The Veterinarian Magazine August 2021 Issue

TheVeterinarian ■ August 2021

■ www.theveterinarian.com.au

Investigating wellbeing at work

Everyone likes to feel appreciated for the work they do and veterinarians are no exception, so the results of a recent study published in Vet Record that invited Australian vets to respond to a Ten Statements Test with the prompt, ‘I derive pleasure in my work as a veterinarian when…’ unsurprisingly confirmed that when vets are shown trust and respect by

their clients, and are thanked for their work, it makes them feel good.

Lead author Madeleine Clise, a psychologist and Adjunct Lecturer at the University of Adelaide’s School of Psychology, said the study investigated the positive side of veterinary work, and specifically focused on what brought vets pleasure in the job. For people to continue to be

inspired and motivated to remain in, and to be attracted to the profession this was an important factor to be considered.

“At a time when there are national shortages of vets - particularly in regional areas - and increased publicity about the risks and challenges in the profession, we need to focus on what contributes to vets experiencing positive emotions so we can better understand how to improve the wellbeing of those who care for our beloved pets, livestock and wildlife,” Clise said.

The survey was completed by 273 vets and the 2536 responses received were then grouped into themes and sub-themes and categorised using the ‘Job Demands-Resources Model’ which focuses on both the positive and negative aspects of a job that are indicative of employee wellbeing.

Believed to be the first empirical study of its kind for vets senior author Michelle McArthur, Associate Professor at the UA’s School of Animal and Veterinary Sciences, said that while the responses were somewhat surprising they revealed To page 30

Mobile wildlife hospital receives bushfire recovery grant Byron Bay Wildlife Hospital has been awarded $401,500 for the construction of accommodation and training facilities for emergency wildlife veterinarians, vet nurses, volunteers and carers.

“Wildlife vets, nurses and carers are critical to the conservation and care of Australian wildlife,” Byron Bay Wildlife Hospital (BBWH) Founder and CEO Stephen Van Mil said.

“They are essentially on call 24/7, putting enormous strain on them and their families. We desperately need infrastructure enabling these care professionals to be accommodated close to the native animals in their care.”

The Wildlife Vet Stay and Training Centre will use local businesses and contractors to plan, construct and fit out two fixed and connected ‘Tiny Houses’ and a facility for education programs. It will also support life education programs for indigenous youth dealing with trauma and loss by facilitating healing and learning through connection with Australian wildlife.

The grant funding is part of the $4.5 billion commitment from the NSW and Commonwealth governments to support economic, social, built and natural environment recovery from the 2019-20 Black Summer Bushfires.

Local Nationals Member of the Legislative Council Ben Franklin said this investment from the State and Commonwealth Government’s would support the Byron Bay Wildlife Hospital to continue offering crucial and life-saving care.

“Byron Bay Wildlife Hospital has treated almost 1000 wildlife patients in ten months, working with wildlife carers and vets across the NSW North Coast andhinterland,” Franklin said.

“Infrastructure of this kind will help the Wildlife Hospital meet the growing demand for dedicated wildlife treatment, provide an essential, practical service for vets, volunteers and carers, and draw people to the region as a hub for education and skills development in wildlife conservation.”

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ON THE INSIDE

4

NEWS Native animal welfare

5 NEWS Supporting mental health

6 FACE TO FACE Warren Foreman

Byron Bay Wildlife Hospital Communications Director Russell Mills, Bree Talbot, and NSW MLC The Hon Ben Franklin

Byron Bay Wildlife Hospital is based in the Northern Rivers, an Australian biodiversity hotspot.

The not for-profit organisation’s footprint is expanding as it continues to relieve the burden of providing wildlife care from general practice veterinarians.

“We’re honoured and grateful that the NSW and Australian governments have seen the merit in our project.

Our vision is that this will help develop a new narrative for our region as a hub for wildlife conservation, with resources and facilities collaboratively created by the community, business, veterinary professionals and the NSW and Australian governments,” Van Mil said.

17 CLINICAL FEATURE Toxicosis in dogs and cats KIWI POST

9

VET ETHICS

11

MANAGEMENT

12

ABSTRACTS

14

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News

Fencing out ferals gives juvenile wallabies a head start A strategy that has helped in the conservation management of birds, fish and reptiles has also proved successful in slowing the decline of Queensland’s bridled nailtail wallaby populations (Onychogalea fraenata).

