the dog had eaten some type of toxin from their garage. Up until the incident the patient had no previous health concerns.

Clinical findings

The dog was carried into the treatment room and was able to hold himself in sternal recumbency. He was panting but thoracic auscultation was difficult due to the severe muscular fasciculations throughout his body. His pulse rate was 160, pulse quality was good, mucous membranes were pale pink and his capillary refill time was under one second. His rectal temperature was 39.5°C. The neurological exam revealed: bilateral miosis, the absence bilaterally of pupillary light reflexes, palpebral and menace responses. The patient also exhibited severe body tremors and hypersalivation, which transitioned to lateral recumbency and status epilepticus within 15 minutes Contact: Ryanp@vet111.co.nz

Photo credit: Ryan Philips with permission of the owner

of presentation. Muscle fasciculations were observed over the entire body but were particularly severe in the hindlimbs and facial muscles. Tremors worsened when loud noises or any part of his body were touched indicating hyperaesthesia, this soon disappeared once the status epilepticus developed.

Initial management

The clinical findings were not specific for any particular toxin. As a result, a generic approach to treatment was undertaken to try and decontaminate the toxin from the dog. Clinical signs such as tremors, hypersalivation, hyperaesthesia and seizures were consistent with metaldehyde toxicity, whereas other clinical signs such as constricted pupils and the multiple cranial nerve deficits were not. Other differentials considered were organophosphate insecticide ingestion and trauma (Teichmann-Knorrn et al. 2020).

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

Intravenous catheters were placed in both cephalic veins. Blood samples for a complete blood count and baseline biochemistry panel were taken, the results of which showed no significant changes. Urinalysis was not conducted. To begin controlling the seizure activity, 1 mg/kg diazepam (Pamlin; Ceva Animal Health NZ, Auckland, NZ) was administered through one I/V access point. The other I/V access point was used to administer 0.9% sodium chloride (Baxter, Sydney Australia) at 5mL/kg/hour. I/V fluid therapy helps to maintain perfusion, correct acid-base abnormalities caused by many toxicities, and promote diuresis and thus excretion the toxin (if the toxin is metabolised and excreted via the kidneys). A second dose of diazepam was given 30–40 minutes later. However, the response was limited as the dog continued to seizure. It was then decided to induce general anaesthesia with I/V 3 mg/kg alfaxalone (Alfaxan; Jurox, Rutherford, Australia), intubate the patient and maintain anaesthesia with 1–2% isoflurane. The patient was kept at stage 3, plane 2 of anaesthesia for approximately 1 hour. A veterinary nurse was present to monitor the anaesthesia at all times. During this time, I/V 0.5mg/kg metoclopramide (Metoclopramide; Pfizer, Auckland, NZ) was started along with 1 mg/kg maropitant (Cerenia; Zoetis, Auckland, NZ), to promote gastrointestinal motility and prevent aspiration once the patient was awake. During this time, the patient also underwent gastric lavage. This was accomplished by pre-measuring a large bore gastric tube to the last rib, to determine the maximum length of insertion. Once the tube was inserted, 10 cycles of 1–2 L of warm water was fed through the tube via gravity, and then emptied by creating a siphon. A considerable amount of small green pellets was retrieved which were later identified as slug bait. This was confirmed by the owner finding a box of slug bait in his garage that looked two-thirds eaten. The active ingredient of the bait was metaldehyde. During the gastric lavage, large amounts of the slug bait passed out along with faeces as the patient developed severe diarrhoea. Once clear fluid began to be siphoned

out of the stomach, 2.5 g/kg of activated charcoal (Carbosorb X; Phebra, Sydney, Australia) was fed through the gastric tube, followed by 500 mL of warm water. Before removal of the gastric tube, air was blown into the tube, it was then kinked and removed in one smooth motion. This allowed any remaining fluid and activated charcoal to enter the stomach and prevented fluid leaking out of the tube as it was removed. The patient remained anaesthetised for another 40 minutes with his head slightly lower than his body to promote any additional fluid to drain out. During recovery, the endotracheal tube remained in place with the cuff inflated until the patient started to wake up. The patient was then recovered in a dark room in lateral recumbency, with the head elevated to reduce the risk of aspiration. The eyes were covered, and cotton balls placed in his ears to reduce noise and light triggering hyperaesthesia. After the anaesthetic recovery, the patient’s tremors were difficult to manage. Multiple I/V boluses of alfaxalone were used with no significant long-lasting resolution. Three low I/V doses (0.005 mg/kg) of medetomidine (Domitor; Zoetis NZ) were later administered. This was partially successful as the tremors seemed to reduce in severity. As the third dose of medetomidine began to wear off, the patient began to regain his palpebral reflex and showed improvements in pupillary light reflex. Approximately, 12 hours after admission the patient relapsed back to severe tremors, status epilepticus, and hyperthermia with a rectal temperature of 41°C. Active cooling was instituted with air conditioning and wet towels placed over the patient. This was stopped when the rectal temperature reached 39.5°C. At the same time a constant rate infusion (CRI) of 0.015 mg/kg/minute propofol (Aquafol; Ceva Animal Health) was begun (alfaxalone was not continued due to a stock shortage). As there were no syringe infusion sets available to allow easy administration of the CRI, an empty 0.9% sodium chloride bag was used and the propofol was diluted appropriately with 0.9% sodium chloride. An ordinary drip pump was then used to administer

the CRI at the desired rate which was titrated to effect. The remaining I/V line was used to administer 0.9% sodium chloride at maintenance rates with additional fluids to account for losses due to diarrhoea. The propofol CRI significantly reduced the seizure activity. The patient remained on the CRI for 6–7 hours, which during the morning was slowly reduced and titrated to effect. As the CRI was reduced over the day, the patient’s palpebral reflex, pupillary light reflex and consciousness began to improve. At the same time, there was no longer evidence of slug bait pellets in the faeces. There was also indication that the activated charcoal had fully passed through the digestive system as it was now seen in the patient’s faeces. The patient was rotated every 2–3 hours and approximately 24 hours after admission, began to lift his head, eat, and drink. There were still mild muscle fasciculations and tremors, but the patient was conscious and no longer in status epilepticus.

Outcome

Three days after admission the patient was walking, eating, drinking and toileting normally. He was discharged later that day with no notable clinical abnormalities. Serum biochemistry parameters measured at 24 and 72 hours showed decreasing alkaline phosphatase activities (which had not been particularly high to begin with). Activity of alanine aminotransferase was just above normal 24 and 72 hours after ingestion. No other significant changes to serum biochemistry were noted. Administration of activated charcoal, metoclopramide, omeprazole, and oral diazepam were continued for 1 week after admission to promote further decontamination, protect mucosal surfaces and reduce any minor muscular fasciculations.

Discussion

Metaldehyde is a pesticide that is commonly used to kill garden slugs and snails. Unfortunately, metaldehyde is attractive to mammals due to its taste and is the second most common toxin ingested by dogs after chocolate (Castle

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

et al. 2017). Metaldehyde intoxication has been aptly named ‘shake and bake syndrome’ as acute signs of seizure-like activity and hyperthermia are often seen (Bates et al. 2012). The exact mechanism for toxicity in mammals is not fully understood, but there is some speculation that metaldehyde may undergo gastric hydrolysis to form acetaldehyde which later disrupts the neurotransmitters gamma-aminobutyric acid (GABA), noradrenalin and serotonin (Bates et al. 2012; Bergamini et al. 2020). Disruption to the GABA system, which is the main inhibitory neurotransmitter in the nervous system, results in the convulsive clinical signs seen (Bates et al. 2012). As a result of the increased muscular and seizure activity hyperthermia develops (Yas-Natan et al. 2007). The biochemical findings seen in metaldehyde toxicity vary. In a retrospective study, Yas-Natan et al. (2007) describes that seizure activity can result in direct thermal damage to cells causing rhabdomyolysis, as a result, increases in biochemical parameters are most commonly muscular in origin rather than hepatic or renal. Yas-Natan et al. (2007) describes the main biochemical changes include increases in the activities of creatinine kinase, lactate dehydrogenase, aspartate aminotransferase, and alanine aminotransferase. In this case only alanine aminotransferase was increased, as the other parameters were not available to test. Increases in alkaline phosphatase could also be attributable to hepatobiliary damage, which is commonly seen 24–72 hours after exposure (Bates et al. 2012). Once again, this was not seen, as the alkaline phosphatase activity decreased over the duration of treatment. These variable biochemical changes highlight their non-specificity for metaldehyde toxicity. Conducting a repeatable and reliable neurological exam can be difficult especially if the patient is in status epilepticus. The cranial nerve deficits seen were not typical of metaldehyde toxicity. Bilateral miosis, and absence bilaterally of pupillary light reflexes, palpebral reflexes and menace response suggested a forebrain neurolocalisation

