NZVA COMPANION ANIMAL SOCIETY NEWSLETTER
Volume 26 No 4 December 2015
In This Issue ...
• Hemivertebra in dogs • Anxiety and pain in companion animals • Treatment of jaw abcesses in rabbits • Unusual dermatological conditions – feline paraneoplastic alopecia • Case study – lateral condylar fracture • Specialist profile – Peter Collinson • NZVJ companion animal digest • What is your diagnosis?
VOLUME 26 NO 4 DECEMBER 2015
Newsletter
Volume 26 No. 4 December 2015 ISSN No. 1173-6941
EXECUTIVE COMMITTEE 2015
Contents
President
Brendon Bullen
Editorial................................................................................................2
brendonbullen@gmail.com
From your society.................................................................................4
Secretary
Rochelle Ferguson
Grants & scholarships..........................................................................6
rochellemf@hotmail.com
Article of the Issue winner....................................................................6
Treasurer
Practitioner on Sabbatical 2015 Report................................................8
Aimee Brooker ollyaimee@gmail.com
Karina Wilde
Committee Members
What is your diagnosis?.....................................................................10
Helen Beattie
Kevin Frame
helenbnz@gmail.com
Hannah Bain
Hemivertebra in dogs.........................................................................14
hannah.bain@merck.com
Boyd R Jones, Nicola Moffat
Warren Stroud
stroud@wellpet.co.nz
Anxiety and pain in companion animals in the clinic...........................18
John Munday
Katherine Reid
j.munday@massey.ac.nz
Catherine Watson
Treatment options for rabbit jaw abscesses........................................24
cath@vetservices.co.nz
Brendon Bullen
EDITORAL COMMITTEE
Unusual dermatological conditions – role of pathology in achieving a diagnosis................................................................................... 30
Sarah Fowler (Editor) Genevieve Rogerson Angus Fechney Craig Irving Christine Moloney (Advertising) Janice Thompson Simon Clark
Geoff Orbell
Lateral condylar fracture in a 13-week-old puppy: A case study.........32 Karina Wilde
Address for submitting copy/ correspondence etc.
CAS Specialist Profile – Peter N. Collinson........................................ 40
66 Callum Brae Drive Rototuna Hamilton 3210 Ph H:(07) 845-7455 Mob: 027-358-4674 Email: sarah.fowler@gmail.com
Companion Animal Health Foundation............................................... 43
NZVJ: Companion Animal Digest Volume 63, Issue 6, 2015................42
Sarah Fowler
Cath Watson
What is your diagnosis: The answer................................................... 44 Massey Home Page........................................................................... 45
Advertising Manager
Guidelines for Authors....................................................................... 46
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
Cover Design & Newsletter Setting
CAS Website
http://cas.nzva.org.nz
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
Vets in Stress Programme 24 Hour Freephone Confidential Counselling Service
0508 664 981 Helps you solve personal and work problems, including: Relationship problems Drug and alcohol issues Work issues Change Stress Grief
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 health and safety reform bill has been recently passed by Parliament and will come into effect as the Health and Safety at Work Act 2015, on the 4th April 2016. There is some finalisation to be done on the regulations that support this Act, but now is a good time for both employees and employers to familiarise themselves with the Act, and review their workplace health and safety. The main aspects of the Act that are relevant to most veterinary practice include: • Redefining the primary duty of care. • Increased obligations on workplaces with the purpose of increasing worker engagement and participation in health and safety matters. • Changing health and safety requirements for contractors, and visitors to a place of work. • A change in language used from employee/ employer to worker and ‘persons conducting a business or undertaking’ (PCBU). • A wider range of enforcement tools for inspectors and the regulator, and increased penalties. The new bill uses the language “persons conducting a business or undertaking” (PCBU) to replace employer/business. Despite the confusing use of the word ‘persons’, this will usually be a business, however sole traders and self-employed people will also be defined as a PCBU. The relevance of this language change for veterinary practices and the duties to workers is that health and safety duties are linked to the work of the business, not simply the physical workplace, which is important for home and farm visits. Additionally businesses need to think about the health and safety of everyone who is working in their business including contractors, and not just employees. The primary duty of care requires all PCBUs to ensure, so far as is reasonably practicable: 1. The health and safety of its workers or those workers who are influenced or directed by the PCBU (for example its workers and contractors). 2. That the health and safety of other people is not put at risk from work carried out as part of the conduct of the business or undertaking (for example its visitors and customers). The PCBU’s specific obligations, so far as is reasonably practicable, include - Providing and maintaining a work environment, plant and systems of work that are without risks to health and safety.
- Ensuring the safe use, handling and storage of plant, structures and substances. - Providing adequate facilities at work for the welfare of workers, including ensuring access to those facilities. - Providing information, training, instruction or supervision necessary to protect workers and others from risks to their health and safety. - Monitoring the health of workers and the conditions at the workplace for the purpose of preventing illness or injury. The specific duties of workers include: - Taking reasonable care for his or her own health and safety. - Taking reasonable care that his or her acts or omissions do not adversely affect the health and safety of other persons. - Complying, so far as reasonably able, with any reasonable instruction that is given to them by the PCBU to allow the PCBU to comply with the law. - Co-operating with any reasonable policy or procedure of the PCBU relating to health or safety at the workplace that has been notified to workers. The Act defines customers or visitors to the workplace as ‘other people in the workplace’. These ‘other people’ will have the first three duties of workers listed above when visiting the workplace. Veterinary clinics have a duty to inform ‘other people’ such as clients that come out the back of the clinic, or workers that enter the premises i.e. electricians or plumbers of potential hazards of risks. A potential way for veterinary clinics to fulfil their requirements would be to have a prepared list of potential hazards and instructions in a laminated sheet that is discussed with the person before providing access. Although this may seem cumbersome, the public will become used to this approach as it becomes normal for NZ businesses. Before the new Act comes into effect there will be development and release of specific guidance documentation prepared by Worksafe New Zealand to clarify the new requirements. This can be found at www.business.govt.nz/worksafe. This editorial is my personal interpretation of the legislation and should not be interpreted as legal advice. Brendon Bullen, CAS President
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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 29 and 30 July 2015 at IVABS, Massey University in Palmerston North Attendance: Catherine Watson, Aimee Brooker, Rochelle Ferguson, Helen Beattie, Brendon Bullen, Hannah Bain, Warren Stroud, Sarah Fowler and John Munday Apologies: Pauline Calvert. Matters arising from previous minutes and correspondence: Comments were made for the VCNZ performance and communication survey. President’s report – Cath Watson: Cath Watson appointed to the CAHF as a CAS representative. Discussed talks with NAWAC regarding improving welfare for dog breeds. Proposal for CAS to directly engage with individual breed clubs to begin discussions around breed standards and conformation. NAWAC are hopeful that tail docking and banding will become illegal under new legislation later this year. Treasurer’s report – Aimee Brooker: Accepted. Discussion around falling interest rates and the impact this will have on current reserves. Newsletter Editor’s report – Sarah Fowler: Discussion around CAS newsletter and plans were made to give it a refresh, along with formatting it to an optional digital version. CAHF and CAS grants update: Chris Hutchings has resigned. Plans made to approach Boyd Jones to chair the Trust. Interest shown in the idea to look at driving the direction of research supported by CAHF rather than passively supporting projects as they come along. Guest: Nick Cave: Nick gave us an update on how his Companion Animal Surveillance Project is developing. This is a disease surveillance programme linked to companion animal veterinary records. Phase one of a three-phase project is complete and work has begun on Phase Two. Trials are expected to begin by October. NZCAC: The new structure for the NZCAC is now in place. Veterinary Refresher Scheme: Updating modules continues with planned refresh of medicine module for 2016. Technical Advisory Group: Concerns have been raised about the strategic planning of topics by NZVA being disrupted by other parties offering continuing education and being marketed by the NZVA. Marketing courses also confers an NZVA endorsement, even though quality is not able to be assessed or managed. CAS will give feedback to NZVA on this. TradeMe: Concern that the veterinary record given to breeders may be interpreted as a pre-purchase certificate. Guidance notes to go out in e-CAS to clarify this and disclaimer for the bottom of the template. We agreed to advise VPIS and VCNZ about this issue.
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AMR Update: Discussion around the AMR press release by NZVA. While we are on the whole supportive of the position, we do not endorse the process. We were disappointed not to be consulted, despite having expertise in this area and have concerns about the wording of the press statement released. Guest: Christine Moloney – Christine presented her report. This was discussed and the cost of advertising was raised slightly. Euthanasia policy update: The policy is in its final stages with issues of CO methods and sentience of the foetus to be ironed out. Recommendations to breeders on euthanasia of deformed puppies or kittens will be that euthanasia should be performed by a veterinarian with IP barbiturate mixed with lignocaine. Guest: Danielle Page, Hills Pet Nutrition – We discussed the Hills Pet Nutrition/CAS Educating the Educator’s Scholarship and the value this was to CAS. This will need to be redrafted each year and no longer be open ended. Guest: Callum Irvine, NZVA – Life membership was discussed and the need to ensure it was retained for a select few to maintain its prestige. The CAS resourse position motion was passed at the AGM last night and NZVA will now manage the recruitment phase. There is discussion about forming a companion animal strategic group. Callum explained the process behind the AMR statement. He stated that the campaign was well meaning and the World Veterinary Association had been supportive of the NZVA position on this subject. Election of Officers and confirm Newsletter Editor and Advertising Manager – Brendon Bullen was elected as President, Rochelle Ferguson was re-elected as Secretary, Aimee Brooker re-elected as Treasurer, Sarah Fowler was confirmed as Newsletter Editor and Christine Moloney as Advertising Manager. Cath Watson was thanked for her efforts over the last 3.5 years as President. In this period she oversaw WSAVA 2013, lead CAS through the NZVA realignment project, established the Wellness Project, improved liaison with stakeholders – particularly the NZKC and has made a generally massive contribution to CAS. Cat Management: A national cat management meeting is planned with local authorities, SPCA, NZVA, CAS, NZCAC and the Morgan Foundation. The agenda is to progress initiatives on national cat management. Cat Show Guidelines: Issue raised by a member regarding veterinary examination of cats for cat shows. Discussion around this – why they are being examined and difficulties in meaningfully examining a large number of cats in less than ideal circumstances while being watched by a crowd. Will discuss this further with Cat Fancy and determine their requirements.
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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 Judith Visser September 2015, Volume 26(3), p 16
Paper: “Rubber Jaw Syndrome in a Cavalier King Charles Spaniel”
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This article has been written as part of the requirements for receiving the CAS Practitioner on Sabbatical Grant.
