Editors choice articles from vetscript oct16

VetScript THE OFFICIAL MAGAZINE OF THE NEW ZEALAND VETERINARY ASSOCIATION

PRACTICE READY: A new approach for graduates

HEALING

HANDS Canine therapists are thinking outside the box

O CTO B E R 2 0 16

BRAIN SURGERY: A real option

PET NUTRITION: Are you walking the talk?

NEWS AND VIEWS

One Health in action Alison Dewes finds a reality check in the water contamination event at Havelock North.

RECENT EVENTS IN Havelock North are a wake-up call for New Zealand.

The water contamination incident is merely the tip of the iceberg, highlighting the important role we veterinarians have at the intersection of animals, humans and the environment and also the many challenges we face as One Health professionals. We are all connected, and we all have a key role to play in the solution.

As this issue of VetScript goes to print the exact source of the Campylobacter in the Havelock drinking water is unknown, apart from being ruminant in origin. We may never know the exact source. However, a series of events occurred that allowed all the checks and balances to be bypassed, resulting in more than 5,000 people falling ill. It has been a bit like all the holes in a block of Swiss cheese lining up in a way that no-one anticipated.

The events leading up to this crisis are multifactorial, including some bore contaminations in previous years, a ‘rain bomb’, subsequent power failures, a large, diffuse surface run-off from agricultural activity on vulnerable soils, the hydrogeological features of the subcatchment and increased pressure on drinking-water infrastructure – the list of risks goes on.

The big picture is that regional councils have a responsibility to minimise potential contamination risks through appropriate land management upstream of registered drinking-water sources. A key point in the National Environmental Standards is that no permitted activities that might

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contaminate water supplies should be allowed upstream. Interpreting which subcatchments qualify as ‘upstream’ is the tricky bit.

Given that agricultural agendas are encouraging further intensification of more marginal landscapes in an effort to increase output, our landscapes and catchments are under increased pressure, while regional regulations have partly failed to keep up.

In Canterbury (the Selwyn and Hinds catchments, for example) we see an increasing frequency of outbreaks of gastrointestinal disease in rural communities, and an increasing burden being placed on drinking-water treatment and infrastructure.

Monitoring by ECAN indicates that a number of shallow bores are becoming increasingly enriched with the leachate from intensive land uses.

In both catchments, there has been a steady increase in the number of shallow bores showing nutrient and pathogen enrichment.

The Havelock North episode may be an indicator of a larger One Health challenge for New Zealand. We need to understand that land use and agricultural activities are connected to human communities via the water that links us all. And we need a One Health solution to tackle the growing challenges, dealing with source pathogen loads where ‘crap inside the gate’ can arrive in the water that our communities drink.

This will include a range of approaches, from the implementation by councils of suitable land management rules to

EVERYTHING IS CONNECTED. ANIMALS ARE CONNECTED TO PEOPLE VIA WATER. THERE ARE A SERIES OF CRITICAL CONTROL POINTS FROM ‘THE SOURCE OF THE CRAP RIGHT THROUGH TO THE TAP’.

reduce pathogen connectivity to receiving waterbodies, to better freshwater bottom lines (E. coli concentration in our surface waters, for instance) – right through to the end user with better water treatment, monitoring and infrastructure for receiving communities.

Everything is connected. Animals are connected to people via water. There is a series of critical control points, from ‘the source of the crap right through to the tap’, and this means working collaboratively with a multidisciplinary approach, with the origin of this work starting inside the farm gate.

Our own veterinary profession is key here. Through education, prevention, management and a reduction in the sources of zoonotic diseases at source, we can also help our farmers to minimise the risk of diffuse pathogen loss from farms and across landscapes.

FEATURE

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PHOTO: ISTOCKPHOTO.COM

FEATURE

With growing concerns about the commoditisation of veterinary medicines and third-party traders, the NZVA wants to raise the bar on sustainable stewardship.

Bette Flagler reports.

IN THE PAST five years, shares in NASDAQ-listed PetMed Express (trading as 1-800-PetMeds) have increased from $6.96 to $20.37. The current year-to-date return is 18.84%. It’s enough to make an investor giddy.

But it should also be enough to make us pause. Roughly 40% of PetMed Express’s income comes from the sale of prescription medications, including heartworm preventatives, treatments for arthritis, thyroid disease and diabetes, pain medications and antibiotics.

And PetMed Express is just one player in the commoditisation of veterinary medicines in the US. In addition to online sales of veterinary medicines, pharmacies in big stores are into the act. Walmart has even launched its own generic heartworm preventative.