(Asokan et al. 2019). An important differential considered which include these cranial nerve deficits was organophosphate toxicity (Asokan et al. 2019). This was considered less likely as the dog and owner were not residing on a farm where these chemicals are commonly found. MacKay (2004) also describes that trauma can cause injury to the fore or midbrain which produces similar cranial nerve deficits but once again there was no evidence or history of trauma. There are varying survival rates and LD50 ranges for metaldehyde intoxication described in veterinary literature. Survival rates from metaldehyde toxicity range from 60–80%, depending on how early and aggressively treatment was initiated (Bates et al. 2012; Bergamini et al. 2020; Teichmann-Knorrn et al. 2020; Yas-Natan et al. 2007). The LD50 of metaldehyde stated in the literature ranges from 100–1000 mg/ kg which suggests that some animals may be more severely affected than others (Castle et al. 2017; Yas-Natan et al. 2007). I estimate that this patient ingested approximately two-thirds of the box of pellets equating to 4000 mg of metaldehyde, which at 100 mg/ kg placed him at the lower end of the LD50 range. It can be hard to determine how much metaldehyde an animal has consumed, and often there are differing concentrations of metaldehyde products available. Unpublished data from the Animal Poison Control Centre suggests that veterinary assessment should be sought if the animal has ingested 2mg/ kg or more of the toxin (Dolder 2003). Due to its variable LD50, and differing concentrations of metaldehyde products any amount ingested should prompt veterinary intervention.

Decontamination of metaldehyde

Treatment of poisoned animals does not hugely vary between toxins and is based on supportive and symptomatic therapy. The main goal of metaldehyde decontamination is removal of the toxin from the animal’s body and control of the clinical signs. If the patient is conscious and only recently ingested the toxin, inducing emesis, with a product such as apomorphine, is a logical first step (Tinson and Cook 2020). However,

in this case the patient had overt neurological signs which contraindicates induction of emesis due to the risk of aspiration. Enhancing the rate of elimination of toxins can be accomplished in multiple ways. Firstly, diuresis may be promoted with high I/V fluid rates. Lee (2018) discusses that forced diuresis is more beneficial for toxins that are metabolised and excreted by the kidneys. Metaldehyde is not known to be highly excreted by the kidneys; Booze and Oehme (1986), found that less than 1% of metaldehyde is excreted into the urine of dogs. Fluid diuresis was still instituted in this case as the initial cause for the toxicity was not known. Along with this, maintaining perfusion initiates resolution of acid-base abnormalities, as a majority of patients with metaldehyde toxicity develop metabolic acidosis (Dolder 2003). Fluid rates were gradually reduced to maintenance rates plus any additional losses due to the patient’s diarrhoea. Secondly, promoting gastric emptying and increasing the transition of contents through the gastrointestinal tract, using prokinetics like metoclopramide, will reduce absorption of systemic toxins (Lee 2018). The use of maropitant as a prokinetic has been studied, and there is no clear evidence that it exerts these effects or increases gastric emptying (Schmitz et al. 2016). In this case it was used primarily to prevent nausea and vomiting once the patient had recovered. Additionally, warm water enemas can be utilised while the patient is sedated or under anaesthesia to further promote decontamination (Bergamini et al. 2020). In this case, warm water enemas were not used, as the patient was readily producing large volumes of diarrhoea containing significant amounts of metaldehyde pellets. Lastly, gastric lavage can aid in the removal of large quantities of the toxin before they are digested and absorbed by the body. Conducting a gastric lavage is not a benign procedure and can carry risks. The biggest risk is aspiration which can have flow on effects such as hypoxemia and pneumonia (Lee 2018). The author goes on to discuss that in human poisoning

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

cases, gastric lavage has poor rates of recovery of the toxin (29–38%), with higher rates when intervention occurs earlier. In veterinary medicine, robust data on the success of gastric lavage is lacking, as most patients present to the clinic on average an hour after ingesting the toxin, and this can reduce success rates (Bates et al. 2012; Lee 2018). In this case, the benefits outweighed the risks as a significant amount of toxin was ingested and retrieving any amount had the potential to be beneficial for the patient. The risk of aspiration was reduced by ensuring selection of an appropriate size of endotracheal tube, adequate inflation of the endotracheal tube cuff, lowering the head, and using medications such as metoclopramide and maropitant to reduce the risk of aspiration during anaesthetic recovery. Following gastric lavage, the patient received activated charcoal (AC). Lee (2018) describes that AC has the ability to bind certain toxins and thereby decrease systemic absorption. The use of AC in human poisoning cases has recently sparked debate. A position paper published by The American Academy of Clinical Toxicology and the European Association of Poisons Centres and Clinical Toxicologists advised against its use as it has not shown to improve clinical outcome in humans (Chyka et al. 2005). However, the use of AC is still advocated for by many in veterinary medicine (Bergamini et al. 2020; Chyka et al. 2005; Lee 2018). A study conducted on rats by Shintani et al. (1999), showed that intestinal absorption of metaldehyde was reduced by up to 45% when orally administered AC was given early when compared to the control group. Because binding of AC to toxins is also reversible, the addition of a cathartic, such as sorbitol, is advised to enhance faecal expulsion whilst the toxin is still bound to the AC (Lee 2018; Tinson and Cook 2020). The AC used in this case did not include a cathartic because the patient was already displaying signs of advanced gastrointestinal motility.

Management of seizures

Management of refractory seizures (also known as status epilepticus; SE) is crucial for providing a favourable outcome in cases of metaldehyde toxicity. Being able to control seizure activity reduces energy demands of muscle cells, limits further neurological damage and helps maintain normothermia (Marios et al. 2021). Currently, the recommended first line therapy for seizures are the benzodiazepines (Charalambous et al. 2021). Often these may fail and the need for a CRI of an injectable anaesthetic is required (Gommeren et al. 2010; Heidenreich et al. 2016). In this case, a propofol CRI was used with great success. There have been limited studies that compare propofol and alfaxalone in the treatment of status epilepticus. There is some evidence that giving alfaxalone can result in increased myotonic and myoclonic movements in the recovery phase, which in a patient with status epilepticus is not ideal, and its effect on a seizure focus has not fully been studied (Jiménez et al. 2012; Metea et al. 2018). Because of this and stock issues, propofol was used instead of alfaxalone for the remaining management of the case. Even though there was no access to a syringe infusion set, simple calculations allowed the use of a standard drip pump to administer the drug. Additionally, Heidenreich et al. (2016) found that at low doses, medetomidine may have neuroprotective properties and cause cerebral vasoconstriction which reduces the development of cerebral oedema, a common sequelae of status epilepticus. Although there was a poor response to controlling the status epilepticus with low dose medetomidine boluses, Heidenreich et al. (2016) suggests that its use as a CRI along with propofol may have propofol sparing effects and may reduce the side effects commonly seen with propofol. These include hypoventilation leading to hypercapnia and eventually brain oedema. The use of a low dose medetomidine CRI along with a propofol CRI should be considered if there is access to a syringe infusion set as this combination may improve patient

outcomes. Recommended dose rates vary from 0.5–1 µg /kg/hour (Bergamini et al. 2020; Gioeni et al. 2020; Heidenreich et al. 2016).

Novel approaches to the treatment of metaldehyde toxicity

Novel treatment options for metaldehyde toxicity, such as intravenous lipid emulsions (ILE) and haemodialysis, have been reported to have good success rates (Kopke and Yozova 2020; Lee 2018; Lelescu et al. 2017; Spray 2016; Teichmann-Knorrn et al. 2020). ILE therapy is still being investigated for its efficacy in the treatment of metaldehyde toxicity, as its use is currently debatable. ILE therapy is likely more readily available in general practice, well described in human literature, and therefore will be focussed on here. The use of ILE has been hypothesised to reduce metaldehyde tissue concentration as this toxin is lipid soluble (Lelescu et al. 2017). Although the exact mechanism is unknown, it is theorised that a ‘lipid sink’ is created where the toxin is drawn out of the tissue into an extended lipid phase where it can no longer exert its pharmacological action (Spray 2016). Lelescu et al. (2017) describe a case of metaldehyde toxicosis that was unresponsive after 8 hours of treatment with anti-epileptic medications and a propofol CRI. A 20% ILE bolus followed by an ILE CRI were then administered via a peripheral catheter. Within 1 hour of beginning this therapy, the authors noted that pulse and respiratory rates began to normalise, and SE was abolished. Another case report (Kopke and Yozova 2020) described resolution of seizure activity caused by presumptive permethrin toxicosis using similar doses and routes of administration of 20% ILE. Although there are only a few case reports for the use of ILE in veterinary medicine, further research is needed in this field. The use of ILE is something to consider as it is relatively safe. Potential adverse effects include bacterial infection from contaminated product, hypersensitivity reactions, and fat overload syndromes (such as pancreatitis, icterus, and haemolysis).

