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From science to solutions in veterinary care
Informed consent: What exactly do I need to disclose?
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Contents
Volume 1 | No. 3 EDITORIAL EDITOR: René Bosman René.Bosman@media24.com SUB EDITOR: Gill Abrahams LAYOUT & DESIGN: Allison McCallum ADVERTISING KEY ACCOUNT MANAGER Cindy Riederer | 082 492 0229 Cindy.Riederer@media24.com DISTRIBUTION & SUBSCRIPTIONS Rae Morrison Rae.Morrison@media24.com PUBLISHING TEAM General Manager: Dev Naidoo Head of Content & Digital Strategy: Varushka Padayachi Production Manager: Angela Silver Group Art Director: David Kyslinger MEDIA24 MEDIA CEO: Minette Ferreira CFO: Luxolo Dywili MEDIA24 CORPORATE CEO MEDIA24: Raj Lalbahadur CFO MEDIA24: Nelmarie Beyers B2B JOHANNESBURG OFFICE Building 13, The Woodlands Office Park, 20 Woodlands Drive, Woodmead, Sandton PO Box 784698, Sandton 2146 Tel: +27 11 867 6111 Published by Media24 B2B www.medicalacademic.co.za PRINTING Printed by Novus Print, Cape Town Cover photograph: Getty Images/GlobalP
Unless previously agreed in writing, Vet’s Hub owns all rights to all contributions, whether image or text. SOURCES: Getty Images, supplied images, editorial staff. While precautions have been taken to ensure the accuracy of its contents and information given to readers, neither the editor, publisher, or its agents can accept responsibility for damages or injury which may arise therefrom. All rights reserved. © Vet’s Hub. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, photocopying, electronic, mechanical or otherwise without the prior written permission of the copyright owners.
Disclaimer: Please take note that the products featured in this journal are available in South Africa. Products may be marketed under a different name or might not be registered in your country. For more information, contact your local representative. All content in Vet’s Hub is sourced independently and under no circumstances should articles be considered promotional unless specified with a postscript. Articles are created with the assistance of artificial intelligence (AI) tools to aid in research and drafting. The content has been reviewed and edited by a human expert for quality and reliability. Please note that all advertising is intended for healthcare professionals only.
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Editor’s note: From burnout to biodiversity: Connecting care across every level
News: Burnout among veterinarians: Understanding the crisis and strategies to cope Vet’s Nursing Corner: Key domains of veterinary nurse contributions Medicolegal: Informed consent: What exactly do I need to disclose?
Practice Management: What you need to consider when running a successful veterinary practice – Part 2 Health awareness: Not just old bones: Rethinking canine osteoarthritis
Infectious diseases: Rabies: A preventable but persistent global threat Companion animals: Treating inflammation first: Are we rethinking canine otitis externa?
Nutrition of ageing cats: Understanding the unique needs of senior felines Cat-astrophe averted: Evidence-based diabetes management in cats CPD activity: Protecting kidney function in cats: Preserving companionship from diagnosis to longevity
Livestock: Itchy horses? Solutions beyond the scratches Spring flush syndrome in cattle: Managing the risks of rapid pasture transition
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Wildside: South Africa’s biodiversity plan puts farms, livelihoods and nature at the centre
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Vet’s Hub
Editor’s Note
Volume 1 | No. 3
From burnout to biodiversity: Connecting care across every level
Welcome to issue 3 of Vet’s Hub, where we explore veterinary medicine beyond the consulting room. This edition spans the wellbeing of veterinary professionals, advances in clinical practice, effective practice management, One Health and the broader role of the profession in protecting biodiversity. The mental wellbeing of the veterinary profession: Burnout
accurate staging and nutritional intervention to preserve kidney
is not a personal weakness but a recognised occupational risk
function and improve quality of life.
affecting veterinarians worldwide. In this issue, we examine
Marking Itchy Pet Awareness Month, we examine allergic skin
the factors driving burnout and explore practical strategies to
disease in horses, exploring the latest understanding of insect
help veterinary professionals build resilience and safeguard
bite hypersensitivity and equine atopic dermatitis. Advances in
their wellbeing.
veterinary dermatology continue to improve our understanding
Veterinary medicine has always been a team effort, and
of the complex interactions between genetics, immune function
veterinary nurses are central to that success. Their contribution
and skin barrier integrity, enabling more targeted, evidence-based
extends well beyond clinical support to infection prevention,
treatment strategies.
antimicrobial stewardship, public education, disaster response
Prevention remains a recurring theme throughout this
and animal welfare. Together, veterinarians and veterinary
issue. As World Rabies Awareness Day approaches, we revisit
nurses embody the principles of One Health, recognising the
one of the world’s most preventable, yet persistent zoonotic
interconnected health of animals, people and the environment.
diseases and the collective responsibility required to eliminate
Outstanding veterinary care depends not only on clinical
human deaths.
expertise but also on communication, leadership and efficient
Finally, we broaden our perspective to South Africa’s
practice management. In our Medicolegal feature, Dr Cornelia
remarkable natural heritage. The draft National Biodiversity
Els reminds us that informed consent is far more than a
Strategy and Action Plan reminds us that conservation extends
signed document – it is an ongoing conversation built on trust,
well beyond protected areas, recognising biodiversity as living
transparency and shared decision-making.
infrastructure that supports healthy ecosystems, resilient
Marianne van Wyk continues her practice management series, highlighting how exceptional patient care, outstanding client
communities and sustainable livelihoods. Whether your passion lies in companion animals, equine
service and effective stock control form the foundations of a
practice, livestock, wildlife or practice leadership, we hope
successful veterinary practice.
this edition provides practical insights, fresh perspectives and
This issue also brings together a diverse range of clinical
inspiration for your daily work. Thank you for being part of the
topics across companion animals and equine medicine. Dr
Vet’s Hub community. We hope these pages leave you better
Myra Rose Marais explores evidence-based management of
informed, better connected
canine otitis externa, questioning whether every case requires
and ready to embrace
antibiotic or antifungal therapy and reinforcing the importance of
the opportunities and
antimicrobial stewardship.
challenges ahead. U
Dr Angeliki Kaldelis summarises the latest Royal Canin Veterinary Academy insights into the changing nutritional needs of ageing cats, while we examine the latest International Cat Care consensus guideline on feline diabetes, emphasising early diagnosis, structured management and long-term caregiver engagement. We also revisit highlights from our inaugural CPD-accredited Vet’s Hub webinar, where Dr Melanie Wergin discussed chronic kidney disease, underscoring the importance of early detection,
Renè Bosman
Writer & Editor
Vet’s Hub
News
Volume 1 | No. 3
Burnout among veterinarians The veterinary profession faces a critical challenge: Burnout. Long hours, emotional strain, financial pressures, and difficult client interactions contribute to stress and drive veterinary professionals from the field. This harms not only their well-being but also patient care and workplace morale. Research highlights the concerning mental state of veterinarians, with studies finding high rates of burnout, compassion fatigue, and burden transfer (stress from client challenges). Early-career and female veterinarians are most vulnerable. Several studies explore interventions to improve veterinary well-being.1 Burnout is not simply feeling tired or stressed at the end of
The consequences extend beyond the individual. Burnout is
a long shift – it is a psychological syndrome rooted in prolonged
strongly associated with increased rates of depression, anxiety,
exposure to chronic interpersonal job stressors. It is characterised
compassion fatigue, and suicide risk. In a study of practising
by three distinct and measurable dimensions: Exhaustion,
veterinarians in Spain, 36.9% were classified as experiencing
cynicism, and reduced professional efficacy. 2
high emotional exhaustion, 33.3% as high in cynicism, and 19.8%
Exhaustion reflects the overwhelming depletion of physical and
reported a formal diagnosis of anxiety or depression.4 A further
emotional energy. Cynicism – sometimes called depersonalisation
31.9% felt they needed professional mental health treatment but had
or disengagement – describes a detached, negative, or indifferent
not been diagnosed – suggesting a significant gap between need
attitude toward work, colleagues, and patients.2
and access. Concerningly, 19.1% reported using benzodiazepines,
Reduced professional efficacy refers to a growing sense of incompetence and failure to achieve meaningful outcomes. Importantly, burnout is not synonymous with depression, though
with ~50% doing so without a prescription, underscoring the depth of untreated psychological distress in the profession.4 The suicide risk among veterinarians is particularly sobering. In
the two are closely interrelated and can mutually reinforce one
the United States, veterinarians die by suicide at a rate 3.9 times
another. Burnout is fundamentally situational and occupational
higher than the general population, while British veterinarians face
in nature, arising from structural mismatches between a worker
~4 times the national average suicide rate. Female veterinarians in
and their work environment rather than from individual character
the United States face a 3.4-fold increased risk compared to the
weakness or personal failing. 2
general female population. The ready availability of euthanasia
These structural mismatches are best understood through the Areas of Worklife model, which identifies six key domains in which
drugs is a compounding factor, increasing suicide risk fourfold in this professional group. 3
imbalance drives burnout: Workload, control, reward, community, fairness, and values. When chronic demands outpace available
Who is most at risk?
resources – as is common in veterinary practice – the resulting
Not all veterinary professionals are equally vulnerable. Research
resource loss creates a cascade of exhaustion, disengagement,
consistently identifies early-career veterinarians and female
and ultimately departure from the profession.
practitioners as the groups at greatest risk of burnout and
2
Social relationships at work play a particularly critical role. Burnout is contagious, spreading through teams when left
its consequences.4 In the Spanish study of registered veterinarians, younger
unaddressed, and poor supervisory support, unresolved conflict,
practitioners and those with one- to 10- years of professional
and workplace incivility all significantly accelerate its progression. 2
experience reported significantly higher levels of emotional exhaustion and cynicism. Those with >10-years of experience
The scale of the crisis in veterinary medicine
reported greater professional efficacy and higher self-compassion –
The data on burnout in veterinary medicine is alarming. About 49%
psychological vulnerability that warrants targeted support.4
suggesting that the early career period is a window of particular
of American veterinarians report high burnout, while 86% of British
Female veterinarians consistently face higher burnout scores
veterinary professionals reported emotional exhaustion in a 2021
across multiple domains. In the Spanish sample – where 72.3% of
survey. In Australia, 61% of veterinarians scored high on validated
respondents were female, reflecting the increasingly feminised nature
burnout measures, and among American small-animal practitioners –
of the profession – women showed higher exhaustion and cynicism
a group with particularly heavy exposure to euthanasia decisions and
tendencies and lower self-compassion on several subscales.3
emotionally distressed clients – the figure reaches 74%.3 Veterinary students and interns are equally at risk: 70% of
Heavy student debt, which averages ~R2.5m (US$150 000) for new graduates in the United States and is associated with
American veterinary students reported burnout symptoms in
2.5 times greater stress in early-career veterinarians, further
2023, and 77% of American veterinary interns reported burnout
compounds this burden. Rural practitioners, equine and zoo
before graduation. These are not isolated or regional findings,
veterinarians, and veterinary technicians also face an increased
burnout rates consistently fall between 55% and 74% across roles,
risk, reflecting the diverse and often isolated conditions in which
specialties, and countries worldwide.
