Companion Quarterly Vol 33 No1 March 2022 by Companion Quarterly

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

Companion Quarterly

VOLUME 33 NO 1 March 2022

Guidelines for management of feline retroviruses

Radioactive iodine treatment for feline hyperthyroidism

A case of feline hyperaldosteronism

OFFICIAL Newsletter of the Companion Animal veterinarians branch of the nzva Volume 33, No. 1 | March 2022

Snippets from the 31st ACVIM-CA (virtual) Congress

A Week With.... reports: Craig Irving and Lisa Argilla

Volume 33 | No. 1 | March 2022 ISSN No. 2463-753X Executive Committee 2022 cav@vets.org.nz

Contents

President

Natalie Lloyd

Companion Quarterly

Vice President Simon Clark

Treasurer

Kevanne McGlade

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

Veterinary Manager (companion animal) TBA

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

2 4 6 8 10 12 14 20 24 28 30

The whole of the content of the Companion Quarterly is copyright, The Companion Animal Veterinarians Branch of the NZVA (CAV) and The New Zealand Veterinary Association (NZVA) Inc.

Cover credit

Photo of a happy orange kitty keeping itself busy taken by Dorothe Wouters for Unsplash

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

32 34 36 38 40 42 44

Editorial CAV activities and meeting highlights CAV Noticeboard What is your diagnosis?

Alex Walker, Tommy Fluen, Devon Thompson

Guidelines for the management of feline retroviruses Socialising your puppy resource Radioactive iodine (RAI) treatment for feline hyperthyroidism

Jing-Lu Teh

Horse or zebra? A case of feline hyperaldosteronism

Grace Kaemper

Conference report: European College of Veterinary Internal Medicine – Companion Animal: 31st Annual Congress

Kelsey Renner

A Week With ... Veterinary Ophthalmologist, Craig Irving

Leanne Norman

A Week With ... Lisa Argilla at the Dunedin Wildlife Hospital

Lisa Stuart

What is your diagnosis? The answers Companion Animals NZ update Healthy Pets NZ update Massey news All dogs great and small NZVJ abstracts Committee biographies

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

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Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

EDITORial

Someone has a birthday coming up……… This year CAV turns 50! And that is an incredible achievement that is worth celebrating.

and Dr Jess Beer rounding out our Puppy Project (these wonderful speakers will also be presenting at the upcoming NZVA conference in June).

I first became a CAV member – or a Companion Animal Society (CAS) member as it was then known – over half of CAV’s lifetime ago. Don’t go doing the maths on my age now … please? In the years since I have been a member, I know I have certainly seen some change. And change is the only thing in life that is certain – right? Even this beloved newsletter has undergone a few facelifts, and we hope to provide you some insight into this in the upcoming year. Since the inception of CAS in 1972, some incredible people have done some incredible things on behalf of you, the companion animal veterinarians of New Zealand. One of those “incredible things” was the hosting of WSAVA in Auckland in 2013. This was driven strongly by the CAS committee (before my time) and involved a huge amount of work and dedication. The work that went into hosting that event also set up CAV members to benefit for years into the future. To see speakers from all over the world presenting in little old New Zealand was an inspiration and for me, sowed the seed that this committee might be something I should find out more about. And since I have joined the committee, we have also had some memorable moments. Most notable in recent times was the banning of tail docking in New Zealand. This was a goal for CAV/CAS members who had been championing this issue tirelessly, and for a long time before I was here. We have represented you at stakeholder meetings with Dogs NZ, the National Cat Management Strategy Group, and Companion Animals New Zealand. We have provided input into the National Cat Management Strategy Document, and reviews of Animal Welfare Regulations including Significant Surgical Procedures. We drafted, reviewed and circulated policies and position statements on Companion Animal Vaccinations, The Ethical Guide to buying a Puppy, Responsible Dog Ownership, The Breeder’s Toolkit, and Behaviour Modifying Collar Use on Dogs.

We worked alongside other SIBs and with the NZVA to establish veterinarians as critical workers at the outset of COVID-19 in 2020 and then worked with the Vet Team providing advice for companion animal practitioners throughout 2020 and 2021. We even provided some support in 2020 in the form of free Balint therapy sessions for a few members. In 2020, CAV, alongside the Wildlife Branch, hosted a fantastic webinar presented by Dr Elsa Flint and Dr Yolanda van Heezik on the management of wildlife and companion cats. Last year we provided practitioners with content on management of FIV (check out the summary for the new Australian Feline Retrovirus Guidelines on page 10) and then hosted a great webinar on this topic from A/Prof. Richard Squires and Dr Mark Westman. Recently practitioners told us they were struggling with an explosion of puppies and finding challenges in balancing good advice on socialisation with vaccination requirements. So we surveyed the membership to find out what current practice was, sought expert advice on socialisation from a veterinary behaviourist and then set to reviewing current literature on vaccine protection. This was presented in the December issue of Companion Quarterly. You told us through the survey that a resource with a checklist would be useful in discussions with your clients so Jess, CAV and CANZ have collaborated to produce the Socialisation Handout on page 12. In early March we hosted a fantastic webinar from Lindsay Skyner

There is no doubt that there has been a lot of politics. In fact, if you ask me, far too many politics. Structural changes to our association have occurred right throughout my presidency. There was the Change Project involving changes to the constitution and governance. There have been (now) three different iterations of our veterinary support role at national office, each one looking slightly different. And of course, we have recently been through a NZVA restructure that has created another wave of passionate discourse. So what has not changed? What has not changed is this ….. 1) We are still here unwaveringly for you through the good and the bad (and I know the COVID-19 epidemic has brought both of those aspects). 2) Companion animal veterinarian’s welfare, and the welfare of the animals we care for is still the guiding principle of every decision our committee makes. 3) We still debate issues robustly, accepting that we sometimes we won’t always agree. We are vets after all! 4) We are still (and always) open to suggestions from you about how we can communicate with you better, or what projects you would like to see us work on for you. 2022 will bring some new changes. We have some exciting ideas for webinars in the making. We want to improve our ability to communicate with you, so you know what we are up to, and we know what is important to you. Just quietly, we are also planning on a bit of a party at the NZVA Mega Conference in June. And that is something I think everyone deserves. But even if conference does not happen, because we do live in an uncertain world, keep reading your Companion Quarterly and e-CAV so we can share some good news stories about this amazing branch and the wonderful people who have supported it since 1972.

Natalie Lloyd, CAV President

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

Working to promote and support companion animal practice in new zealand

CAV Committee activities and meeting highlights

In December 2021, the CAV President spoke on behalf of CAV members at the Special General Meeting that was called as a result of the disestablishment of the Chief Veterinary Officer role at the NZVA. Much of what was put forward was based on feedback from CAV members gathered through a survey conducted immediately prior to the SGM. At the time of this newsletter going to print an independent review was underway focusing on the 2019 changes to the constitution and on governance of the NZVA to determine if they are meeting member needs. Results of this review are expected to be shared with members in April 2022.

Puppy socialisation resource and webinar

We are pleased to share a new client resource with members, full of useful information about socialising new puppies while they are completing their primary vaccination course! The resource has been developed as part of last year’s ‘Puppy Project’ that aimed to provide clinicians with good information about how to balance the need for effective socialisation of puppies that are not yet fully vaccinated against parvovirus. Jess Beer of Kiwi Vet Behaviour worked with a group from the CAV committee to the double-sided A4 handout, which will also be shared with our friends at Companion Animals NZ. It can be downloaded from the Companion Animal Health and Welfare page of the Positions and Resources section on the NZVA website (https:// www.nzva.org.nz/resource/companionanimal/) and is reproduced on page 12. Rounding out CAV’s puppy socialisation resources, Dr Jess Beer (veterinary behaviourist) and Dr Lyndsay Skyner

(animal behaviourist and member of the CANZ training accreditation panel) present a webinar on the importance of puppy socialisation and choosing the right trainer. The webinar was presented on 3rd March. If you were unable to make it on the night, be sure to check out the recording once available! See the Companion Animal page of the NZVA’s Education Hub for more details.

Dechra/CAV A Week With… grant applications open

Applications for the Dechra A Week With… grant are open until the end of March. This grant provides general practitioners the opportunity to spend time alongside a specialist or special interest practitioner who works in the GP’s field of interest. Our host practitioners for 2022 are: Dr Lucy Scott, Veterinary Behaviour Services NZ, Waikato l Dr Becky Murphy, TCI Glenbred, Feilding l Dr Steve Heap, McMaster & Heap, Christchurch l Dr Alastair Coomer, Veterinary Specialists Aotearoa, Christchurch Applications close on 31st March. More information and application forms can be found on the CAV branch page of the NZVA website (https://www.nzva.org.nz/ branches/cav/) or email cav@vets.org.nz l

achievements and dedication of individual veterinarians. Each year it is presented to a CAV member who has contributed significantly to the branch or to the companion animal sector of the veterinary profession over a number of years. A list of previous recipients of the award is available on the CAV branch page of the NZVA website (https://www. nzva.org.nz/branches/cav/). If you know someone you think should join the list of winners, then nominate them now! Your nomination should include the person’s name, current location, role and a brief outline of why you believe their contributions should be recognised. Please email nominations to cav@vets.org.nz by Monday 14th March 2022.

Executive committee meeting The CAV executive committee will have their first meeting of 2022 later this month. Agenda items will include: l

Recruitment update of the Head of Veterinary Services – Companion Animal role. Feedback from interviews for the independent review. Planning for CAV's 50th anniversary celebrations. CAV Annual Service Award recipient for 2022. l

CAV Annual Service Award nominations are open The CAV executive committee invites you to nominate a deserving CAV member for this year’s CAV Annual Service Award. This award was first initiated in 1993 to celebrate the

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

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 March. 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 2022 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

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.

WINNER

"Transarterial closure of a patent ductus arteriosus in a Corgi puppy"

Miranda Tong

December 2021 | Volume 32(4) | Page 39

Article of the Issue

EyeVet Services Limited

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

What is your diagnosis? THE QUESTIONS… Dr Alex Walker , BVSc, Zoetis Intern at Veterinary Specialists Aotearoa Dr Tommy Fluen, FANZCVS, Registered Specialist Small Animal Internal Medicine at Veterinary Specialists Aotearoa Dr Devon Thompson, DipECVDI, Registered Specialist Radiologist at Veterinary Specialists Aotearoa

Table 1. Serum biochemistry results for 8-month-old Rottweiler with anorexia and hypodipsia. Red text indicates results greater than the reference interval.

Case history

A 40 kg, 8-month-old, male-entire Rottweiler was presented to its regular veterinary clinic for anorexia and hypodipsia. The hypodipsia was not specifically quantified but water intake was markedly reduced compared to normal. There was no reported history of toxin exposure, diet change, vomiting or diarrhoea.

Clinical findings

On physical examination the dog was dull, weak, and lethargic with an elevated temperature of 40°C. A blood sample was collected and sent to Gribbles Veterinary diagnostic laboratory for haematology and biochemistry (Table 1), an additional biochemistry panel was performed the following day. A free catch urine sample was collected and analysed in-house. Haematology was unremarkable, urine specific gravity was optimally concentrated at 1.055, with 3+ protein on dipstick.

Contact: alex.walker@hotmail.co.nz

Analyte

Units

Test 1

Test 2a

Reference interval

Sodium Potassium Na K Ratio Chloride Creatinine Urea Phosphate Cholesterol TP Albumin Globulin A/G Ratio Calcium Bilirubin Alk phos ALT AST CK Amylase Bicarbonate Anion gap

mmol/L mmol/L ratio mmol/L μmol/L mmol/L mmol/L mmol/L g/L g/L g/L RATIO mmol/L μmol/L IU/L IU/L IU/L IU/L IU/L mmol/L mmol/L

186 4.1 45.8 138

187 4.2 44.6 139 107 5.6 1.75 5.9 70 42 28 1.52 2.89 4.3 32 66 338 2705 472

141–153 4.0–5.4 27–36 104–123 48–109 2.5–9.0 0.92–1.82 3.3–9.8 54–74 33–44 19–35 0.52–1.7 2.08–2.82 1.0–3.0 0–87 0–88 0–51 0–385 0–1074 18–27 8.0–26.0

20 32.1

Sample 2 was collected 24 hours after Sample 1

Following 2 weeks of intermittent treatment and hospitalisation for a variety of differential diagnoses the dog was subsequently referred. During this time under the care of the referring veterinarian, therapeutics included amoxicillin-clavulanic acid, enrofloxacin, metronidazole, dexamethasone and I/V fluid therapy with lactated Ringer’s solution.

level of consciousness, delayed menace reflex in the left eye and proprioceptive deficits in the left pelvic limb. An inhouse venous blood-gas confirmed persistent hypernatremia (176 mmol/L, reference range 139–150 mmol/L).

