NZVA COMPANION ANIMAL SOCIETY NEWSLETTER
Volume 26 No 2 June 2015
In This Issue ...
• History of dogs in warfare • Case report on dentigerous cysts • Gastrointestinal ultrasound review • Neurological damage due to mouth-gags in cats • Specialist Profile: Alastair Coomer • Unusual dermatological conditions – necrotising fasciitis
VOLUME 26 NO 2 JUNE 2015
Newsletter
Volume 26 No. 2 June 2015 ISSN No. 1173-6941
EXECUTIVE COMMITTEE 2015 President
Contents
Catherine Watson
cath@vetservices.co.nz
Editorial................................................................................................................... 2
Secretary
From your society...................................................................................................4
Rochelle Ferguson rochellemf@hotmail.com
Grants & scholarships............................................................................................. 6
Treasurer
Article of the Issue winner.......................................................................................6
Aimee Brooker
Prize Winners of CAS Continuing Education Grants for 2015.................................. 8
ollyaimee@gmail.com
Committee Members
CAS Executive News............................................................................................. 10
Helen Beattie
Article of the Year winner...................................................................................... 10
Helen.Beattie@op.ac.nz
Brendon Bullen
On the history of dogs in warfare.......................................................................... 12
brendonbullen@gmail.com
Boyd R Jones
Hannah Bain
hannah.bain@merck.com
Case report on dentigerous cysts: Or the value of dental radiographs...................20
Warren Stroud
Craig Hunger
stroud@wellpet.co.nz
Pauline Calvert
A review of the use of ultrasound for gastrointestinal conditions in small animals...........................................................................................................26
pcalvert@xtra.co.nz
John Munday
Kate Heller
j.munday@massey.ac.nz
Can mouth-gags in cats cause blindness and neurological damage?....................32
EDITORAL COMMITTEE
Mike Gieseg
Sarah Fowler (Editor) Genevieve Rogerson Angus Fechney Craig Irving Christine Moloney (Advertising) Janice Thompson Simon Clark
CAS Specialist Profile............................................................................................34 Alastair Coomer
Unusual dermatological conditions – role of pathology in achieving a diagnosis.........36 Geoff Orbell
Address for submitting copy/ correspondence etc.
Companion Animal Health Foundation Report.......................................................38 Chris Hutchings
Sarah Fowler
66 Callum Brae Drive Rototuna Hamilton 3210 Ph H:(07) 845-7455 Mob: 027-358-4674 Email: sarah.fowler@gmail.com
2015 CAS call for nominations and AGM notice....................................................39 Massey Home Page..............................................................................................40 Continuing Education Calendar............................................................................. 41 Guidelines for Authors...........................................................................................42
Advertising Manager Christine Moloney
25 Manchester St, Feilding Telephone: 06 323 6161 Fax: 06 323 6179 Email: christine.moloney@totallyvets.co.nz
Cover Photograph
Koko and Gypsy who belong to Kylee & Paul Scotney-Hopkins. Photo by Catherine Holmes
NZVA Website
http://www.nzva.org.nz
CAS Website
http://cas.nzva.org.nz
Cover Design & Newsletter Setting
The whole of the content of the CAS Newsletter is copyright, CAS/New Zealand Veterinary Association Inc.
Penny May Aorangi Print Email: penfriend@xtra.co.nz
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Disclaimer: The CAS newsletter is a non peer reviewed publication. It is published by the Companion Animal Society (CAS), 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 CAS newsletter, the CAS executive, the NZVA, and neither CAS nor the editor endorses any products or services advertised. CAS 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 CAS 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 CAS, 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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Editorial The CAS committee is at a crossroads. At the AGM in August we will be seeking a mandate from members to make a significant change to the way the committee workload is managed as increasing demands on committee members now makes it unreasonable to rely solely on volunteers. Unless you have been closely involved with CAS, you may have little knowledge of the work we do apart from producing the CAS Newsletter and the e-CAS bulletin. To help understand why the committee sees a need to change the way we work, it seems like a good idea to give an overview of the work that goes on behind the scenes on behalf of members. The CAS committee is made up of nine volunteers from various regions around the country and across the range of companion animal veterinary roles (clinical, industry, academic). President, Secretary and Treasurer roles attract an honorarium to reflect their increased workloads and responsibility, but otherwise committee members are only reimbursed for costs to attend meetings. There are several sub-committees such as the Editorial committee who produce the Newsletter, and the Education Technical Advisory Group (TAG) who plan out companion animal CPD (Conferences, webinars, wetlabs etc) on behalf of CAS. These are made up of committee members and other volunteers. Each year the CAS committee produces and updates an annual plan and a welfare plan. These plans incorporate all the activities covered by CAS. It includes major projects like the WSAVA Conference, Veterinary Refresher Scheme development, Wellness project, Cat Research project, antibiotic guidelines along with a lot of far less visible activity. Our work includes writing articles and advisories for various industry bodies like the NZ Kennel Club, SPCA, and Trade Me, as well as representing CAS in meetings with stakeholders like the VCNZ, NZCAC, and CCMF, on a variety of topics such as cat management, dog breeding, animal trading and exporting, as well as collaborative efforts with other NZVA special interest and regional branches at meetings such as the NZVA Branch Summit. We respond to media requests and prepare for future requests through position statement development. We also write and review policies on a wide range of companion animal topics and advise on or deal with companion animal queries that come through the NZVA and VCNZ from both veterinarians and the public.
We administer our own scholarships and grants – the Hills/CAS Educating the Educators Grant and The Practitioner on Sabbatical scholarship, along with the CAHF project grants. We also make recommendations and prepare citations for awards within the NZVA both nationally and internationally, to ensure our high achieving members are recognized for their contributions. The CAS committee feels that currently we are only just managing the projects we are undertaking. Due to an increasing workload the Secretary role in particular, has grown larger than what can be reasonably expected from a volunteer. This position has essentially been a 14hr+/week commitment for some time. Increasing demands on the President’s role has also meant it is unmanageable for someone who is working full time. We have had people in these positions for extended periods of time due to difficulties in finding suitable replacements. Projects such as Wellness, welfare issues like inherited disorders, and student membership strategies have not had the time and energy dedicated to them as our committee members juggle both work and family commitments. One solution we have considered is to divert the honoraria we pay for some officer positions into a part-time ‘CAS Veterinary Resource position on a contract basis. This contract would be managed by the NZVA but funded by CAS and would focus solely on achieving CAS objectives. We envisage this position being around 25 hours a week, requiring a mixture of veterinary and administration skills and paying between $40,000–50,000 depending on the applicant’s skill level. It would encompass the current Secretary workload, along with some of the President’s workload and also include work on projects that CAS would like to progress. Funding for this position would come from the current Secretary Honorarium ($15k) and interest from current reserves ($18,000). Reserves would need to be used to make up the shortfall. We would retain the current structure of the committee with President, Secretary and Treasurer but the Secretary role would no longer attract an honorarium. By having a CAS Veterinary Resource Manager to support the CAS committee, we seek to improve delivery of our objectives and create a sustainable model for the future of CAS. We look forward to your feedback on this important change for CAS and will be asking for members to give a mandate for this proposal by voting on it at our upcoming AGM in July.
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Newsletter Design Phone: 06 323-4516 Fax: 06 323-3156 Mobile: 021 255-1140 Address: 125 Campbell Rd, RD 5, Feilding 4775 Email: print@aorangi.co.nz
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From your society Summary of minutes Meeting held 17–18 March 2015 at the Best Western Ellerslie boardroom in Auckland Attendance: Catherine Watson, Aimee Brooker, Rochelle Ferguson, Helen Beattie, Brendon Bullen, Hannah Bain, Warren Stroud, Pauline Calvert and John Munday Apologies: Sarah Fowler. Matters arising from previous minutes and correspondence: The committee were if full support of the WSAVA campaign to ensure veterinary access to ketamine. We discussed section 29 issues and plan to continue to lobby for access to these medications for the veterinary profession and also saw the need to inform veterinarians of the best sources for medication that they may be importing – given the number of quality issues seen with drugs from China.
Guests – NZVA – Peter Benstead and Callum Irvine via conference call. We were updated on meetings with NAWAC, ACVM and discussed section 29 drugs. Cat issues: HB stressed the importance of correct definitions when using the term feral and stray in regard to cats. NZCAC: The NZCAC has made a proposal to their members to restructure the council to position themselves for the future to become a more visible authority on companion animal issues and an organisation of significance.
Treasurer’s report – Aimee Brooker: Accepted with no increase to CAS subscription rate in 2016.
Succession and managing workloads: Cath Watson to step down as President at 2015 AGM and Brendon Bullen to take on this role. Work to continue on developing a CAS veterinary resource position that will be based at the NZVA but be focused solely on CAS initiatives. No change to the honorarium but President, Secretary and Treasurer to track their hours. Future committee members were identified and training planned for new committee members.
Newsletter Editor’s report – Sarah Fowler: Discussed making the online student version available to members who would like an electronic copy. Plan to check with advertisers to ensure they are comfortable with this before proceeding.
Strategic planning: Reviewed annual plan and animal welfare strategy. Discussed how best to support members with continuing education and ideas to celebrate members achievements by showcasing them in our newsletter.
CAHF and CAS grants update: The CAHF annual report was tabled and will be reported at the AGM. Chris Hutchings has indicated that it may be time for a new chair so we will be considering suitable replacements.
Guest: Allan Bell – Allan gave us an overview and update on MRSP in dogs. We identified the need for national surveillance and further education to veterinarians on how to manage this type of case in the first instance.
NZKC: They have invited us to have another veterinarian on their inherited disorders committee along with Kirsten Wyllie.
VCNZ minimum practising standards – Discussed difficulties in meeting these standards 1005 of the time when in the “real world”. CAS to give feedback to VCNZ about this.
President’s report – Cath Watson: Have had discussions with NZVA about developing the CAS resource veterinary position and the speakers’ kit. Jess Beer has offered to represent us on the CCMF in place of Campbell Johnston. We were very grateful for the work Campbell did for CAS in the forum.
Guest: Alastair Coomer: We discussed continuing education seminars in NZ and the need to ensure that they are delivering good quality information including the context around interventions, along with being ethically sound. The shortage of specialists in New Zealand was also discussed and we considered ways to promote the path of specialisation to New Zealand veterinarians. Student and associate members – We know have 100 student members of CAS and preperations are
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underway to host Dr Leslie Lyons to speak to them at Massey in April on Cat genetics. Discussed CAS appeal to veterinary acaedemia and making Massey clinicians associate members of CAS.
Veterinary nurse registration – CAS in support of this initiative by the NZVNA. Social media strategy – discussed need to consider this avenue to ensure we are connecting in a relevant manner with our members now and in the future. Next meeting date July 29 and 30 at Massey University. n
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NZVA CAS members are encouraged to apply for these Grants and Scholarships:
The New Zealand Veterinary Association Companion Animal Society
Hill’s Pet Nutrition/CAS Educating the Educators Scholarship This scholarship provides assistance for veterinary educators to attend advanced level continuing education events outside New Zealand. We recognise the importance in supporting our leading veterinarians’ participation in international conferences to ensure they remain up to date. With the terms of the scholarship we also encourage the dissemination of this knowledge to the wider CAS membership through articles in the CAS Newsletter and presentations to regional branches. This scholarship is open to both CAS members and non-members – with CAS members being more generously supported. Applications are considered at the end of March and September each year but can also be made on a case by case basis. The scholarship provides $10,000 per annum to be divided between applicants. We are very grateful to Hill’s Pet Nutrition as the principle sponsor along with support from Massey University Institute of Veterinary, Animal and Biomedical Sciences and VetLearn. Please email the CAS Secretary Rochelle Ferguson cas@vets.org.nz for more information or see our website. Thanks to Hill’s Pet Nutrition for their ongoing support
CAS/CAHF Annual Project Grant 2015 Sponsored by Virbac The Companion Animal Health Foundation (CAHF) is a charitable trust established by the Companion Animal Society to fund research projects that will enhance companion animal health and welfare. The CAHF website has a list of the projects that have been supported by the CAHF and details of the papers published following this research. Applications are invited from CAS members each March and September for funding towards research projects that meet the aims and objectives of the CAHF. Application details along with the terms and conditions are also available from the website or by contacting the CAS Secretary Rochelle Ferguson on cas@vets.org.nz
EYEVET Services Limited
Article of the Issue Winner Tania Krupitza
March 2015, Volume 26(1), Pp20–26
Paper: “Management of a cat with traumatic brain injury.”
