Companion Quarterly Vol28 No3 September 2017

COMPANION QUARTERLY – Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA

Companion Quarterly

OFFICIAL NEWSLETTER OF THE COMPANION ANIMAL VETERINARIANS BRANCH OF THE NZVA Volume 28, No. 3 | September 2017

VOLUME 28 NO 3 SEPTEMBER 2017

MRSA and MRSP in companion animals

Managing iris melanoma in cats

What CPD should I do?

Anaesthesia of brachycephalic dogs

Conference report: ECVO Congress

Volume 28 | No. 3 | September 2017 ISSN No. 2463-753X EXECUTIVE COMMITTEE 2017 cas@vets.org.nz

CONTENTS

President

Helen Beattie

Companion Quarterly

Operations Manager Rochelle Ferguson

Treasurer

Aimee Brooker

Committee Members Simon Clark Nina Field John Munday Toni Anns Natalie Lloyd Pauline Calvert Paula Short

EDITORAL COMMITTEE Sarah Fowler (Editor) Bart Karalus Crystal Loh Ian Millward Juliet Matthews Simon Clark Shanaka Sarathchandra

2 Editorial 4 Highlights from CAS Executive Meeting

8 CAV Noticeboard 12 News in brief 16 What is your diagnosis?

Neil Stuttle

Address for submitting copy/ correspondence

18 Meticillin-resistant

Advertising Manager

22 Tips for managing

Sarah Fowler 66 Callum Brae Drive, Rototuna, Hamilton 3210 T (H) 07 845 7455 | M 027 358 4674 E sarah.fowler@gmail.com Christine Moloney 25 Manchester St, Feilding T 06 323 6161 | F 06 323 6179 E christine.moloney@totallyvets.co.nz

NZVA website www.nzva.org.nz CAV website www.cas.nzva.org.nz

staphylococcal infections of small animals: new consensus guidelines Allan Bell iris melanosis and melanoma in cats Craig Irving

24 Study shows brachycephalic

dogs are at greatest risk when giving birth Sarah Fowler

Copyright

26 “I haven’t got time for

Cover photograph

32 CPD record template for CQ

Newsletter design and setting

36 The complicated

The whole of the content of the Companion Quarterly is copyright, The Companion Animal Veterinarians Branch of the NZVA (CAV) and The New Zealand Veterinary Association (NZVA) Inc. Photo courtesy of Pixabay.com Penny May T 021-255-1140 E penfriend1163@gmail.com

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

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this!" Keeping up with CPD requirements Sarah Fowler

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September 2017

brachycephalics: reducing the morbidity and mortality of elective brachycephalic anaesthesia Keaton R.S. Morgan, Kyle Clark

38 What is your diagnosis? The answers

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40 Massey News 42 Photos from NZVA Conference 2017

46 European College of Veterinary Opthalmologists Congress Kellam Bayley

48 Specialist Profile – Janelle Wierenga

50 New Zealand Companion

Animal Health Foundation Update

Vets in Stress Programme 24 Hour Freephone Confidential Counselling Service

0508 664 981 Helps you solve personal and work problems, including: Relationship problems Drug and alcohol issues Work issues Change Stress Grief

52 Guidelines for authors

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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EDITORIAL

What a quarter! Or was that, What a month? Or perhaps, What a day?

It seemed the quarter involved almost more days away from home, hours in airports, strange hotel beds, social events and catching up with people from yesteryear, than it did time at home with my family and bikes. And also so bizarre, and lovely at the same time, how time falls away (not so much the wrinkles....) and it's just like 1998, all over again. The hum of the CAV, SB&D, and VBG conference was palpable, warming the cockles of my heart. It's a pretty special thing, in fact, seeing our profession get together – the movers, and the shakers, the fresh, the not-so-fresh, the coal face of our industry, and great to see everyone relax, and enjoy good company, food and wine, and learn a little bit along the way. My message is, get involved! Not only do you learn, and have some fun, but the networking and the support networks that are forged are so important.

Which leads me to remembering how I was moved and distressed all at the same time, to be approached by a young veterinarian at the conference, with whom I had a very long and deep discussion about her struggle with returning to work, the expectations made of her, and lack of support that she felt. She told me how my story in the VetScript resonated, and that she was thankful to know that she wasn't alone in her thoughts of inadequacy, not being ‘good enough’, vulnerability, and self-doubt. Moved, and distressed, I was. And alarmed that the feedback and support from those with whom she worked was not what she needed to help resolve these issues. Notwithstanding that I understand we are all busy, and I understand that few people manage to perfectly align tasks and available time, we surely understand that priority must be afforded to people seeking support and asking for help. My message is, take the time. In the end, people matter.

Support is critical. Walk the talk. Everyone's needs are different, but valid. Providing a little will reap a lot. Be kind, patient and generous. The consequences of not doing this are not something I would want on my conscience.

Which leads me to being thankful for those that do provide so much to our profession. The CAV executive were delighted to have Kate Hill back from overseas to receive her service award from 2016, and privileged to have the opportunity to present (in absentia) Campbell Johnston with his service award for 2017. As I so inelegantly proposed during the presentation, there was a changing of the "old guard" about the time that I started on the CAV executive. I remember being quite in awe of these amazing people who have given such brilliant service to the CAS (as it was) and New Zealand veterinary profession, and slightly concerned that they were stepping aside leaving people like Callum in charge... (turns out he was alright too).

What transpires is the depth of fabulous people that we have in our profession, and what each has to offer. My message is, don't be shy! When the call goes out to get involved, take the 2

plunge; it's a hugely rewarding and fun thing to do, and there are people to meet along the way whose counsel for which you will ever be grateful.

Which leads me to the month of June which was filled with animal welfare-related events that opened my mind and eyes a little more to the challenges we face in this space. I attended a talk by Rebecca Ledger who spoke about animal welfare cases being successfully presented and prosecuted based on emotional harm and suffering through distress and pain, despite the absence of physical evidence. That might not sound like a big deal, but in a world where we have only just introduced sentience to the Animal Welfare Act 1999, and not all countries have the same, this is big news. My message is, stay open-minded. The animal welfare arena is shifting and changing as we progress the welfare spectrum. It is a long road that will be made up of many small steps. We are the voice for those that have none, on this journey.

Which leads me to the reward and heady highs of what 22 years of quiet, solid, unrelenting science-backed and valuesbased lobbying has now achieved in the tale (pun intended) of animal welfare in New Zealand. It was a momentous day for all those who have been involved over the 2 decades when in July the New Zealand Government announced that cosmetic tail docking would be banned. We should be proud of this achievement, and we should be proud of our behaviour and courage in the face of criticism, and opposition. My message is, never give up. Perseverance, advocacy for the vulnerable and for animal welfare, and a good dose of science go a long way.

It's who we are; it's what we do.

And I think we are pretty darn good at it. Let's continue.

B. Helen Beattie, CAV President. l

Mr Brown is pleased all dogs get to have an awesome tail like his.

Photo courtesy of Jenny Carter

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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WORKING TO PROMOTE AND SUPPORT COMPANION ANIMAL PRACTICE IN NEW ZEALAND

CAV activities and meeting highlights

Conference

The CAV stream at conference was a huge success. Our speakers, headed up

by Richard Woolley, and ably supported

by Janelle Wierenga and Robyn Gear, were truly world class. CAV were also very proud to present the 2017 CAV Service Award during the AGM to Campbell Johnston for his outstanding contribution to the work of the CAV committee, including establishing the CAV Veterinary Refresher Scheme and managing the sponsorship portfolio for WSAVA Congress 2013.

International relationship building

CAV hosted Geeta Saini, the Australian Small Animal Veterinarians (ASAV) President and Shane Ryan, PresidentElect of the World Small Animal Veterinary Association (WSAVA) at our conference. It is valuable to exchange notes on activities and initiatives with our overseas counterparts. Many of the issues we face as a profession are comparable and these ongoing relationships ensure we don’t waste time ‘reinventing the wheel.’ In the spirit of global exchange, CAV will be represented at WSAVA in Copenhagen

by Charlotte Matthews, and at the FASAVA/ASAV conference in the Gold Coast by Pieter Verhoek and Natalie Lloyd.

CAV student members

CAV met with the 4th year veterinary students in May to share lunch and enjoy a presentation from Dogs New Zealand’s (formally the New Zealand Kennel Club) Becky Murphy who spoke on improving the health and welfare of pedigree dogs.

Scholarships

CAV and RxVet: “A Week With…”

We received many worthy applications, resorting to a random ballot to decide our final two candidates. The successful

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applicants were Susan Murray, who will spend a week with Pru Galloway, and Jane Ough who is planning to see practice with Warrick Bruce. We are grateful to those that took the time to apply, the specialists for making themselves available and to RxVet for sponsoring the grant.

Hill’s Pet Nutrition/CAV Educating the Educators Scholarship

This scholarship supports veterinarians with advanced skills to obtain continuing professional development overseas.

Their new knowledge is brought back and shared with members through regional branch presentations and articles in the Companion Quarterly.

With Kellam Bayley and Jos van Hees obtaining further education in ophthalmology, Elsa Flint attending the behaviour stream at ANZCVS Science week, and Janine van Dam planning to attend a dental conference, we can look forward to topics that will have something for everyone. Our sincere thanks go to our sponsors Hill’s Pet Nutrition, VetLearn and the Institute of Veterinary, Animal and Biomedical Sciences for their ongoing support.

Veterinary Council of New Zealand (VCNZ)

Wayne Ricketts from VCNZ was our guest at the last committee meeting. We discussed the following curly issues seen in everyday practice, and he provided the following sage advice.

Stray cats

Veterinarians have no legal ability to hold stray animals and rehome them, but this can be facilitated by working with your local SPCA. As an approved organisation, the SPCA can provide authority to hold the cat at the veterinary clinic. At the end of 7 days, you can then re-home the cat once transfer of ownership is conferred.

In reality, how stray cats are managed will depend on individual relationships between veterinary clinics and their local SPCA. Members should be encouraged to develop these relationships in advance of issues arising with stray animals being presented to veterinary clinics, and develop a local Memorandum of Understanding (MOU) to this effect. It is hoped that with the move to one RNZSPCA this November, a national MOU will be able to provide guidance on this issue.

Veterinary operating instructions

There is a discrepancy between small animal and large animal practice where farmers regularly vaccinate their own animals, yet cat and dog owners do not. While an authorisation could be written to allow an owner to administer a vaccine to their cat or dog, it is not common practice and Wayne’s opinion is that we should be retaining vaccination as an “in-clinic” procedure. The point was made that anaphylactic reactions although rare, can occur and this would be a particularly difficult event to manage outside of a clinic setting. You also have to take into account the lack of expertise and competence of the owner in inserting a vaccination needle into the skin of their pets. Farmers are much more experienced and used to doing this.

Where VOI are written for nurses to administer vaccinations, Wayne referred us to the Agricultural Compounds and Veterinary Medicine (ACVM) guidelines.

Wayne thinks these are great guidelines and a number of veterinarians have told him they are also using the checklist for the authorisation of restricted veterinary medicines.

Microchipping guidelines

Veterinarians are not the pet police and pet ownership is not established solely on being the person registered to a microchip in an animal.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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Veterinarians should always talk openly with the presenting client about their concerns, giving them the benefit of the doubt. If there is an unexplained discrepancy or the client accepts they found (or stole) the animal, an attempt should be made to persuade them to co-operate in notifying the true owner of the animal’s whereabouts and having it returned. It’s the decision of the person presenting the animal however.

Be careful as this is a very tricky area.