On presentation to the referral clinic, the dog was hyperthermic with a decreased

3. What are your next diagnostic steps?

Questions

1. What is this dog's problem list? 2. What are your differential diagnoses? 4. What is your treatment plan?

Answers on page 32

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

CAV update

Guidelines for the management of feline retroviruses In 2021 Boehringer Ingelheim Australia sponsored the production of a set of guidelines for the management of feline retroviruses. CAV have sought permission to share these guidelines for our members which has been kindly provided by Boehringer Ingelheim New Zealand. These guidelines were put together by the Australian Feline Retrovirus Advisory Panel. The panel was made up of the following members: l l l l l l l

Dr Mark Westman (Panel Chair) Prof. Jacqueline Norris Dr Sally Coggins Dr Moira van Dorsselaer Prof. Richard Malik A/Prof. Richard Squires A/Prof. Mary Thompson

Sean Corcoran Pixabay

We believe these guidelines are a valuable tool for New Zealand practitioners, despite the intended audience being our Australian colleagues. They are packed with tips and tricks and are presented in a visually appealing and easy to read format. The guidelines cover the following (not exhaustive) list of information about feline immunodeficiency virus (FIV). l l l

l l

Prevalence data and pathology of FIV infection in cats. Recommended testing methods including both point-of-care test kits and the PCR test. The use of both blood and saliva samples for point of care testing and some feline friendly tips for taking blood samples (including a lovely method for testing from the foot pad or ear tip) A section on when it is appropriate to test for FIV infection Options for preventing cats from being infected with the FIV virus including considerations of the Five Pillars of Feline Welfare for cats that are kept indoors

l l

Also included in the “Prevention from FIV” section is a section on FIV Vaccination including discussion on findings of recently published efficacy studies Recommended vaccination procedures for recently bitten cats and “brawler” cats Management of FIV-positive cats considering the following aspects o Making improvements to the cat’s husbandry (with a checklist of recommendations for basic health care and husbandry measures for FIV-infected cats) o Detection of concurrent diseases o Monitoring for immunodeficiency o The use of antiretroviral agents

The full guidelines can be found at https://www.nzva.org.nz/ resource/companion-animal/. A huge thank you to all the panelists involved as well as Boehringer for sponsoring the production of this incredibly useful information.

Contact: cav@vets.org.nz

Puppy socialisation resource CAV, in conjunction with Companion Animals NZ and behaviourist Jess Beer have produced a poster/handout providing guidance on how clients can safely socialise their puppies during their vaccination course. This resource can be downloaded from the Companion Animal Health 10

and Welfare section of Positions and Resources on the NZVA website (see https://www.nzva.org.nz/resource/ companion-animal/) and is reproduced on the following pages. Many thanks also to NZVA’s talented graphic designer, Lydia Bristow.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

Feature Article

Radioactive iodine (RAI) treatment for feline hyperthyroidism Jing-Lu Teh, BVM&S, MRCVS

Introduction

Feline hyperthyroidism (FHT) is currently the most diagnosed endocrine disease among cats worldwide (Carney et al. 2016; Peterson 2020). Until the exact cause is determined, and prevention becomes possible, the prevalence of FHT is likely to increase (Rijnberk and Kooistra 2010a; Carney et al. 2016; Peterson 2020). FHT arises most frequently from adenomatous hyperplasia, rarely malignant carcinoma and results in deleterious effects on kidney, heart, gastrointestinal tract and systemic blood pressure (Rijnberk and Kooistra 2010a; Carney et al. 2016; Peterson 2020). With proper treatment and monitoring hyperthyroid cats can be cured or controlled; and live >2 years (Carney et al. 2016; Peterson 2020). Currently there are four treatment methods available: radioiodine (RAI), thyroidectomy, medical management (e.g. methimazole) and dietary management (Rijnberk and Kooistra 2010a; Carney et al. 2016; Peterson 2020). This article focuses on RAI, now widely considered as the gold standard treatment and discusses its pros, cons, pre- and post-treatment management. Targeted ablation of the abnormal thyroid tissue is achieved via selective uptake and concentration of I-131 by the hyperfunctional thyroid tissue (Peterson 2020). Normal or atrophied thyroid tissue does not absorb I-131 as much as the hyperactive thyroid tissue thus remains unaffected (Rijnberk and Kooistra 2010).

Pros and efficacy of radioactive iodine treatment

Radioactive iodine treatment has a high cure rate (85–95%) (Slater et al. 1994; Rijnberk and Kooistra 2010a; Volckaert et al. 2016; Peterson 2020). In most cases the concentration of serum total T4 (TT4) reduced significantly within 1 month and continued to reduce gradually up to 6 months post-treatment (Mooney 2005; Peterson 2006). Successfully RAI-treated cats lived a median of 4 years after treatment, twice as long compared to cats undergoing methimazole treatment (Milner et al. 2006; Rijnberk and Kooistra 2010a). RAI targets specifically hyperfunctional thyroid tissue while sparing the surrounding healthy tissue (Peterson 2006; Rijnberk and Kooistra 2010a; Carney et al. 2016). It is more efficacious than surgery in treating ectopic thyroid, which was reported in 3.9–23% of hyperthyroid cats (Mullowney et al. 2021). RAI is a simple, anaesthesia-sparing procedure, administered by injection or orally (Carney et al. 2016; Peterson 2020). Contact: Chatswood Vet Clinic Willoughby, NSW, Australia. j.l.teh83@gmail.com

Amber Kipp from Unsplash

The cons and side effects of radioactive iodine treatment Radioactive iodine has a higher upfront but lower longterm cost compared to other treatment (Carney et al. 2016; Peterson 2020). RAI may not be easily accessible in some areas as the procedure must be carried out at a licensed facility (Peterson 2006, 2020). The requirement for hospitalisation post-treatment may be stressful for some cats and owners (Peterson 2020). After treatment, clients need to adhere to regional rules and regulation to minimise human exposure to radiation (Mooney 2005; Rijnberk and Kooistra 2010a; Peterson 2020). Transient fever and dysphagia have occasionally been reported soon after treatment (Peterson 2006, 2020). Cases of iatrogenic hypothyroidism post-treatment have been reported when a standard high fixed-dose protocol (4–5 mCi) was used frequently in the past (Lucy et al. 2017). The incidence

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

is now reduced due to the preference for individualised, lower dosage protocol (3–5 mci) based on the TT4 concentration and the thyroid volume (Lucy et al. 2017; Peterson 2020).

Patient selection

All hyperthyroid cats should be screened for any cardiorespiratory, renal, gastrointestinal, or neoplastic illness prior RAI treatment because comorbidities have a great impact on survival time regardless of the treatment methods for FHT (Carney et al. 2016; Peterson 2020). The most suitable candidate is expected to live >3 years and is free of comorbidities (Peterson 2020). One should be aware that it is not possible to distinguish hypertrophic cardiomyopathy from hyperthyroidrelated cardiomyopathy until cats have been euthyroid for 3–6 months (Carney et al. 2016). Palliative care should be considered for cats with moderate to severe comorbidities especially chronic kidney disease (CKD) (Peterson 2006, 2020). Cats with mild or stable CKD without other comorbidities can still be considered a candidate with careful consideration of RAI dosage to avoid iatrogenic hypothyroidism (Peterson 2006, 2020).

Post-RAI monitoring

All RAI-treated patients should be followed up long-term for the best outcome. Monitoring during the first 6 months after treatment is to identify any hypothyroidism, CKD or treatment failure. Subsequent yearly monitoring is to check for relapse or development of hypothyroidism (Carney et al. 2016; Peterson 2020).

Rijnberk and Kooistra 2010a). While symmetric dimethylarginine (SDMA) has been shown to be better than creatinine as a marker for renal function in healthy cats and cats with CKD, this was not the case for cats with FHT (Buresova et al. 2019; DeMonaco et al. 2020). One study showed that elevated concentrations of SDMA pre-treatment has high specificity (97.7%) but poor sensitivity (33.3%) for predicting development of azotaemia after RAI treatment (DeMonaco et al. 2020). Another study demonstrated SDMA was not a reliable renal marker in assessing renal function after RAI treatment due to poor correlation with GFR (Buresova et al. 2019). In contrast, both the creatinine and USG correlated better with GFR after RAI treatment (Buresova et al. 2019). The trend of SDMA pre- and post-treatment was inconsistent with other renal markers and CKD stages (DeMonaco et al. 2020). Hence, SDMA should be interpreted along with concentrations of creatinine, urea and USG; with consideration of physiological factors, breed variation and thyroid status (Yu et al. 2020). GFR shows most significant changes within 1 month of a cat becoming euthyroid; minimal changes from 1–6 months and no changes beyond 6 months (Peterson 2006). The most reliable time to assess kidney status would arguably be 3–6 months after the cat becomes euthyroid (Peterson 2020). Between 14–25% of RAI-treated cats became azotemic within 6 months of treatment (Slater et al. 1994; Milner et al. 2006; Peterson 2020).

Hypothyroidism

Twenty percent of cats that receive either RAI or methimazole treatment developed hypothyroidism (Peterson 2006; Aldridge et al. 2015; Carney et al. 2016). This maybe an underestimate given that not all cats in these studies were monitored long term and that subclinical hypothyroidism maybe overlooked (Williams et al. 2010; Aldridge et al. 2015; Peterson 2020). In the study by Williams et al. (2010), the hypothyroid cats had a higher incidence of azotemia compared to the euthyroid group. Of 255 RAI-treated cats followed long-term, by Slater et al. (1994), 27% had concurrent hypothyroid and CKD. Hypothyroid cats with azotemia survived half as long as hypothyroid cats without azotemia (456 vs. 905 days) (Williams et al. 2010). In the euthyroid group, the survival time between azotemic and non-azotemic cats were not significantly different thus suggesting hypothyroidism may be contributing to progression of CKD and is thus a negative prognostic indicator in azotemic cats. In this population, 68% of hypothyroid cats (TT4 <10 nmol/L) had high TSH concentrations (>0.15 ng/ mL) detected within 6 months after RAI treatment. The exact time taken for TSH suppression to be reversed after cats become euthyroid is currently unknown (Williams et al. 2010). TSH concentration could potentially be low or normal in hypothyroid cats at early stages (Aldridge et al. 2015). To avoid iatrogenic hypothyroidism, the ideal recommended TT4 concentration post-RAI treatment is

Chronic kidney disease

A patient’s renal status after RAI treatment is critical due to the lack of reliable markers to identify pre-existing CKD in the presence of FHT (Peterson et al. 2018; DeMonaco et al. 2020; Peterson 2020; Yu et al. 2020). Azotemia can be masked by combination of increased glomerular filtration rate (GFR) and decreased body mass in FHT (Peterson et al. 2018). There is also confounding effect on interpretation of urine specific gravity (USG) due to thyrotoxicosis-induced psychogenic polydipsia or acquired nephrogenic diabetes insipidus (Mooney 2005;

Kari Shea from Unsplash

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

in the middle of the reference interval (Williams et al. 2010; Peterson 2020). For cats with decompensated renal disease following RAI treatment, it is imperative to identify iatrogenic hypothyroidism promptly because L-thyroxine supplementation can potentially halt the progression and improve survival (Peterson 2006; Aldridge et al. 2015).