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Prize Winners of CAS Continuing Education Grants for 2015 Every year CAS has a draw to select two practitioners, one new member and one continuing member to receive a prize of $500 towards Companion Animal Continuing Education from VetLearn. The winners for 2014 are Holly Rabone (new member) and Jana Nortje (continuing member).
Jana Nortje Jana was born and bred in South Africa, where she qualified with a BVSc from the University of Pretoria in 2006. Since graduation, Jana spent four years gaining experience in England, before immigrating to Auckland in 2010 to be with her family. In 2012 Jana completed a rotating internship at Massey University, after which she relocated down south to VetSouth in Gore. It is here she met her Kiwi-fiancé and they are happily settled in Southern life with their fur babies Jack, Spooky and Lexy. Jana is interested in all aspects of companion animal healthcare, but particularly enjoys spending time in surgeries. Jana will be putting the prize draw towards a Vetscholar course on Anaesthesia and Critical Care.
Holly Rabone My name is Holly Rabone and I am a new graduate working at Tauranga Vets in the Bay of Plenty. I split my time between the main Tauranga clinic and the Te Puna branch where I enjoy a wide variety of clients and animal species. It is not unusual at Te Puna to have horses, sheep and goats come down for a visit as well as cats and dogs. I enjoy the challenges of mixed practice but have a particular interest in small animal medicine. I hope to put my prize money towards an oncology course in September. Oncology cases can be very challenging for a new graduate with a lot of treatment options and emotionally charged owners. It is a growing area and I would like to improve my skills to offer better in clinic service to our clients.
What is your diagnosis? The Companion Animal Society publishes a regular feature in which an interesting companion animal case is presented to readers. The initial page presents the case history, signalment and initial diagnostic results (physical exam findings, radiographs, ultrasound images, bloodwork etc). Questions are then posed to challenge readers understanding of the case, for example: • What is your list of differential diagnoses? • How would you confirm which is correct? • What treatment options are available? • What other factors must be considered? On a later page the questions are answered and the remainder of the case report revealed (e.g. conclusive diagnosis, treatment or treatment options, outcome). We invite submission of articles following this format from any interested veterinarian (or student). For each case accepted for publication there is a payment of $150 sponsored by MSD Animal Health. The deadlines for submission are the 25th of January, April, July and October, 2015. Please see the Instructions for authors in the December issue of the CAS Newsletter or available from the Editor. Make sure you include your name, qualifications, title and contact details.
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CAS Executive News Welcome to our new CAS Executive Committee members; Pauline Calvert, Warren Stroud and John Munday.
Warren Stroud
I grew up in Auckland on a lifestyle block; we had a variety of animals so I have always been interested in things ‘animal’. I did a BSc at Auckland and travelled before trying to get into the vet degree at Massey in the early ‘90s. Since graduating, my partner (Lyn – a vet student of same vintage – how romantic! Now my wife) and I went to Europe working in the UK and travelling for a couple of years. I worked in mixed practice there, then for the PDSA in small animal practice. Returning to NZ, I worked in large animal practice in the Manawatu before we bought a small animal practice on the Kapiti coast in the late ‘90s. Since then we have had 4 kids, bought another practice, purpose built, relocated and modernised both practices, rebranded them and moved to a largish lifestyle block. When not being a vet, I watch kid’s sport and help ferry them around. I am a keen football fan, and player (still) and complete the occasional marathon for fun. I look forward to making a positive contribution to the CAS committee.
John Munday
My first veterinary job was in Whangarei, but an interest in research lured me back to Massey after a couple of years of clinical practice. After completing a PhD looking at the role of alcohol and antioxidants in the prevention of heart disease in people (good and useless respectively), I decided that understanding how diseases develop was the thing that interested me most. To learn more, I completed a two-year pathology residency at Michigan State University. After passing my board examinations to become a member of the American College of Veterinary Pathologists, I obtained a position as a diagnostic pathologist at the University of Georgia where I spent many a happy hour looking at skin diseases and tumours from companion animals. After four years in Georgia I decided it was time to return home and I have been in the pathology department at Massey University for the last ten years. During that time I continued my interest in tumours of companion animals and my main research interest is investigating causes of cancer in animals and trying to more accurately predict cancer behaviour. I also enjoy the teaching component of my job and think having a member of the CAS executive on the staff at the Veterinary School will be beneficial both to increase the visibility of CAS to the students, but also to determine how best CAS will be able to meet the needs of our future graduates. Moving back to New Zealand was the best decision of my life as here I met my wonderful partner with whom I now have two young children. In my free time I enjoy mountain biking and taking our dog on long walks.
It is with great sadness that we farewell Kate Hill from the CAS executive who has (temporarily we understand) relocated to Belgium. Kate served on the CAS Executive Committee for seven years during which she provided invaluable technical advice to the committee, worked hard to ensure antimicrobial resistance issues were kept to the forefront and enthusiastically promoted CAS and its activities among Massey staff and students. She has been particularly active on the education front as Conference convenor, speaker and author of many interesting and informative articles for the CAS Newsletter. Kate, along with Pru Galloway and Richard Jerram were also responsible for compiling the speakers programme for the hugely successful WSAVA 20214 conference in Auckland. Kate’s input to the exec will be sorely missed and should she return to NZ, we hope she will consider rejoining the committee. The remaining committee members wish her all the best and together with CAS members thank her very much for her efforts advancing our collective aims and objectives. We would also like to say a huge thank-you to Catherine Watson who will be stepping down after 3.5 years’ service as CAS president on 30th July 2015. Cath will be handing over the reins to the current vice-president, Brendon Bullon. Brendon is a companion animal veterinarian from Wellington who has been a member of the CAS executive committee for the last two years. Fortunately Cath will continue her fine work for the Companion Animal Society as she will remain a member of the CAS executive committee.
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Article of the Year Winner
Magdeline Soo
Paper:
June 2014, Volume 25(2), Pp26–29
“The use of juvenile pubic symphysiodesis in the surgical management of skeletallyimmature canine hip dysplasia patients.”
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On the history of dogs in warfare Boyd R Jones, BVSc, FACVSc, DECVIM-Ca, Professor Emeritus This year is the 100th anniversary of the commencement of the 1914–18 war. There are commemorative events, stamp issues, new books, website information and newspaper articles on events and soldiers, marking the ‘Great War’. Animals – horses and dogs – played a significant role in that conflict. Horses were used as cavalry and for transport but the part dogs played is often forgotten. I prepared a lecture on the history of working dogs for the World Small Animal Veterinary Association Congress in Jeju, Korea a few years ago and recently read the article ‘Dogs of War’ in the BSAVA Companion (October 2014). I thought I would depart from the academic/medical theme for this issue and write something about Dogs in Warfare. The use of ’War dogs’ goes back to ancient times before Christ: the Greeks, Persians, Egyptians, Britons and Romans all used dogs (Figure 1), mostly in a sentry role but sometimes taken into battle. The earliest report involved the Alyattes of Lydia against the Cimmerians in 600 BC, when the Lydian dogs killed some invaders. In mid 7th century BC Magnesian horsemen, in a war against the Ephesians, were each accompanied by a war dog and a spearwielding attendant. The dogs were released to breach the enemy ranks, followed by a spear assault and then a cavalry charge. War dogs were often sent into battle with spiked collars and coats of mail armour. Dogs were used by the Romans during invasions to hunt out local guerrillas who resisted the Roman invaders. Caesar’s invasion of Britain was opposed by Celtic warriors and their dogs in 55 BC, the English mastiff being one of the oldest recorded breeds. Attila the
Figure 1.
An ancient war dog in battle from ‘Dogs of war – a short history of canines in combat’. 8 Nov 2012, www.Military History now.com/2012/11/08
Hun used giant Molosser dogs (similar to the mastiff) in his military campaigns. Other civilisations used armoured dogs to defend their position or attack enemies. Their key role was to distract soldiers and unseat horsemen. Mastiffs and other large breeds were used by the Spanish conquistadors against native Americans in the 1500s. Elizabeth I used dogs against the Irish in Ireland in 1580. Frederick the Great and Napoleon both used dogs as messengers and as guard dogs during their campaigns. With the advent of ‘modern’ weapons and guns the role of dogs changed from attack to other less confrontational but essential aspects of warfare: for sentry and guard duties, logistics and communications, rescue and casualty, warning dogs, detection and tracking, medical research, scouting, drug and explosive detection, and as companions and mascots. The first use of dogs in the United States was in the Seminole wars and hounds were used in the American civil war as messengers and to guard prisoners. In the last stand of the British 66th Royal Berkshire Regiment in the second Afghan war in the 1880s, the mascot of the 2nd Battalion, ‘Bobbie’, was the only survivor of the battle of Maiwand. ‘Bobbie’ received the Afghan Medal from Queen Victoria in 1881; he died the year after, run down by a horse cab!
Roles and functions of dogs in World War I
Dogs were employed in many different roles and were of value in the trenches on the western front as sentry and guard dogs, pack animals (machine guns and stretcher bearers, Figure 2), warning dogs, messenger dogs and rescue dogs. Sentry or guard dogs on a short lead were trained to accompany a soldier and taught to growl, snarl or stiffen (hackles raised), to indicate when they detected someone advancing. Dobermann pinschers were favoured for this role. Scout dogs would go with soldiers on foot, patrolling the terrain ahead of them. They could scent the enemy up to 1000 yards away, sooner than a human. Silence was
Figure 2. Belgian dogs trained to draw quick firing machine guns. WE Mason. Dogs All Nations 105, public domain.
Massey University, Palmerston North
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important and raising of hackles and pointing of the tail indicated the enemy was encroaching. Casualty/rescue dogs were trained to find the wounded and dying on the battle field and were equipped with medical supplies to assist the wounded. They were trained to remain with the wounded man, and many soldiers died while the dog waited beside them. To guide stretcher bearers, the casualty dogs wore Red Cross collars or coats. When the Germans introduced gas warfare, dogs were trained to detect gas and alert troops so that soldiers could don gas masks. Dogs were also issued with gas masks for protection (Figure 3). One famous dog, ‘Stubby’, fostered by American troops, detected incoming artillery shells before the soldiers could hear them. They watched Stubby who alerted them when to take cover. Stubby was promoted to Sergeant before his return to the United States as a hero, and he became mascot of the Washington Hogas football team.
would be allowed into Britain. The owners/handlers paid £2 and the RSPCA the rest. The first batch of dogs arrived in the UK from France in 1919. What happened to the hundreds and maybe thousands of dogs left behind after the armistice is not recorded. New Zealand dogs • ‘Caesar’, a bulldog, accompanied the NZ Rifle Brigade as a trained Red Cross dog and helped rescue wounded NZ troops in the battle of the Somme. He was killed in action. • ‘Freda’, a harlequin great Dane, was adopted as the mascot for NZ 5 Battalion at Cannock Chase, England. • ‘Pelorus Jack’ was the mascot for the battle cruiser HMS New Zealand. There were two ‘Pelorus Jacks’, both bulldogs: one was discharged dead in 1916; the other achieved the rank of Leading Sea Dog and fought at the battle of Jutland. • ‘Floss’, a fox terrier, was the mascot of the NZ Army rugby team that toured England in 1917. Floss raised many pounds for rehabilitation of disabled servicemen and women. Many other NZ army and navy units had canine mascots. The 1914 NZ war dog postcard emphasised the call to support “the cause”, the Empire (Figure 4).