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

The clinician should also advise the client that this treatment is off-label, and have judged that the benefits outweigh the risks before administering the product. Varying dose rates are proposed for 20% ILE products, however a loading dose of 1.5 mL/kg over 10–15 minutes, followed by a CRI at 0.25 mL/kg/minute is frequently reported (Kopke and Yozova 2020; Lelescu et al. 2017; Spray 2016).

Conclusion

The management of patients with toxin ingestion requires quick action by both the client and clinician. It is both a large commitment financially for the client and also involves intensive monitoring by the clinician. Clients and clinicians should always be prepared for both successes and relapses during treatment period. Clear communication between the clinician and client plays a vital role in toxicity case management. Treatment almost always involves a multimodal approach to decontamination of the toxin for a successful outcome. It is not necessary to have complex monitoring equipment or extensive medications to have a successful result. It is the combination of having a basic understanding of the available medications in general practice, along with the confidence in performing decontamination procedures that will allow the patient, client, and clinician to have a successful outcome.

Acknowledgements

Special thanks to the nursing staff and Dr. Finja Philips from the Veterinary Centre, Waimate, for their help managing this case.

References

Asokan VR, Kerl ME, Evans T, Harmon M. Organophosphate intoxication in 2 dogs from ingestion of cattle ear tags. Journal of Veterinary Emergency and Critical Care 29, 424–430, https://doi.org/https://doi.org/10.1111/ vec.12855, 2019 Bates NS, Sutton NM, Campbell A. Suspected metaldehyde slug bait poisoning in dogs: A retrospective analysis of cases reported to the Veterinary Poisons Information Service. Veterinary Record 171, 324, 2012

Bergamini I, Mattavelli C, Grossi G, Magagnoli I, Giunti M. Conventional treatment of a metaldehyde-intoxicated cat with additional use of low-dose intravenous lipid emulsion. Journal of Feline Medicine and Surgery Open Reports 6, doi:10.1177/2055116920940177, 2020 Booze TF, Oehme FW. An investigation of metaldehyde and acetaldehyde toxicities in dogs. Fundamental and Applied Toxicology 6, 440–6, 1986 Castle GD, Mills GA, Gravell A, Jones L, Townsend I, Cameron DG, Fones GR. Review of the molluscicide metaldehyde in the environment. Environmental Science: Water Research & Technology 3, 415–28, 2017 Charalambous M, Volk HA, Van Ham L, Bhatti SFM. First-line management of canine status epilepticus at home and in hospital-opportunities and limitations of the various administration routes of benzodiazepines. BMC Veterinary Research 17, 1–19, 2021 Chyka PA, Seger D, Krenzelok EP, Vale JA. Position paper: Single-dose activated charcoal. Clinical Toxicology 43, 61–87, 2005 Dolder LK. Metaldehyde toxicosis. Veterinary Medicine 98, 213–215, 2003 Gioeni D, Di Cesare F, D'Urso ES, Rabbogliatti V, Ravasio G. Ketaminedexmedetomidine combination and controlled mild hypothermia for the treatment of long-lasting and superrefractory status epilepticus in 3 dogs suffering from idiopathic epilepsy. Journal of Veterinary Emergency and Critical Care 30, 455–60, 2020 Gommeren K, Claeys S, De Rooster H, Hamaide A, Daminet S. Outcome from status epilepticus after portosystemic shunt attenuation in 3 dogs treated with propofol and phenobarbital. Journal of Veterinary Emergency and Critical Care 20, 346–51, 2010 Heidenreich DC, Giordano P, Kirby BM. Successful treatment of refractory seizures with phenobarbital, propofol, and medetomidine following congenital portosystemic shunt ligation in a dog. Journal of Veterinary Emergency and Critical Care 26, 831–6, 2016 Jiménez CP, Mathis A, Mora SS, Brodbelt D, Alibhai H. Evaluation of the quality of the recovery after administration of propofol or alfaxalone for induction of anaesthesia in dogs anaesthetized for magnetic resonance imaging. Veterinary Anaesthesia and Analgesia 39, 151–9, 2012 Kopke MA, Yozova ID. Management of presumptive canine permethrin toxicosis using intravenous lipid emulsion as an adjunctive therapy. Veterinary Record Case Reports 8, DOI:10.1136/ vetreccr-2019-001041, 2020

Lee JA. Decontamination and Toxicological Analyses of the Poisoned Patient. In: Textbook of Small Animal Emergency Medicine. Pp 819–30, 2018 Lelescu C, Mureşan C, Muste A, Taulescu M, Neagu AM, Nagy AL. Successful treatment of metaldehyde toxicosis with intravenous lipid emulsion in a dog. Acta Veterinaria Brno 86, 379–83, 2017 MacKay RJ. Brain injury after head trauma: pathophysiology, diagnosis, and treatment. Veterinary Clinics of North America: Equine Practice 20, 199-216, https://doi.org/https://doi.org/10.1016/j. cveq.2003.11.006, 2004 Marios C, Holger AV, Luc Van H, Sofie FMB. First-line management of canine status epilepticus at home and in hospital-opportunities and limitations of the various administration routes of benzodiazepines. BMC Veterinary Research 17, 1–19, 2021 Metea MR, Appleby C, Kearney K. Characterization of alfaxalone-induced seizures in dogs upon emergence from anesthesia. Journal of Pharmacological and Toxicological Methods 93, 135, https:// doi.org/https://doi.org/10.1016/j. vascn.2018.01.451, 2018 Schmitz S, Fink T, Failing K, Borsch C, Kunz C, Clemence R, Savary-Bataille K, Neiger R. Effects of the neurokinin-1 antagonist maropitant on canine gastric emptying assessed by radioscintigraphy and breath test. Tierarztl Prax Ausg K Kleintiere Heimtiere 44, 163–169, 2016 Shintani S, Goto K, Endo Y, Iwamoto C, Ohata K. Adsorption effects of activated charcoal on metaldehyde toxicity in rats. Veterinary and Human Toxicology 41, 15–8, 1999 Spray JW. Review of intravenous lipid emulsion therapy. Journal of Infusion Nursing 39, 377–80, 2016 Teichmann-Knorrn S, Doerfelt S, Doerfelt R. Retrospective evaluation of the use of hemodialysis in dogs with suspected metaldehyde poisoning (2012– 2017): 11 cases. Journal of Veterinary Emergency and Critical Care 30, 194–201, 2020 Tinson E, Cook S. Supporting the intoxicated patient: toxicants affecting the neurological and cardiovascular systems. In Practice 42, 27–38, 2020 Yas-Natan E, Segev G, Aroch I. Clinical, neurological and clinicopathological signs, treatment and outcome of metaldehyde intoxication in 18 dogs. Journal of Small Animal Practice 48, 438–43, 2007 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

CAV Specialist Profile

Dr Tommy Fluen

BSc, MSc (Hons) DVM, FANZCVS This issue we bring back a regular feature from the past: the Specialist Profile aims to provide an insight into the path New Zealand veterinarians have taken to achieve specialisation This issue Toni Anns talks to TOMMY FLUEN, a registered veterinary specialist in INTERNAL MEDICINE who works for vsa in Auckland

What is your specialty, and how many years have you been practicing as a registered specialist?

I am a specialist in small animal internal medicine, and I have been a registered specialist since January 2021 but working in referral practice since 2016.

Where did you obtain your veterinary degree, and did you move directly into a residency from there?

I went to The University of Melbourne for my veterinary degree (DVM) and then moved to the United Kingdom and worked in general practice for 18 months followed by a rotating internship at a large private practice referral center. After the internship I moved back to New Zealand for my residency at VSG in Auckland.

What drove you to specialise, and why did you choose internal medicine?

I had always enjoyed the problem-solving aspect of internal medicine and had some really great examples of great internists to aspire to during both my veterinary degree and during my internship.

Explain the process you took to become a registered specialist

I went through the Fellowship program of the Australian and New Zealand College of Veterinary Scientists. This required a 3-year supervised residency during which I had to collate a specific case log, compete externships locally and overseas,

Photo courtesy of Tommy Fluen

present at a conference and produce two scientific papers. To be eligible for Fellowship I also had to pass Membership exams which I did in 2018. At the end of my residency, once I had fulfilled all the relevant criteria, I was eligible for the examination which once passed allows you to become a Fellow. Once you have achieved Fellowship you can apply to the Veterinary Council of New Zealand to become registered as a specialist.

What do you like most about your job?

Discussing tricky cases with my colleagues and hopefully coming up with a solution gives me a lot of satisfaction.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

What is the worst and/or most challenging part of your job?

Managing expectations of owners can be very difficult and in referral practice we obviously are met with a subset of the petowning population with particularly high expectations who are very devoted to their animals. The flip side of this is we are very lucky to have owners which allow us, in most circumstances, to do the very best for their animals.

What advice would you give to someone thinking of specialisation?

Do you think NZ needs more specialists, and if yes, in what areas?