many veterinary professionals work.3
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Vet’s Hub
News
The protective role of self-compassion Emerging evidence points to self-compassion as a significant and measurable protective factor against burnout. Self-compassion encompasses three interlocking elements: Self-kindness (treating oneself with the same care one would offer a friend in distress), common humanity (recognising that suffering and imperfection are universal rather than isolating experiences), and mindfulness (observing distressing thoughts without over-identification or suppression).4 In the Spanish veterinary study, self-compassion showed a strong inverse correlation with emotional exhaustion (Spearman’s p = −0.567) and a significant negative correlation with cynicism (p = −0.368), confirming its role as a meaningful buffer against the core dimensions of burnout.4 Veterinarians with lower self-compassion were more likely to engage in self-judgment, feel isolated in their struggles, and over-identify with workrelated failures – all of which accelerate the burnout trajectory. Perfectionism, common among high-achieving professionals, acts as a particular vulnerability, as it undermines the self-kindness component of self-compassion and drives individuals toward unsustainable standards.4 Critically, self-compassion is not a fixed trait. It can be cultivated through deliberate practice, making it a viable target for both personal development and structured
Volume 1 | No. 3
100 practices and reduced staff turnover by 28%, while Employee Assistance Programme access within US veterinary school programmes achieved a 45% reduction in student burnout.3 The evidence also supports addressing access-to-means risk, particularly the availability of euthanasia drugs. Strengthening safe storage protocols and offering structured debriefing after ethically traumatic events – such as difficult euthanasias or highconflict client interactions – can meaningfully reduce both acute and cumulative psychological harm. These provisions should be standard components of workplace safety planning in veterinary settings.2,3
Building a culture of wellbeing in veterinary practice Perhaps the most important systemic shift required is cultural. Burnout thrives in environments where help-seeking is stigmatised, suffering is normalised as an inevitable professional rite of passage, and workload concerns are dismissed as individual weakness rather than systemic failures. Changing this requires visible leadership commitment to mental health, routine and non-judgemental checkins, anti-stigma campaigns, and the explicit integration of wellbeing metrics into practice performance standards.2 Veterinary education must also take greater responsibility for equipping students and graduates with the psychological tools
wellness interventions in veterinary education and workplaces.4
they need before they reach crisis point. This means embedding
Strategies for coping: Individual and organisational interventions
skills into veterinary curricula – rather than treating them as
Addressing burnout effectively requires a dual approach: supporting the individual while simultaneously reforming the structural conditions that create and sustain burnout. Individuallevel strategies are valuable and measurable. 2 Mindfulness and resilience training have demonstrated significant outcomes in veterinary populations. A United Kingdom Royal College of Veterinary Surgeons mindfulness pilot involving 500 veterinarians lowered depression scores by 35%, and resilience workshops in New Zealand reached 1200 participants and reduced suicidal ideation by 22%.3 Peer support programmes are equally promising – the Not One More Vet initiative in the United States has reached >15 000 veterinarians and reported a 55% improvement in wellbeing scores among participants. Digital tools and wellness applications have also demonstrated utility, with 78% of veterinarians using mindfulness-based apps reporting meaningful reductions in stress.3 At the organisational level – which research argues must take priority, given that burnout is primarily a situational and systemic phenomenon – the most impactful interventions target root causes directly. These include workload reduction, enforcement of reasonable working hours, improved staffing ratios, streamlined administrative burden, equitable reward structures, and clear confidential pathways for reporting distress without career penalty.3 The American Veterinary Medical Association wellbeing programme, in which 63% of participating practitioners reduced burnout levels by 25%, demonstrates the scalability of structured workplace wellness investment. Canadian wellness grants funded
self-compassion training, mental health literacy, and wellness afterthoughts or optional extras.4 Universities and professional bodies should develop clear, accessible psychological support services and ensure that early-career veterinarians – the most vulnerable group – are proactively connected to these resources from the moment they enter the profession.4
Conclusion Burnout among veterinarians is a systemic crisis with serious individual, professional, and public health consequences. It is not inevitable, and it is not the result of personal weakness. It arises from sustained structural mismatches between the exceptional demands of veterinary work and the resources, support, and recognition available to those who perform it. Addressing it effectively requires honest acknowledgement of the scale of the problem, sustained investment in both individual coping strategies and organisational reform, and a cultural shift that places veterinary wellbeing at the centre – not the periphery – of professional practice.
Help at hand The South African Veterinary Association’s Stress Management Hotline is available to support members experiencing personal or emotional challenges by providing access to professional counselling and advice. The hotline offers compassionate support for issues such as anxiety, depression, anger, grief, loneliness, and fear, and can assist with referrals to appropriate professionals when additional care or guidance is needed. To find out more, go to https://www.sava.co.za/sava-stress-management-hotline/ References available on request. U
FUEL EXTRAORDINARY
HIGH-QUALITY ANIMAL PROTEINS TO SUPPORT LEAN MUSCLE MASS Reg. No. V15465, V15467, V23641. (Act 36/1947)
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Vet’s Hub
Vet’s Nursing Corner
Volume 1 | No. 3
Key domains of veterinary nurse contributions The image of the veterinary nurse as a behind-the-scenes assistant – handing instruments to the veterinarian, comforting anxious animals in the waiting room, updating patient records – is giving way to something far more expansive. Across Europe and globally, veterinary nurses are increasingly recognised as frontline actors in the protection of human, animal, and environmental health. Their evolving role positions them not merely as clinical support staff, but as essential contributors to what is now widely referred to as the One Health framework: The recognition that the health of people, animals, and the planet are inextricably linked.
For much of it s history, veterinary nursing has been practised
matured considerably. University-trained veterinary nurses –
in the shadow of the veterinary profession – essential in practice,
as distinct from those trained through shorter vocational
invisible in policy. That is changing. Driven by the growing
programmes – now graduate with competencies that include
complexity of animal care, the rising prominence of zoonotic
infection prevention, biosecurity planning, zoonosis surveillance,
disease, antimicrobial resistance, and climate-related health
behavioural medicine, and client education in public health. They
threats, veterinary nurses have assumed responsibilities that
are, the authors argue, among the most underrecognised assets
extend well beyond the consulting room.
in the global health system.
A landmark European perspective paper by Ferrinho et al substantive contributions to One Health, spanning infection
Infection control and antimicrobial stewardship
control, antimicrobial stewardship, animal welfare, disaster
Among the most clinically critical of their evolving responsibilities
response, public education, environmental monitoring, and more.
is the role veterinary nurses play in infection prevention and
identified 10 distinct domains in which veterinary nurses make
This breadth of contribution reflects a profession that has
control (IPC). In practice settings, they implement and monitor IPC protocols, advise on biosecurity measures, and educate both clients and colleagues on the risks of zoonotic transmission. Their proximity to animals – and to the people who own them – makes them natural sentinels for the early detection of unusual illness patterns that may signal emerging infectious threats. Closely related is their growing role in antimicrobial stewardship (AMS). Veterinary nurses administer antibiotics, monitor treatment compliance, educate owners on appropriate antimicrobial use, and advise on the safe disposal of medications to prevent environmental contamination. In doing so, they sit at the intersection of clinical care and public health in one of the most pressing global health challenges of our time:
Vet’s Hub
Vet’s Nursing Corner
Volume 1 | No. 3
The increase of antimicrobial resistance. Despite this, systematic
gaps in many training programmes, with insufficient coverage of
inclusion of veterinary nurses in national AMS frameworks
zoonoses, biosecurity, public health, and behavioural science. In
remains limited – a gap that the authors identify as a significant
addition, structured career pathways to specialisation – typically
missed opportunity.
available only after four to six years of practice – exist in some systems but are far from universal.
Welfare, behaviour, and safeguarding The expanding scope of veterinary nursing also encompasses animal welfare and behavioural medicine. Veterinary nurses increasingly conduct behavioural assessments, identify early warning signs of distress or aggression, and implement welfarefocused interventions that prevent abandonment, reduce community risk, and improve quality of life for animals and their owners alike. This is not incidental to their clinical role – it is central to it, as behavioural problems represent one of the most common reasons animals are relinquished or euthanased. Perhaps less expected, but equally important, is the safeguarding dimension of veterinary nursing. Research has
Veterinary nurses are essential contributors to the One Health framework – the recognition that the health of people, animals, and the planet are inextricably linked.” – Ferrinho et al. (One Health, 2025)
established strong links between animal abuse and domestic violence – a phenomenon sometimes called the ‘link’. Veterinary nurses, through their regular and trusted contact with pet owners,
The path forward
are well positioned to identify unexplained or recurrent injuries in
Ferrinho et al’s central argument is both clear and urgent:
animals that may signal abuse in the household.
veterinary nurses must be formally recognised, better educated, and meaningfully integrated into One Health policy and practice
Disaster response and community resilience
if the global health community is to respond effectively to
In an era of increasing climate instability, the disaster response
resistance, climate change, and food insecurity.
the interconnected threats of zoonotic disease, antimicrobial
capabilities of veterinary nurses have taken on new urgency.
This will require harmonised education standards across
During floods, earthquakes, pandemics, and other crises,
countries, legally defined scopes of practice, inclusion in national
veterinary nurses contribute to triage, sheltering, and the
and regional AMS and surveillance frameworks, and stronger
reunification of displaced animals with their owners. They help
professional representation in policy forums.
maintain the health of livestock on which communities depend
Professional bodies such as the British Veterinary Nursing
for food and economic stability, and they provide practical and
Association and the European Veterinary Nurses and Technicians
psychosocial support for families whose animals are central to
Association have made important strides in advocacy, but
their livelihoods and wellbeing.
formal inclusion of veterinary nurses in decision-making
This capacity for community resilience extends also to
processes – in outbreak preparedness, public health policy, and
environmental health monitoring. Veterinary nurses who work
education reform – remains insufficient. Investment in research to
with livestock, wildlife, or food-producing animals are positioned
systematically document the contributions of veterinary nurses
to recognise and report environmental hazards – contaminated
will be essential to sustain the case for their integration.
water sources, vector risk, the effects of heat stress – and to collect samples that support broader surveillance. As climate
Conclusion
change continues to alter the distribution of disease vectors
The role of the veterinary nurse is no longer – if it ever truly was –
and the vulnerability of both animal and human populations, this
confined to the clinic. It extends into communities, households,
environmental intelligence function grows ever more important.
food systems, emergency shelters, and the environmental monitoring networks on which early disease detection depends.
An uneven landscape: education and regulation
University-trained veterinary nurses are, as Ferrinho and
Despite the breadth and importance of their contributions, the
One Health actors working today. Realising their full potential will
profession of veterinary nursing remains strikingly uneven in its
require systemic changes to education, regulation, and policy.
recognition and structure across the globe. This heterogeneity
The rewards, in terms of improved health outcomes for animals,
has real consequences. Where legal recognition is absent or
humans, and the environment alike, will be substantial.
colleagues compellingly argue, among the most underrecognised
poorly defined, veterinary nurses are confined to subordinate technical roles, limiting their ability to contribute meaningfully to
Reference
public health, surveillance, or policy processes.
Ferrinho R, Afonso AM, Ferrinho P. Veterinary nurses at the forefront of one health: European perspectives. One Health, 2025. U
These structural constraints are compounded by curricular
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Medicolegal
Volume 1 | No. 3
Dr Cornelia Els, Consultant, Veterinary Defence Association
Informed consent:
What exactly do I need to disclose?
Did the client really understand what they agreed to? It is a question that comes up in almost every complaint file that crosses my desk – and it is rarely about whether consent was obtained. It’s about whether it was informed. Informed consent is not a form. It is not a signature. It is a conversation, and if that conversation did not happen properly, the signature at the bottom of the page wouldn’t save you.
It is 7h30, and the waiting room is full. Bella, a nine-year-
A rough number given in passing, and a treatment decision made
old Yorkie, is dropped off for her third dental in three years by
mid-procedure on the vet’s own judgment, both skip the one thing
her owner’s wife – she practically knows the drill by now. The
that actually matters – telling the client and letting them decide.
receptionist checks her in, pulls up last year’s consent form,
Variations on this theme show up constantly. Rosie’s owner
updates the date, and has her sign before rushing off to work. The
could not be reached when the vet found a mass far worse than
vet, mid-consult with another patient, glances at the form on the
the scans suggested and had to decide alone whether to proceed.
way to theatre. It looks the same as always, so she does not stop
Tumble’s family expected a full recovery and got a permanent
to check it.
head tilt instead – a ‘successful’ surgery that did not look like what
By the time Bella’s dental is done that afternoon, she
they had pictured. Duke’s owner had her phone off in a meeting.
has developed a jaw fracture during extraction – rare, but not
The practice tried her three times over twenty minutes before the
impossible in a small-breed dog with advanced periodontal
vet made the call alone, in theatre, and Duke never woke up.
disease. Her owner’s husband, collecting her that evening, is
It is the same pattern in almost every consent complaint that
furious: Nobody told him this could happen. The vet is confident
crosses my desk: Decisions made for the client instead of with
it was mentioned ‘last time’. But the consent form says nothing
them, and a gap between what was actually discussed and what
about fracture risk, does not reflect any breed- or age-specific
is on paper.
discussion, and was filled in by a receptionist who has never been in theatre.