There are legal and ethical aspects. You need to consider seeking legal advice or contacting VCNZ or NZVA. Read Wayne’s upcoming article in the September Vetscript.

Dangerous dogs

While there is no ethical obligation for a veterinarian to report a dangerous dog, that in their opinion, poses a risk to human safety, a veterinarian may feel a moral obligation to act.

Wayne’s advice is to pass the details on to a local animal control officer (ACO) for them to follow up. This is a potential breach of the Privacy Act 1993. However Principle 11(e) of the Privacy Act 1993 allows you to disclose details of an owner without their permission to prevent or lessen a serious threat to public health or public safety. If an ACO asks you for information about the ownership of a dangerous dog, in regard to a potential breach of the Dog Control Act, you can also use Principle 11(e) on the basis of avoiding prejudice to the maintenance of the law. When providing this information to an ACO, it is judicious to state in writing the reasons why you are doing so, before the fact, including the reference to Principle 11(e).

Veterinarians can decline to see a dog that exhibits aggressive behaviour on health and safety grounds, but he notes that veterinarians are obliged to provide an alternative arrangements or contacts for veterinary care in order for the welfare needs to be met.

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Media work

Brachycephalic issues

An article on Stuff in May to which CAV contributed, highlighted the welfare issues associated with many brachycephalic dogs. As with all external media, we are at the mercy of the reporter to accurately convey our message and some of the message didn’t make it through to the final article in its full context. To capitalise on the heightened awareness created by the article, and to clarify our concerns, CAV followed this up with an ethical guide to sourcing a puppy, shared on the NZVA Facebook page and available on our website. The message was also supported by a timely article in Vetscript that discussed this issue, including the science around the welfare concerns.

Tail docking ban

We are now celebrating the right of every dog to wag their tail! In addition to the supplementary submission made in November last year, CAV provided further supporting information to MPI in April and made comment on the results of the independent review in June. This has been a long campaign starting in the late eighties, in which the profession has maintained strong, steady pressure to advance animal welfare. Every veterinarian should be proud of the unified front the profession presented to get this job done.

National Cat Management Strategy

Final NCMS documents will be made public once final editing is completed.

No decision about how to progress this work or group has been made, and is constrained by funding. This needs further discussion and consideration, with several options mooted, including disbanding, splitting and dividing operational workload, or key stakeholders forming a steering group.

New Zealand Companion Animal Council

At the strategic retreat in May, the NZCAC decided that only national organisations would be represented on the board.

This means that CAV will likely lose their seat at the board table, although the NZVA seat will remain. With Pieter Verhoek (previous CAV President) being the current NZVA representative and NZCAC Chair-in-waiting, we are confident that veterinarians will continue to have strong representation at the council board table, albeit in diminished numbers. l

Dog Control Act Amendments

CAV have met with the Department of Internal Affairs and RNZSPCA twice following our meeting with Minister Jacqui Dean in April, to discuss proposed amendments to the Dog Control Act 1999. The outcomes of these meetings have produced some positive changes to the proposed legislation, however we still hold concerns regarding the breed-specific focus of many of the amendments. The Minister and the department have been thoroughly appraised of our concerns.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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The CAV Noticeboard Hill’s Pet Nutrition/CAV Educating the Educators Scholarship This scholarship provides assistance for veterinary educators to attend advanced level continuing education events outside New Zealand, in exchange for articles, reports and presentations on their area of interest.

Through this partnership, we recognise the importance in supporting our leading veterinarians’ participation in international conferences to ensure they remain up to date, and disseminate this knowledge to the wider CAV membership.

This scholarship is open to both CAV members and non-members. Successful applicants are

usually specialists in their field but we also support those who have developed advanced skills in a specialist area.

If you would like to partner with us to improve the knowledge of NZ veterinarians, then see our website, or contact cav@vets.org.nz for application forms and a list of the terms and conditions.

We are very grateful to Hill’s Pet Nutrition as the principle sponsor along with support we receive from the Institute of Veterinary, Animal and Biomedical Sciences and VetLearn.

CAV/CAHF Project Grant 2017 The Companion Animal Health Foundation is a charitable trust that acts as the research funding arm for CAV. Funding applications are invited in March and September for research projects that will enhance companion animal health and welfare.

See the CAHF website (www.healthypets.org.nz) to find out how we are supporting projects on elbow dysplasia, bone marrow sampling techniques and FIV

WINNER

Article of the Issue

Jeffrey Cline

prevalence. Any queries on how to make an application or donate contact Rochelle Ferguson (CAV Operations Manager) on cav@vets.org.nz

G SCH RAN OL TS & AR SH Ava IPS ilab CAV le to me mb ers

“Opioids and gastro-oesophageal reflux, regurgitation and vomiting in the perianaesthetic period” June 2017 | Volume 28 (2) | Pages 24–29

EYEVET Services Limited

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Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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INDUSTRY NEWS

A range of parasite protection Summer and spring are the busy seasons for parasites. Prevention and treatment strategies with effective products are key to keeping them under control. With these products, Virbac has a range of options to help you help your clients prevent and control parasitism by intestinal worms and fleas.

Easy administration wormers

As vets, we understand that ease of use is very important in ensuring regular worming treatments are kept up. However, actives such as praziquantel are quite foul tasting and quite disliked by companion animals.

Virbac has developed two praziquantel containing worming treatments which focus on palatability for pets – and ease of use for owners.

Milpro® Premium Wormer for cats and dogs comes in a small-sized tablet

with a meat-flavoured film-coating which pets find delicious. Available in 4 sizes, for kittens, cats, puppies and dogs. All have highly effective active ingredients, praziquantel for cestodes and milbemycin oxime (a macrocyclic lactone) for nematodes.

Endogard® Palatable All-Wormer

features a tasty flavouring that is mixed throughout the tablet, to give owners options for administration: give whole and chewed or broken up and mixed with food. It’s a good option for pets with delicate tummies as the active for nematodes, benzimidazole oxibendazole, is known for its gentle action.

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Sheep Measles

‘Sheep Measles’ are the cysts caused by the Taenia ovis tapeworm in sheep which are intermediate hosts. They cause significant carcass damage and loss of value at the abattoir. But before that, they supress the immunity of sheep, leading to poor health and other diseases. Taeniid tapeworms are extremely fecund, will heavily contaminate pastures quickly and are very difficult to remove once introduced. The damaging effect on the farm can be substantial.

Dogs play an essential role in the worm’s lifecycle. Quarterly treatment of farm dogs will prevent the clinical disease in dogs, but to help prevent contamination of sheep carcasses and stop the parasite spreading between farms dogs need to be treated monthly. Regular dosing is important as unexposed sheep have lowered immunity against the tapeworm, so infections can be more extensive.

Urban dogs also need to be treated whenever travelling anywhere near sheep.

Wormicide Tape is a straight

praziquantel tablet of a high concentration for preventing the transmission of Sheep Measles to sheep. Given monthly, it’s a simple way to help prevent the spread of this extremely damaging parasite.

For complete flea prevention treat the house and the pet.

It is a surprising fact that 95% of a flea’s lifecycle is not spent on a host. The flea’s lifecycle is such that eggs and larvae live in soft furnishings, carpets

– literally every nook and cranny.

Therefore environmental management of fleas is essential for complete flea control.

The best time to use house-based treatments is in the spring (September/ October). This will stop the first generation of fleas from reproducing and, as a result, prevent the build-up of large numbers of adult fleas at the beginning of summer.

Indorex is an excellent environmental treatment that is applied as a spray, for areas such as pet beds, or as a fogger for the whole house.

It contains pyriproxyfen, a new generation juvenile hormone analogue which kills flea larvae. By disrupting the moult process, it prevents incubation of the egg, the metamorphosis of larvae into pupae and (provided exposure occurs prior to the cocoon forming) the pupae into adult. Pyriproxyfen will also render adult fleas infertile. Pyriproxyfen is a very photostable molecule giving this product a 12 month duration of effect. This can help control gravid adult fleas that pets pick up from other animals. These adults can lay eggs before they are killed by the individual treatment leading to environmental contamination.

It also contains permethrin to kill adult fleas, and the stabiliser piperonyl butoxide.

Thank you to all of you who have been supporting our new cat and dog wormer Milpro®. Virbac is very proud of our range of companion animal parasite treatments.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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NEWS IN BRIEF

New members of the CAV Executive Committee This issue we introduce two more new members of the CAV Executive Committee.

Welcome aboard to Nina Field and Paula Short.

Nina Field: I left the sunshine of Motueka for Palmerston North and Massey after high school and graduated in 1991. My first job was in a companion animal practice in Rotorua and after 18 months my itchy feet got the better of me and I headed off for my OE. The next 11 years were spent based in the UK in a variety of mainly CA jobs, both as a locum and full time employment interspersed with lots of travel and the occasional small stint of locums back here in NZ. Finally I arrived back home on a oneway ticket with husband, son, dog and cat and we settled in Christchurch.

There I worked part-time in a lot of the companion animal clinics, had a daughter and enjoyed being near family and the sea! My husband’s work however had us moving a little further south and we are now ensconced in Ashburton and I am working part time for VetEnt. I’ve been at Riverside for nearly 4 years and I am loving working in a team, learning from my colleagues and using my many years of experience to help them as well. This is also the first time I’ve been involved with dairy veterinarians and the dairy industry, making me more aware of the veterinary profession as a nationwide (if not worldwide) community.

I’m hoping that my experience as a veterinarian and as a person can be of use as a mentor as well as someone who has been in most CA situations and survived! Also as an example of making the job work part-time, so other vets aren’t perhaps so tempted to leave clinical work and employers can embrace the benefits of part-timers.

The more experiences you have in your life you have a greater awareness

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CAV Executive Committee Front row, L to R: Toni Anns, Natalie Lloyd, Paula Short, Aimee Brooke. Back row, L to R: Simon Clark, Rochelle Ferguson, Helen Beattie, Nina Field, John Munday

Photo courtesy of Sue Blaikie

of your individual responsibility not only to yourself and immediate family but also the community, the land and the future. Joining the CAV Executive Committee is my attempt to give back to the profession and hopefully help New Zealand in its aims to provide a healthy and productive environment for us all to live in and become good global citizens, therefore able to help others less fortunate than ourselves.

mixed practice position at Riverside Vets in Ashburton under then owner Lewis Griffiths. Following that I worked in small animal practice in New Zealand and in England and had short stints in the pharmaceutical industry and with MAF.

Paula Short: Growing up on a dairy farm in Southland inevitably led me to vet school at Massey University to follow my passion for animals. Whilst there I also discovered a love of the great outdoors and spent many weekends away kayaking, climbing and tramping with the Massey Alpine Club.

I’m now following my dual passions for animal nutrition and business by setting up a small pet food company producing healthy, sustainable and ethically sourced pet food. I strongly believe in the direction our profession is currently taking with its focus on animals, people and the environment and look forward to contributing, where I can, to drive this forward. l

After graduating in 2000 I was lucky enough to find myself working in a

Practice ownership beckoned and I spent the next 8 years in the Nelson region growing Tasman Bay Vets before selling it to a neighbouring practice so I could spend more time with my young family.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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NEWS IN BRIEF

2017 CAV Service Award We are very pleased to announce that the CAV service award for 2017 has been awarded to Campbell Johnston. This award was presented to Dr. Johnston at the CAV AGM held during the 2017 Conference in Blenheim in June.

Campbell Johnston graduated in 1980 with distinction from Massey University.