Practitioner on Sabbatical 2015 Report Karina Wilde, BVSc GPCert(SAS), CAS Practitioner on Sabbatical 2015 I have been working in Gisborne for the last three and a half years in a mixed animal practice, and I am a companion animal veterinarian. Since working here I have gained a huge appreciation for the typical working dog trauma cases which we see on a daily basis. I had been fortunate prior to working in Gisborne to work overseas for an extended period, and had gained a General Practitioner’s Certificate in Small Animal Surgery whilst in Wales in 2008. When I became aware of the Practitioner on Sabbatical Grant which is sponsored by the Companion Animal Society, giving a practitioner the opportunity to see practice with the specialist of their choice for two weeks, I thought this was an awesome opportunity. You can never finish learning, and with the current costs of continuing education, as well as the ongoing challenge to log sufficient CPD points each year, this seemed to be amazing value. Unfortunately, due to the lack of applicants each year this valuable grant may not be available for much longer. It is a terrible shame, as it is such a generous opportunity. Perhaps the lack of applicants is due to people being busy in their normal lives, or thinking that they would need to be studying towards a Certificate or other post graduate study to qualify for this. But unless you have started on the long road towards specialisation, most of us have “merely” qualified and practised and lived our lives since graduation. There is no shame in being a General Practitioner – as we form the backbone of the profession, and surely it is our duty to be the best we can be. I was fortunate to spend my time with the surgical team at Massey University Veterinary Teaching Hospital. I came here because of their close association with working dog health. I was primarily observing practice with Andrew Worth, but also spent valuable time with Kat Crosse and Kyle Clark. I had the opportunity to sit in on clinical rounds and tutorials with the final year students as well as journal and clinical round groups with the specialists who work here. I can’t decide if my memory has become selective, or if the students are simply working a lot harder than we did in my day. Certainly the hospital has changed out of recognition, as have the services offered. It was a sobering moment during a tutorial session to realise that the changing nature of our profession is constant, to the point where some of the things I was taught as an undergraduate are now outdated! The main area I wished to observe was orthopaedic surgery as this is an area in which I wish to enhance my knowledge in. The case load at MUVTH was quite varied during my time there, so I had the opportunity to scrub in on many orthopaedic surgeries, as well as observe a number of specialist soft tissue procedures. In between cases there was time for discussion of these as well as observing some of the specialised diagnostic
equipment in action; such as the CT scanner and the fluoroscopy unit. In my second week at MUVTH we did have some working dogs referred in for surgical procedures so it was good to see how the specialists approached these cases. The cost versus outcome is much more important than for a pet dog, as these valuable working dogs only hold their value if they are still able to do their work to the levels required by the farmer. I knew that seeing practice in a specialist centre would involve seeing procedures which we would never offer in general practice such as modified hemilaminectomies for Hansen’s type 1 intervertebral disc disease, and arthroscopic retrieval of osteochondritis dissecans fragments from the caudo-lateral humeral head in a juvenile German Shepherd. But it was extremely enjoyable to gain an appreciation of all these fantastic procedures which are typically referral only, as well as the thought process and work up that occurs prior to the surgery. I also gained a huge respect for my specialist colleagues, in terms of the additional study they have done and the ongoing high standards they achieve as well as the long hours they work. I will fondly remember this experience and I’m very happy to remain a General Practitioner with a special interest in surgery and a busy case load. I plan to bring my enhanced knowledge back to my employers, with a reinvigorated enthusiasm. Special thanks especially to the Companion Animal Society for funding such an excellent scholarship.
Eastland Vet Services, Gisborne. karina@evs.co.nz
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CAS presents: “A week with…” We would like to support a CAS member to upgrade their skills in an area of interest and have enlisted the support of five specialists who have offered to host a CAS member for a week. Applications are invited from practitioners with over 3 years’ experience who would be interested in spending a week with one of the following specialists: • Dr Andrew Worth, BVsc, MANZCVS (Radiology), PGDipVCS, FANZCVS to see orthopaedic surgery at Massey University Teaching Hospital in Palmerston North. • Dr Pru Galloway, FACVS (feline medicine), to see feline medical referrals at Petvet Lower Hutt in Wellington. • Dr Warrick Bruce, BVSc(Dist), MVM, DSAS(ortho), CertSAO, MANZCVS, to see orthopaedic surgery at Vet SOS in Hamilton. • Dr Alastair Coomer, BVSc, MS, Diplomate. ACVS, to see small animal referral surgery at the Veterinary Specialist Group in Auckland. • Dr John Munday, BVSc, PhD, Diplomate ACVP to find out what the real diagnosis was in the pathology department at Massey University in Palmerston North. This is a chance to tailor a CPD course to your own specific interest at a time that suits you best. The grant is for $2000 and covers your time away from practice and travel costs. To benefit all CAS members, as a condition of the grant we would like you to share your experience by writing a report about your time seeing practice and an article based on a topic of interest for the CAS newsletter. Further information and application forms available from the CAS Secretary cas@vets.org.nz
Applications close on 31 March 2016.
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What is your diagnosis? Kevin Frame, BVSc, Zoetis Intern 2015, Massey University Veterinary Teaching Hospital
A 6-month-old, male, American pit bull terrier was presented having been hit by a car 24 hours prior to presentation. He presented non-weight bearing lame and painful on the left hind limb. Physical exam was largely normal with no palpable long bone fractures or joint instability on orthopaedic exam. However, pain was elicited on deep palpation of the left hip, specifically over the femoral head. The following radiographs of the hip were taken (Figure 1, a and b): What abnormalities are present in these radiographs? Can you make a diagnosis? What is the next course of action? 1a
1b
Figure 1. Ventro-dorsal extended leg (a) and left lateral (b) pelvic radiographic views.
(Answer on Page 44) K.R.Frame@massey.ac.nz
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Industry News
Ear cleaning and Otoflush Dr. Debbie Simpson BVSc MANZCVS (Small Animal Medicine) FANZCVS (Veterinary Dermatology)
Debbie is a Massey grad who specialised in dermatology almost immediately after graduating in 2008. She is a member as well as a fellow of the Australian and New Zealand College of Veterinary Scientists. Debbie has trained both in New Zealand and Australia, as well as at Cornell University in New York State. Debbie is returning to New Zealand in January 2016 and will be based in Auckland and available for dermatology referral cases. Debbie can be contacted at www.theskinvet.co.nz Treating ear disease can be a frustrating experience for vets and clients alike. The first step if the ears are blocked with ceruminoliths, an excess of wax and debris or full of pus and too painful to touch or examine, is to thoroughly clean the ear under a general anaesthetic. This allows a thorough assessment of the ear canals, and for any foreign bodies, tumours or structural abnormalities to be identified. It is a good idea to smear some of the debris from the deep aspect of the canal on a glass slide during the ear flush as sometimes the organisms found in the deep canal are different from those in the vertical canal and all organisms present must be treated to successfully resolve the infection. Once the ears are clean and the status of the tympanic membrane is known, appropriate treatment based on cytological findings can be initiated. Otoflush is an extremely useful adjunct to treatment, especially in those difficult cases when rods are present, if the tympanic membrane is ruptured or if its status is unknown. It is one of the few treatments which is safe to use if the eardrums are ruptured1. I have found Otoflush to be very well tolerated (it is pH neutral) and have not had any reports of irritation or pain even when put in ulcerated ears. I use Otoflush before other antibiotic drops mainly to get the benefits of the Tromethamine EDTA (Tris-EDTA). Tris-EDTA chelates metals present in bacterial cell walls, and inactivates calcium-mediated efflux pumps relevant in Pseudomonas infections in particular. This damages the cell walls of the bacteria and makes them more susceptible to the antibiotic drops which follow. It also changes the pH of the ear, making certain antibiotics such as fluoroquinolones more effective. The synergy between Otoflush and antibiotic drops can make the difference between success and failure in treating some of the tough ear infections I have seen. The polyhexanide in Otoflush has a broad spectrum coverage against gram positive and negative bacteria and yeasts and is also safe to use in the middle ear. I would not rely on Otoflush alone to treat otitis externa – its main benefit for me is to potentiate the effect of the antibiotic drops which follow. My usual recommendation to clients is to instill Otoflush just before medicated drops once to twice a day (depending on the recommended frequency of the antibiotic drops which I am using). The dog should be allowed to shake the excess Otoflush out then the medicated drops can be applied to the ear canals straight away. I also use Otoflush for the same reason on the skin if I am treating a mixed infection in the facial folds or interdigital areas and want to potentiate the efficacy of other topical antimicrobial treatments. I am delighted we will have access to Otoflush now in New Zealand and can definitely recommend its use to improve outcomes in the situations outlined above. References:
1. Mills, Ahlstrom and Wilson. Ototoxicity and tolerance assessment of a TrisEDTA and polyhexamethylene biguanide ear flush formulation in dogs. Journal of Veterinary Pharmacological Therapy. 28, 391–397, 2005.
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Hemivertebra in dogs Boyd R Jones, BVSc,FACVsc,DECVIM-Ca, Professor Emeritus, Massey University, Palmerston North, and Nicola Moffat, DCR (London), Radiographer, IVABS Hemivertebra is one of the most common congenital developmental abnormalities of the spinal column in dogs. The hemivertebra is produced by failure of fusion of the left and right ossification centres of the vertebral bodies (Chrisman, 1991) (Figure 1). The breeds most commonly affected are the “screw tail” breeds; the English bulldog, French bulldog, Boston terrier and the pug. The vertebrae most often affected are located between T7 and L1 (Figure 2). Hemivertebra may be be associated with spinal column deformity; scoliosis, lordosis or kyphosis. There may be no clinical signs but if there is concurrent vertebral instability at the site of the hemivertebra spinal cord compression can result, with varying degrees of hind limb paresis, ataxia, pain, incontinence or paralysis in severe cases. The genetics of hemivertebrae in the “screw tailed” breeds has yet to be determined. The genes that
determine the “screw tail” in the at-risk breeds may also contribute to hemivertebrae at sites in the spinal column other than the tail. Hemivertebra is inherited as an autosomal recessive in the German short haired pointer (Kramer et al., 1982). Clinical cases have been diagnosed in many countries including New Zealand and, in recent times welfare issues relating to the breeding of pure breed dogs have been paramount. Hemivertebra was identified as a concern in pugs and French bulldogs in the UK (Godfrey and Godfrey, 2011). Some breed societies have taken a responsible approach and encouraged radiographic screening of breeding stock and progeny. The United Kingdom Pug Dog Club (www.org.uk/ wp) and the French Bulldog Club of New South Wales (www.frenchbulldogclubnsw.asn.au) have recently established operational schemes. The goal being to identify dogs with hemivertebra and breed dogs without thoracic and thoraco-lumbar hemivertebrae. In the February e-CAS Newsflash (25 February 2015) there was a reference to ‘hemivertebrae testing’ for French bulldogs, a mandatory test for accredited NZKC breeders of this breed. A link to notes by Dr Karen Hedberg (Australian National Kennel Council Canine Health Committee) was provided along with reference to an English radiological scoring system for French bulldogs with hemivertebrae (not the UK Pug Dog Club scheme). The English scoring scheme for French bulldogs referred to, which is reported to be functioning for some time, is as follows:
Figure 1. In hemivertebra there is failure of sclerotome differentiation on one side of the vertebral body. The defect may be associated with lordosis, kyphosis or scoliosis.
