N.Z. Veterinary Nurse Journal March 2019

VOLUME 25 No. 89 MARCH 2019

What’s your brand?

Mass removal on a goldfish Pemphigus foliaceus in dogs Keeping drugs safe

NZVNA

ANNUAL

CONFERENCE

14th – 15th June 2019 Heritage Hotel, Auckland Registration and accommodation details can be found at: www.nzvna.org.nz

CONTENTS

04

VO LUME 2 5 No. 8 9 MA R CH 201 9

05 EXECUTIVE COMMITTEE OFFICERS

06

President Julie Hutt PO Box 35831 Browns Bay Auckland 0753 021 599 059 president@nzvna.org.nz

07 08

Vice-President Amy Ross 021 852 664 vicepresident@nzvna.org.nz

10

Treasurer & Membership Secretary Kathy Waugh 021 843 277 treasurer@nzvna.org.nz

11 12

National Secretary Luanne Corles 027 472 1072 secretary@nzvna.org.nz

17

17

JOURNAL EDITOR Antoinette Ratcliffe journal@nzvna.org.nz Assistant Editor: Catherine Taylor catherine.ellen.taylor@gmail.com

EDITORIAL BOARD Exotics: Kylie Martin Equine: Lyn Hobbs OSH: Libby Leader CPD: Christina Searle and Patricia Gleason

COVER: ‘Biggy’ by Hayley Bradshaw

NZVNA FORMS The registration or list badge order forms, merchandise order forms and new membership forms can now all be found on the website www.nzvna.org.nz or by emailing membership@nzvna.org.nz

The New Zealand Veterinary Nursing Association would like to thank Hill’s™ Pet Nutrition NZ, our gold sponsors, for their continued support of the NZVNA and the veterinary nursing profession.

21 23 30 32 34

Letter from the Editor

by Antoinette Ratcliffe

Membership Secretary report

by Kathy Waugh

Executive Committee update Fiona Hastie

Mushroom toxicity New Zealand Companion Animal Register update by Nygllhuw Morris CPD corner: What’s your brand?

by Patricia Gleason

Increase your word power Mass removal on a goldfish

by Hayley Bradshaw

A TRoo Story – part one

by Cindy Paton

Managing compassion fatigue in our clinic by Zoe Hyett Pemphigus foliaceus in dogs

by Ellie Clark

Conference research posters

by Laura Harvey

Keeping drugs safe by Seton Butler Book review by Amy Ross

OUR VISION Caring for our community by promoting excellence in animal healthcare.

DISCLAIMER The New Zealand Veterinary Nursing Association Journal is published by the New Zealand Veterinary Nursing Association Incorporated (NZVNA).

The views expressed in the articles and letters do not necessarily represent those of the NZVNA or the editor, and neither the NZVNA nor the editor endorse any products or services advertised. The NZVNA 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 any legal responsibility for the truth or accuracy of the information contained herein. Neither the NZVNA nor the editor accepts any liability whatsoever for the contents of this publication or for any consequences which may result from the use of the information contained herein or advice given herein. The provision is intended to exclude the NZVNA, the editor and its staff from all liability whatsoever, including liability for negligence in the publication or reproduction of the materials set out herein.

24

NZVNA

Letter from the Editor Photograph by Amanda Ratcliffe

This summer I’ve spent a lot of time out doors. One of my favourite trips was to Matiu/Somes Island in the Wellington harbour. Our day on the island started in a small biosecurity hut where a DOC ranger explained the islands native ecosystem and it’s cultural significance to local iwi.

After inspecting our bags for predators and harmful plant matter, we headed up to the top of the island, laptops in tow, for an outdoor studio day. This was also the day that the SPCA announced that they wanted to ban the use of 1080.

Spending the day on Matiu/Somes Island with an entomologist, who has a passion for native flora and fauna meant that the discussions were insightful for both of us.

For example, when the discussion turned to feral and unmanaged unsocialised stray cats (and an opposition towards cat colonies), I was able to talk about the New Zealand National Cat Management Strategy Discussion Paper published by the NZCAC in September 2017, and how supporting bodies, including DOC, had contributed to its creation.

This encouraged me to think about my own stance on this, as a cat lady, a taxidermist, someone who has been trolled by an anti-1080 activist, and a veterinary nurse.

As veterinary nurses, I’m sure we agree that all animal life should be valued equally (the reason why you see a variety of species in the journal articles), and

| Above: Cece enjoying her holiday naps

4 March 2019

that any animal suffering is unacceptable.

The paradox for us lies in opposing what scientists state is the only effective means to stop predators in our forests. This would allow these predators to continue to kill our mostly defenseless wildlife - again, causing animal suffering, that is, until a better option is found to be as effective. This puts us in a unique position, and potentially one that could help bridge the gap between the two opposing sides of this argument.

I encourage you, when faced with these conversations that are usually heated, to educate others on the work of our supporting bodies like the New Zealand Companion Animal Council, and local council legislation. Research, and find your own position in the argument, and have your opinion ready to be challenged.

Forest and Bird have since met with the SPCA, but at the time of this journal going to print, the SPCA have not yet published their clarified stance.

In the spirit of ‘all creatures great and small’, I hope you enjoy reading Hayley Bradshaw’s article on goldfish mass removal, Ellie Clark’s case study on Pemphigus Follaceus, and Cindy Paton’s article on the challenges she faced when she adopted her dog Roo. And as always, if you have an idea for an article, please email me at journal@nzvna. org.nz. I’d love to read about your ideas.

Antoinette

NZVNA

Membership Secretary report If you have gained voluntary registration this year and want to purchase a badge, these are available on our website until the end of March. As they are engraved with your individual registration number, the expected delivery date is two to three weeks from time of purchase.

Don’t forget to upload proof of hours together with your CPD certificates this year; we had to chase a lot of members who forgot to upload documentation in 2018. The more help we get from our members, the quicker the register will be published.

A reminder also that if you have a change of address, please send me an email or

change it yourself on the website. To do this log in and go to Membership, and click on Manage my Account.

If you are not getting regular emails from us then perhaps we do not have your email address. You can add this in the same way through Manage my Account Kathy

March 2019 5

NZVNA

Executive Committee update It’s January 2019, and sitting here as I open my computer and tap the keys to write this, it certainly is summer; with heat in the sun and time at the beach an essential.

Once again it feels like the new year has so much to offer.

All over social media I’m seeing the #10yearchallenge with photographs of people and places and how they’ve changed in the last ten years. It makes you think about what has changed in the last decade, both with myself and my family, as well as in the world. A little over ten years ago, I was a new member of the NZVNA executive committee, committed as a (younger) veterinary nurse that I wanted to give back to the community that had served me so well. Funnily enough the beginning of my time with the NZVNA was about ten years after I’d graduated and started the more formal part of my career in this wonderful industry.

Where were you ten years ago? Maybe you were just starting out your career as a veterinary nurse, or considering what subjects to focus on at high school leading to a role in this industry. Or perhaps you were in a clinic with a family pet chatting to a wonderful veterinary nurse and an early love of animals was starting to burn in you. Or maybe you were one of the amazing early leaders in this field, striving towards what we see as ‘normal’ today because of the hard work and foresight of those that came before us.

It’s nice sometimes to reflect on how far we’ve progressed with our careers, whether that be with education, skills, how we’ve helped others grow, experience gained, or diversity within our roles. What have you done to progress from the 2009 veterinary nurse version of yourself, to the 2019 version? Who has helped you on that journey? What did you learn from and contribute to in some of your favourite teams? What were some of those standout moments? The ones you might remember fondly, or perhaps would rather forget, but served as an excellent learning experience?

6 March 2019

I reflect on the last ten years of my time with the NZVNA, including the wonderful executive members that have spent countless hours of time and effort to make this association better for all.

Most recently I’ve been heartened to see over 600 members willing to complete continuing education; submitting records of nursing hours and qualifications to support their own registration when we reviewed the 2018 register. While this is a large time commitment for those involved, it’s so positive to see many motivated veterinary nurses out there wanting to be recognised. For me that certainly is an amazing achievement for the executive committee and one that is far from over.

“Are you on the way to following a passion into an area of study you might not have considered before?”

Now that you’ve considered where you’ve come from, it’s a great opportunity to consider where you are going. Are you on the way to following a passion into an area of study you might not have considered before? Perhaps an opportunity in your practice has come up to develop an area of the business to increase turnover? Have you recently recruited a new graduate to your practice and you’re committed to helping them grow into a capable and talented member of the veterinary community? Are you focused on a work life balance? Are you looking after yourself and others’ well being in your clinic? Or is it as simple as the commitment to retaining your registration, publicly showing your pledge to this industry?

Whatever your goal is, you’ll be better for having achieved it. This year, and the next ten years are all ahead of you. How will you look back on 2019 when you’re reflecting in 2029? Make it something you’re proud of.

Fiona Hastie

VETCHECK

Mushroom toxicity © Luke Feldman Group Pty Ltd All rights reserved

Many mushroom species are toxic and some are not. But, as there is no proven way to know, it’s best to avoid them altogether.

Overview Mushroom toxicity occurs commonly in late spring to autumn when pets spend time outdoors, particularly in bushland.

Wet, warm weather is ideal for mushroom development. When environmental conditions are right, mushrooms can pop up overnight. Dogs are natural explorers and scavengers so they are at highest risk of mushroom toxicity.

Signs When ingested, mushrooms can cause illness within 2-24 hours.

Toxicologic classification of mushrooms Cyclopeptide toxin Found in Amanita spp (death caps, death angels, deadly agaric) & Galerina spp Causes liver failure, 6-20 hours after ingestion Muscarine toxin Found in Inocybe, Clitocybe, Panaeolus, Mycena spp Causes muscarinic signs such as salivation, increased tears, urinating and diarrhoea, dilated pupils and slowed heartbeat Psilocybin and psilocin toxin Found in Psilocybe, Panaeolus, Copelandia, Gympnopilus, Pluteus (magic mushroom) Causes dysphoria, hallucinations Monomethylhydrazine toxin Found in Gyromitra spp (false morels) Causes neurological symptoms Isoxazole Found in Amanita spp Causes psychoactive symptoms Orelline and orellanine toxin Found in Cortinarius spp Causes acute renal failure

Common signs of mushroom toxicity: • Vomiting • Diarrhoea • Abdominal pain • Jaundice • Liver failure • Death If you suspect your pet has been exposed to mushrooms, contact your veterinarian immediately. Your vet may also ask for the mushroom to be brought in for analysis.

