Companion Quarterly Vol 32 No4 December 2021 by Companion Quarterly

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 32, No. 4 | December 2021

VOLUME 32 NO 4 December 2021

The puppy vaccination dilemma

Socialisation for puppies

Treatment of pyoderma in dogs: a clinical study of totarol products

New treatments for FIP

Transcatheter occlusion of PDA in a puppy

Volume 32 | No. 4 | December 2021 ISSN No. 2463-753X Executive Committee 2021 cav@vets.org.nz

Contents

President

Natalie Lloyd

Companion Quarterly

Vice President Simon Clark

Treasurer

Kevanne McGlade

Committee Members Nina Field Toni Anns Alison Pickering Becky Murphy Sally Aitken Shanaka Sarathchandra

Veterinary Manager (companion animal) Lorelle Barrett

EDITORIAL COMMITTEE Sarah Fowler (Editor) Bart Karalus Ian Millward Juliet Matthews Aurore Scordino Shanaka Sarathchandra

Address for submitting copy/ correspondence

Sarah Fowler 66 Callum Brae Drive, Rototuna, Hamilton 3210 T (H) 07 845 7455 | M 027 358 4674 E sarah.fowler@gmail.com

Advertising Manager

Tony Leggett NZ Farmlife Media Ltd Agribusiness Centre 8 Weld St, Feilding T 027 4746 093 E tony.leggett@nzfarmlife.co.nz

NZVA website www.nzva.org.nz CAV website www.nzva.org.nz/cav Copyright

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.

Cover credit

Stagridge Kennels

Newsletter design and setting 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.

2 Editorial 4 CAV activities and meeting highlights

6 CAV Noticeboard 8 News in brief 12 Letters to the editor 14 What is your diagnosis?

Alex Walker, Devon Thompson, Tommy Fluen

16 The puppy vaccination dilemma CAV Executive committee

24 Puppy socialisation: how do we advise clients?

Jess Beer

26 Catio adventures Simon Clark

28 Treatment of feline infectious

peritonitis in cats in New Zealand

Ryan Cattin

30 Does the term 'Dietary Elimination Trial' send chills up your spine?

Corey Regnerus

34 Some observations on the treatment

of superficial pyoderma in dogs with totarol

26 39

Heidi Ward-McGrath, Allan Bell, Janis Bridges, Boyd Jones

39 Trans-arterial closure of a patent

ductus arteriosus in a Corgi puppy: use of the Amplatz canine ductal occluder device

Miranda Tong

42 A Week With ... Veterinary

Dermatologist, Debbie Simpson

Kathryn Hamlet

46 What is your diagnosis? The answers 48 Companion Animals NZ update 49 Healthy Pets NZ update 50 Shaggy dog stories – a New Zealand theme

Boyd Jones

53 Authors' guidelines 54 Committee biographies

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

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

EDITORial

A heart-felt thanks As I write this article National Vet Nurse Awareness Week comes to a close. The aim of the week is to educate the public about veterinary nurses and their vital role as part of the veterinary team. At the end of the week NZVNA want to have “reinforced the value and professionalism of veterinary nurses to veterinarians and the public and provided an opportunity for veterinary nurses to acknowledge one another for excellent performance in their work.” Reading posts of support for vet nurses over the last week, made me reflect upon the vet nurses I have worked alongside, who helped shape me to be the veterinarian that I am today. The first vet nurse I ever worked with as a new graduate had been nursing for decades. She had never received any formal training and she was vet nurse, receptionist, coach, support crew and educator all wrapped up in one package. She was very hands-on and she often gave me a rundown of “how my boss would manage a case” if he was not in the clinic. She was a calming influence when I could not exteriorise (or worse… dropped!) an ovarian pedicle. She was, I must admit, a teeny bit formidable: I am still awfully good at tidying up after myself when I am in a consult room! Then along came a vet nurse who was living in NZ on a working holiday. UKtrained vet nurses were a whole new experience for me! She was funny, very clever, the clients loved her, and she pretty much retrained me to place I/V catheters. She taught me how to place a PEG tube, re-educated me on nutrition and generally gave me a taste for what best practice medicine could look like. We became good friends and I stayed with her for a while when I travelled to the UK on the obligatory Kiwi OE.

On my return to New Zealand, I worked in a clinic with a student nurse who then went on to become a new graduate nurse in our clinic. We worked in a small clinic together: it was just the two of us most of the time. We became close friends, we learnt how to “manage” our wee clinic, how to best look after our customers, we attended CPD events together and we enjoyed the odd evening out or rugby game. Even after I left that clinic, we stayed good friends. She was my bridesmaid at our wedding and to this day is one of the funniest people I know. She taught me how to read behaviour, how to approach fearful animals, the numerous benefits of being patient, and how to have some fun at the same time! Not long after I left that clinic, I bought my own clinic with my husband. Within a few years, we were hiring nurses and a CV arrived from someone who had recently moved to town from a large referral clinic where she was a lead surgical nurse. We offered her an interview but thought that we would never be able to offer her the same kind of challenge she had experienced in her previous job. Our clinic was too small and too “boring” wasn’t it? Not so, she was keen to learn, adapt, try something new. She wanted to understand general practice again after working in a referral clinic for a long time. And 10 years later, when I left that clinic, she was still there, managing it like the professional she was. Still keen to learn, still caring and supportive to everyone she worked with, still modest but incredibly talented all at the same time.

certainly been reinforced to me. While there were also many veterinarians who were mentors for me; I hold in the very highest esteem those vet nurses who stayed behind at night with me, held up veins, rearranged my appointments, talked me through a procedure, encouraged me to give it a go, and counselled me when I got it wrong. I am grateful for all the times they told me that my patients needed more analgesia, or we needed to focus more closely on a patient’s nutrition. For the times our nurses suggested that we should consider more cat-friendly techniques, or maybe we could do some procedures in the consult room with the pet’s guardian present. And of course, all those times where nurses would go fearlessly into a situation with an anxious or fearful patient. At a time when we are talking about the veterinary shortage, I am aware that it is a veterinary TEAM shortage. Our nurses are as time-stretched and exhausted as we are. And I thank those nurses for being supportive, for being professional and for being the caring and brave people that we have the privilege to work alongside. Natalie Lloyd, CAV President

So the value and professionalism that I have experienced, not just from those amazing people, but ALL the vet nurses I have worked with over my career has

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Working to promote and support companion animal practice in new zealand

CAV activities and meeting highlights

CAV’s Annual General Meeting was held via Zoom on Monday 22 November. Items covered included the President’s report, financial report, and results of committee elections. Four incumbent committee members were due for re-election this year – Toni Anns, Simon Clark, Nina Field, and Natalie Lloyd. As no other nominations for the committee were received, they were all re-elected unopposed.

The committee reviewed MPI’s draft Import Health Standard for cats and dogs, as part of the NZVA’s feedback process. If passed, the revised standard will include several new requirements for organisms such as Angiostrongylus vasorum, Babesia rossi and Leishmania infantum. There will also be amended requirements for external parasite treatments (no longer limited to topical products).

The CAV executive committee had its last meeting for 2021 in mid-November. Items for discussion included projects for 2022, how CQ advertising is tracking under the new publication strategy, and a catch up with members of the national office team.

Dr Natalie Lloyd, CAV’s President, was one of the speakers at this year’s Companion Animal New Zealand conference. Originally set to be in Wellington, the conference was moved on-line due to (you guessed it!) the country’s COVID-19 status. The theme

of the conference was ‘Towards A Good Life’. Natalie’s presentation ‘Old age is not a disease’ looked at how pet guardians and veterinarians can work together to ensure ‘A Good Life’ for senior animals where age is not used as an excuse for compromised welfare. l

Companion Quarterly – a call for contributions Do you have a clinical case to share, need to tick off a task on your CPD plan or want to earn some pocket money? CQ publishes case studies, clinical updates, reviews etc. on topics that are of interest to companion animal veterinarians. An award of $300 is paid for all published articles, with the chance to win the Best Article of the Issue and Best Article of the Year (thanks to Eyevet Services). Please send your contributions to the Editor at sarah.fowler@gmail.com Microsoft Word format is preferred and photographs/ images are welcome, preferably 2 megapixels or higher, and sent as a separate attachment (rather than embedded within the Word document).

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

The CAV Noticeboard Hill’s Pet Nutrition and CAV present: Educating the Educators Scholarship Applications are now open for the Hills/CAV Educating the Educators Scholarship. This scholarship provides assistance for veterinary educators to attend advanced level continuing education events, in exchange for articles, reports and presentations on their area of interest. While we typically provide support for events held outside NZ, applications will currently be considered for assistance to attend virtual events.

The scholarship is open to both CAV members and nonmembers. Successful applicants are usually specialists in their field, but we also support those who have developed advanced skills in an area of special interest. There are two funding rounds each year, in March and September.

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

We gratefully acknowledge Hill’s Pet Nutrition as the principle sponsor, along with the support we receive from the School of Veterinary Sciences at Massey University. The closing date for this application round is 31 March. For more information, check out the CPD section of the CAV website (https://www.nzva.org.nz/branches/cav/ scholarships/), or email Lorelle Barrett at cav@vets.org.nz.

Healthy Pets NZ Project Grant 2021 Healthy Pets NZ 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 Healthy Pets NZ website (www. healthypets.org.nz) to find out how we

are supporting projects on analgesia for ovariohysterectomy, treatment of squamous cell carcinoma and FIV prevalence. Any queries on how to make an application or donate please email healthypetsnz@gmail.com.

WINNER

"What is your diagnosis? Emphysematous cystitis"

Emily Ball, Devon Thompson & Tommy Fluen

September 2021 | Volume 32(3) | Pages 12, 40–41

Article of the Issue

EyeVet Services Limited

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

News in Brief

2021 CAV Service Award We are pleased to announce that Sandra Forsyth is the recipient of the CAV service Award of 2021. While we are saddened not to be able to present this award in person, the purpose of this article is to illustrate to readers why Sandra is such a deserving recipient of this article. A very big thank you to Boyd Jones, Lotte Cantley, Rebecca Allen, Richard Campbell and Kate Hill for helping put this article together.

Sandra graduated from Massey University Veterinary School in 1981. She spent 2 years in practice in Southland after graduation and then went on to complete the obligatory overseas experience working a locum in the United Kingdom. From the United Kingdom, Sandra headed for Missouri with her partner Grant Guilford. Sandra worked in the anaesthesia department of the University of Missouri College of Veterinary Medicine and became head of that unit before moving to California to complete a residency in anaesthesia and critical patient care. She completed her residency training between 1987–1990 to become a diplomate in anaesthesia and intensive care. After completion of her diploma studies, she spent 6 months at Colorado State University before returning to New Zealand as a senior lecturer in anaesthesia at Massey University. Students from 1991 to 2001 will remember her as an excellent lecturer who worked well with students, was never intimidating and who had a practical and workable approach to cases. Sandra was also always there for staff when you needed her. If there was a job to do, she never shirked responsibility. Emergencies and difficult cases were her “bread and butter”; she was well trained in these cases, and we all recognised her special skills. Sandra was responsible for the highly successful introduction of anaesthesia technologists to the Massey hospital. She had a keen sense of humour, referring to her skills in anaesthesia in her typical self-deprecating way by saying “passing gas is not all that hard”. While working in the anaesthesia department of the Massey University 8

listen and always has a practical piece of advice to offer. In 2001 came a move from anaesthesia and critical care to clinical pathology. Sandra became a senior lecturer in clinical pathology and provided more excellent student training and clinical service in this discipline. In 2004 she joined New Zealand Veterinary Pathology which later became IDEXX labs, and in 2016 she moved to SVS laboratories in Hamilton. The support she has provided as a clinical pathologist to clinicians across the country has been immense. Whether it is her kind and patient opinion offered on the end of a phone, advice on a practical and sensible approach to a difficult case (and I know I have been the grateful recipient of Sandra’s advice on many occasions) or her enthusiasm and generosity in sharing her valuable expertise. Sandra has provided continuing education for veterinarians for many, many years, in almost too many capacities to list. [Photo credit: Sandra Forsyth]

Veterinary Hospital she met Lotte Cantley. At this stage Lotte had just arrived in New Zealand for her equine residency (1994–1997). They worked closely together in equine anaesthesia. Lotte describes Sandra as a calm and supportive colleague who was always incredibly kind and helpful. The words used by Lotte resonated for me: in writing this article I talked to many colleagues of Sandra’s, and the themes of kindness and generosity were recurring. Sandra was described as someone who always makes time to

Her support for the CAV Veterinary Refresher scheme has been a vital part of the success of this scheme, designed for practitioners looking to brush up their companion animal veterinary skills. Sandra has spoken at numerous NZVA conferences and provided expertise at local regional network meetings. She is always approachable and very happy to help. Her knowledge and expertise is exemplary across her chosen disciplines. She has provided written content for Companion Quarterly and Vetscript and authored many publications. In addition, she has supervised some significant New Zealand veterinary research projects among which were

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Andrew Scuffham’s study of anaesthetic machines in veterinary practices; and Steve Fox’s study of post and perioperative pain management for ovariohysterectomy in bitches. Sandra has also provided support to practitioners outside of New Zealand. She has contributed to the Post Graduate Foundation of the University of Sydney (now the Centre of Veterinary Education; CVE) as a tutor in critical care (from 1995) and clinical pathology (from 2010). In these roles she has provided distance learning opportunities to veterinarians in Australia, New Zealand, Asia and further afield. Her courses are well subscribed each year and receive significant plaudits from participants. Richard Campbell, General Manager of SVS Labs (where Sandra has worked since 2016) has the following to say about Sandra: “Sandra combines great technical and scientific knowledge with superb communication skills, honed by many years of teaching experience. This is not a common combination of attributes and is one that endears her greatly to her practitioner clients. Her reports are

much valued, and she is always willing to spend time discussing diagnoses and the path forward. The time and effort she puts into supporting clinicians has seen her form strong and longstanding relationships throughout the veterinary profession. These relationships are founded in both professional and personal respect. Sandra is no less committed to supporting her colleagues, this extends beyond her frequent discussion of cases with fellow pathologists. It is common for me to see her in a white lab coat at the bench taking our technicians through a case of interest. She has a genuine desire to help people be the very best they can be in their work. Her inputs are not restricted to the technical aspects of SVS Labs. I always smile when I get an email from Sandra that starts with “I don’t know anything about business but…”. These emails are questioning the direction of a strategy we are considering for the business and often come with additional or alternative approaches. Sandra is adept at challenging others to think deeply and laterally and our initiatives are always better off for her input.

Sandra’s insatiable appetite to keep learning is a quality that continues to amaze me. Her shift in career from anaesthesia to clinical pathology is a clear demonstration of this. Within pathology she is forever reading and researching new developments. This is driven by both her personal quest to keep learning and her desire to provide her clients with the best and latest options.” It's a beautiful summary of someone who has been an outstanding advocate for companion animals, and their veterinarians. I can’t begin to thank Sandra enough for all the years of service she has provided to so many of us. Sandra has the veterinary profession at heart and she truly cares. She is a valued and treasured colleague. She is a patient and giving colleague who is that rare combination of possessing great talent, along with the generosity to share with our profession. We are very pleased to be awarding Sandra the CAV Service Award for 2021.

Companion Animals NZ Assisi Awards: congratulations to CAV member, Helen Sheard Every two years CANZ presents its Assisi Awards in "recognition of outstanding service to animals" to individuals who have contributed to the welfare of animals, whether in New Zealand or internationally. See https://www. companionanimals.nz/assisi for a list of all award recipients. One of the three winners for 2021 was Dr Helen Sheard, who was nominated by the CAV committee, and seconded by Martin Aldridge at Totally Vets Fielding, for her work with the Retired Working Dogs Trust.

Helen Sheard getting her award.

[Photo credit: CANZ]

The Retired Working Dogs Trust has found loving forever homes for hundreds of dogs since 2012. Helen has supported working dogs getting a second lease on life in many ways. She is the on-team vet providing knowledge and guidance. She has done countless

consults and surgeries, all in her own time. Helen fosters dogs, curates the organisation's website, maintains social media and fundraises. This includes organising the annual calendar, sharing the images and stories of retired working dogs nationwide. Helen helps working dogs with nowhere else to go have A Good Life into their golden years. We thank Helen for her amazing work with these dogs and heartily congratulate her for being recognised by the veterinary community. Two other winners were also announced: Gordon Trainer, ex-Chair of RNZSPCA, and Nicole Peddie, the SPCA National Education Manager who has spearheaded the SPCA Teachers portal – bringing animal welfare into New Zealand’s primary school curriculum.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

CAV member Becky Murphy joins the WSAVA Hereditory Disease Committee CAV is pleased to report that, pending completion of the application process, CAV executive committee member Becky Murphy will be joining the WSAVA Hereditary Disease Committee. The mission of the HDC is to raise awareness and understanding of hereditary diseases and genetic predispositions to disease in small animals by providing educational opportunities, sound resources, and guidelines. The WSAVA Hereditary Disease Committee strives to enhance the level of the small animal clinician’s confidence and competence in recognising and managing hereditary diseases in small animals and thereby improve the health of their patients now and in future generations. Becky’s practice, TCI Glenbred, is devoted to inherited disease screening and theriogenology of dogs and she has been the Dogs NZ (NZKC) Veterinarian since 2016.