After marrying Alison, a veterinary school classmate, he trod the well-worn path of spending a few years in mixed practice before heading overseas to take up locum work and travel. After returning to New Zealand in 1986, Campbell began work at a 2-vet practice in Tauranga. He later went on to become an owner of this business, successfully growing it so that it now employs six veterinarians, working out of four clinics.

Campbell has shown a keen interest in developing his veterinary skills throughout his career. He was the very first CAS Practitioner in Residence in 1994, spending a month at Massey University Veterinary Teaching Hospital, developing his interest in orthopaedic surgery and endoscopy. This experience was described by him in his CAV bio as “enlightening” – it’s not clear if this description relates to the exposure to the highest echelons of veterinary academia or from mixing with the final year veterinary students at happy hour!

Campbell has taken his knowledge and experience and used it to provide high quality companion animal services, offering regional veterinary referral services in surgery and endoscopy to his practice in Tauranga.

Campbell was asked to join the CAV executive in 2007. We did a little digging, and have been told by a reliable source (perhaps… Pieter??) that he didn’t think it would be polite to say no. Lucky for us!

Campbell served on the committee until May 2013. During this time, he made

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resource and it is highly valued by the participants.

significant contributions to companion animal veterinarians in New Zealand.

The challenges faced by veterinarians re-entering the profession was a big issue for the committee and had been a common subject discussed around the board table for a number of years.

Campbell picked up the responsibility for this from an outgoing committee member and over four years he explored numerous options, scenarios and permutations and talked with everyone at NZVA, at Massey, and to specialists, then galvanised all of this talk into action, leading a project team to develop the CAV Veterinary Refresher Scheme. This scheme is now in its sixth year and provides a clear pathway for veterinarians wishing to return, refresh or change to companion animal practice.

The CAV executive is very proud of this

Campbell’s contribution to CAV also included serving on the Local Organising Committee for WSAVA 2013.

The congress was highly successful, being the largest companion animal conference ever held in New Zealand, with 1800 delegates. Campbell was in charge of sponsorship and exhibitors and it is to his credit that the sponsorship and exhibition packages were completely sold out – bringing in revenue far in excess of the best case scenario projections. It is on this solid financial base that the success of the congress was built. His influence extended beyond the financial, with his contributions giving the organisers an invaluable perspective on each and every subject.

Campbell’s fellow executive committee members all speak highly of him, describing him as a stalwart of the committee, a highly honourable man and passionate about companion animal veterinarians and what they have to offer.

Special mention was made of his emails, known affectionately as “The Campbell Rant” and of his legendary persistence.

During what was a very busy time for the committee, Campbell’s ability to listen and consider different points of view was invaluable.

We thank Campbell very much for his service to the CAV executive committee, the CAV membership and the wider veterinary profession. l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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What is your diagnosis?

THE QUESTIONS… NEIL STUTTLE BVSc

Case history

A 2-year-old male working heading dog was presented for severe respiratory distress, anorexia and diarrhoea that developed over the past week. On clinical exam, he was severely dyspnoeic (both inspiratory and expiratory) and tachypnoeic (80 breaths per minute), exhibiting open-mouth breathing and cyanotic mucous membranes. Thoracic auscultation revealed increased lung sounds audible bilaterally. No heart murmur was heard and his pulse rate was 160 beats per minute. The rectal temperature was 38.4°C and fresh blood was present on the end of the thermometer.

a

Supplemental oxygen was provided and thoracocentesis was performed on both sides of the chest. No fluid or air could be aspirated. A lateral thoracic radiograph was then taken (Figure 1).

Questions

1. What are your radiographic findings?

2. What are your differential diagnoses based on these findings? l

Answers on page 38

b Contact: Vet Services (HB) Ltd, Hastings. 801 Heretaunga Street Hastings. Ph (06) 876 7001

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Figure 1. (a) Left lateral radiographic view of the thorax of a 2-yearold male heading dog that presented with dyspnoea and tachypnoea. (b) Magnification of left lateral radiograph highlighting dorsal lung fields.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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CLINICAL UPDATE

Meticillin-resistant staphylococcal infections of small animals: new consensus guidelines ALLAN BELL, BVSc, MACVSc, FACVSc, Registered Specialist in Veterinary Dermatology The June 2017 issue of Veterinary Dermatology (http://onlinelibrary. wiley.com/doi/10.1111/vde.2017.28. issue-3/issuetoc) contains two Clinical Consensus Guidelines from the World Association of Veterinary Dermatology, both of which are open access. The first is for the diagnosis and treatment of dermatophytosis in dogs and cats (Moriello et al. 2017) and the second is recommendations for approaches to meticillin-resistant staphylococcal (MRS) infections in small animals (Morris et al. 2017). The two excellent editorials (Foster 2017; Barnett 2017) preceding these papers should be compulsory reading for veterinarians, as they discuss the restrictions on the value and implementation of such documents. General practitioners are likely to recognise the conscious and subconscious factors affecting their decisions and treatment advice discussed in the second editorial.

Below I offer some comments on the Consensus Guidelines on MRS infection and provide some New Zealand context.

The Consensus is twenty-six pages and is a significant and comprehensive undertaking. Despite the size, it is not intimidating, offering both a detailed table of contents and an excellent summary page. It is easy to navigate.

The five authors are all prominent in their fields and the Consensus covers infection, epidemiology, therapeutics and microbiology. The statements are based on evidence (well referenced) available before September 2016. Where evidence is lacking, it offers a consensus or discussion of expert opinions.

Contact: dermvet.bell@xtra.co.nz

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Photographs courtesy of the author

Comments were solicited from the wider veterinary dermatology community on the draft document presented at the World Veterinary Dermatology Congress last year. The usual editorial rigor was applied when the paper was submitted to Veterinary Dermatology.

My comments

The panel considers the minimum laboratory reporting for staphylococci should include complete speciation. In New Zealand we usually have to settle for staphylococcal intermedius group (SIG) reports because the software used to analyse the MALDI-TOF (matrix assisted laser desorption/ionisation time-of-flight) data for Staphlococcus pseudintermedius is not up to date.

But, to be fair, SIG probably equates to S. pseudintermedius as long as other staphylococcal species are ruled out.

Meticillin resistant S. aureus (MRSA) in cats and dogs is discussed in detail.

The nasal carriage of MRSA in cats is consistent with that of humans in their households in contrast to MRSA carriage in dogs. Some of us will have experienced healthy dogs and cats being presented for tests requested by the owners' medical advisors. When this involves testing for MRSA, the Consensus advises asking why the testing has been requested and what is planned should that test be positive.

The usually transient canine carriage of MRSA is a minor risk to humans and self-resolves. A chronic recurring MRSA problem with a human patient may be a different story, although other human and environmental sources of human re-infection are more likely. Send this Consensus to the requesting health professional!

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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Topical treatment of superficial staphylococcal skin infections, including meticillin resistant strains, is recommended "whenever a pet and owner can be expected to be compliant".

I think you have a good case to insist on a 10–14 day followup and possibly culture and sensitivity, when compliance is unlikely.

With the anecdotal increase in meticillin resistant isolates in New Zealand (we still don't have a national or regional reporting system) we need to perform culture and sensitivity on all cases of canine staphylococcal infection that are deep, recurrent or are known contacts of meticillin-resistant S. pseudintermedius (MRSP)-infected dogs.

There is an excellent section on canine MRSP carriage and what might be done about it. No consensus was reached in the Consensus panel. In short, they thought investigation and decolonisation was not effective where the incidence of MRSP was high. However some members thought decolonisation of carriers might be attempted in countries or areas with a low incidence, to try and reduce contagion. Preoperative oral sampling to detect carriage of MRSP is considered useful in dogs about to undergo tibial plateau levelling osteotomy. This is referenced.

Typing of MRSP

This has the dual problems of conferring very little benefit to the patient, and also being expensive. However it is important for a country with a low incidence of MRSP to establish which strains of MRSP are involved. This, in turn, might have some benefit at a later time, in an "outbreak", for dogs that require antibiotic treatment. Some clones have antibiograms that are sufficiently typical enabling immediate appropriate antibiotic treatment pending the culture and sensitivity result. Your laboratory should be able to organise typing if required.

Veterinary hospital infection control

This section commences with the statement "there is an ever-present risk of MRS exposure for patients and humans in a veterinary hospital" and follows with sections covering personal protection equipment, isolation practices and cleaning and disinfection. It fails to discuss the opportunities to avoid socialization, in the waiting room or parking lot, of the susceptible antibiotic-treated dog with pyoderma, and other dogs who may be either carriers, or be infected with, MRSP. This might be achieved through strategic timing of appointments and client education (Bell 2015).

Community spaces

There is a long discussion of control of MRS at the community level because there is a lack of good evidence suggesting a particular approach. I suggest there are three subsets of dogs to consider; (1) those that have or have just had an MRSP infection; (2) those that have a methicillin-sensitive S. pseudintermedius infection and are being treated with antibiotics, and (3) those who are healthy but may carry MRSP. The first group constitute a direct or indirect risk to, at least, the second group. The second are at risk from the first group and those dogs in the third group who are carriers. The Consensus considers that dogs in the first group should be restricted from dog contacts at least until they are responding to treatment.

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Photographs courtesy of the author

The second group should avoid contacts until their skin is healed and a bit longer. Advising clients with dogs that fall into the first or second group will require a thorough understanding of where and how their dogs live.

The authors note that this Consensus is based on current information. As more information is obtained it will be updated.

Read it!

References:

Barnett T. Clinical Consensus Guidelines and the role of social sciences. Veterinary Dermatology 28, 263–5, 2017 Bell A. Time to prepare! Vetscript 28 (10), 48–51, 2015 Foster A. Introduction to the World Association for Veterinary Dermatology and the Clinical Consensus Guidelines. Veterinary Dermatology 28, 261, 2017 Moriello KA, Coyner K, Paterson S, Mignon B. Diagnosis and treatment of dermatophytosis in dogs and cats. Clinical Consensus Guidelines of the World Association for Veterinary Dermatology. Veterinary Dermatology 28, 266–68, 2017 Morris DO, Loeffler A, Davis MF, Guardabassi L, Weese JS. Recommendations for approaches to meticillin-resistant staphylococcal infections of small animals: diagnosis, therapeutic considerations and preventative measures: Clinical Consensus Guidelines of the World Association for Veterinary Dermatology.

Veterinary Dermatology 28, 304–69, 2017 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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CLINICAL UPDATE

Tips for managing iris melanosis and melanoma in cats CRAIG IRVING, BVSc, MACVSc, CertVet Ophthal, Registered Specialist Veterinary Ophthalmologist Iris pigmentary lesions, also known as iris melanosis, iris freckles, iris nevi, melanocytoma, or iris hyperpigmentation syndrome are benign accumulations of melanocytes which present as flat, solitary to multifocal, brown patches of pigment present on the iris surface (Figure 1). Benign pigmentary changes in the cat iris may be precursor lesions to malignant iris melanoma. It has been found that these localised, non-raised pigment areas on the anterior face of the iris stroma may sometimes progressively increase in size with the histopathologic features of the melanocytes transforming to show features of malignancy.

l Progression to iris melanoma is suggested by the following

features: ¡ Increased in size of the lesion ¡ Change in the surface contour of the lesion – typically becoming raised and velvetty ¡ Darkening of the lesion ¡ Dyscoria due to infiltration and distortion of the iris ¡ The aqueous humour becomes cloudy or contains pigment due to cellular exfoliation ¡ Increased intraocular pressure l In advanced cases, diffuse iris melanoma may progress to

infiltrate the stroma of the iris, the cilliary body and the iridocorneal angle. At this point, tumour growth may block aqueous outflow pathways leading to secondary glaucoma.