Although common during the early days of European settlement, the nocturnal nailtails were believed to be extinct by the late 1930s. They were rediscovered by chance in 1973 when a fencing contractor working on a property at Dingo recognised their distinctive white bridle markings after reading an article about the species in a women’s magazine.

Since then, conservation efforts for the species have proved challenging due to feral cat predation on juvenile nailtails, which at under 3kg are easy prey for cats, but the results of a study published recently in Current Biology has found the ‘head starting’ method to be a costeffective intervention that can help ensure juveniles reach a size when they are less at of a risk from cats.

Lead author and PhD candidate Alexandra Ross, from the University of NSW’s School of Biological, Earth and Environmental Sciences, said previous studies had shown

more than half of the young bridled nailtails were killed before they reached adulthood, whereas the survival rate for adults was much greater, suggesting size was a good predictor of survival.

“We figured out if we can just get the juveniles through that tough period – when they’re still little and an easy size for a cat to prey on – by putting them in feral-free protected areas, then we could make a positive difference to the population numbers,” Ross said.

Between 2015 and 2018 scientists rounded up 56 bridled nailtail juveniles and placed them within the headstart enclosure at Emerald’s Avocet Nature Refuge, in central Queensland.

At the beginning of the study in 2015 there were an estimated 16 animals at Avocet, but when a recount was conducted in 2018 after three years of gradually releasing headstarted wallabies that had reached the right size, the estimate of the total nailtail population – both inside and outside the enclosure – was 47.

Co-author Mike Letnic, also from UNSW’s School of Biological, Earth and Environmental Sciences, said

the head starting project involved fencing off an area of about 10 hectares, which was big enough to hold about 30 or 40 wallabies at a time.

“We’re basically growing them from football size to medicine ball size before releasing them back into the wild, which can take anything from a few months to a year.

For the most part they’re fending for themselves in the head start enclosure, just like they do in the wild except without the threat of feral animals. But they aren’t completely protected – they can still get eaten by eagles, which means there’s still some predator recognition,” Letnic said.

When Ross and her fellow researchers did the modelling to determine how the population would fare without, or with, varying lengths of head starting scenarios either none, five years, 10 years, 20 years, and 50 years - they found extinction resulted once head starting ceased - within a timeframe of two to 52 years.

“What this tells us is that until we find a way to eliminate feral cats in the wild, head starting may be the only way to keep this population at a sustainable level, and one of the

great things about head starting is that it’s relatively cheap, doesn’t interfere too much with animals’ awareness of predators, and can get good results in a short time,” she said, adding that other land-based and endangered mammal species that are particularly vulnerable in their early life stage could also potentially thrive under the strategy.

One drawback to head starting that has been identified is that time spent in feral-free enclosures can result in animals losing their fear of predators, but Ross believes this problem can be avoided because animals are only separated from predators for a few months, or at most a year. Human interaction is also minimal, and the juveniles retain some predator awareness since they are still preyed upon by snakes and eagles.

It is believed just 500 nailtails live in the wild, and there are over 2000 of the animals in captivity.

Ross’ future project will examine the length of time it takes for wallabies to fully integrate back into the wild after being released from the head start enclosure.

Outcry over repeated export cruelty breaches

place until the department is satisfied that the exporter's arrangements at the facility will meet Australia's export requirements,” a department spokesman said.

“The department has commenced an investigation into the matter and will take regulatory measures where warranted as the investigation progresses.”

A spokesperson for LSS told ABC News that the Jordanian facility in question had not previously had non-compliance issues, and that the company suspended slaughter and sales at the location and commenced an investigation.

“LSS [is] currently working with local authorities to remove all the remaining sheep from the facility and relocate them to an approved feedlot,” the spokesperson said.

“Loading of the sheep will be overseen by the Jordan supply chain manager to ensure animal handling and transport meets ESCAS requirements.”

Calls are growing for tougher enforcement of live export regulations following repeated breaches by a Jordanian-owned company.

RSPCA Australia said Perthbased exporter Livestock Shipping Services (LSS) has notched 44 breaches of the Exporter Supply Chain Assurance System (ESCAS) framework created to prevent cruelty in supply chains.

The non-compliance is reported to have involved sheep and to have occurred at an unnamed abattoir in Jordan, according to ABC News.

RSPCA Australia Senior Policy Officer, Jed Goodfellow, said the Department of Agriculture’s regulatory approach requires more teeth.