Yes!!! I can only speak for small animal practice but given the busyness of referral and the growing appetite of clients for gold-standard care, specialists in all areas of veterinary medicine would be in demand.

What are your passions outside of work?

I love watching rugby but most of my spare time is spent attempting to tire out my 3-year-old son, Ted. l

I would highly recommend an internship (often required before undergoing residency anyway) or spending some time observing at a referral clinic first. Making sure that the referral environment is where you see yourself long term is very important before committing to such a long and typically arduous pathway.

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

I don’t think this is an issue and if anything, the greater maturity and experience these candidates will have is likely to serve them very well in the referral environment.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

What is your diagnosis? THE ANSWERS… 1. What are the radiographic findings?

There is good serosal detail. The bladder silhouette contains extensive radiolucent/gas opaque streaks and pockets, both within the lumen and conforming to the bladder wall (Figure 2). The prostate gland is moderately enlarged. There is mild ventral vertebral spondylosis deformans noted at L6/L7 and L7/S1.

2. What is the radiographic diagnosis?

The appearance of the urinary bladder is consistent with a diagnosis of emphysematous cystitis. The prostatomegaly in an entire male dog most likely represents benign prostatic hyperplasia, however concurrent prostatic inflammation/infection (i.e. prostatitis) cannot be excluded.

3. What would be the next diagnostic step?

Not all cases of emphysematous cystitis are readily identified from radiographs, particularly if only a small amount of intramural gas is present, or if the bladder is superimposed by intestinal loops. Abdominal ultrasound has therefore been suggested as a more sensitive means for detecting emphysematous changes in the bladder (Petite et al. 2006), and whilst it was not necessary for the diagnosis in this case, the patient was referred for a specialist abdominal ultrasound to look for an underlying cause. The ultrasound revealed a highly abnormal urinary bladder with large amounts of both intraluminal and intramural gas which cast hazy distal acoustic shadows (Figure 3), consistent with severe emphysematous cystitis. Visualisation of the bladder lumen and far wall was hindered by the distal acoustic shadowing artefact, however, the far wall of the bladder had the impression of moderate to severe diffuse

Figure 2. The same right lateral abdominal radiograph as in Figure 1. Note the extensive gas streaks and pockets within the bladder lumen and bladder wall (white arrows), and the enlarged prostate gland (red circle).

thickening. Multifocal collections of free peritoneal gas were also identified within the caudal abdomen, likely due to translocation of gas across the bladder wall, however, there was no evidence of free peritoneal fluid. The prostate gland was moderately enlarged with smooth capsular contours and symmetrical lobes, however, there were multiple irregularly shaped and poorly demarcated hypoechoic regions within the parenchyma. The appearance of the prostate was most suspicious for benign prostatic hyperplasia with concurrent prostatitis, although an underlying malignancy could not be entirely excluded without tissue sampling.

The liver was also moderately diffusely enlarged with an increase in parenchymal echogenicity and coarsening of echotexture. This hepatopathy/hepatomegaly was the likely cause of the increased ALP found on biochemistry. As a non-specific finding, causes are varied but include vacuolar hepatopathy, hepatitis, cholangiohepatitis, infiltrative neoplasia or nodular regeneration, and tissue sampling would be required for a definitive diagnosis.

Discussion

Emphysematous cystitis (EC) is a form of complicated urinary tract infection, defined by the presence of gas within the bladder wall and lumen (Fumeo

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

et al. 2017). Reports on the required duration of treatment are currently lacking. Previous recommendations for the treatment of complicated or recurrent bacterial cystitis in veterinary species was four weeks (Weese et al. 2019), however, no studies focusing specifically on EC currently exist. A review of human EC cases found the median length of treatment to be 10 days (Grupper et al. 2007), suggesting that shorter courses of antimicrobials may be effective in animals as well.

Figure 3. Sagittal ultrasound image of the urinary bladder showing the extensive distal acoustic shadowing artefact due to severe emphysematous cystitis.

et al. 2019). An uncommon disease in veterinary medicine, EC is reported to occur predominantly in animals with diabetes mellitus or primary glycosuria. Fermentation of glucose results in production of carbon dioxide gas, with subsequent gas accumulation within tissues (Petite et al. 2006). In nonglycosuric dogs, EC occurs secondary to other co-morbidities including chronic urinary tract infections, bladder trigone diverticulum, and long-term corticosteroid administration (Petite et al. 2006; Lippi et al. 2019). In these cases, urinary albumin and lactose are thought to act as substrates for gas production (Fumeo et al. 2019). In this patient, urine glucose was negative and the dog was normoglycaemic, thereby excluding diabetes mellitus and primary renal glycosuria as the likely underlying cause of EC. Abdominal ultrasound did not reveal any underlying cause either, although serial ultrasound evaluations may have been more reliable in ruling out structural abnormalities, especially when thorough evaluation was hindered by luminal gas (Lippi et al. 2019). Clinical signs of EC are varied, usually with any combination of lower urinary tract signs including haematuria, stranguria, pollakiuria, urinary incontinence, polyuria and polydipsia (Fumeo et al. 2019). As in this patient,

haematuria is reported to be the most common presenting sign (Lippi et al. 2019), and may occur in the absence of other signs. Of note, emphysematous pyelonephritis and peritonitis have been reported as rare consequences of EC, stressing the importance of early diagnosis and initiation of appropriate treatment (Merkel et al. 2017). Following the radiographic or sonographic diagnosis of EC, aerobic and anaerobic urine cultures and antibiogram should be the next step in the diagnostic workup (Fumeo et al. 2019). In humans with EC, Escherichia coli and Klebsiella pneumoniae are the major pathogens isolated from urine, with approximately 60% of cases associated with E.coli infection (Amano and Shimizu 2014). As in humans, E.coli is the most prevalent isolate from canine EC cases (Merkel et al. 2017; Lippi et al. 2019), and whilst culture and susceptibility results were not available for this case, E.coli infection would be the most likely causative organism. Treatment for EC should be initiated as soon as a diagnosis is made and consists of appropriate antimicrobial therapy and management of co-morbidities. Susceptibility testing should guide drug selection, and pending results, empirical treatment with a lipid soluble, bactericidal drug with good tissue and urine penetration is appropriate (Merkel

Emphysematous cystitis is therefore an uncommon but potential differential for patients with clinical signs attributable to lower urinary tract disease. Given that many of these cases may not undergo diagnostic imaging, the true prevalence of EC is unknown, however the prognosis once identified is good, and most cases of emphysematous cystitis in dogs respond to oral antimicrobials (Merkel et al. 2017).

References

Amano M, Shimizu T. Emphysematous cystitis: A review of the literature. Internal Medicine 53, 79–82, 2014 Fumeo M, Manfredi S, Volta A. Emphysematous cystitis: review of current literature, diagnosis and management challenges. Veterinary Medicine: Research and Reports 10, 77–83, 2019 Grupper M, Kravtsov A, Potasman I. Emphysematous cystitis: Illustrative case report and review of the literature. Medicine 86, 47–53, 2007 Lippi I, Mannucci T, Santa DD, Barella G, Oranges M, Citi S. Emphysematous cystitis: retrospective evaluation of predisposing factors and ultrasound features in 36 dogs and 2 cats. The Canadian Veterinary Journal 60, 514–8, 2019 Merkel LK, Lulich J, Polzin D, Ober C, Westropp J, Sykes J. Clinicopathologic and microbiologic findings associated with emphysematous cystitis in 27 dogs. Journal of the American Animal Hospital Association 53, 313–20, 2017 Petite A, Busoni V, Heinem M-P, Billen F, Snaps F. Radiographic and ultrasonographic findings of emphysematous cystitis in four nondiabetic female dogs. Veterinary Radiology and Ultrasound 47, 90–3, 2006 Weese JS, Blondeau J, Boothe D, Guardabassi LG, Gumley N, Papich M, Jessen LR, Lappin M, Rankin S, Westropp JL, Sykes J. International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats. The Veterinary Journal 247, 8–25, 2019 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

Massey News Anaesthesia staffing improves

After a difficult period of low staffing in anaesthesia, the VTH is happy to report the successful recruitment of two anaesthesiologists and the return of a valued anaesthesia nurse, Lydia. Over the last few months, the burden of the entire service (teaching as well as clinical work for both small animal and equine) has fallen on our amazing Vicki Walsh and the team of hard-working nurses, notably CeeJay and Nicole, backed up by interns and Heidi Lehmann. In mid-May we took the unprecedented step of suspending bookings for non-urgent small animal surgeries to concentrate on the critical patient case load and ease the pressure on anaesthesia. There is now greater depth in anaesthesia with the recent appointment of Sandeep Karna. Sandeep hails from Nepal and has completed his PhD studies in New Zealand, in anaesthesia under the supervision of Paul Chambers and Craig Johnston. With the appointment of Sandeep we will have two anesthesiologists and in January 2022 we expect to welcome a highly experienced anesthesiologist from across the ditch.