Livestock and equine are in the game too. With a few clicks on any number of sites, anyone can order antibiotics and vaccines. Fancy a trip to town? Rock up to the local farm supply and fill the truck with just about any veterinary medicine imaginable (though most states still require rabies vaccinations to be given by a veterinarian, technician or nurse).

The selling points are convenience and cost savings. The risk? No oversight or stewardship of veterinary medicines.

You might say things have got a little out of hand and, in light of the National Action Plan for Combating AntibioticResistant Bacteria released by the White

House in March 2015, you definitely might wonder how that country is going to rein it back in. The plan includes five overarching goals, the first being to “Slow the emergence of resistant bacteria and prevent the spread of resistant infections”. Along with implementing stricter use and oversight of antibiotics for human health, two actions under this goal are: Eliminate the use of medically important antibiotics for growth promotion in food-producing animals, and bring other agricultural uses of antibiotics for treatment, control, and prevention of disease under veterinary oversight.

Identify and implement measures to foster stewardship of antibiotics in animals.

Good luck to them, but it does feel that they are on the back foot. Thankfully, that’s not the situation we have in New Zealand.

“We have a much stricter environment and that’s something we should absolutely foster,” says NZVA Head of Veterinary Services Callum Irvine. “We should be incredibly proud of what we have and we also need to be incredibly protective.”

Product stewardship is one of the NZVA’s key strategic outcomes for the

next 18 months. President Caroline Robertson says that, among a number of aspects, the association wants to work with veterinarians and stakeholders to get alignment on what sustainable stewardship looks like.

Irvine argues that we need to raise the bar. “We’re at a very critical point in the global environment around the use, prescribing, dispensing and stewardship of antimicrobials and other veterinary medicines,” he says. “We’ve got a pretty good environment here in New Zealand; it’s highly regulated with rules in place.

But we need to tighten it up. More than ever, the veterinary community and profession must play a greater role in not only prescribing and dispensing these drugs, but in auditing and monitoring their use on farms. We need a big conversation around stewardship and it needs to happen relatively soon.”

Why the urgency? In part, because our international trading partners are beginning to require more verification and auditing of food provenance, and also because we are in the middle of a perfect storm. Not only are we in the midst of a dairy downturn, but we are seeing online and third-party behaviour that threatens the profession’s ability to manage veterinary medicines.

“When the ACVM requirements changed to allow third-party traders and online pharmacies, the knee-jerk reaction was about lost business and what

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FEATURE

challenges that might represent for the profession,” says Irvine. “Initially, much of the activity was around companion animals. Clients were offered medications and over-the-counter products like worm and flea treatments online. The veterinary profession was really worried about the effect that would have on businesses and how the model would have to change to cope with that.

“The penetration into the market hasn’t been as significant as vets thought it might be. There wasn’t this rush of clients going out to buy their medications from a third party, because it is slightly more awkward to do and many, many people had fundamentally relied on the relationship they had with their vets.

“But over time, the penetration of third-party traders has shifted to being much more competitive in the production animal space, particularly around some fairly big items like dry cow therapy.”

An outsider may think it’s a great idea to have more products available cheaply online and that it makes sense for farmers to seek out the lowest cost for expensive items, particularly when they are faced with an unstable or depressed economy. But here’s the deal: third-party traders make their money by buying in bulk, selling for less, and treating veterinary medicines like a commodity.

“Commoditising veterinary medicine is a dangerous thing to do, and countries that have gone down that pathway are desperately trying to get back,” says Irvine, pointing to the US action plan.

“Antimicrobials shouldn’t be traded around the rural community for the best price. We need to recognise that they are a valuable product, that there are real concerns about their usage and real impacts around getting that usage wrong.”

Through the veterinary authorisation process, farmers in New Zealand are able to hold a significant number of veterinary medicines to use as and when needed. It’s a privilege that is not always replicated in other countries. The veterinary profession, says Irvine, has a key role in ensuring that the farming community recognises this.

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Veterinarians providing oversight is critical to stewardship and reinforces the importance of the relationship between the veterinarian and farmer. But that relationship can be challenged if a farmer buys veterinary medicines through a third party. If, for example, a client buys from a third-party trader, will the prescribing veterinarian be able to maintain stewardship over those medications? The veterinarian will have no control over how the products are handled prior to their reaching the farm, and how can they be sure that farmers are using and storing the products appropriately?

“There is a lot of pressure put on veterinarians to relax their product stewardship or really not to be given

“WE SHOULD BE INCREDIBLY PROUD OF WHAT WE HAVE AND WE ALSO NEED TO BE INCREDIBLY PROTECTIVE.”

the opportunity to provide product stewardship,” says Robertson.