[Photo credit: PicsbyFran on Pixabay]

Letters to the editor Dear editor In the last issue of CQ (vol 32(3) page 8), the nomination proposal of Lotte Cantley for my award of life membership of NZVA was published. I am delighted to receive the award but there are some corrections needed in the citation that I am sure my aged/aging colleagues will identify. I am not a diplomate of the American College of Veterinary internal Medicine. I passed the qualifying examinations but did not sit the final certifying examinations for a variety of reasons. I am not a Fellow of the Royal College. I was a RCVS registered specialist for 12 years and a fellowship examiner in Small Animal medicine and Feline medicine for them but not a Fellow.

I returned to New Zealand from Australia in 1974 and had a role in the early days of the small animal society but it was John Middlemiss and his Auckland team who founded the society later to become the Companion Animal society. While I was involved in early discussions about the Companion Animal Health Foundation it was Richard Squires and Chris Hutchings and colleagues who set up the Foundation after I left for Ireland. I became involved on Chris Hutching’s retirement from the Board after I returned to New Zealand.

On behalf of CAV and CQ I would like to apologise to Boyd and to our readers for this error. In future all award citations will be checked with the recipient before publication. Sarah Fowler, CQ Editor

The past is often misty and information sometimes not easily available. I am pleased with my award and thank Lotte for her nomination. Boyd Jones 14th September 2021

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Dear editor, I am grateful to David Smith for his letter regarding feline immunodeficiency virus (FIV) vaccination in New Zealand (NZ), published in the September edition of Companion Quarterly. He raises some interesting points, and I am heartened to hear vets engaging in critical analysis of this controversial topic. I am similarly passionate about the practical application of evidence based veterinary medicine (Brownlie 2018) and the importance of veterinarians critically analysing data that is presented to them. Many NZ vets found the independent expert perspectives of Dr Richard Squires and Dr Mark Westman at the recent CAV webinar on this topic particularly helpful. I would encourage all vets to watch this engaging webinar which can be accessed at the NZVA website1. To address the letter’s point that there is currently no evidence that Fel-O-Vax FIV protects cats in NZ, this vaccine has been through a robust registration process including assessment of efficacy studies prior to authorisation by the Agricultural Compounds and Veterinary Medicines committee (ACVM) with ongoing assessment of any ‘lack of efficacy’ reports. Additionally, Fel-OVax FIV has been assessed by the World Small Animal Veterinary Association Vaccination Guidelines Group (WSAVA VGG) in 2015 as a non-core vaccine which should be offered to cats based on individual risk benefit analysis. It is also listed as a non-core vaccine in the NZVA CAV vaccine guidelines. The evidence to support the use of this vaccine in at risk cats has therefore been assessed by two independent expert professional organisations (WSAVA and ACVM). Although I agree that providing local field efficacy information for veterinary vaccines prior to licensing would provide additional information, in both veterinary and human medicine it is rare that this is possible or required. There are several laboratory efficacy studies for Fel-O-Vax FIV, in addition to the Australian field efficacy study. As the previous letter states, it is correct that despite careful study design and many years of sample collection, the Australian study team were unable to obtain a sample of eligible cats that would allow them to find a statistically significant difference (p=0.14) To access the NZVA webinar on FIV vaccination and diagnostics please visit the NZVA website and navigate to NZVA Positions and Resources  Companion Animal Health and Welfare  scroll down to ‘An update on FIV vaccination and diagnostics’

in prevalence between vaccinated and unvaccinated cats. However, the study concluded with a vaccine protective rate of 56% and to compare this to the core cat flu vaccine efficacy, WSAVA VGG estimate their field efficacy to be 60–70%. It is interesting that, as Dr Squires noted in the recent NZVA webinar, Fel-O-Vax FIV seems to have been held to a higher standard (with respect to efficacy) than other feline vaccines. One of the historic challenges in FIV research has been the lack of a reliable, cost-effective, patient-side diagnostic test which can differentiate between vaccinated and infected cats. The relatively recent availability of tests such as WITNESS FIV with a sensitivity of 100% and specificity of 98% regardless of vaccination status has enabled new research to be published in this space (Westman et al. 2015). One of the major concerns regarding the 2020 Massey study, as noted by the authors, was the lack of reliability of the PCR testing method that they used (Stickney et al. 2020). It was considered that infection of these cats could not be confirmed especially given that PCR testing is not considered the gold standard for FIV diagnosis. It is worth remembering that in addition to concerns around lack of age/ sex matching and assessment of outdoor access in this study, only five cats were conventional PCR test positive, all from the Hawke’s Bay and Bay of Plenty, which is a very small population in a geographically limited area from which to extrapolate vaccine efficacy throughout NZ. In both human and veterinary medicine, vaccine field efficacy is continuously monitored in the target population by the regulators and manufacturers via the adverse event reporting system which includes suspected ‘lack of efficacy’ reports. Expert guidelines recommend testing cats with Witness(Zoetis) or Anigen (Bionote) FIV tests prior to annual vaccination to confirm cats have not become infected with FIV despite vaccination (Westman et al. 2019). In addition, any vaccinated cats testing positive should be reported to ACVM and/ or Zoetis as a suspected lack of efficacy. Any vaccination (or injection) comes with possible risk, although suspected adverse events (including suspected lack of efficacy) are classified as ‘rare’ for FelO-Vax FIV2. Feline injection site sarcoma

Adverse events are classified as ‘rare’ if they occur in less than 0.1% of cats receiving a vaccine dose. This includes all adverse events reported, regardless of causality. It also includes ‘on label’ post vaccination reactions such as lethargy.

(FISS) is also considered very rare in NZ although it is worth noting that the most important tool to minimise the risk of FISS is rotation of injection sites. Given the high prevalence of FIV across NZ (Luckman and Gates 2017), and the fact that the majority of cats in this country have outdoor access, it is likely this vaccine will benefit many NZ cats. As recommended by Dr. Squires in the recent webinar, Zoetis would also encourage practitioners to apply their own local knowledge of FIV prevalence and pathogenesis in their region. Unfortunately, the nature of scientific research means it takes considerable time to generate useful, high-quality results. While we wait for further work to provide more information on Fel-OVax field efficacy in NZ, Zoetis would continue to encourage practitioners to use a reliable test (such as WITNESS FIV) to better understand FIV prevalence in their area, apply their local knowledge when discussing Fel-O-Vax FIV with cat owners, and seek independent expert advice on this topic by accessing the NZVA webinar described above. Zoetis hope this reassures the many practitioners who continue to offer Fel-O-Vax FIV to cat owners but would encourage those with further questions to feel free to contact the Zoetis VetOps team at 0800 100 109 to discuss further. Warm regards, Keara Brownlie BVSc Companion Animal Veterinary Advisor for Zoetis NZ

References:

Brownlie K. Letter to the Editor on the importance of Evidence Based Veterinary Medicine in clinical practice. Companion Quarterly 29 (3), 10, 2018 Luckman C, Gates MC. Epidemiology and clinical outcomes of feline immunodeficiency virus and feline leukaemia virus in client-owned cats in New Zealand. JFMS Open Reports 3, 2055116917729311, 2017 Stickney AG, S. Cave, N.J. Dunowska, M. Lack of protection against feline immunodeficiency virus infection among domestic cats in New Zealand vaccinated with the Fel-O-Vax FIV vaccine. Veterinary Microbiology 250, 108865, 2020 Westman ME, Malik R, Hall E, Sheehy PA, Norris JM. Determining the feline immunodeficiency virus (FIV) status of FIV-vaccinated cats using point-of-care antibody kits. Comparative Immunology, Microbiology and Infectious Diseases 42, 43–52, 2015 Westman ME, Malik R, Norris JM. Diagnosing feline immunodeficiency virus (FIV) and feline leukaemia virus (FeLV) infection: an update for clinicians. Aust ralian Veterinary Journal 97, 47–55, 2019

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

What is your diagnosis? THE QUESTIONS… Alex Walker BVSc (Dist), VSA Zoetis intern

2021

Devon Thompson BVSc (Dist), MVS (Hon), MANZCVSc (Radiol), DipECVDI, Registered Specialist Veterinary Radiology Tommy Fluen BSc, MSc, DVM, FANZCVS, Registered Specialist Small Animal Internal Medicine

Case history

A 9-year-old, female, spayed Labrador presented for lethargy of 1 week’s duration. Other signs included anorexia, a distended abdomen, and vomiting. There was no other relevant history, or findings noted on clinical examination. A biochemistry panel revealed a mild-to-moderate hyperbilirubinemia (28 μmol/L; reference range 0–15 μmol/L), mild-moderate hypercholesterolemia (9.83 mmol/L; reference range 2.84–8.26 mmol/L) and the concentration of alkaline phosphatase in serum was above the limits of detection (detection limit >2000; reference range 23–212 U/L). The remainder of the biochemistry panel and complete blood count was within normal limits. As part of the diagnostic workup, a two-view abdominal radiographic series was acquired (Figure 1.)

Questions

1. What are your radiographic findings? 2. What is your radiographic diagnosis?

3. What would be your next diagnostic step?

Answers on page 46

Contact: intern.alex@vsnz.co.nz

Figure 1. Ventrodorsal (a) and right lateral (b) abdominal radiographs of a 9-year-old spayed female dog with lethargy, vomiting and a distended abdomen.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

CAV clinical update

The puppy vaccination dilemma CAV Executive committee

cases confirmed of the 25 cases that were reported to MPI in the last 10 years (H Beattie1 pers. comm.). Hence, this article will predominantly focus on risks and vaccination protection against CPV.

Introduction

The Companion Animal Veterinarians (CAV) committee received feedback earlier this year that puppy owners were receiving conflicting advice from veterinarians with regard to the socialisation of puppies. This lack of unity is challenging for puppy guardians. This is a complicated subject where no single answer fits all. Advice differs amongst veterinarians and between households. Veterinarians who practice in areas of higher parvovirus burden are likely to be more reluctant to prioritise socialisation over immunisation status. In areas with lower parvovirus risk, vets may be more willing to advise socialisation before the immunisation schedule has been finished. The key period for socialisation is between 3–17 weeks of age (RSPCA Australia 2019) coinciding with the period when puppies are most at risk from parvovirus. Appropriate socialisation of puppies during this time is critical to the long-term behavioural health of a dog (Day et al. 2016). It is during these critical early months that the puppy’s cognitive development is shaped by the experiences it has. Further exploration was undertaken by the committee. A survey was performed to understand what NZVA members are currently recommending to new puppy owners (see results of the survey in the September 2021 issue of CQ). The next step, presented here, is to provide information on disease risk from a global and a local perspective. Following this, we will present expert advice on socialisation from a veterinary behaviourist (see page 24).

Contact: cav@vets.org.nz

[Photo credit: Elena Mozhvilo for Unsplash]

Our aim is to provide you with current and accurate information in the following key areas: 1. Possible disease risk and, specifically for New Zealand puppies, the risk from canine parvovirus infection. 2. How to use vaccines to protect an individual against this risk. 3. How to provide advice on puppy socialisation to your clients, recognising that the critical socialisation window is short, and poor guidance here can impact significantly on the goal – that is, to see the development of a happy and safe adult dog. It is worth noting that we are aware that the World Small Animal Veterinary Association (WSAVA) Vaccination Guidelines were due to be updated at the time this article was written. CAV will undertake to provide further information to practitioners on new information from these guidelines by way of a webinar in 2022 from Dr Richard Squires, chair of the WSAVA Vaccination Guideline Group (details to be confirmed).

Risk of disease

The core antigen of greatest concern for puppies in New Zealand is canine parvovirus (CPV). Canine distemper is now a notifiable disease with only three

New Zealand published data on CPV is currently limited to information about circulating strains (Ohneiser et al. 2015). Of 70 positive samples surveyed, from puppies that were unvaccinated or not fully vaccinated, 69 samples were subtyped as CPV-2a, and one as CPV-2. Current literature supports the fact that all modified live CPV-2 vaccines stimulate a long lasting immune response to all current CPV variants, including CPV-2c. However, further research in the area of New Zealand CPV strains is currently being undertaken by Hannah Bain of Merck Sharp & Dohme (MSD) and Magda Dunowska of Massey University. See page 49 of the March 2021 issue of Companion Quarterly for information on how to participate in this study. Unfortunately, New Zealand-specific data on geographical prevalence and risk is lacking. However, a comprehensive study of cases of canine parvovirus in Australia as reported to the Disease Watchdog database was published in 2012 (Ling et al. 2012). In this study 48/1451 (3.3%) parvovirus cases were in dogs that received a complete primary vaccination course as a puppy. A primary vaccination course was defined as one that was completed with a final dose being administered at or after 14 weeks of age. In addition, a further Australian study based on data of CPV cases from the same database over a longer period of time (Altman et al. 2017) concluded that the age of the puppy when they received their last CPV vaccine, prior to presenting with disease, was a significant

H. Beattie, Chief Veterinary Officer, NZVA, Wellington, NZ

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

risk factor for vaccination failure. This was irrespective of whether the vaccine was marketed with a vaccination protocol that finished at 10-weeks, or 12-weeks or greater. It is reasonable to presume that the situation in New Zealand and Australia is similar, hence these studies provide us with local evidence supporting the finding that finishing the primary vaccination course early (before 16 weeks of age), is likely to be a significant contributor to the risk of disease in young, vaccinated dogs. Ling et al. (2012) also demonstrated in their analysis of the Disease Watchdog database that 60.5% of dogs whose cases were reviewed became sick with parvovirus in less than 14 days from vaccination administration. Parvovirus has an incubation time of 3–7 days and it takes up to 2 weeks for dogs to establish protective immunity. In these cases, it is plausible that a proportion of these dogs developed disease due to an insufficient time interval between vaccination and exposure to the virus.

Other risk factors that may be associated with CPV infection l

Age: 89.5% of the parvovirus cases were in dogs less than 12 months old (Ling et al. 2012) l Socioeconomics: areas with a lower socioeconomic status had more cases compared to areas with higher socioeconomic status (Kelman et al. 2020) l Rurality: a rural predisposition for CPV cases has been reported previously in Australia as well as in other countries (Kelman et al. 2020) l Temperature: a strong association between high temperature in the hottest month of the year, and higher annual CPV case reporting and case numbers has been identified. Seasonality as a risk factor for CPV cases has been reported in New Zealand, Canada and Brazil (spring and summer); Colorado, USA (summer and autumn); and Australia (autumn and spring) (Ling et al. 2012; Kelman et al. 2020) l Rainfall: an association has been shown between areas of lower rainfall (annual, highest daily or highest

monthly) and higher occurrence of CPV-reporting hospitals. It has been postulated that periods of reduced rainfall may contribute to environmental persistence of CPV, increasing risk to naïve individuals (Kelman et al. 2020). l Environment: parvovirus is hardy and can remain in faecally contaminated ground for periods of several months where conditions are favourable. Faeces of infected dogs can contaminate breeding establishments, shelters and pet shops (Nandi and Kumar 2010) Previous cases of CPV in a household or shelter are a well-recognised risk for a susceptible population like unvaccinated puppies. Veterinary teams need to remain vigilant about cleaning and hygiene practices to prevent spread of disease between patients, and should provide advice to clients on ways to reduce risk to puppies visiting the clinic (e.g. avoiding common toileting areas outside the clinic).

Using vaccines to reduce risk of disease

The most important message of the WSAVA Vaccination Guideline Group is encapsulated in the following statement (Day et al. 2016):

We should aim to vaccinate every animal with core vaccines. Non-core vaccines should be given no more frequently than is deemed necessary It is accepted that practitioners provide education for puppy owners on core versus non-core vaccines, with an understanding that a recommendation is made that every puppy is vaccinated against the following core antigens: l

Canine parvovirus (CPV) l Canine distemper virus (CDV) l Infectious canine hepatitis (CAV-1 antigen, vaccinal protection provided by CAV-2)) l Canine respiratory adenovirus (CAV-2)

Types of vaccines

Infectious: these vaccines contain organisms that are attenuated to reduce virulence such as a modified-live virus (MLV). They consistently induce

robust cell-mediated and antibodymediated (humoral) immunity after parental administration. Some are also formulated to be administered directly to mucosal surfaces (intranasal or oral vaccines). When administered to an animal with no maternally derived antibody (MDA), protection will generally be acquired with a single dose. All core vaccines available in New Zealand are modified live viral vaccines (MLV). Non-infectious: also known as killed or inactivated vaccines. They generally require an adjuvant to increase their potency and even in an adult animal require multiple doses to induce protection. They are administered parenterally and may be less likely to induce an immune response. They generally have a shorter duration of immunity (DOI) than infectious vaccines.