What ‘informed’ actually means
A few weeks later, Max, a young Boerboel, is booked in for a
Consent is only valid if the client had enough information to make
lump removal. His owner’s wife calls ahead. The receptionist, mid-
a real choice. In practice, that means a reasonable client – not a
call with another client waiting, ducks into theatre and asks the vet
veterinarian, not a specialist, an ordinary pet or livestock owner –
for a rough number, then writes it on the form as the quote. On
needs to understand:
the table, the vet finds a second, larger mass nearby and removes
U What you are proposing to do, in plain terms.
that one too, reasoning any owner would obviously want it dealt
U Why – the diagnosis or suspected diagnosis prompting
with in the same trip. Max’s owner, collecting him that afternoon, is billed for two removals he only consented to one of – and hears about the second mass for the first time at the till. He is not wrong to feel like the decision was made without him.
the procedure. U The material risks involved, including the ones that are rare but serious. U The reasonable alternatives, including doing nothing.
Vet’s Hub
Medicolegal
Volume 1 | No. 3
U The likely cost, and what happens if complications push that cost up. U The prognosis – with and without treatment.
writing, that costs may change if the clinical picture does – and the treating vet should be the one confirming that has been said, before the procedure, not explaining it after the invoice.
If a client cannot repeat this back to you in their own words, they probably were not informed. That is the standard a court or the
Practical steps that hold up
South African Veterinary Council (SAVC) will apply after the fact,
Document the discussion in your clinical notes, not just the signed
however good your intentions were at the time.
form – what was explained, what alternatives were offered, and how the client responded.
The word that trips vets up: ‘Material’
U Use the consent form to support the conversation, not replace
You do not need to disclose every conceivable risk – that is
it. For higher-risk or costly procedures, build in a brief pause
neither possible nor useful, and it can overwhelm a client into
before signature so the client is not rushed.
decision paralysis. What you need to disclose is what is material:
U Where a client declines a recommended option, record that
Risks that are either common, or rare but severe, or specifically
too – informed consent includes the right to informed refusal.
relevant to this particular animal, this particular procedure, this
U Revisit consent if the clinical picture changes intraoperatively in
particular client. A rare but severe complication still needs mentioning, even
ways the client did not anticipate. U Treat consent as occasion-specific, not indefinite – a
if it is unlikely. A client with a nervous breed, a geriatric patient,
returning patient like Bella does not come with standing
or a known drug sensitivity changes what is material for that
consent attached.
consultation. Materiality is assessed from the client’s perspective, not yours – would this client, with this animal, have wanted to know? The consent form is evidence that a conversation happened. It is not a substitute for the conversation.
Where consent forms go wrong I regularly see disciplinary and civil matters where the paperwork looks fine on its face but falls apart under scrutiny. Common failure points: U Generic forms treated as sufficient. A blanket ‘I consent to treatment’ line does not discharge the duty if the specific risks of this procedure were never actually discussed. U No record of the discussion itself. If the consult notes do not reflect what was disclosed, you are relying on memory – yours, months or years later, against a client who says they were never told. U Consent taken from the wrong person. Verify you are dealing with the animal’s owner or someone with authority
The bottom line
to consent on their behalf, particularly in boarding, referral, or
Informed consent protects the client’s right to decide what
multi-owner situations.
happens to their animal – and it protects you, but only if it
U Estimates or consent detail filled in by reception, not the vet.
is genuine. A signed form backed by a real, documented
If non-clinical staff assist with the paperwork or a quote, the
conversation is a strong defence. A signed form standing alone is
treating vet still needs to confirm what was actually disclosed,
not. If you are ever unsure whether you have disclosed enough,
before signature.
ask yourself what a reasonable client, in this specific situation,
U Handwriting and figures not corroborated. Cost estimates and
would have wanted to know before saying yes. If in doubt, tell
options discussed on the form should match what is in your
them. As for Bella and Max – a two-minute conversation, at
clinical notes. Discrepancies between the two are one of the
the right moment, would have closed both gaps. That is the
first things scrutinised in a complaint.
whole exercise, really: not more paperwork, just making sure the
U Consent obtained too late. Consent given as the animal is already being wheeled into theatre, under time pressure,
paperwork reflects a conversation that actually happened, with the person who is actually deciding.
is vulnerable to challenge – particularly for elective or non-
Dr Cornelia Els is a dual-qualified veterinarian and attorney,
urgent procedures.
and a consultant to the Veterinary Defence Association,
U If reception is taking bookings, quotes, or intake details, the estimate needs a standing caveat, said out loud and put in
where she advises on SAVC disciplinary matters, professional liability, and legal risk in veterinary practice. U
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Practice management
Volume 1 | No. 3
What you need to consider when running a
successful veterinary practice – Part 2 Mari an
ne
v
an Wy
k
In Part 2 of this three-part series, Marianne van Wyk, CEO of Vetmaster Online, explores several essential areas that every veterinary practice should prioritise to remain competitive, efficient and patient-focused in modern veterinary medicine.
A well-managed veterinary practice not only improves
customer service and effective operational systems all play a
patient outcomes but also enhances client satisfaction, staff
vital role.
retention and long-term profitability. In today’s competitive veterinary industry, success depends on much more than
Below are three key areas that every modern veterinary practice should focus on.
excellent clinical skills. Efficient management, exceptional
1. Deliver outstanding patient care The health and welfare of every patient should always be your highest priority. Consistently providing excellent veterinary care builds trust, strengthens your reputation and encourages long-term client loyalty.
Successful practices should: U Follow current veterinary best practices and treatment protocols. U Invest in modern diagnostic and medical equipment. U Maintain accurate, complete and secure patient records using a reliable veterinary practice management system. U Encourage continuous professional development for veterinarians, veterinary nurses and support staff. U Promote preventative healthcare through vaccinations, parasite control, nutrition counselling and routine wellness examinations. U Exceptional patient care remains the foundation of every successful veterinary practice.
Vet’s Hub Volume 1 | No. 3
2. Provide exceptional customer service Today’s pet owners expect clear communication, empathy and professionalism throughout every stage of their visit.
Successful practices: U Clearly explain diagnoses and treatment options. U Discuss costs before treatment begins to avoid misunderstandings. U Keep clients informed while their pets are hospitalised or undergoing surgery. U Follow up after major procedures to monitor recovery. U Make courtesy calls after consultations or treatments to check on the patient’s progress and demonstrate genuine care. Excellent customer service is often what distinguishes one practice from another. Never underestimate the power of word-ofmouth marketing. A delighted client may recommend your practice to friends and family, while one poor experience can discourage several potential clients. Every interaction is an opportunity to build trust and strengthen your reputation.
3. Maintain effective stock control Poor inventory management can significantly reduce profitability and negatively impact patient care.
Best practices include: U Monitor stock levels daily. U Set minimum and maximum stock quantities. U Track medication expiry dates. Perform regular stock takes (weekly). U Reduce expired, damaged and obsolete stock. U Closely monitor high-value pharmaceuticals and controlled medicines. U Follow the first in, first out (FIFO) principle to minimise wastage. U Keep the drug register accurate and up to date to ensure regulatory compliance. U Avoid purchasing excessive quantities simply because products are on special from suppliers. U Do every week ghost stock taking – nobody knows what product will be in line for stock staking at what moment. An effective inventory management system helps reduce waste, improve cash flow and ensures that essential medications and products are always available when patients need them. If you missed Part 1, click on the link https://www.vetshub. co.za/what-you-need-toconsider-when-runninga-successful-veterinarypractice/ or scan the QR code to catch up and stay tuned for Part 3, where we’ll explore practical strategies to grow your practice, improve profitability and future-proof your veterinary business. U
Practice management
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Health awareness
Volume 1 | No. 3
Not just old bones:
Rethinking canine osteoarthritis
Save the Date Animal Pain Awareness Month September
OA is more than wear and tear Canine osteoarthritis (OA) is a progressive degenerative joint disease driven by mechanical, genetic, metabolic, and traumatic factors that disrupt joint homeostasis across cartilage, bone, and synovial structures. It causes structural changes such as cartilage loss, subchondral bone sclerosis, osteophyte formation, and synovial inflammation, leading to pain, reduced mobility, and impaired quality of life (QoL), without systemic illness in most cases.1
Silent pain, visible impact Diagnosis is clinical, supported by imaging and sometimes synovial fluid analysis. Joint pain is the dominant sign, often presenting as lameness, stiffness, or reduced activity. Physical findings may include crepitus, effusion, muscle atrophy, fibrosis, and restricted movement, though these are not OA-specific and must be differentiated from immune-mediated or other joint diseases. Radiographic changes typically confirm later-stage disease.2
References Budsberg SC. Canine Osteoarthritis: Understanding the etiology, clinical presentation, and diagnosis. DVM360. [Internet]. Available at: https://www. dvm360.com/view/canine-osteoarthritis-understanding-etiology-clinicalpresentation-and-diagnosis 2. Cachon T, Frykman O, Innes JF, et al. The COAST Development Group’s international consensus guidelines for the treatment of canine osteoarthritis. Front Vet Sci, 2023. 3. Anderson KL, Zulch H, O’Neill DG, et al. Risk Factors for Canine Osteoarthritis and Its Predisposing Arthropathies: A Systematic Review. Front Vet Sci, 2020. 1.
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Practice pearls 1.
2.
3.
4.
5.
OA is an active inflammatory disease process – not simply ‘wear and tear’ – and early intervention changes long-term outcomes. Radiographic severity does not always correlate with pain levels, clinical signs and owner observations remain central to assessment. Weight management is one of the most effective OA interventions, with even modest weight loss improving mobility and comfort. Multimodal therapy works best: Combine NSAIDs, rehabilitation, nutrition, exercise modification, and environmental support throughout disease progression. Breakthrough pain in advanced OA requires rapid reassessment and short-term escalation strategies, including hospital-based analgesia when necessary.
Who is at risk? OA is multifactorial, shaped by genetics, conformation, obesity, environment, and age. Large breeds (Labradors, German Shepherds, Rottweilers) are predisposed to hip, elbow, and cruciate disease, while small breeds (Chihuahuas, Pomeranians) are prone to patellar luxation. Obesity is a key modifiable risk factor, increasing joint load and accelerating degeneration. Rapid growth, overfeeding, and neuter status may further increase risk.3
COASTeR: A staged roadmap for care The COASTeR framework guides stage-based OA management, prioritising early intervention and lifelong monitoring.2 Stage 0-1: Risk-based prevention, weight control, education, exercise optimisation. Stage 2: Mild OA – introduce nutrition support, omega-3s, activity modification. Stage 3: Moderate OA – multi-modal therapy, NSAIDs, more frequent reassessment. Stage 4: Severe OA – intensive pain control, mobility aids, multidisciplinary care, and end-of-life planning.
Multimodal care is key Breakthrough pain needs rapid action Severe pain episodes may occur at any stage, especially Stage 4 OA. Hospital-based interventions include ketamine and lidocaine infusions, with opioids used in acute crisis situations. These are short-term stabilisation tools, not long-term solutions. Palliative care planning, caregiver education, and mobility aids are critical in advanced disease.2
OA management is lifelong and multimodal, combining lifestyle, pharmacologic, and supportive therapies. Nonsteroidal antiinflammatory drugs (NSAIDs) are recommended as first-line oral therapy but require monitoring for adverse effects. Injectable therapies and adjunct analgesics are added in progressive disease stages. Rehabilitation, weight management, and environmental modifications are essential across all stages.1,2
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Health awareness
Volume 1 | No. 3
Rabies: A preventable but persistent global threat
Save the Date World Rabies Awareness Day 28 September Theme: Stronger together
Rabies is one of the world’s deadliest zoonotic diseases, with an almost 100% fatality rate once clinical symptoms develop. Despite being entirely preventable, rabies still causes ~59 000 human deaths annually, predominantly in Africa and Asia, where limited healthcare infrastructure and inadequate access to vaccines continue to perpetuate infection cycles.1
Domestic dogs are responsible for 99% of human rabies
particularly vulnerable due to poor access to healthcare and
cases globally, making canine vaccination the cornerstone
inconsistent canine vaccination coverage.1,2
of disease prevention and elimination strategies. Children are
Effective prevention depends on both pre-exposure
disproportionately affected, accounting for ~40% of rabies deaths
prophylaxis (PrEP) for high-risk groups and rapid post-exposure
because of their frequent contact with animals and increased
prophylaxis (PEP) following suspected exposure. PEP includes
vulnerability following bites.1
immediate wound washing, rabies vaccination, and where
Rabies is caused by a neurotropic virus transmitted primarily through the saliva of infected animals via bites, scratches, or contamination of broken skin and mucosal surfaces. Following infection, the virus attacks the central nervous system, resulting in progressive encephalitis and death. 2 Clinical disease occurs in two forms: Furious rabies, characterised by agitation, hydrophobia, hypersalivation, and hallucinations, and paralytic rabies, which presents with progressive weakness and paralysis. Initial symptoms are nonspecific and include fever, headache, nausea, and discomfort at the wound site before neurological deterioration rapidly develops. Survival after symptom onset remains exceptionally rare. 2 South Africa continues to face endemic rabies, with domestic dogs serving as the principal reservoir for human infection. Wildlife species such as jackals may also contribute to transmission. Rural communities remain
indicated, rabies immunoglobulin administration. When initiated before symptom onset, PEP is virtually 100% effective.3
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Crash course: South African puppy and kitten vaccination guidelines According to the guidelines available on the South African Veterinary Council website, vaccination is essential not only for individual pets, but also for maintaining ‘herd immunity’ and reducing outbreaks of infectious diseases such as canine parvovirus and feline panleukopenia.4 For puppies, the core vaccines are canine parvovirus, canine distemper virus, canine adenovirus, and rabies. The guidelines recommend starting vaccinations at six-weeks of age because South Africa experiences high levels of parvovirus infection and poor herd immunity.4 Puppies should receive core vaccines at six-, nine-, and 12-weeks of age, with some veterinarians recommending an additional booster at 16-weeks because maternal antibodies may interfere with vaccine years depending on lifestyle and risk. Cats living in multi-cat
effectiveness until that age. 4
households or catteries are considered higher risk and may require
Rabies vaccination is legally required from 12-weeks of age,
more frequent vaccination.4
followed by a booster between four- months and one-year of
The guidelines also recognise the value of serological testing
age, and thereafter every three-years. In high-risk environments such as breeding kennels and shelters, vaccination may begin as
to measure immunity and avoid unnecessary vaccination.
early as four-weeks using approved high-titer vaccines.