Figure 2.
Any hemivertebrae in T1–T7 – score 1 point for each abnormal vertebra Any hemivertebrae between T8–T11 – score 2 points for each abnormal vertebra Any hemivertebrae affecting T12 or T13 – score 3 points for each abnormal vertebra No comment was made about lumbar hemivertebrae
Lateral radiographic view showing thoracic hemivertebra in an adult pug dog.
Massey University, Palmerston North
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3a
Figure 3.
(a) Lateral and (b) ventrodorsal radiographs of a 7½-week-old pug puppy. There is excellent differentiation of the vertebrae at this age, allowing diagnosis of hemivertebra or other anomalies. This puppy is healthy.
3b
by the UK veterinarian who reads the UK radiographs. It has been suggested (by the UK veterinarian) that one should not breed from dogs with backs that score over 10. Also, the suggested advice (from the same UK source) is never to breed from any dog or bitch with hemivertebrae at T12 or T13. Dr Hedberg recognised the potential merit of the English scheme but advised caution regarding implementation of its scoring system. She was right to do so. The basis for the advice and recommendations has neither been validated nor is there any evidence that the advice provided, based on the score for a dog will reduce the occurrence of hemivertebra in French bulldogs.
Massey University experience
In New Zealand hemivertebra was common in pug dogs in the 1980s and ’90s and was of major concern to pug breeders. All pug dogs have hemivertebra, how else would they get their curly tails! However, thoracic and thoracolumbar hemivertebrae can result in instability at the site with associated spinal cord compression and clinical signs and some pugs with signs were examined. The dogs developing clinical signs most often have thoroco-lumbar hemivertebrae. It was found that a pug dog sire with undiagnosed hemivertebra had been imported into New Zealand and used widely, producing affected progeny. Once diagnosed he was retired from breeding. Bitches (mated to that sire) that produced puppies with hemivertebra were radiographed and not used for breeding if thoracic or thoraco-lumbar hemivertebra was diagnosed. Pug dog breeders agreed to a scheme where all puppies in a litter were radiographed at 5–8 weeks of age before they were sold. (Figures 3a and 3b). Only puppies without hemivertebra were sold to new owners and were provided with certification from Massey University that they did not have hemivertebrae. The pug dog breeders who subscribed to the Massey scheme were compliant, and after about 15 years those breeders who had their puppies radiographed at Massey University did not produce any more puppies with hemivertebra, and this continues to be the case. It is interesting that the United Kingdom Pug Dog club requires dogs that are radiographed to be one year of age or older. We believe that requirement is not necessary as radiographs in young puppies are diagnostic. Some other studies were conducted at that time. The chromosome karyotype (identified by Dr Al Rowland, Massey University) of the pugs with hemivertebra was no different from that of healthy pugs. This was the pre-molecular genetic era and there may be opportunity for molecular diagnostic investigation to be undertaken now. Two test matings of a sire and dam, both with thoracolumbar hemivertebrae, produced two litters (5 puppies) all without hemivertebra. We are not sure what this result means; the numbers are too small but probably emphasises that the genetics of the condition are complex! The Massey study in pug dogs showed that identification of breeding animals with hemivertebrae and not breeding from them, reduced the incidence of the condition. The concurrent radiographic surveillance scheme to identify puppies with hemivertebra when they were very young and eliminating them as potential breeding stock also contributed to the reduced incidence. French bulldog breeders and veterinarians assisting them should take notice of the Massey University ‘pug experience’ when selecting their breeding stock and evaluating the results of their surveillance scheme.
References
Chrisman CL. Chapter 17. In Problems in Small Animal Neurology, 2nd Ed, p403, Lea and Febiger, Philadelphia, USA, 1991 Godfrey R, Godfrey D. Genetic welfare problems of companion animals: Hemivertebrae www.UFAW.org.uk/hemivertebrae.php, 2011 KramerJM, Schipper SP, Sande PD, Ratanen NW, Whitener EK. Characterisation of heritable thoracic hemivertebra of German short haired pointers. Journal of the American Veterinary Medical Association, 181, 814–815, 1982
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BVSc Student article
Anxiety and pain in companion animals in the clinic Katherine Reid, MS, BVScIV Veterinarians genuinely have their patient’s best interests in mind. Unfortunately, the patients don’t always see it that way when it is time to visit the vet. A pet that is otherwise calm and well behaved at home can experience considerable fear and anxiety during a visit to the veterinary clinic. For a dog with an existing anxiety problem, a clinic visit can be problematic or even dangerous. If the dog is presenting to the clinic because it is unwell, it may already be experiencing considerable emotional stress due to illness. Emotional stress impacts not only their medical treatment but also the ease and comfort of delivery of treatment. While there are some who question whether animals experience emotions at all, an increasing body of evidence from neuroscience indicates not only that animals have emotions and their behaviour is based on emotional affect but that emotion impacts their physiology and the experience of pain. Animal welfare science is beginning to describe the relationship between anxiety and clinically important pathology such as pain, inflammation and immunity. Since Melzack and Wall first suggested the Gate Theory of Pain Modulation, Melzack also hypothesised on the relationship between anxiety and increased acute pain perception. He notes that anxiety in humans reduces the efficacy of analgesia (Melzack, 2001). The relationship of anxiety and pain in animals has also been investigated, for example (Rowan, 1988; Sullivan et al., 1999; Dreschel, 2010). Anxiety and the physiological responses to anxiety have been implicated in the development of chronic pain conditions (Sullivan et al., 1999). Moreover, the experience of anxiety alone is implicated in causing suffering in animals (Broom, 2010). Animal behaviouralists have shown that anxiety can lead to the development of long-term behavioural problems in many animal species based on mechanisms of memory and neural plasticity (Ohl et al., 2008).
Neurological and molecular mechanisms of pain and anxiety perception
Understanding of the activities of neurons and neurotransmitters in the brain of a nervous animal becomes useful when attempting to treat anxiety and understand how it affects the perception of pain. First it should be remembered that pain, fear and anxiety are useful, adaptive responses (Ohl et al., 2008). Pain is the response to a potentially damaging stimulus and pain pathways are well known to veterinarians (Calvino and Grilo, 2006). Fear allows an animal to respond to a threatening environment or event for self-preservation. The mechanism of fear is based in the amygdala (Kim and Gorman, 2005; Kim et al., 2011). Anxiety, a little less tangible but equally useful, permits an animal to anticipate potentially threatening situations based on memory of previous events (Kim et al., 2011) and thus respond appropriately to this event or even avoid it all
together. Because it requires a memory of a previous event, its mechanisms are based in the hippocampal cortex (Ploghaus et al., 2001), the seat of long-term memory. Anxiety occurs in response to events in the external environment and incorporates memories of past experience. Anxiety commonly occurs when the animal is unable to exert control over its environment, in unfamiliar environments, or when expression of normal behaviour is limited (Boissy, 1995). When considering whether animals do genuinely experience emotions such as anxiety, it is helpful to consider the relative survival value of anxiety: it allows animals to anticipate and prepare for potential dangers. Anxiety’s effects on pain and the provision of analgesia are profound because the neuroanatomy involved in generating these responses is closely interconnected. In fact, emotion and pain share many pathways and both are adaptations to allow the animal to manage threat and minimise harm. These systems are highly conserved among mammals due to their value in provision of survival benefit (Panksepp et al., 2011). Because of similarity among mammalian species, it can be concluded that all animals experience some degree of emotional affect but the quality varies by species. The amygdala, responsible for generation of emotions, projects to the hypothalamus. Hypothalamic connection facilitates initiation of a physiological stress response when an aversive stimulus occurs. The result is that physiology maintains homeostasis to cope with the stimulus and emotion provides behavioural motivation to alleviate the aversive situation (Chen et al., 2012). The amygdala also shares connections with the hippocampus wherein memory is consolidated. The amygdala connection allows the animal to incorporate past experiences with the analysis of current threats when developing an emotional response to a situation or environment. Pain is the perceptive arm of nociception and requires consciousness. Nociceptive signals arise in the periphery to signal actual or impending tissue damage and this ascending information triggers subconscious homeostatic responses by their synapse in the hypothalamus and other areas of the brainstem. Pain occurs when this information further ascends to the cortex via the thalamus. At this stage it is further modified by input of the emotions generated in the amygdala and hippocampus. This input provides behavioural motivation intended to alleviate the threatening or damaging situation. When the hypothalamus and the stress response are previously activated by anxiety in a threatening situation, the nociceptive input has greater impact because of the prior sensitisation of these pathways. In practice, a small pain becomes a stronger warning to withdraw from threat or damage.
Email: katherine.reid9@gmail.com
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Anxiety and pain perception share some chemical mediators. One example of these is the GABA receptor. GABA receptors bind the neurotransmitter GABA which is the primary inhibitory neurotransmitter in the CNS. GABA receptors located in the amygdala modify sensory perception relative to emotional state including inputs based on nociception. The GABA receptor is a target of the benzodiazepines, a group of drugs with useful sedative effects. In humans, benzodiazepines are the gold-standard anxiolytic drug (Shephard, 1986). Because of homologous anatomy among mammals, benzodiazepines are also considered anxiolytic in animals and used as the positive control drug in pharmacological studies of anxiety using mouse models. Binding of benzodiazepines to the GABA receptor inhibits activity in the amygdala thus alleviating anxiety. Benzodiazepines such as midazolam are a helpful inclusion in sedation protocols especially during recovery from anaesthesia since they reduce anxiety during the excitement phase of recovery and lead to a calmer recovery. Additionally, including midazolam or diazepam in the sedation protocol for invasive, mildly painful procedures can be helpful. Sedating the animal not only alleviates the suffering of anxiety but also makes analgesia more effective.