Causes Although only 1% of mushrooms are fatal, it is difficult to identify these from the nonharmful ones. So, all mushrooms should be deemed poisonous until proven otherwise.

Prevention It is best to assume that all wild mushrooms are toxic to pets.

To help prevent mushroom ingestion: • Remove any mushrooms from the yard immediately • Keep your pet on a leash when walking • Train your pet to come and stay so you can direct your pet away from any mushrooms Disclaimer Content is provided for informational and educational purposes only. The information is not a substitute for professional health or other advice and is in no way intended to be used or relied upon to diagnose or treat the health condition of any animal, or as a prognosis of any health condition.

Always seek advice or consult a health or other appropriate professional before relying on any information provided.

Source VetCheck digital pet health summaries, handouts and forms. To add your practice logo and start sharing directly to the pet owner’s mobile phone, visit www. vetcheck.it. Pet owners can now store their veterinary health record, receive pet reminders and get curated pet news at www.petcheck.it.

March 2019 7

MICROCHIPPING

New Zealand Companion Animal Register update: our most commonly asked questions

By Nygllhuw Morris Manager – Animal Register Limited

It is recognised that that there are variations in clinic policies regarding the microchipping and registration process.

Likewise what happens when a missing or stolen pet is presented at a veterinary clinic also varies greatly between clinics.

This last scenario is currently being reviewed by the NZVA with the goal to create a process for clinics to follow.

Feedback and case studies have been supplied by the NZCAR. More details will be circulated as soon as they are available.

What is the most important information?

All the details on the form are necessary to ensure the best chance of the pet getting home when lost. Please check all details carefully. The email is very important as this is how owners will keep their details up to date.

While these discussions are happening, it is a good opportunity to refresh yourself on the microchip registration process.

Below are some of the most common questions the NZCAR are asked by implanters.

Can I update details for a microchip?

Registered users with implanter status can update contact details on the NZCAR. NO CHANGES CAN BE MADE TO A RECORD WITHOUT THE LISTED PERSONS CONSENT. The only exception to this rule is where pets have been legally rehomed.

Can I microchip an animal and get the owner to register later?

The NZCAR does NOT recommend microchipping only. Found animals that are not registered are less likely to get home.

Do I need to scan an animal before implanting?

Yes, it is essential that an animal is scanned before chipping. We also recommend a scan with every visit to ensure the chip is still working properly.

Nygllhuw (Nigel) Morris is the Manager of the NZCAR. Before finding a role helping lost pets Nygllhuw worked in town planning and IT, as well as holding a number of community positions. He currently owns two IT companies. His passions are his family, the five precepts and “The Settlers of Catan.”

8 March 2019

Can I enter microchip forms myself?

Registered agents who have implant status can enter forms. Agents with enquiry status can only look up chip numbers. If preferred, implanters can send the registration forms by post, fax or email to the NZCAR team, who will enter them. There is no additional charge for this service.

How can I check a chip has been entered?

A list of microchips entered by your clinic is attached to each month’s invoice. We recommend checking this list to ensure all chips have been added.

Can I search for a microchip?

Anyone can see if a microchip is already registered in the NZCAR by clicking on the CHIPCHECK button on the home page of www.animalregister.co.nz.

Can an owner update their own details?

Yes, if the email has been provided at registration. Or they can call NZCAR during office hours to update their record.

Owners with a valid email are now advised annually to check their details are up to date.

What do I do if a pet is NZCAR registered and the chip has failed?

The NZCAR can hold three chip numbers for each pet. To have the second number added simply email the NZCAR team with the old number, new number and the owners name – We will then follow up to ensure the record is updated.

Are microchips also GPS trackers?

No they are not. Microchips offer guaranteed animal identification – not GPS tracking.

For more information or to ask your own questions contact the NZCAR team at info@animalregister.co.nz, or call 0800 LOSTPET (567873).

Non-staining Non-staining Non-irritant Non-irritant Non-toxic Non-toxic

e in 10 litre Now concentrates! available in 10 litre concentrates!

best Are your protection? clients getting the best protection?

• Safe4 does not contain harmful phenols, alcohol or aldehydes ols, alcohol or aldehydes • Safe4 is non-toxic, non-staining, non-tainting and non-irritant in diluted form -tainting and non-irritant in diluted form need to sluice awaySafe with water after application. while Safe for animals while surfaces wet ter• No application. for animals surfaces areare wet • Water based and biodegradable • Manufactured in the United Kingdom and efficacy tested UK by recognised UK laboratories and efficacy tested by recognised laboratories

s,The zoos, productkennels of choice for vets, and zoos, catteries kennels and catteries worldwide worldwide

March 2019 9

www.safe4all.co.nz www.safe4all.co.nz o@safe4all.co.nz 0800 723 347 4info@safe4all.co.nz

CPD CORNER

What’s your brand?

By Patricia Gleason Dip. VN

In our fast-paced, continually changing world, it is becoming increasingly important to promote ourselves in the right way to leverage the career growth and pathway we desire. This selfpromotion is our reputation; also known as our personal brand.

Personal brands A personal brand is the overall impression people have of you; a package summing up and communicating the essence of who you are. It is a mixture of people’s perceptions of your knowledge, skills, abilities and your image, both physical and social.

Personal brands are powerful; they are the image of what you stand for, what is immediately conjured in people’s minds when your name is said - think Beyoncé, Oprah, Ellen or even Elvis. Personal brands are also how you can differentiate yourself and make yourself memorable; they are a way to establish and reinforce who you are and what you stand for in both your career and personal life.

Your brand as a patient caregiver relates directly to the quality of your skills and level of patient care you provide. You can build on this brand with additional skills, such as through your continuing education and development, by contributing publicly to the profession through articles in The New Zealand Veterinary Nurse journal or speaking at conference, as well as being consistent in how you perform and behave.

After a career in biodiversity conservation, Patricia completed her Diploma of Veterinary Nursing (Distinction) at Massey University and worked at veterinary clinics in the Bay of Plenty and Waikato before becoming a veterinary nurse educator. She is a founding member of the AVPRC. She now works in a learning and development role coaching staff and teams in the education sector.

10 March 2019

Why have a personal brand?

Many of us think our work speaks for itself; assuming that if we work hard, the quality and impact of what we do on a daily basis will be obvious to others. But career accomplishments may not count for much if no one knows about them. Within the veterinary industry, there remains significant inconsistency in how veterinary nurses are viewed and valued, so personal branding may be even more important for some who need to gain more visibility for the work they contribute.

If we effectively create and communicate our personal brand, people learn to associate us as the go-to person for specific things. When I was in practice, I loved anaesthesia and continually tried to learn more and more. I remember the first time one of the veterinarians I worked with was vocal about scheduling me for a surgery that would be a very high-risk anaesthetic due to the level of trust she had in my ability. It was a great feeling to be recognised and valued in this way.

A recognisable personal brand is a way to create the vision for your future and open the door to new professional opportunities.

This might be in the form of a better job, recognition within the industry or even better contacts with clients which benefit your clinic or company. Your brand helps you establish who you are, what makes you different from others and how you contribute and bring value in a way no one else can. It is a way to shift people’s perceptions of you which may be limiting your career.

How to develop a personal brand There are some easily accessible resources that can walk you through planning, developing and maintaining your personal brand (refer to the Patel and Aguis resource for a good starting point). The basis of a personal brand is knowing yourself and being authentic.

It requires identifying your core values, understanding your career and life goals, and determining how you want to be known. This requires some reflection and deep engagement with those close to you to create your ideal brand and compare it to your current reality, i.e. how are you actually seen. If there is a gap between how you want to be seen and how others see you, you will need to honestly consider the behaviours that make people think of you as something other than your ideal.

Consider what ability do you want to be known for? What areas of specialty do you have and how do you want them to be applied? What are your strengths and how

CPD CORNER

do you want to use them? Be passionate and believe in your personal brand, because if you don’t, why should anyone else? Your passion will make you stand out and when opportunities come up in your niche, people will automatically think of you.

Do whatever you can to invest in your brand, particularly in the beginning. Find ways to remind yourself that your daily actions need to align with your brand AND not contradict it - this includes your actions at work, outside of work, online… anywhere they will be seen by others.

As a veterinary professional, your use of social media can impact your personal brand. Maintain a critical awareness of your online presence and how that can be viewed by others. Remember employers and clients use the internet and social media too, and no matter what filters and privacy settings you use, once posted online, nothing is ever truly deleted. Be thoughtful and considered in your use of social media, maintaining respect for how it can elevate or harm your personal brand and long-term career. This includes awareness of your posts as well as those who you reply to, people you are friends with and follow.

Over time, people will equate you with the brand you have developed, keeping in mind that once created, your personal brand is not permanent and set in stone.

It should grow as you do, so that your personal and professional growth is reflected in it.

Conclusion The key to developing your career is to reframe your self-image from merely an employee, to one of CEO of your own business, where the essential service being offered is you, and your primary goal is ensuring your business thrives.

Everything we do either strengthens or dilutes the personal brand we are trying to create. Take control of what others see and remember about you by developing a personal brand which is authentic to you, matches your values and ensure every action you take aligns with that brand to set you apart as the unique and talented individual you are. Focus your professional development on those things which will help you achieve your long-term vision and reinforce your brand.

Personal branding takes time, effort, and energy. However, without the investment in developing your own personal brand, you will end up being branded by others and this may not align to the professional you want to be. Once you have developed and refined your personal brand, it will feel like a superpower and you’ll wonder how you existed without it.