Figure 3.
World War 1 dogs and soldiers wearing gas masks in German trenches (circa 1916–18). www.time.com/ time/photogallery
Communications were often difficult and crude at best at the front line and dogs provided reliable and rapid communication between units. Dogs were less of a target to a sniper and could travel over the difficult terrain, pock marked with shell craters. Some dogs were trained to trail telephone wires between locations. One of the important roles dogs provided in the conflict was companionship. Units were encouraged to adopt dogs which acted as mascots, giving psychological comfort in the squalid and horrific conditions the soldiers lived through. Relationships were strong and there are stories of dogs that would sit beside their dead master or wait at their grave. Small terriers were sponsored by the British YMCA to deliver cigarettes to the troops in the trenches! Despite the important role dogs played in the conflict there is little mention in the official record of veterinary service for dogs in the war. Furthermore, because rabies was present in continental Europe, disease control was a potential problem. It was decided that ‘a proportion of dogs could be brought to Britain subject to proper precautions’. Quarantine stations were established, with the RSPCA covering the cost for 500 dogs only. The commanding officer of each unit in all theatres of war decided which individual dogs
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Figure 4.
War dog of New Zealand, a postcard, 1914. Courtesy of Glen Reddiex, private postcard collection, http://100nzww1postcards.blogspot.co.nz/
The Second World War
Dogs returned to action in the Second World War (Figure 5). In the opening weeks of the German invasion of Russia, dogs were equipped with mines that would magnetically detonate when the dogs ducked under the German Panzer tanks. The dogs were trained with Soviet tanks but in many cases they
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ran alongside the tanks or did not distinguish German from Russian tanks – not an effective strategy! The Soviet Army also used dogs to assist soldiers wounded in battle, dragging them on sleds in the snow. Dogs could travel in deep snow, improving a wounded soldier’s chance of survival when temperatures were extremely low. On one sector of the front a team of sled dogs carried 1239 wounded men from the battlefield and hauled 330 tons of ammunition. Samoyed dogs were useful in winter for sled transport and haulage. Dogs were used in a security role to detect booby traps, ambushes, weapon stores or enemy soldiers. Detection dogs were trained to detect mines but were not that effective under combat conditions. Throughout the war dogs were used by the Germans for guard duty in concentration camps and prisoner of war camps. Most armies had sentry or guard dogs for surveillance of camps or equipment. Dogs were also used to track escaped prisoners by the Germans and Japanese.
Figure 6.
Figure 5.
Two Airedale terriers, one wearing a gas mask and the other carrying rations for a wounded soldier in World War 2. Fox photos/Walton archive/getty images
Pacific dogs: US Marines take scouting and messenger dogs to the front lines on Bougainville, late 1943. From Wikipedia, www.archives.gov, photo by T Sgt Samo, Ca, 1943.
research dogs received medals ‘for outstanding service to humanity’. As expected, the ethics of using dogs for such experiments came under scrutiny and received significant criticism after the war (Figure 7). Political review led to the adoption in 1966 of the United States Laboratory Animal Welfare Act.
The United States Marine Corps used dogs, donated by their American owners, in the Pacific to help take islands back from the Japanese occupying forces (Figure 6). They were used for sentry duties and for tracking the enemy soldiers in the jungle. All breeds were eligible but Dobermanns and German shepherd dogs were generally selected. The Dobermann Pinscher became the ‘official’ dog of the USMC. Many dogs went home with their handlers and almost all returned to civilian life. ‘Chips’ was the most famous – a German shepherd/Siberian husky cross. He served in North Africa, Sicily, France and Germany. In Sicily ‘Chips’ broke away from his handler and entered an enemy pillbox, attacking the gunners inside, who surrendered as a result. Later he helped capture Italian soldiers. ‘Chips’ was awarded the Distinguished Service Cross, Silver Star and Purple Heart but these honours were later revoked because army policy prevented official commendation of animals! His unit unofficially awarded him suitable decorations in recognition of his actions. ‘Chips’ was returned to his family after the war. Major ‘Major’ was the mascot of the 2nd NZEF and of the 19th Battalion from 1939. Wounded at El Alamein he was promoted to Major in late 1942. He died of sickness in Italy in 1944 and was buried with full military honours. During World War II in the United States, dogs were the primary animals used in medical research to test new drugs without risking human lives. The US government proclaimed these dogs as heroes and
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Figure 7.
World War 2 cartoon. Medical research. American visuals corporation/NLM. www.nlm-n.h.gov/ exhibition/animals/canine
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After World War II
Dogs have been used by most countries’ armies in different theatres of war. Approximately 5000 American war dogs served in the Vietnam War and about 10,000 personnel served as dog handlers (Figure 8). About 250 dogs and 300 handlers were killed in action. In Vietnam dogs were mostly used in a sentry role guarding the areas in front of gun towers or bunkers and the perimeter of airbases. Their detection of Viet Cong intruders resulted in rapid deployment of new reinforcements. The sentry dogs were highly successful and feared by the Viet Cong who even placed a bounty on the lives of handler and dog. Some dogs were trained to silently locate booby traps and mines. Despite the success of the dog teams in Vietnam, at the conclusion of this conflict the dogs were not returned to the United States. About 200 dogs were reassigned to US bases outside the USA. The remainder were euthanased or left behind. There was huge public outcry at that time about the decision not to repatriate the dogs that had saved many lives. Dogs were regarded as expendable equipment.
adoption of retired military dogs. The US Air Force trains dogs in different roles at the Lackland Airforce base in Texas. Military dogs were deployed widely in Iraq (Figure 10) and Afghanistan for detection of drugs and explosives. They were also used for intimidation of the enemy. The use of dogs to intimidate prisoners in Iraq and Guantanamo Bay resulted in military court-martial and prohibition of dogs being used in this way.
Figure 10. Belgian Malinois, US Airforce, on top of a M2A3 Bradley fighting vehicle in Iraq, 2007. US Airforce photo by Staff Sgt SL Pearsall. www.defendamerica. mil.
A Belgian Malinois dog, ‘Cairo’, accompanied the SEAL team that stormed Osama bin Laden’s compound in Abbottabad, Pakistan, in 2011. The dog’s role was to detect bombs, concealed enemies and sealed doors or passageways in the Al Qaeda safe house. ‘Cairo’ was dropped into the compound from a helicopter along with the SEALs.
Figure 8. Returning from patrol. Muzzled sentry dogs and their handlers in a truck, Danang, Vietnam 1969. RA Elder, Hulton archive/Getty images. www.time.com/ time/photogallery
Dogs have participated in military roles in most modern conflicts. Their roles are often similar to those of the past but many new roles have been created. Dogs are equipped with tactical vests with microphones and cameras that can relay audio and video messages to the handler (Figure 9). The German shepherd is still the most popular breed but smaller dogs with a keener sense of smell for detection are also used. The dogs are trained with one handler and, in the US, new laws permit the return home and
Figure 9. Military working dog carries a flak jacket and specialised equipment. Reuters K9 Storm Inc handout. www.totallycoolpix.com/2011/05/dogs of war
In 2014 a memorial to war dogs was unveiled at Camp Pendleton in California to pay tribute to canine military members of the US Army as far back as World War I. The New Zealand Army until now has not had a dog unit but is in the process of developing a canine tactical unit. The NZ Airforce has dogs to guard the Whenuapai airbase. Dogs used in warfare have made huge contributions to many conflicts and, in most countries, legislation now protects their welfare and defines their use. The relationship and bonding between a dog and its handler remains, as it always has, the key to a dog’s ability as a war dog.
References and reading
Jones BV, Dogs of War, BSAVA Companion, 4–6, October 2014 Dogs in warfare http://en.wikipedia.org/wiki/dogs-in-warfare Dogs in World War One http://www.historylearningsite.co.uk/ dogs-in-world-war-one.htm The dogs of war Photos of canines in combat – TIME http:// combat.time.com/time/photogallery/0,29307,2070141,00. html First World War mascots – animals at war by Philippa Werry http:// literaryonline.tki.org.nz/content/download/28223/297054/ file Caesar, the ANZAC dog New Zealand history on line http:// nzhistor y.net.nz/media/photo/Caesar-the-anzac-dog (Ministry for Culture and Heritage) updated 31 July 2014 There are numerous other websites, books and monographs with pictures, stories and comment about World Wars I and II and other conflicts where dogs and other animals were used in a combat or support role.
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This article was written as part of the requirements for receiving the CAS/Hills Pet Nutrition Educating the Educators scholarship.
Case report on dentigerous cysts: Or the value of dental radiographs Craig Hunger, BVSc, MANZCVS Small Animal Dentistry and Oral Surgery Introduction
Dentigerous cysts are developmental cysts associated with unerrupted teeth. They can be seen in all breeds of dog, but are more common in boxers, shih tzus and other brachycephalic breeds. There is a predilection for the mandibular premolars, with the first mandibular premolar most commonly affected. Dentigerous cyst will be associated with a missing tooth and should be a primary differential for any swelling in an edentulous area of the jaw. Diagnosis is by dental X-rays and biopsy. The cyst is seen centered on the unerrupted tooth. Treatment involves complete removal of the unerrupted tooth and cystic lining. The cyst and tooth should be submitted for histological examination.
A pharyngeal gag was placed and the mouth was rinsed with chlorhexidine (CLS Solution), the teeth were scaled supra- and subgingivally and then polished with a pumice paste. A complete oral and dental examination was performed and the mouth charted. Relevant findings were that the left and right, first mandibular premolars (305, 405) were found to be missing. These areas were radiographed with dental X-rays. The right first mandibular premolar (405) was found to be impacted under the gingiva and surrounded by a very large cystic lesion extending from the second mandibular incisor (402) to the second mandibular premolar (406) (Figures 2 and 3).
Case report
A 2-year-old male, neutered boxer dog was referred to the clinic, for evaluation and treatment of a suspected fracture of the maxillary right canine (104) and discolouration of the mandibular right canine (404). On physical examination, he was found to be bright, alert, responsive, and in good body condition (BCS4). Cardinal signs were within normal ranges. He had a class 3 variant occlusion; normal for a boxer. Tooth 404 was discoloured and worn on the distal surface and 104 was worn on the mesial surface. The wear appeared to be due to attrition occurring between 104 and 404 (Figure 1). With the discolouration, the 404 was highly likely to be dead, with a necrotic pulp and would eventually develop a peri-apical abscess without treatment (Hale, 2001). After discussion with the owner, it was decided to book the dog in for dental radiographs and a standard root canal therapy of 404 and dental radiographs and direct pulp capping or standard root canal therapy of 104.
Figure 1.
Figure 2. Oblique dental radiograph of right mandible showing large dentigerous cyst (indicated by the small arrows). Note the unerrupted 405 (indicated by the arrowhead)
Class 3 malocclusion showing attrition between 104 and 404. Note the discolouration of 404.
The dog was admitted for surgery. After running pre-anaesthetic blood tests, he was premedicated with morphine (0.6 mg/kg) and acepromazine (0.01 mg/ kg), placed on IV fluids (5 ml/kg/h), induced with diazepam (0.5 mg/kg) and propofol (2 mg/kg) and maintained on Isoflurane. Cephazolin (22 mg/kg) was given via slow IV over 4–5 minutes.
Figure 3.
Dental radiograph of rostral mandible showing large dentigerous cyst in the right hemimandible (indicated by the arrows). A smaller dentigerous cyst in the left hemimandible is not clearly visible in this radiographic view.