Treatment failure

Thyroid carcinoma is often the reason for treatment failure (Harvey et al. 2009; Peterson 2020; Mullowney et al. 2021). One study found cats with TT4 concentration >150 nmol/L at discharge following RAI treatment were more likely to fail to become euthyroid and 86% of cats became euthyroid with a second RAI treatment (Mullowney et al. 2021). With high I-131 dosage, RAI can potentially cure thyroid carcinoma (Peterson 2006; Harvey et al. 2009; Mullowney et al. 2021). The prevalence of thyroid carcinoma has been reported to be 0.5–3 % (Harvey et al. 2009; Rijnberk and Kooistra 2010a; Peterson 2020; Mullowney et al. 2021). This could be an underestimate due to difficulty in diagnosis: scintigraphy cannot distinguish benign from malignant features in 100% of cases and histology is not always conclusive (Harvey et al. 2009). Compared to canine thyroid carcinoma, there is a low rate of metastasis in cats (Harvey et al. 2009; Rijnberk and Kooistra 2010a; Peterson and Broome 2015).

Conclusion

Successful RAI treatment offers definitive cure for FHT with significant improvement in quality of life and survival time (Peterson 2006; Rijnberk and Kooistra 2010a; Peterson 2020). Critical selection of patients; appropriate RAI dosage; and monitoring for any azotemia, hypothyroid, treatment failure or relapse post-treatment are important parts of management.

References

Aldridge C, Behrend EN, Martin LG, Refsal K, Kemppainen RJ, Lee HP, Chciuk K. Evaluation of thyroidstimulating hormone, total thyroxine, and free thyroxine concentrations in hyperthyroid cats receiving methimazole treatment. Journal of Veterinary Internal Medicine 29, 862–8, 2015

Berg RIM, Nelson RW, Feldman EC, Kass PH, Pollard R, Refsal KR. Serum insulin-like growth factor-I concentration in cats with diabetes mellitus and acromegaly. Journal of Veterinary Internal Medicine 21, 892–8, 2007 Buresova E, Stock E, Paepe D, Stammeleer L, Vandermeulen E, Smets P, Duchateau L, Lefebvre HP, Daminet S. Assessment of symmetric dimethylarginine as a biomarker of renal function in hyperthyroid cats treated with radioiodine. Journal of Veterinary Internal Medicine 33, 516–22, 2019 Carney HC, Ward CR, Bailey SJ, Bruyette D, Dennis S, Ferguson D, Hinc A, Rucinsky AR. 2016 AAFP guidelines for the management of feline hyperthyroidism. Journal of Feline Medicine and Surgery 18, 400–16, 2016 DeMonaco SM, Panciera DL, Morre WA, Conway T, Werre S. Symmetric dimethylarginine in hyperthyroid cats before and after treatment with radioactive iodine. Journal of Feline Medicine and Surgery 22, 531–8, 2020 Harvey AM, Hibbert A, Barrett EL, Day MJ, Quiggin AV, Brannan RM, Caney SM. Scintigraphic findings in 120 hyperthyroid cats. Journal of Feline Medicine and Surgery 11, 96–106, 2009 Lucy JM, Peterson ME, Randolph JF, Scrivani PV, Rishniw M, Davignon DL, Thompson MS, Scarlett JM. Efficacy of low-dose (2 millicurie) versus standard-dose (4 millicurie) radioiodine treatment for cats with mild-to-moderate hyperthyroidism. Journal of Veterinary Internal Medicine 31, 326–34, 2017 Milner RJ, Channell CD, Levy JK, Schaer M. Survival times for cats with hyperthyroidism treated with iodine 131, methimazole, or both: 167 cases (1996– 2003). Journal of the American Veterinary Medical Association 228, 559–63, 2006 Mooney CT. Hyperthyroidism. In: Ettinger SJ, Feldman EC (eds). Textbook of Veterinary Internal Medicine: Diseases of the Dog and Cat. 6th Edtn. p 1548. Elsevier/Saunders, St Louis, MO, USA, 2005 Mullowney D, Chang Y-M, Glanemann B, Syme HM. Treatment failure in hyperthyroid cats after radioiodine (I-131) injection. Journal of Veterinary Internal Medicine 35, 1688–96, 2021 Peterson ME. Radioiodine treatment of hyperthyroidism. Clinical Techniques in Small Animal Practice 21, 34–9, 2006 Peterson ME, Broome MR. Thyroid scintigraphy findings in 2096 cats with hyperthyroidism. Veterinary Radiology and Ultrasound 56, 84–95, 2015

Peterson ME, Varela FV, Rishniw M, Polzin DJ. Evaluation of serum symmetric dimethylarginine concentration as a marker for masked chronic kidney disease in cats With hyperthyroidism. Journal of Veterinary Internal Medicine 32, 295–304, 2018 Peterson ME. Hyperthyroidism in cats: considering the impact of treatment modality on quality of life for cats and their owners. Veterinary Clinics of North America: Small Animal Practice 50, 1065–84, 2020 Rijnberk A, Kooistra HS. Hyperthyroidism and thyroid tumours. In: Clinical Endocrinology of Dogs and Cats: an Illustrated Text. 2nd Edtn. p 6. Schlütersche, Hannover, Germany 2010a Rijnberk A, Kooistra HS. Hypothalamuspituitary system. In: Rijnberk A, Kooistra HS (eds). Clinical Endocrinology of Dogs and Cats 2nd Edtn. Pp 13–34. Schlütersche, Hannover, Germany, 2010b Slater MR, Komkov A, Robinson LE, Hightower D. Long-term follow-up of hyperthyroid cats treated with I-131. Veterinary Radiology & Ultrasound 35, 204–9, 1994 Starkey SR, Tan K, Church DB. Investigation of serum IGF-I levels amongst diabetic and non-diabetic cats. Journal of Feline Medicine and Surgery 6, 149–55, 2004 Volckaert V, Vandermeulen E, Dobbeleir A, Duchateau L, Saunders JH, Peremans K. Effect of thyroid volume on radioiodine therapy outcome in hyperthyroid cats. Journal of Feline Medicine & Surgery 18, 144–9, 2016 Williams TL, Elliott J, Syme HM. Association of iatrogenic hypothyroidism with azotemia and reduced survival time in cats treated for hyperthyroidism. Journal of Veterinary Internal Medicine 24, 1086–92, 2010 Yu L, Lacorcia L, Finch S, Johnstone T. Assessment of serum symmetric dimethylarginine and creatinine concentrations in hyperthyroid cats before and after a fixed dose of orally administered radioiodine. Journal of Veterinary Internal Medicine 34, 1423–31, 2020 l

This review was written as part of the requirements for completing the Master of Veterinary Medicine programme at Massey University.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

Case REPORT

Horse or zebra? A case of feline hyperaldosteronism Grace Kaemper BVSc

(dist.)

Introduction

Hyperaldosteronism is the most common adrenal endocrine disease in cats (Kooista 2020). The true frequency is difficult to determine, as it is generally regarded to be underdiagnosed (Schulman 2010). This case study examines the presenting signs, diagnosis, and treatment of feline hyperaldosteronism; and proposes that this not uncommon endocrine disease should be routinely put on differential diagnosis lists when presented with hypertensive or hypokalaemic cats, rather than considered a ‘zebra’.

Case history

A 12-year-old female spayed domestic short hair cat presented for acute onset of blindness. The cat had mildly increased water intake, but there were no other significant historical findings.

Clinical findings

On physical exam, there was bilateral mydriasis, and menace and pupillary light reflexes were absent. There was no pain on ocular retropulsion. Ophthalmoscopic examination revealed regions of retinal haemorrhage. Systemic arterial blood pressure was measured as 280 mmHg using a Doppler flow detector, therefore hypertensive retinopathy was diagnosed. The physical exam was otherwise within normal limits. An in-house biochemistry renal panel (Kidney Profile Plus; Abaxis, Griesheim, Germany) revealed moderate hypokalaemia of 2.8 (reference range 3.7–5.8) mmol/L, and mild elevations in the concentration of urea and content of tCO2. The concentration of creatinine was within normal limits, as were other electrolytes.

Contact: gracekaemper.bayvets@gmail.com

Hypertensive retinopathy and hypokalaemia were the key clinical findings. Hypertension can be idiopathic but is more commonly secondary to another pathology (Acierno et al. 2018). In cats, the most common causes are hyperthyroidism, chronic kidney disease, hyperaldosteronism, protein losing nephropathy, and less commonly diabetes mellitus (Acierno et al. 2018). The combination of hypertension and hypokalaemia made hyperaldosteronism the most likely differential.

Further diagnostic findings

Hyperthyroidism was ruled out by a normal concentration of free thyroxine (T4) (T4/Cholesterol Test; Abaxis) in serum. In-house urinalysis collected by cystocentesis showed a urine specific gravity of 1.043, negative glucose, 2+ protein and an inactive sediment; thereby ruling out chronic kidney disease, protein-losing nephropathy and diabetes mellitus. Although there was moderate proteinuria, this was most likely secondary to hypertension rather than the cause. An aldosterone assay was run on frozen serum resulting in a concentration of 1,430 pmol/L. A study by Yu et al. (1998) found the median plasma aldosterone concentration of healthy cats was 161 pmol/L. As the upper value set by the laboratory for healthy domestic cats was 700 pmol/L, this result confirmed the diagnosis of primary hyperaldosteronism.

Treatment

While waiting for the results of the aldosterone assay, symptomatic treatment with 0.65 mg/cat amlodipine (Amodip 1.25 mg; CEVA Animal Health Pty Ltd, Glenorie, Australia) once daily and oral potassium gluconate supplementation at 0.5 mEq/kg (Kaminox 2 mEq/2mL; VetPlus Ltd, Docklands, UK) were initiated. The amlodipine dose was increased to 1.25 mg/cat once daily after 1 week due to

insufficient response. Two weeks after starting treatment, the diagnosis of hyperaldosteronism was confirmed, and spironolactone (Spiractin 25mg; Mylan New Zealand Ltd, Auckland, NZ) was initiated at a dose of 2 mg/kg twice daily. At this point, systolic blood pressure had decreased to a mean of 148 mmHg, which fell within the ideal range. However shortly after beginning treatment with spironolactone, the cat developed acute forelimb pain and lethargy due to hypokalaemic myopathy. Persistent hypokalaemia of 3.2 mmol/L was confirmed despite oral supplementation. Intravenous potassium supplementation was provided with 10 mEq/L potassium chloride (Biomed Ltd, Auckland, NZ) and Metabolase (Ethical Agents Ltd, Auckland, NZ) added into a constant rate infusion of 0.9% NaCl at 9 mL/hour. Treatment was unsuccessful and the cat entered cardiac arrest.