Glaucoma may also be caused by cells exfoliating from the tumour and collecting within the drainage angle. l Ocular melanoma may be locally invasive, including extraocular extension into the orbit, or it may metastasize widely to other locations including liver, spleen, kidneys, lungs, and the brain. l The time interval of transformation and tumour growth is variable and often prolonged, ranging from several months to several years. l The known or suspected metastasis rate of diffuse iris melanoma in cats, according to three studies is 53–66%. l When metastasis does occur, it is often not evident for months to several years following documented progressive tumour growth.

Equally important and critical are the factors which are not known regarding this condition. These include:

Figure 1. Examples of benign iris hyperpigmentation.

l The percentage of cats in which the cellular transformation

This raises questions as to the appropriate course of action for the veterinarian when confronted with a feline patient with iris pigmentary changes.

l The risk factors associated with this transformation.

The following facts are known or strongly suspected regarding iris melanoma in cats: l Benign, non-raised pigmentary lesions in cat irises may

transform morphologically and biologically into iris melanoma.

Contact: Eyevet Services, craigeyevet@clear.net.nz

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from benign pigmentary foci to malignant melanoma occurs. l Whether feline iris melanoma may arise spontaneously i.e.

de novo, without progression from a benign pigmentary lesion. l Whether early enucleation has any beneficial or protective effect on the long-term rate of metastasis. While controversial, some studies in humans suggest that enucleation may actually increase the rate of metastasis of ocular melanoma presumably due to inadvertent release of metastatic cells into the circulation during the enucleation surgery.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

The dilemma facing the veterinarian is when to intervene surgically with enucleation. Interestingly, physician ophthalmologists have debated this issue for the past 100 years, without resolution or a clear recommendation.

Distinguishing many early iridal pigmentary changes as benign or malignant can be difficult. Cytology of the aqueous humour or a fine-needle aspirate of the lesion are unlikely to yield representative or diagnostic samples and a biopsy of the iris (referral to specialist ophthalmologist is recommended) is likely to result in haemorrhage potentially facilitating spread of neoplastic cells. Thus, a definitive diagnosis of iris melanoma is usually only able to be made after histopathology of the enucleated globe.

Also controversial is the proper course action for management of enlarging pigmentary changes in the iris, suspected to be melanoma. One argument suggests that enucleation is only indicated when advanced iris infiltration and secondary glaucoma is evident, as there is reluctance to remove a visual, pain-free globe, especially considering the variable rate of tumour growth and variable and often prolonged time-interval to metastasis.

Clinicians ascribing to this philosophy monitor for tumour growth, and some have attempted chemotherapeutic or laser ablative surgical techniques to arrest tumour growth or induce

remission. The counter argument suggests that enucleation is indicated when a diagnosis of melanoma becomes evident (and admittedly, this diagnosis may be difficult to make).

Clinicians favouring early enucleation rationalize that this prevents malignant cells from reaching the aqueous outflow pathways, or other routes of metastasis, and that definitive evidence exists with regards to the benefit of early enucleation. Several studies have suggested cats with the most favourable prognosis were those in which enucleation occurred when melanoma was still confined to the anterior stromal face of the iris. Conversely those with the poorest prognosis had more advanced ocular involvement at the time of enucleation, particularly those with iridocorneal angle and scleral venous plexus involvement. What is unclear from these studies is whether these differences in metastatic rate reflected the time interval that these cats had iris melanoma, or other undefined risk factors which influence the likelihood and speed of metastatic spread of the tumour.

A definitive recommendation on when to intervene with feline iris melanoma may be exceedingly difficult to obtain.

A controlled, retrospective clinical study comparing the long term survival rate (over at least 3–5 years) of cats receiving early enucleation with those being

monitored for the development of glaucoma and receiving late enucleation, would be of great benefit. Controlling the variables in such a study and obtaining the necessary follow up would obviously be a challenge.

Based on the information discussed above, I would advise the following: 1. Unilateral flat iris hyperpigmentation alone: watch/photograph and recheck 3–6 monthly.

2. As above, plus evidence of progression >20% over 6 months: watch as for 1. If evidence of dyscoria (irregularity in the pupil) or restricted pupil movement, then enucleate.

3. Flat hyperpigmentation with angle involvement: enucleate.

4. Hyperpigmentation with a raised velvety surface texture: watch as for 1 but enucleate if angle involvements occurs.

5. Concurrent uveitis which appears secondary to an iris lesion: enucleate if condition does not quickly respond to treatment.

6. Concurrent glaucoma: enucleate.

7. Painful globe: enucleate.

8. Blind globe: enucleate.

The final decision for each patient is an individualised one made in concert by an informed veterinarian and an enlightened client. l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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CLINICAL UPDATE

Study shows brachycephalic dogs are at greatest risk when giving birth SARAH FOWLER , CQ Editor A recent study from the UK by Dan O’Neill and colleagues from the Royal Veterinary College, in collaboration with clinicians from Vets Now (a large multi-site after-hours emergency practice) has shown that small brachycephalic breeds such as French bulldogs, Boston terrriers and pugs are significantly more likely to be presented for dystocia than cross-breed bitches.

The retrospective study, published in Veterinary Record in May, is part of a research project called VetCompass led by researchers at RVC. Anonymised clinical data is gathered from a large number of UK first-opinion and emergency care practices and analysed, with the aim of improving the evidence base for companion animal clinical descision making. This is the latest of 25 studies generated from this project. Other VetCompass studies have looked at the prevalence of and risk factors for corneal ulceration in UK dogs, the epidemiology of diabetes melitus in cats and the demography and health of pugs.

The large study population included the records of 18,758 entire female dogs presented to 50 Vets Now clinics across the UK between 2012 and 2014. In this group there were 701 dystocia cases. Thus the prevalance of dystocia among entire bitches presenting as an emergency was 3.7%. Statistical modelling of the data showed that of the animals in the study, French Bulldogs were 16 times more likely to be presented for dystocia than cross-breed bitches, Boston terriers were 13 times more likely, pugs 11 times and Chihuahuas 10 times. The study also showed middle aged bitches (3–6 years old) were 3 times more likely to be presented for dystocia than bitches <3 years old.

This study provides support for existence of breed dispositions towards dystocia, particularly in bitches of flat-faced breeds.

However, as the authors acknowledge, there are several factors which limit the conclusions that may be drawn from these data.

It must be noted that rather than analysing the proportion of all births by a breed that resulted in dystocia, this study compares the over-representation of that breed in the group of bitches presenting to emergency clinics for dystocia. This is highlighted by the fact that several small brachycephalic breeds have been reported to have dystocia rates near 100%. It is interesting to note that English bulldogs, a breed renouned its poor self-whelping abilities was not mentioned in this study as being at increased risk. This may be due to breeder awareness

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Source: Pixabay.com

of the high prevalence of dystocia in this breed meaning they are more likely to present to their routine veterinarian for an elective caesarean. Thus while the general trends revealed in this study are likely genunine, the absolute magnitude of the risk may be an over or under estimate.

The authors suggest that this information can be used to assist veterinarians when advising clients on choice of breed or when making breeding recommendations to breeders.

Related articles/websites:

O'Neill DG, Darwent EC, Church DB, Brodbelt DC. Demography and health of Pugs under primary veterinary care in England. Canine Genetics and Epidemiology 2016, O'Neill DG, Gostelow R, Orme C, Church DB, Niessen SJM, Verheyen K, Brodbelt DC. Epidemiology of diabetes mellitus among 193,435 cats attending primary-care veterinary practices in England. Journal of Veterinary Internal Medicine 3, 1–12, 2017 O’Neill DG, Lee MM, Brodbelt DC, Church DB, Sanchez RF. Corneal ulcerative disease in dogs under primary veterinary care in England: epidemiology and clinical management. Canine Genetics and Epidemiology 4, 5, 2017 O’Neill DG, O’Sullivan AM, Manson EA, Church DB, Boag AK, McGreevy PD, Brodbelt DC. Canine dystocia in 50 UK first-opinion emergency care veterinary practices: prevalence and risk factors. Veterinary Record DOI10.1136/vr.104108, 2017 VetCompass. Health and Surveillance for UK companion animals. http://www.rvc.ac.uk/VetCOMPASS/ l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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FEATURE ARTICLE

“I haven’t got time for this!" Keeping up with CPD requirements SARAH FOWLER , BSc, BVSc, MSc, PhD, Editor

Companion Quarterly

Advances in veterinary medicine are happening at a fast pace, and pet owners/farmers are demanding more from veterinarians. We have to be ahead of the game. The Veterinary Council of New Zealand (VCNZ) requires that all veterinarians declare (and if selected for an audit, demonstrate) involvement in continuing professional development (CPD) activities. The aim is to not only maintain, but to improve your competence and performance in your area of practice.

Here is a guide for practitioners to identify ‘quality’ CPD offerings and how to get the best out of any CPD you undertake, from the Editor of the Companion Quarterly.

What is good CPD?

There are two considerations here; firstly how to find CPD that delivers quality information and learning, and secondly figuring out what CPD is good for you.

Ideally, the CPD you undertake should relate to the areas in which you normally practice. This includes fields in which you may only practice occasionally. Examples of this would be veterinarians whose main job is non-clinical but who occasionally locum in clinics, or veterinarians who work in mixed practices and normally only see large (or small) animals but whose on-call roster requires them to see small (or large) animal cases. Veterinarians in this situation are required to keep up to date with broad developments in this additional field as well as their main area of practice.

Assessing CPD quality

In general, a quality CPD course or programme delivers accurate, evidence-based, up-to-date information. Its outcomes should be reasonable, achievable and useful, with clearly defined goals that participants can achieve by completing the activity and ideally it would also include some form of assessment so that the learning of participants can be tested. A formal continuing veterinary education activity will qualify as acceptable CPD for VCNZ auditing purposes if the criteria listed in Box 1 are met, and these criteria can be viewed as illustrative of quality CPD opportunities in general.

Box 1. Features of acceptable continuing veterinary education activities l It has defined educational aims/learning outcomes that relate to their area of work l It reflects accepted practice and is evidence based l The provider has sufficient expertise to develop and run course l Bias is declared l Ideally some post-activity evaluation/reflection l You consider relevant useful learning has occurred

What to consider when deciding what CPD to do

Beyond these general features, to pick good CPD opportunities veterinarians need to know what they want from it.

Appropriate, quality CPD can help vets achieve a variety of goals:

Otoscopy wetlab at "Ears close up: Taking the pain out of otitis externa workshop" (NZVA) presented by Craig Griffin, September 2014, Massey University, Palmerston North. Photo credit: Sarah Fowler 26

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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l staying current, l staying satisfied, l increasing income, l increasing job opportunities, l maintaining a good curriculum vitae

(CV) for future job prospects, l strengthening your peer network.

Kate Hill, director of Massey University’s Master of Veterinary Medicine (MVM) programme says “CPD that adds up to a degree can certainly enhance the CV, increase job prospects, increase job satisfaction [and] groom thinking skills.

Short intensive practical wet labs can rapidly up-speed skills to translate to practice an increase income (i.e. cytology of skin diseases etc., can rapidly increase practice income).”

There is a wide variety of veterinary CPD on offer from a multitude of sources.

Veterinarians need to do some research and planning and work out what will work best for them in their situation.

There is a cost associated with most CPD, however this is a worthy investment.

Developing a long term CPD plan which is tailored to your needs and includes your future goals and directions will ensure you get the most out of it.