Pet Doctors at Animates Takanini, craig.hunger@gmail.com
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Figure 5. Intra-operative photo of the dentigerous cyst (arrows), and with the mental foramen indicated by the arrowhead. Figure 4. Oblique dental radiogrpah of left mandible showing dentigerous cyst (indicated by the arrows). Note unerrupted 305 (arrowhead) and dilacerated root of 306.
The left side was radiographed and the first mandibular molar (305) was impacted and surrounded by a cystic area involving 305 and 306 (Figures 3 and 4). The right maxillary canine was probed and radiographed. There was no exposure of the pulp cavity, the tooth appeared vital, with the pulp canal the same width as the contra lateral tooth and no evidence of periapical lysis.
Oral assessment and treatment
The diagnosis was bilateral odontogenic cysts involving the first mandibular premolars. The right side was very large. Treatment involved removal of the affected teeth and the cystic lining in its entirety. A bilateral mandibular nerve block was performed using lidocaine 2% (Lopaine). A large envelope mucogingival flap was created from 401 to the line angle of 407. The flap was raised with the use of a periosteal elevator (Figure 5). The mandibular artery and vein were ligated and an en bloc resection performed of the cyst and overlying bone removing 401, 402,403, 404, 405 and 406. The cystic lining was then curreted from the lingual side of the mandibular bone (Figure 6). The area was flushed with sterile saline and a synthetic bone graft placed (Figure 7). The mucogingival flap was freed up with periosteal releasing incisions and sutured with 4/0 Monosyn in a simple interrupted pattern, with no tension (Figure 8). On the left side, the cyst involved the mesial root of the second mandibular premolar (306) and the roots were dilacerated. A mucogingival envelope flap was raised, 306 was surgically extracted. Tooth 305 was exposed with a size 4 round burr and then extracted. The cyst was removed, curreted and lavaged. The flap closed with 4/0 Monosyn. The maxillary right canine (104) was worn and there was damage to the tip, leaving it prone to fracture. The cause of the attrition, the mandibular canine (104) had been removed, so there would be no further abnormal contact. There was no pulpal exposure and the tooth appeared vital on dental radiographs (Figure 9), so the plan was to remove the damaged enamel and dentin and place a composite restoration to protect the tooth. A right-sided infraorbital bupivacaine (Marcain 0.5%) nerve block was performed. The damaged tip of the
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Figure 6. Intra-operative photo of the cystic lining being removed from the underlying bone.
Figure 7.
Intra-operative photo after placement of synthetic bone graft.
Figure 8. Intra-operative photo mucogingival flap.
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repeat radiographs in six months and then six monthly to check for complete healing and that there is no recurrence of the cysts.
Discussion
Missing teeth are common, especially in small breed dogs. Missing teeth may be: 1. Genuinely missing, having never existed or having been extracted previously. 2. The crown may be missing, with root remnants present or 3. The tooth may be unerrupted or impacted.
Figure 9.
Dental radiograph of 104 showing wear of the crown.
maxillary right canine (104) was removed along with any damaged enamel using a fine diamond burr. This resulted in a near pulpal exposure. A layer of glass ionomer was applied over the near pulpal exposure and then light cured. The tooth was then acidetched with 30% phosphoric acid for 30 seconds, rinsed off and then an unfilled bonded resin applied and light cured. This was followed by a layer of flowable composite (Wave), which was light cured for 20 seconds and then a layer of a hybrid composite (Z100). The tooth was then shaped, smoothed and polished using Soflex discs and then a final layer of unfilled bonded resin (Stae) was applied, thinned and then light cured (Figure 10).
Dentigerous cysts can be seen in all breeds of dog, but are most common in boxers, shih tzus and other brachycephalic breeds. The reported prevalence of odontogenic cysts is low at 1.4% with 71% of cysts classified as ‘dentigerous’ (Verstraete et al., 2011). The prevalence is based on histological diagnosis. The age of initial diagnosis ranges from six months to 10 years, with highest frequency diagnosed between two and three years of age (Verstraete et al., 2011). There is a predilection for mandibular premolars, with the first mandibular premolar most commonly affected. Unerrupted mandibular and maxillary canines can also be affected. These can be multiple and bilateral especially in boxers. Dentigerous cysts develop slowly and cause loss of bone due to expansion. Adjacent teeth can be affected. Cysts can become very large and cause damage to surrounding structures and severe weakening of jaw (Niemiec, 2010).
The cyst and surrounding bone and teeth on the right mandible was sent for histology. The dog was reexamined seven days later and the surgical sites had healed well.
Dentigerous cysts are developmental cysts associated with unerrupted teeth and arise from the proliferation of the tissue remnants of the enamel organ. When the tooth is developing, a protective layer is laid down on top of the enamel, called the primary cuticle. This is normally worn away when the tooth erupts. If the tooth does not erupt, the amelioblasts can continue secreting fluid, forming a dentigerous cyst. Not all unerrupted or impacted teeth develop dentigerous cysts, so there may be other factors involved in their development. Dentigerous cyst will be associated with a missing tooth and should be a primary differential for any swelling in an edentulous area of the jaw.
The histology results indicated an odontogenic cyst. With the cyst centred around an unerrupted tooth, the cyst is dentigerous by definition. The plan is to
Diagnosis is by dental radiography and biopsy. The cyst is seen centred on the unerrupted tooth, with damage to surrounding teeth and structures due to
Figure 10. Tooth 104 after treatment.
The patient was discharged that evening with postoperative instructions, to feed a soft food diet for seven days, and avoid chewing on hard objects. Clavulox (dose rate?) and Previcox (dose rate?) were dispensed, along with tramadol (dose rate), if required for further pain relief.
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The observation of any missing teeth, should be confirmed radiographically. Unerrupted or impacted teeth are very common in clinical practice. Impacted teeth are due to a physical barrier; either bone or fibrous gingiva. Unerrupted teeth are due to a lack of eruptive forces. If the teeth are not present past the age of expected eruption, they should be radiographed. If it is due to an area of thickened gingiva (an operculum) a window can be cut through the fibrous gingiva to allow the tooth to erupt. Once the apex of the tooth closes, the tooth will no longer passively erupt. If there is a bony obstruction or the dog is older than 12 months then surgical extraction is the treatment of choice (Taney and Smith, 2006). In older dogs if no cyst is present, the tooth may be monitored via dental radiographs (Wiggs and Lobrise, 1997; Niemiec, 2010).
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expansion of adjacent bone. Dental X-rays will show loss of cortical bone, with a circular radiolucent area with a defined border. The unerrupted and adjacent tooth may be displaced or have resorption occurring. Treatment involves complete surgical excision of the affected teeth and the cystic lining. Marsupialisation and decompression of large cysts to allow drainage and reduction in size of the cyst prior to surgical excision at a later date has been reported (D’Astous, 2011). Prognosis is excellent if the cyst is removed in its entirety. The cyst and tooth should be submitted for histological examination to rule out other more obscure causes or malignant transformation. The case should be followed up with radiographs six-monthly for two years or until there is complete ossification of the cystic cavity (Chamberlain and Verstraete, 2012). In this case I placed a bone graft to help prevent a pathological fracture due to the large amount of mandible that was removed. I could have performed a marsupialisation first, but the right mandibular canine was likely dead and needed to be removed as it wasn’t a candidate for root canal therapy due to the loss of bone. The dog was presented due to suspected fractured and discoloured teeth. This shows the importance of a full oral examination and to radiograph any missing teeth that have not been documented has having been removed. For completeness and to provide further information about alternatives to extraction, I have included a quick discussion on the other pathology found in this patient’s mouth. Complicated fractured teeth by definition involve exposure of the pulp cavity and require treatment. Pulpal exposure will invariably result in pulpitis and pulpal necrosis, leading to infection and chronic pain (Ricucci et al., 2006). Treatment options include extraction or standard root canal therapy (RCT). With RCT we are left with a non-vital tooth that is structurally sound. RCT can be performed on fractured teeth of any duration. The tooth requires a closed apex for root canal therapy. Immature, acutely fractured teeth can be treated with a vital pulpotomy, which leaves a vital tooth. The goal of RCT is to remove all pulpal material via mechanical and biological debridement, to prevent bacterial growth, then fill and seal the canal. If this is successful any peri–apical infection will resolve with antibiotics. The benefit of root canal therapy is that the tooth is still functional, and the procedure is less traumatic than extractions. The lower canines, especially provides a lot of strength of the rostral mandible and keeping the tooth is ideal. There are eight strategic teeth in a dogs mouth: the four canines and the four carnassials. In felines, the four strategic teeth that we perform root canal therapy on are the canines.
materials other than the opposing dentition. This can be fur, stones, tennis balls, or wood. Both cause loss of enamel and dentin. As the tooth wears, the pulp is stimulated to produce tertiary dentin to try and protect the pulp. This is seen as a brown circular spot. If the wear is slow enough the pulp may remain vital, but if the wear is too quick then it can result in pulpitis and necrosis. Diagnosis of worn teeth is via a dental explorer to check for exposure of the pulp cavity, and radiographs should be taken to check for signs of pulpal necrosis (Niemiec, 2010). Blunt force trauma to teeth can cause pulpal haemorrhage. Blood then enters the dentinal tubules, causing initially a pink discolouration that over time becomes a darker brown or grey. In most cases this will lead to irreversible pulpitis and pulpal necrosis. A study by Dr Fraser Hale showed that 96% of discoloured teeth due to trauma had gross or radiographic signs on endodontic disease (Hale, 2001). So all discoloured teeth need to be radiographed to look for evidence of periapical pathology and pulpal necrosis. Treatment is either extraction or root canal therapy.
References
Chamberlain TP, Verstraete FJM. Clinical behaviour and management of odontogenic cysts. In: Verstraete FJM. Oral and Maxofacial Surgery in Dogs and Cats. Pp 481–486. Saunders, 2012 D’Astous J. An overview of dentigerous cysts in dogs and cats. Canadian Veterinary Journal, 52, 905–7, 2011 Hale FA. Localised intrinsic staining of teeth due to pulpitis and pulp necrosis in dogs. Journal of Veterinary Dentistry, 18, 14–20, 2001 Niemiec BA. Pathology in the Paediatric Patient. In: Niemiec BA. (ed.) Small Animal Dental, Oral and Maxofacial Disease, Pp 89–126, Manson, 2010 Ricucci D, Pascon EA, Ford TR, Langeland K. A study of periapical lesions correlating the presence of a radiopaque lamina with histological findings. Oral Surgery Oral Medicine Oral Pathology Oral Radiology, 101, 239–49, 2006 Taney KM, Smith MM. Surgical extraction of impacted teeth in a dog. Journal of Veterinary Dentistry, 23, 168–77, 2006 Verstraete FJM, Zin BP, Kass PH, Cox DP, Jordon RC. Clinical signs and histologic findings in dogs with odonotogenic cysts: 41 cases (1995–200). Journal of the American Veterinary Medical Association, 239, 1470–6, 2011 Wiggs RB, Lobprise HB. Clinical Oral Pathology. In: Wiggs RB, Lobprise HB (eds). Veterinary Dentistry, principles and practice. Pp 104–139, Lippincott-Raven, 1997
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Attrition is the loss of dental structure through wear against the opposing dentition, this is due to some form of malocclusion. Abrasion is the loss of dental structure through wear against
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This article has been submitted as part of the requirements of receiving the CAS/MSD Practitioner on Sabbatical Study Grant
A review of the use of ultrasound for gastrointestinal conditions in small animals Kate Heller, BVSc, Practitio ner on Sabbatical 2014 Ultrasound is another tool in our diagnostic armour that can be useful to examine the gastrointestinal (GI) tract of small animals. It has the potential to offer additional and complementary information to that provided by other imaging modalities such as radiography, including contrast radiography, and MRI. Ultrasound is advantageous as it also requires little preparation, is non-invasive, non-painful for the patient and does not have any recognised biologic risk at routinely-used diagnostic frequencies (1–10MHz).
frequency probes to identify five main wall layers from the lumen of the bowel outwards (see Figure 2) starting with the mucosal surface, mucosa, submucosa, muscularis, and serosa. It is sometimes not possible to identify all these layers due to interference from gas artifacts as well as limited resolution when using lower frequency probes etc. and it is important not to overinterpret this as pathology in the bowel.