Testing may help determine whether an animal still has protective
4
Optional but highly recommended non-core vaccines include
immunity, especially before administering additional boosters.
parainfluenza and Bordetella bronchiseptica, especially for
Overall, the South African vaccination guidelines aim to balance
dogs exposed to kennels, shows, travel, or boarding facilities.
scientific evidence, local disease pressures, legal requirements,
Leptospirosis vaccination may also be considered where
and practical realities to improve the health and protection of
risk exists, although evidence of the disease in South Africa
puppies and kittens.4
remains limited.4
Conclusion
The guidelines stress that maternal antibodies transferred through colostrum can interfere with vaccination in young puppies
Rabies is a major yet preventable public health threat, particularly
and kittens. Because antibody levels vary between littermates,
in developing countries such as South Africa where canine
multiple vaccinations are necessary to ensure protection.
transmission continues to place vulnerable communities at risk.
Completing the vaccine series is considered critical, as stopping
Strengthening vaccination coverage in domestic dogs and cats
too early is one of the most common causes of vaccine failure.
is essential to reducing disease transmission and protecting both
4
For kittens, the core vaccines are feline panleukopenia
animal and human health. Public awareness, responsible pet
virus, feline herpesvirus-1, feline calicivirus, and rabies. Initial
ownership, routine veterinary care, and rapid access to post-
vaccinations are recommended at six-, nine-, and 12-weeks of
exposure prophylaxis are critical components of rabies prevention.
age, with a possible additional booster at 16-weeks if required.
Adherence to South African vaccination guidelines, together
Rabies vaccination is administered from 12-weeks onward,
with improved community education and healthcare access, can
with revaccination depending on travel requirements and
significantly reduce rabies-related deaths and contribute toward
risk exposure.4
the global goal of eliminating dog-mediated human rabies.
The guidelines strongly recommend feline leukaemia virus (FeLV) vaccination in young cats, even though it is internationally
References
classified as non-core, because of its importance in protecting
1.
kittens from severe disease. FeLV vaccination begins at eightto nine-weeks with a second dose three- weeks later. Other non-core vaccines for cats include Bordetella bronchiseptica and Chlamydia felis, mainly for cats in shelters, breeding catteries, or multi-cat households.4 A booster vaccination is recommended at six-months to oneyear of age for both puppies and kittens to protect animals that may not have responded fully to earlier vaccinations. Thereafter, core vaccines in dogs are generally recommended every threeyears, while cats may receive boosters annually or every three-
World Organization for Animal Health. Rabies. 2026 [Internet]. Available at: https://www.woah.org/en/disease/rabies/ 2. National Institute of Communicable Diseases. Rabies Update. 2026 [Internet]. Available at: https://www.nicd.ac.za/rabiesupdates/ 3. National Institute of Communicable Diseases. 2025 [Internet]. Available at: https://www.nicd.ac.za/rabies-prevention-andvaccine-update-chirorab-now-available-in-south-africa/ 4. De Cramer K. Dog and cat vaccination guidelines for South Africa (2019) – Evidence. Available at: https://www.sava.co.za/ wp-content/uploads/2015/10/DOG-AND-CAT-VACCINATIONGUIDELINES-FOR-SOUTH-AFRICA-2019-EVIDENCE-rev-3-DeCramer-002.docx U
Vet’s Hub
Companion animals
Volume 1 | No. 3 Dr Myra Rose Marais, deputy head generalist department at Fourways Veterinary Hospital
Treating inflammation first: Are we rethinking canine otitis externa?
Skin disease remains one of the most common and frustrating conditions encountered in small animal practice, driving veterinarians, owners and patients alike to exhaustion. Despite this, dermatology is still often considered ‘bread and butter’ medicine within general practice. Once the primary underlying condition is identified and controlled, many patients are still left battling one particularly frustrating problem: Otitis externa, specifically erythemato-ceruminous otitis externa.
For many veterinarians, the sight of an erythematous,
This concept is particularly interesting in chronic allergic
uncomfortable ear immediately triggers a familiar treatment
patients. Many veterinarians will recognise the ‘recurrent ear dog’ –
pathway – topical combination products containing antibiotics,
the patient repeatedly treated with various combination products,
antifungals and corticosteroids. However, recent studies and
only to re-present several weeks later with another flare.
discussions within the dermatology field suggest that perhaps this reflexive approach deserves reconsideration.
While infection certainly plays an important role in some cases, it is often the underlying allergic or inflammatory disease
As antimicrobial stewardship (AMS) becomes an increasingly
process that remains insufficiently controlled. Identifying and
important conversation in veterinary medicine, growing attention
managing the primary disease remains of utmost importance.
has been placed on whether every mild otitis case truly requires
Cost is another important consideration. Managing chronic
antibiotic or antifungal therapy.
skin and ear disease can become financially taxing for owners,
Recent literature, including work highlighted by Virbac,
particularly in patients requiring repeated treatment courses.
has explored the use of topical corticosteroid-only therapy in
This raises the question of whether chronic intermittent use of
selected cases. These findings challenge us to reconsider the role
topical corticosteroids (CS), alongside improved owner education
inflammation itself plays in the development and perpetuation of
and long-term management strategies, may offer a more cost-
otitis externa.
effective and practical approach in selected cases of chronic otitis externa.
Inflammation versus infection in chronic cases
The importance of careful case selection
In many patients, particularly allergic dogs, inflammation is often
Importantly, the idea of steroid-only therapy does not suggest
the primary driver of disease. Secondary microbial or yeast
abandoning diagnostics, overlooking infection, or avoiding further
overgrowth may be relatively mild – or even incidental – in early
investigation into the primary underlying cause. Cytology remains
presentations. In these cases, effectively reducing inflammation
an essential part of the otitis work-up and plays a critical role in
may help restore the normal ear canal environment and improve
determining appropriate case selection.
clinical signs without the immediate need for combination therapy.
Suppurative otitis, severe microbial overgrowth, painful
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ulcerative ears, rod infections, significant biofilm formation, or
can still challenge long-standing habits and assumptions within
suspected ruptured tympanic membranes would clearly not be
general practice. It will certainly be interesting to see how future
appropriate candidates for CS-only management. Rather, this
studies continue to shape our approach to managing canine otitis
discussion highlights the importance of approaching otitis externa
externa in the years ahead. U
thoughtfully and individually, instead of reflexively reaching for triple-therapy products in every case.
Practice pearls 1.
Long-term management and antimicrobial stewardship As general practitioners, we are uniquely positioned to influence AMS through our everyday prescribing habits. Even small shifts
2.
in how we assess and manage common conditions such as otitis externa may contribute meaningfully to reducing unnecessary antimicrobial exposure over time.
3.
At the same time, this evolving approach reinforces something many clinicians managing chronic dermatology patients already appreciate: Successful long-term otitis management rarely relies on treating infection alone. Identifying
4.
and controlling the primary cause – whether allergic dermatitis, conformational disease, endocrine disease, or another underlying pathology – remains the cornerstone of preventing recurrence. Dermatology continues to evolve rapidly, and conversations such as these remind us that even very common conditions
5.
Cytology remains essential when assessing otitis externa and should guide treatment selection rather than relying on reflexive prescribing habits. In allergic dogs, inflammation may be the primary disease driver long before significant bacterial or yeast overgrowth develops. Recurrent otitis cases often require better longterm control of underlying allergic or inflammatory disease, not repeated antimicrobial therapy alone. CS-only therapy may be appropriate in carefully selected erythemato-ceruminous otitis cases with minimal microbial involvement. AMS in general practice starts with thoughtful case selection and avoiding unnecessary antibiotic exposure in mild ear disease.
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Companion animals
Volume 1 | No. 3
Nutrition of ageing cats:
Understanding the unique needs of senior felines
In this article, Dr Angeliki Kaldelis, Scientific Communications manager South Africa at Royal Canin, summarises key insights from the Royal Canin Veterinary Academy on the evolving nutritional needs of ageing cats. The original article, Nutrition of Ageing Cats, written by Lori Prantil and Becca Leung (2024) explores how age-related changes in digestion, appetite, hydration, muscle maintenance, and disease risk influence dietary requirements, while highlighting practical nutritional strategies to support healthy ageing, maintain quality of life, and promote longevity in senior and super senior cats.
As cats age, their nutritional requirements evolve, reflecting
food intake and nutrient utilisation. Sarcopenia, the age-related
changes in their physiology, metabolism, and health status. While
loss of muscle mass independent of disease, also contributes to
life stages for cats have only recently been clearly defined, with
these challenges.
organisations such as the American Animal Hospital Association
Given these factors, senior cats often require diets with higher
and the International Society of Feline Medicine providing slightly
caloric density and enhanced digestibility to maintain body weight
differing categorisations, there remains a notable gap in specific
and muscle condition. Regular monitoring of body weight, body
nutritional guidelines tailored for senior cats. This lack of formal
condition score, and muscle condition score is essential to tailor
guidance presents a challenge, especially as the population of
dietary adjustments appropriately. Feeding strategies may include
senior and super senior cats grows.
offering foods with varied aromas and flavors and serving meals at optimal temperatures to stimulate appetite.
Decline in digestive efficiency One of the most significant changes observed in ageing cats
Hydration – another concern
is a decline in digestive efficiency. Research indicates that up
Hydration is another concern in ageing cats. Older cats may
to one-third of senior cats experience reduced fat digestibility,
experience a decreased thirst drive, reduced mobility, or underlying
and approximately 20% show diminished protein digestion. This
diseases that predispose them to dehydration. However, clinical
reduction in nutrient absorption contributes to common clinical
signs of dehydration can be subtle or inconsistent, making
observations such as weight loss, decreased lean body mass,
proactive encouragement of water intake vital.
and a decline in muscle condition scores.
Providing fresh, clean water is fundamental, but incorporating
These changes may be partly due to a negative nitrogen
dietary moisture through wet food can be especially beneficial.
balance resulting from insufficient protein digestion. Importantly,
This approach not only supports hydration but also aids cats
current protein intake recommendations, which aim to maintain
with dental disease, which affects over half of senior cats and can
nitrogen balance, may not be adequate to preserve muscle mass
make chewing dry kibble painful.
in older cats. Beyond digestive changes, sensory decline – such
Wet diets are also advantageous in managing conditions
as diminished smell and taste – can reduce appetite and food
like CKD and urinary tract diseases. However, because wet
interest, further complicating nutritional management.
food has lower caloric density, it is important to ensure that cats
Additionally, diseases prevalent in older cats, including
consume sufficient quantities to meet their energy needs. For cats
hyperthyroidism, chronic kidney disease (CKD), lymphoma, and
struggling to consume adequate volumes, a combination of wet
diabetes, as well as medication side effects, can negatively impact
and dry food may be necessary.