“There is almost no deterrence built into the Department’s compliance approach,” he said.

“No wonder this keeps happening.”

Goodfellow said that last year sheep exported by LSS were found in 10 separate unapproved locations

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in Jordan, with various posts on social media advertising their sale outside of approved supply chains.

“But where were the actual consequences? The Department required LSS to develop a ‘more robust management plan” for next time’”, he said.

“With ‘sanctions’ like this, it’s no wonder the exporter has a rap sheet as long as it does.”

Goodfellow said LSS’s 44 breaches of ESCAS over the past eight years is 14 more than the next highest exporter.

“If exporters cannot respect Australian law, they do not deserve to do business here,” he said.

“Removing LSS’s export licence is the only appropriate sanction…in no other line of work do you get to break the rules 44 times, and still keep your licence.

“Revoking their licence would be proportionate to the scale of non-compliance this exporter has

engaged in and the magnitude of suffering to which it has contributed over many years.”

The RSPCA wrote to Minister David Littleproud and Department Secretary Andrew Metcalfe in August last year calling for an urgent review of the framework, but the organisation reports it has not been notified of any outcome to this review.

“The Department of Agriculture must get serious about upholding its own regulations, because it’s clear that without tough penalties, exporters will continue flouting the rules,” Goodhew said.

“We are once again calling for an urgent review of the Department’s enforcement framework.”

The Department told ABC News that it had contacted an Australian exporter in late July and directed it to cease supply of sheep to an export-approved facility in Jordan.

“This direction will remain in

■ ANNE LAYTON-BENNETT

■ SAM WORRAD

AUGUST 2021 TheVeterinarian 3

News

AVA recommends action against habitat clearing The Australian Veterinary Association (AVA) has published a new policy on native animal welfare which incorporates recommendations designed to protect Australia’s native animals from the threat of habitat clearing. The policy acknowledges the importance of habitat loss along with the suffering of animals killed by such clearing.

“This new Native Animal Welfare policy is important as it recognises the threat of habitat clearing and advocates important steps to mitigate key issues. These include minimising the area of native vegetation impacted, assessing biodiversity risks and considering codes of conduct to monitor and support animals displaced where possible,” Michael Banyard, an Executive Committee member of the Australian Veterinary Conservation Biology special interest group, said.

“With respect to habitat clearing, many animals and populations of animals not killed immediately die from ‘legacy’ effects, which can set a species on a declining trajectory and possible extinction years or decades later. Many of Australia’s native animal habitats have been heavily impacted by human activity, and the list of species under threat is increasing rapidly. Native animals depend

solely on their environment for shelter, food and breeding security.”

The new policy states that where clearing of wildlife habitat is proposed, operators should adhere to the principles of ecologically sustainable development, and every effort should be made to minimise the animal welfare impacts on native wildlife.

The policy also states that a native wildlife assessment should be performed to evaluate the potential impact on wildlife and biodiversity in the bioregion if the habitat is a remnant or mature regrowth habitat, an area of high conservation status, or where clearing approval is required under existing legislation.

Land should also be set aside as designated national parks or reserves and wildlife corridors in each bioregion, for the maintenance of a balanced and healthy ecosystem.

“Animal welfare legislation in a number of states also need to be amended to ensure that exemptions from prosecution are replaced by a duty of care to ensure that native animals impacted by habitat clearing are given the same level of protection as other animals.”

“Actions are urgently needed not only to protect native animals but also to support the environment on

which all of humanity depends. This environmental protection is critical for the provision of ecosystem services like clean water, clean air, climate mitigation and minimising the threat of emerging infectious diseases like COVID-19 and Hendra virus,” Banyard said.

The Native Animal Welfare (Habitat Clearing) policy outlines that where habitat clearing occurs, five recommendations should be followed to improve welfare outcomes for wildlife. First, that the minimum area of native or remnant habitat should be cleared. Secondly, that wildlife affected by habitat clearing should be protected by animal welfare legislation and codes of practice.

Further recommendations state that the landowner or lessee meet their duty of care to take all reasonable steps to mitigate the death and suffering of wildlife as regulated by the relevant State and Federal legislation. In conjunction with this, exemptions from prosecution for animal welfare infringements during habitat clearing should be removed from legislation and replaced by a duty of care requirement.

The policy also recommends management of National Parks and

Picture RSPCA

other Reserves be in accord with nature or managed by legislation sensitive to the natural order to prevent catastrophic destruction of habitats and the subsequent impacts on the welfare of native animals.