Discussion

Hyperaldosteronism is the most common adrenal endocrine disease in cats (Kooistra 2020). However, the true frequency is difficult to determine, as it is generally regarded to be underdiagnosed (Schulman 2010). Lo et al. (2014) estimate that primary adrenal tumours make up 0.2% of all neoplasms in cats. Many studies argue that hyperaldosteronism should be considered as a differential when middle-aged to older cats present with either hypertension or hypokalaemia (Ash 2005, Kooistra 2020). One proposed reason for underdiagnosis is that chronic kidney disease is blamed for hypertension and hypokalaemia, and no further diagnostics are performed (Javardi et al. 2005). In reality, hyperaldosteronism can accelerate the progression of CKD and the two diseases are present concurrently in a proportion of azotaemic cats (Javardi et al. 2005). Aldosterone is secreted from the zona glomerulosa in the adrenal cortex. In a healthy animal, its release is regulated by

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

the renin-angiotensin system (involved in blood volume homeostasis) and serum potassium concentration. Aldosterone acts at the distal convoluted tubule to increase sodium resorption and potassium secretion, thereby decreasing water loss in urine and maintaining blood volume. It also increases blood pressure by increasing systemic vascular resistance. Primary hyperaldosteronism leads to an increase in circulating aldosterone, causing the classic clinical signs of hypertension and hypokalaemia. Unlike Cushing’s disease (hyperadrenocorticism), hyperaldosteronism is caused by hyperplasia or functional tumours of the adrenal gland, not by pituitary lesions. These adrenal tumours are most commonly unilateral but can be bilateral (Kooistra 2020). Common presenting clinical signs associated with hypokalaemia include polymyopathy, episodic muscle weakness, muscle pain, and/or ventroflexion of the neck. This muscle weakness can progress to difficulty breathing and paresis. Clinical signs are seen when blood potassium falls below 2.5 mmol/L (Kooistra 2020). Blindness secondary to hypertension is another common presenting sign. Not all cats will present with signs of both hypertension and hypokalaemia (Kooistra 2020, Ash et al. 2005). Some cats are polyuric/polydipsic however this is suspected to be due to secondary renal disease (Ash et al. 2005). Secondary hypertensive cardiomyopathy can also be seen (Bento et al. 2016). There are a range of confirmatory diagnostics. This author found measurement of serum aldosterone concentration to be a cheap, readily available, straightforward and reliable test, especially in the absence of referral ultrasonography. The disadvantage of testing serum aldosterone is that it is highly labile, therefore a frozen serum sample must be sent to the diagnostic laboratory. Additionally, it is only available at human laboratories, and there can be a delay in receiving results. Both an elevated or a high-normal aldosterone concentration in the face of hypertension/hypokalaemia, are suggestive of primary hyperaldosteronism due to negative feedback mechanisms (Kooistra 2020). Other diagnostic methods include the measurement of the serum aldosterone

to renin ratio, urinary aldosterone to creatinine ratio, and dynamic aldosterone secretion testing (fludrocortisone suppression test or telmisartan suppression test) (Kooistra 2020). Abdominal ultrasound is the diagnostic test of choice, when available, as it is non-invasive and allows for determination of unilateral versus bilateral adrenal abnormalities (Kooistra 2020). The normal dorsoventral length of the adrenal gland in cats is 4 mm (Moore et al. 2000). Gold standard treatment for unilateral hyperaldosteronism is unilateral adrenalectomy. However, this is a difficult, referral procedure with a high intra-operative complication rate. In a retrospective study of ten cats by Lo et al. (2014), two cats were euthanised prior to discharge due to surgical complications, which included haemorrhage, hypotension and sepsis. The remaining eight cats required no further medical treatment for hyperaldosteronism. The median survival time was nearly 1,300 days. Although few owners are willing to pursue this route due to cost and risk, the clinical outcomes can be excellent. Medical management, as described in this case study, is centred on spironolactone 2 mg/kg twice daily. Amlodipine at 0.625–1.25 mg/cat is given once daily to reduce blood pressure, aiming for systolic blood pressure <150 mmHg. Oral potassium supplementation with potassium gluconate at 0.5 mEq/kg is often required (Kooistra 2020). Survival time for conservative treatment ranges from months to years (Bento et al. 2016). When reflecting on management of this case, the poor outcome was likely due to long-term uncontrolled hypokalaemia. This cat would have benefited from I/V potassium supplementation at the initial consult. Studies show there is poor oral absorption of potassium in cats with hyperaldosteronism (Ash et al. 2005). Further questioning of the owners also revealed that they struggled to give Kaminox routinely, further reducing the efficacy of oral treatment. Additionally, due to the marked hypertension, amlodipine could have been started on the higher dose of 1.25 mg/cat, rather than titrating up (Acierno et al. 2018). In conclusion, hyperaldosteronism should be considered whenever patients present with hypertension or hypokalaemia, especially in poorly responsive renal

cases, as hyperaldosteronism may be the underlying cause. Diagnosis can be made in general practice without referral, utilising either ultrasonography or serum aldosterone. When picked up early enough, these cases can be very rewarding; and with greater awareness of the disease, frequency of diagnosis in general practice is likely to increase.

Acknowledgements

Thanks to my colleagues at Bay Vets for their support and trust; and to Sandra Forsyth at SVS laboratories for her diagnostic advice.

References

Acierno MJ, Brown S, Coleman AE, Jepson RE, Papich M, Stepien RL, Syme HM. ACVIM consensus statement: Guidelines f or the identification, evaluation, and management of systemic hypertension in dogs and cats. Journal of Veterinary Internal Medicine 32, 1803–1822, 2018 Ash RA, Harvey AM, Tasker S. Primary hyperaldosteronism in the cat: A series of 13 cases. Journal of Feline Medicine and Surgery 7, 173–82, 2005 Bento DD, Zahn FS, Duarte LC, de Araújo Machado LH. Feline primary hyperaldosteronism: An emerging endocrine disease. Ciência Rural 46, 686–93, 2016 Javardi S, Djajadiningrat-Laanen S, Kooistra HS, van Dongen AM, Voorhout G, van Sluis FJ, van den Ingh TSGAM, Boer WH, Rijnberk A. Primary hyperaldosteronism, a mediator of progressive renal disease in cats. Domestic Animal Endocrinology 28, 85–104, 2005 Kooistra HS. Primary hyperaldosteronism in cats: An underdiagnosed disorder. Veterinary Clinical Small Animal 50, 1053–63, 2020 Lo AJ, Holt DE, Brown DC, Schlicksup RJ, Orsher RJ, Agnello KA. Treatment of aldosterone-secreting adrenocortical tumors in cats by unilateral adrenalectomy: 10 cases (2002–2012). Journal of Veterinary Internal Medicine 28, 137–43, 2014 Moore LE, Biller DS, Smith TA. Use of abdominal ultrasonography in the diagnosis of primary hyperaldosteronism in a cat. Journal of the American Veterinary Medical Association 217, 213–5, 2000 Yu S, Morris JG. Plasma aldosterone concentration of cats. The Veterinary Journal 155, 63–68, 1998 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

Virtual Conference report

European College of Veterinary Internal Medicine – Companion Animal 31st Annual Congress Online 1–4 September 2021

Kelsey Renner BVSc It has been difficult to appreciate the good things recently due to the SARSCOVID-19 pandemic. However, the ability to virtually attend international conferences is exciting, particularly for veterinarians in the Southern Hemisphere. I was very fortunate to receive sponsorship from Royal Canin NZ to attend the 2021 virtual ECVIMCA conference. There was a broad range of topics, abstracts and research reports presented by a number of brilliant speakers. The virtual exhibit hall provided interactive exhibitions on new diets and pharmaceuticals. The lounge held virtual social events, such as yoga, cocktail parties and dance parties to enjoy with people from all around the world. This conference report includes only a small portion of the fascinating lectures, abstracts and new research presented at the congress. Aerodigestive disorders. Megan Grobman, DVM, MS, DACVIM (SAIM), PhD - Aspiration pneumonia is the most widely recognised aerodigestive disorder in dogs, however the range of aerodigestive disorders affecting dogs is far broader. - Macroaspiration and microaspiration (aspiration of large and small volumes of oropharyngeal/gastric contents, respectively) are associated with upper respiratory disease (rhinitis, laryngitis), oropharyngeal disease

Contact: Kelsey.renner@arcvets.co.nz

(tonsilitis, pharyngitis), bronchiolar disease, aspiration pneumonia/ pneumonitis, and interstitial disease. - Aerodigestive disorders can be difficult to diagnose as not all patients present with gastrointestinal signs. Gastroesophageal reflux disorder (GERD) - GERD is another common aerodigestive disorder in dogs, particularly in brachycephalic breeds. - Risk factors include hiatal hernia, obesity, brachycephalic breeds, pyloric stenosis, paralysispolyneuropathy syndrome and lower esophageal sphincter achalasia-like syndrome. - Affected dogs do not always have obvious gastrointestinal signs. Subtle signs such as lip-licking, swallowing, and abdominal pain may be missed by owners. - Videofluoroscopic swallowing studies are the modality of choice for confirming and characterising GERD. - Managing GERD involves reducing the volume and composition of reflux. Treatment trials should be at least 4 weeks long, as clinical signs are often intermittent. 1. Proton pump inhibitors (1 mg/kg twice daily) are more effective than H2 blockers for increasing the pH of gastric contents. 2. Metoclopramide promotes more rapid gastric emptying, but it does not affect the lower esophageal sphincter tone. 3. Cisapride promotes more rapid gastric emptying and increases lower esophageal tone. Cisapride

has more side effects than metoclopramide (cramping, diarrhoea). The speaker often tries metoclopramide first. 4. Feeding – smaller, more frequent meals (3 per day). Wet foods (or soaked kibble), low in fat and served at room temperature, have been shown to be helpful. Avoid feeding within 2 hours of bedtime. Aspiration pneumonia and pneumonitis - Pneumonitis is inflammation of the lung tissue, whereas pneumonia is inflammation of the lung tissue caused by bacteria/viruses. - It is not only bacteria and gastric acid that can cause inflammation of the lung tissue. Digestive enzymes, bile acids, and small non-acidified particles (SNAPs) all contribute to inflammation. - The respiratory tract is not sterile. Bacteria are introduced during microaspiration, which occurs frequently. The presence of bacteria in a bronchoalveolar lavage (BAL) does not unequivocally confirm pneumonia. - The diagnosis of bacterial pneumonia in humans is made based on strict criteria. High numbers of intra-cellular bacteria and high CFU on culture are required for diagnosis. In veterinary medicine, typically a lower threshold of bacterial numbers is used for diagnosis of pneumonia which is not ideal for antibiotic stewardship. With increasing concerns for antibiotic resistance, this is an area that will need to be reassessed going forward.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

Abstract: Antimicrobial discontinuation in dogs with acute aspiration pneumonia based on normal C-reactive protein and clinical improvement. N. Rodrigues, L. Giraud, G. Bolen, A. Fastres, K. Gommeren, C. Clercx, and F. Billen. - Treatment guidelines for canine aspiration pneumonia recommend 4–6 weeks of antibiotic therapy. - Evidence for the optimal duration of treatment, and the role of thoracic radiographs/ultrasonography to assess treatment success is limited. - Discontinuation of antimicrobials in people with community-acquired pneumonia is based on resolution of clinical signs and normalisation of C-reactive protein. The duration of antimicrobial treatment in humans is far shorter (7–10 days) than duration of treatment for aspiration pneumonia in veterinary patients. - This prospective observational study suggests that aspiration pneumonia can be effectively treated with shorter courses of antimicrobials based on resolution of clinical signs and normalisation of C-reactive protein. - The utility of follow-up thoracic imaging is questionable. Only 3/13 dogs showed complete short-term resolution of radiographic lesions. Lesions seen on lung ultrasound improved with serial scans, but lesions persisted in the short-term follow up period. Glucose monitoring in diabetic cats. Ian Ramsey, BVSc, PhD, DSAM, DECVIMCA, FHEA, FRCVS. - Until recently, in-clinic blood glucose curves have been the most convenient way (for owners and clinicians) to monitor treatment success in diabetic cats. However, blood glucose curves in clinic have many flaws. They only give a snapshot in time of the patient's blood glucose concentrations, and they do not represent normal day-today life for our patients. - The Freestyle Libre flash glucose monitoring system has been validated for use in cats and dogs and it has proven to be a game-changer.

- Continuous glucose monitoring allows the patients interstitial glucose to be measured over several days, and up to 2 weeks. This allows clinicians to make adjustments to treatment protocols based on a larger and more representative data set. The role of bacteria in acute and chronic diarrhoea. Stefan Unterer, DVM, Dr. habil., DECVIM-CA. - Clostridium difficile, Clostridium perfringens, Campylobacter spp. and Salmonella spp. are considered potential enteropathogens. However, they do not usually play a role in uncomplicated acute and chronic diarrhoea. - Bacteria-associated diarrhoea can be due to infection with enteropathogenic bacteria, dysbiosis and invasion of bacteria through the intestinal wall. Bacteria-associated diarrhoea should be considered in cases with acute haemorrhagic diarrhoea, pyrexia, systemic inflammation and poor response to supportive care (I/V fluid therapy, analgesia). - In cases of chronic diarrhoea, bacteria-associated diarrhoea should be considered in cases with granulomatous and neutrophilic intestinal inflammation. Boxers and French Bulldogs are predisposed to chronic histiocytic colitis, caused by ineffective destruction of intracellular Escherichia coli. - Faecal culture has limited use for diagnosing enteric infections due to similar isolation rates of most enteropathogens in dogs with and without diarrhoea. Faecal culture should only be considered in patients showing signs of sepsis. In these cases, blood culture may be more helpful. Patients showing signs of sepsis should be started on I/V, broadspectrum antibiotics while culture is pending. Faecal culture cannot be used to diagnose intestinal dysbiosis in cases of chronic diarrhoea. - Antibiotics are not indicated in cases of uncomplicated haemorrhagic diarrhoea. Antibiotics should be restricted to patients showing signs of systemic inflammation and are considered essential for those with histiocytic colitis.