Some of the most common indications for GI ultrasonography include chronic vomiting, diarrhoea, abdominal pain, palpable abdominal masses, palpable bowel wall thickening, weight loss, suspected GI foreign bodies, suspected intussusception, staging of neoplastic conditions, and suspected hernias. The presence of gas in the GI tract often makes it challenging to examine by ultrasound as gas creates artifacts such as reverberation (see Figure 1), comet tails and shadowing. It is recommended to fast the patient for 6–12 hours prior to examination by ultrasound, however access to water should be maintained up until the point of examination as dehydration can reduce perfusion of organs altering their ultrasonographic appearance. Use of a medium to high frequency sector or curvilinear probe is recommended to allow the best resolution and examination of bowel wall layering patterns.
Figure 2.
The thickness of the bowel wall can be measured from the hyperechoic mucosal surface through to the hyperechoic serosal layer, and varies depending on body weight for dogs as well as the location in the GI tract (Table 1). Table 1.
Figure 1.
Gas reverberation, an ultrasound artefact due to the presence of gas in the GI tract (indicated by white arrows). Image from Wilson et al., 1999.
Normal GI ultrasonographic appearance
The wall layering pattern seen on ultrasound varies throughout the GI tract. It is possible with higher
Normal intestinal wall layering pattern (Image from Agut A, http://vetgrad.com/show10MinuteTopUp. php?type=&Entity=10MinuteTopUps&ID=89)
(From Gaschen and Rodriguez, 2012)
Body weight (kg)
Jejunum (mm)
<10
4.1
Duodenum (mm) 5.1
10–20
4.1
5.0
21–30
4.4
5.3
31–40
4.4
6.0
>41
4.7
5.7
In cats, the mean wall thickness is reported to be 2.1 mm for small bowel and 1.7 mm for the colon (Pennink, 2002). The duodenum has a thick mucous layer compared to other parts of the small bowel and is easily identified as it runs close to the body wall on the right side of the abdomen. The stomach has a similar wall layering pattern to the rest of the gastrointestinal tract but has prominent rugal folds and the appearance is variable dependant on the contents and degree of distension at the time of examination. When measuring stomach wall thickness it is best to measure on a transverse image in between the rugal folds which is normally 3–5 mm in the dog, and 2.2 mm in the cat (Gaschen and Rodriguez, 2012). Gastrointestinal disease can be split into three basic categories on ultrasound; obstructive, inflammatory and neoplastic. During my time at Veterinary Specialist Group (VSG) I was able to see many and varied cases that demonstrated the use of ultrasound imaging in all three of these categories.
etak_vet@hotmail.com
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Obstructive disease
When a GI foreign body is present some of the ultrasonographic patterns to look for include: acoustic shadowing, fluid or gas distension, a mixture of distended and empty loops of bowel, hyper-peristalsis of the stomach and small intestine, plication or corrugation of the bowel, wall thickening and disruption of the wall layers. However it should be noted that these patterns do not always occur in the presence of GI disease and/or GI foreign bodies. The acoustic pattern arising varies depending on the type of foreign object present (Tidwell and Penninck, 1992) and is dependant on their innate physical properties and how that interacts with an ultrasound beam. If the object transmits the beam, it will be more accurately represented and the shape will indicate that it is something foreign rather than biologic (Figure 3). Foreign objects that attenuate the ultrasound beam either by reflection or absorption or both, produce an acoustic shadow. An acoustic shadow seen in association with the lumen of the GI tract, can be a useful indicator of foreign material being present. Differentiating foreign material from gas is easier when there is intraluminal fluid surrounding the object if it maintains its shape.
Figure 3.
Inflammatory disease
The type and duration of inflammatory disease alter what we see on ultrasound examinations. Inflammatory conditions generally cause a more extensive or diffuse and symmetrical thickening in the bowel wall, with the normal layering patterns being retained (Pennink, 2002). The changes seen ultr asonographically with inflammatory disease can overlap with those seen in neoplastic conditions but are typically more subtle. There can also be enlargement of the local lymph nodes as well. Small intestinal wall thickening is not sensitive or specific for enteritis, and normal bowel wall thickness should not rule out inflammatory disease (Larson and Biller, 2009). In cats inflammatory bowel disease it is common to see a thickening of the muscularis layer to equal or greater than the thickness of the mucosal layer. However this can also occur with neoplastic change in cases of lymphoma, for example, so intestinal biopsy would be required to confirm a definitive diagnosis. Hyperechoic speckles and striations (Figure 4) within the mucosal layer likely represent dilated lacteals and can occur with inflammatory bowel disease and lymphangiectasia in the dog (Gaschen and Rodriguez, 2012). Mucosal speckling can also be a normal variation of the mucosal surface in some dogs so biopsy would be required to confirm a diagnosis in cases with clinical signs.
Disc-shaped intestinal foreign body (image courtesy of Chris Warman, Veterinary Specialist Group).
When attempting to distinguish surgical from nonsurgical cases of intestinal disease, ultrasound can be very useful to rule out the presence of radiolucent foreign bodies. One study compared the use of radiography and ultrasonography to indentify small intestinal obstruction in vomiting dogs. Radiography produced a definitive result (i.e. obstructed or not obstructed) in 58/82 (70%) of dogs; ultrasonography produced a definitive result in 80/82 (97%) of dogs (Sharma etâ&#x20AC;Żal., 2011). However, irregularly shaped GI foreign bodies are difficult to identify ultrasonographically unless they cause complete obstruction and a fluid accumulation in the proximal segment of bowel, so segments of empty bowel as well as distended bowel can be seen. Smooth edged objects such as balls are easier to identify as they often produce a bright interface with a strong acoustic shadow. Linear foreign bodies (more commonly found in cats) tend to cause plication of the intestine and this can be easily recognised with ultrasound. Sometimes it is possible to identify an intraluminal echogenic structure. Ultrasonography can complement
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radiography in most cases of suspect gastrointestinal obstructive disease.
Figure 4. Ultrasonographic image of canine jejunum. Hyperechoic mucosal speckling is indicated by the red arrow (image courtesy of Chris Warman, Veterinary Specialist Group).
Neoplastic disease
Gastrointestinal tumours in dogs and cats have a relatively low incidence compared with other types of neoplastic disease. In cats lymphomas are the most common type seen, while adenocarcinomas are more commonly found in dogs. Gastric and intestinal neoplasia most commonly results in dramatic wall thickening with complete loss of wall layers. In one report, the average intestinal wall thickness in dogs with intestinal neoplasia was 1.5 cm, much higher than that reported for enteritis. (Penninck etâ&#x20AC;Żal., 2003). Complete loss of visualization of wall layering is common with either gastric or intestinal neoplasia and is considered the most specific ultrasound indication of neoplastic disease. Individual wall layers are
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replaced by a more uniform hypoechoic thickening in many cases. The thickening can cause a secondary obstructive pattern if the bowel lumen starts to become occluded. Mesenteric lymph nodes are usually more dramatically enlarged with neoplastic involvement compared to an underlying inflammatory disease, with an average thickness of 1.9 centimetres (Penninck et al., 2003). It is often necessary to obtain samples for cytology or histopathology for a definitive diagnosis to be made. Some gastrointestinal tumors have ultrasound characteristics that may allow a preliminary diagnosis. Gastric adenocarcinoma has been reported to cause ‘‘pseudolayering,’’ with alternating hypoechoic and hyperechoic layers in the thickened wall because of the uneven distribution of tissue in the tumour rather than a true alteration in the normal layers of the gastric wall. Leiomyosarcomas tend to have a mixed echogenic pattern and are often very large and frequently grow out of the serosal layer as extraluminal masses (Penninck, 2002). Histopathology is still recommended to confirm the diagnosis even if the lesion looks characteristic. Neoplastic masses may be successfully diagnosed using ultrasound-guided, fineneedle aspiration if large enough. The bowel or gastric lumen should be avoided during biopsy procedures so to prevent contamination of the abdomen and peritonitis. In summary, ultrasound appears to be a fast, safe, noninvasive and accessible diagnostic tool as an adjunct to radiography for the detection of gastrointestinal foreign bodies and other gastrointestinal diseases. To use ultrasound to effectivley detect and diagnose gastrointestinal conditions requires experience using the ultrasound machine and the ability to recognise common artifacts as well as variations in the normal structure and layering pattern in the gastrointestinal wall. Foreign bodies can have a variable appearance on ultrasound depending on the shape and composition of the object. Acoustic shadowing and a buildup of fluid are common ultrasonographic
findings with intestinal foreign bodies. Inflammatory and neoplastic gastrointestinal conditions can overlap significantly in ultrasonographic appearance so cytologic or histopathologic samples are required to obtain a more definitive diagnosis. I would like to acknowledge and thank Chris Warman, Anna and the rest of the radiology team at the Veterinary Specialist Group in Auckland for providing me with a fantastic learning opportunity and sharing their knowledge during this sabbatical. They have also shared some of the images in this article as examples of some gastrointestinal conditions seen. Also, thank you to CAS and MSD for the opportunity to further my experience and skills through the Practitioner on Sabbatical programme.
References
Agut A. Ultrasonography of the small intestine in small animals – Part 1. Downloaded 28 April 2015 from: http://vetgrad.com/show10MinuteTopUp. php?type=&Entity=10MinuteTopUps&ID=89 Gaschen L, Rodriguez D. Stomach, small and large intestines. In: Barr F, Gaschen L. BSAVA Manual of Canine and Feline Ultrasonography, Pp 124–38. British Small Animal Veterinary Association, Gloucester, England, 2012 Larson M, Biller D. Ultrasound of the Gastrointestinal tract, Veterinary Clinics: Small Animal Practice 39,747–759, 2009 Penninck D. Gastrointestinal Tract. In: Nylan T and Matoon J, (Eds), Small Animal Diagnostic Ultrasound 2nd Edition, p210, WB Saunders, Philadelphia, 2002 Penninck D, Smyers B, Webster C, Rand W, Moore AS. Diagnostic value of ultrasonography in differentiating enteritis from intestinal neoplasia in dogs, Veterinary Radiology and Ultrasound, 44, 570–5, 2003 Sharma A, Thompson MS, Scrivani PV, Dykes NL, Yeager AE, Freer SR, Erb HN. Comparison of radiography and ultrasonography for diagnosing small-intestinal mechanical obstruction in vomiting dogs. Veterinary Radiology and Ultrasound, 52, 248–55, 2011 Tidwell A, Penninck D. Ultrasonography of Gastrointestinal Foreign bodies. Veterinary Radiology and Ultrasound, 33, 160–169, 1992 Wilson SR, Burns PN, Wilkinson LM, Simpson DH, Muradali D. Gas at Abdominal US: Appearance, Relevance, and Analysis of Artifacts. Radiology, 210, 113–23, 1999.