“Habitat loss in area and degradation in quality, including the incursion of feral species like cats, cane toads, plants and novel fungi, have directly and indirectly contributed directly to the death of millions of native animals yearon-year,” Banyard said.

“The decline in free-living vertebrate animals in the last 50 years is stark. The key driver is humaninduced change. This policy reinforces the AVA’s position as a key animal welfare advocate.”

Fears of toxic chemical overload in pinnipeds Part of a long-term collaborative health study of Australia’s seal and sea lion populations, conducted from 2017 to 2020 in several of their South Australian and Victorian colonies, has identified per- and polyfluoroalkyl chemical substances - known collectively as PFAS - in the pups, juveniles, and one adult male, of these endangered pinnipeds.

Researchers also found evidence that PFAS chemicals transfer from mothers to newborns.

Several previous studies have reported the toxic effects of PFAS on both animals and humans but research on how they impact on marine wildlife has been, ‘predominantly limited to studies in the northern hemisphere and Antarctica’, according to this latest study published recently in the journal Science of the Total Environment.

A growing awareness of the environmental and health impacts from PFAS has resulted in, ‘a gradual phase out of selected compounds’ that may cause cancer, reproductive and developmental defects, endocrine disruption, and compromised immune systems. PFAS exposure can occur through contaminated air, soil, and water, as well as commonly used household products that contain these chemicals. These include stain repellents, polishes, paints and coatings, and some fire-fighting foams.

South Australia banned the use of fire-fighting foams that contained PFAS in 2018 but they are still in use in Victoria, and in partial use in NSW, putting further pressure on Australian sea lion populations which have already declined more than 60 per cent over the last 4 TheVeterinarian AUGUST 2021

40 years. In addition to threats from hookworm and tuberculosis (The Veterinarian, Jan/Feb 2021) the scientists suggest PFAS concentrations in some pinniped species are comparable to those in marine mammals in the northern hemisphere, including sea otters and harbour seals.

“Upper trophic marine predators are particularly vulnerable to bioaccumulation of these substances due to the high affinity of PFAS for protein-rich tissue and their slow elimination by the body,” the study stated.

Co-leader of the research team, Rachael Gray, senior lecturer in veterinary pathology at the University of Sydney’s School of Veterinary Sciences, said the particularly high concentrations of PFAS chemicals found in newborns, transferred during gestation or via their mother’s milk was especially concerning given the importance of the developing immune system in neonatal animals.

“While it’s not possible to examine the direct impacts of PFAS on the health of individual animals, the results are crucial for ongoing monitoring. With the Australian sea lion now listed as endangered, and Australian fur seals suffering colonyspecific population declines, it’s critical that we understand all threats to these species, including the role of human-made chemicals, if we’re to implement effective conservation management,” Gray explained.

She said there were also potential human health impacts from environmental PFAS contamination, so the findings have implications for the entire food chain. To page 30 ■ www.theveterinarian.com.au

News

Supporting good mental health in vets across Australia

Natasha Wilks is joining forces with Beyond Blue and animal health company Zoetis to raise awareness of the importance of good mental health of Australian veterinarians and to reduce the suicide rate in the profession nationwide. The campaign, which was launched in 2016, is now entering its sixth year of raising much needed funds, supporting veterinarians with wellbeing challenges and reducing the stigma around managing mental health. Given that veterinarians are four times more likely than members of the general population to take their own lives, the need for mental health support to the profession is vital.

“I’ve been a speaker for Beyond Blue since 2016,” Wilks said. “I became involved in 2019 to assist Zoetis and Beyond Blue amplify these important mental health challenges, and importantly, encouraging the veterinary industry to start having the conversation around mental health, and through this initiative offer practical tips on managing mental health and to help to connect vets with support networks.”

Wilks is uniquely placed to lend her voice to this important joint initiative. After qualifying as a veterinarian in 1999, she began working as coach in 2006 and founded her business, High Performance Vets, five years later. She is particularly interested in helping veterinarians enjoy their practice, recognising that they need far more than clinical skills to work effectively and successfully. Naturally, all of these skills are far more easily acquired and developed if they are based on a firm foundation of good mental health – not only for veterinarians, but also for vet nurses, practice

managers and all clinic staff.

“Prioritising the mental health and wellbeing of employees is important in veterinary practice,” Wilks explained. “Wellbeing is the ability to feel good and function well, not just the absence of disease.