What is the evidence for pre and post-biotics? Silke Salavati, Dr.med.vet., PhD, DECVIM-CA, FHEA, MRCVS. - There are very few (<10) randomised control trials investigating the benefits of probiotics and synbiotics in dogs, and only one in cats. These studies are difficult to compare due to the wide range of different products available for use. - There is some evidence to show that certain prebiotics and synbiotics may improve gastrointestinal signs in some gastrointestinal conditions (canine parvovirus, canine acute haemorrhagic diarrhoea syndrome and feline Tritrichomonas foetus infection). - Further studies evaluating the benefits of probiotics and synbiotics are needed. Faecal microbiota transplantation. Silke Salavati - Faecal microbiota transplantation (FMT) has been used in human medicine primarily to treat Clostridium difficile infections. Recently, research has been extended to chronic enteropathies, such as Crohn's disease. - Several preparations (fresh, frozen, freeze-dried), volumes and routes (enemas, oral capsules, nasogastric tubes, endoscopically) have been described in veterinary and human medicine. - Studies in veterinary species are sparse. FMT enemas have been shown to be beneficial in cases of canine parvovirus and acute haemorrhagic diarrhoea syndrome. Currently, there are only a few case reports and small case series documenting the use of FMT in chronic enteropathies in dogs. - FMT as ancillary or rescue therapy in dogs with chronic enteropathies have shown mixed results, with some dogs responding well, some relapsing and others not responding at all (unpublished data). - Criteria for donors is largely unknown. “Super donors” have been identified in human medicine. The dysbiosis index is one screening test available, but it has not been standardised.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

Feline enteric coronavirus and feline infectious peritonitis. Sandra Felten, Dr.med.vet., DECVIM-CA. - Feline coronavirus (FCoV) is ubiquitous in multi-cat environments and has a high prevalence of up to 90% in some populations of cats. - Feline infectious peritonitis (FIP) only develops in a small percentage of cats that have been infected with feline coronavirus. - Confirming a diagnosis of FIP can be challenging. The gold standard method of diagnosis is detection of FCoV antigen within macrophages in tissue. However, this requires invasive diagnostics (laparotomy) or in many cases it cannot be achieved without post-mortem examination. - FCoV antigen can be detected in effusions, cerebrospinal fluid (CSF), aqueous humor and aspirates of lymph nodes using immunocytochemistry however the specificity of this test is low, making it unsuitable for diagnosing FIP. - Traditional reverse transcriptasePCR for detection of FCoV antigen in effusions, CSF, and aqueous humor does not allow differentiation between mutated and non-mutated virus. It is possible for cats to have unmutated FCoV in these samples without having FIP. However, if a high viral load is detected in these samples in a cat with clinical signs then infection with FIP is likely. - A spike (S) gene mutation has been identified in mutated FCoV and this is believed to allow FCoV to infect macrophages. An RT-PCR test has been designed to detect the S gene (FIP Virus RealPCR test, IDEXX Laboratories). This test’s sensitivity is best in effusions, but poor in CSF and aqueous humor. Blood is not suitable

due to low viral load. The specificity of these tests is controversial. Detection of the S gene using RT-PCR is quite specific in effusions and tissue samples, however false positives have been detected. These false positives may indicate systemic spread of unmutated virus, rather than an infection with mutated virus. - Confirming a diagnosis of FIP antemortem continues to be challenging in many cases. Further investigation into different diagnostic tests and their specificity is warranted. The challenges of diagnosing canine hypothyroidism. Peter A. Graham, BVMS, PhD, CertVR, DECVCP, MRCVS; Hans S. Kooistra, DVM, PhD, DECVIM-CA. - The pathophysiology of canine hypothyroidism can complicate interpretation of diagnostic results, and the diagnosis or exclusion of hypothyroidism. The “classic” laboratory findings we expect to see in hypothyroid dogs are low total thyroxine (TT4) and elevated thyroid stimulating hormone (TSH). However, the concentrations of TT4, TSH and thyroglobulin autoantibody (TAA) concentrations are different in each stage of lymphocytic thyroiditis. Therefore, the laboratory test results you receive depend on the stage of disease. - Early in disease, TT4 and TSH remain within the reference range due to the gland’s functional reserve. TAA will be increased as soon as there is destruction of thyroid tissue. - As disease progresses, TT4 may remain normal due to increased production of TSH (above reference range). TAA remains positive.

- In end-stage thyroid gland atrophy, TT4 is below reference range, and TSH is elevated. TAA is negative as there is no thyroid tissue left to cause antigenic stimulation. - Differentiating between hypothyroidism and non-thyroidal illness (euthyroid sick syndrome) in dogs with low TT4 can also be challenging. Approximately 80% of dogs with low TT4 have non-thyroidal illness. Therefore, it is important to consider signalment, clinical signs, medications and routine diagnostic test results. - Additional diagnostic tests can be used to help determine whether a dog has hypothyroidism. The speakers' go-to test in these cases is thyroid scintigraphy. However, this is unattainable in most practices. Thyroid releasing hormone and TSH stimulation tests are also very useful, however they are not available in NZ. Measurement of free T4 is the most attainable test in NZ that can be used for this purpose. However, it is an expensive test. Free T4 only has a moderate sensitivity (90%) for diagnosing hypothyroidism so it should not be performed as a firstline test. However, it has a very good specificity (98%). The vast majority of dogs with hypothyroidism will have low free T4. In contrast, very few dogs with non-thyroidal illness will have low free T4. I am very grateful to Royal Canin for this wonderful opportunity! I hope that virtual attendance of conferences will remain an option in the future. l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

A Week With ...

... Veterinary Ophthalmologist, Craig Irving Leanne Norman, BVSc It would be fair to say I can be prone to letting advertised opportunities slip by unnoticed without stopping to take a hard look at them. Busy family and working life will do that to you. I have seen the Dechra/CAV ‘A week with…’ scholarship advertised in the past, read the articles from past recipients and even had friends report back about their amazing weeks. Even with these prompts, it hadn’t struck me to apply, that was until this year. Two days before applications closed, I gave myself a good talking to, dusted off a rather outdated c.v. (an eye opener in itself; I have been working here how long? And did I really graduate that long ago?) and emailed off an application with crossed fingers but not really expecting much to come of it. Several weeks later I was excited to get a phone call to let me know my application was successful and the wheels were in motion for what turned out to be a great week for learning and skill development at Eyevet Services. Eyevet Services appealed to me, being a long-time enthusiast of all thing’s “eyes”. Monday was a crisp and clear morning as I arrived at the Totally Vets Clinic in Feilding, home of Eyevet Services for the first day of my weeklong stint with Craig Irving and Petra Price. After taking care of housekeeping and health and safety requirements I was straight into observing a superficial keratectomy of an indolent ulcer and temporary tarsorrhaphy. It was a great opportunity to question Petra on initial management of this condition and how we manage them in clinical practice, something familiar and sometimes frustrating to many of us. Contact: leanne.n@vetora.nz

Learning to use the slit lamp took a bit of practice but by the end of the week I was able to look at different parts of the eye in much more detail.[photo courtesy of the author]

This was followed up with a full morning of consults where I got plenty of opportunity to practice use of the indirect ophthalmoscope, slit lamp and tonometer, as well as tools I am more familiar with such as Schirmer tear tests, fluorescein staining and retro illumination. Throughout the week it became more and more apparent that setting yourself up for success in an ophthalmic examination involves light and magnification. Although it is not something most of us are ever going

to be lucky enough to have access to in general practice, using the slit lamp was a revelation (after I eventually got the hang of it) and seeing details of the cornea and lens up close made me more aware of the limitations we can have with of our examination techniques in general practice. After a quick bite to eat Petra took me under her wing and we worked our way through some slide shows recognising different ophthalmic conditions

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

and answering questions related to signalment, pathology and treatment. I found these sessions, which we did most afternoons generated great discussion, triggered my memory on cases I had seen in the past and was an ideal opportunity for me to question, learn and further my understanding of cases I am seeing in day-to-day clinical work. Tuesday morning saw Craig and I heading down to Plimmerton for a morning of consultations there. The highlight was the opportunity to examine a Poodle-cross with advanced progressive retinal atrophy and early secondary cataracts. I was able to appreciate the attenuated vasculature and hyperreflectivity of the fundus and the early cataracts forming on the posterior lens that I could see with the slit lamp. Also, of great importance was stopping at the German bakery for a ‘cruffin’ on the way home, an experienced not to be missed when you are next in Plimmerton! Across the week I was able to observe multiple surgeries. Nearly all the surgeries are done with magnification.

Head loupes were used for lid and adnexal work and a free-standing operating microscope for anything corneal or intraocular. I was honoured to be present for the grand unveiling of the new phaco-emulsification unit and watched as a mature cataract obscuring vision was fragmented and removed through the smallest of areas. I carefully watched several lid surgeries picking up tips and techniques to use in my clinical work. Petra really stressed the importance of symmetry and deliberate placement of sutures, suture material and pattern selection to ensure exact alignment and maximising results, something I have really taken on board. Overall, it was a very useful and worthwhile experience. I thoroughly enjoyed the whole week. I learnt a vast number of new skills in diagnostics, treatment and surgical tips and tricks that I am now putting into practise back in the Waikato. I would absolutely recommend that anyone with an interest in increasing their skills and interest in one of the offered areas to apply for this grant when next offered. You won’t be disappointed.

Thank you to CAV and Dechra for the opportunity to make this happen, Craig, Petra and Vanessa for their time and patience and the team at Totally Vets in Feilding for the morning teas and friendly welcome. Also thank you to Vetora for their continued support for continuing education. l

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

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

A Week With ...

Lisa Argilla and the team at the Dunedin Wildlife Hospital Lisa Stuart, BVSc (dist),

PGCertSc.

I was privileged to be awarded the 2020 Dechra/CAV “A Week With …” opportunity and chose to spend my week with the amazing team at the Dunedin Wildlife Hospital. Since early in my career, I have been lucky enough to be involved in assessment, treatment and referral for rehabilitation of New Zealand native birds. Mostly, it has been kereru who are notorious for window strike injuries. Wanting to update my knowledge and learn from experts in this area was the reason I applied for this award. Founded by Dr Lisa Argilla, the Dunedin Wildlife Hospital opened its doors in January 2018 on the grounds of the Otago Polytechnic, School of Veterinary Nursing. It is only able to exist through phenomenal fundraising efforts headed by Jordana Whyte, who manages the Wildlife Hospital Trust, and local community support. The core team of Dr Lisa Argilla, veterinarian Dr Lizzie Thomas, senior veterinary wildlife nurse Gina Martelli and veterinary technician Emily Brewer, were supported by volunteers, Department of Conservation rangers, Yellow-eyed Penguin Trust rangers and Penguin Place conservation reserve volunteers during the time I spent with them. Planning my visit for 16–20 November 2021 meant I arrived right in the thick of hoiho (yellow eyed penguin) chick season. Intensive monitoring of wild nests by rangers allows early identification of chicks failing to thrive

Contact: lisas@vetsouth.co.nz

The author taking the opportunity to get to know Uri the kākāpō, a patient at the Dunedin Wildlife Hospital, who was recovering from cloacitis.