Resources Campbell-Avenell, Z. (2016). Drop

everything and read this guide to personal branding. Career FAQs. https://www.careerfaqs.com. au/news/news-and-views/ personal-branding-guide Carlson, K. (2019). Protect your nursing brand on social media. Nurses USA. http://nursesusa.org/article_protect_ your_nursing_brand_on_social_media. asp Colon, R. (2013). Promote your nursing career like a business. Lippincott’s 2013 nursing career and education directory, 43: 1, p.7-9. Retrieved from: https://www.nursingcenter. com/journalarticle?Article_ ID=1493951&Journal_ID=54016&Issue_ ID=1493946 Liu, J. (2018). 5 ways to build your personal brand at work, Forbes, https://www.forbes.com/ sites/josephliu/2018/04/30/ personal-brand-work/#6ba4739f7232 Patel, N. and Agius, A. (2014). The complete guide to building your personal brand. Retrieved from: https:// www.quicksprout.com/the-completeguide-to-building-your-personal-brand/ Shama, H. (2014). 7 Things you can do to build an awesome personal brand. Retrieved from: https://www.forbes.com/sites/ shamahyder/2014/08/18/7-things-youcan-do-to-build-an-awesome-personalbrand/#28b78be3c3a4

Increase your word power All definitions are from the Dictionary of Veterinary Nursing (2nd edition), D. R. Lane and S. Guthrie

Bacteriostatic

Friability

Pathogenicity

Polydipsia

Proprioception

Tetracycline

Preventing the growth or increase in numbers of bacteria Brittle, crumbling The ability to cause disease Increased thirst; common clinical sign and often associated with polyuria. The causes include dehydration, hyperthermia, restricted access to water, diabetes insipidus, diabetes mellitus, renal disease, liver disease, pyometra, Cushing’s disease, Addison’s disease, hyperthyroidism, etc The sense of spatial awareness and limb positioning Broad-spectrum, bacteriostatic antibiotic; may sometimes cause yellowing of teeth if given to immature animals March 2019 11

GOLDFISH SURGERY

Mass removal on a goldfish

By Hayley Bradshaw RVN, Pet Doctors, St Lukes

Biggy is a 12-year-old fantail goldfish of unknown gender (hereby referred to as a female) that presented with a large skin mass.

History Biggy has lived with her owners since she was small in an indoor tank with one other, slightly smaller goldfish. The tank is 100L of freshwater with a filter and heated to 25°C. Tank maintenance includes a weekly 60% water change with rainwater. Both fish are fed generic goldfish pellets, peas and cooked spinach. She weighs 140g.

Biggy has had a previous history of fin rot and intermittent buoyancy issues over the past four to five years, but no other current medical concerns.

The flank mass began as a small nodule and treatment was attempted with salt and antifungal treatments two months previous. Over three months the mass has grown to its current size.

Examination Upon presentation at the clinic, Biggy had old scarring on the tips of her fins, bilateral slight opacity of the eyes and an occasional tilt when swimming. The mass was located on her right lateral flank/ chest; irregular in shape, approximately 15-20mm in diameter, and attached to the body by a short stalk along the rostral edge.

Hayley has been a senior exotics veterinary nurse at Pet Doctors St Lukes and Exotics for the past four years. She is also qualified in captive wild animal management.

Hayley has a special interest in chinchillas and owns two: Ardie (three-legged rescue) and Keela who live alongside her three cats Bella, Zac and Elfy. Her other clinical interests include anything weird and wonderful (the less common the species or condition the better!), unusual or complicated surgeries, medical ICU cases and anything neonate or pediatric!

12 March 2019

Differential diagnoses were given as swim bladder disease (a gaseous disease for the buoyancy issues), neoplasia, or infection of the mass.

Plan The owner was offered radiographs to assess the swim bladder and origins of the mass. A fine needle aspirate (FNA) of the mass was also offered to ascertain the kind of cells present, or excisional biopsy with histopathology. The third option offered was no testing and supportive care while monitoring quality of life.

The owners opted for the radiographs and excisional biopsy with histopathology.

Diagnostics Conscious radiographs were performed on a mammography x-ray machine with factors placed at kV 32 and mAs of 6 and 12 then digitally processed. Two views, ventrodorsal (Figure 1) and lateral (Figure 2) were taken by removing Biggy from her travel container quickly, using polyethelene gloves to avoid damaging the slime layer that coats a fish’s scales. She was placed on a layer of glad wrap and lightly covered over with another to keep her in place for the lateral radiograph and wrapped in glad wrap and leaned against a large plastic bottle for the dorsoventral view and and immediately replaced into her travel container once the image was taken.

The radiographs were negative for any obvious internal disease and confirmed the mass to be external soft-tissue related and not connected to the abdomen.

Figure 1: Ventrodorsal radiograph view

GOLDFISH SURGERY

Figure 2: Lateral radiograph view

would not respond to tail pinching but remained breathing on her own (fish stop breathing when under a deep surgical anaesthetic plane).

As Biggy began to lose proprioception, she bumped her mass on the side of the tank causing it to bleed slightly and come loose from her body at the cranial-most aspect.

The bleeding stopped within three minutes and required no intervention at this stage.

Tank two (surgical ‘tray’, Figure 4) consisted of two small towels folded to raise Biggy up from the bottom of the surgical tray.

Surgery took place with Biggy in left lateral recumbency with the right side of her body exposed out of the water.

Treatment Biggy underwent surgery the day following her diagnostics.

A specialised anaesthesia system was set up with three tanks. All water used for each tank was conditioned with API tap water conditioner at a dose of 0.01mL per 1L, to remove chlorines and neutralise chloramines and heavy metals in the water making it safer for the fish to swim in.

Tank one (induction tank, Figure 3) contained 5L of water, aerated with an air bubbler.

The induction agent Isoeugenol, a highly water-soluble castor oil derivative at an initial dose of 0.014mL/L (0.07mL), was added to the tank. It was then mixed and allowed to disperse. An additional volume was mixed in 1mL of water. Preparing the extra portion in this way allowed for fast dispersal, as opposed to dropping the extra dose as a concentrate right next to Biggy in only one spot.

Biggy was then transferred into this tank.

An additional 0.04mL was required to get Biggy to a light surgical depth where she

The towels were pre-soaked in a small amount of the same water from the induction tank which were used as the ‘table’ for Biggy to lay on, coating the bottom quarter of the tray to provide a moist platform for her. The surgical drape was positioned in two parts with the first layer against the fish being a moist fenestrated swab placed over the abdomen, leaving the head and gills exposed. The second drape is a sterile plastic fenestrated drape covering the whole fish.

Figure 3: Biggy in her induction tank

March 2019 13

GOLDFISH SURGERY

Figure 4: Biggy in tank two, her surgical ‘tray’

The surgical site was prepared simply by wiping the area gently with swabs to remove the protective mucous coating.

Anaesthesia checklist One 200 L/hr internal fish tank filter as the main water pump, with a circuit put together using aquarium tubing, intravenous fluid line, anaesthetic connectors, 60ml syringes, and three jugs: • Jug one contained the filter/pump and isoeugenol water, initially at induction strength • Jug two contained clean, non-medicated water for adjusting of the anaesthesia depth when required • Jug three was for waste water removed from the system when adjusting the isoeugenol concentration for anaesthesia adjustment Two nurses to assist in surgery: • Nurse one was the anaesthetist, controlling the anaesthesia and monitoring the patient • Nurse two assisted to move water from the surgery tank to the anaesthesia tub keeping the water level below the midline of the fish to prevent contamination of the surgical site Anaesthetic The rest of the water in jug one, containing isoeugenol, was pumped through the filter and over the Biggy’s gills to maintain her depth of anaesthesia. It is important to note that Biggy herself was out of the 14 March 2019

simple continuous pattern. The external layers of skin and scales were left to heal by second intention.

water (but on the wet towels) for the surgery and we were careful the keep the water level below her midline so as to avoid contaminating the surgical site.

Approximately ten minutes into the surgery Biggy’s gill movements slowed, indicating a decrease in respiratory rate, and the concentration of the water in circulation was decreased by removing one third of the water containing isoeugenol and replacing it with the same volume of the ‘clean’ water. Following this Biggy returned to regular respirations of 25 breaths per minute within two minutes.

Towards the end of the surgery when the final suturing was being completed, Biggy began to react with flapping movements however, it was decided not to increase the anaesthesia at this point and the anaesthesia nurse aided in control of the patient by holding the head and tail.

Surgery The mass was very friable and as such was very difficult to remove in one piece. The bulk of the mass was able to be removed together however the attachment to the body, in the form of a stalk, crumbled when handled.

The mass seemed to originate from the fascia layer and as such a portion of this layer was removed to provide a surrounding margin.

The fascia defect was then sutured closed with 5/0 Serasynth™ suture material in a

Recovery As soon as the surgery was complete, Biggy was placed into the third tank (the recovery tank, see Figure 5) which consisted of 50% home tank water that came in with Biggy and 50% conditioned tap water with a clean air bubbler. She was aided in recovery by being supported by a gloved hand and moved around in slow circles in the tank to keep the fresh water passing over her gills to encourage recovery from the anaesthesia. After 20 minutes she was able to stay upright and swim on her own. She began eating small amounts of goldfish flakes within two hours of the surgery.

Biggy was given Butorphanol at 0.1mg/kg and Baytril at 10mg/kg as subcutaneous injections post operatively (Carpenter, 2012).

Biggy remained in the recovery tank until discharge later that evening when she returned to her travel tank.

The mass was sent to an external laboratory for histopathology.

Follow up Eight days after surgery Biggy returned to the clinic for a revisit. The owner reported Biggy had been doing very well at home, she was swimming well and eating.

The veterinarian’s assessment found Biggy bright, alert and responsive. Her surgical incision was healing well with scar tissue and the natural mucous coating filling in the defect from the mass removal. The incision was now visible only as a thin red line.

Histopathology determined the mass was a sarcoma with undefined margins due to the friability of the mass.

The future With Biggy recovered from her surgery she no longer requires revisits unless the owners have any concerns. We advised the owner to monitor the site of the original mass as we could not be sure that the entirety of the cancerous cells were removed. If the mass is to return, we plan

GOLDFISH SURGERY

to surgically remove any regrowth with larger margins.

Discussion With the anaesthetic circuit design used in this case we were unable to effectively control the flow rate of the water over the patient’s gills. This made control of the anaesthetic depth solely by the

concentration of the anaesthetic agent in the water. It also made the anaesthesia less efficient by requiring a second nurse to constantly circulate the water manually. This fast rate was not required to maintain the surgical anaesthetic plane.

Since this case study, we have modified the circuit to include an aquarium valve.

Figure 5: Biggy in her post surgical recovery tank

This has allowed us to now control the rate of water flow to the point of adjusting the depth of anaesthesia without changing the concentration of large volumes of water in a very short period.

This will also allow us to use our circuit for smaller fish in the future as we can now use a slower rate of water flow avoiding potential damage to the gills from a flow that is too fast.

We have also now added to our fish monitoring protocol heart monitoring via doppler placement (best functioning when placed on the ventral surface of the fish immediately caudal to the pectoral and pelvic fins). This allows us much more accurate monitoring regarding anaesthesia depth and patient stability.

Reference Carpenter, J. W., (2012.) Exotic Animal Formulary (4th ed.). Missouri, USA: Elsevier

Need help paying your vet bills?

Get financial assistance to cover your vet costs At VetCare Finance, we know how stressful it can be when your pet needs veterinary care you just can’t afford.