It may be helpful to make a list of topics under different categories; for example, topics that you find interesting relating to career development; topics you could benefit from a refresher (or up-skilling) in and topics that you think are changing rapidly and so you may need updating/ up-skilling in the future. You can then seek out CPD offerings covering these topics as they become available.

Other aspects to consider when formulating your CPD plan: l Some courses may be for short term

gain and others for long-term career enhancement l Try different types of CPD (see below) l Consider the importance of collegial activities. Learning experiences are enhanced by the informal chats between colleagues, not to mention the moral support that is derived from being with a group of professionals that understand the challenges, frustrations and joys of practicing veterinary medicine.

Types of CPD

There is a wide variety of different learning activities that may be considered by VCNZ as suitable 28

veterinary CPD. Activities you participate in that helps you revise/retain current knowledge/skills or acquire new skills or knowledge that is relevant to your field of practice may be considered CPD. It is important, however, to remember that points may only be claimed towards your required CPD total if you believe useful learning occurred.

Online options are generally less expensive or no charge, flexible, and are useful for topics based on theory.

‘Offline’ options where sessions are taught on-site may also include a practical session or wet lab and are therefore more helpful in gaining practical skills and hands-on experience.

It is good to understand your learning style, be that visual, kinesthetic or auditory and then look for CPD sessions that make the most of your preferred learning style. You can then maximise the time you devote to your CPD. VCNZ considers veterinary CPD as falling into one of three categories: 1. Continuing Veterinary Education (CVE). CVE activities are structured learning opportunities that have defined educational aims and usually have some form of assessment or verification of participation by the provider, e.g. postgraduate courses, conferences, seminars and workshops, and online learning. A CVE activity will be accepted by VCNZ as CPD if it meets the criteria listed in Box 1.

You can expect that CVE activities provided, for example, by universities, the New Zealand Veterinary Association (NZVA) (and national veterinary associations from other countries), organisations affiliated with the World Organisation for Animal Health (OIE) would normally meet these criteria. Large employers and industry partners (e.g. food, pharma and equipment companies may also hold CPD events that constitute CVE. 2. Collegial Learning Activities (CLA).

CLA are interactions with colleagues, whether planned or unplanned that result in learning. Collegial learning may take place with veterinary or non-veterinary colleagues. Examples include joint treatment planning/ management sessions, journal clubs, team/vet meetings, in-house training sessions, clinical rounds, professional body meetings, mentoring of colleagues.

3. Self Directed Learning (SDL). SDL activities are those activities you

undertake, on your own initiative, to update your knowledge/skills using, for example journals, websites, podcasts. This often occurs when a particular issue arises in the course of your work such as a case that needs further research. Examples of SDL include: research/preparation for managing a case or performing a procedure, studying for exams, updating knowledge by reading journals, textbooks, websites and webinars, preparing articles for publication. You can also record the time spent developing your CPD plan and completing reflective learning records.

For SDL and CLA activities, unless the activity provides documented evidence that you participated in this activity, preferably with some detail of the educational objectives of the activity, then you must create and retain a reflective record in order for the activity to qualify for CPD points. A reflective record is a written summary of what you learned from the activity and how you see this learning improving your practice.

The VCNZ website states that “Engaging in reflective practice is associated with improved performance and professional and personal growth. Research in other professions indicates that the most effective CPD is that which is based on the individual’s work environment.”

Some sources of veterinary CPD

Note that this is by no means an exhaustive list, rather it is sources that we have used ourselves or are aware of, that we consider to offer quality veterinary CPD. Not included in this list are opportunities and events that occur in day to day veterinary practice that may be counted as CPD i.e. mentoring junior staff members, learning techniques etc. from colleagues, discussing cases with colleagues/specialists (see http:// www.vetcouncil.org.nz/documentation/ CPDInformationforVets.pdf for more info on these CPD opportunities).

Universities: post-graduate education courses offered by universities “are considered to be fully acceptable and equivalent” for the purposes of CPD. Many universities including Massey offer distance learning some of which may lead to a post-graduate degree/diploma/ certificate. Some also offer conferences, workshops, short-courses and even podcasts (Sydney).

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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l Massey e.g. MVM (http://www.massey.

ac.nz/massey/learning/colleges/ college-of-sciences/students/mvm/ mvm-home.cfm) l University of Sydney Centre for Veterinary Education (http://www.cve. edu.au/) l Royal Veterinary College (UK): (http:// cpd.rvc.ac.uk/) Veterinary Associations: Courses and conferences run by professional veterinary associations or recognised private providers: these courses are usually of a high standard and well presented. VCNZ considers these to be of equal value to courses run by Universities. l NZVA runs seminars, workshops,

webinars, conferences and online courses which are available for everyone (discounted if you are a NZVA member). l NZVA regional branch meetings. l Conferences and conferences run by other national/international veterinary associations and specialty subgroups e.g. British Small Animal Association (BSAVA), World Small Animal Veterinary Association (WSAVA), Austrailian Veterinary Association (AVA) etc.

Websites. These may be free but many require a subscription for access.

Courses from these sources may be considered CVE or SDL depending on

whether an assessment is included.

Many are RACE (Register of Approved Continuing Education; maintained by the American Association of Veterinary State Boards which is the American equivalent of VCNZ) approved. l Vetgirl (http://vetgirlontherun.com/):

Subscription based, webinar, podcasts, RACE approved. l VIN (www.vin.com): Subscription based, message boards, online courses, webinars, RACE approved. l Clinicians Brief (https://www. cliniciansbrief.com/). Free online articles reviewing a wide variety of topics from a clinical viewpoint. l DVM360 (http://www.dvm360.com/): Free articles, online courses, calendar of CPD offerings, webinars. l Webinar vet (https://www. thewebinarvet.com/): Subscriptionbased, live and recorded webinars.

Some available free. BVA approved. l Vet Education (http://veteducation. com.au/). Online courses (including study for MANZCVS), webinars (subscription or one-off cost), online conferences. RACE approved. l IVIS (http://www.ivis.org/home.asp).

Publishes books and proceedings (meetings and symposia), calendar of veterinary events, links to online courses and ‘auto-tutorial’ websites (pre-screened and evaluated).

Food/pharma/equipment companies: provide educational opportunities, usually at no cost. These may include on- and off-line options including webinars and seminars, roadshows, journal clubs, in-clinic trainings on disease states that may or may not include product knowledge, and published documentation including study reviews. Some providers also include quizzes and feedback opportunities, and notes with your learnings available for future reference.

These may meet requirements of CVE but it is up to you to make a judgement that the presenter has sufficient expertise, that bias/conflict of interest is transparent, and that commercial considerations are taken into account.

In conclusion, there are a multitude of CPD opportunities available. Speak to your practice manager about what your workplace is willing to provide and fund.

Have an understanding of the different types available, know where to look and who to speak to, formulate your own plan and know where you want your future direction to go. Make the most of opportunities that come your way, be present, take notes, write a reflective record, share your learnings with others in your practice.

Top tip: it is much easier to record as you go, than have to scramble for what you did a year ago when it comes time to fill out your APC! l

Earn CPD points for reading the Companion Quarterly Under the Veterinary Council of New Zealand’s (VCNZ) CPD framework, you can earn 1 self-directed learning (SDL) point for every 2 hours spent reading the Companion Quarterly (CQ).

prepopulated with the CQ articles for that issue.

To make it easier to claim these CPD points, we have produced templates to record your reading.

For each CQ issue, a template will be printed in the back of each magazine.

You can then simply fill it in, tear it out and file it with your other CPD records.

For those who prefer to keep their records electronically, the template is also available as Word document from our website (www.nzva.org.nz/ cavmembers); click on the CAV Education drop-down menu and select the 30

Source: Pixabay.com

“Recording CPD from the Companion Quarterly” option.

If you are using the New Zealand Veterinary Association’s MyCPD site to manage your CPD records, the CAV website also has the option for you to link to a MyCPD entry that has been

To be compliant with the VCNZ CPD requirements, you will need to write a reflective record for the activity. A reflective record is a written summary of your reflections on what you learned from a CPD activity and how it might benefit your practice. CPD points can only be claimed if you learnt something useful from the article that will help to maintain and enhance your practice.

On the following pages are the template filled out as an example, followed by a blank template for members to use as they wish. l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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CPD RECORD Read articles from Companion Quarterly 28(3) September 2017

Date of Activity: …31 September 2017………………………

Activity description Read articles in the September 2017 issue of Companion Quarterly (tick those that apply) 

Meticillin-resistant staphylococcal infections of small animals: new consensus guidelines (Allan Bell)  The complicated brachycephalics: reducing the morbidity and mortality of elective brachycephalic anaesthesia (Keaton Morgan and Kyle Clark)  Tips for managing iris melanosis and melanoma in cats (Craig Irving) o Report: European College of Veterinary Opthalmologists Congress (Kellam Bailey)  What is Your Diagnosis – paraquat toxicity (Neil Stuttle) o Brachycephalic dogs are at greatest risk when giving birth (CQ Ed) o ………………………………………………………………………………………………………… o …………………………………………………………………………………………………………

Activity type: Category: Self-directed activity Self-Directed Activity Type: Updating knowledge or preparatory reading/research Hours claimed: 2 VCNZ Points (0.5 per hour reading): 1 Reflective record: Actual learning outcomes and the impact on your practice What did you teach or learn from this activity? …I was unaware that many dogs with BOAS have gastrointestinal effects of this condition even without obvious clinical signs and that dogs with this condition should be medically treated for reflux and gastritis before anesthesia.

I leanrt that reports of MRSP in NZ are increasing providing even more reason to advise Culture and sensitivity particularly in deep, or recurrent cases or if the dog has had contact with a known MRSP case. ………………… ……………………………………………………………………………………

How do you think this will impact on your practice? …I will be more aware of the potential for gastritis and reflux when assessing bracycephalic dogs whether before surgery or otherwise. I plan to premedicate brachycephalic dogs with antacids before anaesthesia. for…I will remember to be aware that any skin infection in dogs could be MRSP and strongly recommend C&S in cases of deep or recurrent pyoderma ……………………

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Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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CPD RECORD

Read articles from Companion Quarterly 28(3) September 2017

Date of Activity: …………………………

Activity description Read articles in the September 2017 issue of Companion Quarterly (tick those that apply) o

Meticillin-resistant staphylococcal infections of small animals: new consensus guidelines (Allan Bell) o The complicated brachycephalics: reducing the morbidity and mortality of elective brachycephalic anaesthesia (Keaton Morgan and Kyle Clark) o Tips for managing iris melanosis and melanoma in cats(Craig Irving) o Report: European College of Veterinary Opthalmologists Congress (Kellam Bailey) o What is Your Diagnosis – paraquat toxicity (Neil Stuttle) o Brachycephalic dogs are at greatest risk when giving birth (CQ Ed) o ………………………………………………………………………………………………………… o ………………………………………………………………………………………………………… o …………………………………………………………………………………………………………

Activity type: Category: Self-directed activity Self-Directed Activity Type: Updating knowledge or preparatory reading/research Hours claimed: VCNZ Points (0.5 per hour reading): Reflective record: Actual learning outcomes and the impact on your practice What did you teach or learn from this activity? ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................

How do you think this will impact on your practice? ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................ ............................................................................................................................................................................................................................................................................................................

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Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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FEATURE ARTICLE

The complicated brachycephalics: reducing the morbidity and mortality of elective brachycephalic anaesthesia KEATON R.S. MORGAN

BVSc (dist) – Zoetis Rotating Intern, Veterinary Specialist Group.

KYLE CLARK BVSc (dist), MCVSc, Diplomate ACVS-SA, Specialist in Small Animal Surgery, Veterinary Specialist Group

Introduction

The selection of brachycephalic dogs for a shortened skull has made them prone to a syndrome called brachycephalic obstructive airway syndrome (BOAS).