My aim here at Massey Vets will be to work as close as you wish together with you, as a possible extension of your practice. In the past this meant that patients were sent to me for endoscopies, or any patient who doesn´t want to eat, loses weight for no obvious reason, has chronic GI problems, PU/ PD, coughing/sneezing or any chronic or recurrent problems in your practice but not enough time for longer workup …

A huge thank you goes to the anaesthesia team, especially Vicki, for their huge effort to keep the service running in difficult circumstances.

I understand that we all put the patient first, but there are business aspects to your work as well. I understand that we are all together in this extremely challenging profession with a knowledge build-up at exuberant speed, faster than ever before. I look forward to meeting you and to working together with you and your team!

Non-urgent surgery bookings recommence at the end of August

Gaby Verburgh Hoffmann DVM, PhD, Dr. med.vet, DACVIM, DECVIM-CA, FANZCVS Associate Professor in Small Animal Medicine

Routine small animal surgery bookings will recommence at the end of August. We will still have to manage the caseload and balance our staff resources without overstretching them, therefore waiting lists are likely to persist.

Internal medicine service recommences

We have also successfully recruited two internal medicine specialists and will soon be resuming a referral Small Animal Medicine Service. The expectation is that we will be accepting internal medicine referrals from early September.

Introducing the first Internist out of MIQ – Gaby Hoffmann I graduated as veterinarian 1996 in Germany, went to South Africa to learn at the Animal Eye Clinic in Cape Town for some months, and to Japan, to the University of Kyoto, in Inuyama before going to Switzerland for my first Dr. thesis at the veterinary faculty in Zurich. I did an internship in private practice and a residency in Small Animal Internal Medicine at the University of Berne, in Switzerland. This was a shared residency between Berne and Louisiana State University, USA. After my residency I went to Utrecht University in the Netherlands in 2002 where I did my PhD studies in copper-

associated chronic hepatitis in Labrador Retrievers and became faculty (head of small animal gastroenterology). In 2010 I became practice owner of a first-, second- and third-opinion small animal hospital in Southern Germany. After being Internist during daytime and on call 24/7 all year long for 6 years my husband and I sold the business and took off to the Caribbean where we became faculty at US-owned private veterinary schools. After some wonderful, colourful years in paradise we went back to the Netherlands in 2019, where I worked full time since and through a very busy COVID time, in the country’s largest private referral hospital in The Hague.

Gaby

Services

These are the current referral avenues: l

Small Animal Surgery – fully open for emergencies, reopening very end of August for non-urgent case revival. l Small Animal Medicine – service to resume sometime in September l Oncology – coordinated by VN Carolyn Liggins (for referral to Surgery/Medicine/Chemo) l Radioactive iodine and strontium therapy – Susan Tomlin l Dentistry – in-house dentist Angus Fechney l Dermatology – out-patient clinics run by specialist dermatologist Helen Orbell l Cardiology – outpatient clinics provided by specialist cardiologist Jacqui Huxley

Building update

The work on the new large animal hospital and teaching laboratory space is proceeding at pace with the majority of the superstructure erected. The current disruption is mainly to car parking and referral clients should be warned to arrive with sufficient time to find a parking stop close to the university. l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

Healthy Pets NZ update

Welcome to Spring!

Cath Watson, Director,

Healthy Pets NZ

Firstly, thanks to all those who have read the recent articles in Companion Quarterly on our annual report, and the research summary on the FIV vaccine study in New Zealand. Healthy Pets New Zealand raises funds for independent scientific studies that provide evidence for what vets and owners can (or can’t!) do to enhance the lives of New Zealand pets. Being able to publish summaries of these studies in Companion Quarterly helps us to get the word out about what’s happening right here in New Zealand and relevant to you in practice. If you’d like further updates on what Healthy Pets NZ gets up to, check out our Facebook page http://www. healthypets.org.nz/research/apply and subscribe to our PawPrint e-newsletter which comes out three time a year. CAV have been long-term supporters of HPNZ since its inception over 20 years ago, providing both financial and administrative support. While CAV would seem like a natural fit; with the outcomes of HPNZ funded research going on to benefit companion animal veterinarians and the pets they treat in clinical practice; it is a valued relationship for HPNZ. CAV now sponsors our new Research in Practice Grant. Grant applications are assessed twice a year, with the next round for applications closing 1 November 2021. http://www. healthypets.org.nz/research/apply HPNZ can help with providing mentors for those without a research background to help ensure your project is properly designed to meet the acceptance criteria, and to achieve a usable outcome in practice.

Contact: http://healthypets.org.nz/

Photo credit: Chewy for Unsplash

More recently, premium pet food manufacturer Royal Canin have partnered with HPNZ as the first HumanAnimal Bond partner. One of the underpinning values of Royal Canin is the ‘pursuit of knowledge’ and their goal is to help make a better world for both pets and their people. Royal Canin has a long association with pets in New Zealand, and has an excellent reputation for premium quality food products, along with a range of veterinary prescription foods backed by extensive research. Their partnership with HPNZ has got off to a great start with a large amount of interest in the new Human-Animal Bond grant. The successful applicants have a world-first study into the benefits of cat fostering. Led by researchers from Victoria and Massey Universities, the study will seek to inform the development of best-practice cat fostering and improved understanding of the human-animal bond. Partnerships like these make a big difference to HPNZ research outputs which ultimately benefit Kiwi pets, so from all us: THANK YOU! l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

CANZ update

Recommend trainers with confidence: part II Fiona Esam, CANZ Welfare and Operations Officer We all have some patients who could do with a good trainer: the staffy who drags you around the clinic by the lead; the terrier owner with legs covered in scratches from their dog jumping up; the schnauzer who just won’t stop barking. It’s easy enough to tell owners they should enrol their dog with a trainer, but who exactly should you recommend? There is an ever-growing body of literature suggesting that trainers who use aversive methodologies should be avoided (Fernandes et al. 2017, de Castro et al. 2020, Masson et al. 2018). Use of aversive-based training can be harmful to animals both physically and mentally, damage the bond and trust between owner and pet, and can even make behaviour problems worse rather than better. By contrast, a trainer who fosters the human-animal bond through use of reward-based, or Least Invasive Minimally Aversive (LIMA) principles can produce a happy dog and a happy client. Multiple scientific studies have shown that LIMA/reward-based training is as effective, if not more effective, than aversive training. But how can you tell if a trainer uses aversive techniques? Recent research (Skyner et al. 2020) shows that nearly 21% of trainers in New Zealand still use a mixture of aversive and reward-based training. With aversive equipment such as shock collars, which are banned in many other countries, still legal in New Zealand, veterinarians are naturally cautious to not recommend a trainer that may be harmful to their patient. Companion Animals NZ is proud to announce a major step forward for Kiwi vets to identify welfare-friendly trainers. CANZ has recently welcomed the Association of Pet Dog Trainers New Zealand (APDTNZ) Trainer Endorsement Programme (TEP) into their stable of accredited organisations. “Welcoming APDTNZ aboard is a milestone for CANZ Accreditation. As the largest organisation representing dog trainers in New Zealand, they offer an excellent pathway for trainers to show that they are putting animal Contact: manager@companionanimals.nz

welfare first,” says Companion Animals New Zealand General Manager David Lloyd. If a trainer is CANZ Accredited, what does this mean? l Humane methods: The trainer will use humane training methods based on an understanding of the way animals learn. These trainers will not use aversive techniques or equipment e.g. shock, choke, prong or citronella collars. l Scope of practice: The trainer has clear understanding of their area of expertise and limitations, and seeks qualified professional advice, e.g. from a veterinarian, as necessary. l Ethical communication: The trainer is committed to clear and honest communication with clients. l Continuing education: The trainer undertakes appropriate CPD on an annual basis to maintain, develop and enhance their skills. l Assessed: The trainer has undergone a robust assessment process to gain accreditation. CANZ accreditation cannot be gained simply by paying a membership fee. Skyner et al. (2020) showed that 59% of New Zealand trainers were interested in gaining accreditation from a national accreditation body. Now that there is an accessible, domestic pathway for trainers to do so, CANZ anticipates significant uptake of the scheme, but needs your help to make the programme a success. A major motivator for trainers to become accredited is demand for CANZ-accredited trainers from responsible companion animal owners. Therefore, getting the word out about CANZ accreditation to owners is vital. This is where companion animal veterinarians can help. By recommending CANZ-accredited trainers wherever possible, not only are you ensuring the best for your patients and clients, but you are helping to grow the accreditation scheme as a whole. See Table 1 for a list of accredited organisation

and the training they are accredited to provide. Want to recommend a CANZ Accredited trainer in your area? Check out our directory at www.companionanimals.nz/ canz-accredited-professionals.