Thankfully, we offer a simple solution. VetCare Finance provides fast, easy loans nationwide with flexible repayment options, so your furry friend can get the health care they need.

Benefits of VetCare Finance • Fast application approval • Ongoing cover available • Up to 24 months to pay • Friendly, pet-loving staff • No deposit required • Beneficiaries catered for • Low setup fees • WINZ registered • Easy repayments Requirements • Identification • Proof of Address • Proof of Income

APPLY ONLINE www.vetcarefinance.co.nz or at your vet clinic Freephone 0508 738 765 March 2019 15

Gentle

monthly dosing FOR A

HAPPY dog Inside & out

The delicious chew that’s tough on fleas, ticks and worms. Not on dogs.

16 March 2019

Boehringer Ingelheim Animal Health New Zealand Limited. Level 3, 2 Osterley Way, Manukau, Auckland, New Zealand. NEXGARD SPECTRA® is a registered trademark of the Boehringer Ingelheim Group. Registered pursuant to the ACVM Act. 1997 I No. A011184 I ©Copyright 2018 Boehringer Ingelheim Animal Health New Zealand Limited. All rights reserved. NZ-18-SPE-226.

DOG BEHAVIOUR

A TRoo Story - part one

By Cindy Paton VN, Cambridge Vets Photography by Carol Howell Photography

Roo is a dog of indeterminate breeding.

A mongrel, a mutt, a cross bred with who knows what, a hybrid. I quite like the sound of owning a hybrid but maybe this comes from watching too many Twilight movies. He is not one of those designer breeds with the fancy schmancy mash up of names - Pomsky, Cockapoo, and Weeranian to name a few. He is a Tokoroa-special, pound-special, pig dog, cross-breed, mixed-breed, whatever the euphemism is that is locally fashionable for this type of dog.

This mutt of mine was picked up at five months old, a serial wanderer on the streets of Raetihi. Well known to dog control, he was eventually signed over to face his fate. I think that age was on his side and some kind hearted soul took pity on this tan and white scrap of a dog, so off to dog rescue he was sent.

Cindy Paton left school to pursue her dream of working with horses, but after six years she became disillusioned with the industry, and turned her attention towards becoming a veterinary nurse. After graduating from The Waikato Polytech in 1997 she landed her job at Cambridge Vets where she remains to this day, happily monitoring the daily dental caseload, conducting behaviour consults, and running puppy preschool classes.

He quickly became a favourite of one of the workers, Angela, who fostered him for a while. She was involved in agility, so added Roo into her mix of dogs and proceeded to take him with her to competition agility events.

This is how he came upon his first long term home. A fellow competitor, Ross, was looking for a young dog to bring to the sport and decided that Roo fit the bill.

Roo became a ‘Jaffa’ and moved to the big smoke. He lived, not always harmoniously, with Ross’s two older dogs, and was described as a whirlwind with a larger than life presence.

Ross worked hard with Roo and trained him in basic obedience with some success, worked on basic agility skills with great success but not a lot of control, and at the age of 18 months began to compete with no success.

The sport of agility is similar to showjumping with horses. Handler and dog must complete a series of obstacles comprising of jumps, tunnels, tyres, walk over obstacles and 12 weave poles in a timely and precise fashion - the fastest clear round wins. As you can imagine there are a lot of dogs that are very energised by this sport and this can make them hard to control. A wired, over-aroused dog is not able to listen and follow commands very well at all.

Roo had all the speed in the world, it’s just the precision element that needed work. A lot of work. He would leave the start line without permission in a flash of tan and white, maybe take the first jump, probably crash through the second and third, ignore the turn left command onto the fourth obstacle and barrel off course to take any and every tunnel he could find whilst barking and spinning in circles. A round as chaotic as this results in an immediate disqualification. The competitor collects their dog and leaves the ring to nurse their bruised ego and try again another day.

Many young dogs go through this over excited type of behaviour as they are learning, and with time and training they March 2019 17

DOG BEHAVIOUR

come out the other end fast and correct.

Not Roo. He is a full-on, energetic dog who reacts before he thinks. After 18 months of this, Ross decided he couldn’t cope any longer. Competition round after competition round and training night after training night, Roo repeated his routine of running off course, interrupting other dogs that were also training, doing laps of the training grounds with a goofy grin on his face and generally being a disruptive handful. I know because I tried this too when he came to live with me.

Roo was placed with another agility competitor, Susan, who had a dog that chose to ignore Roo. They lived in harmony until unfortunately, due to Susan’s ill health, Roo was again up for adoption again just two months later.

I have enjoyed agility off and on for a number of years and with two older, retired dogs, and was looking for a new dog to take on. Roo came to my attention through a colleague and long story short, he came to live with me, my husband, two dogs, two elderly cats, our chickens, a cow and sometimes sheep, on a small lifestyle block south of Cambridge two short weeks later.

Wow! What a dog! Very wired, not able to sit still, apparently did not even know his name, not able to listen and carry out simple commands, constantly on the move, into everything, but his most redeeming feature was that he was good with my two original dogs and did not chase the cats (be thankful for small mercies). My long suffering husband thought I had gone quite mad and did not know what to make of our newest arrival.

Now, I consider myself an okay dog trainer.

I have had dogs for many years and have previously trained four dogs in basic obedience and agility. Throughout my veterinary nursing career, I have attended seminars and conferences, studied dog behaviour, taught Puppy Preschool, instructed dog obedience classes, completed courses and have developed a real passion for all things dog behaviour. I now found myself not knowing what to do next. I quickly came to the understanding that I have always had compliant, nonconfrontational dogs that were happy 18 March 2019

to do what was asked of them and to sit quietly when told.

Not Roo. He wanted to know what was in it for him and he wanted to know why!

‘Just because I said so’, was not an answer he understood. Or he might do as asked but not be able to hold the position longer than a nano-second. I thought my training skills were good but I have learned to be more precise and faster with my rate of reinforcement. I have found that he got bored and frustrated very quickly, especially if I fumble or am not clear enough. He had no recall so was I was unable to let him off his lead when we were out of our small property. His large personal bubble caused him to over react if another dog approached, and he was not comfortable if new people approached him and leant over to pat him. He is not the kind of dog to back off if he felt threatened and he was always confident in his approach. This is very confronting and intimidating for both dogs and humans, and I never thought I would own such a unique dog with these types of challenges.

I did not know of his history and problems when I took him on. I would not change him for the world, to me he is a super dog.

His whole body wags with his tail, I see his soft side and love his glass-half-full attitude. His challenges have encouraged more flexibility in my training and I am continuing to learn and improve myself so I can help him navigate in a human world. I am less demanding – ‘You WILL do this!’ Now it’s more questioning, ‘Can you do this?’ I now realise that if he can’t perform the cue presented it means he is too aroused and I have asked too much of him in this situation, or I have not taught him properly by working in enough distractions for him to perform under the present circumstances.

I have learnt a lot with Roo. We have learnt a lot! He will always be a work in progress but he is much more relaxed now. I know and understand his triggers better and I manage him, along with working on these stimulators, so I can have a more calm, relaxed dog wherever we go, hopefully!

A dog like Roo can be quite isolating. In the beginning I would find unpopulated areas to walk him so he and I could enjoy some calm time without constantly scanning for interruptions. I avoided busy dog parks, I would try to pick times of the day that there might be quiet places. I didn’t walk him on the beach in case an off lead dog approached. If another dog did approach, I would panic and transmit my insecurity down the lead to Roo because I didn’t know how to deal with his reactivity.

I have found that working with Roo has given me more empathy for owners who come into the clinic with a challenging dog with reactivity, lead aggression and more. I offer behaviour and training classes through my clinic and instead of thinking owners aren’t putting in the time and effort needed to change their dogs’ behaviour, I now understand that I have to look at these dogs differently. I have worked on myself, becoming calmer, and teaching Roo new behaviours by becoming repeatable and reliable and someone he can trust. I have taught him coping behaviours and now have a variety of ways to distract and work with him in challenging situations. It doesn’t always work but the majority of the time, it does. He now is slower to react and quicker to calm down.

I am not doing agility at the moment as I have discovered that, like his previous families, I too have minimal control, so have switched to obedience training. I did this in the hopes of a calming effect and did not expect to enjoy it as much as I do. Roo loves it! His tail wags the whole time and he enjoys the precision of the movements and the high rate of reinforcement. He makes me laugh with his boundless enthusiasm and this gets me off the couch to train even if it is cold and dark.

I am also prepared for the long haul. I am his fifth owner in his short life and I believe that he came to me for a reason.

If the reason is that he gives me grey hairs as we learn together, then so be it! Roo had spent two years practising his behaviours before he came to me so I know there is no quick fix. I chip away at the things I don’t like him practising, one small behaviour at a time. Dogs perform behaviours that work for them. If the

DOG BEHAVIOUR

behaviour no longer works they abandon it and try something else. My job is to teach a conflicting behaviour for him to perform instead so that we can begin to change those ingrained behaviours.

I am constantly asked, as are most cross-bred dog owners, what sort of dog Roo is. He was advertised as a foxy cross but if anything it was a foxy on steroids!

He is 20kg, tan and white, tall and lean.

As I have come to know him and watch him play and interact with life I started to think he was boxer-cross. The other dogs I have are a Border Collie x Whippet and a full Whippet. Roo pretty quickly picked up

Ancestry Report

on the Whippet trait of sleeping soundly when there was nothing happening.

He would instantly rouse to full alert if needed, but had learned the art of doing nothing for short periods of time. So I surmised he was Boxer x Whippet to the amusement of all.

I decided to silence the critics and did a Canine DNA Breed Identification test through New Zealand Veterinary Pathology (NZVP) in Hamilton. The cheek swab is sent away to Australia and takes seven long weeks for results to return (please note this test is no longer available through NZVP).

It was fun to read the results and learn of my dogs’ heritage. It did help explain some of the traits he shows and, when relaxed, his happy-go-lucky attitude. Also I am aware that he is made up of different and conflicting types of dogs. He is of mastiff type, guarding breed heritage – Boxer and Bull Terrier - mashed up with a herding breed – Border Collie - and good dollop of tenacious Terrier in there as well. How can his tendency to guard manifest if he is also genetically geared to chase and hunt? This is not a harmonious cross. I think it may go some way to explaining his high levels of frustration and conflict

W hat b re eds make u p Ro o?

The Wisdom Panel® Insights computer algorithm performed over seven million calculations using 11 different models (from a single breed to complex combinations of breeds) to predict the most likely combination of pure and mixed breed dogs in the last 3 ancestral generations that best fit the DNA marker pattern observed in Roo. The ancestry chart depicting the best statistical result of this analysis is shown in the picture below.