Primary vaccination courses for puppies

We would encourage practitioners to familiarise themselves with the WSAVA Vaccination Guidelines (Day et al. 2016) and the NZVA-CAV policy, "Vaccine Use in New Zealand Cats and Dogs" which can be found at https://www.nzva. org.nz/resource/companion-animal/ vaccines/. However, a summary of the recommendations for the primary course of vaccinations for Canine Parvovirus (CPV), Canine Distemper Virus (CDV) and Canine Adenovirus 2 (CAV-2), when using parenteral, modified live viral vaccines from WSAVA are: Puppy Vaccinations: 6–8 weeks of age, then every 2–4 weeks until 16 weeks of age. Initial adult vaccination: two doses of vaccines are generally recommended by most manufacturers; however, a single dose of a modified live vaccine is generally considered effective. Revaccination interval: Booster vaccination given at either 6 or 12 months of age, then no more frequently than every 3 years. The rationale to finish the course at 16 weeks of age is to ensure vaccines are provided at an age at which the majority of puppies are likely to be able to mount

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

an appropriate immune response to the vaccine. By 16 weeks of age, MDA levels will have declined allowing development of a protective immune response in most healthy individuals. The biggest cause of vaccination failure is when puppies do not receive a vaccination late enough (i.e. last vaccination given before 16 weeks of age) (Kelman 2017). However, it should be noted that l

A very small number of puppies may still have sufficient MDA to interfere with the development of immunity even after a final vaccination is administered at 16 weeks of age. It is for this reason that WSAVA VGG suggest clinicians consider minimising this window of susceptibility by bringing forward the timing of the first annual vaccination to 6–12 months of age (Day et al. 2016) l A population of dogs properly vaccinated with MLV CDV, CPV-2 and CAV-2 antigens would have ≥98% protection from disease. Similarly, we would expect a very high level of protection from infection (Day et al. 2016). However, it is important for clinicians to remember that no vaccine is 100% effective in 100% of individuals. This is a valuable point to consider in the discussion around vaccination protection with puppy guardians.

Why administer multiple doses of vaccines to puppies in a primary course?

Puppies receive MDA from their dams that interferes with antibody production by the puppies’ immune system. Most MDA are transferred from the bitch to the puppy via ingested colostrum with a small amount (5–10%) being transferred during pregnancy. Passive transfer of MDA against canine parvovirus via milk has been demonstrated to occur for up to 38 days after whelping, hence immunity derived from feeding from the bitch contributes to ongoing protection from CPV infection (Decaro et al. 2005). MDA titres decline exponentially over time, with half-lives of parvoviral antibodies ranging from 8.3–13.5 days in serum. However, some studies have shown antibodies may persist for as long as 13–15 weeks in some puppies.

Figure 1. Window of susceptibility in puppies vaccinated for canine parvovirus

MDA are able to block immunity derived from vaccines by neutralising vaccinal virus antigen. Where the MDA titre is low enough that it no longer provides protection from infection (generally accepted to be titre <1:80) (Decaro et al. 2020) but is still high enough to neutralise vaccine virus (>1:20) a “window of susceptibility” occurs (see Figure 1). This period usually lasts 2–3 weeks. During this period pups can become infected and may develop disease. Timing of the window of susceptibility varies for each vaccinal antigen, between individuals, and even will be variable amongst a litter of puppies The primary vaccination course consequently involves administering multiple doses of vaccine to an individual to account for the variation of when this window of susceptibility may occur. For example, pups with poor MDA levels may be able to respond to vaccination much earlier than a more robust puppy with higher titres. The first puppy has an early window of susceptibility and needs vaccine administration as early as 8 weeks of age. The latter puppy will only be able to respond when high MDA titres decline, at a later date (e.g. after 14 weeks of age) The persistence of MDA is the key difference when recommending the number and timing of vaccinations between a puppy from a protected bitch, or a naive dog (puppy or adult). Ideally vaccines are given at 2-to 4-week intervals (no closer than 2 weeks) and this should be maintained until the last vaccination at 16 weeks of age.

When is vaccination protection “complete”?

From our recent survey of NZ veterinary practitioners, there was variation in information being provided to owners about the timing of onset of immunity following vaccine administration in the primary course (Barrett 2021). There is evidence to support that immunity may take up to 2 weeks to develop in puppies and unvaccinated adults (Ling et al. 2012). Dr Mark Kelman, a veterinary scientist with a special interest in parvovirus, advises that animals that are vaccinated should be kept isolated until 14 days after vaccination. His advice is that only after this 14-day period is immunity considered to have reached a sufficient level in all dogs (Kelman 2017). However, the WSAVA Vaccination Guideline Group makes the following statement around onset of immunity to canine parvovirus “In the absence of MDA, MLV vaccines provide immunity as early as 3 days after vaccination (Schultz and Larson 1996). “There are core vaccines registered in New Zealand that have a claim for onset of immunity from 7 days after the primary vaccination course has been completed”. MLV vaccines have been proven to be “very effective and safe, since they are characterised by early onset of protection (within a few days after vaccination) and long duration of immunity (several years)“ (Bergmann et al. 2021). Evidence for rapid onset of protection has been demonstrated

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

References

in seronegative pups, where haemagglutination inhibition titres have been demonstrated as early as 2 days after vaccination, with maximal titres developing in a week (Carmichael et al. 1982). So, while there is evidence for protection developing in as short a period as a few days, each puppy's immune system will respond variably, with the time taken to develop immunity varying across the puppy population and forming a bell curve pattern. A few puppies will respond very rapidly, and some may take weeks. Hence, there is no single definitive answer then that will be accurate for every puppy patient we see. A puppy’s time and ability to respond to vaccination will be variable. And so, with literature citing intervals for onset of immunity anywhere between 3 and 14 days, a recommendation to wait 1–2 weeks after the vaccine has been administered before considering protection to be complete (again accounting for risk) would be reasonable. Once again, balancing risk from disease against the need for socialisation needs to be measured in light of the geographic environment and the individual risk profile for that puppy. In the article on page 24 Jess Beer will discuss some options for socialisation that do not include mixing with other dogs or public areas.

Can I socialise my unvaccinated puppy with other puppies or dogs?

From the recent CAV survey, it was apparent that veterinarians were most likely to recommend puppy playschools or socialisation with other vaccinated dogs as safe options for puppies. In fact, these are not the only options available (see page 24). Healthy dogs may pose a risk to puppies whose vaccination protection is not complete. Clinically infected dogs can shed parvovirus asymptomatically and can act as a source of risk. Recommendations to socialise a puppy who has not completed a primary vaccine course with other puppies or adult dogs should be carefully considered (Day et al. 2016). But healthy and fully vaccinated adult dogs pose the smallest risk to a puppy whose vaccination course is not complete.

Photo courtesy of Debbie Simpson

Summary

Vaccination is still our most effective measure to protect puppies from infection with Canine Parvovirus. Primary vaccination courses should be finished at 16 weeks of age, and while onset of immunity is likely to occur within 1–2 weeks from the final vaccination dose, this article illustrates that there will be individual variation within that time frame. Risk factors such as age, socioeconomic and geographical location, in addition to weather variations such as low rainfall and high temperature, all impact the chance a puppy will develop parvoviral illness. Veterinarians need to be familiar with local risk factors when making recommendations about when a safe time to start socialising puppies outdoors might be. However, there are also real risks associated with leaving socialisation too late. The risk that a poorly socialised dog poses to their household, to the community they live in, as well as to themselves, is significant and well documented. Activities that new puppy guardians can start at home, allowing a safe way to commence this behavioural education, are vital to the development of a happy puppy that is also safe from disease.

Altman KD, Kelman M, Ward MP. Are vaccine strain, type or administration protocol risk factors for canine parvovirus vaccine failure? Veterinary Microbiology 210, 8–16, 2017 Barrett L. Understanding current Veterinary advice about vaccination and socialisation in puppies: a CAV Survey. Companion Quarterly 32 (3), 16–21, 2021 Bergmann M, Freisl M, Hartmann K. Prophylaxis of canine parvovirosis – Part 2: Vaccines. Tierarztl Prax Ausg K Kleintiere Heimtiere 49, 122–5, 2021 Carmichael LE, Joubert JC, Pollock, RV. A modified live canine parvovirus vaccine. II. Immune response. The Cornell Veterinarian 73, 13–29, 1982 Day MJ, Horzinek MC, Schultz RD, Squires RA. WSAVA Guidelines for the vaccination of dogs and cats. Journal of Small Animal Practice 57, E1–E45, 2016 Decaro N, Buonavoglia C, Barrs VR. Canine parvovirus vaccination and immunisation failures: Are we far from disease eradication? Veterinary Microbiology 247, 108760, 2020 Decaro N, Campolo M, Desario C, Elia G, Martella V, Lorusso E, Buonavoglia C. Maternally-derived antibodies in pups and protection from canine parvovirus infection. Biologicals 33, 261–7, 2005 Kelman M. How to Stop Canine Parvovirus from Preventing Us Getting Them Home. https://tinyurl.com/23vfmzkv (accessed 25 October 2021), 7th National G2Z Summit, Surfers Paradise, Australia, 2017 Kelman M, Barrs VR, Norris JM, Ward MP. Socioeconomic, geographic and climatic risk factors for canine parvovirus infection and euthanasia in Australia. Preventive Veterinary Medicine 174, 104816, 2020 Ling M, Norris JM, Kelman M, Ward MP. Risk factors for death from canine parvoviral-related disease in Australia. Veterinary Microbiology 158, 280–90, 2012 Ohneiser SA, Hills SF, Cave NJ, Passmore D, Dunowska M. Canine parvoviruses in New Zealand form a monophyletic group distinct from the viruses circulating in other parts of the world. Veterinary Microbiology 178, 190–200, 2015 Nandi S, Kumar M. Canine parvovirus: current perspective. Indian journal of virology: an official organ of Indian Virological Society 21, 31–44, 2010 RSPCA Australia. Is socialising my puppy important? https://kb.rspca.org.au/ knowledge-base/is-socialising-mypuppy-important/ (accessed 5 November 2021), 2019 Schultz RD, Larson LJ. The new generation of parvovirus vaccines. A comparison study. Compendium of Continuing Education for the Practicing Veterinarian 18, 640–1, 1996 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

What do I do if I want to go to 16 weeks with my vaccine programme but the product is not registered for this? The VCNZ Code of professional conduct allows for discretionary use of restricted veterinary medicines (RVM), specifically referred to as “off-label” use, such as when authorising the use of vaccines outside their registered primary vaccination timeframe. The VCNZ Statement on the Discretionary Use of Human and Veterinary Medicines by Veterinarians (see VCNZ website, Standards and Guidance; https://tinyurl.com/4687be88) outlines the key steps that must be met by a veterinarian authorising off-label use of an RVM and it would be prudent to familiarise oneself with the details in advance. Importantly these steps include that the veterinarian must: l Undertake a consultation (see VCNZ Code: glossary definition of a Veterinary Consultation) in regard to the discretionary use l Assess the scientific data available so as to reasonably predict the efficacy of the intended use, and that unnecessary pain or distress will not result from the discretionary use l The process of reaching a decision about which product to use can be compared to a linear cascade. If there is a registered veterinary medicine that can be used in compliance with the label and registration conditions (or an exempted veterinary medicine) to achieve the intended clinical effect, it should be considered first. With regards to use of vaccines, it is expected that the veterinarian would ensure that they include in their consultation process a discussion with the client outlining their thinking about their vaccination plan for their pet. This would include discussing the need to complete a vaccination course for canine parvovirus (and other core vaccines) at or after 16 weeks of age, referring to scientific information either verbally or in a brochure, and covering any potential risks etc. Importantly the veterinarian needs to research and develop an appropriate scientific evidence-based treatment plan for their patients. This would entail reviewing current published scientific literature to satisfy themselves that the proposed use of the product is suitably supported. Regarding vaccination protocols, the veterinarian would be able to safely rely on information published by internationally well-regarded bodies such as WSAVA1, AAHA2, AAHA/AAFP3 and BSAVA4 and to which I believe the NZVA-CAV guidelines are closely aligned. WSAVA stress that that their guidelines “do NOT serve as a set of globally-applicable rules” but are intended to be used by national associations and individual veterinary practices to develop vaccination schedules relevant to the local situation. Such a plan could be at the level of an individual veterinarian or veterinary team and would be regularly reviewed and updated using current information. Lastly, that the veterinarian would have also reflected on alternative products using the cascade system and must consider their use in the circumstances. The veterinarian can then use their discretion to choose their preferred product. It is my understanding that at present there is not a companion animal vaccine range registered in New Zealand whose label aligns with the WSAVA primary vaccination guidelines however this may not always be the case. Should a veterinarian’s decision be scrutinised following a complaint, the veterinarian would firstly be able to rely on the registered claims of the product under the ACVM framework. Secondly under the off-label discretionary use framework, the veterinarian would present high quality scientific information, e.g. Level 1 Evidence5, to support their decision. This does leave a small gap in the framework where one veterinarian may stop a vaccination programme at say, 12 weeks, where another may recommend continuing to 16 weeks of age. The value of our Code is that it allows for a level of discretionary judgement by the veterinarian and in this instance both are right and defendable … one may be considered superior by safely and significantly reducing the risk of disease in puppies using an immunologically valid evidence-based veterinary medicine approach to vaccination however that does not make the other wrong per se. Seton Butler, VCNZ Professional Advisor https://wsava.org/global-guidelines/vaccination-guidelines/ https://www.aaha.org/aaha-guidelines/vaccination-canine-configuration/vaccination-recommendations-for-general-practice/ 3 https://www.aaha.org/aaha-guidelines/2020-aahaaafp-feline-vaccination-guidelines/feline-vaccination-home/ 4 https://www.bsava.com/Resources/Veterinary-resources/Position-statements/Vaccination 5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124652 1 2

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

clinical update

Puppy socialisation: how do we advise clients? Dr Jess Beer BVSc MANZCVS – Veterinary Behaviour We know that the need for appropriate socialisation is the key to shaping dogs into well behaved pets and sociable members of society. This early sensitive period of socialisation is often defined as between 2 weeks and 16 weeks of age. This falls within the cautionary period of fulfilling the recommend WSAVA puppy vaccination guidelines. As veterinarians we need to balance the risk and health benefits when advising clients what they can and cannot do. This will also vary based on the specific practice location and prevalence of infectious disease. BUT the priority is to also inform clients of the need for appropriate socialisation and highlighting the risks of future behaviour problems if timely socialisation is not provided. Behaviour is one of the primary causes of euthanasia and relinquishment of dogs under the age of 2 years old. This risk needs to be weighed up in conjunction with the risk of death due to infectious disease in young pups, primarily parvovirus. Perceived risks can be reduced and ameliorated by simple rules and environmental management. With parvovirus known to exist in the environment, dormant for up to 2 years, it is understandable people are wary. Focus on what safe socialisation we can advise and how to compensate for the limitations. Interestingly such limitations in socialisation have been highlighted by the restrictions imposed by social lockdowns in the last 18 months. Recent survey results from CAV indicate that there is a deficit in knowledge of what safe socialisation can be recommended. Outside of the puppy

Contact: https://www.kiwivetbehaviour.net/

{photo credit: Jametlene Reskp on Unsplash

classes and safe dogs, there is so much more we can advise clients of that will not put their puppies at risk (see Figure 1 for results of a recent survey of NZ veterinarians). The limitations of having no puppy classes or regular social groupings due to the COVID restrictions has also left us with the need to emphasise what else can be done to protect puppies from future behaviour issues. What is interesting about the results shown in Figure 1, is that although survey respondents considered themselves confident talking about socialisation, the advice given to clients was limited and did not extend much beyond safe dog and puppy classes. We have more to offer to clients when recommended safe socialisation practices.

What can we recommend?

It helps to define what socialisation is and what other learning processes are needed for a dog to feel safe in new environments:

Socialisation is the process of an individual or group learning the expected norms and customs of a group or society through social interaction. l Habituation is the process of animals becoming used to something, so that they no longer find it unpleasant or think it is a threat. l Classical Conditioning is conditioning in which the conditioned stimulus (such as the sound of a bell) is paired with and precedes the unconditioned stimulus (such as the sight of food) until the conditioned stimulus alone is sufficient to elicit the response (such as salivation in a dog). We can use this to create a positive emotional response to the planned experiences. Using these learning processes, we can independently find more ways to allow these puppies to learn about the world, even before their vaccination course is completed.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Figure 1. Types of socialisation activity recommended by veterinarians (n = 113). ‘Safe dogs’ = allowing contact with vaccinated dogs on properties with no known parvovirus risk; ‘Car rides’ = taking puppy in the car when family is going out and about; ‘Carried in public’ = carrying puppy (in arms/carrier/ pushchair etc.) out in public but not allowing them onto the ground; ‘Walked in public’ = e.g. on neighbourhood pavements, the beach at low tide, but generally avoiding areas with high dog traffic levels; ‘Sights and sounds’ = exposure to everyday noises/sights, e.g. vacuum cleaners, noisy vehicles, hand-held objects such as umbrellas; ‘New people’ = meeting people outside of the immediate family, e.g. extended family, friends, children, the elderly etc.; ‘Vet clinic visits’ = visits with no interventions/procedures performed, just positive interactions with veterinary staff; ‘Nothing else’ = no other socialisation activities recommended above puppy classes. (note: this image was previously published in the September 2021 issue of Companion Quarterly)

What it means is providing a healthy and positive exposure to the sights, sounds, smells and tactile experiences of the world. It is not simply puppy parties and overwhelming dog social spaces. Such experiences can be provided in the home, in safe homes of family and friends and family, prams and carry bags for small dogs, car rides and protected exposure in public on clean surfaces, such as on a picnic blanket. Videos, sounds, and novel items and movements provided in the home can all contribute to a more resilient puppy once they get out and about more. Approved puppy classes and veterinary clinic visits also play a valuable role in puppies learning and having positive interactions with the people and situations they will need to tolerate in the future. Raising awareness of the need to prepare their puppy for the world before 16 weeks is just as important for our clients as the need to vaccinate against infectious disease.