Multiple anatomic abnormalities contribute to this syndrome including an elongated soft palate, stenotic nares and varying degrees of laryngeal collapse complicated by tracheal hypoplasia (Senn et al. 2011). However, less well known are the gastrointestinal (GI) aspects of this disorder including ptyalism, nasal discharge, dysphagia, regurgitation and vomiting.

A study by Poncet et al. (2005) showed a positive correlation between the severity of respiratory clinical signs and gastrointestinal clinical signs, particularly in French bulldogs. Furthermore, endoscopic evaluation showed that 97.3% (71/73) of the brachycephalic dogs had evidence of oesophageal, gastric and duodenal abnormalities such as distal oesophagitis and visible gastrooesphageal reflux during inspiration.

This included dogs with no clinical signs of gastrointestinal dysfunction.

Histological evaluation of gastric mucosa showed 98% (50/51) had evidence of gastritis. The most severe gastric signs were seen in English bulldogs and heavier brachycephalic dogs, two of which had evidence of chronic Contact: Keaton.morgan@vsg.co.nz or Kyle. clark@vsg.co.nz

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Source: pixabay.com

gastritis but had never demonstrated gastrointestinal signs. Twenty-seven cases had endoscopic evidence of distal oesophagitis, 23 of which had visible gastro-oesophageal reflux during inspiration.

These gastrointestinal signs are thought to occur secondary to increased intrathoracic pressures generated in dogs with upper airway obstruction. This in turn results in ptyalism, regurgitation, vomiting and reflux which can irritate the pharyngeal region promoting persistent inflammation, aggravating respiratory signs and predisposing to aspiration pneumonia (Poncet et al. 2005). This cycle progresses throughout the animal’s life and can end in a respiratory crisis or complicate recovery from anaesthesia.

Pre-anaesthetic management The effects of BOAS on the gastrointestinal system should be taken into consideration when planning

anaesthesia of a brachycephalic dog.

Medical treatment prior to surgery, aimed at reducing the incidence and severity of gastritis and esophagitis, may reduce the risk of vomiting and regurgitation that can lead to a respiratory crisis or aspiration pneumonia on recovery (Poncet et al.

2006; Kraus 2013). Medical treatment typically includes hydrogen ion pump inhibitors such as omeprazole, and pro-kinetic drugs such as cisapride or metoclopramide (Poncet et al.

2006). In our practice, we assume all brachycephalic dogs have some degree of gastrointestinal inflammation. We typically pre-treat these dogs with omeprazole (1 mg/kg, PO, every 12–24 hours) and metoclopramide (0.2–0.5 mg/ kg, PO, every 8–12 hours) for 1–2 weeks prior to elective surgery. After surgery, we continue treatment for 1–2 weeks in asymptomatic animals, or 2 months in dogs that have gastrointestinal signs. Maropitant (Cerenia; Zoetis New

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Zealand Ltd., Auckland, NZ) is also used in the anaesthetic pre-medication and is continued for 3–5 days after surgery as an anti-emetic and visceral analgesic (Kraus 2013). Longer-term treatment can be considered in dogs that respond very well to medical management or dogs that have recurrent signs once medical management is discontinued. Further investigation of upper gastrointestinal disease is warranted in cases that fail to respond to airway surgery and standard medical management.

Post-anaesthetic management

Recovery from anaesthesia is the highest risk-period for dogs undergoing corrective surgery for BOAS, since swelling at the surgical site may further obstruct airflow (Senn et al. 2011).

Standard recovery protocols include the use of dexamethasone at antiinflammatory doses (0.05–0.1 mg/kg IV) and supplemental oxygen (Reiter and Holt 2012). However, nasal or flow-by oxygen is unlikely to be effective in dogs with severe pharyngeal obstruction.

Alternatively, a nasotracheal tube may be placed, which bypasses the areas of swelling thus providing direct oxygen supplementation. A retrospective study of 36 dogs that underwent surgery for BOAS found that 31% (5/16) of dogs which did not have oxygen supplemented via a nasotracheal tube during recovery had an episode of respiratory distress post-operatively whereas none of the 20 dogs which had oxygen supplementation via a nasotracheal tube experienced respiratory distress (Senn et al. 2011). The most common complication reported which was specific to nasotracheal tube placement was coughing. However,

this was only severe enough to warrant removal of the tube in one patient.

Nasotracheal tubes are placed under general anaesthesia immediately after surgery and before recovering the patient. A nasogastric feeding tube (5–10 Fr) can be used. To place a nasotracheal tube, measure from the tip of the nose to a point halfway between the mandibular angle and thoracic inlet (Senn et al. 2011) and mark this point on the tube. While the endotracheal tube is still in place, and after lubricating the nasotracheal tube, advance the tip into the ventral aspect of the nostril. Once it has passed the distal margin of the soft palate, open the mouth and using long forceps grasp the tip of the nasotracheal tube and exteriorise it. At this point, remove the endotracheal tube and advance the tip of the nasotracheal tube into the trachea until the pre-measured mark reaches the nare. Replace the ET tube and secure the nasotracheal tube with skin sutures or adhesive glue to the face (Senn et al. 2011). The animal can now be recovered and extubated carefully to prevent displacement of the nasotracheal tube. Oxygen can then be delivered via the nasotracheal tube at a standard flow of 1–2 L/minute.

To summarise, brachycephalic dogs typically have concurrent upper gastrointestinal tract disease that is associated with the brachycephalic obstructive airway syndrome and which may not cause any apparent clinical signs. Regurgitation, vomiting and gastric reflux are thought to result from increased intrathoracic pressure which then perpetuates inflammation of the upper respiratory tract. The combination of respiratory and gastrointestinal disease significantly

increases the risk of regurgitation, aspiration pneumonia, pharyngeal swelling, and respiratory distress in the immediate post-operative period. Even in the absence of upper gastrointestinal signs, virtually all brachycephalic dogs have endoscopic and histological evidence of gastritis and/or oesophagitis.

Our recommendation, based on the study by Poncet et al. (2006), is to medically treat inflammation of the upper gastrointestinal system before a brachycephalic dog undergoes elective general anaesthesia. For corrective BOAS surgery, we recommended a nasotracheal tube is placed postoperatively to guarantee oxygen delivery to compromised patients and reduce the risk of respiratory distress events.

References

Kraus BLH. Efficacy of maropitant in preventing vomiting in dogs premedicated with hydromorphone.

Veterinary Anaesthesia and Analgesia 40, 28–34, 2013 Poncet CM, Dupre GP, Freiche VG, Bouvy BM. Long-term results of upper respiratory syndrome surgery and gastrointestinal tract medical treatment in 51 brachycephalic dogs. Journal of Small Animal Practice 47, 137–42, 2006 Poncet CM, Dupre GP, Freiche VG, Estrada MM. Prevalence of gastrointestinal tract lesions in 73 brachycephalic dogs with upper respiratory syndrome. Journal of Small Animal Practice 46, 273–9, 2005 Reiter AM, Holt DE. Palate. In: Tobias KM, Johnston SA (eds). Veterinary Surgery Small Animal. Pp. 1717. Elsevier Saunders, St Louis, MO, USA, 2012 Senn D, Sigrist N, Forterre F, Howard J, Spreng D. Retrospective evaluation of postoperative nasotracheal tubes for oxygen supplementation in dogs following surgery for brachycephalic syndrome: 36 cases (2003–2007). Journal of Veterinary Emergency and Critical Care 21, 261–7, 2011 l

Allan Bell Dermvet-online Consultancy service by a Registered Specialist in Veterinary Dermatology (for veterinarians in the South Island and from Wellington as far north as Lake Taupo) For cases where referral is difficult but help is required.

Contact dermvet.bell@xtra.co.nz for cost estimates and protocol

Allan Bell BVSc MACVSc (canine med) FACVSc (dermatology)

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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What is your diagnosis?

THE ANSWERS… 1. Radiographic Findings The caudodorsal lung fields have increased radiodensity with a diffuse unstructured interstitial lung pattern. The terminal trachea appears dilated.

2. Differential diagnoses for a diffuse unstructured interstitial lung pattern (Thrall 2002).

1. Artifact – underexposed radiograph, underinflated lung (end expiratory exposure), obesity, “old dog lung” 2. Lymphosarcoma 3. Diffuse pulmonary metastasis 4. Pneumonitis – viral (distemper), parasitic (aelurostrongylosis), metabolic (uremia, pancreatitis, septicemia), inhalant (allergy, smoke), toxic (paraquat) 5. Idiopathic pulmonary fibrosis (West Highland White terriers) 6. Disease in transition – oedema, bronchopneumonia, haemorrhage

Clinical outcome

Supplementary oxygen provided little relief to the severe dyspnoea and after discussion with the owner euthanasia was elected. A necropsy was performed.

All the lung tissue was dark red-coloured, haemorrhagic and consolidated with serosanguinous fluid leaking from the cut surface. The terminal trachea and tracheal bifurcation appeared markedly distended. All other organs appeared grossly unremarkable.

Samples of fixed lung, liver and kidney tissue were submitted to Gribbles Veterinary Pathology (Palmerston North) for histopathology.

Histology results (morphological diagnosis)

Severe, chronic, diffuse interstitial pneumonia with type II pneumocyte hyperplasia was seen in the lung tissue, indicating pulmonary fibrosis. There was also marked vascular congestion in the liver and kidney.

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The diffuse alveolar damage was highly suggestive of paraquat toxicity.

Other differentials for diffuse alveolar damage include oxygen toxicity, uremic pneumonitis, gastric aspiration and idiopathic diseases (e.g. familial acute respiratory distress syndrome in Dalmatians). All differential diagnoses were able to be excluded by lack of consistent history and/or supporting lesions in other tissues (e.g. there was no evidence of chronic renal disease or foreign material in the lung) except for paraquat toxicity.

Discussion

Paraquat is a bipyridyl nonselective contact herbicide widely used in agriculture and horticulture. It is available in New Zealand as “Gramoxone” (Syngenta New Zealand, Auckland, NZ) and PQ 200 (Orion Agriscience Ltd., Christchurch, NZ). Paraquat is inactivated by absorption to clay minerals and when used properly should present a low risk of toxicity. Toxicity (LD50 22–262 mg/ kg) occurs when it is ingested directly (Parton et al. 2006).

Following oral ingestion, paraquat is absorbed and accumulates in the lungs until the concentration is 10 times that in other tissues. The absorbed dose is almost completely excreted in the urine within 24–48 hours. The typical course of paraquat poisoning is biphasic. In the initial phase the gastrointestinal tract is affected with swelling, oedema and ulceration. Pulmonary oedema and transient renal and hepatic insufficiency also occur (Pond 1990). Initial clinical signs include depression, dehydration, ataxia and diarrhoea. If a large dose is ingested, acute renal necrosis develops followed by death (Parton et al. 2006).

The second phase involves the development of pulmonary fibrosis leading to respiratory difficulties generally starting 2–5 days after ingestion. Type I pneumocytes

selectively accumulate paraquat.

Biotransformation of the paraquat in these cells results in free-radical production with resulting lipid peroxidation and cell injury. Haemorrhagic proteinaceous oedema fluid and leukocytes infiltrate the alveolar spaces, after which there is a rapid proliferation of fibroblasts impairing gas exchange. There is progressive proliferation of fibrous connective tissue in the alveoli leading eventually to death from asphyxia and tissue anorexia (Giulivi et al. 1995). Clinical signs typically seen at this stage are severe dyspnoea and tachycardia. Upon necropsy, the lungs are heavy, dark and rubbery due to severe congestion. There are few gross changes in the other organs (Parton et al. 2006).