Mixed Breed†

Boxer

Bull Terrier

Boxer Mix

Mixed Breed†

Border Collie

Bull Terrier Mix

Mixed Breed†

Mixed Breed†

Mixed Breed†

Mixed Breed†

Border Collie Mix

Roo Boxer / Bull Terrier Mix

Border Collie Mix

Boxer / Bull Terrier Mix crossed with Border Collie Mix | Above: Results of DNA test

†

Mixed breed Ancestor. See next page for more details...

March 2019 19

DOG BEHAVIOUR

within himself as he expresses his inbuilt desires in a human world. I have the job of guiding his responses, teaching a conflicting behaviour for him to exhibit in times of distraction and also teaching him to cap himself when his bottle has been shaken and he is starting to fizz. This is a job that I relish and the rewards are enormous as we work together. It is very easy to focus on the day to day frustrations but I find if I look back I can see how far we have come.

Help comes in all guises. Internet searches and sites, dog training friends, dog obedience and agility training, a sympathetic day care facility, grandparents prepared to babysit, books, seminars, and trial and error. Take it all in and sift through the information so you can absorb those snippets of information that speak to you and fit with your philosophy.

Be prepared to be challenged as you continue to grow and develop a greater understanding of this world inhabited by these wonderful creatures we are lucky enough to call ‘mans’ best friend’.

| Above: Moss, Border collie x Whippet and Roo

In the next edition Cindy will discuss reactive dog behaviour and some of the techniques she has used in Roo’s training. | Above: Roo in constant motion

NZVNA NOTICES Notice for the Annual General Meeting of the New Zealand Veterinary Nursing Association (Inc) Notice is hereby given to all members that the Annual General Meeting of the New Zealand Veterinary Nursing Association (Inc) will be held during the NZVNA conference at Heritage Hotel on Friday 14th June at 11.30am.

All members of the NZVNA are invited to attend. An agenda, call for nominations, an election of executive committee members’ details will be posted via email and on www.nzvna.org.nz at a later date.

Any questions or enquiries, please contact Luanne Corles, National Secretary via email secretary @nzvna.org.nz.

2019 Listed and Registered Veterinary Nurses The official 2019 list and register will be published on our website www.nzvna.org.nz under Regulation on the 1st March 2019.

Please note that engraved badges will be available for purchase until the end of March. Expected delivery date is two to three weeks from time of purchase.

20 March 2019

COMPASSION FATIGUE

Managing compassion fatigue in our clinic

By Zoe Hyett LVN, At The Vets, Christchurch

“The expectations that we can be immersed in suffering and loss daily and not be touched by it, is as unrealistic as expecting to be able to walk through water without getting wet.”

Remen, 1996 (Middleton, 2015).

Burnout is a term we frequently hear used in our industry. But how do we know how to recognise it not only in ourselves, but in our workmates? This is something I thought about often, and after attending continuing professional development (CPD) events and completing online courses, I felt that I had been given the tools I needed to be able to set up a structured way to assess colleagues’ mental wellbeing and monitor this throughout the year. I have since been asked numerous times about these same questionnaires, sending them to a number of nurses and practice managers in the UK and Australia to use in their clinics.

In 2016 Zoe Hyett decided to implement compassion fatigue assessments and coping strategies into her role as head veterinary nurse. Having qualified in 2013, she quickly recognised the need to address stress in her fellow team members. Zoe has undertaken CPD in this area and her article highlights the need to look after yourself and your staff, in order to give the best of care to your patients and clients.

There are several components related to compassion fatigue, the most frequently talked about one being burnout, but secondary traumatic stress or vicarious trauma is something I find people aren’t as familiar with. It is very easy after dealing with a traumatic situation to immediately approach one of our peers and start offloading about the impact it has had on us. As soon as we start going into details about something we found awfully stressful to someone else, they then have to take on the weight of that themselves, and for some people this can be too much to deal with. We all need to get things off our chest, but asking before you offload can mean the difference between that person coping, or being pushed over the edge resulting in secondary traumatic stress.

To see what was going on with the staff at my clinic I initially organised one-onone meetings with every staff member where we discussed what compassion satisfaction, burnout and secondary traumatic stress are. I then got them to answer a few questions I compiled

such as – What do you do when you go home after work? How do you cope when asked to do something outside of your beliefs? And what are your warning signs?

Knowing all this information can help you become aware of when a person may be struggling and you need to step in and ask if they are okay. It can also be helpful when another team member doesn’t know what to do in one of these situations, to then offer some options and strategies from other staff.

After answering these questions, we move on to the ‘professional quality of life measure’. This is an amazing questionnaire I sourced online from www.proqol.org that was originally designed for therapists, but fits well with veterinarians and veterinary nurses. It asks that you rate each statement from one to five and then analyses your answers to assess your level of compassion satisfaction, burnout and secondary trauma. The questions are worded in a way so as to not sound negative, meaning the questionnaire can give you a more accurate result. It is best to advise staff when filling in this questionnaire to go with the first answer that comes to mind, rather than dwell on questions for too long.

This website has a few more resources, helpful videos and tools to go along with compassion fatigue and coping mechanisms that I have found useful.

The final area evaluated is based more on home life rather than work; we all know that a stressful home life can affect our work. It is something we also should be keeping an eye on, if our staff are willing to talk to us about it. I refer to the questionnaire sourced from the Crampton Consulting Group called ‘What’s draining you?’. Some of the questions are rather personal, so I do advise staff if they don’t feel comfortable answering any of the questions then they don’t need to. The categories examined are relationships, environment, body, mind, spirit and money. Staff need to answer yes or no to questions about their personal life, and the totals for each category are then March 2019 21

COMPASSION FATIGUE

added up at the end to identify areas that are draining energy and positivity.

From there you can make an action plan with staff to minimise these ‘drainers’, so they are better equipped to deal with compassion fatigue in the workplace.

Please email me at zoehyettwork@gmail. com if you would like a copy.

I repeat this exercise every three months, with each staff member, and have found since bringing this to our practice the levels of compassion satisfaction overall have risen. Burnout and secondary trauma have also dropped. We have had this in place for close to two years now and I have had positive feedback from all staff, as well as the opportunity to discuss everyone’s mental wellbeing one-on-one.

The most important thing is to keep these confidential. I do not show these to any other staff members, and feel it has really built up trust with everyone. Making staff feel like they can answer and discuss things openly and honestly with me is vital in this process.

I have now learnt how all our staff cope with difficult situations, what their warning signs are when they are suffering from burnout, and am able to recognise their signals before someone tips over the edge. I compare the previous guided evaluations with the most current one to see if things are improving, or if the person is struggling. Occasionally there will be times when you look at someone’s results and see they are not doing so well and really need some help. In this situation you have a few options – if it’s serious they should consult their GP and you should recommend appropriate counselling. If the staff members’ answers indicate a less severe result on the scale, but you think they may be suffering from compassion fatigue, discuss with them ways they can relax at home and try to make their work life a bit easier; for example, asking other staff to help with euthanasia, or welfare cases for the next few weeks. It can be a good idea to have them repeat the guided evaluation in a months’ time, rather than in three months.

I wanted to make the workplace a positive environment for everybody each day, so I started a veterinary nurse of the 22 March 2019

month award. Staff can put nominations in a box for another veterinary nurse that has given outstanding customer service, or gone above and beyond at work and the winner will get a yummy doughnut and their photo on the wall.

The veterinary nurses have loved this and it makes everyone so happy to receive a nomination and positive feedback from others. Every month I have at least 50 nominations in the box and have now included our veterinarians in this too as they were feeling a bit left out!

A number of our veterinary nurses have started using an app called Headspace and have found it really helps them wind down from a stressful day, clearing their mind to sleep better at night. Finding ways to switch off from work at home is important, so definitely discuss this with your team and write down ideas that others can use.

We need to be on the lookout for physical signs and symptoms of compassion fatigue in our team members. These can include, but are not limited to exhaustion, negative self-image or becoming ill often.

Behavioural signs such as forgetfulness, anger and irritability; drug or alcohol dependency can also feature.

One of our team members, who agreed to let me discuss their case, became very depressed and down, and was really struggling at work and at home. I had noticed a change in their behaviour, they had become quite short with people and would be very emotional over small things asked of them. This definitely was not normal for this person, so I asked this staff member to complete all of our guided questionnaires. The scores were much different to the general scores of the rest of the team which was quite concerning.

The first step we discussed was going to see their GP and request counselling.

Once this had been done we focussed on exactly what it was about their work that was causing them to feel this way and affecting their home life. With permission I discussed this case with our practice manager and practice owner and we all worked together to help this person get their confidence back and enjoy their work again. Sometimes in cases like

this you do need to talk to other people in your workplace, but make sure you have permission from the staff member first. After three months we repeated the surveys and the scores had all improved drastically, which was amazing! Another three months after that and they are still on track with one of the clinics’ highest compassion satisfaction scores and a low secondary trauma and burnout score.

Every case and every person will score differently, so it is just a matter of observing your team and having regular one-on-one catch ups with people to ensure they are doing okay. I would recommend doing this three monthly where possible so you will notice if someone isn’t coping before it goes on for too long. I am happy to help you answer any questions or discuss cases with you if needed so please don’t hesitate to get in touch with me at my clinic – At the Vets in Christchurch.

“People will forget what you said, people will forget what you did, but people will never forget how you made them feel” Maya Angelou.

References Middleton, J. (2015) Addressing Secondary Trauma and Compassion Fatigue in Work with Older Veterans: An Ethical Imperative Retrieved from https:// www.aginglifecarejournal.org/ addressing-secondary-trauma-andcompassion-fatigue-in-work-witholder-veterans-an-ethical-imperative/ Professional quality of life (2012).

Professional quality of life measure.

Retrieved from https://proqol.org/ ProQol_Test.html

| Above: Veterinary nurse of the month poster

PEMPHIGUS FOLIACEUS

Pemphigus foliaceus in dogs

By Ellie Clark RVN, The Skin Vet, Auckland

Pemphigus foliaceus (PF) is an autoimmune disease of the skin which affects many species including canines, felines, equines and humans. It is the most common autoimmune disease seen in small animal practice, and can present acutely as a debilitating and often painful condition. It is characterised by acantholysis and has associated clinical signs including pustules and crusting on the skin surface.

This case study looks at the pathogenesis, clinical signs, diagnosis and treatment of pemphigus foliaceus in dogs.