A large part of the NZVA project will involve how to improve on-farm management of medicines and addressing concerns introduced through the use of third-party suppliers. The work plan currently being developed is board driven but will likely sit within Irvine’s responsibility. It will, however, be a whole-of-profession project, working closely with the SIBs and relying on the expertise of veterinarians in the field to ensure that any tools, templates and guidelines produced are practical for veterinarians at the coalface.

The project aims to develop standards of product stewardship across the different classes of drugs and for the various species.

To do so, it will consider New Zealand’s present prescribing and dispensing environment and what is needed to ensure a safe and well-managed environment for veterinary medicine and use in the future.

PHOTO: ISTOCKPHOTO.COM

FEATURE Caroline Robertson

Aside from the desire to deliver the very best animal care, the motivation for change is ultimately being driven by the end users. “Consumers are demanding food that they can trust,” says Robertson.

“There’s an assumption that when people buy New Zealand food there is a very high level of veterinary oversight. The reality is that the regulatory environment we work in is actually quite light-handed compared with, for example, Scandinavia.”

Robertson is not convinced that people who buy our primary products understand the overview veterinarians are able to provide, and argues that this risks being exacerbated by online behaviour leading to commoditisation of veterinary medicines driving prices down.

It’s not what we want for products that should be elevated in position, she says.

“If we’re going to survive, we need to achieve in high-value global markets. We all need to work towards ensuring that the provenance story is true and that food quality and integrity is absolutely number one in New Zealand. We are protecting NZ Inc and expect to work with the

PHOTO: VIVIENNE HALDANE

“THERE IS A LOT OF PRESSURE PUT ON VETERINARIANS TO RELAX THEIR PRODUCT STEWARDSHIP OR REALLY NOT TO BE GIVEN THE OPPORTUNITY TO PROVIDE PRODUCT STEWARDSHIP.”

ACVM, VCNZ, dairy companies, meat companies, farming companies, and the food and pharmaceutical industries. We all need to have a stake in this and we all need to find alignment.”

Irvine agrees. “Our trading partners now come and look at the way we manage our on-farm environment. They’re not just worried about the animal once it turns up at the processing plant or that it’s free of TB. They’re going out to farms, auditing how things are actually done, and that can include everything from animal welfare to how veterinary

medicines are held on farms and under what circumstances they are used. So there’s a real opportunity for us as a profession to grasp this and raise the bar.

In doing so we do a better job, and that’s important for everyone.”

A timely example of the new wave of stewardship is the provision of analgesia at disbudding required under the new Animal Welfare Amendment Act 2015.

How will it work for every calf in the country to get local analgesia for a painful procedure like disbudding? How can New Zealand responsibly ensure that industry needs are met, but also that the veterinary profession is able to provide stewardship around the prescription, dispensation and use of the drugs?

“Doing an exemplary job of product stewardship must be high on our list,” says Irvine. “It’s a privilege to not have a substantially deregulated environment.

But that privilege is also the reason we are encumbered to do a really good job in every case and to emphasise the importance of stewardship of veterinary medicines in this country.”

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AT THE INTERSECTION

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PHOTOS: AMANDA TRAYES

AT THE INTERSECTION

A HIGHLY INVENTIVE

VET

A Waikato veterinarian is showing the way on animal wellbeing with an innovative on-farm device.

Andy Allison reports.

TIRAU VETERINARY CENTRE’S website, with a whiff of intrigue and understatement, says that Ursula Haywood is “inventing a gadget to help calves and cockies in spring”.

This ‘gadget’ was launched at this year’s National Agricultural Fieldays at Mystery Creek and it’s already being licensed for distribution in Australia, Mexico, Europe, the US and the UK. Haywood sold 800 in three days, and was so busy she “didn’t get to the bathroom until four in the afternoon”, she says. “I had no idea there would be this response. It was crazy.”

And the reason for all the fuss? After two years of research and trialling, Haywood has launched the Antahi Trusti Tuber – a replacement for the traditional calf tube feeder, addressing the tendency to damage the larynx and oesophagus and upset the animal.

“Many farmers dread having to use the tube,” she told NZFarmer prior to Fieldays. “It became my mission to produce a product that was kinder and safer to the calf. Tube feeding calves used to be unpleasant for farmers and

uncomfortable and distressing for the animals. Poorly designed equipment combined with sometimes dodgy onfarm techniques and lack of operator understanding can make the procedure difficult and dangerous.”

With the strapline “kinder, easier, safer, faster”, it’s claimed that the Trusti Tuber achieves an 88% reduction in the visible signs of stress, halving average feeding times as a result.