References

Skyner LJ, Cameron KE, Dale A, Walker JK. The need for a national accreditation programme for professionals working in the field of animal training and behavioural modification in New Zealand. Animals 10, 1111, 2020 Fernandes JG, Olsson IAS, de Castro ACV. Do aversive-based training methods actually compromise dog welfare?: a literature review. Applied Animal Behaviour Science 196, 1–12, 2017 de Castro ACV, Fuchs D, Morello GM, Pastur S, de Sousa L, Olsson IAS. Does training method matter? Evidence for the negative impact of aversive-based methods on companion dog welfare. PloS One 15, e0225023, 2020 Masson S, de la Vega S, Gazzano A, Mariti C, Da Graça Pereira G, Halsberghe C, Leyvraz AM, McPeake K, Schoening B. Electronic training devices: discussion on the pros and cons of their use in dogs as a basis for the position statement of the European Society of Veterinary Clinical Ethology. Journal of Veterinary Behavior 25, 71–5, 2018 l

Table 1. CANZ-accredited organisation Accredited organisations Association of Pet Dog Trainers (NZ-based) International Association of Animal Behaviour Consultants Pet Professional Accreditation Board

Accredited for Animal Training (Dog), Animal Training Instructor (Dog) Animal Behaviour Consultant Animal Training, Animal Training Instructor, Animal Behaviour Consultant

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

Dogs NZ update

Respiratory function grading scheme announcement Dogs New Zealand (previously known as the New Zealand Kennel Club) are collaborating with Cambridge University and the UK Kennel Club to take action to improve and protect the health of brachycephalic breeds worldwide by agreeing to operate under license the Kennel Club/University of Cambridge Respiratory Function Grading (RFG) Scheme. We are extremely fortunate to have secured Dr Kat Crosse as our Chief Assessor with Dr Richard Jerram working alongside in support. This RFG tool enables breeders and owners of Bulldogs, French Bulldogs and Pugs to make informed decisions and aims to create a healthier future for these breeds. This move also enables further and international data collection on complex health conditions related to brachycephaly which is vital for ongoing research to provide evidence-based solutions. Dogs NZ President Mr Brian Harris says that adopting the RFG scheme was part of an evidence-based approach for Dogs NZ Breeders to improve the health of Pugs, Bulldogs and French Bulldogs in NZ. “The RFG scheme will be one of the compulsory health tests available for these three brachycephalic breeds should they adopt our Litter Registration Limitation (LRL) Health schemes” said Mr Harris. “In addition, the RFG Scheme will be immediately designated as a mandatory test for the three breeds under our Accredited Breeders Scheme. We look forward to all Pugs, Bulldogs and French Bulldogs in New Zealand having the opportunity to participate in this evidencebased scheme.” Indeed, since the announcement of the RFG scheme collaboration in New Zealand, Dogs NZ Pug breeders have voted in favour of compulsory brachycephalic obstructive airway syndrome (BOAS) screening using the RFG scheme once it is established here. At that time, each pedigree pug dog that is bred must have had this test done. This is wonderful news for the health and welfare of this breed. Dogs NZ have encouraged other Kennel Clubs across the world who are committed to improving the health of brachycephalic dogs globally to follow New Zealand’s lead and contact the Kennel Club’s health team. By working together, we can make a difference for dogs and we look forward to collaborating with other Kennel Clubs and organisations internationally to license the Respiratory Function Grading Scheme. Unfortunately, there have been ongoing difficulties in getting the scheme up and running in New Zealand, and all other countries who have signed up to operate it, due to the COVID-19 situation in the UK.

Brochure produced by UK Kennel Club to inform breeders of the Respiratory Function Grading Scheme.

The Kennel Club have advised that they are developing a comprehensive online training resource for Chief Assessors, which will replace the immediate need for face-to-face training, allowing it to be delayed until international travel is deemed appropriate. The UK lockdown restrictions will slowly ease and providing these are lifted then filming of the training course can begin with resources being available to our Chief Assessors in due course. Once our Chief Assessors are trained up in the scheme, we can begin a National roll-out so that Regional Assessors can receive their training and begin performing assessments (see next page for assessment protocol). This will be advertised in Companion Quarterly and expressions of interest can be submitted to caninehealth@dogsnz.org.nz.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

Respiratory Function Grading Scheme Assessment Protocol for Assessors Initial examination prior to exercise test: the dog should be kept as calm as possible with gentle restraint. If the dog is stressed, please allow a period of time to calm. Auscultation is performed directly over the larynx from the side, avoiding any upward pressure on the pharynx and larynx. Head should be in a neutral position, not flexed. l Exercise test: this is designed to keep the dog active for 3 minutes. The dog should be encouraged to trot at 4–5 miles per hour by the assessors or the owners, but not pulled on the lead. Toilet stops should be accommodated. If the dog has reasons that it cannot manage this pace (e.g. osteoarthritis, obesity, anxiety), a fast walk should be attempted. l Examination after the exercise test: the dog should be auscultated immediately following the exercise test. l Functional grading: The clinical grading was based on respiratory signs before (pre-ET) and immediately after the exercise test (post-ET). The highest grade from any of the three categories (respiratory noise, inspiratory effort, dyspnoea/cyanosis/syncope) should be given as the final grade. l

Some dogs may have quieter mouth breathing after exercise than nasal breathing prior to exercise. These are usually grade I dogs. l If the dog is under 12 months old when first graded, it should be re-graded after a year. Respiratory noise (stertor and/or stridor) was diagnosed by pharyngolaryngeal auscultation. Mild: only audible under auscultation; moderate: intermittent audible noise that can be heard without stethoscope; severe: loud, constant audible noise that can be heard without stethoscope. b An abnormal respiratory cycle characterized by evidence of increased effort to inhale the air in with the use of diaphragm and/or accessory muscles of respiration and/or nasal flaring with an increase in breathing rate. Mild: minimal use of diaphragm; moderate: evidence of use of diaphragm and accessary muscles of respiration; severe: marked movement of diaphragm and accessary muscles of respiration. c Dogs that have had episodes of syncope and/or cyanosis as documented by owner’s report are classified into Grade III without ET. Dyspnoea: irregular breathing, signs of discomfort, and labored breathing. d Dogs with moderate intermittent nasal stertor when sniffing have similar BOAS index (objective respiratory function) to dogs only with mild respiratory noise, therefore, these dogs are considered Grade I a

Functional Grading Respiratory noise a Grade 0

Grade I

Grade II

Pre-ET

Inspiratory effort b

Dyspnoea/ Cyanosis/ Syncope c

Not audible

Not present

Post-ET Not audible

Not present

Pre-ET

Not present

Not audible to mild stertor, and/or moderate intermittent nasal stertor when sniffing d

Post-ET Mild stertor, and/or moderate intermittent Not present to mild nasal stertor when sniffing d, and/or intermittent gentle stertor when panting

Not present

Pre-ET

Not present to moderate

Not present

Moderate to severe and/or regurgitation of foam/saliva

Dyspnoea; cyanosis or syncope not present

Moderate to severe

Dyspnoea; may or may not present cyanosis. Inability to exercise.

Mild to moderate stertor

Post-ET Moderate to severe stertor Grade III Pre-ET

Moderate to severe stertor or any stridor

Post-ET Severe stertor or any stridor

Severe and/or regurgitation of foam/saliva Dyspnoea; may or may not present cyanosis or syncope

EST, exercise test

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

Obituary

A life of great success, cut short Frazer James Allan (1966–2021) I first met Frazer when he entered 4th year of the Massey BVSc course. Here was an enthusiastic and organised student with clear goals, who not only wanted to learn and achieve but also to enjoy student life and all that the University had to offer. I think his Territorial Army training created the organised approach to clinical problems and to making diagnoses that he developed. He was clever and I was pleased that on graduation he chose small animal medicine as a discipline when many of his contemporaries went to large animal practice. Frazer had some time in small animal practice in Hamilton before he returned to Massey to undertake residency training in internal medicine with myself and Grant Guilford as supervisors. What a great time that was! As expected he applied himself to the programme, worked hard, was fun to work with, accepted the challenges, solved the medical puzzles with application and study and even survived the ‘set ups‘ that Grant and I thought would test him. The research study component of his programme validated the use of BIPS for the diagnosis of gastrointestinal diseases in dogs and cats, his first taste of clinical research which led to his Master of Veterinary Medicine degree. In addition, he became a member of the Australian and New Zealand College of Veterinary Scientists in canine medicine. The expectation was that he would complete his specialist diploma examinations, but his decision was to undertake a PhD programme with Keith Thompson. I can remember many earnest discussions about this decision, and its wisdom. Complete the PhD he did, on aspects of lipoprotein metabolism related to diet in pigs but having completed the bench research he decided to leave Massey to work at The Pet Practice in Hamilton. He wrote up his PhD and submitted whilst working as a medicine clinician at the practice, on time and to plan. After 3 years at The Pet Practice, he returned to academia to become director of the Massey University Veterinary Teaching Hospital, the beginning of his administrative career. I am not sure how Rebecca and Frazer’s children coped with the frequent moves and Frazer’s changes of plan but I am sure they knew what was best for their family at the time. It was with great skill that Frazer ran the Massey University Veterinary Hospital and Clinics. He made the hospital a financial success and established a structure that was