Photo courtesy of the author

and they are then brought to the Wildlife Hospital for assessment and treatment, with the goal being to return the chicks to their original nests. It was an eyeopening experience to see the level of detail and effort put into the chick monitoring. All chicks are weighed daily, their food is calculated based on body weight and percentage of weight gain/ loss calculated. Depending on their age,

the daily number and quantity of feeds of fish slurry given via oesophageal tube are adjusted. In the 2020 season the team was also dealing with a number of chicks coming in with stomatitis lesions, on which information was being gathered for further research. Any chicks which died or were euthanised had a post-mortem examination and samples collected for this research.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

At such a busy time of the year for the hospital, everyone mucks in to make sure the hoiho get the best outcomes possible – this means a lot of washing (they are definitely not litter box-trained), a lot of fish slurry to be made and a lot of drawing up the right feed volume for each chick. Once in hospital, the chicks were identified by one or two nail polish colours on a wing, rather than by which nest they had come from, to make it easier to communicate about their progress. There were other patients during my time at the hospital however the Forest Bird ward was fairly quiet during my week-long visit. This was good news for all the kereru who didn’t fly into windows, just unfortunate for my best laid plans to see how the Wildlife Hospital made decisions for these cases. However, there were other cases to observe in the Forest Bird ward. These included Rotoroa the kea who was fairly opinionated when it came time to get his medicine, liked to personalise his cage but tolerated his daily time in the nebuliser quite well; Uri the kākāpō who was nearing the end of his time at the hospital for treatment for cloacitis/vent dermatitis; and a northern giant petrel recovering from seizures. In addition, there was a continual stream of red billed gulls brought in, most harbouring enormous engorged ticks especially around the head and neck. A lot of the learning I have taken away from the week at the hospital and used since then has related to small pieces of information and systems for doing things that I hadn’t previously thought of. The initial approach to all cases reiterated what we all know for all species – stabilise first! Don’t underestimate the

need for pain relief, ensure a low stress environment (covering the cage, low voices, minimal handling) and fluid therapy (often oral) is important just as it is in mammalian patients. When it comes time for radiographs to check for orthopaedic injuries (which may be a day or more since admission), adding midazolam at 1.5–2mg/kg IM to the premedication is useful for kereru and can allow the butorphanol dose to be reduced from the 4 mg/kg used for pain relief initially to 2 mg/kg IM. To reduce the anaesthetic risk, the isoflurane rate was adjusted in a consistent manner with 0.5% incremental increases every 30 seconds until the desired anaesthetic depth is achieved; this snippet of information has worked very well for our nurse team once I returned to general practice. The hospital system was best summarised by ‘attention to detail’. All birds were weighed at the start of each day and given a check over. The food was weighed into the cages and the residual weighed prior to disposal. This allowed for quick identification of any problems or failure to respond to treatment as expected. Tail feathers are carefully protected with plastic bags where needed to prevent feather damage and loss. With regards to medications, most drugs used on birds in New Zealand are off-label and the dose rates are either from the depths of textbooks or from the experienced brains of wildlife vets such as Lisa and Lizzie. In the case of kereru, butorphanol at 4 mg/kg I/M was used in hospital as the first line opioid pain relief. The addition of oral tramadol as another pain relief option at 30 mg/ kg per os twice daily seemed like a

great option and I have since started using this in practice. Using a 50 mg/ml suspension made from 50 mg tramadol capsules offers a very cost-effective option and seemed to work well. The meloxicam dose used for birds varies with each paper published, and I learnt that the dose is even higher in birds than I had been using. In the hospital, once hydrated and eating, the dose administered orally was up to 1–1.5 mg/kg twice daily if appropriate, with titration to the lowest effective dose after that. Antifungals were used more in the hospital setting than I have used in general practice. Voriconazole was the one most in use in the hospital for cases of suspected, or at risk of, aspergillosis. The experience of spending a week away from general practice and being immersed in a different type of hospital environment was invaluable. The team of Lisa, Lizzie, Gina, Jordana and Emily, along with all the volunteers I encountered were welcoming and made it an enjoyable time away. Having access to this facility for our southern native birds is a credit to the hard work put in by this team. Thank you to the NZVA Companion Animal Veterinarians and Dechra for giving me this opportunity. l

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

Kewl from pixabay

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

What is your diagnosis? THE ANSWERS… What is the dog’s problem list? 1. 2. 3. 4. 5.

Hypodipsia*/anorexia Hypernatremia* Lateralised neurological deficits* Pyrexia Lethargy

Highest yielding problems with respect to treatment considerations and development of differential lists.

What are the differential diagnoses?

1. Hypodipsia; meningoencephalitis of unknown origin, ependymal cyst, hydrocephalus, neoplasia, cryptococcosis. 2. Hypernatremia is differentiated into three categories; a. Isovolemic hypernatremia (water deficit): primary adipsia/hypodipsia diabetes insipidus (central vs. nephrogenic) b. Hypotonic hypernatremia: renal (chronic kidney disease, diabetes mellitus, diuretics), gastrointestinal (diarrhoea and vomiting, small intestinal obstruction), and third space (peritonitis, uroabdomen, pancreatitis) c. Sodium overload: hyperaldosteronism, salt poisoning, over administration of sodium-containing fluids. 3. Lateralised neurological deficits are suspicious for acquired structural central nervous system disease which may be infectious (coccidial, cryptococcosis), inflammatory (e.g. meningoencephalitis of unknown origin), neoplastic, vascular, other

What is your treatment plan?

Due to the severity of the hypernatremia (both chronic duration and magnitude), correction was initiated prior to further diagnostic workup.

Based on an initial sodium concentration in serum of 176 mmol/L, the free water deficit was calculated at 3 L. This was to be corrected, using 5% dextrose in water, over 48 hours (70 mL/hour), with the target sodium concentration of 160 mmol/L. The aim was to lower the sodium concentration at a rate ≤0.5 mEq/hour or 8–10 mEq over 12 hours. The sodium concentration was monitored for 48 hours (see Table 2).

cm H x 1.7 cm W x 2.3 cm L) which was uniformly hyperdense to normal brain (mass~55 HU; brain ~33 HU) and exhibited minimal to no enhancement. As a result of the subsequent mass effect there was severe compression of the hypothalamic and thalamic regions, loss of visualisation of the third ventricle, and both mild caudal displacement and flattening of the rostral border of the cerebellum.

Table 2. Serial measurement of the sodium concentration in serum collected every 6 hours from a 40 kg, 8-month-old Rottweiler with hypodipsia.

Following CT, a cerebral spinal fluid (CSF) sample was acquired from the cerebellomedullary cistern and an additional blood sample collected for infectious disease titres. Results from the CSF revealed a marked neutrophilic pleocytosis. This can be seen in a variety of infectious, inflammatory, ischemic and degenerative diseases. The CSF and serum were submitted for latex cryptococcal antigen agglutination test (LCAT) and were subsequently negative.

Test number 1 (Initiation of therapy) 2 3 4 5 6 7

Sodium concentration (reference range 139–150 mmol/L) 176 179 178 176 170 167 161

What are your next diagnostic steps?

Given the marked hypernatremia in the context of hypodipsia, elevated temperature that was non-responsive to antibiotics and the neurological deficits on the physical exam, a central nervous system lesion was suspected. Meningoencephalitis of unknown origin, ependymal cyst, hydrocephalus, neoplasia, and cryptococcosis were differential diagnoses that were considered. In terms of further investigation, magnetic resonance imaging (MRI) of the brain would be the imaging modality of choice, however, due to a delay in accessibility of MRI, the dog was placed under general anaesthesia for computed tomography (CT) of its brain (Figure 1). On CT, arising from within the pituitary fossa and extending well beyond the dorsal rim of the osseous sella turcica and into the diencephalon, there was a very large and well demarcated mass lesion (~2.4

Outcome

Following the general anaesthesia for CT and CSF acquisition, the dog had a prolonged recovery despite the administration of reversal agents (naloxone and flumazenil). Given the high suspicion for intracranial neoplasia and the dog’s difficult anaesthetic recovery, the client declined on-going supportive care and treatment, and elected euthanasia. Post-mortem examination was declined.

Diagnosis

Differentials for an intracranial neoplasm arising from the pituitary fossa include a macroadenoma or adenocarcinoma, or less likely, a meningioma, primary or secondary lymphoma, ependymoma, granular cell tumours, germ cell tumours, or craniopharyngioma. Pituitary haemorrhage (apoplexy) is also a potential consideration in this location, however, it is considered unlikely in this particular patient as it is typically a more heterogenous mass lesion and presents with more acute clinical signs.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

Figure 1. CT images of the brain. The top row are sagittal sections, and the bottom row transverse sections. Images in the left column are from a Jack Russell Terrier representing normal intracranial structures. Images in the right column are from of the Rottweiler described in this report and show a mass arising from the pituitary fossa.

Discussion

Hypernatremia can occur from either water loss or excessive sodium gain but in veterinary medicine, water loss is the most common cause. Water loss can be described as pure water loss with isovolemia (minimal signs of extracellular dehydration) or hypotonic water fluid loss with hypovolemia (signs of extracellular dehydration) (Schaer and Goldkamp 2007). Determining the volume/ hydration status of a patient with hypernatremia is essential for deriving an appropriate set of differentials. Pure water loss and secondary hypernatremia can occur with hypodipsia due to abnormal thirst mechanisms, defective osmoregulation or, as was found in this case, an intracranial lesion affecting the hypothalamus (Ettinger et al. 2017; Chapman et al. 2009). The hypodipsia in this case resulted from a compressive hypothalamic lesion that interferes with the osmoreceptor activity of the neurons involved with the consumption of water (thirst). Additionally, in this case the increased temperature is likely

defined as hyperthermia rather than pyrexia, due to the mass compressing the heat-loss centre located in the rostral hypothalamus (DeLahunta et al. 2015). This centre is responsible for reducing body temperature by sweating, increased respiration, peripheral vasodilation and panting. As a result, the dog could not reduce its temperature through normal thermoregulatory mechanisms (DeLahunta et al. 2015). The aim of treatment for hypernatremia is to restore the extracellular fluid (ECF) volume and to correct water deficits over an extended period to avoid complications. Rapid repletion of body water with ECF dilution causes translocation of water into cells resulting in cerebral oedema, which is seen as clinically as worsening of the neurological status (Schaer and Goldkamp 2007). The water deficit should be replaced over 48–72 hours with correction of sodium no faster than 0.5–1 mEq/hour in cases that have had chronic hypernatremia of >24 hours duration (DiBartola 2001). During the period of re-establishment of normal sodium concentration, electrolyte

concentrations in serum should be measured every 4–6 hours to determine rate of sodium replacement (Schaer and Goldkamp 2007). In animals with hypovolemic hypernatremia, circulating volume should be restored with an isotonic crystalloid fluid that must be formulated to the patient’s specific sodium concentrations and used to support cardiovascular function, while ECF restoration is addressed as per the general guidelines above.

References

Chapman PS, Petrus D, Neiger R. Hypodipsic hypernatremia in eight dogs. Tierarztliche Praxis Ausgabe K: Kleintiere/ Heimtiere 37, 15–20, 2009 DeLahunta A, Glass E, Kent M. (eds). Veterinary Neuroanatomy and Clinical Neurology. 4th Edtn. Elsevier, St. Louis, Missouri, US, 2015 DiBartola SP. Disorders of sodium and water: hyponatremia and hyponatremia. Journal of Feline Medicine and Surgery 3, 185–7, 2001 Ettinger SJ, Feldman EC, Cote E. (eds). Textbook of Veterinary Internal Medicine. 8th Edtn. Elsevier, St. Louis, Missouri, US, 2017 Schaer M, Goldkamp C. Hypernatremia in dogs. Compendium: Continuing Education for Veterinarians 29, 152–61, 2007 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

Companion Animals NZ update David Lloyd, General

Manager, CANZ

New Zealand Companion Animals Register (NZCAR) registration is the primary method of companion animal identification in Aotearoa, but what happens if the client presenting an animal is not the registered guardian on the NZCAR? We have been pleased to discuss these situations with NZVA and VCNZ recently. In January, VCNZ posted some guidance on their website under News>Technical Advice (full link here: https://www.vetcouncil.org.nz/Web/ News/Technical_advice/Technical_ advice__Microchipping_minefields. aspx ) The NZCAR allows implanters (that’s you) to transfer an animal from one person to another very easily, but occasionally ‘ownership disputes’ create difficult, time consuming and litigious situations. As owners of the NZ Companion Animal Register, we would like to reaffirm our offer to relieve veterinary staff of these tricky animal transfers. It is important to keep a good working relationship with your client (whether they are the registered guardian or not) and, after all, the contract for microchip registration services lies with NZCAR, rather than your vet clinic.

So, what can NZCAR support staff do with a dispute?