With guidance from Massey University, calves were tested using the Trusti Tuber and a traditional feeder to understand differences in heart rates, kicking and vocalisations between the two groups. Those fed with the Trusti Tuber averaged 1.6 kicks/vocalisations per feed, compared with 14.1 kicks/ vocalisations for the traditional feeder.

Heart rates were monitored pre- and post-feeding, with an increase of four beats per minute in the Trusti Tuber-fed calves, compared with an increase of 34 beats per minute in the rigid tube-fed calves.

The Trusti Tuber minimises the chance of the tube entering the airway, and the soft, flexible tube is guided easily around

and through the delicate tissue to the oesophagus with a syringe-like motion.

A guard sits against the muzzle and farmers can either hold it themselves or there is a strap option for securing the mouthpiece in place. A four-litre bottle with flow valve removes the need for frequent refills.

The flow valve is the only part of the product not made in New Zealand; the rest is made locally in Hamilton.

“A lot of people have asked if we’ve thought about manufacturing in China, but there are so many benefits in being close to the manufacturer,” she says.

Another big advantage is the manufacturer’s experience with other products. “They’ve been invaluable with contacts and advice on how not to waste money. They’ve seen a lot of people spend all their money on tooling and intellectual property costs, leaving not enough for commercialisation.”

The biggest thing that Haywood has learned in the product development, IP protection, marketing and distribution process has been the importance of working with the right people. “We’ve been incredibly lucky finding so many people who want it to work and who have offered such good advice, saving us large amounts of time and money.”

Among them are farmers, whose feedback has led to several refinements, including a teat attachment and practical design features such as a larger bottle handle for farmers’ big hands.

Haywood says she’s been pleasantly surprised by how motivated dairy farmers are to do the right thing for their animals. “I’ve had so many comments about the anxiety they’ve felt, and about the confidence that we’re doing the right thing for them and their animals.

“I was surprised to find that I took my knowledge of calf anatomy for granted,” she adds. “A common misunderstanding is that the oesophagus lies below the airway, leading to technique issues.

Sometimes simply explaining how the throat looks and how swallowing works helps people to understand how they can improve their technique.”

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AT THE INTERSECTION

“THE FACT THAT IT WAS DEVELOPED BY A VET AND IS ONLY DISTRIBUTED BY VETS MAKES A DIFFERENCE. VETS ARE PROBLEM-SOLVERS AND THIS IS AN EXTENSION OF WHAT WE DO EVERY DAY.”

Haywood’s husband Mark, an Agribank manager, is a convert.

“He’s probably a bit more risk averse and I am more of a risk taker, so we balance each other pretty well.

He brings a lot to the table from the commercial side. When he experienced the difference for himself and saw the reaction from farmers using it, he got really, really excited. He said, ‘Wow that’s amazing – you’re not wasting your time here.’”

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Another of her product innovations has been covers for young calves. (The ‘Thermoo’ is featured on her website www.antahi.com.)

Haywood is also considering a feeder for lambs, although it’s a smaller market and needs careful consideration.

There might be other ideas in the pipeline too, and she’s confident the lessons learned from developing the Trusti Tuber will stand her in good stead.

“There was a lot more to it than I

thought and it’s been a steep learning curve. When I look back, I think that starting off naïvely was a blessing in disguise.”

Haywood describes the veterinary community support as “excellent” and, despite being approached by other retailers, wants distribution to remain vet only. She has had particularly strong support from SVS Veterinary Supplies.

“The fact that it was developed by a vet and is only distributed by vets makes a difference. Vets are problemsolvers and this is an extension of what we do every day.”

So is she first and foremost an inventor or a veterinarian? “I think I’m a vet who’s learned how to be an inventor. As a vet you’re always looking for better solutions, and this problem came along at the same time as my ‘seven-year itch’.”

She thinks she may have scratched it. “I guess seven years [in practice] is a point where you wonder about a lot of things. Most people get it, and they battle through it or make a change and it passes.

“This [developing the Trusti Tuber] has helped me and added extra variety in the week. It allows me to make a bigger difference than I can make in clinical practice alone.”

The timing seems to be good from another perspective. “There’s a lot more talk now about what’s acceptable and what isn’t about animal wellbeing. That’s as it should be. The SAFE debacle had some benefits because some people have been getting away with things they shouldn’t be, putting a shadow on those who are doing a good job.”

Curiously enough, the Trusti Tuber has also benefited from an animal that has precious little to do with calves.

Unable to find a stuffed calf large enough to demonstrate the product at Fieldays, they made do with a stuffed zebra. “That made people laugh and it ended up being a good marketing tactic,” she says.

Perhaps there’s an idea here: next gadget, a tube feeder for baby giraffes?