When puppies cannot get out into public then we need to provide all the other experiences they need at home. Remember it is about exposure to all the senses, e.g. vacuums, hairdryer, showers, cars, bikes, prams, skateboards, dogs barking, sirens, fireworks, thunder, physical handling/examination, other animals, tactile carpet, tiles, grass, concrete, and so much more… Such exposure helps build resilience that is essential for coping with future emotional stress. It is time to advocate for our patient’s mental health, not just their vaccination status. Talk to your clients about what they CAN and should do, not just what they cannot do with their puppies.

References

Pegram C, Gray C, Packer RM, Richards Y, Church DB, Brodbelt DC, O’Neill DG. Proportion and risk factors for death by euthanasia in dogs in the UK. Scientific Reports 11, 1–2, 2021 https://avsab.org/resources/positionstatements/

https://wsava.org/wp-content/ uploads/2020/01/WSAVA-VaccinationGuidelines-2015.pdf http://www.dogpsychologistoncall.com/ hierarchy-of-dog-needs-tm/ Howell TJ, King T, Bennett PC. Puppy parties and beyond: the role of early age socialization practices on adult dog behavior. Veterinary Medicine: Research and Reports 6, 143, 2015 Wormald D, Lawrence AJ, Carter G, Fisher AD. Analysis of correlations between early social exposure and reported aggression in the dog. Journal of Veterinary Behavior 15, 31–6, 2016 l

Look out for CAV's client resource to support socialisation activities for puppies. Coming soon!

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

CAV update

Catio adventures Simon Clark , BVSc, MVM There is a common belief in Aotearoa New Zealand that cats have a fundamental need to have access to the outdoors. Having lived and practiced in the USA (California and Nevada) for a few years, I am aware that this belief about cats is not universal and maybe even unique. The majority of cats in California and Nevada were indoors only, especially in Las Vegas where cats outdoors ran the risk of heat stroke, dehydration, poisoning by snakes and predation from eagles or coyotes. Cats still needed a lot of entertainment indoors and structures for them to climb, hide in and play with were essential for their physical and mental health. Ever since I returned to Aotearoa in 2009, I have continued to keep my cats exclusively indoors to avoid road traffic accidents, infection, poisoning, dog attacks and cat fights. All of them have appeared to be quite content with this arrangement, until my latest kitten. Pyro (Figure 1) has been a particularly hyperactive individual. Behaviourist Jess Beer has assured me that his behaviour is within normal expectations for a kitten, but I have never experienced one so energetic at all times of the day and night. He climbs curtains, chews on furniture, knocks things off counters, runs high speed circuits of the house, and worst of all, picks fights with his elderly housemate, Phoenix. My partner and I have decided to provide a compromise for Pyro and build him a catio (a cat patio). We wanted to document this experience as an example to others, vet clinic staff and vet clinic clients, that we can provide fresh air and sunshine while still keeping our cats contained and safe.

Figure 1. Pyro (top) – the rascal in question [full name Blackbeard the Pyrate Rumskallion De Sploinger], and his considerably less rambunctious buddy Phoenix (bottom).

We chose an area of the house that had a window for the cats to access the area, and a door for humans to access it too (Figure 2a). Conveniently there was a metal frame washing line already there to use as the basis of the frame-work. I used decking boards as the bottom of

the frame and timber mouldings for the frame where it was attached to the house. The mouldings were painted with fence paint and glued to the house using silicone caulking. Chicken wire was stapled to the framework for the sides, and bird netting was stapled to

Contact: simonthevet@gmail.com

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Figure 2. Construction of the catio showing (a) area to be used with washing line and base of frame in place and (b) finished catio with netting on sides and roof.

the framework for the roof (Figure 2b). Where sections of chicken wire or bird netting met, they were weaved together with twine. It is not a very sturdy structure, but it is cat-proof. Neither is it very beautiful, but I was able to assemble it myself for not a large amount of expense and my limited set of construction skills. Pyro has been enjoying his access to a small amount of outdoors (Figure 3) and the cats have been getting along a little bit better. We are going to furnish the enclosed area with some weatherproof cat furniture for them to climb on. There are a wide variety of catios available commercially including kit sets, finished products and design plans available for sale online. l

Figure 3. Pyro investigating his new catio.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Clinical update

Treatment of feline infectious peritonitis in cats in New Zealand Ryan Cattin, BVSc,

In better news, there is ongoing research at the University of Sydney on the use of remdesivir (GS-5734), that so far is showing similar success. Remdesivir is a very closely related molecule, being the pro-drug of GS-441524 that was designed to improve intracellular penetration. This has circumvented the problems with sourcing GS-441524 as remdesivir can be compounded within New Zealand.

FANZCVS, Internal Medicine Specialist, Animal Referral Centre Feline infectious peritonitis (FIP) is a viral disease in cats that is perhaps the most common infectious cause of mortality in young cats in New Zealand. This disease occurs when the feline enteric coronavirus acquires a mutation that allows multiplication within macrophages. Traditionally the marked inflammatory response that ensued was a life-ending disease. There have been multiple studies in the past investigating treatment options including feline interferonomega, immunostimulant medications, and prednisone, with limited success. Fortunately, a recent study by Pedersen et al. (2019) demonstrated remarkable success using an antiviral medication as treatment for FIP. GS-441524 is a nucleoside analogue. Nucleoside analogues are similar molecules to the ‘true’ nucleosides that are the building blocks of DNA and RNA. Because of their structural similarities, they can interfere with key enzymes in DNA or RNA replication, or are integrated into DNA or RNA strands, leading to chain termination or non-functional nucleic acids. One of the limiting factors is these analogues are not only utilised by viral enzymes, but also by mammalian enzymes, which largely accounts for their potential toxicity. This initial study investigated the use of GS-441524 in 31 cats with FIP. Twenty five of these cats survived long term (approx. 2 years at the time the article was written). Four of the non-surviving cats were initially severely affected and were either euthanised or died in the initial days of the treatment regime. The recommended treatment regime involved daily treatment

Contact: Ryan.Cattin@arcvets.co.nz

The University of Sydney is currently working through a prospective clinical trial of remdesivir, as well as a retrospective study based on records of cats treated elsewhere, so watch this space for further published evidence and changes to the treatment protocols (including study of oral medications). Ollie, one of the adorable cats treated for FIP at the Animal Referral Centre

[Photo courtesy of the author]

for 12 weeks, however some cats required repeat protocols following relapse. Considering this disease has in the past been reported as almost universally fatal, long-term survival in 80% of cats is remarkable. The total number of cats in this study was relatively small, so there is only limited data on adverse effects, however those reported in this study were typically relatively mild. Injection site reactions, and pain while injecting this medication were common. Other adverse effects were very uncommon; one cat had significant increases in the concentrations of urea, and SDMA in serum. Anaemia is typically a common problem with nucleoside analogues but was not a feature in this study. The publication of Pederson et al. (2019) documenting treatment success with a drug that is not easily available (see Box at end of article), rapidly resulted in a blackmarket to source this medication.

The Animal Referral Centre (Auckland) is in the process of treating five cats that have FIP with compounded remdesivir. Two cats’ treatment protocols have been completed, with the cats in remission. The other three cats are so far responding very positively to this regime. This includes four young cats with the effusive form of FIP and one older cat with the noneffusive form; two of the cats are currently on treatment week 8 of 12 and remain in remission. While treatment of FIP is still in its early days, it is critically important that veterinarians around New Zealand are aware there is now a legitimate treatment option. While both involved, and expensive, these developments may save New Zealand cats. Hopefully this is the beginning of a new chapter of anti-viral treatments in veterinary medicine.

Reference

Pedersen NC, Perron M, Bannasch M, Montgomery E, Murakami E, Liepnieks M, Liu H. Efficacy and safety of the nucleoside analog GS-441524 for treatment of cats with naturally occurring feline infectious peritonitis. Journal of Feline Medicine and Surgery 21, 271-81, 2019 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Status of GS-441524 in New Zealand

Under the Agricultural Compounds and Veterinary Medicines Act 1997 (the Act), GS-441524 would be considered a veterinary medicine, because its intended use is for treatment of a condition in animals. Veterinary medicines are classified as agricultural compounds under the Act. Agricultural compounds can only be legally imported if they have an authorisation under the Act. These being: (a) is a registered trade name product; or (b) is exempt from registration under section 8A of the Act; or (c) is only to be exported, with or without further processing This means any person importing an agricultural compound (including veterinary medicines) must first comply with one of the authorisations above. Persons who do not have such an authorisation or fail to declare they are importing an agricultural compound could be subject to compliance action under the Act. Where registration of the product may not be an option, a special circumstance approval under section 8C of the Act may be applicable. Any person can apply for this, however, whether the application is successful or not is dependent on a number of factors. One of the key factors for a veterinary medicine special circumstance approval is knowledge and expertise of the person using the product. Generally this means a veterinarian is the only appropriate person. Veterinarians have obligations under VCNZ’s Code of Professional Conduct regarding the use of veterinary medicines, including the obligation to meet the requirements of the ACVM Act. VCNZ’s Technical Advice: Use and recommendation for use of unregistered Veterinary Medicines states that is unlawful for veterinarians to authorise UVMs and they should not facilitate their use. However, the Code does not prevent a veterinarian from providing advice, monitoring an animal’s health or responding to and providing treatment for an adverse event. See the full statement from VCNZ on their website. With thanks to MPI’s ACVM group and VCNZ for contributing to this information.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

CLINICAL update

Does the term 'Dietary Elimination Trial' send chills up your spine? Corey Regnerus, BVSc, BSc, Scientific Services Veterinarian, Royal Canin Australia and New Zealand Dietary elimination trials (DET) are commonly discussed in clinical environments with our client base as best practice (Verlinden et al. 2006) to diagnose cutaneous adverse food reactions (CAFR; Olivry et al. 2015) or food-induced atopic dermatitis (FIAD; Rosser 2013) in dogs and cats. However, have you considered DET are a diagnostic test that we rely completely on the client to perform and interpret the results allowing us to determine a diagnosis? Additionally, this is one of the longest diagnostic assessments for a condition, typically spanning 8–12 weeks, in order to accurately diagnose 90% of cases (Figures 1 and 2). Combine these two factors, and it is no wonder that many of us have an overwhelming feeling of anxiety when we see an itchy patient in our appointment schedule for the day. With all of that in mind we can clearly see why the main reason for failings in a DET either in general practice or referral would boil down to client compliance. So how do we set them up for success in managing this complex process in order to be the best patient advocates that we can be as veterinarians? The reality is that it isn’t captured within a 15-minute consultation period and will require a team effort from the practice with plenty of follow up and communication. Twoway communication and collaboration is essential in obtaining the most valid data set for interpretation which will lead to a final diagnosis (Box 1).

Contact: corey.regnerus@royalcanin.com

Figure 1. Cumulative percentages of clinical remission in 209 dogs with CAFR over time (in weeks). Data taken from five published studies.

Image credit: Olivry et al. (2015). The Creative Commons Public Domain Dedication waiver (http:// creativecommons.org/publicdomain/zero/1.0/) applies to this data.

Figure 2. Cumulative percentages of CAFRs over time (in weeks). Data

clinical remission in 40 cats with taken from three published studies.

Image credit: Olivry et al. (2015). The Creative Commons Public Domain Dedication waiver (http:// creativecommons.org/publicdomain/zero/1.0/) applies to this data.

Taking one step back, what is required for a DET? The most important piece of information, again relying on the pet owner, is a full and detailed history of all proteins that the pet has likely been exposed to. This can be by means of primary diet (i.e., commercial pet foods), as well as treats (including table-scraps),

medications and supplements to build a complete data base of the different meat and carbohydrate-based proteins that the patient has consumed throughout its life. This is complicated for pets feeding commercial diets as most commercial pet foods will contain a mix of protein sources leading to multiple exposures

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Box 1. Recommended key communication points for dietary elimination trial patients l

Pre-appointment comprehensive dietary and clinical history questionnaire

1-week check to ensure transition of diet went well

Note: dietary feeding trial commences after the 1-week check

3 weeks to check on compliance and answer any questions

5 weeks re-check appointment to assess if any additional management interventions are required

7 weeks to continue compliance and answer any questions and book re-check

9 weeks re-check appointment to consider results and start challenge

10 weeks to check in and ensure no clinical signs have appeared with the challenge diet

within a single diet (Mandigers et al. 2010). Ideally to manage a DET, a diet would be formulated for that individual patient avoiding all these protein sources, and therefore identifying a ‘novel’ protein diet (Biourge et al. 2004) for that patient. This is where the concept of ‘homecooked’ diets was founded for DET. By individualising the elimination diet to that patient, we achieve the best chance to determine the trigger for that individual. The other approach is to use hydrolysed proteins, ideally <10 kDa in size (Olivry et al. 2015). These can be novel or ones that the patient might have previously been exposed to in order to reduce the chance of an allergenic response to those proteins. Hydrolysed diets have been produced by commercial pet food operators for many years using proteins that are commonly allergenic like chicken or beef (Mueller et al. 2016), or proteins that are less commonly allergenic like soy. More recent innovations include diets with proteins from unique sources to which animals are unlikely to have had the opportunity to have developed an immunes response, such as feather protein hydrolysate (used in Royal Canin’s Anallergenic). This diet is also extensively hydrolysed such that 95% of the protein composition for the diet is <1 kDa in size, and 88% is free amino acids, further reducing risk of immunologic reactions to the trial diet.

How do we then convey what is best for our patients to the pet owners? As a reminder, the outcomes rely completely on client compliance. Therefore placing ourselves in their shoes is important for the overall result for that patient. The absolute best practice for the patient from the diagnostic standpoint would be an individualised, complete and balanced novel protein home-made diet. The reality is, however, that this is more complicated than it sounds. A 2013 study demonstrated that homemade diets for maintenance (not with an added complexity of novel proteins and ingredients) were more often than not ‘unbalanced’ or ‘incomplete’ by AAFCO and NRC guidelines. Of the 200 recipes evaluated, 95% had at least one nutrient not meeting the appropriate guidelines, and 85% with 2 or more (Stockman et al. 2013). Of the 5% that were appropriately complete and balanced, these were all formulated by veterinary nutritionists. This is the reason why it is best practice to enlist their support when formulating a novel home-cooked diet for DET. This all sounds great right? But how practical is it again for the pet owner who is at the centre for success with this diagnostic test? There are limited veterinary nutrition referral sources around the globe, and even more so within the Asia-Pacific region. Majority of these services are based at universities veterinary schools where boarded Veterinary Nutritionists

are employed. The cost for a digital nutrition consult for a home-cooked elimination diet will range anywhere from NZ$240–NZ$650 at cost (not including any potential mark-up for these services) to get one or two recipes. Home-made diets have proved problematic at times for palatability (Tapp et al. 2002), and commonly multiple additional recipes might be required at further costs averaging an additional NZ$222 per recipe. This is just for obtaining the recipe itself. The requirement then is to follow through with the formulation, purchase the ingredients and have owners commit to daily food preparation for the patient. Majority of the formulated diets will utilise the only nutritionist developed vitamin and mineral supplement for cats and dogs from a company called BallanceIT out of the USA. This therefore requires importing these supplements for the recipes, as well as purchasing locally several additional sources of essential fatty acids and micronutrients. A recent formula that I assisted a clinic with obtaining required an outlay cost of NZ$413 per month for ingredients, working out at NZ$13.68 per day for the ingredients alone. These costs are similar to previously published evaluations from Europe which reported that it cost, on average €3.60 more per day for a homecooked diet compared to an extensively hydrolysed elimination diet (Cadiergues et al. 2015) (Figure 3).

Figure 3. Mean daily cost (in France) of home-cooked diet vs. commercial hypoallergenic diet (Anallergic, Royal Canin) standardised for a 20-kg dog

(Source: Royal Canin Dermatology Range Brochure, based on Cadiergues et al. 2015)

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Circling back to the purpose of a DET and the reliance on pet owners for a complete, consistent approach during the elimination phase, this begins to shed light on the pressures that we place on our clients. While this would be a gold standard approach, we need to ask is it practical? How likely are we to achieve a diagnostic data set at the end of this trial period? And is it sustainable for the pet owner? There is an unspoken fear of using commercial DET products in the veterinary community. Some of these concerns are founded, however others have been extrapolated from human medicine without an evidence-based assessment. For example, there is a demonstrated connection in human medicine where food reactions have been attributed to food additives, however this hasn’t been established as a definitive link in cats and dogs (Guilford 1996). A more appropriate concern we should consider is how do we confirm that what is prescribed for your patients is exactly what it says it is? Some studies have found that up to 75% of commercial diets, primarily nonprescription diets, have discrepancies between the protein declaration on the pack compared to the results of protein analysis (Horvath-Ungerboeck et al. 2017) on those products. This indicates risk of cross contamination in these products, and a potential to lead to a falsepositive reaction. In order to minimise the risk of cross-contamination, gold standard elimination diets are produced on dedicated processing lines, with stringent cleaning and decontamination procedures. The absence of crosscontaminating proteins should then confirmed by PCR testing of every batch before release (Lesponne et al. 2018). This presents another opportunity for discussion with your pet owners about the importance of acquiring a reliable source of food for the DET to prevent the risk of undeclared ingredients that could lead to a failed elimination trial.