Reducing anxiety in the veterinary clinic
With an improved understanding of anxiety and its effects on pain, this knowledge can be used to improve the experience of animals during their visit to the clinic. Anxiety can be assessed and this assessment combined with pain evaluation. Behavioural signs of anxiety vary by species but can include heightened arousal and sensitivity to noise, excessive startle or reactivity and increased locomotion or vocalisation. Treatment of anxiety in the clinic environment can also be considered within the analgesic plan. Evaluating not only a pain score for the patient but an assessment of their anxiety, can give clinicians more information upon which to base decisions regarding sedation and analgesia, and the context of signs such as tachycardia or anorexia. Strong emotional states have modulating effects on clinically relevant signs. This modification of signs such as pain is mediated not only via sympathetic innervation and the hypothalamic-pituitary-adrenal axis but also by descending inhibitory and sensitising input on spinal cord somatosensory afferent signals. This adaptive response facilitates homeostasis giving greater impact to peripheral nociceptive signals when the emotional system has indicated that the context of the situation may be threatening. Because of this interconnection, the cardinal signs that are used to determine the status of the dog will need to be considered in the context of the dog’s heightened state of anxiety. Dangerous anxiety in the clinic can be treated aggressively with the use of mild sedatives and tranquilisers. The understanding of how neurotransmitters mediate behaviour is constantly evolving and with it the use of behaviour-modifying drugs. The cause of anxiety in each case is unique and likewise responds differently. This is further complicated by genetic variation in expression of receptors on neurons, making drug actions vary. Many options are available for pharmaceutical therapy of
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anxiety in animals but with variable levels of efficacy. Commonly used drugs include benzodiazepines (diazepam, alprazolam), and phenothiazines (acepromazine). There is also an increasing place for use of selective serotonin reuptake inhibitors (SSRI, fluoxetine) and norepinephrine reuptake inhibitors. These drugs directly affect neurotransmitters known to be involved in emotional processing and its modification of pain perception. Ketamine is gaining popularity for its use in preventing development of severe pain (Schmid et al., 1999). Other NMDA agonists have been suggested for alleviation of anxiety disorders in people. Novel pharmacological mechanisms may be incredibly simple. Magnesium, given as an oral supplement is gaining popularity for use in nervous horses (Reid and Rogers, 2015). The potential anxiolytic use of various drugs is promising. However, a review of the mechanisms and targets of various anxiolytic drugs is outside the scope of this article. Fortunately for most of us, many drugs already employed to control pain likely have some anxiolytic effects as well. Anxiety treatment does not always have to include drugs. Environment is a powerful motivator of emotion because emotions allow adaptation of the animal to its environment. Evaluating and modifying the environment of the patient while it is staying in the clinic can have a powerful effect. Providing for the animal some control over its environment can be useful. Animals, particularly cats, birds and small mammals may appreciate having places to hide out of view or blankets in which to burrow or nest. Some animals seem to just like the ability to “redecorate” their kennels by dumping water dishes and spilling food. Maintaining an environment outside the kennels that is predictable and calming should be considered. Alternatively, providing a drape or barrier on the kennel to simulate a den or burrow can give the patient a sense of security. Unexpected noise and loud activity can be agitating to a convalescent pet accustomed to sleeping at home all day, thus it is important to keep cage/kennel areas quiet as possible. Allowing an animal to see other animals or suitable companions helps to fulfil an inherent need for companionship common in animals. Equally important, animals should be able to get away from others or avoid interaction. Some will require entertainment or attention to alleviate boredom. Surprisingly, even boredom can create anxiety. An animal’s ability to control their environment, even when debilitated, will help to reduce the patient’s anxiety during its stay in the clinic. Most clinics, however, are designed for the convenience of the staff and not the comfort of the patients and some reorganisation and consideration of the facilities may help to provide a more calming and relaxing environment for patients.
Conclusion
Ultimately, consideration and treatment of patient’s anxiety as well as their pain will both serve to improve the medical care and the overall welfare of animals within the clinical environment. Because of the interconnections of the neural systems mediating anxiety and pain the benefits of considering and treating the adverse emotional states of a patient can
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be profound. Addressing an animal’s anxiety will not provide a magic cure for any disease or trauma but rather can be incorporated into the daily practice of any clinic as a way to improve the care of the patients in that clinic.
References
Boissy A. Fear and Fearfulness in Animals. pp. 165, University of Chicago Press, Chicago, USA, 1995 Broom DM. Cognitive ability and awareness in domestic animals and decisions about obligations to animals. Applied Animal Behaviour Science 126, 1–11, 2010 Calvino B, Grilo RM. Central pain control. Joint, Bone, Spine: Revue du Rhumatisme 73, 10–16, 2006 Chen YW, Rada PV, Bützler BP, Leibowitz SF, Hoebel BG. Corticotropin-releasing factor in the nucleus accumbens shell induces swim depression, anxiety, and anhedonia along with changes in local dopamine/acetylcholine balance. Neuroscience 206, 155–166, 2012 Dreschel NA. The effects of fear and anxiety on health and lifespan in pet dogs. Applied Animal Behaviour Science 125, 157–162, 2010 Kim J, Gorman J. The psychobiology of anxiety. Clinical Neuroscience Research 4, 335–347, 2005 Kim MJ, Loucks RA, Palmer AL, Brown AC, Solomon KM, Marchante AN, Whalen PJ. The structural and functional connectivity of the amygdala: From normal emotion to pathological anxiety. Behavioural Brain Research 223, 403– 410, 2011
Melzack R. Pain and the neuromatrix in the brain. Journal of Dental Education 65, 1378–1382, 2001 Ohl F, Arndt SS, van der Staay FJ. Review: Pathological anxiety in animals. The Veterinary Journal 175, 18–26, 2008 Panksepp J, Fuchs T, Iacobucci P. The basic neuroscience of emotional experiences in mammals: The case of subcortical FEAR circuitry and implications for clinical anxiety. Applied Animal Behaviour Science 129, 1–17, 2011 Ploghaus A, Narain C, Beckmann CF, Clare S, Bantick S, Wise R, Matthews PM, Rawlins JNP, Tracey I. Exacerbation of pain by anxiety is associated with activity in a hippocampal network. The Journal of Neuroscience 21, 9896–9903, 2001 Reid K, Rogers CW. Magnesium supplementation and the neurobiological basis for nervous behaviour in horses. Applied Animal Behaviour Science submitted, 2015 Rowan AN. Animal anxiety and animal suffering. Applied Animal Behaviour Science 20, 135–142, 1988 Schmid RL, Sandler AN, Katz J. Use and efficacy of low-dose ketamine in the management of acute postoperative pain: a review of current techniques and outcomes. Pain 82, 111– 125, 1999 Shephard RA. Neurotransmitters, anxiety and benzodiazepines: A behavioral review. Neuroscience and Biobehavioral Reviews 10, 449–461, 1986 Sullivan GM, Coplan JD, Kent JM, Gorman JM. The noradrenergic system in pathological anxiety: a focus on panic with relevance to generalized anxiety and phobias. Biological Psychiatry 46, 1205–1218, 1999
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Free access to Journal articles related to small animal veterinary medicine For the months of November and December 2015, the major academic publisher, Taylor and Francis are offering extensive free access to more than 60 articles from 19 journals, including the NZVJ, Veterinary Quarterly, The Veterinary Nursing Journal and Clinical toxicology among many others. The topics covered include cats, dogs, rabbits and rodents. You can access these articles by following the link to Small Animal Veterinary Medicine from their Veterinary Science page (http://explore.tandfonline.com/content/est/vet-science). Here are some you might find interesting: Agudelo CF. Cystic endometrial hyperplasia-pyometra complex in cats. A review. Veterinary Quarterly 27, 173– 182, 2005 Gugelmann H, Geronac R, Lid C, Tsutaokaa B, Olsona KR, Lung D. ‘Crazy Monkey’ Poisons Man and Dog: Human and canine seizures due to PB-22, a novel synthetic cannabinoid. Clinical Toxicology 52, 635–638, 2014 Carnell S. Post-operative care of the Guinea pig. Veterinary Nursing Journal 23, 23–26, 2008
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Treatment options for rabbit jaw abscesses Brendon Bullen, BVSc, Small Animal Practitioner Introduction
Rabbit abscesses present a significant challenge for clinicians. Rabbit purulent material is caseous, very thick and not amenable to lancing, flushing, or placing drains as can be done in other species. Rabbit abscesses where possible should be treated as tumours, and completely excised with the abscess capsule intact. This approach is not possible for jaw abscessation, and until recently, skull abscesses of the rabbit were considered by many to be incurable. There are now several techniques described for rabbit jaw abscess treatment.
Case history
Henry is a five-year-old male neutered rabbit. He has a history of dental issues with molar and incisor malocclusion. He has required frequent incisor trimmings, and had several anaesthesias for molar burring in the past. He has an excellent high fibre diet, and his previous dental problems were suspected to be congenital in nature.
Clinical presentation
Henry presented to the clinic with trouble eating over the previous 24 hours. He had appeared hungry, approaching his food but would not eat. On clinical examination he was drooling and had a wet chin. A painful, fluctuant swelling was present on the left mandible. Purulent material was visible around the lower molars on oral examination. He had an overgrown lower left incisor, and missing lower right incisor. His upper incisors were laterally deviated and short. Henry was started on meloxicam 0.3 mg/kg BID PO, procaine/benzathine penicillin 80,000 IU/ kg q48h SC and Oxbow Critical Care diet for home supplementary feeding. He was booked in for surgery, awaiting compounding of ciprofloxacin poloxamer gel.
Figure 1. Three loose molars were extracted through the external holes in Henry’s jaw
Treatment
Henry was pre-medicated with midazolam 0.5mg/kg and butorphanol 0.4 mg/kg IM. A catheter was placed in the lateral ear vein, and he was pre-oxygenenated. Alfaxan was drawn up at a rate of 3 mg/kg, and given slowly IV to effect (half this volume was used). He was intubated with a v-gel supraglottic airway device (www. docsinnovent.com/) and maintained on isoflurane. Warmed intravenous lactated ringers solution was administered at a rate of 3 mL/kg. Full examination under anaesthesia revealed two pockets of abscessation in the left mandible. An external approach was made in two separate areas and the area flushed with saline. A curette was used to debride infected material and bone from the abscess site. A large amount of mandibular bone required debridement and three loose molars were extracted through the external holes (Figure 1). Once debridement and flushing was complete, the two incision sites were marsupialised to allow post-operative access (Figure 2), and filled with ciprofloxacin poloxamer gel. Henry recovered well from anaesthesia and was syringe fed with 10 mL Oxbow Critical Care once awake. He was discharged on continued penicillin SC injections for four weeks and meloxicam PO for three weeks. The owners were made aware that the molar extractions
Figure 2.
Photograph of incision sites after marsupialisation to allow ciprofloxacin poloxamer gel to be instilled post-operatively.
had resulted in no occlusal pairs for the left maxillary molars. This was likely to result in maxillary molar overgrowth, and dental procedures were likely to be required ongoing every six weeks to three months. Post-operative checks were done at 2 and 5 days after surgery; there was no further purulent material produced, and the sites were filled with additional ciprofloxacin gel. The owners reported that Henry appeared happy and lively at home and had started eating well from the night of surgery. The sutures were removed at day twelve (Figures 3a and b). Six months later the upper left molars have not overgrown and no further treatment has been required. This suggests that there was maxillary as well as mandibular dental disease, which halted maxillary molar growth.