Pathogenesis The top layer of the skin, the epidermis, is made up of skin cells called keratinocytes which are adhered together by complex structures called desmosomes. PF is a disease in which the body’s immune system attacks these desmosomal connections between it’s own skin cells.

When the intercellular desmosomal connections are broken, the separated keratinocytes become rounded up into a sphere as there are no attachments to stretch them out and keep them in their usual angular shape. These spherical skin cells are called acantholytic cells (see Figure 1).

Because the skin cells are not attached to each other anymore, the space created fills with fluid and superficial blisters form on the skin surface - the blisters are fragile and rupture, then the ulcer becomes a crust.

Clinical signs in dogs and cats PF has many associated pathognomonic clinical signs and is recognised as a ‘pustular disease’ where small pus-filled blisters form on the skin surface. This is a fairly unique clinical sign as there are hardly any to almost no other autoimmune skin diseases which originate with pustules other than PF (Bizikova, 2015).

The onset of clinical signs associated with PF can be fairly rapidly expressed in around one to two weeks or insidiously with signs developing over one or more months (Miller, Griffin, & Campbell, 2013).

Primary lesions present as superficial subcorneal (originating under the skin surface) pustules which are very fragile.

These might not be observed on clinical examination due to them rupturing easily.

The head, face and ears are often the initial areas that lesions are seen.

Pustules and crusts form on the nasal

Figure 1: Layers of the skin and their adhesion sites

Ellie graduated with a Diploma in Veterinary Nursing from the Royal College of Veterinary Surgeons in 2004. She also holds a Certificate in Adult Education from the Southern Institute of Technology and taught the veterinary nursing qualification for two years at Vet Nurse Plus. She began working with Dr Debbie Simpson at The Skin Vet in 2016, and has been trained and mentored by Debbie in many areas of dermatology including skin testing, exclusion diets and immunotherapy.

Ellie has presented talks and webinars to veterinarians and veterinary nurses on various dermatology topics and in 2018 was awarded the Hill’s NZVNA Vet Nurse of the Year award.

Cornified envelope Loricrin, involucrin Tight junction K2

Stratum corneum Lipid bilayer Stratum granulosum Keratohyaline granule: profilaggrin

Stratum spinosum K1 K10 (K6/K16)

K5/K14

Lamellar bodies Desmosomes

Basal layer

March 2019 23

PEMPHIGUS FOLIACEUS

planum, dorsal nasal bridge, the pinnae and the periocular area (see Figure 2).

The lesions often have a striking bilateral symmetry (Miller et al., 2013). The crusting on the face is seen in around 90% of cases presenting with this ‘facial mask’ (Bizikova, 2015).

(see Figure 3). The skin under these crusts is raw and is often painful.

The disease progresses very rapidly from the pustular phase, leading to areas of widespread erosions and crusting (Miller et al., 2013). The crusting is seen due to the skin cells being detached from each other.

Pustules are formed, they then rupture and dry and due to the cyclic and rapid nature of the disease the crusting can form quickly and become quite extensive

Further generalised or associated clinical signs of PF include secondary bacterial infections, pruritus, lymphadenopathy, anorexia, and pain associated with severity of crusts. Depression and pyrexia may be seen, especially as the disease progresses.

Figure 2: Periocular lesions

24 March 2019

Other clinical lesions include erosions, ulcers and alopecia, often progressing from the face to affect the skin on other parts of the body such as the trunk, axillae and limbs.

Crusting of the foot pads can also be seen in around 40-80% of cases which causes

painful pads (Bizikova, 2015). The pustules are especially hard to visualise here due the high rate of rupture caused from the pressure of standing on them (see Figure 4).

Blisters and crusts together with acantholytic cells are the classic clinical signs of PF. Diagnosis Diagnosis of PF is usually based on patient history, clinical signs, cytology and histopathology. Attention to other factors such as breed, recent medical treatment or chronic allergic skin disease should be considered.

PEMPHIGUS FOLIACEUS

Figure 3: Leon’s ear with severe crusting

The presentation of PF is fairly unique with distribution of skin lesions and whether pustules have been visualised, but can often be confused with a secondary bacterial infection. However, a typical staphylococcal skin infection will not originate in a symmetrical pattern on the face and isn’t often associated with the ear pinnae and crusting of the foot pads.

Staphylococcal pyodermas are often associated with hair follicles and so don’t affect the non-haired nasal planum.

Pustular disease that affects both the nasal bridge and the non-haired nasal planum is highly suggestive of PF.

Figure 4: Crusting of the Leon’s foot pads

A thorough examination of the patient should be performed by the clinician and cytology samples taken ideally from intact pustules or from underneath crusts. If acantholytic cells are viewed on cytology they indicate the loss of keratinocyte adhesion. These acantholytic cells can appear singularly or in clumps, often in association with neutrophils.

Eosinophils are also often seen due to the inflammatory component of the disease (see Figure 5).

Cytological examination for bacteria or a culture may also be taken as secondary bacterial infections may be present which will lead to the presence of both intracellular and extracellular cocci (Miller et al., 2013).

Dermatophytosis and demodicosis should be ruled out as differential diagnoses as these diseases have many similar signs to PF – skin scrapes, cytology and histopathology can be helpful.

Figure 5: Spherical acantholytic cells

March 2019 25

PEMPHIGUS FOLIACEUS

A more definitive diagnosis of PF can be attained via a biopsy of ideally an intact pustule, multiple sites should be taken. Histopathology results will show subcorneal pustule formation and acantholysis.

Treatment As PF is an autoimmune disease, the treatment for it requires suppression of the immune system. There are many immunosuppressive medications used to treat PF including corticosteroids, chlorambucil, cyclosporine and azathioprine. There have been some recent reports of oclacitinib (Apoquel™) being helpful in some immune mediated diseases including pemphigus.

Doxycycline and nicotinic acid (Vitamin B3) are often helpful as well.

In many canine patients, glucocorticoid therapy alone appears incapable of Figure 6: Leon at initial presentation

26 March 2019

halting or slowing the progression of skin lesions (Olivry, 2006). Often more than one medication treatment is needed to be used.

In these cases, cytotoxic drugs may be added. Azathioprine (2–2.5 mg/kg every 24 hours), cyclophosphamide (25 mg/ m2 every 24 hours), or chlorambucil (0.2 mg/kg, every 24–48 hours) have been proposed as adjunct cytotoxic drugs (Olivry, 2006).

It is advisable to take initial CBC and biochemistry bloods as a baseline prior to commencing treatment and to monitor these periodically when animals are undergoing treatment.

Corticosteroids such as prednisone or prednisolone are usually the initial favoured treatment option, due to the other options having potentially more harmful side effects with closer monitoring

needed and regular blood work advised.

There are high and low dose corticosteroid options for the treatment of PF which will commence dependent on the clinician’s preference and on the severity of the presenting disease.

Prednisone or prednisolone administered initially at a rate of 2-6 mg/kg every 24 hours is commonly used. Most cases will improve with this therapy over 10-14 days and then the dosage is gradually reduced over the next 30-40 days, with the goal to be an alternate-day regime of 1mg/kg with clinical signs controlled (Miller et al., 2013).

Studies have looked in to the use of corticosteroids, where they are given at much higher doses (10-11mg/kg once daily) and pulsed for a short amount of time initially (one to three days) and then reduced (2-6mg/kg once). This pulsing

PEMPHIGUS FOLIACEUS

therapy may need to be repeated until the clinical signs are improved with no adherent crusts. This treatment has been found to be more effective in some cases with the animals receiving less prednisone overall than with the lower traditional dosing, as seen in the ‘Oral glucocorticoid pulse therapy for induction of treatment of canine pemphigus foliaceus – a comparative study’ where the proportion of dogs achieving complete remission using high dose pulsed prednisone was 61% vs 15% for the traditional dosing (Bizikova & Olivry, 2005).

Side effects of prednisone such as lethargy, polyuria, polydipsia, diarrhoea, aggressive behaviour, and the possibility of iatrogenic Cushing’s disease, should be made aware to owners. Gastric protectants may also be administered.

Treatment is repeated and continued until

the signs of PF have diminished and the animal has gone into remission. Treatment is then slowly tapered off by around 25% per month, however repeating of the pulse treatment of prednisone or adding in another immunosuppressive medication may be needed if there is reoccurrence or worsening of clinical signs.

effects and is used at a lower dose rate than for treating infection. Nicotinic acid is vitamin B3 which is given due to its antiinflammatory effects and is thought to help reduce the amount of corticosteroid treatment needed. Topical corticosteroids can be a useful supplement to treat localised lesions.

Remission can take several months with the average time to complete remission being around nine months.

Treatment is generally long term, and in some instances will be lifelong to control the signs of PF and ensure it is kept in remission. Frequent follow up appointments and close monitoring is vital to check response to the medication and to ensure that there is no occurrence of detrimental side effects.

Doxycycline (tetracycline) is often given as well as nicotinic acid (niacin) as an adjunctive treatment for PF. For dogs less than 10 kg: 250 mg each of niacinamide and tetracycline PO three times daily.

For dogs larger than 10 kg: 500 mg each of niacinamide and tetracycline PO three times daily (Plumb, 2008).

Doxycycline is not used for its antibiotic properties but has immunomodulatory

Prognosis Not all animals will respond to treatment for PF, however it can generally be successfully treated with many animals going into remission. Owner compliance

Figure 7: Leon two days post starting treatment

Figure 8: Leon with some remaining adherent crusts

Figure 9: Leon in remission six weeks later

March 2019 27

PEMPHIGUS FOLIACEUS

and close monitoring of patients is very important for ongoing success. For some animals, it will mean they need to stay on lifelong medications at low doses.

However some animals once they have gone into remission are able to stop medication fully with no recurrence of PF. Case study Leon a seven year old, male neutered, Hungarian Vizsla was referred to Dr Debbie Simpson at The Skin Vet in June 2017 with an acute onset of skin disease.

Leon has a history of chronic otitis externa and some transient skin disease. He has been diagnosed with a grade 1 heart murmur but otherwise has been an active and well dog.

Leon’s clinical signs had started around three weeks prior to seeing The Skin Vet and presented initially with a suspected pyoderma focused around his face. He had some small lesions around his muzzle area and on his pinnae, his left ear was pruritic, and he had a bacterial infection of his skin.

He was treated medically by his own vet and was seen around a week later as the lesions had progressed to his abdomen, groin and medial thigh area. At this stage Leon was still bright and well in himself, eating and drinking as normal.