Hopefully that hasn’t scared you off ever approaching the management of a DET in your practice but does highlight the importance of dedicating some time in supporting clients in the best outcome for their pets and your patients. The trade-off between best practice and achieving a diagnostic outcome for DET is a case-by-case assessment on the financial investment, as well as the workload and lifestyle of the pet owner to manage a complicated process. Prescription based commercial pet food designed for DET are a fantastic tool supporting your dermatology cases in practice. They are high value for money items that add additional securities to the diagnostic assessment and can facilitate a more positive relationship with the pet owner and their companion.

References

Biourge VC, Fontaine J, Vroom MW. Diagnosis of adverse reactions to food in dogs: efficacy of a soy-isolate hydrolyzate-based diet. The Journal of Nutrition 134, 2062S–2063S, 2004 Cadiergues MC, Muller A,Bensignor E, Heripret D, Yaguiyan-Colliard L, Mougeot I. Cost evaluation of homecooked and an extensively hydrolyzed diets during an elimination trial: a randomized prospective study. [presented as an abstract to the 28th Annual Congress of the ECVD-ESVD]. Veterinary Dermatology 26, 293–313, 2015 Guilford WG. Adverse reactions to food. In Guilford, WG, Center SA, Strombeck DR, Williams DA, Meyer DJ (Eds), Strombeck's Small Animal Gastroenterology. Pp. 436–50. WB Saunders, Philadelphia, PA, USA, 1996 Horvath-Ungerboeck C, Widmann K, Handl S. Detection of DNA from undeclared animal species in commercial elimination diets for dogs using PCR. Veterinary Dermatology 28, 373, 2017 Lesponne I, Naar J, Planchon S, Serchi T, Montano M. DNA and protein analysis to confirm absence of crosscontamination and support the clinical relaibility of extensively hydrolysed diets for adverse food reaction-pets. Journal of Veterinary Science 5, 63, 2018

Mandigers PJ, Biourge V, van den Ingh TS, Ankringa N, German SJ. A randomized, open-label, positivelycontrolled field trial of a hydrolyzed protein diet in dogs with chronic small bowel enteropathy. Journal of Veterinary Internal Medicine 24, 1350–7, 2010 Mueller RS, Olivry T, Prelaud P. Critically appraised topic on adverse food reactions of companion animals (2): common food allergen sources in dogs and cats. BMC Veterinary Research 12, 9, 2016 Olivry T Mueller RS, Prelaud P. Critically appraised topic on adverse food reactions of companion animals (1): duration of elimination diets. BMC Veterinary Research 11, 225, 2015 Rosser EJ. Diagnostic work-up of food hypersensitivity. In: Noli C, Foster A, Rosenkrantz W (Eds), Veterinary Allergy. Pp. 119–23). John Wiley & Sons, Oxford, UK, 2013. Stockman J, Fascetti A, Kass PH, Larsen JA. Evaluation of recipes of home-prepared maintenance diets for dogs. Journal of American Veterinary Medical Association 242, 1500–5, 2013 Tapp T, Griffin C, Rosenkrantz W, Muse R, Boord M. Comparison of a commercial limited-antigen diet versus home-prepared diets in the diagnosis of canine adverse food reaction. Veterinary Therapeutics 3, 244–51, 2002 Verlinden A, Hesta M, Millet S, Janssens GP. Food allergy in dogs and cats: a review. Critical Reviews in Food Science and Nutrition 46, 259–73, 2006 l

This article was kindly supplied by Royal Canin. Copyright is retained by Royal Canin.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Study REPORT

Some observations on the treatment of superficial pyoderma in dogs with totarol Heidi Ward-McGrath

BVSc, Allan Bell BVSc MANZCVS FANZCVS, Janis Bridges and Boyd Jones BVSc, FACVSc, DECVIM-Ca Superficial bacterial skin infection (superficial pyoderma) is common in dogs, being one of the most common conditions seen in veterinary practices in New Zealand especially in the summer. The major bacterial commensal and pathogen is Staphylococcus pseudintermedius but other bacterial pathogens are identified including Staphylococcus aureus (Schmidt 2017). Antibiotic resistant organisms including methicillin resistant S. pseudintermedius have been identified in dogs in New Zealand (Schmidt 2017; Bell et al. 2016). Surface and superficial pyoderma include fold pyodermas (lip, face, vulva), impetigo, bacterial folliculitis, superficial spreading pyoderma and combinations of folliculitis and spreading pyoderma (Gross et al. 2005). Bacterial folliculitis is the most common pyoderma seen in dogs and has many clinical presentations: a follicular papule or pustule progressing to epidermal collarettes characterised by a circular area of hair loss with variable erythema, exudation, crusting and pigmentation. Pruritus may be present especially in atopic dogs where pyoderma is a cofactor that promotes itching. Veterinary treatment of superficial pyoderma has included the administration of systemic and/or topical antibiotics or the application of local antiseptic agents. While a number of biocides have been used, 2–4% chlorhexidine is currently the most Contact: vetcare@xtra.co.nz

effective topical agent and the treatment of choice of many veterinarians based on trial evidence (Murayama et al. 2010; Loeffler et al. 2011; Mueller et al. 2012).

on the history and the characteristic clinical signs of superficial bacterial skin infection (Figure 1).

Totarol, an aromatic diterpenoid phenol, is a natural organic extract of the tōtara tree (Podocarpus totara) which has potent antibacterial action against gram positive organisms in vitro (Kubo et al. 1992). Totarol was first isolated in 1937 (Short and Stromberg 1937) but the medicinal properties of totara tree extracts were known to Māori for many years before. Totarol has been used as an antibacterial agent for skin infections and in other medications for people but there are no equivalent clinical data to support claims for the treatment of superficial pyoderma in dogs. Nevertheless, there are anecdotal reports of its use to treat skin infections in dogs. The purpose of this pilot study was to confirm the efficacy of totarol applied in a vehicle of sodium bentonite clay (1% w/v) or as a 0.2% aqueous spray for the treatment of superficial bacterial skin infections in dogs. A positive control group of dogs was treated with 3% chlorhexidine wash, an accepted topical biocide treatment for dogs.

Materials and methods

Massey University ethics approval applied to the study (AEC/18 amended 04/17) and owner consent was obtained for all cases.

Animals

Eighteen client-owned dogs of mixed age and breed were recruited from three veterinary practices in the North Island. The dogs were presented for examination of their skin condition and a clinical diagnosis of superficial bacterial skin infection was made by the attending veterinarian based

Figure 1. A typical “hot spot” with moderate erythema, sparse papules, moderate exudate and fine crusts on a 9-year-old Maltese Terrier crossbreed dog at visit 1 (pre-treatment). Note: hair over the lesion has been clipped.

Skin lesions

Lesion(s) were scored for the presence of each of the following: erythema, pruritus, exudation, hair loss, and depth of the lesion, according to a linear scale) where 0=none, 1= mild, 2=moderate, 3=severe. The same veterinarian scored the skin lesions for each dog at days 1, 7 and 28.

Cytology

An impression smear of the exudate was taken from the lesion(s), air dried, stained with Diff Quick and examined (AGB).

Microbiology

A swab taken from the lesion was sent to a veterinary diagnostic laboratory for bacterial culture and antibiotic sensitivity determination.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Treatment

The selection of a treatment was randomly selected by dice throw. Based on the dice throw each dog was allocated to a treatment group: 1. Six dogs were treated daily for 7 days with 3% chlorhexidine wash (PyodermRS; Virbac, Sydney, Australia) 2. Six dogs were treated daily for 7 days with topical 0.2% totarol aqueous spray (Totarol; Vetcarevets, Masterton, NZ) 3. Six dogs were treated daily for 7 days with topical 1% w/v totarol in medical grade sodium bentonite clay (Pet Putty; Vetcarevets, Masterton, NZ) If necessary, hair was clipped from over and around the lesion and the owners were shown how to apply the topical medications to the lesion(s). A treatment sheet was provided for each owner which contained a full explanation of how treatment should be undertaken each day until the next visit.

Revisits

Each dog was examined 7 days after the first visit (Figure 2). Medications were withdrawn and the dogs then re-examined 28 days after the first visit. Owners were asked to complete a short questionnaire on their experience using the prescribed products.

Data analysis

Outcome of treatment

Results

The appearance of the lesions 7 days after treatment and the score differences for each clinical sign showed all products were effective but the improvement in the totarol/clay group was significantly better than that of the chlorhexidine group (p=0.031) (Table 2). There was no evidence of a difference in the score reductions for each clinical sign in any group except for hair loss. Figure 3 shows box plots of the reduction in total score between days 1 and 7 for each treatment group.

Score difference was defined as the difference between day 1 scores and day 7 scores for the measures; erythema, pruritus, exudation, hair loss, depth and total score. Mean score differences for the three treatment groups were compared using the non-parametric Kruskal-Wallis test. The Dunn test (Dunn, 1964) was applied for multiple comparisons. The p-values were adjusted for type I and type II errors using the Benjamini-Hochberg method. P-values <0.05 were considered significant. All analyses were carried out using R statistical software version 3.6.3 (R Development Core Team 2020; R Foundation for Statistical Computing, Vienna, Austria).

One dog from the totarol group was excluded from the final results as it was bitten by another dog 4 days after treatment started. The bite injuries to this dog required antibiotic treatment

Cytology

All remaining dogs in each treatment group improved, with resolution of most of their clinical signs and a reduction in their severity scores by day 7 (Table 1). By day 28 the severity scores were zero for 15/17 dogs. One dog in the chlorhexidine group and one dog in the totarol spray group still showed some signs both with a severity score of 2. The dog receiving totarol spray resisted application by the owners. It had a score of 10 before treatment began and 6 after 7 days.

Surface cytology revealed cocci and neutrophils in 15/17 dogs. Yeast-like organisms, rod bacteria, melanosomes and red blood cells were seen infrequently and in very low numbers. The findings in all dogs supported a diagnosis of superficial bacterial infection.

Microbiology

Staphylococcus pseudintermedius was recovered from the lesion(s) of 15 dogs including the two which had negative cytological results. All isolates were sensitive to antibiotics in common use by veterinarians. No isolate was multi-antibiotic resistant. Streptococcus dysgalactiae and Klebsiella spp. were recovered from the lesions in two dogs. Other bacteria recovered from some dogs were regarded as contaminants or of questionable significance.

Figure 2. The same dog as in Figure 1 after 7 days of treatment with Pet putty. There is superficial ulceration, resolution of papules and mild erythema. The hair over the lesion was clipped.

The two dogs with negative cultures had evidence of bacterial infection on cytology. The transport delay in submission to the laboratory was considered the reason for a negative culture.

Figures 3. Box plots showing distribution of (a) the difference in total scores between day 1 (pre-treatment) and day 7 and (b) total scores on days 1 and 7, for dogs treated with 3% chlorhexidine wash (n=6), 0.2% totarol spray (n=5) and Pet putty (1% totarol in bentonite clay; n=6).

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Table 1. Age, breed and sex of dogs included in a study comparing the effect of totarol with chlorhexidine for treatment of superficial pyoderma and the scores allocated to each dog for the clinical signs of erythema, exudation, pruritus, hair loss, depth of lesion before treatment (pre) and at day 7 after treatment for each treatment group. Clinical sign Treatment groups

Time

Erythema

Itch

Exudate

Hair loss

Depth

Total

Chlorhexidine group (age, sex, breed) 12 years 5 years 5.5 years 4.5 years 1.6 years 3 years

FS FS FS FS MN MN

Bichon Mastiff Huntaway Mastiff X Labrador X Mastiff X

Pre

7 day

Pre

7 day

Pre

7 day

Pre

7 day

Pre

7 day

Pre

7 day

Totarol spray group (age, sex, breed) 3y 15 years

M M

3 years

2 years

1 years

Labrador Fox Terrier X Labrador Ridgeback X Labrador

Pre

7 day

Pre

7 day

Pre

7 day

Pre

7 day

Pre

7 day

Pet Putty group (age, sex, breed) 4 years 5 years 8 years

MN M FS

Maltese Cairn X Maltese X

9 years

Labrador

3 years

Ridgeback

9 years

Owner questionnaire

Shih Tzu

Pre

7 Day

Pre

7 day

Pre

7 day

Pre

7 day

Pre

7 day

Pre

7 day

All owners followed the requested treatment protocol and were positive about the result of treatment for their dog. Three dogs tried to lick off the totarol/clay preparation after the first application, but this did not affect the outcome for these dogs and further applications in the following days were tolerated well. One dog in the totarol spray group did not accept the spray application and the owners found application difficult.

Table 2. Comparison of mean differences in the total pyoderma lesion score between pre-treatment to day 7 for dogs with superficial pyoderma treated with 3% chlorhexidine wash (n=6), Pet putty (1% totarol in bentonite clay; n=6) or 0.2% totarol spray (n=5). P-valuea Groups compared

a b

Unadjusted

Adjustedb

Chlorhexidine vs. Pet putty

–2.5644

0.010335

0.031

Chlorhexidine vs. Totarol spray

–0.8022

0.42437

0.422

Pet putty vs. Totarol spray

1.642863

0.100411

0.150

Significance of difference between groups based on Kruskal-Wallis P-values adjusted using the Benjamini-Hochberg method

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Discussion

The antibacterial action of totarol is established (Kubo et al. 1992; Muroi and Kubo 1996; Guo et al. 2015). The results of this study show that when applied topically for 7 days to dogs with superficial pyoderma 1% w/v totarol in bentonite clay achieved a greater reduction in lesion scores than chlorhexidine wash. There was no evidence of a difference in efficacy between 0.2% totarol aqueous spray and chlorhexidine wash. The two preparations containing totarol were both effective. The reason two dogs, one in the totarol spray group and one in the chlorhexidine group, still showed signs at day 28 was not established. The score for the dog in the totarol spray group at day 7 improved from day 1 but the dog resisted application and we suspect it received inadequate treatment; more prolonged treatment might have resulted in a better outcome. The dog in the chlorhexidine group that did not improve had equivalent scores at days 1 and 7 and although improved by day 28 the lesions had not resolved fully. The significance of hair loss between the totarol/clay and spray groups was confounded by clipping the hair over and around the lesion(s) in some dogs thus no weighting should be given to this finding. The effectiveness of totarol in this study is claimed due to its antibacterial properties but there is also evidence that totarol has anti-inflammatory properties (Young et al. 1989), and also inhibits lipid peroxidation (Harraguchi et al. 1997). These properties were not investigated in this study but may have contributed to its effectiveness. No methicillin resistant Staphylococcus spp. were recovered from any of the dogs but there is evidence to support totarol’s antibacterial properties and efficacy against methicillin resistant Staphylococcus spp. (Kubo et al. 1992; Kubo et al. 1994; Muroi et al. 1996; Smith et al. 2007; Guo et al. 2015) which is an additional advantage if resistant strains are suspected or recovered.

Veterinarians involved in this study did not identify underlying predisposing causes for the pyoderma in any dog in the study population but the authors acknowledge that identification of predisposing causes of pyoderma e.g. atopy is important to assist recovery. The role of topical antibacterial biocides is important and while chlorhexidine is the current biocide of choice for the treatment of superficial pyoderma in dogs, the effectiveness of totarol in this study gives practitioners the choice of a biocide which could be prescribed instead of chlorhexidine. The sample size for each group in this study is very small and as such there is the risk of type I and II error. However, we believe there is sufficient preliminary evidence to support the use of topical totarol as a 0.2% aqueous spray or as a 1% w/v totarol/clay preparation for the successful treatment of localised superficial pyoderma in dogs.

Acknowledgements

Healthy Pets New Zealand helped fund the project, IDEXX Laboratories (NZ) ULC for assisted with culture and sensitivity determinations, the practitioners who participated and the owners of the dogs who returned their animals at the required revisit times and for completing the exit questionnaire.