Pet Doctors Kelburn, 44 Upland Road. clinickelburn@nzpetdoctors.co.nz
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3(a)
3(b)
Figure 3. Photographs of Henry (a) approximately 6 weeks after surgery to excise mandibular abcesses. (b) Shows appearance of healing surgical site.
Discussion
Jaw abscesses in rabbits are most often caused by molar disease of the mandibular teeth, but maxillary abscesses can also occur. Abscesses can develop as a result of oral injury from malocclusion or overgrown teeth, food impaction between teeth, periodontal disease, or tooth fracture. The majority of cases are related to improper diet with insufficient levels of fibre. The ideal diet for rabbits consists of 80–90% hay and grass, and overfeeding of pellets is the most common cause of dental issues. Radiographs are an important part of diagnosis, and ventro-dorsal, lateral and oblique views should be obtained to visualize all of the tooth roots. Periosteal new bone is formed at the abscess site. Due to financial restraints, radiographs were not performed in this case. Rabbit dental therapy is made significantly easier by appropriate equipment. An otoscope with a plastic head can be used for oral examination in the consult room. A rabbit dental table, cheek dilators and good directional lighting allow for thorough oral examination under general anaesthesia. A straight nose cone attached to a low speed handpiece allows for burring of molar spurs. Cotton buds can be used to delivery water cooling to the site, and a metal spatula helps prevent soft tissue damage during burring. The surgical approach should be made externally. All affected bone and soft tissue should be removed from
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jaw abscesses and this requires aggressive curetting followed by thorough flushing, assisted by complete visualization and access to the abscess site. Extraction of affected molars is recommended, however personally I have found that successful resolution is possible without dental extraction. I extract molars if they are loose, and leave them in situ if there is no laxity. Extracting molars almost guarantees that regular dental procedures will be required for the life of the rabbit from overgrowth of occlusal pairs. A 2002 study examined the bacterial flora of dental abscesses in 12 rabbits. The species cultured were a mixture of Gram positive and negative, anaerobic and aerobic bacteria. Pasteurella multocida and Staphlococcus aureus which are frequently associated with rabbit abscesses were not isolated from any of these cases. The bacterial population of jaw abscesses can vary significantly and appropriate antibiotic therapy should be selected on the basis of culture and sensitivity results. A broad-spectrum antibiotic can be started while waiting for results. Trimethoprim sulfa and enrofloxacin, while safe choices for rabbits, have poor efficacy for jaw abscesses when used systemically. Penicillin benzathine/procaine can be administered subcutaneously at a rate of 80,000 IU/ kg q48h. Owners can be shown how to administer this at home. Ingested penicillin can be fatal to rabbits, and any coat spillages must be thoroughly cleaned. Medication should be discontinued if any diarrhoea or anorexia occurs. Systemic antibiotic therapy should be continued for 2–4 weeks postoperatively. Multiple topical treatment modalities have been described for rabbit jaw abscesses following debridement and flushing, with varying degrees of success: - Saline lavage alone - Antibiotic impregnated polymethylmethacrylate beads (AIPMMA) - Antibiotic impregnated plaster of paris - Bioactive ceramic (Consil) - Antibiotic soaked synthetic gauze. I have had most consistent success with using poloxamer gel compounded with enrofloxacin or ciprofloxacin. I have performed six procedures using this technique with complete remission in each case after a single surgery. Poloxamer solutions are liquid at low temperatures and form a gel at body temperatures in a reversible process. This allows them to be applied into the site as a liquid where they fill available space and then harden into a gel. The treatment modality is available in New Zealand through compounding by Optimus Healthcare (http://www.optimushealth. co.nz). Marsupialising the abscess site allows further gel to be applied post operatively. Despite the increase in treatment options available, rabbit jaw abscesses remain significant clinical challenges to resolve. Owners should be warned that multiple surgeries may be required, and success is not guaranteed.
References
Aiken S. Surgical treatment of dental abscesses in rabbits. In: Quesenberry KE, Carpenter JW (eds). Ferrets, Rabbits, and Rodents Clinical Medicine and Surgery. Pp 379–382. Saunders, Missouri, USA, 2004 Johnson D. Treating jaw abscesses in rabbits. Proceedings of the Atlantic Coast Veterinary Conference, 2006 Tyrrell KL, Citron DM, Jenkins JR, Goldstein EJC et al. Periodontal bacteria in rabbit mandibular and maxillary abscesses. Journal of Clinical Microbiology, 40, 1044–104, 2002
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Industry News
Bravecto® is now approved for canine demodicosis
Hannah Bain, BVSc (Dist.), Veterinary Technical Advisor – Companion Animal & Equine, MSD Animal Health hannah.bain@merck.com Canine demodicosis is an inflammatory skin condition that occurs due to overpopulation of Demodex spp. mites. Chronic generalised demodicosis can be frustrating and difficult to treat, and in otherwise healthy dogs is unlikely to resolve without therapy. Acaricidal treatment decreases the antigenic load and reverses ‘T-cell exhaustion’, leading to a clinical cure.1 In New Zealand, treatment is usually with macrocyclic lactone (ML) anthelmintic drugs e.g. ivermectin, doramectin (both off-label use) or moxidectin. For a successful outcome, these treatments usually require multiple doses over periods of up to three months or more. Some ML drugs carry risks for dogs that carry the MDR1-/- (‘ivermectin sensitive’) gene. Bravecto (fluralaner) was launched in New Zealand mid-2014, and is the only oral chew that provides 12 weeks’ efficacy against fleas and ticks. In October 2015, Bravecto was approved for the treatment and control of generalised demodicosis for 12 weeks. A 2015 study2 carried out in South Africa investigated the efficacy of Bravecto against generalised demodicosis in a group of dogs.
Study overview Sixteen dogs, over 12 months of age, with naturally acquired generalised demodectic mange, were assigned to two groups. One group received one Bravecto chew once orally at the minimum clinical dose of fluralaner 25mg/kg. The other group was treated topically on three occasions at 28-day intervals with a commercially available imidacloprid/moxidectin topical product (Advocate®). Study results After a single oral Bravecto treatment, mite numbers were reduced by 99.8% on Day 28, and 100% on Days 56 and 84. A marked decrease was observed in erythematous patches, crusts, casts and scales in the dogs treated with Bravecto (Figure 1)
Figure 1: Dog from the Bravecto treatment group prior to treatment (a) and 12 weeks after treatment was started (b).
Mite numbers in the topical treatment group were reduced by 98% on Day 28, by 96.5% on Day 56, and by 94.7% on Day 84. Erythematous patches had markedly reduced by the end of the study. In both treatment groups, all but one dog exhibited hair regrowth ≥ 90% at the end of the study in comparison with their pre-treatment hair-coat.
Discussion A single Bravecto chew given to dogs with generalised demodicosis resulted in significantly lower mean mite counts at 56 and 84 days after treatment compared with three successive treatments with topical imidacloprid/moxidectin. Reduction of mites corresponded with a reduction in clinical signs. Bravecto has a very good safety profile, and a study3 in confirmed MDR1-/- Collie breed dogs at three times the clinical dose of Bravecto found no adverse effects, indicating that Bravecto is safe in ‘ivermectin sensitive’ dogs. Bravecto offers a new, safe and convenient option for the treatment of canine demodicosis, and should be considered as a treatment option for affected dogs. 1. Ferrer L. Immunology and pathogenesis of canine demodicosis. Veterinary Dermatology 25, 427, 2014 2. Fourie JJ, Liebenberg JE, Horak IG, Taenzler J, Heckeroth AR Frenais R. Efficacy of orally administered fluralaner (Bravecto) or topically applied imidacloprid/moxidectin (Advocate) against generalised demodicosis in dogs. Parasites and Vectors 8, 187, 2015 3. Walther FM, Paul AJ, Allan MJ, Roepke RK, Nuernberger MC. Safety of fluralaner, a novel systemic antiparasitic drug, in MDR1(-/-) Collies after oral administration. Parasites and Vectors 7, 86, 2014 Advocate® is a registered trademark of Bayer NZ Ltd. ACVM No: A009119. Bravecto® is a registered trademark of Schering-Plough Animal Health Ltd. ACVM No: A11019. Phone: 0800 800 543. www.msd-animal-health.co.nz. NZ/BRV/1015/0025
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Unusual dermatological conditions – role of pathology in achieving a diagnosis Geoff Orbell, BVSc, DipSc, BSc, MVS (Hons), DipACVP, Registered Specialist in Anatomic Pathology There are few dermatological emergencies in veterinary medicine. However there are occasions where skin biopsies examined by a pathologist 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.
3. Feline Paraneoplastic Alopecia
Maisie was a 14-year-old female desexed DSH cat with a sudden onset of non-pruritic adherent skin crusts, coat thinning and symmetrical alopecia along the ventrum and distal limbs. There were also similar crusts involving nonhaired skin of the nailbeds and pads. Lesions developed within a few days of a routine dental, then progressed rapidly to become more generalised including the pinnae. Lesion progression was also associated with rapid weight loss.
Figure 1. Dorsal surface of distal hindlimb demonstrating alopecia, adherent crusts and a smooth, shiny skin surface characteristic of feline paraneoplastic alopecia.
On closer examination, the skin in some areas of alopecia was smooth and shiny (Figure 1) and remaining hair was easily epilated. All footpads exhibited adherent ringshaped crusts (Figure 2) with no evidence of ulceration. Sticky tape preparations from crusted areas revealed moderate numbers of yeasts and crusts submitted to the laboratory for fungal culture revealed Malassezia. Multiple 8 mm skin biopsies from the centre of areas of alopecia were submitted for histology. These biopsies revealed diffuse telogenisation of hair follicles with normal sebaceous glands. The epidermis was mildly hyperplastic with moderate compacted parakeratotic hyperkeratosis and moderate numbers of associated yeasts.
Based on the characteristic histology along with the clinical history and gross lesions, a diagnosis of paraneoplastic alopecia was made.
Figure 2. Ventral surface of distal forelimb showing adherent ring-shaped crusts on the food pads and alopecia.
Maisie continued to deteriorate rapidly therefore the decision was made to euthanase her. Post-mortem examination revealed multiple large umbilicated lesions disseminated throughout the liver (Figure  3) and focally within the lung and spleen. A 2 cm diameter firm mass was palpated in the right lobe of the pancreas which was confirmed as a pancreatic adenocarcinoma by histology. Feline paraneoplastic alopecia The histology findings along with the clinical description and images submitted by the clinician enabled the pathologist to make a presumptive diagnosis of feline paraneoplastic alopecia. This is a rare condition in old cats with a classical clinical presentation and relatively distinctive skin lesions as described above. The underlying pathogenesis is not fully understood it almost always occurs secondary to a pancreatic adenocarcinoma.