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Nutritional protein requirements in senior cats is nuanced
inorganic phosphates and maintaining an appropriate calcium-
While we know some older cats have reduced protein digestibility,
to-phosphorus ratio is advisable to support kidney health in
it is unclear what protein level should be recommended for healthy
ageing cats. However, because protein and organic phosphorus
older cats. While CKD is a common diagnosis in older cats, there
levels often correlate in pet foods, balancing high protein intake
is insufficient evidence to support lowering protein intake in all
with low phosphorus content can be challenging, especially in
ageing cats as a preventive measure against CKD.
maintenance diets.
In fact, reducing protein prematurely may exacerbate
Consequently, avoiding diets with high levels of soluble
Vitamins and minerals remain essential for all life stages, but
sarcopenia, given cats’ status as obligate carnivores with
ageing cats may face additional challenges in absorbing fat-
inherently high protein requirements. Therefore, protein restriction
soluble vitamins due to decreased fat digestibility. Although data
should be reserved for cats with diagnosed renal disease rather
on deficiencies in older cats are limited, inadequate absorption
than applied broadly to healthy seniors.
combined with poor diet quality or intake could lead to deficiencies. Antioxidant vitamins such as vitamin E and beta-carotene
Healthy ageing in cats starts with nutrition tailored to changing digestion, hydration, muscle maintenance, and cognitive and joint health needs
have shown potential benefits in promoting longevity. Watersoluble vitamins like vitamin B12 may require supplementation in cases of increased urinary loss or malabsorption.
Fish oils, fuzzy memories, and the quest for nine good lives Degenerative joint disease (DJD) is prevalent in senior cats, with radiographic evidence found in >90% of cats older than 14-years. Among various supplements studied, eicosapentaenoic acid and
Fat intake also warrants careful consideration. Since fat
docosahexaenoic acid, omega-3 fatty acids commonly found in
provides more calories per gram than protein or carbohydrates,
fish or algal oil, have demonstrated the most consistent benefits.
reduced fat digestibility in senior cats can contribute to unintended
Supplementation with these fatty acids has been associated with
weight loss. For cats losing weight without underlying disease,
improved activity levels, reduced stiffness, and enhanced quality
diets higher in fat, alongside improved protein and carbohydrate
of life.
digestibility, may help maintain body condition. Conversely, overweight or obese senior cats – who represent
Cognitive decline is increasingly recognised in ageing cats, with a significant proportion of owners reporting behavioural
a significant proportion of the feline population – may benefit
changes consistent with cognitive dysfunction. While some
from lower-fat diets to support weight loss and reduce the risk of
supplements, such as S-adenosyl-l-methionine, show promise,
associated health problems.
evidence for others like melatonin, L-theanine, and medium-chain
Carbohydrates, although not essential nutrients for cats, play
triglycerides remains inconclusive. Emerging research targeting the
a supportive role in balancing dietary energy and sparing protein
gut-brain axis, including the use of prebiotics and probiotics, holds
from being used as an energy source. Cooked carbohydrates are
potential for future interventions.
readily digestible and can provide glucose, reducing the need for gluconeogenesis from protein. Importantly, there is no evidence
Conclusion
linking digestible carbohydrates to obesity or diabetes in cats.
In conclusion, while many commercial diets and supplements
Dietary fiber, particularly fermentable fibers like beet pulp and
are marketed for senior cats, the scientific understanding of their
fructo-oligosaccharides, supports intestinal health by promoting
specific nutritional needs remains incomplete. Ageing cats represent
beneficial microbiota and producing short-chain fatty acids. In
a diverse group with varying health statuses, making individualised
senior dogs, increased dietary fiber has been shown to reduce
dietary assessment and management essential. Regular
intestinal ammonia, which may have implications for cats with
monitoring of body weight, body condition, muscle condition, and
CKD or hepatic encephalopathy. However, fiber also lowers
hydration status, combined with evidence-based adjustments
caloric density and can affect palatability, so its inclusion must be
to diet composition, can help support healthy aging. As research
balanced carefully.
advances, more precise nutritional
Mineral content, especially concerning phosphorus and
recommendations will emerge,
the calcium-to-phosphorus ratio, is a critical area of focus.
enabling better care for our senior
Recent studies have demonstrated that diets high in inorganic
feline companions.
phosphorus, particularly with calcium-to-phosphorus ratios below
For the full article with
1:1, can induce renal changes in healthy cats. Inorganic phosphorus
references please visit: https://
causes a dose-dependent increase in plasma phosphorus
academy.royalcanin.com/en/
concentrations, which is more pronounced than with organic
veterinary/nutrition-of-aging-
phosphorus sources.
cats U
EASY
ENRIC
EAT & D TO
EST IG
D IN EPA HE
HA &D
RGY RIC NE
H
E
Every year matters for healthy ageing
Reg. No. V23337, V23334, V25139 (Act 36/1947)
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Cat-astrophe averted:
Evidence-based diabetes management in cats In late 2025, International Cat Care (iCatCare) published a consensus guideline offering comprehensive recommendations for the diagnosis, treatment, and long-term management of feline diabetes. As the second most common endocrine disorder in cats after hyperthyroidism, diabetes mellitus represents a growing clinical challenge requiring structured assessment, ongoing monitoring, and sustained caregiver engagement.¹ The guideline strongly emphasises a multidisciplinary approach,
such as chronic kidney disease or pancreatitis may obscure
where veterinary professionals and caregivers work collaboratively
classical presentations. Cats with HST may also exhibit subtle soft
to optimise outcomes, recognising that successful long-term control
tissue enlargement rather than obvious phenotypic changes.¹
depends on coordination rather than isolated clinical intervention.¹
More severe cases may present with diabetic ketoacidosis (DKA), while chronic hyperglycaemia can result in diabetic
Epidemiology and risk profile
neuropathy, often manifesting as a plantigrade stance. The
Feline diabetes affects ~0.5% of the general cat population,
heterogeneity of clinical presentation highlights the importance of
equating to roughly one in 200-250 cats, with prevalence
thorough assessment and tailored diagnostic evaluation.¹
increasing in parallel with rising obesity rates. Age remains the strongest risk factor, with most affected cats older than six years
Diagnosis and the ALIVE Framework
and a mean age at diagnosis of around 10-years, peaking between
Diagnosis relies on clinical signs supported by biochemical
nine- and 13-years. Diabetes in younger cats is uncommon.1,2
evidence of persistent hyperglycaemia. Home monitoring,
Obesity is a major modifiable risk factor, increasing the likelihood
continuous glucose monitoring (CGM), and urine dipstick testing
of diabetes by three- to fivefold. More than 40% of cats aged five-
using naturally voided samples can help distinguish stress
to 11-years are overweight, underscoring the expanding metabolic
hyperglycaemia from true diabetes.¹
disease burden in companion animals. Neutered cats are nearly
The ALIVE diagnostic criteria define two pathways:
twice as likely to develop diabetes, while males have a 1.5-fold
In the first pathway, diabetes is diagnosed when a random
increased risk compared with females.1,2 Genetic predisposition
blood glucose ≥15mmol/l is present alongside classic clinical
may also play a role, particularly in Burmese cats. Environmental
signs, with no alternative explanation, or in the context of a
and lifestyle contributors, including indoor confinement, reduced
hyperglycaemic crisis. At least one additional criterion is required,
physical activity, and high-calorie diets, further amplify risk.
such as elevated glycated proteins (eg fructosamine) or repeated
1,2
glucosuria from home-collected urine samples taken at least two
Pathophysiology and disease classification Feline diabetes shares similarities with human diabetes and is
days post-stress.¹ The second pathway applies to blood glucose levels between
broadly classified as insulin-dependent (type 1 diabetes [T1DM])
7-15mmol/l and requires at least two supporting criteria, including
or non-insulin-dependent (type 2 diabetes [T2DM]). True T1DM,
clinical signs, elevated glycated proteins, or repeated glucosuria.¹
caused by immune-mediated beta-cell destruction, is rare in cats.¹
Early diagnosis improves outcomes and increases the
T2DM accounts for ~75%-80% of cases and is characterised
likelihood of diabetic remission, defined as at least four weeks
by insulin resistance combined with impaired insulin secretion.
without exogenous insulin and absence of clinical signs.
Contributing mechanisms include islet amyloid deposition,
Remission significantly improves quality of life (QoL) and may be
glucotoxicity from chronic hyperglycaemia, pancreatitis, and other
more likely when underlying causes such as HST are addressed.¹
pancreatic insults or neoplasia.¹ Secondary diabetes comprises around 20%-25% of cases,
Principles of individualised management
most commonly associated with hypersomatotropism (HST).
Management must be tailored to the individual patient, particularly
HST involves chronic excess growth hormone secretion and is
where concurrent disease is present. Cats with anorexia,
now recognised in approximately 20%-30% of diabetic cats. Many
dehydration, or systemic compromise may require urgent
affected cats lack overt acromegalic features such as enlarged
stabilisation, including DKA protocols.¹ A comprehensive baseline
paws, facial bone changes, or organomegaly, making HST a
assessment should include body weight, ideal body weight,
frequently underdiagnosed driver of insulin resistance.
body condition score, muscle condition score, dietary history,
1,2
medication review, and identification of comorbidities.¹
Clinical presentation Typical clinical signs include polyuria, polydipsia, polyphagia with
Insulin therapy as the foundation of care
concurrent weight loss, and lethargy. However, comorbid conditions
Insulin remains the cornerstone of feline diabetes management.
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Volume 1 | No. 3
It directly addresses hyperglycaemia, reduces glucotoxicity, and
SGLT2i are most appropriate for clinically stable (‘happy’)
supports recovery of beta-cell function – critical for achieving
diabetic cats and require careful pre-treatment screening,
remission in T2DM. Its benefits extend beyond glycaemic control,
including ketone assessment and evaluation for concurrent
including improvement in clinical signs, prevention of DKA, and
endocrinopathies. The highest risk period for euglycaemic diabetic
increased likelihood of remission.¹
ketoacidosis (eDKA) is within the first two-weeks of therapy.¹
Insulin types and pharmacokinetics
fructosamine levels, and CGM data, as urine glucose becomes
Insulin preparations fall into two categories:
unreliable due to drug mechanism. Adverse effects include
1.
Suspensions (eg porcine lente, NPH, protamine zinc insulin)
gastrointestinal (GI) signs, dehydration, and rarely eDKA, which
require resuspension before administration. Their absorption
requires immediate discontinuation and supportive care.¹
Long-term monitoring focuses on clinical signs, body weight,
is variable, with intermediate duration of action and twice-daily dosing commonly required. Incorrect mixing can lead to dosing
GLP-1RA emerging adjunct therapy
inconsistencies and poor control.¹
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) enhance
2. Solutions (eg insulin glargine U100/U300 and degludec)
glucose-dependent insulin secretion, suppress glucagon, slow
offer more predictable pharmacokinetics and do not require
gastric emptying, and reduce appetite. These effects make them
resuspension. Glargine U300 provides a stable basal profile, while
theoretically beneficial in obese or insulin-resistant cats.¹
degludec, despite its ultra-long human action, behaves as a 12-
Limited studies, mainly with exenatide, show modest
hour insulin in cats and is not suitable for once-daily dosing.¹
improvements in glycaemic control and reduced insulin requirements when used adjunctively. However, GLP-1RAs have not demonstrated
Practical administration considerations
remission as monotherapy. They may be useful in selected
Insulin timing does not need to be strictly synchronised with
overweight cats but should be avoided or used cautiously in those
meals, particularly with basal or long-acting formulations. Cats on
with GI disease due to potential appetite suppression and nausea.¹
low-carbohydrate diets experience minimal postprandial glucose variation, allowing flexible dosing schedules.¹
Integrated approach to care Effective feline diabetes management requires a multimodal
Insulin selection
strategy combining insulin or SGLT2is, dietary modification,
Choice of insulin depends on multiple factors: Residual beta-cell
weight management, and regular monitoring. Early
function, comorbid disease (such as pancreatitis or renal disease),
diagnosis and identification of underlying conditions such as
caregiver compliance, cost, and availability. Some evidence
hypersomatotropism significantly improve outcomes and increase
suggests glargine formulations may improve remission rates,
remission potential. Adjunct therapies such as GLP-1RAs may
although data remain limited.¹
provide additional metabolic benefits in carefully selected cases but remain secondary to established treatment modalities.¹
Monitoring and dose adjustment Monitoring is essential to optimise therapy and detect remission
Conclusion
early. Blood glucose measurements remain central, while
Feline diabetes management has evolved into a precision-based,
fructosamine provides intermediate-term glycaemic assessment.
individualised discipline. The iCatCare consensus underscores the
CGM offers the most detailed metabolic profiling and is particularly
importance of early diagnosis, structured monitoring, and flexible
useful in unstable or insulin-resistant cases.¹ Clinical parameters –
treatment strategies that integrate pharmacological, nutritional, and
appetite, weight, hydration, and behaviour – remain equally
lifestyle interventions. Insulin remains foundational, while newer agents
important. Dose adjustments should be gradual, typically in one-
such as SGLT2i and GLP-1RA expand therapeutic possibilities.
unit increments, with emphasis on avoiding hypoglycaemia and
Ultimately, successful management depends on collaboration between
preserving quality of life. Remission should be considered when
clinicians and caregivers, careful attention to comorbid disease, and a
cats maintain euglycaemia and clinical stability for at least four
sustained focus on quality of life. When applied thoughtfully, evidence-
weeks without insulin.¹
based interventions not only control disease but significantly increase the likelihood of remission and long-term metabolic stability.