References

Anonymous. www.fda.gov. foodingredientspackaging/gras/ scogs/ucd260870 US Food and Drug Administration, US Government, Washington DC, USA, 2015 Bell AG, Combs GW, Cater B, Douglass C. First report of a mecApositive multidrug resistant Staphylococcus pseudintermedius isolated from a dog in New Zealand. New Zealand Veterinary Journal 64, 253–6, 2016 Dunn OJ. Multiple comparisons using rank sums. Technometrics 6, 241–52, 1964 Gross TL, Irke PJ, Walder EJ, Affolter VK. Pustular diseases of the epidermis. In: Skin Diseases of the Dog and Cat. Pp 1–26, Blackwell Science, Hoboken, NJ, USA, 2005 Guo N, Wenli L, Zaho X, Shi C, Zonghui L, Yu L. The synergy of berberine chloride and totarol against Staph. aureus in planktonic biofilm cultures. Journal of Medical Microbiology 64, 891–900, 2015

Harraguchi H, Ishikawa H, Kubo I. Anti-oxidative action of diterpenoids from Podocarpus nagi. Pharma Medica 63, 213–5, 1997 Jaiswal R, Beuria, TK, Mohan R, Mahajan S, Panda D. Totarol inhibits bacterial cytokinesis by perturbing the assembly dynamics of FtsZ. Biochemistry 46, 4211–20, 2007 Kubo I, Muroi H, Himejima M. Antibacterial activity of totarol and its potentiation. Journal of Natural Products 55, 1436–40, 1992 Kubo I, Muroi H, Kubo H. Naturally occurring anti-acne agents. Journal of Natural Products 57, 9–17, 1994 Loeffler A, Cobb MA, Bond R. Comparison of a chlorhexidine and a benzoyl peroxide shampoo as sole treatment in canine superficial pyoderma. Veterinary Record 169, 249–53, 2011 Mueller RS, Bensignor E, Bergvall K, Bond R. A review of topical therapy for skin infections with bacteria and yeasts. Veterinary Dermatology 24, 330–41, 2012 Muroi H, Kubo I. Antibacterial activity of anacardic acid and totarol alone and in combination with methicillin, against methicillin resistant Staphylococcus aureus. Journal of Applied Bacteriology 80, 387–94, 1996 Murayama N, Nagata M, Terada Y, Shibata S, Fukata T. Comparison of two formulations of chlorhexidine for treating canine superficial pyoderma. Veterinary Record 167, 532–3,2010 *Schmidt V. Methicillin resistant Staphlococcus pseudintermedius (MRSP) affecting canine and feline skin. Proceedings of the Dermatology Chapter of the Australia and New Zealand College of Veterinary Scientists, Pp 9–17, 2017 Short WF, Stromberg HJ. Totarol; part 1. Journal of the Chemical Society 516–20, 1937 Smith ECJ, Kaatz GW, Seo SM, Wareham N, Williamson EM, Gibbons S. The phenolic diterpene Totarol inhibits multidrug efflux pump activity in Staphlococcus aureus. Antimicrobial Agents and Chemotherapeutics 51, 4480–3, 2007 Young JM, De young LM. Cutaneous models of inflammation for the evaluation of topical and systemic pharmacological agents. In: JY Chang, AJ Lewis (Eds) Pharmacological Methods in the Control of Inflammation. Pp 215–31. Alan R Liss Inc. New York, NY, USA, 1989 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

case report

Trans-arterial closure of a patent ductus arteriosus in a Corgi puppy: use of the Amplatz canine ductal occluder device Miranda Tong, BVSc (dist). Rotating Intern at Animal Referral Centre

Case description

A 14-week-old, entire female Welsh Corgi presented to the Animal Referral Centre (Auckland, NZ) for evaluation of a continuous heart murmur identified on a routine puppy health check. An echocardiogram by the primary care veterinarian was suggestive of a patent ductus arteriosus (PDA) and a cardiac referral was advised. The physical examination on presentation revealed a grade IV/VI, left, axillary, continuous murmur with strong femoral pulses. An echocardiogram by a cardiologist confirmed a haemodynamically significant leftto-right shunting PDA with volumeoverloading of the left heart was volume-overloaded. The minimum ductal diameter of the PDA was 2.5 mm (Figure 1). Given the risk of the puppy developing congestive heart failure, closure of the PDA was recommended. Following some discussion, the owners elected transcatheter closure of the PDA by the cardiologist. The puppy was anaesthetised and positioned in left lateral recumbency. Vascular access to the left femoral artery was achieved using a cut-down technique. A 6-Fr introducer was placed, and an angiogram was performed using a 6-Fr multipurpose catheter (Merit Contact: Miranda.Tong@arcvets.co.nz

(Photo courtesy of the author)

Figure 1. A two-dimensional ultrasonographic image (left) of a left cranial view of the heart of a 14-week old puppy with a continuous heart murmur, showing the patent ductus arteriosus (PDA). The colour Doppler (right) shows continuous turbulent flow into the main pulmonary artery (MPA). The position of the aorta is indicated (Ao).

Figure 2. Angiogram (A) from a puppy with a continuous heart murmur, highlighting the main pulmonary artery (MPA) and the patent ductus arteriosus (PDA), and (B) a magnification from the same angiogram with the PDA morphology (Type IIA) and aorta (Ao) outlined.

Medical, Jordan, UT, USA). Angiography revealed a type IIA PDA with the PDA ostium measuring 2.5 mm (Figure 2). A 4-mm Amplatz canine ductal occluder (ACDO) was deployed in the PDA with the distal flat disk in the pulmonary artery and the proximal cupped disk in the PDA (Figure 3). Once the device was confirmed to be in a stable position, the

ACDO was released from the wire. The femoral artery was ligated, and a routine closure was performed. The patient was uneventfully recovered from the anaesthesia without any complication. No murmur could be auscultated following surgery and a brief postoperative echocardiogram showed no residual flow through the PDA.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

in pulmonary vascular resistance results in an increase in arterial oxygen tension and inhibition of local prostaglandin release, stimulating the ductus arteriosus to contract and close. Over time, the closed ductus arteriosus is replaced by fibrous tissue, forming the ligamentum arteriosum. Failure of the ductus arteriosus to close results in PDA. In contrast to the pre-natal period, after birth the blood pressure in the pulmonary circulation (pulmonary artery) is lower than the systemic circulation (aorta). Therefore, PDA allows continuous blood flow from the aorta to the pulmonary artery (called left-toright shunting). The extra blood that goes to the lungs then circulates back to the left heart, resulting significant left heart volume overload. The left ventricle responds to this by eccentric hypertrophy but left-sided congestive heart failure can ultimately develop in 65% of affected dogs by 1 year of age (Tilley et al. 2007).

Figure 3. Angiograms taken during implantation of an Amplatz canine ductal occluder (ACDO) device in a puppy with patent ductus arteriosus. The ACDO device was positioned with the distal disk within the main pulmonary artery attached to guide wire (A) and then released from guide wire (B).

Post-operative care and follow up

To minimise the risk of device embolisation, strict cage rest for the next 2 weeks was advised. A repeat cardiac examination 4 weeks later showed that the patient remained well at home. No murmur was detected. A repeat echocardiogram showed normal cardiac dimensions and no residual flow around the ACDO. No further cardiac assessment was required, and the puppy is expected to live a normal life and life span.

Discussion

Pathophysiology of PDA

The ductus arteriosus is a normal vessel present during the prenatal stage that connects the main pulmonary artery to the aorta. It provides a way for maternal oxygenated blood to bypass the uninflated lungs during the embryonic state. Following birth, the neonate takes a breath and the decrease

Other differentials for a continuous heart murmur include aortopulmonary window and systemic to pulmonary arterial fistula. However, these differentials are rare. Therefore, PDA should be suspected unless proven otherwise (Brambilla et al. 2020; Saunders 2021). Various morphologies of PDA have been described. The present case had a type IIA, which is the most common type and suitable for ACDO implantation (Miller et al. 2006). This type of PDA has parallel ampulla that abruptly reduce in diameter (>50%) at the point of insertion into the pulmonary artery.

What are the treatment options for PDA?

Treatment options for PDA include surgical ligation and transcatheter approach. The former approach can be very successful and is widely available in New Zealand by specialist surgeons. However, the surgery requires a thoracotomy and death from fatal haemorrhage can result even by an experienced surgeon (up to 5.6% in one study; Tobias and Stauthammer 2010). Furthermore, residual flow following ligation is common; as much as 21% in a reported study (Stanley et al. 2003). This introduces the potential for long term complications such as persistent left heart volume overload and congestive heart failure.

The transcatheter approach to PDA closure is an alternative option and is available in New Zealand. This involves accessing a peripheral vasculature, typically the femoral vein or artery. The PDA closure is performed by deploying an occlusive implant using a long delivery catheter or sheath. Various types of PDA occlusive devices exist, and the ACDO is most frequently used due to its superiority in terms of ease of use, low complication rate, and completeness of the occlusion (Singh et al. 2012). Other occlusive device options include coil, or vascular ductal occluder. The ACDO device is a made of a multilayered nitinol wire mesh in the shape of two discs separated by a short waist (Figure 4). It sits compressed within the delivery cable and self-expands when delivered to the correct location. The thinner, flat distal disc sits in the pulmonary artery, and the thicker, cupped proximal disc sits the ampulla, and the waist sits in between across the ductal ostium at the pulmonic end (Weiss and Berent 2015).

Figure 4. The Amplatz canine duct occluder (ACDO) (Photo by Infiniti Medical, LLC, Palo Alto, CA, USA, reprinted with permission)

There currently are two board-certified veterinary cardiologists in New Zealand (Dr Jacqui Huxley DVC at Apex Cardiology, Palmerston North and Dr Joon Seo DACVIM (Cardiology) at Animal Referral Centre, Auckland). Suitability of the device used for transcatheter closure can be assessed by the cardiologist with the initial echocardiography and confirmed at the time of procedure and may involve factors such as patient size and PDA size. Given the nature of minimally invasive procedures, the complication risk for ACDO closure is lower compared to

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

surgery. The reported complications are mainly from unexpected PDA morphology that is not suitable for ACDO deployment (Singh et al. 2012; Claretti et al. 2019). Mortality was not reported in either study. Other rare complications include infection, haemorrhage at the vascular access site, and device embolisation. However, implementing strict sterility, careful vascular access, and appropriate device selection and cage rest following device placement make these risks very rare.

Key learning points

1. Patent ductus arteriosus is the main differential diagnosis for a continuous heart murmur in dogs. 2. Patent ductus arteriosus closure can be performed by surgery or a transcatheter approach. 3. A transcatheter approach has lower risk of complications.

Acknowledgements

Thanks to Dr. Joon Seo at Animal Referral Centre for help in editing this article, and performing the ACDO placement procedure.

References

Brambilla PG, Polli M, Pradelli D, Papa M, Rizzi R, Bagardi M, Bussadori C. Epidemiological study of congenital heart diseases in dogs: Prevalence, popularity, and volatility throughout twenty years of clinical practice. PLoS One 15, e0230160, 2020 Carlson, JA, Achen SA, Saunders AB, Gordon SG, Miller MW. Delayed embolization of an Amplatz canine duct occluder in a dog. Journal of Veterinary Cardiology 15, 271–6, 2013 Claretti M, Lopez BS, Boz E, Martelli F, Pradelli D, Bussadori, CM. Complications during catheter‐mediated patent ductus arteriosus closure and pulmonary balloon valvuloplasty. Journal of Small Animal Practice 60, 607–15, 2019 Miller MW, Gordon SG, Saunders AB, Arsenault WG, Meurs KM, Lehmkuhl LB, Bonagura JD, Fox PR. Angiographic classification of patent ductus arteriosus morphology in the dog. Journal of Veterinary Cardiology 8, 109–14, 2006 Saunders AB. Key considerations in the approach to congenital heart disease in dogs and cats. Journal of Small Animal Practice 62, 613–23, 2021

Singh MK, Kittleson MD, Kass PH, Griffiths LG. Occlusion devices and approaches in canine patent ductus arteriosus: comparison of outcomes. Journal of Veterinary Internal Medicine 26,85–92, 2012 Stanley, BJ, Luis-Fuentes V, Darke PGG. Comparison of the incidence of residual shunting between two surgical techniques used for ligation of patent ductus arteriosus in the dog. Veterinary Surgery 32, 231–7, 2003 Stauthammer CD. Patent ductus arteriosus. In: Weiss C, Berent A (Eds), Veterinary Image-Guided Interventions. Pp 564–73. Wiley-Blackwell Inc., Hoboken, NJ, USA, 2015 Tilley L, Smith F, Oyama M, Sleeper M. Congenital heart disease. Manual of Canine and Feline Cardiology (4th Edtn). Pp 218–27. Saunders, St Louis, MO, USA, 2007. Tobias AH, Stauthammer CD. Minimally invasive per-catheter occlusion and dilation procedures for congenital cardiovascular abnormalities in dogs. Veterinary Clinics of North America: Small Animal Practice 40, 581–603, 2010 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

A Week With ...

... Veterinary Dermatologist, Debbie Simpson Kathryn Hamlet BVSc

MRCVS

When I saw the CAV and Dechra sponsored “A week with …” scholarship advertised, I was delighted to see that Debbie Simpson at the Skin Vet, Auckland was listed as one of the host specialists. I am currently enrolled in the MVM Dermatology paper at Massey through distance learning – a week with the Skin Vet would be an awesome addition to my course. Even so, I arrived at The Skin Vet’s rooms in Auckland rather nervous, as it has been a very long time since I last “saw practice” (around 30 years!). My fears were totally unfounded, as Debbie and her wonderful nursing team, Ellie and Emma, made me feel very welcome from the moment I stepped in the door. One of the things that struck me with Debbie and her team is how amazingly efficient they are. Ellie and Emma know exactly who is coming and have everything prepared for each patient before they arrive (including hypoallergenic treats if on a food trial!), Debbie has a great range of prepared templates for all her treatments and incorporates this into her clinical notes, and before the client has left the appointment, an email has been sent to both client and referring veterinarian, summarising the visit and treatment plan. Another thing that really impressed me was how relaxed and happy the pets were coming for their visit. While the Skin Vet team is superbly efficient, there is no rushing, everything just glides. The

pets are very relaxed in the lovely room, kitted out with a lovely plush bed to lie on, treat toys to play with and chews to nibble on while Debbie spends a good amount of the consultation time talking and listening to the client, collecting that all-important history, and getting a good feel for what the client’s concerns are, and what the main barriers to treatment might be. I think we all know that a huge part of dermatology (and probably any clinical practice) is communication; Debbie had some good tips for this. Asking “How do you give Fido his Apoquel?”, “Is it easy to give Fluffy her Redipred?” and “Is Fi-fi a good girl when she has her immunotherapy injections?” are non-judgemental ways of finding out whether a pet is getting their medication. Debbie takes the time to find out about the owner’s lifestyle and having a collaborative approach to a treatment plan is clearly appreciated by clients, and leads to better client compliance, as does explaining what each medication was for, how quickly it will work, and any potential side effects to look out for. The value of cytology for almost every animal who came into the room was apparent, with many pets having secondary Malassezia or bacterial skin infections. Debbie utilises a direct sampling technique for many sites, where the slide is pressed directly onto the lesion. I noticed this gave clearer cytology, not being overcrowded with debris and keratinocytes, relying on sticky tape only for the hard-toreach areas. A handy tip I learnt was how to distinguish between purple staining melanin granules and cocci on a slide. The melanin granules are

more evenly sized, tend to be in larger congregations and only associated with the keratinocyte. In retrospect, I’m sure I have put a few owners and their pets through regular medicated bathing routines for their pets to control melanin granules over the past few years! I was fortunate to be involved with an intradermal skin test (IDST) on a dog, which was interesting to see. Watching the interpretation of the testing was quite an experience – and gave me a very deep appreciation of the skill and experience of dermatologists in the subjective assessments of IDST. Many of Debbie’s patients were undergoing allergen specific immunotherapy (ASIT) and it was encouraging to see the positive results with this therapy. The literature reports approximately 80% of dogs and 75% of cats have a positive response to immunotherapy (Olivry et al. 2015; Mueller et al. 2021), but it is important to remember that this means better overall clinical signs and not the complete absence of flare-ups. The other thing to remember is that it can take up to one year for the benefits of this treatment to become apparent, so owners do need to be committed to a minimum of 1 year of treatment, and ideally up to 5 years if responding well to therapy. At this point there can be long-lasting changes to the immune system and better tolerance of allergens and therapy may be withdrawn in some patients. Veterinary dermatologists can now offer two types of immunotherapies: the traditional injectable ASIT, and sublingual immunotherapy (SLIT). These two therapies have equivalent efficacy rates, but an individual patient may respond better to one or the other, around

Contact: Leadvet@druryvets.co.nz

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

50% of dogs will respond to one form when the other was not effective. The advantage of SLIT is that owners do not need to give their pet injections, the disadvantage is that therapy is given daily. ASIT injections for maintenance are usually given every three weeks, which may appeal to some clients, and it may work out a little less expensive than SLIT.

Alpha Keri (Melbourne, Australia) or QV bath oil (Douglas Pharmaceuticals, Auckland, NZ) diluted one capful in 500ml of water and spray or sponge on after rinsing off shampoo will help restore moisture to the skin. Mediderm Shampoo (Blackmores, Sydney, Australia) – is an alternative for Malaseb, as it is gentler on the skin.

One of the things I really enjoyed about seeing practice with Debbie, was the reinforcement that I was on the right track with most of the allergic patients I see in my own practice, and that she was keen to discuss her treatment plans for her patients, to help me better fine tune my own approach. It was also a great opportunity to see a few “zebra” cases too – discoid lupus erythematosus in a Shih-tzu, lupoid onychodystrophy in a cross bred dog, and another dog with possible cutaneous lymphoma, which we don’t get to see so often.