Clinically, differential diagnoses include hyperglucocorticoidism, telogen effluvium, psychogenic alopecia and hepatocutaneous syndrome (not usually alopecic). Most lesions have metastasised to the liver by the time of diagnosis therefore the prognosis is generally poor. However, there are case reports of resolution of the dermatological signs with early surgical intervention prior to metastatic disease. This requires early identification
Figure 3. Appearance of Maisie’s liver at necropsy showing multiple large pale umbilicated lesions disseminated throughout the liver.
of clinical lesions with multiple skin biopsies and abdominal imaging.
Acknowledgements
Dr Peter Whiley for the clinical history and images of gross lesions.
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New Zealand Veterinary Pathology, geoff@nzvp.co.nz
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This article was written as part of the requirements for receiving the CAS Practitioner on Sabbatical Study Grant
Lateral condylar fracture in a 13-week-old puppy: A case study Karina Wilde, BVSc GPCert(SAS), CAS Practitioner on Sabbatical 2015 Case history and treatment
Ginge was a 13½-week-old male entire miniature poodle weighing 2.6 kg. He presented to the referring vet with a history of falling off the bed and injuring his right forelimb. The referring vet found he was non-weightbearing on this limb with pain and crepitus isolated to the right elbow. A lateral condylar fracture of the distal humerus was identified in radiographs of the right elbow and at this point Ginge was referred to Massey University Veterinary Teaching Hospital (MUVTH) for treatment. On presentation to MUVTH Ginge was bright, alert and responsive. His heart rate, respiratory rate and temperature were within normal limits. Thoracic auscultation and abdominal palpation were normal. He was non-weight bearing on the right forelimb but could ambulate well on all other limbs. No abnormal findings were detected on orthopaedic examination aside from the swelling and crepitus of the right elbow. It was recommended that Ginge had surgery to repair this fracture. Repeat radiographs were taken at Massey to allow measurements to be made for the implants that would be necessary (Figure 1a and b). This confirmed the presence of a lateral condylar fracture of the distal humerus. As can be seen on the cranio-caudal radiograph there is the distal fracture at the level of the condyle and the proximal fracture
1a Figure 1.
through the supracondylar crest which is the bone that forms the lateral edge of the supratrochlear foramen. A mini surgical approach through the skin and soft tissues over the epicondyle was made to the lateral aspect of the elbow (Figure 2). This mini approach was centered directly over the soft tissues of the epicondyle rather than a full lateral approach to the elbow joint. The fracture through the lateral supracondylar crest was visible after dissection of these soft tissues. The lateral condyle was reduced and held in place with bone forceps. Once the condylar fracture was reduced, a second pair of bone forceps was placed to reduce the supracondylar fracture and prevent rotation of the bone fragment as the implants were placed. Palpation of the joint in flexion and extension suggested that there had been accurate reduction. A Kirschner (K) wire was placed from lateral to medial, parallel to the joint surface of the distal humerus, and fluoroscopy was used intraoperatively to confirm this positioning as well as ensure that the fracture was accurately reduced (Figures 3a and 3b). Fluoroscopy is a form of imaging which allows xrays to be captured in real time and is typically used for barium swallowing studies for example. The images produced are a “negative” of typical radiographs. In this case it was ideal as the equipment could be brought into the orthopaedic theatre and the images produced instantly to identify placement of the implants.
1b
(a) A lateral radiographic view of Ginge’s elbow. The fracture is not immediately obvious although the displaced fragment can be seen outlined over the ulna (black arrow). (b) Extended caudo-cranial view. The displacement of the fracture fragment in this view. The black arrow indicates the condylar fracture and the white arrow indicates the supracondylar fracture.
Eastland Vet Services, Gisborne. karina@evs.co.nz
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3a
Figure 2.
Intra-operative photograph of Ginge’s leg showing mini surgical approach.
3b
The K wire was then removed and the hole enlarged using a progressively larger K wire. Again the positioning of this implant was confirmed with fluoroscopy. The lateral condyle was then over drilled to create a glide hole and a 2.4 mm lag screw and washer was placed across the condylar fracture. A 0.035� K wire was placed from distal to proximal to reduce the supracondylar fracture and prevent rotation of the bone fragment. Post-operative radiographs (Figures 4a and 4b) showed that there had been accurate fracture reduction with appropriate implant positioning. Ginge made an uneventful recovery following surgery and was discharged the following week with meloxicam (Metacam) and codeine as pain relief and a recommendation of 3–4 weeks of cage rest with follow-up radiographs planned after this time.
Discussion Lateral condylar fractures of the humerus Distal condylar fractures are divided into lateral, medial and intercondylar fractures. The intercondylar fractures are described as Y or T depending upon the direction of the supracondylar fracture lines. The lateral condylar fracture is the most common of these. Retrospective studies of dogs referred for repair of lateral condylar fractures show that it is most prevalent in dogs <1 year old, with most occurring around 4 months of age. In the adult population, the spaniel breeds are over-represented. In puppies with this injury, there is usually a history of low-impact trauma such as a fall. In adult dogs, there is a mixture of low-impact trauma and more involved trauma such as a road traffic accident. The spaniel breeds are over-represented in the low trauma cases and it is known that this breed has a higher incidence relative to other breeds, of incomplete ossification of the humeral condyle (IOHC), which can be a predisposing factor.
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Figure 3.
(a) Photograph showing fluoroscopy being used in theatre. Due to the shape of the fluoroscopy machine the surgeon can operate with the fluoroscopy in position so that images can be taken while surgery is in progress. (b) Fluoroscopy image taken intraoperatively showing placement of the K-wire and the joint congruency when the fracture is reduced.
It is thought that the lateral condyle is the weakest point in the distal humerus. It is slightly offset from the axial plane of the humerus and the supracondylar crest bone is thinner on the lateral aspect compared to the medial aspect. The weight bearing bone of the radius articulates with the lateral condyle so if there is a sudden weight bearing impact, this force will be
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Companion Animal Society Newsletter
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driven laterally through this weak point, resulting in a fracture. The growth plate between the two condyles doesn’t fuse until approximately 8 months of age in most dogs, and in dogs with IOHC it may never completely fuse. As with all fractures, it is essential that orthogonal radiographs are taken as the fracture may not be obvious in the lateral view, but may be clearly visible on the anterior-posterior view. As the fracture involves an articular surface it must be accurately reduced and rigidly stabilised by internal fixation to facilitate uncomplicated fracture healing. It is important that there is no fracture gap after fixation as this is associated with major complications such as implant loosening or failure. To help articular fractures to heal, early load bearing is encouraged as well as passive range of motion exercises as part of a programme of post-operative physiotherapy. Repair techniques for lateral condylar fractures There are a number of surgical techniques described for repair of lateral condylar fractures. All involve the placement of a lag screw across the condylar fracture. This must be parallel to the joint surface and perpendicular to the fracture line but not encroaching on the supracondylar foramen. In young puppies the bone is often protected from the screw by a washer as their bones are very soft. Some form of fixation of the supracondylar fracture is then placed. This is to prevent rotation of the fragment around the long axis of the screw. In small dogs and puppies, a K wire is usually sufficient. In larger breed dogs there may be lower complications associated with the use of a second lag screw or a lateral plate at the supracondylar fracture. In this case the surgeon was able to use a minimally invasive surgical technique through the use of fluoroscopy to check the placement of the implants. This allows preservation of the soft tissues around the bone, an important source of the pluripotential cells which help in fracture repair. In mature patients a more involved approach to the elbow joint is often required. The lag screw can be placed by either an “inside out” approach, where the fragment of bone is rotated outwards allowing drilling of the glide hole from the fracture surface outwards; or a closed approach where the hole is drilled from the lateral surface with the depth of the glide hole measured previously from the radiographs. The lag screw should be 30–50% of the diameter of the condyle at the fracture surface. If the fracture is thought to have been predisposed by IOHC then the largest screw that will fit appropriately is used to provide maximal stabilization. The lag screw should protrude medially so that if the screw does fracture then the fragments will be able to be removed.
4a
4b Figure 4.
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(a) Post operative cranio-caudal view showing the lag screw fixating the condylar fracture and the K-wire fixating the supracondylar fracture. (b) A lateral radiographic view taken post-operatively showing positioning of the implant.
In experienced hands, these fractures have a reasonable outcome. Complications seen postsurgery range from minor, such as seroma formation and inflammation, to major complications such as infection and implant failure. Common long-term sequelae include development of degenerative joint disease as is often seen after articular fractures. Even in some cases which have required repeat surgery due to implant failure or loosening, the longterm outcome has been favourable following the repeat surgery. A retrospective study of working dogs referred for condylar fractures in New Zealand, demonstrated a disproportionate number of heading dogs versus New
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Companion Animal Society Newsletter
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5a Zealand huntaways with this type of injury. This has lead to speculation that there may be an increased incidence of IOHC in this breed which could act as a predisposing factor for condylar fracture. In the spaniel breeds with IOHC, both elbows are commonly affected. The IOHC may be detected as a fissure line in cranio-caudal radiographs of the elbow. The sensitivity of radiography may be increased by using a 15° cranio-medial caudo-lateral view of the elbow. The current gold standard for detecting this fissure is now CT. As can be seen by these images of another case referred to MUVTH, the fissure was not evident in either radiographic view, but it was in the CT image (Figure 5 a, b, c). In this case a lag screw was placed in a pre-emptive fashion to help prevent future condylar fracture.
5b 5c
Andrew Worth at MUVTH is currently doing a prospective study to evaluate the presence of IOHC in heading dogs. For heading dogs referred to MUVTH with a condylar fracture there is funding available for a CT scan of the contralateral limb to assess whether there is evidence of IOHC.
References
Brinker DL, Flo GL. Handbook of Small Animal Orthopaedics and Fracture Repair 3rd Edition. Pp 275–287, WB Saunders Philadelphia, USA, 1997 Butterworth SJ, Innes JF. Incomplete humeral condylar fractures in the dog. Journal of Small Animal Practice 42, 394–398, 2001 Denny HR. Condylar fractures of the humerus in the dog; a review of 133 cases. Journal of Small Animal Practice 24, 185–197, 1984 Johnson AL. Chapter 32 Management of Specific Fractures – Stabilisation of lateral or medial condylar fracture. In: Small Animal Surgery, 3rd Edition. Fossum TW (Ed). Pp 1055–1057. Mosby St Louis, USA 2007 Langley-Hobbs SJ. Chapter 52 Fractures of the Humerus – Distal humeral fractures. In: Veterinary Surgery Small Animal. Tobias KM, Johnston SA (Eds), Pp 717–723, Elsiever Saunders, St Louis, USA, 2012 Martin RB, Crews L, Saveraid M, Conzemius G. Prevalence of incomplete ossification of the humeral condyle in the limb opposite humeral condylar fracture: 14 dogs. Veterinary and Comparative Orthopaedics and Traumatology 3, 168–172, 2010 Moores A. Humeral condylar fractures and incomplete ossification of the humeral condyle in dogs. In Practice 28, 391–397, 2006
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Figure 5.