Over the following few days Leon’s condition worsened with his skin lesions becoming more extensive and pruritic.

He was now miserable in demeanour and reluctant to exercise.

He was hospitalised due to his condition deteriorating and was given antibiotics, analgesia and fluid therapy treatment.

Leon’s skin condition further worsened, with little response to treatment and he was referred to see Dr Debbie Simpson at The Skin Vet. Upon initial presentation Leon was very depressed, anorexic, lame and hyperaesthetic. Dr Simpson performed a thorough clinical examination where she found Leon to have severe and extensive crusting to his face, pinnae, trunk, ventrum, groin and axillae. The crusts were well adhered with ulcers and purulent exudate seen (see Figure 6). On examination the crusts also appeared 28 March 2019

on the edge of his foot pads which was making it hard for him to walk.

Dr Simpson took samples for cytology via impression smears and swabs. These were taken from multiple locations under the crusts. On microscopic examination she found there to be numerous acantholytic cells mixed with numerous nondegenerate neutrophils and eosinophils.

No bacteria were present.

Biopsies were discussed with his owners but due to the cost of biopsies and the fact that his history, clinical presentation and cytology findings supported a diagnosis of PF, it was decided that biopsies wouldn’t be taken at this time and treatment would be started for PF. If improvement was not seen with Leon in a few days biopsies would be taken at that stage.

High dose prednisone treatment was started. The initial dose of corticosteroids was given intravenously into Leon’s existing intravenous catheter of Dexone 5mg/mL (2mg/kg). Oral prednisone 20mg tablets were dispensed to medicate at home (10mg/kg every 24 hours for three days then 2mg/kg every 24 hours).

He had an Elizabethan collar placed to prevent further self trauma, and his owners were advised it could be removed under close observation. He was sent home for monitoring and to encourage him to eat, side effects of prednisone were discussed, and it was advised to bring him straight back or take him to after hours if there were any concerns.

A phone call was made to his owners the following day and it was reported that Leon was already showing some signs of improvement with his demeanour. He had eaten a small meal that night, however he was polydipsic which was to be expected.

Two days later Leon was examined again

by Dr Simpson, and a vast improvement was seen in both his demeanour and his clinical signs. There was an improved appearance of the crusts and lesions on all areas of his body with no evidence of new lesions appearing (see Figure 7).

It was advised that Leon continued with the prednisone at 2mg/kg every 24 hours and adjunctive treatment of doxycycline (150mg twice daily) and nicotinic acid (500mg twice daily) was started.

We maintained close contact with Leon’s owners and he was seen every 10 – 14 days for check-up consultations. He received high pulse doses of prednisone (10mg/kg every 24 hours) for three days.

Improvement was seen on each visit with the skin lesions.

Blood tests were taken periodically for monitoring which were mostly unremarkable, and Leon received treatment for a subsequent ear infection.

After his third pulsed treatment of the prednisone, Leon’s otitis had resolved and he had no new skin lesions, he did however still have some adherent crusts remaining (see Figure 8).

He had responded well to the prednisone, however the crusts were not fully resolved, and as treatment is usually carried on until no adherent crusts are seen, Dr Simpson prescribed chlorambucil to be started as an adjunct to the prednisone.

Leon was started on a low dose of chlorambucil 2mg (0.1 – 0.2 mg/kg every second day) and continued with the prednisone, doxycycline and nicotinic acid at the prescribed doses.

A complete blood count (CBC) test was taken every two weeks to monitor him on the chlorambucil due to it being a cytotoxic medication.

Leon continued his regular follow up appointments and six weeks later in September 2017 he was finally in remission with no sign of active lesions (see Figure 9).

He remained on the current chlorambucil dose (0.1 – 0.2 mg/kg) and the prednisone was gradually tapered over the next few months.

His visits became less frequent over the following few months, although regular blood testing and contact with the owners was continued. He was back to his old self and enjoying going for regular runs on the beach with his owner.

By April 2018, Leon was still in remission, he had a few alopecic spots but no lesions and was advised that the prednisone could be stopped.

PEMPHIGUS FOLIACEUS

By July 2018 Leon was still stable without receiving the prednisone, he had no new lesions and had good hair regrowth, the chlorambucil was stopped and he continued on with the adjunctive treatment of doxycycline and nicotinic acid. Contact was maintained and the updates were positive from his owners.

Figure 10: Leon 15 months post treatment

In September 2018, 15 months after his initial visit Leon came to see us after being off all immunosuppressive medication for six weeks. Leon’s physical exam was perfect, and he was still in remission with no clinical signs of PF returning (see Figure 10).

Dr Simpson advised that all medications could now be discontinued, and that no more routine visits would need to be booked for him.

It has been really interesting assisting Dr Simpson with the care plan for Leon and watching his progression following treatment for pemphigus foliaceus.

I would like to thank Leon’s owners for letting me use him for this case study.

They have been absolutely fabulous and so dedicated to his care and treatment throughout. We are all thrilled that he responded so well to the treatment for this disease and wish him a long and healthy life.

References Bizikova, P. (2015, February 10). Pemphigus Foliaceus – Recent update on Pathogenesis Diagnostic and Treatment. [Video file].

Retrieved from https://www.youtube.com/ watch?v=bhgHrOaMmRY&t=54s Bizikova, P., Olivry, T. (2005). Oral glucocorticoid pulse therapy for induction of treatment of canine pemphigus foliaceus – a comparative study. Veterinary Dermatology Journal, 26(5):354-8, 354358. https://doi.org/10.1111/vde.12241 Miller, W., Griffin, C., & Campbell K. (2013). Muller and Kirk’s Small Animal Dermatology (7th ed.). St Louis, USA: Elsevier.

Olivry, T. (2006). Review of autoimmune skin diseases in domestic animals: superficial pemphigus. Veterinary Dermatology Journal, 17(5), 291-305. https://doi. org/10.1111/j.1365-3164.2006.00540.x Plumb, D.C. (2008). Plumb’s Veterinary Drug Handbook (6th ed.). Ames, USA: Blackwell Publishing.

March 2019 29

CONFERENCE

Conference research posters We are excited to announce that the NZVNA are holding a research poster session at this years NZVNA annual conference. This will be the first time that we have included research posters as part of the NZVNA conference, and we encourage all veterinary nurses to take part. We are inviting the submission of abstracts that detail current research, clinical practice, or new techniques and initiatives in all aspects of veterinary nursing, including equine, large animal, companion animal, industry and education. All abstracts will be peer reviewed and following acceptance, submitters will be given the opportunity to display a poster at the NZVNA 2019 Annual Conference, being held in Auckland on the 14th and 15th June.

Posters are widely used at conferences to present research or information concisely, in an easy to read format, to inform, and

| Above: Laura with her research poster at VNA Congress 2014, Telford, England

30 March 2019

generate discussion. Research posters often include a combination of text, images, and graphs.

If you are unsure if your topic fits the criteria mentioned, we encourage you to submit your abstract for consideration.

Submissions will also be accepted from anyone involved in animal health, welfare and behaviour. NZVNA membership is not required, however attendance at conference on 14th June is.

A question and answer session will be combined with morning tea on June 14th to allow delegates the opportunity to gain further knowledge from poster presenters.

You can find further information and a submission link on our website - https:// www.nzvna.org.nz/Events/Conferences/ posters.html.

Laura Harvey

Free webinar with Dr. Mark Westman

ABOUT THE PRESENTER

Dr Mark Westman BVSc (Hons) MANZCVS (Animal Welfare) PhD

&

THIS FREE WEBINAR WILL COVER THE FOLLOWING LEARNING POINTS: 1. Some point-of-care test kits can be used to diagnose FIV infection in FIV-vaccinated cats 2. The FIV vaccine has an effectiveness of 56% in the field in Australia 3. The FIV vaccine should be used in at-risk cats, but regular FIV testing should continue to ensure no ‘vaccine breakthroughs’ have occurred 4. Exposure to FeLV can have many different outcomes, including regressive infections 5. FeLV vaccination should be considered in all young cats with outdoor access 6. There is potential for saliva to be used for in-clinic FIV and FeLV testing

WEBINAR DETAILS PRESENTED BY: Dr Mark Westman DATE: Tuesday, 19th March 2019 TIME: 7:30pm NZT DURATION: 60 minutes including Q&A

Mark graduated with a BVSc (Hons) from the University of Sydney in 2003.

Following graduation he worked mainly in shelter medicine for 10 years, including the NSW RSPCA and the NSW Animal Welfare League in a management position. During this time he also volunteered for veterinary programs in Papua New Guinea, Thailand, Indonesia and India.

In 2012 Mark returned to the University of Sydney to undertake a PhD investigating feline retroviral diseases, in particular the effectiveness of the FIV vaccine in the field, the FIV antibody response following vaccination and diagnosis of FeLV using different point-of-care kits and PCR. On completion of his PhD in 2016 he moved to the Centre for Virus Research at the University of Glasgow to undertake postdoctoral research in the antibody response of FIV and FeLV vaccinated cats, before returning to Australia in 2017 to commence a lectureship in Veterinary Microbiology and Animal Disease.

Mark also co-founded Pets in the Park in 2012, a charity dedicated to providing free veterinary care to pets owned by the homeless, which now has clinics in NSW, Victoria, Queensland, ACT and Tasmania.

Mark also enjoys running, particularly ultrarunning, and climbing mountains!

HOW TO JOIN THE WEBINAR No need to register – just join by website, phone or app: 1. Website: https://simonthevet.clickmeeting.com/virbac-virtual-lecture-hall 2. Phone: 09 887 8517 Conference PIN: 562748# 3. Click Meeting Mobile App: Room ID: 735-877-331

ADD TO YOUR CALENDAR Google Calendar: http://bit.ly/FIVwebinar1 iCal: http://bit.ly/FIVwebinar2

This free webinar is made possible by Feligen RCP

March 2019 31

RESTRICTED DRUGS

Keeping drugs safe

By Seton Butler Veterinarian Photography by Rob Suisted www.naturespic.com

32 March 2019

In light of recent suicides in Australia linked to the use of veterinary drugs, the team at Kelburn Vets instituted a simple and inexpensive system to safeguard access to controlled drugs, veterinarian Seton Butler explains.

A recent Australian coronial inquest into two suicides that linked the deaths to the use of scheduled drugs indicates that the profession considers it would cost too much to secure the drugs safely. In light of this report, we thought we would share

RESTRICTED DRUGS

a new system we recently implemented in our clinic that, on the face of it, appears to have been very successful. This system is the result of a collaboration between myself, Alix Barclay, Brendon Bullen and our team leader at Kelburn Vets, Emma Blake, whose support and encouragement made implementation possible.