If using prednisone for less than 7 days at a time for acute flare ups, there is no need to taper the dose. Aim for <8–10 days of treatment per month, ideally <5 days per month. If unable to get sufficient control with these doses, then consider another anti-pruritic drug if possible.

I’d like to share some of the handy tips for allergic dogs that I picked up on while at the Skin Vet… For management and prevention of superficial bacterial pyoderma – household bleach (unscented Janola) 1 mL in 750 mL water. Spray or sponge onto affected skin, use daily for treatment, then reduce to twice weekly or weekly for prevention (not effective for Malassezia spp). When shampooing, dilute all shampoos with 1–3 times the volume of water and apply to affected areas, then sponge onto the rest of the body. Never apply shampoo directly to the midline of the back, as it can cause spectacular folliculitis, especially in dogs with already inflamed and sensitive skin. Contact time of 3–6 minutes is sufficient (the longer end of this range for Malassezia), rather than the previously recommended 10 minutes, which may improve owner compliance. When using Malaseb (Dermcare, Brisbane, Australia) shampoo remember that it can quite drying, following with

Cyclosporine is the most “skin infection neutral” of the anti-inflammatory medications, for atopic dogs (compared to prednisone, Apoquel and Cytopoint; Zoetis NZ Ltd, Auckland, NZ). Management of otitis externa: Malacetic wipes (Dechra, Paraparaumu, NZ) to clean ears, rather than flushing ears, to prevent maceration. Alpha ear cleaner (Troy Animal Healthcare, Sydney, Australia) is quite good for using on dogs who swim a lot, as it helps to dry out the ears. Cortavance (hydrocortisone aceponate; Virbac, Hamilton, NZ) and Elocon (mometasone; MSD, Auckland, NZ) lotion have an alcoholic base which will help dry the ear canal in addition to anti-inflammatory effect. It is important that the tympanic membrane is intact. Use sparingly, usually 0.3–1.0 mL in the ear canal twice weekly to every 3 weeks as needed. Ear ointments are good for interdigital dermatitis. Elocon lotion or cream can be applied, in the absence of infection. Bandage with gladwrap and a sock, for 5 minutes after application – make sure dog doesn’t eat the glad wrap or the socks!

l Oral safflower oil – 1 teaspoon per

5–10 kg daily l Topical Dermoscent Essential 6 is

also mildly antibacterial, decreases incidence of infections, and neutralises seborrheic odour. l Supplementation takes several months to impact the skin architecture and function and needs to be continued long term. There were many other pearls of wisdom that Debbie shared with me, but I could be writing all night if I keep going! Thank you very much to Debbie and her team for making me feel so welcome and to CAV and Dechra for this fantastic opportunity to delve deeper into the world of Veterinary Dermatology. I would strongly encourage others who are tempted to give the Dechra “A week with…” scholarship a try – it was a fantastic week.

References

Mueller RS, Nuttall T, Prost C, Schulz B, Bizikova P. Treatment of the feline atopic syndrome – a systematic review. Veterinary Dermatology 32, 43-e8, 2021 Olivry T, DeBoer DJ, Favrot C, Jackson HA, Mueller RS, Nuttall T, Prélaud P. Treatment of canine atopic dermatitis: 2015 updated guidelines from the International Committee on Allergic Diseases of Animals (ICADA). BMC Veterinary Research 11, 1–15, 2015 l

This article was written as part of the requirements for receiving the Dechra/CAV "A week with ..." scholarship.

Supplements to improve intradermal lipid layer and skin barrier function in atopic dogs:

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

What is your diagnosis? THE ANSWERS… 1. Radiographic interpretation

In the right lateral abdominal radiograph, there is a reduction in serosal detail throughout the cranial abdomen, suspicious for a small effusion, but no convincing evidence of free peritoneal gas (Figure 2). Superimposed over the ventral aspect of the hepatic silhouette, the right of midline, there is a focal collection of innumerable small gas opacities, and extending away from this location on both projections, are multiple additional approximately linear gas opacities. On both projections, superimposed over the stomach, there is a large irregularly shaped mineral opaque foreign body which appears to be gravity-dependent, moving from the pylorus on the right lateral projection to the body region on the VD. The small intestinal tract is mildly uniformly gas-filled, however, there is no evidence of an obstructive pattern, and the large intestinal tract contains normal granular faecal material. The appearance of remaining abdominal organs are within normal limits. There is moderate-to-severe ventral vertebral spondylosis deformans at T13–L1 and L1–2 (incidental). Within the left thoracic wall, chronic fractures are identified within the proximal portion of ribs 8–13 (best appreciated on the VD projection) and within the distal portion of ribs 9 and 10 (visible on both projections).

2. Radiographic diagnoses

i. Focal accumulation of intrahepatic gas opacities within the right ventral liver, highly suspicious for either emphysematous cholecystitis or hepatic abscessation. ii. Mobile gastric foreign body which could be a cause of intermittent gastric outflow tract obstruction +/secondary gastritis. iii. Multiple chronic fractures secondary to previous trauma, which are unlikely to be of current clinical significance. iv. Spondylosis: most frequently is incidental, and less frequently IVDD.

3. Diagnostic steps

An abdominal ultrasound was performed (to further assess the abdomen given the findings above) to determine the exact location of the gas (gall bladder vs liver), assess other closely associated structures such as the pancreas, and to look for evidence of peritonitis. Further characterisation of the gastric wall and foreign body was also performed. The ultrasound revealed an abnormally distended gall bladder which exhibited severe diffuse hypoechoic wall thickening (Figure 3) and within the lumen there were numerous non-dependent echogenic interfaces which cast

Figure 2. Same abdominal radiographs as in Figure 1 showing collection of gas opacities overlying ventral hepatic silhouette (green circle), gastric foreign body (blue circle), ventral vertebral spondylosis deformans (red circle) and chronic rib fractures (yellow stars).

‘dirty’ distal acoustic shadows and reverberation artefacts, consistent with gas. Similar echogenic interfaces with associated distal acoustic shadowing were also evident

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

within the larger intrahepatic bile ducts of the right liver. The peripancreatic fat was severely hyperechoic with increased attenuation, which reduced visibility of the pancreas, however, the visible portions of the pancreas were enlarged with a heterogenous reduction in echogenicity. Within the gastric fundus there was a curved hyperechoic interface which cast hard distal acoustic shadows, consistent with the gastric foreign body identified radiographically. No free peritoneal fluid or gas was detected. Alternatively, an abdominal CT should be provided as an option however this can be limiting due to cost and availability.

et al. 2016). Clinical signs commonly associated with acute cholecystitis include vomiting, lethargy, and abdominal pain of varying severity. A diagnosis of EC can often be made on plain radiographs, which is typically seen as a spherical, gas-filled viscus or tracts in the region of the gall bladder (Avgeris and Hoskin 1992). Difficulty can arise from differentiating this from gas within the hepatic parenchyma so differentials should include liver lobe torsion, and hepatic abscess, which may be primary or secondary (e.g. neoplasia) in aetiology (Armstrong et al. 2000). Ultrasound guided percutaneous cholecystocentesis can provide a definitive diagnosis in these cases and provides samples for culture and susceptibility allowing appropriate antimicrobial therapy. Complication rates of cholecystocentesis have been reported to be around 2.7% which include bile peritonitis, systemic inflammatory response syndrome and acute kidney injury (Schiborra et al. 2017). Establishing an early diagnosis and implementing treatment in EC cases is important as the syndrome has a high mortality rate particularly when diagnosis and appropriate treatment is delayed. Initially therapy should be based on stabilisation with I/V fluid therapy followed by the addition of parenteral antibiotics that target Gram-negative and gas forming bacteria. Some cases may require cholecystectomy to prevent gall bladder rupture. While performing the cholecytectomy appropriate bile and hepatic parenchymal samples can be taken for culture and antimicrobial susceptibility testing.

Figure 3. Image from ultrasonographic examination of the gallbladder showing hypoechoic thickening of the gall bladder wall (between solid orange arrows) with gas foci within the gall bladder lumen (solid blue arrows).

Diagnoses

i. Acute emphysematous cholecystitis (EC) and cholangitis without evidence of biliary rupture or secondary peritonitis at this time. ii. Acute pancreatitis with regional steatitis. iii. Presumed, incidental, mobile gastric foreign body.

Treatment and outcome

The dog was placed on four-quadrant antibiotic treatment (amoxicillin/clavulanic acid, enrofloxacin, and metronidazole), and maintenance I/V fluid therapy. After initial improvement during the first 24 hours on fluid therapy and antibiotics, the dog rapidly deteriorated and euthanasia was elected.

Discussion

Emphysematous cholecystitis (EC) is a rare variant of acute cholecystitis and is characterised by gas present in the gallbladder lumen, wall or pericholecystic tissues (Armstrong et al. 2000). This gas producing variant of bacterial cholecystitis is typically associated with Clostridium spp. and Escherichia coli, and often accompanied by comorbidities like diabetes or immunosuppression (Armstrong et al. 2000; Tamborini

Using medical management alone without surgical intervention has been successful in both human and veterinary patients (Safwan and Penny 2016), but biliary tree rupture is reported in 30–60% of dogs with cholecystitis/cholangitis (Tamborini et al. 2016; Harrison et al. 2018). EC has been seen three times at VSA in the last 6 years, however unlike this case, these cases are diagnosed initially on ultrasound with radiographic findings appearing at a later stage of disease.

References

Tamborini A, Jahns H, McAllister H, Kent A, Harris B, Procoli F, Allenspach K, Hall EJ, Day MJ, Watson PJ, O'Neill EJ. Bacterial cholangitis, cholecystitis, or both in dogs. Journal of Veterinary Internal Medicine 30, 10 46–55, 2016 Armstrong JA, Taylor SM, Tryon KA, Porter CD. Emphysematous cholecystitis in a Siberian husky. Canadian Veterinary Journal 41, 60–2, 2000 Avgeris S, Hoskinson JJ. Emphysematous cholecystitis in a dog: A radiographic diagnosis. Journal of the American Animal Hospital Association 28, 344–6, 1992 Safwan M, Penny SM. Emphysematous cholecystitis: a deadly twist to a common disease. Journal of Diagnostic Medical Sonography 32, 131–7, 2016 Schiborra F, McConnell JF, Maddox TW. Percutaneous ultrasound-guided cholecystocentesis: complications and association of ultrasonographic findings with bile culture results. Journal of Small Animal Practice 58, 389–94, 2017 Harrison JL, Turkek BJ, Brown, Bradley C, Callahan Clark J. Cholangitis and cholangiohepatitis in dogs: a descriptive study of cases based on histopathologic diagnosis (2004–2014). Journal of Veterinary Internal Medicine 32, 172–80, 2018 l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Companion Animals NZ update David Lloyd, General Manager, Companion Animals New Zealand The team at Companion Animals New Zealand were very disappointed to hear of the postponement of the NZVA conference. We were looking forward to meeting you all at our trade table and so have eagerly committed to the 2022 event. Our recent pieces of work that may interest you or your workplace include:

1. Animal Behaviour and Training Accreditation

With the recent accreditation of the Association of Pet Dog Trainers NZ (APDTNZ) we are now gaining more interest in the scheme. The accreditations scheme is the culmination of years of work done by CAV, NZVA, NZVNA, SPCA, DogsNZ, Massey University and others, who all realised the risks posed to dogs because the animal training industry is unregulated. If you refer to animal trainers or behaviour consultants, please support this new scheme by referring to accredited trainers or pointing your favourite behaviour professional in our direction. The list of accredited professionals and a biography of each, is on our website (https:// www.companionanimals.nz/ canzaccreditedation).

2. Companion Animals New Zealand Conference

Over two mornings in October we held our biannual conference online. We had excellent speakers from the UK, Australia and New Zealand. The conference officially launched our focus on ‘A Good Life’ for animals (see Figure 1). The concept of A Good Life

Contact: https://www.companionanimals. nz/contact-us-

Figure 1. A good life for companion animals

is to encourage professionals and pet owners to start looking at proactively providing opportunities for positive emotions in animals. The event streaming was sponsored by EzyVet which meant that we could provide all content for free. Royal Canin sponsored our Life Stages session – four talks that focused on providing ‘A Good Life’ via breeding legislation (including licensing breeders), training, senior wellness testing and also at end of life. Other talks covered ‘A Good Life’ opportunities for cats, horses and shelter animals. All talks are free to view and share on our website (https://www. companionanimals.nz/conference).

3. Animal imagery guidelines

During 2021, we have had a couple of near misses with new designers using inappropriate animals in draft design documents. On one occasion they tried to use a Scottish fold cat in

an advert for us, and on another they slipped in a ferret! So we decided to create an Animal Imagery Guideline document to help the design team avoid embarrassing us. We quickly realised that we should be sharing and promoting these guidelines within the animal industry and even with mainstream media. You can find our guidelines on our website. If you are the social media manager for your own organisation, or see some unfortunate imagery in the media, feel free to refer to our document online. The guidelines will not be exhaustive, and we intend to add to them in the future. Our continued thanks to the companion animal veterinary staff working hard around the country. Special kudos to those veterinary teams who have been working under prolonged COVID restrictions this year and another special thanks to those clinical teams supporting animal rescues in your area. l

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Healthy Pets NZ update Cath Watson, Chair,

HPNZ also runs a Dogs’ Day Out event in Invercargill as an opportunity to share our research with the public and to help raise the awareness of what we do, along with raising some funds through public donations and exhibitors fees. While 2021 was the inaugural event and ended up being restricted by a Covid alert level change the night before, it was still a huge hit with the local community, and we’d love to take this event to other centres around New Zealand in the future.

Healthy Pets NZ

The next round of Healthy Pets New Zealand (HPNZ) grant applications closed on 1 November 2021, and it’s been great to see a good number of applications received, and from some new researchers on some great topics! Research is what allows us to make advancements in veterinary medicine. It expands our knowledge base, introduces new ideas, helps with problem solving and encourages curiosity. It can also improve our understanding of topics we think we are already well versed in. It can give us new diagnostics and treatments, but also help us use existing treatments in the best possible way. Research helps us separate fact from opinion. Our Mission at HPNZ is “to support the generation and distribution of knowledge about companion animal health and wellbeing in New Zealand. We achieve this through providing support for projects investigating companion animal health, informing veterinary professionals about industry developments, and through educating the public around advancements in veterinary medicine.” HPNZ has funded over 30 studies which have benefited the New Zealand veterinary community and the animals we treat. The topics have ranged from antimicrobial resistance; novel treatments for cancer and skin disease; the effectiveness of the NZVA hip and elbow dysplasia schemes; the FIV vaccine; the incidence of diseases like leptospirosis, canine leproid granuloma; hardware store solutions for fracture repairs; and many more.

[Photo credit: Noelle Rebekah for Unsplash]

HPNZ has three grant categories. Our Royal Canin-partnered Human-Animal Bond grant, which has seen a great response from researchers in this area since it was established late 2020. Our CAV-partnered Research in Practice grant has also seen a surge in interest in this latest round, which is particularly exciting to see. Our Discretionary grant has traditionally funded the majority of our research and continues to do so.

To keep doing all of this, we rely on your support. If you’d like to know more about us, head to www.healthypets.org. nz, or if you’d like to help HPNZ, contact us through healthypetsnz@gmail.com or call 027-222-8280. I look forward to hearing from you! l

All this research costs money, so HPNZ has to look to a number of avenues to help meet these costs. For starters, we have an awesome team of Trustees who volunteer their time to make HPNZ what it is. Secondly, we have awesome sponsors in Royal Canin and CAV and hope to announce a brand new partner very soon. Thirdly, we have some wonderful veterinary practices who choose to support us through donations. A big shout out to Tauranga Vets, Vet Marlborough and VetCo who have made recent donations.

Contact: http://healthypets.org.nz/

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

Odds and Ends

Shaggy dog stories – a New Zealand theme Boyd Jones, BVSc, FACVSc,

DECVIM-Ca

I am not sure the following can be classified as ‘shaggy’ but here are a few stories with a canine flavour.

The first dogs

The Polynesian dog (kuri) was introduced by the Polynesian ancestors of the Māori in the 13th century. The dogs were short-legged, yellow-brown, sometimes spotted and they howled rather than barked. They were sometimes pets and were also used for hunting nocturnal birds such as kiwi. They were good kai; Captain Cook was reported to have eaten kuri on his 1769 voyage, a time when kuri were plentiful. He reported a taste like lamb. Māori used their skin and fur in the making of cloaks (kahu kuri), poi and other decorative items. Kuri became extinct in the 1860s. Te Papa has a specimen (Figure 1) and some cloaks made with kuri fur.

the Border Collie especially. The NZ Huntaway was developed as a breed over many years based on a response to farming conditions in the high country.