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Calling all Veterinary Students The CAS Newsletter is a non-peer reviewed publication that publishes quality articles on a variety of topics of interest to companion animal veterinarians in New Zealand. Articles include a variety of formats such as case studies, reviews, and scientific studies. We would welcome articles from veterinary students to be considered for publication in the CAS newsletter. These may be related to exemplary case reports and so will probably require only small amounts of work prior to publication. Guidelines to writing articles for the CAS Newsletter are published in each edition of the magazine and additional guidance can be obtained by contacting the Editor or John Munday, the Massey CAS representative. We suggest you consult with your lecturer and have the article reviewed prior to submission. Being published looks great on your CV when applying for internships or post-graduate study and all undergraduate articles selected for publication will receive a $50 award, with the best student article published during the year winning a prize of $400, kindly donated by VetEnt. Please submit your article electronically to the Editor, CAS Newsletter, Sarah Fowler at sarahfowler@ gmail.com
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Can mouth-gags in cats cause blindness and neurological damage? Mike Gieseg, BVSc, BSc(Hons), PhD Post-anaesthetic blindness in cats is uncommon but when it does occur this is a dramatic and debilitating complication that may have no obvious cause. In these situations the cat was classified as healthy prior to the procedure and the anaesthetic period may have been routine. However, upon awakening the cat now appears blind and may have other neurological deficits such as ataxia, changes in proprioception, circling, head tilt, opisthotonus and changed mentation. There are at least three published case reports of this in the literature of which two followed routine anaesthesias for dental cleaning (Jurk et al., 2001; Son et al., 2009) and a third example occurred after anaesthesia for endoscopy (de Miguel Garcia et al., 2013). In 2012 a paper was published that identified a possible cause. Stiles and coworkers published a multicentre study that identified 20 cats that had acute blindness following anaesthesia (Stiles et al., 2012). They identified a surprising association between spring-held mouth gags and blindness in cats. The authors sought medical records from several sources within the United States of America including private veterinary hospitals, and academic institutions. All the cats had no clinical evidence of visual or neurological deficits prior to anaesthesia. They identified 20 cats that were blind following recovery from anaesthesia and reviewed their medical records to identify possible causes or associations with the procedures. The blindness was characterised as cortical blindness either based on their medical records, or in eight cats, by examination by a veterinary ophthalmologist. In addition to blindness, 17 cats had additional neurological irregularities that included circling, ataxia, head tilt, opisthotonus, alterations in proprioception and abnormal mentation. Of the 20 cats, three had suffered a cardiac arrest during the anaesthesia and this was considered to be the cause of the blindness and neurological damage. However, for the remaining 17 cats there was no obvious cause, except in 16 of these animals a spring-held mouth gag was used. This suggests an association between mouth gags, cortical blindness and neurological damage in cats during anaesthesia. The cats were anaesthetised for a variety of procedures, the majority for dentistry (13) with the remaining procedures being endoscopy (four), neutering (two), and urethral obstruction (one). The three cats that had a cardiac arrest were anaesthetised for neutering or urethral obstruction. An obvious confounding factor with this association between mouth gags and neurological damage was the anaesthesia itself. Reduced blood flow to the brain and the resulting hypoxia can cause damage to neurological tissues that could result in blindness. This could be caused by severe hypotension during anaesthesia, primarily from too greater depth of anaesthesia. However, in the cats that did not have a cardiac arrest, hypotension
was documented in only seven cats but another seven cats did not have any blood pressure monitoring and the remaining three cats did not have any hypotension recorded. So it is difficult to implicate hypotension as the sole cause, especially as hypotension (mean arterial blood pressure < 60 mmHg) is not uncommon in small animal anaesthesia. But, perhaps the drugs used in the anaesthesia (including premedication, induction, maintenance and recovery) were the problem? A variety of anaesthetics were used but they were standard anaesthetic protocols with commonly used premedication, induction and maintenance agents. Propofol was the most commonly used induction agent (12 cats) and almost all (18 cats) received isoflurane as a maintenance agent. Nine of the cats had a prolonged recovery time noted, but for ten cats the recovery time was normal and for one cat the recovery time was not noted. Perhaps the cats were anaesthetised for too long? The authors found there was no association between duration of anaesthesia and the severity of the neurological damage. Recovery from the neurological damage and blindness was generally positive with 14 of the cats regaining some vision where they could comfortably navigate after several months. Four cats remained blind and two were lost to follow up. The other neurological deficits also tended to improve with 10 of the 17 cats having a full recovery of their neurological signs, two having a partial recovery and only one being euthanized because it failed to recover. The authors stated however that it was difficult to determine the time for resolution of the neurological signs due to the varying time between examinations. Recent publications have attempted to determine a potential mechanism for how spring-held mouth gags could cause post-anaesthetic blindness. It is thought that the maxillary artery is the major vessel supplying the brain in cats and this travels around the caudal aspect of the mandible. When the mouth is opened fully compression of the maxillary artery can occur in some cats between the medial aspect of the angular process of the mandible and the rostrolateral border of the tympanic bulla (Scrivani et al., 2014). In a group of six anaesthetised cats magnetic resonance imaging showed both reduced perfusion in one or both branches of the maxillary artery in a subset of the cats (BartonLamb et al., 2013). Using electrodiagnostics there was also detectable differences in the electrical activity in the retina and hair cells of the ear when the mouth was opened fully suggesting changes in perfusion of these tissues. Most recently Martin-Flores et al., (2014) have used magnetic resonance angiography to show that even sub-maximal opening of the mouth to 42 mm (the length of a needle cap) resulted in reduced maxillary artery blood flow in one out of six cats tested. This work suggests that there is considerable variability in how spring-held mouth gags affect blood flow in
Research Leader, Veterinary Health Research NZ, Hamilton, New Zealand
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Companion Animal Society Newsletter
Volume 26 Number 2
the maxillary artery and this fits with the clinical picture as blindness in cats following procedures using mouth gags is rare. Most likely the cause is multifactorial with anatomical factors worsening the maxillary artery compression due to the mouth gag and anaesthetic hypotension contributing further to result in reduced blood flow, hypoxia and neurological damage. Stiles et al., give no indication of prevalence or incidence even though, presumably, the authors reviewed the medical records of many thousands of cats (Stiles et al., 2012). Personally, I have observed blindness in a cat at least once following anaesthesia for a routine endoscopy where a spring-held mouth gag was used. This was during four years while working as an anaesthetist in a busy veterinary teaching hospital, suggesting the incidence is low. However, there is the potential that mild neurological damage following the use of mouth gags in cats may occur more frequently than we realise because it goes undetected. In conclusion, these recent publications provide compelling evidence that spring-held mouth gags can cause post-anaesthetic blindness in some cats. Given that their use is not always required and that there are alternatives, veterinarians would be well advised to think twice before using them in cats for any procedure.
June 2015
References
Barton-Lamb AL, Martin-Flores M, Scrivani PV, Bezuidenhout AJ, Loew E, Erb HN, Ludders JW. Evaluation of maxillary arterial blood flow in anesthetized cats with the mouth closed and open. Veterinary Journal, 196, 325–31, 2013 De Miguel Garcia C, Whiting M, Alibhai H. Cerebral hypoxia in a cat following pharyngoscopy involving use of a mouth gag. Veterinary Anaesthesia and Analgesia, 40, 106–8, 2013 Jurk IR, Thibodeau MS, Whitney K, Gilger BC, Davidson MG. Acute vision loss after general anesthesia in a cat. Veterinary Ophthalmology, 4, 155–8, 2001 Martin-Flores M, Scrivani PV, Loew E, Gleed CA, Ludders JW. Maximal and submaximal mouth opening with mouth gags in cats: implications for maxillary artery blood flow. Veterinary Journal, 200, 60–4, 2014 Scrivani PV, Martin-Flores M, van Hatten R, Bezuidenhout AJ. Structural and functional changes relevant to maxillary arterial flow observed during computed tomography and nonselective digital subtraction angiography in cats with the mouth closed and opened. Veterinary Radiology and Ultrasound, 55, 263–71, 2014 Son WG, Jung BY, Kwon TE, Seo KM, Lee I. Acute temporary visual loss after general anesthesia in a cat. Journal of Veterinary Clinics, 26, 480–82, 2009 Stiles J, Weil AB, Packer RA, Lantz GC. Post-anesthetic cortical blindness in cats: twenty cases. Veterinary Journal, 193, 367– 73, 2012
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CAS Specialist Profile
The CAS Specialist Profile is a new feature we plan to run regularly in the CAS Newsletter, aiming to provide an insight into the path New Zealand veterinarians have taken to achieve specialisation. In this issue, Hannah Bain talks to Alastair Coomer who is a registered Specialist in Small Animal Surgery, based at Veterinary Specialist Group in Mount Albert, Auckland. He has been practicing as a specialist for five years (three in New Zealand).
That residency changed my professional life, in that I shared an office and drank beer with some of the legends of veterinary medicine. Over four years they taught me just how little I knew about veterinary medicine.
Where did you obtain your veterinary degree, and did you move directly into a residency from there?
I studied at Massey University, graduating (BVSc) in 2003. I then went into mixed rural practice for 18 months before applying for internships.
Dr Alastair Coomer BVSc, MS, Diplomate ACVS, Registered Specialist Small Animal Surgery
What drove you to specialise, and why did you choose surgery?
As a student at Massey, I was not very good at some subjects, and better at others. It turns out I did better academically in the subjects I really enjoyed. When I was in practice, I quickly realised that I would be more stimulated and satisfied if I could spend most of my time in and around surgery. I think I initially gravitated towards surgery as a student because it seemed more problem and solution-based. That is, you identify the problem, and then fix it. I now realise that is a very naïve and oversimplified version of referral practice, as many of our surgical cases are ongoing for years! Explain the process you took to become a registered specialist
I graduated from Massey with a desire to pursue surgery, but not a lot of confidence or understanding of how to go about it. Thankfully I was mentored by Lewis Griffiths (then NZVA President) and encouraged on the journey. From general practice I was lucky enough to “match” into a Small Animal Internship at the Ontario Veterinary College in Canada. This journey was not only from one side of the world to the other, it was like going from crawling to driving a Formula 1 car overnight. I was completely out of my depth with the business and pressure of a North American hospital, but was also not intimidated by meeting with clients and actually being responsible for cases (unlike my intern-mates straight out of veterinary school). My internship was 12 months, and I then matched straight into a residency at the University of Florida.
Both the internship and residency were exhausting, soul-destroying, humbling and humiliating. They were also extremely rewarding and I feel thoroughly privileged to have been “matched” to those programmes. What do you like most about your job?
Educating owners/families. I enjoy engaging with families so that they understand what is going on with their family member, and seeing the light switch go on when they begin to understand. After a stay in hospital, seeing a dog and its family reunite never loses its appeal. Power-tools are cool and shiny, but surgery is really all about the animals and the people. What is the worst part of your job? Never being home for dinner with my family. What is the most challenging part of your job?
Unrealistic owners. I think more so in referral practice than in my time in general practice, we see owners with exceptionally high expectations; high expectations for achieving an accurate diagnosis, and high expectations for a completely perfect outcome first time. What advice would you give to someone thinking of specialisation?
Realise early that you have to give up something to specialise (that is, you have to be a little bit selfish), and that you will probably never drive an Aston Martin. What do you think about vets specialising later in their careers, after a significant period of time in general practice?
I think anyone specialising, at any stage of their career, is a great idea. However, the requisite sacrifices are often easier to make earlier in life. Time in general practice should add value to the specialist training, rather than detract from it. n
VSG Veterinary Specialist Group. P: 09 845 5455, F: 09 845 5456, 97 Carrington Road, Mt Albert, Auckland. www.v sg.co.nz
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Companion Animal Society Newsletter
Volume 26 Number 2
June 2015
Companion Animal Society Newsletter
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Unusual dermatological conditions â&#x20AC;&#x201C; role of pathology in achieving a diagnosis Geoff Orbell, BVSc, DipSc, BSc, MVS (Hons), Diplomate American College of Veterinary Pathologists, Registered Specialist in Anatomic Pathology There are few dermatological veterinary medicine.
emergencies
in
However there are occasions where skin biopsies examined by a pathologist or microbiology isolates can indicate more serious underlying systemic disease. This series of articles aims to highlight a few of these dermatological conditions which, although rare, can have characteristic clinical presentations or histology that can facilitate an early diagnosis that significantly improves the prognosis or welfare of the patient. Part 1. of this series, titled Sterile Suppurative necrolytic dermatitis of Miniature Schnauzers, appeared on p38 of the December 2014 issue of the CAS Newsletter.