SGLT2 inhibitors a new insulinindependent option
References
Sodium-glucose cotransporter-2 inhibitors (SGLT2i) provide an
1.
insulin-independent mechanism for glucose control by increasing urinary glucose excretion. They act at the proximal renal tubule by blocking SGLT2-mediated glucose reabsorption.¹ Clinical studies of velagliflozin and bexagliflozin demonstrate glycaemic control in 80%-90% of treated cats, with comparable outcomes to porcine lente insulin and no reported clinical hypoglycaemia.¹
Taylor S, Cannon M, Niessen S, et al. iCatCare 2025 consensus guidelines on the diagnosis and management of diabetes mellitus in cats. Journal of Feline Medicine and Surgery, 2025. 2. Herrtage ME. New Strategies in the Management of Feline Diabetes Mellitus. World Small Animal Veterinary Association World Congress Proceedings. 2009 [Internet]. Available at: https://www.vin.com/apputil/content/defaultadv1.aspx?pId= 11290&catId=33314&id=4252689&ind=147&objTypeID=17 U
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Vet’s Hub
CPD activity
Volume 1 | No. 3
Protecting kidney function in cats: Preserving companionship from diagnosis to longevity Chronic kidney disease (CKD) is one of the most common chronic diseases in cats and the leading cause of death in geriatric felines. During this webinar, Dr Melanie Wergin highlighted the importance of early diagnosis, accurate staging and timely intervention to preserve kidney function, improve quality of life (QoL) and extend survival. CKD affects an estimated 2%-20% of cats, with prevalence
progression by about 1.5 years.
increasing markedly with age. Around 80% of cats >15-years
ACE inhibitors are recommended for cats with proteinuria and/
are affected. The disease is multifactorial, with recognised risk
or hypertension to reduce RAAS activation and preserve
factors including breed predisposition (Scottish Fold, Maine Coon,
renal function.
Persian and Abyssinian), male sex, lean body condition, poor
Dr Wergin also discussed supportive therapy using SUC,
dental health, inherited polycystic kidney disease, hypertension,
comprising solidago virgaurea, ubiquinone (coenzyme Q10) and
cardiovascular disease, chronic infections and nephrotoxic
coenzyme preparations. These compounds possess anti-
medications such as non-steroidal anti-inflammatory drugs.
inflammatory and antioxidant properties that may reduce fibrosis,
Although the initiating cause is often unknown, CKD progresses
support mitochondrial function and protect remaining nephrons.
through irreversible nephron loss, chronic inflammation and
An observational multicentre study comparing SUC with
fibrosis, resulting in a continuous decline in renal function.
benazepril in cats with IRIS stage 2 and 3 CKD found comparable
A key driver of disease progression is activation of the
renal outcomes, while cats receiving SUC experienced
renin-angiotensin-aldosterone system (RAAS), which promotes
improvements in creatinine concentrations, appetite, activity,
vasoconstriction, proteinuria, hypertension and further nephron
grooming and overall quality of life. Approximately 70% of stage
damage. Because cats possess substantial renal reserve, serum
3 cats improved sufficiently to move into stage 2. The findings
creatinine does not typically increase until ~70%-75% of kidney
also suggested that treatment should be continued at least twice
function has been lost, meaning many cats remain clinically
weekly to maintain clinical benefit.
normal during the early stages of disease.
A clinical case demonstrated similar improvements following
Clinical signs depend on disease severity. Cats in International
rehydration, renal diet and SUC therapy, with reductions in creatinine
Renal Interest Society (IRIS) stage 1 are often asymptomatic and
and phosphate concentrations, improved urine concentrating ability
identified only through routine screening, while those in stages 2
and a marked improvement in the cat’s overall condition.
and 3 commonly present with increased thirst and urination, poor appetite, vomiting, weight loss, lethargy and reduced grooming. Dr
Conclusion
Wergin recommended annual kidney screening from six years of
Dr Wergin concluded that although CKD is progressive and
age to facilitate earlier diagnosis and improve long-term outcomes.
irreversible, early diagnosis, routine screening, nutritional
Diagnosis relies on serum creatinine and symmetric
intervention, appropriate management of proteinuria and
dimethylarginine (SDMA), which detects declining renal function
hypertension, and supportive therapies can significantly slow
earlier than creatinine and is less influenced by muscle mass.
disease progression, preserve renal function and improve both
Additional assessment should include urinalysis, urine culture,
survival and QoL for affected cats.
urine protein-to-creatinine ratio, blood pressure measurement and
This webinar is currently
renal ultrasonography. These investigations form part of the IRIS
undergoing CPD accreditation.
staging system, which guides prognosis and treatment.
You can still watch the replay and
Management focuses on slowing disease progression
earn points. Click here to watch
and maintaining quality of life. Rehydration is essential before
the replay or scan the QR code.
interpreting renal biomarkers, while nutritional management
Once you have watched the video,
remains a cornerstone of therapy. Commercial renal diets
please send your full names and
restricted in protein and phosphorus have been shown to slow
council registration number to
CKD progression by approximately 43% and delay disease
rene.bosman@media24.com. U
Vet’s Hub
Livestock
Volume 1 | No. 3 Article reviewed by Dr Sue Murray
Save the Date
Itchy horses?
Solutions beyond the scratches
Itchy Pet Awareness Month August
Horse allergies present a significant clinical challenge in equine practice, affecting both animal welfare and performance. Advances in veterinary dermatology have shed light on the complex mechanisms underlying allergic skin conditions, particularly insect bite hypersensitivity (IBH) and equine atopic dermatitis (EAD). Effective management requires an integrated understanding of genetic predisposition, immune dysregulation, and skin barrier dysfunction, enabling veterinarians to implement evidence-based therapeutic strategies.1,2 Dr Rosanna Marsella, a leading researcher in veterinary
and recurrent skin lesions. It often affects multiple body regions
dermatology at the University of Florida (United States), has
and persists year-round. Pathophysiology involves an overactive
provided critical insights into equine skin barrier function. Her work
immune response to environmental allergens such as dust mites,
highlights parallels between allergic skin conditions in horses
pollens, and moulds, leading to immunoglobulin E (IgE)-mediated
and atopic dermatitis (AD) in humans and canines, particularly
inflammation and barrier disruption. 2,5
the disruption of lipid lamellae in the stratum corneum. These structural changes compromise the barrier, facilitating allergen penetration and triggering inflammatory responses.1,3 Recognising the central role of the skin barrier has shifted
Sniffing out allergies: Getting the diagnosis right Accurate diagnosis underpins effective treatment. Veterinary
therapeutic strategies toward not only controlling immune
evaluation should include:
responses but also restoring barrier integrity. In practice, this
U Clinical assessment: Pattern, distribution, and seasonality of
translates to treatment plans that incorporate environmental
pruritus and lesions. 2,6
management, pharmacologic therapy, topical interventions,
U Exclusion of differential diagnoses: Parasitic infestations,
dietary modulation, and emerging biologic therapies.1,2,5,6
bacterial or fungal infections, contact dermatitis, and food hypersensitivities. 2,5
Itch happens: Common equine allergies
U Allergy testing: Intradermal testing or serum IgE assessment
IBH and EAD represent the two most common allergic skin
can guide allergen-specific interventions but should be
conditions encountered in equine practice. 2,5,6,7,8
interpreted alongside clinical findings. 2
Insect bite hypersensitivity IBH, also called ‘sweet itch’, is the most prevalent equine allergic
Taming the itch: A multifaceted approach to equine allergy management
condition and a seasonal hypersensitivity reaction to the saliva of biting
Management of equine allergies is multifaceted, integrating
insects, primarily Culicoides species pluralis. Lesions predominantly
environmental, pharmacologic, dietary, topical, and immunologic
affect the mane, tail base, ears, and ventral body. Molecular studies in
interventions. Veterinary practitioners should tailor strategies to
affected horses demonstrate upregulation of IgE, histamine receptors
individual horses, considering disease severity, seasonal variation,
(HR) (HRH2/HRH4), thymic stromal lymphopoietin, interleukin-33
and owner adherence.1,6,7
(IL-33), and IL-31 receptor alpha, indicating that immune activation is closely linked to skin barrier dysfunction. Effective clinical management
Environmental management
requires strategies that address both the allergic response and the
Environmental modification remains the cornerstone of
underlying barrier impairment.6,7,8
allergy control:2,6 U Stabling practices: Horses should be stabled during peak
Equine AD EAD is a chronic, inflammatory condition characterised by pruritus
insect activity (dawn and dusk). U Protective equipment: Fly sheets, masks, and
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Volume 1 | No. 3
U Shampoos and conditioners: Oatmeal, aloe vera, and ceramide-enriched formulations soothe inflamed skin, reduce pruritus, and restore lipid balance. U Barrier creams and emollients: These help maintain moisture, protect disrupted skin, and limit allergen penetration. U Antimicrobial topicals: In cases with secondary bacterial overgrowth, targeted topical antimicrobials can complement systemic therapy while preserving microbiome diversity.
Next-gen relief: Targeted therapies tackling equine itch IL-31 pathway inhibitors IL-31 is a central mediator of pruritus in equine allergic conditions. Pharmacologic modulation of this pathway, such as with oclacitinib (currently approved in dogs), shows promise in reducing itch severity and improving blankets help reduce insect exposure and subsequent
patient comfort. Early veterinary trials suggest potential off-label
hypersensitivity reactions.
applications in horses, though larger studies are required to
U Repellents: Topical or spray formulations may reduce biting
establish safety and dosing.1,8,11
insect exposure, though efficacy varies. U Pasture management: Limiting standing water and
Barrier restoration agents
maintaining grass at an optimal height reduces insect
Research is increasingly focused on interventions that restore
breeding sites.
lipid integrity and ceramide production in allergic skin. By directly
U Dust and mould control: Ensuring dry, well-ventilated
targeting the underlying barrier dysfunction, these therapies
stables and hay storage minimises exposure to
may reduce allergen penetration and the severity of immune-
environmental allergens.
mediated reactions. 8
Pharmacologic therapy Glucocorticoids
Immunotherapy
Systemic glucocorticoids remain the most effective agents for
approach, particularly for horses with well-characterised triggers.
acute relief of pruritus and inflammation. Oral prednisolone or
Allergen-specific immunotherapy aims to desensitise the immune
dexamethasone can provide rapid improvement, but long-term
system over time. Veterinary protocols typically involve gradual
therapy requires careful monitoring for adverse effects, including
introduction and ongoing monitoring. While requiring long-term
laminitis, immunosuppression, and metabolic disturbances.
commitment, immunotherapy can provide sustainable relief and
Veterinarians should consider tapering protocols and adjunctive
reduce dependence on pharmacologic agents. 2,12
Allergen-specific immunotherapy offers a disease-modifying
therapies to minimise systemic exposure.