The legend of Mackenzie and his dog

In 1855, James Mackenzie was discovered with a thousand sheep that he was accused of stealing with the help of his loyal Border Collie, ‘Friday’ (Figure 2). Mackenzie was captured, escaped, walked 100 miles to Lyttelton, and was captured again. He was tried, found guilty, and sentenced to hard labour. He escaped at least twice, was clapped in irons, and then pardoned in 1856. His exploits were admired by many of the locals, and his route through to the plains now known as the Mackenzie Country. There are poems and songs about Mackenzie and his dog, a legend. James Mackenzie was a Highland shepherd, born in Ross-shire, Scotland. He emigrated to Australia in 1845, and

Figure 1. Specimen of a kuri in the collection of Te Papa Tongarewa, Museum of New Zealand (LM000828).

[Image used under CC BY 4.0 (https:// creativecommons.org/licenses/by/4.0/)]

European breeds

From 1840, European settlers introduced a variety of dog breeds to New Zealand, the most notable being the variety of collie breeds for working with sheep, Contact: B.Jones@massey.ac.nz

Figure 2. A picture of Friday, James Mackenzie’s sheepdog, circa 1850s.

[Alexander Turnbull Library, Wellington, NZ; Ref: 1/2-007818-F]

2 years later arrived in New Zealand and earned a living by sheep driving, thus becoming acquainted with sheep stations in Otago and Canterbury. After residing for some time in the South Canterbury district, Mackenzie tracked northward into the interior on an exploring expedition, with his only companions his collie dog, Friday, and a bullock which carried his possessions and provisions. He discovered country to the north-west of Timaru which was new to pākehā. The Commissioner of Crown Lands in Otago gave him a licence ‘to occupy country bearing north-west from Timaru and midway between the sea and the west coast of the Middle Island.’ In order to stock this territory Mackenzie followed methods said to have been common enough at one time in his native Scotland – rustling/stealing sheep. He was a New Zealand Rob Roy. With the assistance of his dog, Mackenzie cut out a mob of sheep, which he then drove up the valley, over the pass, and down to the plains; that is, into the district now known as the Mackenzie Country. In the stolen mob was a black sheep which the overseer missed and then realised that more than a 1000 other sheep were missing too. With the help of a Māori lad he set forth to find the thief, which he did. There was an altercation and Mackenzie escaped. The authorities in Lyttleton were alerted and a reward was posted for Mackenzie by the owner of the sheep. Mackenzie, probably trying to escape the country, was arrested in Lyttleton. Mackenzie was, in due course, trialled in the Supreme Court. He remained stolid and silent and refused to plead. But during his trial his dog was brought into court; at once recognising her master, she wagged her tail and whined up towards Mackenzie, who was so overcome that he shed tears. The overseer identified the dog in court as the same he had seen guarding the sheep. Mackenzie was found guilty but

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

before being sentenced he begged, with tears in his eyes, that his dog might be allowed to accompany him to his prison. The request was not granted and Mackenzie was sentenced to 5 years’ penal servitude. Within the first year he escaped three times from custody, but was recaptured on each occasion. It was thought advisable, on account of the trouble and expense caused by his escapes and recaptures, that he should be acquitted and allowed to leave the country, under the proviso that he should not return.

and not sufficiently of the heather for her taste, or whether the work was too honest, I can't say, but she would work for no one.’

And what happened to Friday? I have found differing reports. One was that she was taken south, where for years afterwards her progeny were much sought after by runholders and shepherds. Another is that the dog remained with the stolen sheep and when the rightful owners came to retrieve them she protected them and drove them without her master’s control and was aggressive to anyone who came near, and was shot. There is the report from the overseer of the stolen sheep who said ‘he saw the dog with Inspector Pender in Christchurch (who kept it for a time and gave it to a runholder) – a low-set black slut, with tanned muzzle and feet. Friday was accustomed to be worked in Gaelic, and several run holders tried her on sheep in that language; but whether their Gaelic smacked too much of the tussock

In Tekapo, a statue recognises the role the border collie played in farming the high country of the South Island and is a tribute to Friday, one of the most famous of them (Figure 3).

Mackenzie and his dog have given a name to an area of our country and the last verse of one of the popular ballads makes that clear; But the men of the stations knowingly grin When they talk of John and his folly, And they've given a name to the Mackenzie Plain, In honour of the man, and his collie.

The Dog Tax Rebellion

The Dog Tax rebellion was a confrontation in the 1890s between the Crown and a group of Northern Māori led by Hōne Riiwi Tōia, who were opposed to the enforcement of a ‘dog tax’ (Figure 4).

Figure 4. “Strained relations; or 'dogged' resistance” an 1898 cartoon by Ashley Hunter shows a Māori man letting the Premier, RJ Seddon know what he thinks about the dog tax.

[First published in the New Zealand Graphic and Ladies Journal, 14 May 1898 and printed here with permission of the Alexander Turnbull Library, Wellington NZ; Ref: PUBL-0163-1898-001]

Figure 3. Statue at Tekapo to recognise the role of the Border Collie in high country farming.

[Photo credit: Mattinbgn (talkcontribs), CC BY 3.0 https://creativecommons.org/licenses/by/3.0, via Wikimedia Commons]

The Hokianga County Council had imposed a tax of 2/6d (half a crown) on each dog in the district. Many people, particularly in the South Hokianga, refused to pay – Māori had numerous dogs but lacked the money to register them and there were also other grievances between Māori and the Crown.

The Hokianga County Council served 40 summons at Pukemiro, Hōne Tōia’s village. Hōne Tōia advised the Council that they would not pay any taxes and ‘would die on account of the taxes’. They announced they would come from Pukemiro to Rawene, the administrative centre of the district, with their guns to continue the dispute with the council. There were threats on both sides and the escalation led to panic. When the war party, including Hōne Tōia appeared, ‘dressed for war’, many local residents withdrew, along with a small police detachment. Four days later a government force of 130 men arrived on two ships, armed with rifles, two field guns and two rapid fire guns. The sloop HMS Torch also arrived in support of government forces. The government forces advanced but other than some shots fired over the heads of the advancing troops there was no physical conflict; the troops were allowed to advance unmolested to set up camp at the Waimā school. Hōne Tōia and his war party camped nearby and there was potential for serious conflict. The situation was defused by the timely arrival of the Member of the House of Representative (MHR) for Northern Māori, Hōne Heke Ngāpua. He was the grand-nephew of the famous Hōne Heke. He met with Hōne Tōia and negotiated a truce and the surrender of Hōne, his people and some of their guns. Seventeen Māori were arrested and 25 guns were seized. Hōne Heke Ngāpua tried to negotiate with the government for the acquittal of all those arrested but without success. At the Supreme Court hearing all changed their plea to guilty on all charges except the first charge of forming an intention to levy war, which was withdrawn. The first five defendants, four of whom were judged to be the leaders of the rebellion, were sentenced to 2½ years hard labour. The others were fined £10, and required to keep the peace and be of good behaviour for 12 calendar months. Some of these sentences were shortened or remitted. So ended the dog tax rebellion. It is still remembered in the North and the Auckland Central Library had an excellent exhibition about the rebellion

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

a few years ago. At my calculation the dog tax of 2/6d was equivalent to approximately $66 today. The other twist to this tale is that Hōne Heke Ngāpua, the MP who averted a full-on confrontation and negotiated the truce was absent from the House when it was sitting and was therefore ineligible to be paid during his absence – some reward.

Dog – from Footrot Flats

‘Dog’ is familiar to all Kiwis as one of the characters in ‘Footrot Flats’, the comic strip by cartoonist Murray Ball which ran for 20 years from 1976 to 1996 in local newspapers. There are now multiple books with collections of the cartoons (millions of copies sold), a stage musical, a feature film ‘Footrot Flats: The Dogs Tale’ and a theme park in Auckland. Dog, a border collie (Figure 5), is the lead character along with his master, Wal Footrot, and many other characters who have trials, tribulations and other experiences in Raupo, a NZ farming community. Dog is an active, tough, even brave, working dog but he has a soft streak. He works for Wal in all manner of farming duties including eradication of rats and pigs, he likes rabbits and dislikes trees being cut down. He likes his boss Wal and follows his many different sporting activities. He is an impediment to Wal’s success in dates with Darlene ‘Cheeky’ Hobson which often end in disaster.

– Horse had to be tranquilised for the visit. Dog does not trust him even when tranquilised. Dog also has to stop Wal kissing ‘Cheeky’ by pushing them apart…his thoughts are that she could be infectious with hydatids as he hasn’t seen her at the dog dosing strip. Wal’s kiss is spoiled. From a dog’s point of view the understanding of the life cycle could be correct? He must have been to the strip! All through the years Dog remains active and does not age: running, jumping, riding farm bikes, surviving many accidents and run-ins with Horse and other animals. He participates in many of Wal’s sporting activities. After such an active life I would have expected some arthritis, ligament damage and general bodily wear and tear! No visits to the vet or evidence of a bottle of NSAIDs or neutraceutical tablets anywhere! Maybe he prefers to eat sheep guts and lambs’ tails rather than commercial food containing green lipped muscle extract. Oh well, he is ageless and maybe the most famous border collie in NZ, ever (Figure 6).

Figure 6. Statue of Dog and Wal in Gisborne.

[Photo credit: David Thomsen, CC BY-SA 4.0, https://creativecommons.org/licenses/by-sa/4.0, via Wikimedia Commons]

Figure 5. Dog from Footrot Flats.

[Image re-printed with permission of the Murray Ball Estate]

Dog and his antics are famous …… while I am writing this I am humming Dave Dobbin’s ‘Slice of Heaven’. I have not read all the cartoon books but the many I have seen have little reference to veterinary care. Did Dog get vaccinated? Aunt Dolly does take his sworn enemy, ‘Horse’ the cat, to the vet with a wound on his nose (?squamous cell carcinoma?)

Hairy and his friends in adventures where they meet local dogs and cats especially the tom cat ‘Scarface Claw’, Hairy’s arch enemy and clever opponent. The books now have a worldwide readership and Lynley Dodds is famous. Designed to be read to children by an adult and written in rhythmic verse which appeals to young children, the books are fun for all. I enjoyed reading them to my grandchildren. The illustrations for each page are scenes that are recognisable and could be anywhere in NZ – Hairy Mclary and his friends are doing what dogs do! ‘Schnitzel von Krumm with a very low tum, Bitzer Maloney all skinny and bony, Muffin McLay like a bundle of hay, Bottomley Potts covered in spots, Hercules Morse as big as a horse and Hairy Maclary from Donaldson’s Dairy’ If you visit Tauranga you can see and enjoy the stunning life-sized sculptures of all the characters from the Hairy Mclary books, created by Brigitte Wuest (Figure 7). There is a storybook scene of permanent bronze sculptures of Hairy Maclary and some of his friends – Scarface Claw, Slinky Malinki, Hercules Morse, Muffin McLay, Bottomley Potts, Schnitzel von Krumm, Bitzer Maloney and Zachary Quack. The larger-thanlife public art display on the Tauranga waterfront allows kids of all ages to get up close to these familiar characters of the children’s book world. Pay a visit to Tauranga! l

Hairy Maclary

Children of my generation and that of my own children were raised without knowledge or the delight of reading the adventures of ‘Hairy Maclary from Donaldson’s Dairy’. First published in 1983, this book by New Zealand author Lynley Dodd was followed by a series featuring the terrier Hairy Maclary. His adventures are in the company of friends who include Dachshund ‘Schnitzel von Krumm’, Dalmatian ‘Bottomley Potts’, an Old English Sheepdog, ‘Muffin McClay’ and others. The stories usually involve

Figure 7. Statue of Lynley Dodd’s Hairy Maclary characters by Brigitte Wuest on the waterfront in Tauranga.

[Photo credit: Mike Gieseg]

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

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.

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 32 No 4 | December 2021

Executive Committee Members of the NZVA Companion Animal Veterinarians Branch President Natalie, Companion Animal Veterinary Advisor, Zoetis NZ, Wellington I have been a companion animal practitioner for over 20 years with a strong interest in feline medicine, preventative health care and veterinary wellbeing. I joined the team at Zoetis in 2018 after selling my practice in Wellington. I enjoy the opportunities my role provides, meeting companion animal veterinarians across New Zealand, talking to them about the issues they face on a day to day basis, and learning where CAV can focus our member support in the most valuable way. Additional roles: Member of WSAVA Congress Steering Committee Vice-president Simon Clark, Veterinarian at Hamilton Small Animal Veterinary Centre I grew up in suburban Auckland with a love of science. At high school I got a job cleaning the cattery at my local vet clinic and I’ve been in the industry ever since. I quickly found the application of science to immediate family situations fascinating. I continue to love the application of the most up-to-date science to help families. Additional roles: Treasurer and Trustee Healthy Pets NZ, Treasurer Waikato RN Treasurer Kevanne McGlade: community veterinarian, Massey University I work as a companion animal veterinarian in the Community Practice small animal clinic at Massey University’s Täwharau Ora – School of Veterinary Science in Palmerston North. Each year our final year students spend a number of weeks in the clinic. My role is to support and guide them as they take on the role of a veterinarian, conducting first opinion consultations and performing procedures to equip them for practice after graduating. Alison Pickering, Locum Veterinarian, all-over-NZ I am a 1996 Massey graduate currently working as a locum as I travel and house sit around New Zealand. My interests include feline medicine and behaviour – I am a huge fan of the Cat Friendly Clinic initiative. I am also interested in the field of veterinary telehealth, providing clients access to remote triage and advice as a way of supporting and extending existing clinics services. Nina Field, Veterinarian, Evolution Vets and Animal Rehabilitation, Ashburton I've been a vet for a long, long time. Eight years ago I got my certification for canine rehabilitation so have been working as a 'physio' alongside first opinion clinical practice since then. I've been on the CAV committee for 4 years now and really enjoy working and making plans with such a motivated, stimulating team. Additional roles: CAV representative on NZ Companion Animal Trust Shanaka Sarathchandra, Clinical Lead Veterinarian, Pet Doctors Hamilton I am a 2004 Massey graduate working in companion animal practice in Hamilton. I have a special interest in imaging and medicine. I am looking forward to being more involved in the veterinary community.

Sally Aitken, Lead Companion Animal Veterinarian, VetEnt Turangi Community veterinary work is my passion; caring for animals through their life-stages. I grew up in Greymouth, worked 26 years in Taupo in mixed and CA practice and am now based in Turangi providing companion animal community veterinary care with VetEnt. Continuing education, ANZCVS, avian medicine, dermatology and internal medicine are my other vet passions, along with mountain-biking, tramping and raising two fantastic teenagers with my husband here in Taupo. Toni Anns, National Sales and Key Account Manager for Companion Animals, Zoetis NZ, Auckland I have been a member of the CAV executive committee since 2016. I currently work for Zoetis as the National Sales and Key Account Manager for Companion Animals. In this role I am very privileged to be able to meet and talk with many veterinary professionals. I listen to the trials and tribulations, the challenges, the joy and the angst of veterinary life and I want to help in whichever way I can. Ultimately, I would love to see elevation in the reputation of this industry and improved collaboration both nationwide and internationally. My ultimate goal is to help improve the personal satisfaction at the end of each veterinary professional’s day. Becky Murphy, Canine Health & Welfare Vet, Dogs NZ, and owner of TCI Glenbred, Feilding I am a 2010 graduate from Massey University. My practice, TCI GlenBred is devoted to canine inherited disease screening and theriogenology. I have been the Dogs NZ (NZKC) Veterinarian since 2016 and a member of the CAV Committee since 2018. I enjoy working with dog breeders and veterinarians to promote and improve genetic health, particularly in pedigree dogs. Outside of work, my husband and I have two children, one dog, two cats, two bunnies and a very naughty pony, which keeps us very busy! Additional roles: Member of WSAVA Hereditary Disease Committee

Ex officio members Lorelle Barrett, NZVA Veterinary Manager–Companion Animal I have been NZVA’s veterinary manager for companion animals since 2019. In addition to helping NZVA members with queries, I work alongside CAV on their key projects, talking to other CA stakeholders and helping develop NZVA policies/messaging on important CA and professional issues. I’ve explored a few aspects of the veterinary profession, from mixed practice as a new graduate, companion animal locum in the UK, a Masters and then PhD in animal welfare science, and a brief stint teaching animal care and management. I enjoy my NZVA role because it combines my clinical experience with my love of research and writing, and it’s great when I know that our support and advice has made a member’s day easier. Sarah Fowler, Editor – Companion Quarterly (and NZVJ), Hamilton I have been the editor of Companion Quarterly (previously CAS Newsletter) since 2013. I am a 2010 Massey graduate (after a starter career as a plant scientist) and worked in clinical CA practice before starting in 2016 as an assistant editor at the NZVJ. I am now editor-in-chief of NZVJ and I am stoked to have found a niche in veterinary publishing that allows me to use my previous scientific training and my veterinary qualifications. Producing Companion Quarterly as a high quality source of CPD for CA vets in NZ gives me a great deal of satisfaction.

Companion Quarterly: Official Newsletter of the Companion Animal Veterinarians Branch of the NZVA | Volume 32 No 4 | December 2021

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 32, No. 4 | December 2021

VOLUME 32 NO 4 December 2021

The puppy vaccination dilemma

Socialisation for puppies

Treatment of pyoderma in dogs: a clinical study of totarol products

New treatments for FIP

Transcatheter occlusion of PDA in a puppy