2. Necrotising fasciitis in a dog Case History Puck was a two-year-old intact male Huntaway when he presented to the submitting veterinarian. He was pyrexic (41.10°C) and bilaterally the hindlimbs and the right forelimb were swollen and painful distal to the metatarsus and metacarpus respectively. Focally there was subcutaneous accummulation of fluid between the second and third digit of the left hindlimb. The interdigital swelling was lanced and drained and a swab taken for aerobic culture.
Figure 1.
Distal left hindlimb demonstrating diffuse metatarsal and digital swelling, discolouration, exudation and patchy alopecia well demarcated from viable skin proximally.
Figure 2.
Distal left hindlimb after surgical debridement with exposure of digital extensor tendons.
Fluid therapy, amoxicillin and enrofloxacin antimicrobial therapy was initially instigated with normothermia attained after 24 hours. Another 24 hours later Puck had become systemically unwell with anorexia, persistent pyrexia and mild depression. The skin surrounding the wounds had become necrotic indicated by skin thinning, discolouration, alopecia and lack of bleeding when incised. The proximal margin of the necrotic tissue was well demarcated from viable tissue but this margin had been advancing from the initial wound. Microbiology results from the submitted swab identified a b haemolytic Streptococcus and the veterinarian was contacted immediately to advise of the likelihood of necrotising fasciitis. Fortunately by that time the veterinarian had already decided to debride all the necrotic tissue (Figure 1) which exposed some of the digital extensor tendons (Figure 2), flushed the wounds and applied dressings allowing the wounds to heal by secondary intention. Antimicrobial sensitivities indicated sensitivity to amoxicillin and moderate resistance to enrofloxacin. Therefore amoxicillin at 22 mg/kg bid was continued for an additional two weeks. Over the next three months the wounds continued to heal by second intention with only a small defect visible four months later (Figure 3).
Necrotising fasciitis Necrotising fasciitis is a rare disease in dogs characterised by locally extensive necrosis and cellulitis of subcutaneous tissue that extends along fascial planes. The most commonly affected areas are over hock joints, flanks and abdominal skin. Affected tissue is swollen, painful, discoloured and often exudative.
New Zealand Veterinary Pathology, geoff@nzvp.co.nz
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Volume 26 Number 2
Early parenteral antibiotic administration is crucial in these cases. In a mouse model of necrotising fasciitis, ampicillin and erythromycin treatment only positively affected survival when given within two hours of infection whereas clindamycin was still relatively effective with delayed treatment up to 16 hours post infection. Hence clindamycin has become the antibiotic of choice in human and canine cases of necrotising fasciitis. Clindamycin inhibits bacterial protein synthesis which suppresses tumour necrosis factor-α (TNF- α) synthesis slowing the progression of STSS. It also suppresses the synthesis of bacterial toxins by S. canis reducing the toxin-mediated tissue necrosis. Figure 3.
Distal right hindlimb three months post surgery with almost complete healing by second intention.
In dogs it is usually caused by b haemolytic Streptococci e.g. S. canis and results in mortality in up to 80% of cases, most commonly due to Streptococcal Toxic Shock Syndrome (STSS) that can manifest as early as four hours after initial clinical signs. Some dogs will present with sudden death or a haemorrhagic diathesis due to disseminated intravascular coagulation (DIC). b haemolytic streptococci are normal skin commensals in dogs and can be isolated from relatively mild otitis externa or urinary tract infections. However they have the most pathogenic potential when innoculated into subcutaneous tissue via skin wounds due to the vast amounts of exotoxin produced by these bacteria in this environment. Diagnosis Diagnosis can be made with microbiology and/or histology but affected dogs frequently die before these results are available. The best chance of survival relies on early clinical diagnosis and treatment. Sudden onset of localised, intensely painful subcutaneous swellings associated with a history of trauma or wounds and a systemically unwell dog should alert clinicians to this disease. Identification of intracytoplasmic cocci in degenerate neutrophils from aseptically collected aspirates of affected subcutaneous tissue supports the clinical diagnosis. However, aseptically collected samples for culture and sensitivity should still be taken. It is worthwhile noting that most veterinary diagnostic laboratories will only identify isolates as a b Haemolytic Streptococcus rather than to a species level. If available in house, an Activated Clotting Time may be worthwhile for evidence of DIC. Treatment Treatment requires stabilisation with fluid therapy, intravenous penicillin G, oral clindamycin and extensive surgical debridement. The bacteria are frequently resistant to enrofloxacin and aminoglycosides therefore these shouldn’t be used unless indicated by the sensitivity results. Additionally it has been postulated that some cases of toxic shock syndrome due to S. canis were associated with enrofloxacin usage.
June 2015
Debridement of all necrotic tissue and flushing with sterile saline to dilute accumulated exotoxins is recommended which may require multiple surgeries and frequent post-surgical dressing changes are required for two to four weeks. Large skin deficits often require grafting at a later stage therefore additional surgeries are often required. However, smaller wounds will often heal eventually by second intention. Key points • Necrotising fasciitis is one of a few dermatological emergencies in dogs with a high mortality rate. • Characterised by intensely painful localised subcutaneous swellings on distal limbs, flanks or ventrum in systemically unwell dogs. • Usually caused by b haemolytic Streptococci in wounds or trauma sites. • Can rapidly lead to toxic shock syndrome and death (<4 hours) • Successful treatment requires early in clinic diagnosis with surgical debridement, intravenous antibiotics (penicillin) and supportive therapy. • Clindamycin recommended as ancillary antibiotic. • Avoid enrofloxacin at any stage of the disease. • Long-term wound management required for dogs that survive.
Acknowledgements
Dr Alison Myers and Dr Jeff Herkt of Humanimals.
References
Ingrey K, Ren J, Prescott J. A fluoroquinolone induces a novel mitogen-encoding bacteriophage in Streptococcus canis. Infectious Immunology, 71, 3028–33, 2003 Jenkins CM, Winkler K, Rudloff E, Kirby R. Necrotizing Fasciitis in a Dog. Journal of Veterinary Emergency and Critical Care, 11, 299–305, 2001 Prescott JF, Miller CW, Mathews KA, Yager JA, DeWinter L. Update on canine streptococcal toxic shock syndrome and necrotizing fasciitis. The Canadian Veterinary Journal, 38, 241–2, 1997 Sharma B, Srivastava MK, Srivastava A, Singh R. Canine Streptococcal Toxic Shock Syndrome associated with Necrotizing Fasciitis: An Overview. Vet World, 5, 311–9, 2012 Weese JS, Poma R, James F, Buenviaje G, Foster R, Slavic D. Staphylococcus pseudintermedius necrotizing fasciitis in a dog. The Canadian Veterinary Journal, 50, 655–6, 2009
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Companion Animal Health Foundation Report Chris Hutchings, Chairman of Trust Over the last 12 months the Trustees – Chris Hutchings Jodi Salinsky, Kate Hill and Fiona Hollinshead, have funded some exciting projects which we hope to be of value to all companion animal practitioners. The Trust functions to fund projects to improve the health and welfare of companion animals in New Zealand and we have recently funded some significant projects. In this article we wish to give some examples of our recent funding round with a quick synopsis of these project. These projects include: • Anti-mullerian hormone (AMH) as a potential predictive marker of fertility in bitches. • Does the Fel-O-Vax FIV vaccine induce crossreactive immunity against NZ FIV isolates? • Comparison of the prevalence of FIV in vaccinated cats versus unvaccinated cats in NZ – this is a new project about to start.
Investigation into the association of AMH concentration and fertility.
Fiona Hollinshead and Dave Hanlon have now collected 150 serum samples and accompanying artificial insemination (AI) and whelping data from bitches presented to Glenbred – Canine Breeding Services for AI. This collection process has taken one year but they are on track to complete the project as planned. Samples have also been collected from control animals. Laboratory assay work is nearly complete and they hope to analyze and correlate the AMH concentration of each bitch with her pregnancy and whelping outcome. This later information was collected from every bitchowner two months following AI. Compliance with this study has been greater than 95% which is very pleasing.
at The International Conference for Canine and Feline Reproduction in France 2016.
Cross-reactivity of the Fel-O-Vax vaccine – a study by Alison Stickney
It has been shown that extensive genetic variation and constant evolution of FIV is the major contributor to the variation observed in vaccine efficacy studies. Efficacy studies of the vaccine have shown variations from 0–100 % although on average around 60% of cats could be said to be protected by the dual subtype vaccine when used. In New Zealand however it is extremely difficult to draw any definite conclusions. The FIV virus in New Zealand is genetically distinct compared to FIV strains seen elsewhere in the world as approximately 70% of viruses belong to either subtype C, unknown subtypes or are recombinant viruses. This study has shown a preventable fraction of about 44% and the study has highlighted the concerns of efficacy of the vaccine in New Zealand.
Comparison of the prevalence of FIV in vaccinated cats verse unvaccinated cats in New Zealand This additional study by Alison carries on the investigation of the use of FIV vaccines in New Zealand by comparing the prevalence of FIV infection in vaccinated cats with the FIV prevalence in unvaccinated cats. With the widespread use of the vaccine over the last 10 years we have a unique population of FIV vaccinated cats that are naturally exposed to New Zealand strains of the virus. This new study proposes to sample vaccinated and unvaccinated cats throughout New Zealand and to determine the prevalence of FIV infection in both these populations.
This is a world first and the researchers are well on track with the project and aim to present these results
n
Matamata Veterinary Services Ltd, Ph 07 888 8197
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Companion Animal Society Newsletter
Volume 26 Number 2
2015 Companion Animal Society (CAS) Branch of the NZVA call for nominations and notice of AGM Nominations are called from CAS members interested in serving on the branch committee. All CAS members are eligible and welcome to apply. The term of office for committee members is a minimum of 2 years and a maximum of 3 years. Under CAS branch rules three committee members will retire by rotation each year. All three of the members have indicated that they are available for re-election. The 2015 AGM will be held in Palmerston North on the 29th of July. Time and venue to be advised. Signed nomination forms from a proposer, seconder and containing a declaration from the nominee that he/she is prepared to stand for election must be lodged with the Branch Secretary no later than Sunday 14 June 2015. Nomination forms are available from the Secretary at cas@vets.org.nz. Members will also be asked to vote on the following motion: “That the CAS executive committee fund a part-time position for a CAS Veterinary Resource Manager and review its effectiveness after 2 years”. Due to an increasing workload the Secretary role of the CAS committee has grown larger than what can be reasonably expected from a volunteer. In order to achieve CAS objectives we propose to create a part-time position for a “CAS Veterinary Resource Manager” on a fixed-term contract. This contract would be managed by the NZVA but funded by CAS and would focus solely on achieving CAS objectives. We envisage this position being around 25 hours a week, requiring a mixture of veterinary and administration skills. The salary scale would be between $40,000– $50,000 depending on the applicant’s skill level, and there would be a charge from NZVA to manage the position. It would encompass the current Secretary workload, along with some of the President’s workload, and also include work on projects that CAS would like to progress. Funding for this position would come from the current Secretary Honorarium ($15k) and interest from current reserves ($18,000). Reserves would need to be used to make up the shortfall. We would retain the current structure of the committee with President, Secretary and Treasurer but the Secretary role would no longer attract an honorarium. By having a CAS Veterinary Resource Manager to support the CAS committee we would expect to improve the delivery of our objectives and create a sustainable model for the future of CAS. Proxy voting forms and notice of the venue and time of the AGM will be emailed to members 30 days prior to the AGM. Obtain nomination forms and further information about becoming a committee member from the Branch Secretary, Rochelle Ferguson at cas@vet.org.nz.