1. If the person in possession is unaware the animal is already registered. In most cases, a client who discovers they possess an animal that is registered to someone else will be agreeable to relinquish the animal, so the original guardian is happily reunited. If they are not, and you have their permission to alert us and share their details, you

Contact: https://www.companionanimals. nz/contact-us34

Monica Rodriguez from Pixabay

can pass the issue to our staff via 0508LOSTPET*. What will we do? a. With the permission of the person in possession of the animal, we will contact the registered guardian. b. If the registered guardian is happy to relinquish NZCAR guardianship to your client, we can do that and make a note as such in the back end of the NZCAR (visible only to NZCAR staff) c. If they refuse to relinquish guardianship, we cannot change the NZCAR record to your client’s name. d. If they demand the animal back, we will not share your client’s details but will mediate between parties. e. If no resolution can be found, we will suggest pursuing a court decision. It is important to remember that animals are ‘property’ by law. While the SPCA and local council officers have power to seize and dispose of or rehome animals under the Animal Welfare Act and Dog Control Act, the courts are the only entity who can determine who ‘owns’ an animal.

f. If we are officially directed to change an animal record by the courts, SPCA or Animal Control Officer we will. For your protection, we recommend that clinic staff do not pursue this course of action. 2. If the person in possession asks us to transfer the animal into their name. Most commonly, we are asked to change the NZCAR listing by someone who is NOT the registered guardian. In these cases, we follow a similar guideline as above. However, we have special protocols if the registered guardian does not respond to phone calls, texts or emails in a reasonable timeframe (this can take up to 3 weeks). We will also contact their secondary contact during this time, so please encourage your clients to add a second contact person to their account. 3. If the registered guardian is deceased. Unfortunately, we have had ownership disputes over animals registered to guardians that have passed away. We have protocols in place to witness death certificates and also have a T&C that states that in the event of a guardian’s death the animal will be transferred to the secondary contact.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

If we have established the guardian is indeed deceased, and there is no secondary contact, we will likely transfer the animal to the first person wanting to claim the animal. Again, we strongly encourage people to list a trustworthy secondary contact on their account. 4. If there is a relationship breakup. Often the partner or flatmate bringing the animal into a clinic will assign themselves as guardian and their partner or other flatmate as the secondary contact. In the event of a future ownership dispute, we will follow our protocols as above, which can cause some unhappiness. Note: It is possible to list two or more names in the Guardian fields of the NZCAR, however only one email address can be used to log in and manage the animal’s listing.

In summary, we have seen and heard a wide variety of disputes about NZCAR listings and contested ownership of microchipped pets. We hear compelling tales from both parties, and it is impossible for us to be certain who is ‘right’ and who is ‘wrong’. So, we rely on a robust set of terms and conditions to determine our course of action.

Key points l

Veterinary clinics can transfer animals from one guardian to another, but only with permission from the registered guardian. You need your client’s permission to share their details with anyone (even us). NZCAR staff rely on set rules to determine our course of action.

In unresolved disputes, NZCAR recommend the courts are the only way to ascertain ownership. l Scan and check your patients’ NZCAR records at vaccination time to ensure o chips are working, o chip numbers are registered correctly and o guardian details are correct. l Refer dispute cases to 0508 LOSTPET to save your staff time and angst. l Updating NZCAR records is free for the lifetime the pet. It is funded by other registrations and our microchip sales. *Note our 0508 number – many clinics may have our old 0800 number listed on your websites and phone lists. l

NZCAR Glossary Agents:

organisations that have Implanter or Enquirer status with the NZCAR.

Enquirer: Organisations that can scan and search existing microchips on the NZCAR to help get animals home. Guardian: a human that has an account on the NZCAR. Every animal must have a guardian and only that guardian can change, or consent to change, an animal listing. Hazard icon: This icon denotes a hidden note about the animal.

Implanter: Organisations that can search existing microchips, can register new microchips, and change records on the NZCAR. Veterinarians and Diploma-level veterinary nurses automatically qualify for this status. Lay people can apply after reading our best practice guide, completing an online test and being certified by a veterinarian. Owner: We avoid this term. Firstly, the NZCAR registration is not ‘proof of ownership’ so using the term ‘owner’ would be confusing and contradictory. Secondly, Companion Animals New Zealand prefers ‘guardian’ as it better reflects the status of companion animals as, well, companions.

Did you know? That more than one name can be entered in the guardian field? This is encouraged in cases of ‘shared custody’. The NZCAR was previously managed by a third party. Now Companion Animals NZ manages the register directly – including selling our own scanners and microchips. To support animal charities, use the correct phone number – 0508 LOSTPET. In the event of the death of the sole registered guardian, our policy is to pass the registration on to the secondary contact. Clients should choose their secondary contact with care, this person will be secondary contact for all the animals in a guardian’s NZCAR account.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

Healthy Pets NZ update Cath Watson, Director,

Healthy Pets NZ

We’ve got two exciting pieces of news to get 2022 off to a great start. The team at Healthy Pets NZ are very excited to announce our new Principal Partner: NZ pet insurance specialist PD Insurance! Having PD Insurance as a Principal Sponsor allows Healthy Pets New Zealand to focus more on what we’re here to do – research that helps make a difference to what you do in practice every day, helping Kiwi pets. Our vision is to lead the advancement of companion animal health and wellbeing in New Zealand. There is no Government funding for companion animal research in New Zealand, so we rely on organisations like PD Insurance that share our values and wish to support our work. PD Insurance is a relatively new pet insurance company in the New Zealand market, having launched in August 2020, though not new to the world of companion animal care internationally. Healthy Pets New Zealand feels PD Insurance makes a great fit as our Principal Partner, as they have a strong focus on companion animal health in New Zealand. Michelle Le Long, Chief Operating Officer for PD Insurance, describes NZ pets as ‘significantly underinsured’ which means many families are underprepared for the costs of health care for their pets. “Part of the problem is many people just aren’t aware of pet insurance or they are unsure what is covered because policy wording can be so confusing. That is why PD Insurance provides simple, jargon-free plans as a point of difference,” she says. PD Insurance’s goal is to empower pet parents to make easy, quick, care-based decisions on their pet’s health without worrying about cost. They’re also committed to helping those of us that deliver those health care services, and it’s that part of the equation that particularly excites the Healthy Pets New Zealand team. We’re driven to find improvements in veterinary care that are relevant here in New Zealand. Research like this doesn’t come cheap, so having partners like PD Insurance who share our values and are prepared to support the work we do is very important. We look forward to soon announcing our research projects supported by PD Contact: http://healthypets.org.nz/ 36

Insurance, and to a long and productive relationship with Michelle and the rest of the team at PD Insurance. The second piece of exciting news is that we are thrilled to be funding not one, but TWO new research projects under the CAVsponsored Research in Practice Grant. Dr Joon Seo has been awarded a grant to study feline cardiomyopathy in New Zealand cats. Feline cardiomyopathy is a common heart disease that affects one in every seven cats. The disease is progressive and many cats eventually succumb to sudden death, congestive heart failure, and aortic thromboembolism and die. Despite the high prevalence and the disease resulting in a significant number of deaths in cats globally, the natural disease history of feline cardiomyopathy prior to the development of these clinical outcomes remains poorly described. Furthermore, the cause and environmental factors that would speed the progression of the disease are largely unknown, and there is no known treatment for this disease at present. This project will accurately describe the morphological and functional features of the two most common types of feline cardiomyopathies in New Zealand (hypertrophic cardiomyopathy and restrictive cardiomyopathy), using echocardiography by a board certified veterinary cardiologist and provide precise phenotypic description for the planned genotypic studies. Three separate feline populations in New Zealand (non-purebred, Sphynx and Oriental cat breeds) will be prospectively recruited and scanned. The association between the echocardiographic findings and the genotyping in these three populations of cats will be statistically assessed. It is expected the findings will improve understanding of the natural disease history of feline cardiomyopathy, and provide a foundation for future research to identify and evaluate novel therapeutics agents to effectively treat feline cardiomyopathy. This could enhance our management of cats with cardiomyopathy and significantly enhance their quality of life and longevity. The second CAV Research In Practice Grant has been awarded to Dr Lorna Hardy who is looking to study the cardiac effects of diarrhoea on dogs. Diarrhoea is a common presentation in veterinary emergency practice which can present in a variety of ways ranging from mild dehydration and electrolyte disturbances to profound

hypovolaemia, acid base imbalances and even death. It is well recognised in human medicine that volume depletion, electrolyte disturbances and inflammation can affect other organ systems throughout the body including the cardiovascular system. Abnormal cardiac rhythms are frequently identified by general practitioners in dogs presenting with diarrhoea, however the full extent to which the cardiovascular system is affected has never been evaluated. The aim is to determine this by assessing changes to the heart structure and function by performing an assessment of the heart via echocardiogram and by measurement of a cardiac specific biomarker, cardiac troponin I (cTnI). The hypothesis is that the presence of abnormal echocardiographic findings is statistically correlated with elevations in the serum concentration of cTnI. We will also be evaluating how these results correspond to the duration and characteristics of the diarrhoea, the patient’s hydration status, and the definitive or suspected aetiology of the diarrhoea. The outcome of this study will provide emergency veterinarians with a better understanding of the cardiovascular effects of diarrhoea to help them to instigate effective diagnostic and treatment plans for their patients to facilitate a more rapid recovery and reduce mortality. A greater awareness of the interplay between gastrointestinal and cardiovascular disease would not only optimise patient management and improve patient welfare but may also provide us with important prognostic information as has been observed in our human counterparts. The next funding round for grant applications closes on 1 March 2022. If you or your company would like to help support the work Healthy Pets New Zealand does, we love to hear from you healthypetsnz@gmail.com or you can make a donation at http://www.healthypets.org. nz/work#donate

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

Massey News The challenges of COVID-19 continue… 2020 and 2021 will be remembered for the lockdowns and bubbles, on-line teaching and inability to hire. As we enter 2022 the effects of the global pandemic are still with us, and there are numerous challenges ahead for the veterinary profession. Recently a submission to the tertiary education commission has opened a dialogue around increasing the number of funded domestic students by 10%. This is a measure to help ease the pressure on the veterinary sector for graduates within the existing government tertiary funding cap. Any greater increase would require new funding in a future budget and will only be achieved with a concerted effort by all stakeholders to convince the government of the benefit to the economy of investment in New Zealand’s veterinary sector.

At the start of the year, we said goodbye to last year’s hard working SAH interns – (see photo, left to right) Frank Gold, Matt Tomassini, Carrie Flynn, Andre Grafas and Rhea Jagdhane. In addition, former interns Steff Leggett and Steffi Jalava have taken up roles in the ECC group. Interns are the backbone of MUPEC and the ICU and virtually all emergency and referral cases plus many CP cases have benefited from their care. They spend a year with us, and it is hopefully pivotal to an outstanding future career. But the VTH benefits hugely from their commitment and sheer hard work. We are now inducting the next group of interns and look forward to hearing of last year’s crew’s successes.