The early diagnosis of paraquat poisoning is typically based on the history of exposure. However, in the first 24 hours following ingestion, paraquat may be detected in the urine by the presence of a blue colour after addition of 100 mg sodium bicarbonate and 100 mg sodium dithionite to 5 mL of urine (Parton et al. 2006). Most animals are not presented until the onset of clinical signs by which time paraquat is no longer detectable in the urine. A definitive diagnosis is usually made based on necropsy findings rather than chemical analysis of tissue since the absorbed dose is almost completely excreted in the urine within 24–48 hrs.

Treatment must be started as soon as possible after suspected ingestion.

Emetics should be given if presented early enough (within 4 hours) followed by oral administration of mineral adsorbents (activated charcoal, Fuller’s earth, bentonite). Fluid diuresis during the first 24 hours may increase the rate of excretion. Despite the developing hypoxia, oxygen therapy is contraindicated as this worsens the oxidative injury to the lung (Pond 1990).

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Massey News Nick Cave has accepted the role of Group Leader in the Companion Animal Hospital following Jon Bray’s departure. Nick is recognized nationally and internationally for his contributions to the field of small animal nutrition. He is a skilled clinician and a respected researcher, and offers his considerable knowledge around nutrition and internal medicine to the team. We expect great things with Nick at the helm.

Paul Wightman has re-joined the radiology team following study in Australia. Paul complements current staff radiologists Ron Green and Mark Owen, and we are happy to have him back.

Staff surgeon Wendy Baltzer has returned from maternity leave and has the surgery department in full swing. Wendy has

an interest in orthopaedics and rehabilitation, and is doing remarkable things with physiotherapy.

Internist Richard Burchell is leaving Massey for the sunny shores of Australia.

Richard has been a valuable member of the Medicine team here in the VTH for the last 2 years. His wisdom and calming influence will be missed.

Dr. Craig Ruaux joins us from Oregon State University. Craig is in Internist with research interests in pancreatic and small intestinal diseases, biological variability in clinical pathology testing, and minimally invasive markers of gastrointestinal disease. He adds a wealth of GI expertise to the team. He has practiced in the UK, US, and Australia. Welcome, Craig! l

What is your diagnosis: the answers, cont.

Despite early, prompt treatment the prognosis is still guarded for the next 3–4 weeks (Parton et al. 2006).

Conclusion

In this case the source of the paraquat was never identified. Paraquat toxicity should be on the differential list in any dog with progressive dyspnoea and an interstitial lung pattern.

Acknowledgments

Thanks to Bernie Vaatstra from Gribbles Veterinary Pathology (Palmerston North) for the histopathological interpretation.

References

1. Parton K, Bruere AN, Chambers JP. Veterinary Clinical Toxicology 3rd Edtn, Pp 228–31, VetLearn Massey University, Palmerston North New Zealand, 2006

2. Giulivi C, Lavagno CC, Lucesoli F, Bermudez MJ, Boveris A. Lung damage in paraquat poisoning and hyperbaric oxygen exposure: superoxide-mediated inhibition of phospholipase A2. Free Radical Biology and Medicine, 18, 203–13, 1995 3. Pond SM. Manifestations and management of paraquat poisoning.

Medical Journal of Australia 152, 256–9, 1990 4. Thrall DE. Textbook of Veterinary Diagnostic Radiology 4th Edtn. Pp 434–5, Saunders, Philadelphia, PA, USA, 2002

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Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Massey News Nick Cave has accepted the role of Group Leader in the Companion Animal Hospital following Jon Brayâ&#x20AC;&#x2122;s departure. Nick is recognized nationally and internationally for his contributions to the field of small animal nutrition. He is a skilled clinician and a respected researcher, and offers his considerable knowledge around nutrition and internal medicine to the team. We expect great things with Nick at the helm.

Paul Wightman has re-joined the radiology team following study in Australia. Paul complements current staff radiologists Ron Green and Mark Owen, and we are happy to have him back.

Staff surgeon Wendy Baltzer has returned from maternity leave and has the surgery department in full swing. Wendy has

an interest in orthopaedics and rehabilitation, and is doing remarkable things with physiotherapy.

Internist Richard Burchell is leaving Massey for the sunny shores of Australia.

Richard has been a valuable member of the Medicine team here in the VTH for the last 2 years. His wisdom and calming influence will be missed.

Dr. Craig Ruaux joins us from Oregon State University. Craig is in Internist with research interests in pancreatic and small intestinal diseases, biological variability in clinical pathology testing, and minimally invasive markers of gastrointestinal disease. He adds a wealth of GI expertise to the team. He has practiced in the UK, US, and Australia. Welcome, Craig! l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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The Heart of the Matter 2017 Combined conference of CAV/SBCV+Deer/VBG of the NZVA Marlborough Convention Centre, Blenheim, June 21â&#x20AC;&#x201C;23, 2017

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Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

The Heart of the Matter 2017 Combined conference of CAV/SBCV+Deer/VBG of the NZVA Marlborough Convention Centre, Blenheim, June 21â&#x20AC;&#x201C;23, 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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The Heart of the Matter 2017 Combined conference of CAV/SBCV+Deer/VBG of the NZVA Marlborough Convention Centre, Blenheim, June 21â&#x20AC;&#x201C;23, 2017

Photo credit: MarlboroughNZ.com

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Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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CONFERENCE REPORT

European College of Veterinary Opthalmologists Congress Estoril, Portugal, May 2017 This article was written as part of the requirements for receiving the Hill’s Pet Nutrition/CAV Educating the Educators Scholarship

KELLAM BAYLEY, BVSc MVSc(dist) CertVOphthal In May 2017 I was fortunate enough to attend the annual conference of the European Collage of Veterinary Ophthalmologists (ECVO) in Estoril, Portugal. Estoril is on the Portuguese riviera, just outside the capitol city Lisbon where the Targus river empties into the Atlantic. Lisbon itself is one of the oldest cities in Europe, pre-dating London, Paris and Rome by centuries. It was colonised by pre-celtic tribes with archaeological evidence of iron age settlements dating back to the 8th Century BC. Due to its location alongside the natural harbour formed by the Targus river estuary, it has a long history as a trading hub, with evidence of trade with the Phoenicians from 1200 BC. The Romans settled in Lisbon, known to them as Olissipo, for some time until the Vandals arrived in the 5th century. Next came the Moors from North Africa who conquered Lisbon in 711 as they spread up the peninsular into southern Spain. Crusader knights as part of the ‘Reconquista’ besieged and conquered the city in 1147, which returned the city to Christian rule.

The golden time for Portugal was during the so called ‘age of discovery’ from the end of the 15th until the early 17th century. The main event of this period was in 1498 when Vasco De Gama found a new route to India which allowed the Portuguese to set their own trade routes independent from taxation by other

Figure 1. The cloisters within the beautiful Jeronimos monastery in Lisbon.

major trading nations. This influx of wealth and culture into the city lead to buildings such as Jeronimos monastery and Belem Tower. With this rich history, one may think that there would be a treasure trove of ancient culture and monuments to view, however that is not quite the case. In 1755 there was a severe earthquake out in the Atlantic ocean. This earthquake was regarded as one of the strongest ever experienced in European history. The quake and following tsunami killed around 30– 40,000 people in Lisbon (about 20% of the total population) and devastated

85% of the buildings in the city. The city was later rebuilt in a more modern style, with the demolition of damaged structures, no doubt along with other relatively undamaged ancient structures and neighbourhoods. As a result, Lisbon has the feel of many modern European cities with several wide avenues and modern building facades. Some historical structures do remain, notably Jeronimos monastery, Belem tower and Castelo de Sao Jorge which provide glimpses into Lisbon’s long history.

The ECVO conference was held in the large convention centre in Estoril

Contact: kellam.bayley@gmail.com

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Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

to allow sufficient room for the 400 registered attendees, staff and the industrial exhibition. A wide variety of topics were covered, with a focus on inherited and acquired visual disorders. It covered topics such as sudden acquired retinal degeneration syndrome, progressive retinal atrophy, corneal grafting procedures for a variety of conditions, micropulse trans-scleral diode cyclophotocoagulation therapy for refractory glaucoma, along with many other topics.

A standout presentation was the ‘state of the art’ lecture presented by Prof.

Eberhart Zrenner from the University of Tuebingen, Germany. Prof. Zrenner presented on the current approaches to prevent vision loss and restitute vision caused by inherited retinal disease.

He described the current strategies under investigation and the progress occurring in people. There are four main approaches to treating these disorders: l Neuroprotection to protect remaining

cells that are still functioning l Gene replacement therapy to treat cells which are still present, but not functioning l Stem cell techniques to provide new cells which could function l Optogenetic approaches to restitute light sensitivity in the remaining neurons in the inner retina.

To achieve ‘artificial vision’ via the final listed technique, electronic retinal prosthetic implants have been developed which can be inserted within the eye to sit above or below the retina.

These essentially send flashes of light to the inner retina, amplifying the light signals and allowing a different kind of pixilated vision. This has been shown in clinical trials to improve patient’s negotiation of an obstacle course significantly, with one of the systems approved for clinical use in Europe and the USA. Another sub-retinal implant is even financed in Germany by the public health system. These advancements, particularly within gene therapy and electronic retinal prostheses have really opened new therapeutic options for human patients suffering previously untreatable vision loss. Whilst much of the initial research has been

Figure 2. Amazing view from the Sintra castle walls.

performed in animals, the application of these strategies to clinical veterinary patients will be several decades away.

Nonetheless it is very exciting to see what can be done to restore vision in people, and it is great to think that Veterinary Ophthalmologists around the world are contributing to the research and development of new strategies such as this.

what can be done within veterinary ophthalmology. In addition, Portugal is a pretty nice place to visit given the excuse of conference attendance. If you are ever in that region, I highly recommend you take the train from Lisbon out to Sintra to visit the Castle and Palace. The battle with Lisbon’s public transport network is worth the effort. l

I gained a lot of insight from attending this specialist ophthalmologist conference. It was a real ‘eye opener’ to see the level of ophthalmic practice performed in the Northern Hemisphere and it provided an insight into

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CAV SPECIALIST PROFILE

Janelle Wierenga

BS, DVM, DACVECC, MPH The Specialist Profile is a regular feature that aims to provide an insight into the path New Zealand veterinarians have taken to achieve specialisation.

THIS ISSUE TONI ANNS TALKS TO JANELLE WIERENGA, WHO IS A REGISTERED SPECIALIST AND SENIOR LECTURER IN SMALL ANIMAL EMERGENCY AND CRITICAL CARE MEDICINE AT MASSEY UNIVERSITY

What is your specialty, and how many years have you been practicing as a registered specialist?

My specialty is small animal emergency and critical care medicine. I have been board-certified since 2008 as a diplomate of the American College of Emergency and Critical Care and am also a registered specialist in New Zealand through the Australasian Veterinary Boards Council.

Where did you obtain your veterinary degree, and did you move directly into a residency from there?

I obtained my Doctorate of Veterinary Medicine from Michigan State University and then went directly into a rotating internship in small animal medicine and surgery at the University of Illinois followed by a residency in small animal emergency and critical care at UC, Davis.

What drove you to specialise, and why did you choose Emergency and Critical Care?