(a) Cranio-caudal radiographic view of the elbow of a dog with IOHC. In this view the IOHC fissure is not evident. (b) Cranio-caudal view, rotated 15 degrees, of the same dog with the IOHC fissure still not evident. (c) CT image of the elbow of the same dog as in the previous two images. The fissure is evident in the three dimensional view created digitally from the CT scan.
Moores AP, Tivers MS, Grierson J. Clinical assessment of a shaft screw for stabilization of the humeral condyle in dogs. Veterinary and Comparative Orthopaedics and Traumatology 3, 179–185, 2012 Nortje J, Bruce WJ, Worth AJ. Surgical repair of humeral condylar fractures in New Zealand working farm dogs – long-term outcome and owner satisfaction. New Zealand Veterinary Journal 63, 110–116, 2015 Perry KL, Bruce M, Woods S, Davies C, Heaps LA, Arthurs GI. Effects of fixation method on postoperative complications rates after surgical stabilization of lateral humeral condylar fractures in dogs. Veterinary Surgery 4, 246–255, 2014
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CAS Specialist Profile – Peter N. Collinson, BVSc,MVS,FACVSc 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. Peter Collinson is a registered specialist in Veterinary Ophthalmology, based at the Auckland Animal Eye Centre. He has been a registered specialist since 1993. What is your specialty, and how many years have you been practicing as a registered specialist? My speciality is Ophthalmology, and I completed my fellowship programme in 1993, gaining specialist registration in Australia at the end of 1993, then a few years later in New Zealand when specialist registration was allowed. I have been practicing solely referral ophthalmology since 1996, when Michelle (my partner, director and business manager) and I set up New Zealand’s first standalone referral veterinary clinic, the Auckland Animal Eye Centre. Where did you obtain your veterinary degree, and did you move directly into a residency from there? My undergraduate degree was at Massey, and after finishing in 1986 I moved into an Auckland-based small animal clinic that was also offering referral surgery and imaging – working alongside Dr. Alex Walker and Dr. Chris Warman. With this early exposure to referral veterinary care, I knew this was the track that I wanted to follow and after two years I gained a surgical residency position at Melbourne University (this was initially an internship, but changed to a residency position after six weeks, as most of my rough edges had already been smoothed by Drs. Walker and Warman).
W hat drove you to specialise, and why did you choose ophthalmology? Explain the process you took to become a registered specialist. During my surgical residency, Melbourne University did not have an ophthalmologist, and I started to show an interest as I enjoyed the fine surgical work. Showing this interest, I was initially invited to spend one day per week with the Melbourne-based Grandfather of Australasian Veterinary Ophthalmology, Dr. Rowan Blogg, in an attempt to prevent me from being too incompetent! Dr. Blogg strongly encouraged my defection from surgery to ophthalmology, and with the help of Prof. Ken Jubb, who was also amazingly supportive, organised funding via the Barringer fund/scholarship. This allowed me to spend extended periods with US-based universities – giving a rather broad-based training programme. The main externships included a 4–5 month block with Prof.Glenn Severin at Colorado State University, two months with Prof. Robert Pieffer at North Carolina Medical School, and 4–6 week blocks with other Australian-based ophthalmologists in Sydney – Dr. Jeff Smith, and Brisbane – Dr. Richard Smith. As my training programme was not typical, it did take somewhat longer to meet the fellowship requirements – low case load at Melbourne University Veterinary School was one of my biggest problems. What do you like most about your job? Being responsible for what happens with the client, patient and referring veterinarian, and the overall
Dr. Peter Collinson, BVSc, MVS, FACVSc, Registered Specialist in Veterinary Ophthalmology, examines the eye of a baby rhino at Hamilton Zoo. Auckland Animal Eye Centre, Veterinary Eye Specialists, 18 Barrack Road, Mt Wellington AK 1060. Ph 64 9 5277697. Email: eyevet@xtra.co.nz, Web: www.eyevet.co.nz
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Companion Animal Society Newsletter
Volume 26 Number 4
experience that occurs. When all goes to plan everybody is happy, but if not, you have to look in the mirror to work out why, rather than blaming staff, clients or vets – and typically most issues are communication-based problems. Being self-employed also suits my personality, with only Michelle to answer to. It is also relatively easy to occasionally block out periods to enjoy school activities with our children. Ophthalmology has also given opportunities to work with exotic animals in various zoos, and I’ve been able to interact with people from all walks of life – from those struggling to the obscenely wealthy – all just wanting appropriate care for their pets. What is the worst part of your job? Currently the worst part of my job is a lack of locum support – there are no ophthalmology locums to jump in and man the clinic should I want to take a holiday (or become unwell), so shutting up the clinic for periods to allow holidays is currently the only option. This obviously is not ideal for referring vets, clients or income. What is the most challenging part of your job? I believe the greatest challenge with this job would be the same as for most: time – the balance of work/ income/family. With a small lifestyle block, too many horses, and three girls (10–15 years old) and a partner who are all very competitive equestrians, there is not enough time in the day. A very supportive partner is a necessity. It also took some years and maturity to understand that it’s the patient with the problem – not you. All you can do is your best, you don’t always win, and sometimes you will screw up, but the sun always comes up in the morning. You must look after yourself. If you allow clients to get in your head, allow them to ruin and disturb your down time, they will. Strongly protect your free time.
specialising later in their careers, after a significant period of time in general practice? Specialisation is a track not suited to all – there needs to be a good period of your life when you can be particularly focused and very selfish with your time. I could not image trying to complete a training programme with a young family. I have great respect for ‘mature specialisers’, most are very focused and appreciate what and why they are making that change, and those I personally know that have specialised after 10–15 years in general practice have made excellent and respected specialists. Do you think New Zealand needs more specialists, and if yes, in what areas? It would be nice to think New Zealand needs more specialists, and ideally we do. But, with our small population, the still disappointingly low status of pets in a large percentage of New Zealand households, and the comparatively low financial return, I believe that unless there is a strong alternative reason for them to return, most veterinarians who undergo specialist training will work overseas. Several US and UK trained ophthalmologists have visited with the view of setting up in New Zealand, only to realise that in their situation, the lifestyle improvement was not enough to cover the reduced financial return. Oncology, cardiology, and dermatology are all missing in the NZ specialist front – travelling specialists from Australia help, but are not really an ideal solution. What are your passions outside of work? At this point in time, outside of work, horses are our biggest passion and time (and financial) committment; watching our girls’ passion, drive and bonds they have with their horses does significantly dull the pain (and might even keep boys at bay for a few more years). Over the winter months I still play soccer for the local Clevedon team, playing on the paddock rather than in goal keep has markedly reduced the post-game visits to A&E.
What advice would you give to someone thinking of specialisation? What do you think about vets
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December 2015
Companion Animal Society Newsletter
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New Zealand Veterinary Journal: Companion Animal Digest Volume 63, Issue 6, 2015
Sarah Fowler, BSc, Msc, PhD, BVSc, CAS Newsletter Editor Here we present brief summaries of the articles from the most recent issue(s) of the New Zealand Veterinary Journal that are likely to be of interest to companion animal veterinarians. Remember, even if you are not a subscriber to the print version of NZVJ, all NZVA members have free online full-text access to the NZVJ at http://www.sciquest.org.nz/nzvj Why are brachycephalic dogs’ soft palates so thick? Histological evaluation of the soft palate in dogs affected by brachycephalic obstructive airway syndrome KR Crosse, JP Bray, GMB Orbell and CA Preston Pages 319–325
Why they did it Among other anatomic abnormalities that obstruct breathing, brachycephalic dogs typically have soft palate that is longer and thicker than normal. This study investigates the cause of the thickening. What they did Palatine tissue was harvested from nine dogs with brachycephalic obstructive airway syndrome (BOAS) either during surgical treatment of their BOAS utilising the folded-flap palatoplasty technique or subsequent to euthanasia. The palatine tissue was examined histologically along with tissues from four control dogs euthanased for unrelated reasons. The amount and proportions of muscle salivary tissue and stroma was compared. What they found Soft palates from dogs with BOAS showed increased muscle degeneration and necrosis with less muscle tissue and more stroma and salivary gland tissue. This indicates the increased thickness is not due to muscle hypertrophy and the reduced muscle mass may have an effect on the function of the soft palate. Take-home message This study is a first step in understanding the cause of the changes in dogs with BOAS which may ultimately affect when and how cases of this debilitating condition are treated.
work status, currently lameness and whether postoperative complications had occurred. What they found Five of seven dogs had returned to full work while one had not due to moderate persistent lameness. However six of the seven dogs had a constant gait abnormality with a mild to moderate persistent lameness. Removal of the implant was required in four of the cases. All contacted owners were very satisfied with the procedure. Take-home message Working dogs with a carpal injury undergoing PCA (using a hybrid carpal arthrodesis bone plate applied dorsally) have a good prognosis for return to work though plate removal may be required.
What cell type is causing this leukaemia? Novel use of immunohistochemistry for phenotypic evaluation of circulating neoplastic lymphocyte populations JR Finlay and KM Wyatt Pages 335–339
Why they did it Determining the specific lineage of lymphocyte causing a leukaemia can be problematic. Cytology and histopathology of the cells is often unreliable and so advanced diagnostic techniques such as immunohistochemistry, immunocytochemistry, flow cytometry and PCR antigen receptor rearrangement have rapidly become routine supplemental tests overseas and in human oncology. However these diagnostic techniques are not widely available to veterinarians in Australia and New Zealand.
How well do working dogs with pancarpal arthrodesis do long term? Long-term follow-up of working dogs in New Zealand following pancarpal arthrodesis using dorsal hybrid plating DM Sawyere, RM Jerram and AM Walker Pages 326–329
What they did This report describes two cases of leukaemia in dogs in which histopathology and immunohistochemistry of formalin-fixed paraffin-embedded blood clots were used to determine the lineage of the leukaemic cells. A 5–10 ml blood sample was collected, allowed to clot and the clot fixed in10% formalin. The fixed clot was then embedded in paraffin, sectioned and submitted for immunohisto-chemical characterisation to determine the cell lineages present.
Why they did it Working farm dogs are thought to be prone to carpal injuries. A previous study of dogs that underwent pancarpal arthrodesis (PCA) for treatment of carpal fractures and ligamentous injuries indicated that 10/12 returned to normal activity. However anecdotal evidence suggested a number of these dogs had longterm complications.