Photo credit: Leith Allan

nurturing for both academic and support staff. Frazer undertook a Diploma in Business Administration (with distinction) and with that management training he was able to apply business principles to the academic environment. He retained the goodwill of veterinarians and clients as well as creating a productive workplace for staff. His managerial and administrative experience and abilities became clearly evident, and his non-confrontational style of management was accepted by all staff. Importantly, all staff were confident that what he said was true, without ‘hidden agendas’. He was respected by colleagues for his leadership and management skills.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

When Grant Guilford left Massey for University of Auckland Frazer became Head of the Institute of Veterinary and Biomedical Sciences (IVABS), a role in which he showed continued leadership and managerial skills. He was a passionate leader, while retaining a friendly, cheerful countenance with a broad smile that everyone remembers. He was a team player and wanted all sectors of IVABS to advance, to be productive and to work together. He looked after students, attended their functions, listened to their concerns and acted when required to do so. He supervised the curriculum review and the reaccreditation process for the AVMA visitation that was completed successfully. Overall, Frazer was an inspiring academic leader for IVABS. Whilst Frazer’s academic career was advancing, he did not forget that he was part of the wider community. He supported his children with time on the management board of the Massey childcare centre, on the parent teachers association of Tiritea school, as a coach of schoolboy cricket and as treasurer of the United Cricket Club. For the veterinary profession he served on the NZVA’s Board for some time and played a key role behind the scenes for the organisation of the WSAVA congress held in Auckland in 2013. His work with NZVA and the profession was acknowledged in 2017 with the NZVA’s President’s Award, which recognises those who accomplish extraordinary achievements on behalf of the profession and provide meritorious service to the profession in the broadest sense; a prestigious achievement. Frazer moved to Victoria University of Wellington in 2015 becoming its Deputy Vice-Chancellor (Engagement). He was an enthusiastic advocate for the close engagement of universities with their communities. He championed the University’s civic-university ideal – strengthening relationships with central and local government, the private sector, community groups, alumni and friends. He saw engagement as a

pan-university activity, and led the development of the University’s first engagement strategy which ensured that leaders right across the university played their part in building enduring relationships. He led the University’s engagement group which had representation from different sectors of the University and melded their individual professional talents into the University mission. For those of us who knew Frazer as a veterinarian, it was not without amusement to hear that he enthusiastically extolled the virtues of the latest avant-garde exhibition at the Adam Art Gallery and revelled in the latest publishing success at the Ockham Book Awards. One of Frazer’s key achievements while at Wellington was overseeing the creation of the Miramar Creative Centre in partnership with Miramar Creative Ltd. The Centre has gone from strength-to-strength and is a fine example of Frazer’s ability to build enduring partnerships. In 2018 Frazer moved from Wellington, being appointed Head of School and Dean of Veterinary Science at University of Sydney. He had a vision for the future of veterinary science and was about to put that vision in place. The seeds are sown, but alas, those plans will not now be progressed by Frazer. Frazer was greatly respected by his contemporaries and was an exceptional and inspirational leader and beloved manager by those who worked with him. His colleagues remember him as being genuinely kind, particularly when a fellow staff member required support, having a true sense of egalitarianism, and always showing respect to those around him. Staff in all workplaces have fond memories of the lively and purposeful encounters with him. He was friendly, cheerful, a team player and led with professionalism. He was a determinedly positive individual, committed to those around him and to making the world a better place.

Frazer and I (BRJ) spoke reasonably often especially after his move to Sydney. We talked not only about veterinary matters and his vision for change and progress but also about sport. He was a keen supporter of New Zealand cricket through all its ups and mostly downs. The winning of the test match series (and the mace) a few days before he died must have given him immense joy. Although I did not know his children Sophie, Fergus and Phoebe well, he always kept me up-to-date with what they were doing. He was incredibly proud of his children and would often share stories of their lives and successes. His other activity outside work was mountain biking. He was a keen rider in the hills around Palmy and in Wellington; a competitive cyclist, often leaving others in his wake. Several of his colleagues benefitted greatly from his 6 am, enthusiastic road cycling challenges, especially the weaker, shorter ones who could benefit from drafting behind Frazer’s bulk! He was chairman of the Wellington Trails Trust and advocated for the development of more mountain biking tracks around Wellington. Some accidents and the perils of cycling in Sydney led to his interest in rowing in a veterans’ crew at the Leichardt Rowing Club. Rowing was his new sport. Frazer’s life has been one of great success, cut short and with future plans unfulfilled, but it is clear that he made a major contribution to veterinary medicine and the veterinary profession in New Zealand. We must thank him for his vision, his enterprise and his success on our behalf. Our sympathies go to Rebecca, Sophie, Fergus and Phoebe who shared most of Frazer’s life and its ups and downs, and to his wife Leith and stepson Felix, whose future plans with Frazer have been unexpectedly and suddenly curtailed. Farewell Frazer you have been a good friend and colleague. This tribute was written by Boyd Jones and Grant Guilford l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

Odds and Ends

Shaggy dog stories Boyd Jones, BVSc, FACVSc, DECVIM-Ca

“The dog did nothing in the night time.” “That is the curious incident,” remarked Sherlock Holmes.

Some years ago, I was given a copy of Brewer’s Dictionary of Fame and Fable (19th edition) by Dr Darren Merrett, my cotutor for the CVE course in internal medicine which we taught together for the University of Sydney for many years. The book sat on a bookshelf with occasional reference searches but it was not until COVID and “home confinement” that it received a real read and ongoing consultation. The book contains thousands of items: curiosities, odds and ends and themes related to literature, language, and our daily lives. It is a fun read with many surprises and chuckles over meanings of words, origins of sayings and literary quotations.

Dogs in classics and legends must include Odysseus’ dog Argos (Figure 1), who, after waiting 20 years whilst his master was fighting in Troy and making his return journey home to Ithaca, recognises his master although he was disguised as a beggar to enable him to enter his house and expel his wife Penelope’s suitors! Argos who is old and neglected is lying in cow manure and infested with ticks and fleas. He recognises Odysseus but can’t get up to greet his master; however he drops his ears and wags his tail. Odysseus, who does not want to be recognised, sheds a tear but does not acknowledge the faithful Argos. Argos dies.

The short section on dogs appealed to me. So many familiar (and some unfamiliar) sayings and quotations many of which we use in everyday language and in writing. We are all familiar with dogleg (golfers), dog collar (the church), dog’s dinner (a mess), dog tags (military), as sick as a dog (of biblical origin, Proverbs 26:ii, Peter 2:22), dog’s life (a miserable existence), go to the dogs (to go to ruin morally or materially – food unfit for human consumption was given to the dogs). Dogs bollocks (the very best or most outstanding) – a British slang expression perhaps inspired by the notion of conspicuousness according to Brewer? Not sure we use bollocks in the same context. More I see of men the more I love dogs has obvious meaning, whether correct or incorrect is for you to decide! It is attributed to Madame de Sévigné (17th century), Madame Roland (18th Century) and Frederick the Great of Prussia (18th Century). Did I know that Winston Churchill had a poodle called Rufus? Or that Richard Nixon had a dog called Checkers mentioned in his 1952 Checkers speech? I did remember that the Newfoundland, Nana from Peter Pan was the Darling children’s nurse and that Mr Darling was confined to the dog kennel until his children returned, as a penance for his treatment of Nana. Perhaps now we associate the phrase in the dog house as being applied to a husband who has upset his wife/partner or has been behaving badly and is shunned? I knew the phrase Dog in the night time meant an unwitting party to a crime and was in reference to a dog by Sir Arthur Conan Doyle in, I thought, Hound of the Baskervilles – but it was not, it was from his story the Silver Blaze in which the dog did not bark because it knew the man who took the horse from the stables. The exchange between Holmes and inspector Gregory is famous; “Is there a point to which you would wish to draw my attention?” “To the curious incident of the dog in the night-time.” Figure 1. Odysseus and Argos Contact: B.Jones@massey.ac.nz

Credit: Wikipedia https://commons.wikimedia.org/wiki/File:OdysseusArgos. jpg#/media/File:OdysseusArgos.jpg

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

“Argos passed into the darkness of death now that he had fulfilled his destiny of faith and seen his master once more after 20 years.” Homer, Odysseus, Book 17 We learned that story at school or veterinary school. Perhaps the Australian equivalent is the Australian cattle dog 5 miles from Gundagai, who sat on the tuckerbox guarding it and waiting for his master, a bullock driver, to return. He didn’t return and the dog died, waiting and loyal. Stories, books, poems and a song tell this Aussie story. I have visited his statue (Figure 2) which, I think was vandalised some years ago and then restored.