June 2015
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Massey Home Page – June 2015 Buildings The next phase of building to upgrade the Massey University Veterinary Teaching Hospital is underway. A new “street” which will link the IVABS reception with the planned combined frontages of the brand new Wildbase unit and the existing Small Animal Clinic necessitates the relocation to the current isolation unit. The Wildbase and Administration Building project will see a much-needed new hospital for our native wildlife. The building crew has been busy converting the old foal unit into a temporary small animal isolation unit within the large animal hospital. Later in the building process we will have a new isolation unit and this temporary one will become the permanent home for our Iodide 131 treatment unit, a welcome return for this service. This month also sees the small animal reception and retail areas being prepared for when the Wildbase project starts in earnest. For a while there will be a temporary entrance to waiting room, and reception staff will relocate into the current retail area. We will be working hard to minimize any inconvenience to clients. There will be new signs directing clients, visitors, couriers into the building via new routes while the building is happening, and client car parking will be relocated. People Tania Jobson (a medical radiographer) has joined the radiology team as a locum to cover a radiographer on maternity leave. Phil Hyndman, a 2011 Massey grad, has joined us as the first of four new small animals interns (replacing those leaving us at the end of their intern year). Thanks to Zoetis for once again sponsoring our internship program. Paul Wightman is leaving us for 12 months from late July to take up a position with Melbourne University’ radiology department. This is a great opportunity to work in a well-staffed department with an MRI on site. Plans for an MRI on-site within the VTH are still being developed, but greater access through private providers in Palmerston North will likely mean we are well catered for in advanced imaging in the short to medium term. Dr. Bob Bahr, a very experienced radiologist from the USA joins us from 1 July for a seven-month locum to support Ron Green while we are recruiting to fill our second radiologist position. Paola Giordano 40
has joined us as a locum in anaesthesia. She finished her residency training in Dublin will sit European College examinations in September. Becca Leung has joined us as a resident in small animal nutrition sponsored by Hills Pet Nutrition. Becca is a recent Massey-grad and as well as providing nutritional advice to clients and consulting on inpatients, Becca will be embarking on a PhD.
Services Minimally Invasive Surgery and Diagnosis Several staff attended an “-oscopy” workshop at Mid-Central Health. It was a chance to catch up with the latest Storz equipment and to make sure our QA programs are up to human standards. The MUVTH has an impressive suite of minimally invasive surgical and endoscopic equipment. Recent additions include the latest generation video-endoscopes and a brand new digital tower for arthroscopy and rigid endoscopy. We regularly perform arthroscopy of the elbow, shoulder and stifle; laparoscopy for biopsy or minimally invasive surgery; and endoscopic examination and biopsy of the gastrointestinal and urogenital tracts. These procedures can greatly benefit clients referred to the MUVTH. Examples include the investigation of ectopic ureters via urethra/cystoscopy. Intra-mural ectopics that enter the urethra distal to the sphincter can often be managed using endoscopic scissors, creating an opening into the bladder, and avoiding the need for surgery. Key-hole cystotomy with a rigid endoscope is a great technique to remove stones from the bladder under direct visualisation, decreasing the risk of leaving stones behind, a problem that occurs in 25% of all traditional cystotomies. Cardiology Fiona Campbell (specialist Cardiologist) will join us on four occasions through this year. Fiona will be consulting on referral cases and teaching undergraduates as well as doing CPD webinars. Fiona has an interest in interventional radiology and interventional procedures. Boehringer Ingelheim are sponsoring Fiona’s trips to NZ. We will be advising our Patrons the dates for Fiona’s visits. n
Companion Animal Society Newsletter
Volume 26 Number 2
www.nzva.org.nz/events
Calendar 2015 ... 2015 January–December
Vetscholar Online Course: Animal welfare and law: living up to expectations – 5 modules to be completed at your own pace. Tutor: Ian Robertson
January–December
NZVA Leadership Intelligence series – six online modules to be completed at your own pace. Presenters: Sue Crampton and Rosie Overfield
June 15–19
Hills Pet Nutrition Roadshow: The link between feline house soiling and intercat aggression, treating them both. Auckland, Hamilton, Wellington, Christchurch and Tauranga. Presenter: Debra Horwitz.
June 21
Practical Orthopaedic Workshop – MMP and RidgeStop for treatment of CCLR and patella luxation, Novotel Auckland Airport. Presenter – Malcolm Ness.
June 15–July 26
Vetscholar course – Mindfulness: helping you thrive in your veterinary work – Angela Baker.
June–November
VetLearn Case of the Month Online Webinars for companion animal practice. First Tuesday of every month.
June 29–August 9
Veterinary Refresher Scheme for Companion Animal Practice – online course. Module 2: Surgery – Andrew Worth
July
Master of Veterinary Medicine distance programme courses, starting July 2015 – Massey University Canine and Feline Neurology – Christopher Mariani and Chris Thomson Opthalmology in Small Animal Practice – Mark Bilson Canine and Feline Orthopaedic Surgery – Andrew Worth Principles of Veterinary Epidemiology – Naomi Cogger
August 17–Sept 28
Online Vetscholar Course in avian medicine: Mastering medicine for our feathered friends (module 1). Tutors: Lisa Argilla and Janelle Ward.
August 24–October 4
Veterinary Refresher Scheme for Companion Animal Practice – online course. Module 3: Medicine and Practical Pharmacology – Kate Hill
September 3 (Auck) and 4 (Chch)
NZVA Workshop: Vision And Decision: The Importance Of Dental Radiology. Tutors: Angus Fechney, Anthony Caiafa, and John Wood
September 25–26
Essential Oncology Workshop: everything you need to know. Massey University, Palmerston North. More information to follow.
October 5–November 15
Online Vetscholar Course – Mastering the Meds: Essential drug information for the leading edge practitioner. Tutors: Stephen Page and Joanna Griffin.
October 19–Nov 29
Veterinary Refresher Scheme for Companion Animal Practice – online course. Module 4: Clincal Pathology – Tutor TBANovember 13–15 Marketing. Veterinary Business Administration course offered to Master of Veterinary Medicine students in conjunctions with Massey University’s MBA programme. (2-day block course held in Christchurch)
November 20–21
Essential Gastrointestinal Surgery Workshop: Everything you need to know. Massey University, Palmerston North. More information to follow
For further details on these courses and other seminars and online courses please refer to the Vetlearn Updates or the following websites:
http://www.nzva.org.nz/eventcalendar
http://www.massey.ac.nz/massey/learning/colleges/college-of-sciences/students/mvm/mvm-home.cfm CAS publishes this list of national and international small animal veterinary meetings as a member benefit. The Editor takes no responsibility for the accuracy of this information and suggests you contact the organising association directly if you are interested in registration details for any meeting listed.
June 2015
Companion Animal Society Newsletter
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Instructions for Authors Submitting Articles to the CAS Newsletter Sarah Fowler (Editor), for the CAS Newsletter Editorial Committee The CAS newsletter is published quarterly in first week of March, June, September and December of each year. The printing costs are covered by the advertisements. There is therefore a limit of about 55â&#x20AC;&#x201C;60 pages to the size of each issue. There is a balance between political issues, articles for continuing education and other news. Authors are expected to submit their articles and conference in a final form suitable for publication. If practitioners wish assistance with writing, please contact the editor. Also look at previous issues to see the layout.
Articles
The article should have title. Following the title the names of the authors, their degrees, titles, contact details should be present. Submit articles preferably by email, or disk if this is not possible. Submit articles in adequate time for reading and alterations before publication. Contributions must be original. Articles or extracts from articles may be completely copied only if there is permission from the original authors and source of publication. It is the responsibility of the author(s) rather than the editorial committee to obtain this permission. The author(s) should disclose if they have published the same article or a very similar article elsewhere. Articles that are clearly editorials/advertising will be labelled as such at the discretion of the editorial committee. These include articles/editorials that are repeated from other publications such as VetScript and that contain obvious product placement comments.
Proof reading
The authors should proof read their article looking for mistakes, spelling errors, omitted details. While the editorial committee reads through the articles, the articles should be presented error-free.
Articles and conference reports from recipients of grants and scholarships
It is the responsibility of recipients of any grants and scholarships to supply any conference reports and articles written as part of the requirements in the final form suitable for publication.
References
A list of references should be supplied if appropriate. Follow the guidelines for the New Zealand Veterinary Journal for method of reporting of references. The number of references should be kept to a reasonable number relative to the length of article. Keep numbers of references to a minimum when discussing a single point, i.e. do not be repetitive with numerous references when a few will do. The editorial committee will omit references if the list is judged to be excessively long.
Figures
Good quality illustrations that clearly illustrate the necessary points should be submitted with the article. Submit any photos or graphics in their original forms (i.e. JPG, PDF, TIF files) as they lose their clarity when extracting them from word or publisher documents. If positions of figures are not obvious from the text, send a hard copy or some other form of instruction as to where they should be placed.
Articles will be published as soon as possible after submission. The newsletter goes out in the first week of March, June, September and December. Articles therefore need to be submitted at least one month before (i.e. by the end of January, April, July and October) but preferably earlier to allow one month for the collation, printing, binding and posting of the newsletter. Depending on when the articles are received, the size of that particular issue and the need for refereeing, at the editorâ&#x20AC;&#x2122;s discretion articles may be held over for a later issue.
Refereeing
Articles may be sent to appropriate people in that field of expertise for refereeing/proof reading if the editorial committee deems this is necessary. This is to ensure accuracy within the text to protect readers, the authors CAS and the clients and the patients of veterinary practitioners.
SciQuest and NZVA website
Selected scientific articles will be placed on the SciQuest website for access by NZVA. There will be a delay of a year to ensure that practitioners still see a benefit in becoming CAS members. The entire newsletter is now being placed on the CAS website but the most recent issues (i.e. those within a year of publication) are available only to CAS members.
Article of the issue and student article
Prizes are sponsored for the best case report and general article in each quarterly issue. The best overall article in each category for the year is then decided in May and the overall prize awarded at the Annual dinner in June. The members of the editorial committee will judge the articles on their clarity, conciseness, and usefulness to practitioners. Articles that are submitted to the CAS newsletter as part of an obligation due to the author(s) receiving Educating the Educator or Study/Research Grants from CAS are not eligible for the article of the issue prizes. Articles submitted by the editor and the members of the editorial committee are also not eligible for the prizes. There is a separate undergraduate student article competition.
Planning a case report? Some hints as to how do so!
When writing an article take time to look at how articles in other journals are arranged. While articles for the CAS newsletter are not as detailed as the NZVJ the information needs to arranged in a logical manner to make it easy for the reader to follow. Therefore follow some logical headings as detailed below. Not all of these headings will need to be used in all articles and some may be combined depending on the type of case and amount and type of information available.
Figures should be clearly numbered labelled as to top and bottom where necessary.
Introduction, History, Clinical signs, Materials and methods
Features on the figures should be clearly labelled by the author(s).
Results of investigations (e.g. laboratory results, radiography, ultrasonagraphy)
The figure captions should be concise and accurate, and supplied with the text on a separate page at the end of the article. Diagrams/figures can be copied from textbooks only if there is permission from the original author and the source is clearly acknowledged. It is the responsibility of the author(s) to obtain this permission before submitting the article to the newsletter editorial committee.
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Timing of article submission and publication
Discussion, Conclusion, Acknowledgments, References
Companion Animal Society Newsletter
Volume 26 Number 2
NZVA COMPANION ANIMAL SOCIETY NEWSLETTER
Volume 26 No 1 March 2015
In This Issue ...
• Haemangiosarcoma in dogs • Management of traumatic brain injury • Intra-occular prostheses • Managment of insulinoma-induced hypoglycaemia – case study • Update on Feline Leukaemia Virus • Highlights from ECVIM Conference 2014
VOLUME 26 NO 1 MARCH 2015