5
Microbiome-based interventions Antihistamines
Emerging data indicate that restoring microbial balance may
Oral antihistamines have limited efficacy in horses but may serve
support skin barrier function and mitigate allergic responses.
as adjuncts to glucocorticoid therapy. Clinical response is variable,
Approaches may include prebiotics, probiotics, or topical
and practitioners should set realistic expectations with owners
treatments that enhance microbial diversity, representing a
regarding their modest benefits.
complementary strategy to traditional therapies.1,9
5
Dietary omega-3 fatty acids, particularly from fish oil, exert anti-
Practical considerations in clinical management
inflammatory effects and support barrier function. Integrating
Veterinarians should adopt a multimodal, individualised approach
these supplements can reduce the severity of pruritus and
to equine allergies:2,5,6
enhance skin health over time.
U Severity-based protocols: Mild, seasonal cases may
Omega-3 fatty acid supplementation
7,10
respond to environmental modifications and topical therapies
Topical therapies
alone, while chronic or severe cases often require systemic
Topical interventions can provide symptomatic relief and aid
pharmacologic intervention.5,6
barrier restoration:
9,10
U Monitoring and adjustment: Regular follow-up allows
Vet’s Hub
Livestock
Volume 1 | No. 3
allergic skin may yield agents that restore barrier function and
1. Prioritise the skin barrier
reduce allergen sensitivity.
Disrupted lipid lamellae and barrier dysfunction are central to equine allergic skin disease. Therapeutic strategies should not only target immune-mediated inflammation but also focus on restoring barrier integrity through topical formulations, emollients, and dietary lipid support.1,3,8
2. Environmental management is key Environmental modification remains the cornerstone of allergy control. Stabling horses during peak insect activity, using protective fly gear, managing pastures, and reducing dust/mold exposure can significantly reduce allergen and insect contact, especially for IBH. 2,6
3. Tailor pharmacologic therapy Systemic glucocorticoids remain the most effective symptomatic therapy but require careful monitoring for adverse effects. Antihistamines may be adjunctive, while omega-3 supplementation can support barrier function and reduce inflammation.5,7,10
4. Consider targeted and emerging therapies IL-31 pathway inhibitors, barrier restoration agents, and microbiome-based interventions represent promising strategies to address pruritus and allergic inflammation. Early adoption in clinical practice should be guided by patient response and ongoing research.1,8,9,11
5. Immunotherapy offers long-term benefits Allergen-specific immunotherapy can desensitise the horse’s immune system and provide sustainable relief. While requiring longterm commitment, it may reduce reliance on systemic medications and improve quality of life for chronic allergy patients.2,12 practitioners to assess treatment efficacy, adjust medications, and monitor for side effects.5 U Owner education: Owners play a critical role in implementing environmental control measures, administering medications, and observing for early signs of flare-ups. Clear communication improves compliance and clinical outcomes. 2
Future directions Several research avenues are critical to advancing equine allergy management.1,3,4,8,9 U Functional assessments: Evaluating transepidermal water loss, skin hydration, and pH can guide treatment efficacy. U Genetic studies: Understanding filaggrin and other barrier protein polymorphisms may enable personalised therapeutic approaches. U Microbiome research: Comprehensive studies on dysbiosis during flares may inform novel microbiomebased therapies. U Targeted lipid interventions: Clarifying lipid metabolism in
Conclusion Equine allergies reflect a complex interplay between genetic predisposition, immune dysregulation, and skin barrier compromise. Veterinary management requires a multifaceted strategy combining environmental modification, pharmacologic therapy, topical care, emerging biologics, and immunotherapy. Emphasis on barrier restoration, microbiome balance, and cytokine-targeted interventions represents a paradigm shift from purely symptomatic control to disease-modifying approaches. Veterinarians equipped with an understanding of these mechanisms are better positioned to improve clinical outcomes, reduce pruritus, prevent secondary complications, and enhance the quality of life for affected horses.
References Marsella R. Skin barrier function in normal and allergic horses. Vet Sci, 2025, 12(2), 91. Available at: https://doi.org/10.3390/vetsci12020091. 2. NextMune. Atopic dermatitis in horses: diagnosis and management [Internet]. NextMune; 2024 [cited 2025]. Available at: https://nextmune. com/en-us/vet/equine/allergy/atopy. 3. Discepolo DR, Gaare E, Handlos G, Perry EB. Fluctuations in equine cutaneous pH and transepidermal water loss with time of day and ambient conditions. J Equine Vet Sci, 2024 Sep;140:105140. doi: 10.1016/j. jevs.2024.105140. Epub 2024 Jun 29. PMID: 38950715. 4. My Pet Nutritionist. Can genes result in poor skin function? The role of filaggrin in skin barrier integrity [Internet]. 2021 [cited 2025]. Available from: https://mypetnutritionist.com/post/can-genes-result-in-poorskin-function/ 5. Littlewood J. Equine atopic dermatitis: latest on diagnosis and management [Internet]. Vet Times; 2022 [cited 2025]. Available from: https://www.vettimes.com/clinical/equine/equine-atopic-dermatitislatest-on-diagnosis-and-management-cpdeqpreventive. 6. Young A and Finno C. Insect bite hypersensitivity in horses [Internet]. UC Davis CEH; 2022 [cited 2025]. Available from: https:// ceh.vetmed.ucdavis.edu/health-topics/insect-bite-hypersensitivity. 7. Bazay C. Skin allergies in horses: causes, symptoms and treatment [Internet]. Mad Barn; 2025 [cited 2025]. Available from: https://madbarn. ca/skin-allergies-in-horses/ 8. Jebbawi F, Chemnitzer A, Dietrich M, et al. Cytokines and chemokines skin gene expression in correlation with immune cells in blood and severity in equine insect bite hypersensitivity. Front Immunol, 2024 Jul 15;15:1414891. doi: 10.3389/fimmu.2024.1414891. PMID: 39076967; PMCID: PMC11284025. 9. Rodrigues Hoffmann A. The cutaneous ecosystem: the roles of the skin microbiome in health and its association with inflammatory skin conditions in humans and animals. Vet Dermatol, 2017 Feb;28(1):60-e15. doi: 10.1111/vde.12408. PMID: 28133874. 10. Eaton S. Management of Equine Dermatological Allergies: A Review of Conventional and Complementary Therapies. Am J Trad Chin Vet Med, 1.
2024, 19(2):51-66. https://doi.org/10.59565/001c.121506. Marsella R, White S, Fadok VA, et al. Equine allergic skin diseases: Clinical consensus guidelines of the World Association for Veterinary Dermatology. Veterinary Dermatology, 2023. https://doi.org/10.1111/ vde.13168. 12. Veterinary Practice. Atopic dermatitis in dogs, cats and horses: comparative immunotherapy approaches [Internet]. Vet Practice; 2021 [cited 2024]. Available from: https://www.veterinary-practice.com/article/ atopic-dermatitis-in-dogs-cats-and-horses. U 11.
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Livestock
Volume 1 | No. 3
Spring flush syndrome in cattle: Managing the risks of rapid pasture transition With spring approaching in South Africa, cattle farmers face one of the most dangerous seasonal transitions on the farming calendar. ‘Spring flush syndrome’ is not a single disease. It refers to two common and deadly metabolic emergencies that affect cattle grazing on fast-growing, young spring grass: Grass tetany and frothy bloat. Both are triggered by the sudden dietary changes that happen when herds eat highly digestible, lush, new forage.1,2,3,4
After months on dry winter rations – balanced mixes of dry
magnesium absorption. Cattle on lush grass pastures are also more
forage, grains, and co-products – cattle are turned out onto green
likely to develop metabolic alkalosis (urine pH >8.5), which reduces
pasture. This rapid shift from a controlled, dry diet to lush spring grass
the supply of ionised calcium and magnesium, compounding the risk
places enormous stress on the rumen and on the animal’s metabolic
of both hypomagnesaemia and hypocalcaemia.2
system. The new forage is characterised by three challenging
The clinical signs are dramatic and often appear without
properties: low dry matter (often <20%), excessively high protein
warning. Affected cows exhibit hyperexcitability – sudden head-
coupled with moderate energy, and very low fibre content.1
throwing, loud bellowing, and erratic galloping. Muscular spasms
Lush spring grass can frequently be <25% dry matter, meaning
are common, and in severe cases, seizures occur. During seizures,
a lactating 600kg cow may need to consume up to 62.6kg of
cows may display paddling motions, chomping jaws, frothy
fresh grass daily just to meet energy requirements – more than
salivation, and eyelid fluttering. In extreme situations, respiratory
the rumen can physically hold at roughly 45.4-56.7kg.1
distress sets in, potentially leading to collapse and death. Clinical
The cow simply cannot eat enough to sustain herself. At the same time, the protein content of rapidly growing grass frequently exceeds the animal’s requirements while energy remains
signs can cause death within four hours, and a rapid rise in body temperature may follow a tetanic event. 2 Treatment must be immediate. Clinical cases require
inadequate. When rumen microbes face excess protein without
intravenous (IV) magnesium (2-4g), or subcutaneous injection
sufficient energy, deamination occurs: protein is broken down
of 200-400ml of 25% magnesium sulfate. A standard course
into ammonia, which crosses into the bloodstream, is converted
involves slow IV injection of 400ml of 40% calcium borogluconate
to urea by the liver, and excreted in urine. This protein-energy
and 50ml of 25% magnesium sulfate, since hypocalcaemia
imbalance is not merely an inefficiency – it is a direct precursor to
frequently accompanies hypomagnesaemia. However, animals in
both grass tetany and frothy bloat.
coma typically fail treatment, and stimulation during treatment can
1
trigger lethal seizures. 2
Grass tetany: The silent killer Grass tetany, or hypomagnesemia, occurs when the body’s
Frothy bloat: The rumen under pressure
absorption of dietary magnesium is insufficient to meet the demands
The conditions described in the studies – low fibre, high protein,
of lactation (~120mg per kilogram of milk) and maintenance (3mg
and rapid passage rates in lush spring forage – are precisely the
per kilogram of body weight). Unlike calcium, magnesium cannot
factors that predispose cattle to frothy bloat. When cattle graze
be reabsorbed from bone reserves to compensate for a transient deficiency, making cattle entirely dependent on daily dietary intake.
immature, low-fibre pasture, the rumen cannot maintain normal 2
Spring pasture creates the perfect storm. Fast-growing
motility and gas eructation. A stable foam forms that traps fermentation gases, leading to life-threatening rumen distension.
grasses contain high nitrogen levels (ranging from 4.2% to 6.3%,
Meteer observed that the low fibre content of immature
equivalent to 26%-39% crude protein), which leads to elevated
forages results in very high passage rates and unsatisfied cattle –
ammonium ion concentrations in the rumen, raising ruminal pH
cows appear hungry despite being knee-deep in green grass.1
and directly decreasing magnesium bioavailability.
2
The high potassium content of lush spring forage further hinders
The solution is straightforward: supplementing with palatable dry baled forage that is low or moderate in protein (not alfalfa hay)
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Livestock
Volume 1 | No. 3
can help address both the dry matter deficit and the fibre shortage.
and improved antioxidant status compared to those on grass-
Supplementing with grains – though not exceeding 0.5% of body
only pasture, suggesting that diverse swards may help buffer the
weight – or grazing only the top third of the grass plant can also
metabolic extremes of spring flush.4
help restore balance.1
Comprehensive training of farm workers to recognise early warning signs – changes in behaviour, appetite, or milk
Management and prevention
production – is essential for timely intervention. Regular blood and
Prevention of grass tetany centres on ensuring adequate
urine testing for magnesium and metabolic parameters can detect
magnesium intake before and during high-risk periods.
subclinical deficiency before it becomes a clinical emergency. 2
Supplementation with high-magnesium mineral feed should begin
Conclusion
at least 30 days before calving. 2 Cows need ~113g of a mineral mixture containing 12%
Spring flush syndrome demands respect. The transition from
magnesium daily. Magnesium oxide (MgO) can be added to
dry winter feed to lush spring pasture is not a single event but
grains, though its bitter taste requires mixing with palatable
a process requiring careful management. Supplementing with
ingredients such as molasses and concentrate.
magnesium, providing dry fibre alongside pasture, avoiding excess
2
During dangerous periods, 60gr of magnesium oxide can
potassium fertilisation, and considering energy supplementation
be supplemented daily. Magnesium can also be delivered by
and forage diversification are all evidence-based strategies that
spreading MgO powder (500g per cow) on hay or spraying a
protect herds. With preparation and vigilance, South African cattle
2% magnesium sulfate solution on pasture every one- to two-
farmers can harness the nutritional benefits of spring growth
weeks – though if rainfall >40-50mm within two- to three-days,
without falling victim to its hidden dangers.
the treatment must be repeated.