From stories recorded in early Irish literature it is clear that dogs occupied an important place in the Irish imagination. The dog has a dominant place in heroic tales. The most famous Irish hero Cu Chulainn took the place of a guard dog he had accidentally killed (Figure 3). He was known in his youth as Setanta, the nephew of King Conor. Setanta was attacked by the dog of Culann the smith, an animal said to have the strength of a hundred men. Nevertheless the young lad grabbed the dog by the throat and smashed it against a pillar so that its limbs “lept from their sockets”, according to Táin (Irish epic tales). He did not know his own strength. Culann had lost a valuable dog but Setanta promised to replace it with a pup and to guard Culann’s property until the pup was old enough to work. A priest who witnessed the feat of strength renamed the lad Cu Chulainn, the hound of Culann.

Figure 2. The statue of the dog on the tuckerbox at Gundagai

Photocredit: AYArktos, CC BY-SA 2.5, https://commons.wikimedia.org/w/ index.php?curid=406506

The Aussie dog I remember from student days was the dog on the v’randa from the Slim Dusty song Pub with no beer which was sung at a variety of (maybe boozy) student functions and I remember the lines: “Now there’s a dog on the v’randa, for his master, he waits, But his boss is inside, drinking wine with his mates. He hurries for cover and cringes in fear. T’s no place for a dog, round a pub with no beer.” My time in Ireland was useful in collecting legends about dogs. St Patrick who spent six years on a remote hill in Northern Ireland around 432 AD escaped, being directed by an angel who said, “Lo thy ship is ready.” Young Patrick had to travel 200 miles to the ship which was a merchant vessel, bound for Gaul with a cargo of dogs. Breeding of dogs in Ireland was so organised and of such repute in the early 5th century that they were exported to the continent by the shipload (maybe not too different today with puppy farms being of ongoing concern in Ireland).

Figure 3. Setanta slays the hound of Culain. Illustration by Stephen Reid from “The Boys’ Cuchlain” by Eleanor Hull (1904).

https://commons.wikimedia.org/w/index.php?curid=3484385

There are other great stories; the contest between King Conor and Queen Maeve over whom will win the dog called Ailbé, probably an Irish Wolfhound. Ailbé had supernatural intelligence and could run around Leinster (an Irish province) in a single day – he had speed! The dog was asked to decide whether Maeve’s men or Conor’s men were more heroic. Unfortunately this was the end of Ailbé who was killed while pursuing the frightened men of King Conor. Next time some dog stories from New Zealand.

References

The Native Dogs of Ireland (First Edtn.). Pp 2–6, Irish Kennel Club, Dublin, Ireland, 1984 Dent S. (Ed). Brewer’s Dictionary of Fame and Fable (19th Edtn.). Pp 390–4. Chambers Harrap Publishers Ltd., London, UK, 2012 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 3 | September 2021

Instructions for Authors submitting articles to the Companion Quarterly Sarah Fowler (Editor), for

the Companion Quarterly Editorial Committee

The Companion Quarterly is published quarterly in the first week of March, June, September and December of each year. The printing costs are covered by the advertisements. There is therefore a limit of about 55–60 pages to the size of each issue. There is a balance between political issues, articles for continuing education and other news. Authors are expected to submit their articles and conference in a final form suitable for publication. If practitioners wish assistance with writing, please contact the editor. Also look at previous issues to see the layout.

Articles

The article should have a title. Following the title the names of the authors, their degrees, titles, contact details should be present. Submit articles preferably by email, or disk if this is not possible. Submit articles in adequate time for reading and alterations before publication. Contributions must be original. Articles or extracts from articles may be completely copied only if there is permission from the original authors and source of publication. It is the responsibility of the author(s) rather than the editorial committee to obtain this permission. The author(s) should disclose if they have published the same article or a very similar article elsewhere. Articles that are clearly editorials/advertising will be labelled as such at the discretion of the editorial committee. These include articles/editorials that are repeated from other publications such as VetScript and that contain obvious product placement comments.

Proof reading

The authors should proof read their article looking for mistakes, spelling errors, omitted details. While the editorial committee reads through the articles, the articles should be presented error-free.

Articles and conference reports from recipients of grants and scholarships It is the responsibility of recipients of any grants and scholarships to supply any conference reports and articles written as part of the requirements in the final form suitable for publication.

References

A list of references should be supplied if appropriate. Follow the guidelines for the New Zealand Veterinary Journal for method of reporting of references. The number of references should be kept to a reasonable number relative to the length of article. Keep numbers of references to a minimum when discussing a single point, i.e. do not be repetitive with numerous references when a few will do. The editorial committee will omit references if the list is judged to be excessively long.

Figures

Good quality illustrations that clearly illustrate the necessary points should be submitted with the article. Submit any photos or graphics in their original forms (i.e. JPG, PDF, TIF files) as they lose their clarity when extracting them from Word or Publisher documents. If positions of figures are not obvious from the text, send a hard copy or some other form of instruction as to where they should be placed. Figures should be clearly numbered labelled as to top and bottom where necessary. Features on the figures should be clearly labelled by the author(s). The figure captions should be concise and accurate, and supplied with the text on a separate page at the end of the article. Diagrams/figures can be copied from textbooks only if there is permission from the original author and the source is clearly acknowledged. It is the responsibility of the author(s) to obtain this permission before submitting the article to the Quarterly editorial committee.

Timing of article submission and publication

Articles will be published as soon as possible after submission. The newsletter goes out in the first week of March, June, September and December. Articles therefore need to be submitted at least one month before (i.e. by the end of January, April, July and October) but preferably earlier to allow one month for the collation, printing, binding and posting of the Quarterly. Depending on when the articles are received, the size of that particular issue and the need for refereeing, at the editor’s discretion articles may be held over for a later issue.

Refereeing

reading if the editorial committee deems this is necessary. This is to ensure accuracy within the text to protect readers, the authors CAV and the clients and the patients of veterinary practitioners.

SciQuest and the NZVA website

Selected scientific articles will be placed on the SciQuest website for access by NZVA. There will be a delay of a year to ensure that practitioners still see a benefit in becoming CAV members. The entire newsletter is now being placed on the CAV website but the most recent issues (i.e. those within a year of publication) are available only to CAV members.

Article of the issue and student article

Prizes are sponsored for the best case report and general article in each quarterly issue. The best overall article in each category for the year is then decided in May and the overall prize awarded at the Annual dinner in June. The members of the editorial committee will judge the articles on their clarity, conciseness, and usefulness to practitioners. Articles that are submitted to the Quarterly as part of an obligation due to the author(s) receiving Educating the Educator or Study/ Research Grants from CAV are not eligible for the article of the issue prizes. Articles submitted by the editor and the members of the editorial committee are also not eligible for the prizes. There is a separate undergraduate student article competition.

Planning a case report? Some hints as to how do so!

When writing an article take time to look at how articles in other journals are arranged. While articles for the Quarterly are not as detailed as the NZVJ the information needs to be arranged in a logical manner to make it easy for the reader to follow. Therefore follow some logical headings as detailed below. Not all of these headings will need to be used in all articles and some may be combined depending on the type of case and amount and type of information available. • Introduction • History • Clinical signs • Materials and methods • Results (of investigations e.g. laboratory results, radiography). • Discussion • Conclusion • Acknowledgments • References. l

Articles may be sent to appropriate people in that field of expertise for refereeing/proof

Companion Quarterly: Companion Official Quarterly: Newsletter Official of the Newsletter Companion of the Animal Companion Veterinarians AnimalBranch Veterinarians of the NZVA Branch| of Volume the NZVA 32 No|3Volume | September 32 No2021 2 | June 2021

Companion Quarterly – Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA

Companion Quarterly

OFFICIAL Newsletter of the Companion Animal veterinarians branch of the nzva Volume 32, No. 3 | September 2021

VOLUME 32 NO 3 September 2021

Serological survey of leptospiral antibodies in unwell dogs in NZ

Survey results: NZ vets’ advice about vaccination and socialisation of puppies

A case of metaldehyde poisoning in a dog

Specialist Profile returns: Internal medicine specialist Tommy Fluen

Life without ACTH: Part 2

Companion Quarterly Vol 32 No3 September 2021

Articles inside

Shaggy dog stories

Dogs NZ update: Respiratory function grading scheme announcement

Massey News

What is your diagnosis? The answers

“Shake and Bake” – metaldehyde toxicity in a dog

Healthy Pets NZ update: Welcome to Spring!

CANZ update: Recommend trainers with confidence: part II

Serological survey of leptospiral antibodies in clinically unwell dogs in New Zealand

Life without ACTH hypoadrenocorticism

News in brief

What is your diagnosis?

Understanding current veterinary advice about vaccination and socialisation in puppies: a CAV survey

CAV Noticeboard

Letter to the editor

Editorial

CAV activities and meeting highlights

The future of pet groomers in New Zealand