During my veterinary education, I was initially inspired by a faculty member at MSU on my ECC rotation who was excited about teaching students about emergencies, how to diagnose and how to treat them, even when, and especially when, they were emergent and critical. I ended up pursuing additional study with this faculty member to learn more about ECC and then I had the opportunity during my internship to take on additional emergency shifts. During this time, I learned that emergency medicine can be very intimidating for some

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Photo courtesy of Janelle Wierenga

clinicians and students, and the unknown presentations or sudden changes can be anxiety-producing; on the other hand, I found emergency medicine to be challenging both intellectually and mentally which kept me interested and â&#x20AC;&#x153;on my toesâ&#x20AC;?. The critical care medicine almost seems like a different field as it is very detail-oriented and thoughtprovoking rather than reactive as emergency medicine can be though sometimes you still need to make quick calls due to the critical nature of the patients.

Explain the process you took to become a registered specialist.

After completion of a very sleep-deprived internship, I was fortunate to train with and under some exceptional critical care specialists at UC, Davis (USA) for 3 years. At Davis, I went from a novice clinician to a novice specialist-in-training, having

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

the opportunity to see primary emergencies but also very critically-ill patients in the ICU; rotations through other services such as anaesthesia, surgery, cardiology and medicine rounded-out my hands-on experience along with journal club, physiology rounds (called Stump rounds as we were all stumped by Dr. Steve Haskins on a regular basis with his questions) and research during the residency. The training in a residency and the board exam (likely the hardest exam I will ever take, I hope…) are challenging intellectually, sometimes physically, definitely mentally and emotionally, but result in the substance and depth behind the quantity and complexity of cases that are needed to be managed in specialty medicine; these result in a transient compromise of a life outside of work in order to obtain that needed experience and knowledge. Then you actually leave your residency and realize that that is when the learning really starts!

What do you like most about your job?

There are many aspects of the job that are satisfying so it is difficult to state just one. I truly enjoy teaching emergency medicine to students and new clinicians who typically have the “deer in the headlights” look when they are presented with a true emergency patient.

When students and new clinicians realise they can handle these situations in a methodical and logical manner, despite sometimes emotional turmoil going on around them, there is a new level of understanding that they reach both in their knowledge and in their own capabilities. I also enjoy that with emergency and critical care medicine, I never stop learning. And how can I not say that I love the happy endings when you know you have helped to bring an animal back to its family for a little while longer.

What is the worst and most challenging part of your job?

Not surprisingly, the worst and most challenging part of the job is the sadness that sometimes accompanies emergency and critical care cases and situations. It is hard to only be able to be there for the owners, families and patients when it is time to say goodbye though sometimes that is the most important part of the job.

What advice would you give to someone thinking of specialisation?

I think it is important to know what you are passionate about or what excites you – what is it that keeps you thinking about a case and

follow that passion. On the other hand, I think it is important to also figure out if that specialty fits with your personality – do you like to ponder and contemplate, do you get stressed with uncertainty and the unknown, do you like to know your schedule throughout the day, can you stay awake in the radiology room when the lights are off and the heater is on. And it is also important to consider how the specialty could fit with your future plans though these are subject to change and sometimes the specialty opens new doors that you never even considered before.

What do you think about veterinarians specialising later in their careers, after a significant period of time in general practice?

I think taking the extra time to decide on what you want to focus on is important and sometimes this may be identified during the veterinary education and sometimes it takes a couple of years or decades to figure this out. In either scenario, I think there are advantages and this decision later in your career may help to challenge in new ways, open new doors and opportunities and further knowledge-base and experiences. Having the opportunity to obtain a solid foundation of knowledge and experiences in general practice can result in an experienced overall clinician with a balanced perspective.

Do you think New Zealand needs more specialists, and if yes, in what areas?

I am excited about the growth of specialty practice in New Zealand and the personal and unique relationship that the specialists can support within the veterinary community. I would enjoy further progression with specialization in New Zealand, especially in subspecialties not currently covered in New Zealand. The addition of these specialties and further specialty practice can expand the veterinary education we can provide and also can result in higher quality of care that we can provide to our patients and clients.

What are your passions outside of work?

Outside of work, I enjoy anything outdoors, which makes New Zealand such an amazing place to live and play. I have started to challenge myself with triathlons over the last few years and will see where it takes me next, or onto the next challenge.

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Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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Companion Animal Health Foundation Update THANKS!

Thank you to CAV for their annual support of the Foundation. The annual donation from CAV enables us to continue to fund projects to enhance companion animal practice in NZ and improve the welfare of our patients.

CATH WATSON, CAHF Chair,

www.cahf.org.nz

Projects wanted

This generous donation means we have funds available for projects. If you have a project or some research that would benefit companion animals in NZ, we’d like to hear your ideas, and are happy to help with applications. We are particularly interested in hearing from participants in the MVM programme looking to complete their dissertations or research reviews and we can help with ideas where necessary. See our testimonials from past recipients: “We were able to do a massive amount of research and analysis from the funding so thank you again.” Dr Els Acke "I have always found the process relatively easy and have had no problems – hope to apply for it again!!" Dr Andrew Worth CAN YOU RAISE $500? Support the future of pet health by donation to the CAHF. We are asking for the support of all practices in New Zealand and individual veterinarians to raise at least $500 each, a sum

which would secure the future of the Foundation and ensure it works as planned to help our pets enjoy better and healthier lives. Every dollar will be used to help combat health and welfare problems encountered by companion animals in New Zealand.

By joining our $500 Project, we are asking practices to pledge to raise $500 by whatever means they can; external fundraising events, organizing your own internal fundraiser for your practice, or simply by making an individual donation. Please visit our updated website http://www.cahf.org.nz/help/donate for details.

We now also have a Give-A-Little page: https://givealittle.co.nz/ org/healthypets.

Supporting the Foundation will clearly demonstrate to your staff, your clients and your suppliers that you invest in the health of pet companion animals and that you support the veterinary profession through the Foundation.

If you wish to register your practice as an annual $500 practice supporter for the CAHF use the online registration form on the website www.healthypets.org.nz. l

Would you like to see your pet on the cover of Companion Quarterly?

We now have a new cover photo for each issue of Companion Quarterly. This means we are always on the lookout for suitable photos. Photos selected for the cover must be landscape orientation (or able to be cropped to this), crisp and well focused, and of high resolution (at least 300 DPI). They must also be well composed and interesting.

Please send any suitable images to the Editor (sarah. fowler@gmail.com). If however you have a favourite snap of your fur-family that’s not quite up to cover standards, please send that in too: photos that are not selected for the cover may be printed on the back inside cover.

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Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

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Instructions for Authors submitting articles to the Companion Quarterly SARAH FOWLER (Editor), for

the Companion Quarterly Editorial Committee

The Companion Quarterly is published quarterly in the first week of March, June, September and December of each year. The printing costs are covered by the advertisements. There is therefore a limit of about 55–60 pages to the size of each issue. There is a balance between political issues, articles for continuing education and other news.

Authors are expected to submit their articles and conference in a final form suitable for publication. If practitioners wish assistance with writing, please contact the editor. Also look at previous issues to see the layout.

Articles

The article should have a title. Following the title the names of the authors, their degrees, titles, contact details should be present.

Submit articles preferably by email, or disk if this is not possible.

Submit articles in adequate time for reading and alterations before publication.

Contributions must be original. Articles or extracts from articles may be completely copied only if there is permission from the original authors and source of publication. It is the responsibility of the author(s) rather than the editorial committee to obtain this permission.

The author(s) should disclose if they have published the same article or a very similar article elsewhere.

Articles that are clearly editorials/advertising will be labelled as such at the discretion of the editorial committee. These include articles/editorials that are repeated from other publications such as VetScript and that contain obvious product placement comments.

Proof reading

The authors should proof read their article looking for mistakes, spelling errors, omitted details. While the editorial committee reads through the articles, the articles should be presented error-free.

Articles and conference reports from recipients of grants and scholarships It is the responsibility of recipients of any grants and scholarships to supply any conference reports and articles written as part of the requirements in the final form suitable for publication.

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References

A list of references should be supplied if appropriate. Follow the guidelines for the New Zealand Veterinary Journal for method of reporting of references.

The number of references should be kept to a reasonable number relative to the length of article. Keep numbers of references to a minimum when discussing a single point, i.e. do not be repetitive with numerous references when a few will do. The editorial committee will omit references if the list is judged to be excessively long.

Figures

Good quality illustrations that clearly illustrate the necessary points should be submitted with the article.

Submit any photos or graphics in their original forms (i.e. JPG, PDF, TIF files) as they lose their clarity when extracting them from Word or Publisher documents.

If positions of figures are not obvious from the text, send a hard copy or some other form of instruction as to where they should be placed.

Figures should be clearly numbered labelled as to top and bottom where necessary.

Features on the figures should be clearly labelled by the author(s).

The figure captions should be concise and accurate, and supplied with the text on a separate page at the end of the article.

Diagrams/figures can be copied from textbooks only if there is permission from the original author and the source is clearly acknowledged. It is the responsibility of the author(s) to obtain this permission before submitting the article to the Quarterly editorial committee.

Timing of article submission and publication

Articles will be published as soon as possible after submission. The newsletter goes out in the first week of March, June, September and December. Articles therefore need to be submitted at least one month before (i.e. by the end of January, April, July and October) but preferably earlier to allow one month for the collation, printing, binding and posting of the Quarterly.

Depending on when the articles are received, the size of that particular issue and the need for refereeing, at the editor’s discretion articles may be held over for a later issue.

Refereeing

Articles may be sent to appropriate people in that field of expertise for refereeing/proof reading if the editorial committee deems this

is necessary. This is to ensure accuracy within the text to protect readers, the authors CAV and the clients and the patients of veterinary practitioners.

SciQuest and the NZVA website

Selected scientific articles will be placed on the SciQuest website for access by NZVA. There will be a delay of a year to ensure that practitioners still see a benefit in becoming CAV members.

The entire newsletter is now being placed on the CAV website but the most recent issues (i.e. those within a year of publication) are available only to CAV members.

Article of the issue and student article

Prizes are sponsored for the best case report and general article in each quarterly issue.

The best overall article in each category for the year is then decided in May and the overall prize awarded at the Annual dinner in June. The members of the editorial committee will judge the articles on their clarity, conciseness, and usefulness to practitioners.

Articles that are submitted to the Quarterly as part of an obligation due to the author(s) receiving Educating the Educator or Study/ Research Grants from CAV are not eligible for the article of the issue prizes. Articles submitted by the editor and the members of the editorial committee are also not eligible for the prizes.

There is a separate undergraduate student article competition.

Planning a case report?

Some hints as to how do so!

When writing an article take time to look at how articles in other journals are arranged. While articles for the Quarterly are not as detailed as the NZVJ the information needs to be arranged in a logical manner to make it easy for the reader to follow. Therefore follow some logical headings as detailed below. Not all of these headings will need to be used in all articles and some may be combined depending on the type of case and amount and type of information available.

• Introduction • History • Clinical signs • Materials and methods • Results (of investigations e.g. laboratory results, radiography).

• Discussion • Conclusion • Acknowledgments • References. l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 28 No 3 | September 2017

COMPANION QUARTERLY â&#x20AC;&#x201C; Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA

Companion Quarterly

OFFICIAL NEWSLETTER OF THE COMPANION ANIMAL VETERINARIANS BRANCH OF THE NZVA Volume 28, No. 2 | June 2017

VOLUME 28 NO 2 JUNE 2017

A review of femoral head and neck ostectomy

A case of a nasal turbinate cyst in a pug

Go Slow: a foodborne disease of dogs

Juvenile laryngeal paralysis and polyneuropathy in Rottweilers

A week with.....the surgeons at MUVTH