In consideration of the risks to our staff of a number of factors that may contribute to their mental wellness, such as compassion fatigue and normalisation of euthanasia, as well as the heightened responsibilities on business owners/ directors and our obligations under the Code of Professional Conduct, we believed we had a responsibility to tackle the problem of controlled drugs (CDs). We identified a number of issues that needed addressing, with managed access to the drugs being paramount given the suicide risk, but also the recording of drug use to ensure that we abided by the code and to detect possible redirection of drugs for recreational use.

The system we instituted involved installing an electronic safe (for a total cost of less than $2,000) that requires two codes for access. There are further functions that can be added by upscaling the system, such as recording PINs used for access, and installing time-locks that can be set to prevent access out of hours.

The simplicity of the control relies on how that access is tagged. By creating two categories – one for veterinarians and one for veterinary nurses – each staff member has an individual six-digit access code, meaning a veterinarian and a veterinary nurse are required to be present to open the safe door. This means that no single person can open the safe and have unfettered access to CDs, removing the opportunity for impulse-related access or access by subterfuge.

Save the date

Introducing the new system raised a number of questions: • Were there thoughts that we were stepping on the ‘God-given right’ of veterinarians to have unrestricted access to these products? Answer: of course! The way we framed this was that no-one would have access to the safe without a veterinarian being present. Interestingly, it has been my experience that a number of clinics in fact ‘allow’ access by any one of the clinical team, including veterinary nurses,by either shared access codes or a key often hidden somewhere on the premises. Sound familiar?

• Was there disruption to the daily routine? Yes, and this was navigated by the team. Any remaining disruption simply reinforced the principle of the system: controlled access to CDs! • Is there a hurdle on single-veterinarian days when a CD is needed during a sterile surgery? Yes, and the team resolved to ‘share’ that veterinarian’s code with the surgical veterinary nurse and have the manager reset the code at the close of day.

• Did staff accept that the system was ‘safer for all’ in being set up this way?

Yes. • Is it fallible? Yes, we are sure most systems are, but this system at least ensures an additional step in the process of access that we hope provides at least some resistance to anyone motivated to suicide or diversion. For those trying to steal for personal recreational use, I hope it says, ‘we are watching’!

• Does it rely on staff feeling empowered to hold the line or speak up? Yes, absolutely. We of course have associated standard operating

procedures, but the real strength lies with ensuring that staff ultimately feel authorised and empowered to act or speak up. This is often culture related, and we hope our staff accept the responsibility to keep their colleagues safe at work.

Of course we had to navigate a few issues, such as what happened with in-patients needing CDs for pre-meds or during their hospitalisation periods. Our solution was to provide a small ‘Inpatient Box’ of meds that was topped up each morning and had sufficient amounts of the CDs needed for the day.

Another issue that caused concern was what happens when a patient needed out-of-hours treatment. Fortunately we have an after-hours clinic where most of our patients can access out-ofhours care.

However, as a business we committed to a policy that if a patient needed out-ofhours care, we would cover the cost of two staff returning to the clinic to administer medication.

We are fully aware that controlling access to drugs does not address the reasons for someone considering suicide, but it does remove the opportunity to act on impulse.

On reflection, can we really say that a cost as insignificant as $2,000 is really the value we place on a colleague’s life? Come on people, please let’s act!

If you would like further information about the safe and our protocols, I am happy to share. Please email me at setonjb@gmail. com.

Reference Opie R. Suicide deaths spark call to better secure veterinary drug. www.abc.net.au/news/2018-06-26/ regulator-refusing-to-act-on-callsto-secureveterinary-drug/9911654 (accessed 27 July, 2018), ABC, 2018

Veterinary nurses dinner at the NZVNA 2019 Conference is on Friday 14th June 2019 at the Heritage, Auckland March 2019 33

BOOK REVIEW

Exotic Animal Medicine for the Veterinary Technician – Third Edition Reviewed by Amy Ross RVN, NZVNA Executive Committee member Edited by Bonnie Ballard and Ryan Cheek Published: 2016 Publisher: Wiley Blackwell 536 pages (paperback) $90.60 (Book depository, price sourced January 2019)

This book consists of contributions from 22 authors that all have an interest in exotic animal and zoo medicine, and was edited

by Bonnie Ballard and Ryan Cheek. Ballard has worked as a veterinary assistant and then a technician before becoming a DVM with an interest in exotic animal medicine.

Ryan Cheek, RVTg, VTS (ECC) graduated with an Associate of Applied Veterinary Technology where he focused his studies on exotic animal medicine.

It is divided into sections that focus on analgesia and anaesthesia, avian, reptiles, amphibians and aquatic animals, mammals, haematology, zoo aquarium medicine and wildlife before finishing with 17 appendices that can easily be modified for use in private practice as well as zoos and aquariums.

If you are familiar with working with exotic animals, some of the information in the text may appear basic to you, such as the information about the anatomy and physiology of different species. In saying this, the information contained within these chapters is great for a refresher and you may also be able to pick up other useful information that you may not have already known such as why atropine is ineffective in dilating the pupils in birds.

It will also serve as a great reference book for any students that you have coming through your clinic that are not used to dealing with exotic patients.

Nutrition and husbandry are discussed a lot in this book, as this can often be a contributing factor to why an exotic pet is sick and does need to be considered when differential diagnosis are made by the veterinarian. This text offers advice on how to change diets and enclosure set ups to help provide the optimum of care when your patients are discharged.

This information can also be used in a clinical setting if the patient does need to be admitted, and includes optimum

34 March 2019

environmental temperatures and lighting requirements for each species.

Handling of different species is clearly described in the text which is reinforced with the use of clear diagrams and colour photographs. This is especially useful if you have only ever handled, for example, a Budgie and then an Alexandrian Parrot is bought into your clinic as your handling of a pet can cause uncertainty of the veterinarians abilities in the eyes of the owner.

Common diseases are also discussed in each section of the textbook – ranging from psittacosis to metabolic bone disease, from parasitology cloacal prolapse, and gas bubble disease as well as everything in between. This is just an overview of the more common diseases though and if you are wanting further information then you will need to refer to other texts elsewhere.

While exotic animals are starting to be seen regularly in veterinary clinics as more and more pet owners are developing an interest in them. There are some chapters in this book that are not relevant if you are working in New Zealand, such as the chapters on snakes and skunks and the appendices on biological data of North American wild animals – but great if you are planning on travelling with your career.

It is also becoming obvious that veterinary nurses and technicians are wanting to learn more about the species that they are either seeing in clinic or have a personal interest in. I have personally seen an increase in the number of requests in social media groups for continuing education and resources relating to exotic species.

I highly recommend purchasing this book for your own personal collection or clinic library if you have an interest in exotic species or are starting to see exotic species in your clinic as it is an excellent resource to have.

POSTOPERATIVE CARE

I

POSTOPERATIVE CARE

BUSTER Collars

I

BUSTER Collars

BUSTER Dog Collar for Brachycephalic Breeds Our range of BUSTER Collars has been extended with the new BUSTER collar for brachycephalic breeds.

Finally, you can get a suitable collar for the brachycephalic dogs without having to adjust and cut the collar.

AVAILABLE NOW

n n n

Quick fastening system Full body coverage Multiple adjustment points for proper fit

Recommended use for BUSTER dog collar for brachycephalic breeds: n Postoperative care n Wound care n Spay/neuter recovery n Hot spots and other skin ailments n Skin diseases

BUSTER Dog Collar for Brachycephalic Breeds The BUSTER dog collar for brachycephalic breeds is transparent and has the quick and simple “Clic” closing system which is well- known from the BUSTER Clic Collars.

Our range of BUSTER Collars has been extended with the new BUSTER collarThefor collars brachycephalic are made of 100% polypropylene. breeds.

Finally, you can get a suitable collar for the brachycephalic dogs without having to adjust and cut the collar. n n n

Quick fastening system Full body coverage Multiple adjustment points for proper fit

Recommended use for BUSTER dog collar for brachycephalic breeds: n Postoperative care n Wound care n Spay/neuter recovery n Hot spots and other skin ailments n Skin diseases The BUSTER dog collar for brachycephalic breeds is transparent and has the quick and simple “Clic” closing system which is well- known from the BUSTER Clic Collars. www.kruuse.com

The collars are made of 100% polypropylene.

Completing the BUSTER Clic Collar Range...

BUSTER Clic Collars

BUSTER Comfort Collars

BUSTER Premium Collars

• •

•

• •

• •

Quick and simple “clic” closing system.

Makes the application of the collar as easy as buttoning your shirt.

Fully transparent material will allow the animal all-round vision.

Soft and flexible.

•

•

The BUSTER Comfort collar is soft and flexible Features a soft rubber outer edge for better comfort - both for the animal and the surroundings.

The BUSTER Comfort collar is transparent and has the ‘Clic’ quick fastening system.

For more information contact your local Provet Branch 0800 776 838 www.provet.co.nz

• • • •

Preassembled for ease of use.

Soft neoprene for extra comfort and security Completely lined interior to avoid skin irritation Banded edge for additional comfort Soft and flexible Washable

www.kruuse.com

+

OBESITY

STRESS-RELATED FLUTD

Let’s reduce stress and

manage them together REDUCES BODY WEIGHT BY 11% IN 60 DAYS1 REDUCES THE RECURRENCE OF FIC SIGNS BY 89%2

WITH INGREDIENTS TO HELP MANAGE STRESS

NEW Hill’s Prescription Diet™

Metabolic+Urinary Stress + 88% of pets lost weight at home in

two months

3

+ Dissolves struvite stones in as little as 7 days

4

+ With L-tryptophan and hydrolysed casein

to help manage stress

IMMIJ35146/0119

1

composition and resistance to weight gain in cats. J Am Vet Med Assoc. 2015;247(4):365-374.

Kruger JM, Lulich JP, Merrils J, et al. Proceedings. American College of Veterinary Internal Medicine Forum 2013.

Data on file. Hill’s Pet Nutrition, Inc.

2 3

4

dissolution of struvite uroliths in cats. J Am Vet Med Assoc. 2013;243:1147-1153. Average 27 days in vivo study in urolith forming cats. ™ shown are trademarks of Hill’s Pet Nutrition inc. © 2019 Hill’s Pet Nutrition (NZ) Ltd. HIMA-CA-18377183.

hillsvet.co.nz