Small Animal Hospital staffing

After a difficult period of low staffing in 2020–21 we head into 2022 with greater strength in many areas and several important confirmed recruitments. In SA Medicine we have specialists Gaby Verburgh Hoffmann and Sarah Wetzel (see profile below) who joined the inimitable Nick Cave late last year. In SA Surgery we have Kat Crosse, Lee Beever and Andrew Worth supported by residents Sacha Devereux and Sasha Polak. In both services we are receiving cases during normal working hours and manage emergency admissions through MUPEC. Cardiology, Dermatology and Dentistry referrals can be arranged though in-house private consultants Jacqui Huxley, Helen Orbell and Angus Fechney. Congratulations to Angus who has recently passed the American College of Veterinary Dentistry written examination. Next is the practical examination in the USA once the MIQ situation settles, the last stop on the road to become a Diplomate and specialist registration. In Anaesthesia, Vicki Walsh and Sandeep Karna will soon be joined by Thierry Beths from the University of Sydney and in the latter part of the year we will greatly welcome back Hiroki Sano which will take us back to four faculty anaesthesiologists and a full team of technician anaesthetists. A huge thank you goes to the Anaesthesia team [especially Vicki] for their huge effort to keep the service running in difficult circumstances in the last 2 years. Emergency Medicine is currently recruiting with Janelle Wierenga having left the VTH to pursue a PhD in Dunedin. Ivayla Yozova is currently supported in EM by visiting registrar Tove Hultman and a position is open for another ECC specialist. Excitingly we now have a resident in Emergency Medicine – Steffi Jalava, a former SAH intern. Community Practice is fully staffed by Thomas Odom, Susan Tomlin, Steve deGrey, Kevanne McGlade and Jonathan Cochrane. The team has been stable for some time and represents a huge depth of experience from which they teach day-one skills to our BVSc students on clinical rotations. 38

Staff profile: Sarah Wetzel

This is my first move abroad from the United States and I am so happy to be here! I completed my Bachelor of Science degree at University of Michigan (USA) and my Doctorate of Veterinary Medicine at University of Illinois. After veterinary school, I spent two years in general practice and another year in emergency medicine before undertaking a path to become a veterinary oncologist. I completed my rotating internship in Wisconsin and then finished an oncology internship at Oregon State University. Most recently, I finished an oncology residency, under the American College of Veterinary Internal Medicine, at Washington State University prior to accepting this position at Massey University in Internal Medicine. I love the relationships that I get to build with patients and their families and I find great satisfaction in improving pets’ quality of life. It is great to be on the forefront of the rapidly expanding understanding of cancer in companion animals. In my free time, I enjoy baking, reading, and tramping with my energetic Labrador mix, Misha. l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

Odds and Ends

All dogs great and small A recent article in Current Biology (https://tinyurl.com/2p87pfzh also see commentary from Nature: https://tinyurl.com/3u3twua6) has shed light on how dogs came to be both so big and so small. The 40-fold variation in size from the largest Great Dane to the smallest Chihuahua is greater than any other mammal species on Earth. As the ancestors of dogs, ancient wolves differ in size to only a small degree, until recently it was presumed that the mutations that led to these extremes developed during the intensive period of dog breeding over the last 200 years. However, study by a large consortium of researchers from across the globe, has suggested as least some of these mutations are much more ancient. Plaissais et al. (2021) analysed the genomes of more than 1,400 canids, including ancient dogs, wolves, coyotes and 230 modern dog breeds. They identified a sequence variation associated with variation in body size in a DNA region involved in controlling levels of the IGF1 protein. IGF1 acts as a growth hormone and has long been known to be play a role in determining body size. The newly identified DNA variant comes in two alleles. Dogs with two copies of the large-bodied allele tend to weigh >25 kgs and have greater serum concentrations of IGF1. Furthermore, this relationship also holds true for other canids: wolves, foxes, jackals, indicating an ancient origin for the variant. This is not the entire story of how dog size is determined however. Future work includes determining the mechanism by which the variant regulates concentrations of IGF1 protein and identifying additional genetic determinants of dog size. IGF1 only accounts for about 15% of the variation between breeds – that is, it is only one of many mutations that have a small but additive effect on body size. Together these variants determine whether a dog is small enough to fit into a handbag or large enough to pull a cart.

WINNER

Photo credit: Karolina VW for Unsplash

The article has been published open access and can be downloaded for free: J Plassais et al. Natural and human-driven selection of a single noncoding body size variant in ancient and modern canids. Current Biology, https://doi.org/10.1016/j.cub.2021.12.036, 2022

Article of 2021

"Transarterial closure of a patent ductus arteriosus in a Corgi puppy"

Miranda Tong

December 2021 | Volume 32(4) | Page 39

EyeVet Services Limited

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

NZVJ Abstracts

Companion animal reviews There are two invited reviews published in recent issues of the New Zealand Veterinary Journal that will be of interest to CAV members. Topics and authors of both reviews were requested by the CAV Executive Committee and the articles were generously supported by Healthy Pets NZ. The abstracts are printed below and all NZVA members can access the full article for free via SciQuest: http://www.sciquest.org.nz/elibrary/edition/8045

The effects of raw-meat diets on the gastrointestinal microbiota of the cat and dog: a review CF Butowski, CD Moon, DG Thomas, W Young and EN Bermingham New Zealand Veterinary Journal 70 (1), 1–9, 2021

The aim of this review is to summarise the available literature on the effects of consuming raw, red meat diets on the gastrointestinal microbiome of the cat and dog. In recent years, feeding raw meat diets to cats and dogs has increased, in part associated with trends in human nutrition for “natural” and “species-appropriate” diets. These diets range from home-prepared unprocessed, nutritionally incomplete diets to complete

and balanced diets with sterilisation steps in their manufacturing process. Feeding some formats of raw meat diets has been associated with nutritional inadequacies and zoonotic transfer of pathogens. The feeding of raw meat diets has been shown to alter the gastrointestinal microbiome of the cat and dog, increasing the relative abundances of bacteria associated with protein and fat utilisation, including members of the genera Fusobacterium and Clostridium. While in humans, these genera are more commonly known for members that are associated with disease, they are a diverse group that also contains harmless commensals that are a normal component of the gastrointestinal microbiota. Moreover, members of these genera are known to produce butyrate from protein and amino acid fermentation and contribute to intestinal homeostasis in raw meat-fed dogs and cats. Currently, only a limited number of studies have examined the impacts of raw meat diets on the cat and dog microbiota, with many of these being descriptive. Additional controlled and systems-based studies are required to functionally characterise the roles of key microbial groups in the metabolism of raw meat diets, and determine their impacts on the health and nutrition of the host. l

Presurgical hand preparation in veterinary practice KR Crosse New Zealand Veterinary Journal 70 (2), 69–78, 2021

Abstract

The objective of this paper is to review the evidence for different methods of surgical hand preparation applicable to veterinary practice. Surgical hand preparation is an

essential step in performing surgery as a veterinarian. Recommended protocols and products for surgical hand preparation have varied since its inception in the late 1800s. Many factors must be considered when assessing the efficacy, safety, and users’ compliance with any available product. Traditional scrub methods employing chlorhexidine gluconate or povidone-iodine have been compared to alcohol-based rub protocols with respect to immediate and prolonged efficacy, safety, compliance, requirements for theatre furniture, cost and water usage. Although much of the comparative data has been generated in human medical facilities, extrapolation of the data to veterinary surgery is appropriate. Considerations for veterinary practice are specifically discussed. Overall, the benefits of alcohol-based rubs indicate that this should be the preferred method of presurgical hand preparation for veterinarians in all types of practice. l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

Executive Committee Members of the NZVA Companion Animal Veterinarians Branch President Natalie, Companion Animal Veterinary Advisor, Zoetis NZ, Wellington I have been a companion animal practitioner for over 20 years with a strong interest in feline medicine, preventative health care and veterinary wellbeing. I joined the team at Zoetis in 2018 after selling my practice in Wellington. I enjoy the opportunities my role provides, meeting companion animal veterinarians across New Zealand, talking to them about the issues they face on a day to day basis, and learning where CAV can focus our member support in the most valuable way. Additional roles: Member of WSAVA Congress Steering Committee Vice-president Simon Clark, Veterinarian at Hamilton Small Animal Veterinary Centre I grew up in suburban Auckland with a love of science. At high school I got a job cleaning the cattery at my local vet clinic and I’ve been in the industry ever since. I quickly found the application of science to immediate family situations fascinating. I continue to love the application of the most up-to-date science to help families. Additional roles: Treasurer and Trustee Healthy Pets NZ, Treasurer Waikato RN Treasurer Kevanne McGlade: community veterinarian, Massey University I work as a companion animal veterinarian in the Community Practice small animal clinic at Massey University’s Täwharau Ora – School of Veterinary Science in Palmerston North. Each year our final year students spend a number of weeks in the clinic. My role is to support and guide them as they take on the role of a veterinarian, conducting first opinion consultations and performing procedures to equip them for practice after graduating. Alison Pickering, Locum Veterinarian, all-over-NZ I am a 1996 Massey graduate currently working as a locum as I travel and house sit around New Zealand. My interests include feline medicine and behaviour – I am a huge fan of the Cat Friendly Clinic initiative. I am also interested in the field of veterinary telehealth, providing clients access to remote triage and advice as a way of supporting and extending existing clinics services. Nina Field, Veterinarian, Evolution Vets and Animal Rehabilitation, Ashburton I've been a vet for a long, long time. Eight years ago I got my certification for canine rehabilitation so have been working as a 'physio' alongside first opinion clinical practice since then. I've been on the CAV committee for 4 years now and really enjoy working and making plans with such a motivated, stimulating team. Additional roles: CAV representative on NZ Companion Animal Trust Shanaka Sarathchandra, Clinical Lead Veterinarian, Pet Doctors Hamilton I am a 2004 Massey graduate working in companion animal practice in Hamilton. I have a special interest in imaging and medicine. I am looking forward to being more involved in the veterinary community.

Sally Aitken, Lead Companion Animal Veterinarian, VetEnt Turangi Community veterinary work is my passion; caring for animals through their life-stages. I grew up in Greymouth, worked 26 years in Taupo in mixed and CA practice and am now based in Turangi providing companion animal community veterinary care with VetEnt. Continuing education, ANZCVS, avian medicine, dermatology and internal medicine are my other vet passions, along with mountain-biking, tramping and raising two fantastic teenagers with my husband here in Taupo. Toni Anns, National Sales and Key Account Manager for Companion Animals, Zoetis NZ, Auckland I have been a member of the CAV executive committee since 2016. I currently work for Zoetis as the National Sales and Key Account Manager for Companion Animals. In this role I am very privileged to be able to meet and talk with many veterinary professionals. I listen to the trials and tribulations, the challenges, the joy and the angst of veterinary life and I want to help in whichever way I can. Ultimately, I would love to see elevation in the reputation of this industry and improved collaboration both nationwide and internationally. My ultimate goal is to help improve the personal satisfaction at the end of each veterinary professional’s day. Becky Murphy, Canine Health & Welfare Vet, Dogs NZ, and owner of TCI Glenbred, Feilding I am a 2010 graduate from Massey University. My practice, TCI GlenBred is devoted to canine inherited disease screening and theriogenology. I have been the Dogs NZ (NZKC) Veterinarian since 2016 and a member of the CAV Committee since 2018. I enjoy working with dog breeders and veterinarians to promote and improve genetic health, particularly in pedigree dogs. Outside of work, my husband and I have two children, one dog, two cats, two bunnies and a very naughty pony, which keeps us very busy! Additional roles: Member of WSAVA Hereditary Disease Committee

Ex officio members NZVA Veterinary Manager–Companion Animal To be advised.

Sarah Fowler, Editor – Companion Quarterly (and NZVJ), Hamilton I have been the editor of Companion Quarterly (previously CAS Newsletter) since 2013. I am a 2010 Massey graduate (after a starter career as a plant scientist) and worked in clinical CA practice before starting in 2016 as an assistant editor at the NZVJ. I am now editor-in-chief of NZVJ and I am stoked to have found a niche in veterinary publishing that allows me to use my previous scientific training and my veterinary qualifications. Producing Companion Quarterly as a high quality source of CPD for CA vets in NZ gives me a great deal of satisfaction.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 33 No 1 | March 2022

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

Companion Quarterly

VOLUME 33 NO 1 March 2022

Guidelines for management of feline retroviruses

Radioactive iodine treatment for feline hyperthyroidism

A case of feline hyperaldosteronism

OFFICIAL Newsletter of the Companion Animal veterinarians branch of the nzva Volume 33, No. 1 | March 2022

Snippets from the 31st ACVIM-CA (virtual) Congress

A Week With.... reports: Craig Irving and Lisa Argilla

Companion Quarterly Vol 33 No1 March 2022

Articles inside

NZVJ abstracts

All dogs great and small

Massey news

Companion Animals NZ update

A Week With ... Lisa Argilla at the Dunedin Wildlife Hospital

Healthy Pets NZ update

Horse or zebra? A case of feline hyperaldosteronism

Editorial

A Week With ... Veterinary Ophthalmologist, Craig Irving

CAV activities and meeting highlights

Radioactive iodine (RAI) treatment for feline hyperthyroidism

Guidelines for the management of feline retroviruses

What is your diagnosis?