2
Pasture management is equally critical. Fertilisation should follow soil testing, and excessive potassium fertiliser should be avoided, as high potassium in lush spring forage directly hinders magnesium absorption. Providing dry hay or limiting grazing time to two- to three-hours per day slows food passage through the digestive tract and promotes magnesium absorption. 2 Energy supplementation during spring grazing can also help address the protein-energy imbalance. Research showed that supplementing grazing dairy cows with high moisture maize lowered milk and plasma urea concentrations by 0.72mmol/l and 0.76mmol/l respectively, compared to cracked wheat, indicating better nitrogen utilisation and a more balanced rumen environment.3 Pasture diversification also matters: Cows grazing legume and forb-based pastures showed lower beta-hydroxybutyric acid
References Meteer WT. Mitigating the Challenges of Grazing Lush, Spring Forages. [Internet]. Available at: https://uknowledge.uky.edu/cgi/ viewcontent.cgi?article=1147&context=ky_grazing 2. Kang D, Lungu SE, Danso F, et al. Animal health and nutrition: metabolic disorders in cattle and improvement strategies. Front Vet Sci, 2025. 3. Merino VM, Leichtle L, Balocchi OA, et al. Metabolic and Productive Response and Grazing Behavior of Lactating Dairy Cows Supplemented with High Moisture Maize or Cracked Wheat Grazing at Two Herbage Allowances in Spring. Animals (Basel). 2021. 4. Ford HR, Busato S, Trevisi E, et al. Effects of Pasture Type on Metabolism, Liver and Kidney Function, Antioxidant Status, and Plant Secondary Compounds in Plasma of Grazing, Jersey Dairy Cattle During Mid-lactation. Front Anim Sci, 2021. U 1.
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Wildside
Volume 1 | No. 3
South Africa’s biodiversity plan puts farms, livelihoods and nature at the centre
South Africa’s biodiversity is not a luxury reserved for national parks. It is living infrastructure behind productive land, reliable water, food, jobs and rural livelihoods. The country is one of the world’s megadiverse nations, contains three of the 36 global biodiversity hotspots and has almost 1000 distinct ecosystem types across terrestrial, freshwater, estuarine and marine environments.
More than 20 000 indigenous plant species occur here, with
The warning from the 2025 assessment
60.5% found nowhere else on Earth. The country has identified
The National Biodiversity Assessment 2025 provides a clear
263 terrestrial Key Biodiversity Areas, while its 3 000 km coastline
picture of the country’s ecological condition. Almost half (48%)
links rocky shores, beaches, estuaries, kelp forests, coral reefs
of South Africa’s ecosystem types are threatened. Estuaries,
and deep-sea habitats. More than 13 000 marine species have
rivers and wetlands are the most threatened and least protected,
been recorded. Around 290 functional estuaries support diverse
a serious concern in a country where water security is inseparable
life and help protect coastal communities from extreme weather.
from functioning catchments and wetlands. Around 16% of
South Africa now has 32 Ramsar sites (important wetlands
assessed plant species and 10% of assessed animal species are
protected under an international treaty).
threatened. Freshwater fish face especially high risk (66%), as do
This natural wealth is working wealth. Indigenous plants and harvested marine species contribute to food and livelihoods.
cartilaginous fish (42%). The assessment also introduces a genetic warning: 58%
Savannas and grasslands support rangelands and crop
of assessed populations are below the effective size required
agriculture, while strategic water source areas provide 50% of the
for long-term genetic health. A population with too little genetic
nation’s water from only 10% of its land area.
diversity is less able to withstand disease, drought or changing
The draft National Biodiversity Strategy and Action Plan
conditions. For agriculture, this is a reminder of the value of
(NBSAP) 2026-2035 therefore matters well beyond the
indigenous genetic resources, crop wild relatives, landraces and
conservation sector. It is South Africa’s third NBSAP and its latest
locally adapted livestock systems.
vehicle for meeting responsibilities under the Convention on
Protected areas have expanded. In 2025, protected and
Biological Diversity (CBD), ratified in 1995. Its question is practical:
conserved areas covered ~17% of South Africa’s terrestrial area
How can South Africa conserve the systems on which people
and 15% of its marine territory. Biodiversity stewardship was central
depend while sharing biodiversity’s benefits fairly?
to meeting and exceeding terrestrial protected-area targets by
South Africa’s biodiversity is more than a conservation priority. It is the natural capital that underpins our economy, wellbeing and future resilience.
2020, showing what can be achieved when private and communal landholders are partners in conservation. Yet rivers and wetlands remain poorly protected, and a percentage on a map does not by itself guarantee ecological health. The pressures are familiar to farmers and rural communities. Land conversion for croplands, grazing, plantation forestry, settlements and mining removes habitat. Overgrazing reduces vegetation cover, accelerates soil erosion and sends damaging effects downstream. Dams, abstraction and altered river flows affect estuaries.
Vet’s Hub
Wildside
Volume 1 | No. 3
Invasive alien plants consume water and increase fuel
Biodiversity: An inclusive, transformed society living in harmony
loads, while non-native predatory fish disrupt rivers. Acid mine
with nature, where biodiversity conservation and sustainable use
drainage, industrial and urban effluent, agricultural return flows and
ensure healthy ecosystems, with improved benefits that are fairly
stormwater runoff further degrade aquatic environments.
and equitably shared for present and future generations.
These are not separate problems. Degraded soil means less
Its impact is expressed simply as ‘Thriving People and
productive grazing and greater vulnerability to drought. A damaged
Nature’. The strategy aligns with the Kunming-Montreal Global
wetland stores and filters less water, while a cleared or invaded
Biodiversity Framework adopted by CBD Parties in 2022, while
catchment can increase flood risk and reduce dry-season flows.
reflecting South Africa’s water scarcity, land degradation, rural
Declining ecosystem resilience eventually becomes a direct cost to farming, livestock production, households and local economies.
What the previous plans teach us South Africa’s first NBSAP, published in 2005, was built on the National Spatial Biodiversity Assessment of 2004. Of its 122 activities, 54% were fully or substantially achieved. It strengthened institutional coordination and contributed to provincial spatial
Protecting biodiversity requires action far beyond protected areas, with every sector playing a role in securing South Africa’s natural heritage
biodiversity plans and the first National Biodiversity Framework. But it also showed that mainstreaming biodiversity into other sectors takes longer than expected and depends on opportunities outside the direct control of the biodiversity sector. The second NBSAP, covering 2015-2025, delivered significant
poverty, diverse farming sector and need for transformation. The action plan is organised into 12 thematic areas: Mainstreaming, restoration and invasive alien species, ecosystem and species conservation, human-wildlife coexistence,
gains. Terrestrial protected-area targets were met or exceeded
sustainable use and the biodiversity economy, pollution and
by 2020, largely through biodiversity stewardship, and marine
waste, ecological infrastructure and climate resilience, access
protection increased dramatically from less than 0.5% to 5.4%.
and benefit sharing, biosafety and biotechnology, means of
Technical capacity also improved, including an integrated national
implementation, and knowledge, participation and inclusion.
ecosystem map and natural-capital accounting for protected areas and strategic water source areas. Progress was uneven. Only five of 22 strategic outcomes were
This recognises that conservation cannot be delivered by protected areas alone. Biodiversity must influence spatial planning, agriculture, water management, mining, infrastructure, urban
fully achieved - 14 remained in progress and three had unknown
development and private-sector decisions, supported by restoration,
status, largely because monitoring was lacking. Although nominal
compliance, finance, research and meaningful participation.
expenditure increased, inflation reduced its real purchasing power. The lesson is to set achievable outcomes, assign
From pressure to practical response
responsibility, publish progress and measure whether conditions
The plan’s response to habitat loss includes biodiversity-inclusive
improve – not merely whether activities were listed.
spatial planning and better management of protected areas. Restoration is an ecological and livelihood opportunity. Rangeland
A plan for ‘Thriving People and Nature’
initiatives promoting rotational grazing, native vegetation recovery
The 2026-2036 draft NBSAP adopts the vision of the White
and community governance offer a model for livestock areas.
Paper on the Conservation and Sustainable Use of South Africa’s
Invasive alien species management is paired with restoration rather than treated as a once-off clearing exercise. Priority catchments and strategic water source areas can benefit twice: Habitat recovers, while water security and climate resilience improve. The plan also links ecological infrastructure to ecosystem-based adaptation and nature-based solutions. Healthy wetlands, rivers and riparian zones regulate water flows, buffer floods and droughts, protect infrastructure and sustain livelihoods. Pollution has its own thematic area for the first time. That is significant because agricultural nutrient runoff, pesticides, failing wastewater systems, mining legacies and illegal dumping cannot be solved by conservation agencies working in isolation. The draft calls for stronger baselines, accountability, compliance monitoring, enforcement and remediation of contaminated sites.
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Wildside
Farmers are part of this solution through responsible soil, nutrient
Volume 1 | No. 3
hunting, harvesting, hiking and cultural uses. Traditional medicines
and water management, but they also need reliable municipal
and indigenous products connect natural resources to rural
services and fair, consistent regulation upstream and downstream.
enterprises and livelihoods.
Climate change increases urgency. Prolonged drought in the
The draft plan places sustainable use at the centre of this
arid west contributes to species declines, while extreme weather
opportunity. Its intention is not to extract more until resources
affects coastal and estuarine systems.
are depleted, but to build legal, well-regulated and inclusive value
Climate change also amplifies other pressures by interacting
chains. Enterprise development should create space for rural
with invasive species, altered fire regimes and habitat degradation.
communities and designated groups, while better permitting,
Maintaining connected, functioning ecosystems is therefore a
traceability, compliance and enforcement protect the biological
form of risk management for agriculture and rural communities,
foundation of the economy. When people receive meaningful
not an alternative to development.
benefits from well-managed biodiversity, they have a stronger stake in protecting it.
Healthy ecosystems provide clean water, food security, climate resilience and sustainable livelihoods, making biodiversity an investment in our collective future
Access and benefit sharing is particularly important for farmers, communities and traditional knowledge holders. The plan proposes stronger systems for sharing monetary and nonmonetary benefits arising from genetic resources and associated knowledge. It also recognises the importance of securing indigenous genetic resources, crop wild relatives and domestic landraces in gene banks and community seed banks – an investment in future food security as much as in conservation.
Implementation will decide the outcome
The marine evidence is equally sobering.
The largest risk is that the third NBSAP becomes another
The number of species evaluated in South Africa’s marine fishery
statement of good intentions. Biodiversity investment remains
resources report grew from 22 in 2008 to 65 in 2025, reflecting
heavily dependent on the public sector and accounts for less than
improved monitoring. Yet depleted or heavily depleted stocks
1% of the consolidated government budget. Nominal expenditure
accounted for 31% of monitored resources in 2025. Sustainable
rose from R15.25 billion in 2016 to R20.14 billion in 2024, but real
use, science-based management, bycatch reduction and support
purchasing power fell from R14.31 billion to R12.9 billion. The draft
for customary and small-scale fishers are essential if coastal
calls for domestic resources, international climate finance and
livelihoods are to endure.
private-sector contributions, with an access goal of $8 billion annually and greater use of innovative finance.
Growing the biodiversity economy fairly
It also proposes outcome-oriented indicators aligned with
South Africa already has a substantial biodiversity economy.
the Kunming-Montreal Global Biodiversity Framework. This
Biodiversity-based tourism contributed R27.7 billion in direct GDP
means asking whether ecosystems are recovering, extinction
and supported more than 90 000 positions in 2019. The wider
risk is falling, water-related ecological infrastructure is functioning,
biodiversity economy includes fishing, aquaculture, ecotourism,
resource use is sustainable and benefits are reaching rights holders. Monitoring must be regular, public and useful to decision-makers. For South Africa’s farmers, livestock producers and rural communities, the stakes are concrete: soil that stays on the land, water that remains available, rangelands that recover, fisheries that support families and biodiversity-based enterprises that share value fairly. The draft NBSAP’s strongest idea is that these outcomes are connected. Thriving nature is the foundation that allows people, farms and rural economies to thrive.
Reference Department of Forestry, Fishery and the Environment. South Africa National Biodiversity Strategy and Action Plan 2026-2035. 2026 [Internet]. Available at: https:// www.dffe.gov.za/sites/default/files/docs/strategy. framework/biodiversity/draft.nbsap202636.pdf U
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