What they found In both cases, immunohistochemistry on FF-PE blood clots revealed a circulating T cell lymphocyte population, consistent with T cell lymphoproliferative neoplasia. A major strength of looking at formalinfixed paraffin-embedded blood clots was the greater stability of samples during storage allowing for ease of transport and retrospective examination.
What they did The authors contacted the owners of dogs that had PCA surgery as part of the previous study. The median time since surgery was 3 years (range 1–6 years). The owners were asked about the dogs current age, weight,
Take-home message Immunohistochemistry of formalin-fixed blood clots is a reliable, inexpensive and minimally invasive method for determining the lineage of neoplastic lymphocytes in circulation.
n
* sarah.fowler@gmail.com
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Companion Animal Society Newsletter
Volume 26 Number 4
Companion Animal Health Foundation Cath Watson, CAS Executive Member. The Companion Animal Health Foundation(CAHF) was established by NZVA CAS in 1998 to stand as an independent charitable organisation to enable the promotion of animal health and welfare in NZ. In other words, CAHF is our charity. The trustees generally include CAS, NZVA, NZVNA and IVABS representatives. The key goals of the Companion Animal Health Foundation are; 1. To promote and expand the publics knowledge regarding the welfare, breeding, nutrition, management, health, diseases and performance of companion animals of all types 2. To encourage the study and understanding of all matters relating to companion animals in New Zealand 3. To foster, promote, assist or undertake projects or welfare work in connection with companion animals 4. To identify, instigate or grant assistance in connection with projects related to advancing the well-being of all companion animals. The projects supported to date include research ranging from new techniques in diagnostics and surgery, relevant information about common diseases in NZ, antimicrobial usage in animals in NZ, and surveys of current attitudes of companion animal owners and veterinarians. To see the projects currently supported and in progress, see the table below. Funding is available to all CAS members who meet the application criteria. MVM candidates may be interested in CAHF support for a research project. The website www.healthypets. org.nz has all the information you need. Go there and see what the CAHF has to offer. CAHF receives and relies on financial donations from pet owners, veterinarians and companion animal clubs and societies, and industry. No government funding is received. With the success of WSAVA, CAS was able to make a significant contribution to CAHF, but really important and essential are the regular donors like Virbac who contribute a percentage of the cost of every pet casket sold, The Vet Centre Marlborough who run a memorial scheme where owners are encouraged to make a donation in memory of deceased pets, and Waikiwi Vets Ltd., who make a donation for every animal euthanasia performed in their practice. To be really successful and to be able to support more research relevant to NZ the CAHF needs financial support and regular contributions to enable more funds to be provided for significant research and welfare studies. Additional funds would also
provide greater opportunity for NZ veterinarians to decide on investigations and studies that are really relevant to companion animal health care in NZ. The leader for any project funded by CAHF is required to provide progress reports on their study and at its conclusion the results must be available to the public and veterinarians though refereed publication in appropriate journals or other suitable publications or conference/meeting presentations. Owners can be encouraged to make a donation to the CAHF in an appreciation of the care their pet has received and to acknowledge the impact diagnostic and therapeutic advances through research that have made into the many problems of companion animals. There is no doubt veterinary clinics can come up with some amazing ideas for fundraising that suit their practice so they can make a regular donation in support of CAHF, a charity that directly benefits companion animals in NZ. All donations are tax deductible in accordance with IRD regulations. A member of the board of trustees of the CAHF will be in touch with you or your practice to discuss/agree a way you might assist the Foundation in the future. NZVA Companion Animal Society/Companion Animal Health Foundation list of current projects: Year
Recipient
2014
Fiona Hollinshead
AMH as a potential predictive Abstract pending marker for fertility in bitches
Project Title
Status
2014
Els Acke
Exploring the virulence of Campylobacter spp. using Galleria mellonella and whole genomes
Poster presented, abstract published, PhD publication pending
2014
Kavitha Kongara
Comparative effects of methadone, buprenorphine and morphine on electroencephalographic responses to castration in cats.
Research report received
2013
Alison Stickney
Does Fel-O-Vax vaccine induce cross reactive immunity against NZ FIV isolates?
Underway
2012
Mike Gieseg
The effect of the mdr1-1 delta mutation on dog sedation
Publication pending
2012
Ali Karkaba and Kate Hill
Investigating the strains of multidrug resistant E. coli that are causing clinical infections in companion animals in NZ
Publication pending
2011
Alison Harland
Epidemiology of leptospirosis infection in NZ dogs
Publication pending
2010
Andrew Worth
Determination of the amount of genetic change in 3 large breed dogs that have been selected for better hips by the NZVA HD scheme
Published in NZVJ
2010
Kate Hill
Clinical and biochemical profiles of NZ working farm dogs
Publication pending
2008
Ben Leitch and Andrew Worth
Evaluation of an epoxy resin connecting bar/clamp external skeletal fixator for feline long bone fractures.
Publication pending
cath@vetservices.co.nz
December 2015
Companion Animal Society Newsletter
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“What is your diagnosis?” The answer (From page 10)
What abnormalities are present? The extended VD radiograph is unremarkable. The lateral femoral radiograph (oblique pelvic view) is suspicious for abnormal alignment of the proximal femur and the head of the femur. Can you make a diagnosis? No obvious cause of the dog’s hip pain can be diagnosed from the clinical exam and these radiographs. What is the next course of action? Additional radiographic views are required. A ventro-dorsal “frog leg” radiograph was taken and is shown in Figure 2.
Figure 2.
Ventro-dorsal flexed-leg (frog-legged) radiographic view of the pelvis.
In this view it can be clearly seen that the capital epiphysis of the left femur is displaced relative to the metaphysis (compare to the right), confirming the presence of a Type I Salter Harris fracture. These transverse fractures across the physis are typical for this location. This example illustrates the importance of taking multiple radiographic views including a flexed (frog-leg) ventro-dorsal pelvic view when investigating hip pain in young animals following trauma. Capital physeal fractures commonly self-reduce depending on the leg’s position, and are therefore not apparent on radiographs, when the hip is in extension. Less commonly, a capital physeal fracture may be visible on the extended view rather than the frog leg view.
to the hip. Two or three divergent (parallel in very young patients) Kirschner wires or small diameter Steinman pins are placed depending on the size of the dog. Careful observation/palpation, or fluoroscopy, are used to ascertain that the pins have not been advanced into the joint. Owners should be warned that damage to the blood supply to the joint capsule and/or epiphysis can lead to avascular necrosis of the femoral head. This may then necessitate a salvage procedure such as a femoral head and neck ostectomy (FHO)or total hip replacement at a later date. Conservative treatment of Salter Harris Type I fractures is not recommended as it consistently results in poor functional outcome (chronic discomfort, persistent lameness, muscle atrophy, osteoarthritis). The exception is a well-reduced fracture that maintains reduction though out the range of motion. Conservative management consists of strict kennel/cage rest for 6–8 weeks and pain relief. The animal should be periodically assessed to ensure there are no animal welfare implications. Abnormal development of the coxo-femoral joint is seen in all cases treated conservatively. In cases where conservative management is attempted and fails due to continued pain and lameness, FHO may be required. Generally, these patients are too young to consider total hip replacement. In this case, the owners opted for conservative management due to financial considerations. As discussed above, 6–8 weeks of strict cage rest were recommended with short lead walks to toilet only. The owners were cautioned that if the pain worsened or the patient was still very painful after 2 weeks then an FHO would be required. They were also instructed to return in 6 weeks for radiographs to check fracture healing. At 2 weeks after the initial visit, the owners reported that the patient was still not using the limb and occasionally crying out when sitting awkwardly. However a revisit was declined. The owners also declined recheck radiographs and were lost to follow up until 3 months post-injury. At this time, the owners reported that the dog is able to run around fairly comfortably and is only lame after exercise, however it has not been examined by a veterinarian. Osteoarthritis will continue to progress in the joint and a salvage procedure will likely be necessary later in life. n
Discussion Surgical treatment is recommended for Salter Harris Type I fractures of the femoral head. Early surgical intervention is recommended as delay in reduction and stabilization allows for ongoing trauma to the local vasculature and physeal surfaces. The fracture is reduced from a craniolateral approach
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Companion Animal Society Newsletter
Volume 26 Number 4
Small Animal Hospital PATRONS’ DAY
MASSEY UNIVERSIT Y
TE KUNENGA KI PUR EHUROA
VETERINARY TEACHING HOSPITAL
Friday 4th December 2015
(Note the VetLearn Bandaging And Wound Management Workshop is on Saturday the 5th Dec, also at the MUVTH)
8:30 – 9.00 am
Registration, coffee/tea in the Vet Tower foyer – Lectures in ICLT
Theme
Hot Topics in Internal Medicine chaired by Jonathan Bray
9:00 – 9:20
Hypothyroidism: epidemic or misnomer – Sarah Hill
9:20 – 9:40
Hyperthyroidism: What you need to know about I131 therapy – Valerie Poirier
9:40 – 10:00
IMHA: anything new, current treatment recommendations – Richard Burchell
10:00 – 10.20
Hyperadrenocorticism: medical tx or surgery? – Arnon Gal
10:20 – 10.45
Morning Coffee
Theme
Dealing with Complicated Surgical Cases chaired by Andrew Worth
10:45 – 11:05
Investigating a poor outcome after cruciate surgery – Richard Kuipers von Lande
11:05 – 11:20
Imaging the acute abdomen – Robert Bahr
11:20 – 11:45
Septic peritonitis following intestinal surgery – Malcolm Jack
11.45 – 12.00
Nutritional management of the anorectic surgical patient – Becca Leung
12:00 – 1:00
Lunch
Theme
Recent Developments and Improvements to Clinical Practice chaired by A Worth
1:00 – 1:20
Anaesthetic management in cardiac disease – Kerrie Lewis
1:20 – 1:40
Radiation Therapy 101 – Valerie Poirier
1:40 – 2:00
Top Ten Tips from primary practice at Massey – Steve deGrey
2:00 – 2:20
International veterinary epilepsy task force consensus – Laura Thornton
2:20 – 2:40
How to treat: Lumbosacral disease in dogs – Andrew Worth
2:40 – 3:00
Afternoon Tea
Theme
SAH research projects chaired by Jonathan Bray
3:00 – 3:20
Calcaneo-tibial screw fixation for canine talocrural instability – Kevin Frame
3:20 – 3:40
Variability in the ACTH stimulation test for HAC – Arnon Gal
3.40 – 4.00
TBA – Hiroki Sano
4.00 – 4.20
Disease surveillance in practice. Could NZ lead the world? – Nick Cave
4.20 – 4.30
The VTH 2016 and Beyound – Jonathan Bray Companion Animal Group Leader
4.30
Drinks Patrons’ Day is generously sponsored by;
FOR ANIMALS. FOR HEALTH. FOR YOU. December 2015
Companion Animal Society Newsletter
45
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 4
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