High levels of wellbeing in the workplace contribute to higher performance and productivity, increased engagement and satisfaction, as well as less absenteeism, fewer workplace accidents and reduced staff turnover.”

Beyond Blue provides free and readily available resources for anyone struggling to maintain their wellbeing. The funds raised by the joint Zoetis/Beyond Blue campaign will go towards supporting existing support services including online forums providing peer networks and human connection, as well as counselling, advice and referrals via phone, webchat and email.

“To date, Zoetis’ donations across veterinary and rural farming initiatives have allowed over 8,000 people, including vets, to get the help they need through the Beyond Blue Support Service,” Wilks said. “We are hoping to help more people this year.”

A new service that may be beneficial to veterinarians requiring assistance is Beyond Blue’s recently launched NewAccess for Small Business Owners, which is a free and confidential mental health coaching program. “Delivered over six telehealth sessions, coaches who themselves have a small business background help small business owners experiencing stress and worry,” Wilks said. “Coaches operate with oversight from clinicians and are trained to refer participants to specialist services if required.”

Wilks herself has contributed an on-demand webinar specifically for veterinarians as part of the campaign called Wellbeing for Vet Practices. “I created the webinar as an introduction to wellbeing and understanding the importance of mental health,” Wilks explained.

“It is a short training video of 25 minutes, which can be viewed individually or used in a team meeting, and contains actionable strategies that can be implemented immediately.” To page 30

NATASHA WILKS’ TIPS FOR MANAGING MENTAL HEALTH Here are some practical tips on managing mental health in a veterinary practice: Manage your energy & capacity - Physical and emotional exhaustion contribute to burnout. It’s important to be aware of your energy levels and your capacity to cope with the challenges of the workday and work week. Recognise when you are fatigued and take the time to rest, recover and recharge. The key five are critical for your mental health: getting enough sleep, healthy nutrition, physical activity, taking a break every day and holidays.

Focus on what you can control - There is so much outside of your control at the moment, such as client behaviour and the lockdowns. Focus on what you can control, which is your response to various situations. Don’t waste your energy on what you can’t control.

Embrace self-compassion - Being an essential worker, veterinary teams have worked through the pandemic with a significant increase in workload and change in the way they work. Listen to your body when you are tired and overwhelmed and be kind to yourself. Give yourself permission to take breaks, to put goals on hold and do what you need to cope in these challenging times.

Change your perspective - As vets, we go through academia seeing mistakes as failures that affect our grades. In the real world, we need to live with the unexpected, so we have to be realistic and kind with ourselves to grow from adversity.

Moments of joy - It’s so easy to focus on everything that is going wrong. However, change your focus to notice what is going well during the workday. Begin to notice those small moments that bring you joy, whether it’s a case gone well, a client saying thank you or something as simple as puppy cuddles.

Be hopeful and optimistic - Having a positive expectation for the future is an important component of resilience. The pandemic will end, and you can get through this.

Stay Connected - This can be a time of significant isolation for many people. Look for moments of connection with your team and clients in practice, reach out to friends and family to stay connected and use them as support when needed.

Find empowerment - Clinical Leaders and Practice Managers should provide a clear process for dealing with customers and guidance on when to escalate problems. Letting team members know that they have your support and what they can say in tough situations will give them the confidence to engage and disengage as needed. Part of dealing with difficult conversations is also understanding that customers are going through some of the same challenges we are.

Speak out and get help – Reach out to organisations that specialise in supporting mental health. Beyond Blue has developed a free six-week program, NewAccess for Small Business, which offers support by trained mental health coaches who have a background in small business.

For more information, visit www.beyondblue.org.au/newaccess-SBO

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AUGUST 2021 TheVeterinarian 5

FACE TO FACE It is fortunate that Warren Foreman knows how to pace himself. As a two time participant in the Paris-Brest-Paris cycling event, which requires competitors to cover more than 1, 200 kilometres within just 96 hours, Foreman is no stranger to challenging himself physically.

While the French countryside en route is spectacular and the camaraderie between the riders delightful, Foreman admits that coping with lack of sleep is among the biggest challenges for contestants, who have to ride virtually all day and all night to complete the course in the time allowed.

More recently, Foreman has been testing his endurance in a rather different way: almost a year after being announced as the 2020 Veterinarian of the Year, he has been waiting and hoping – stay at home orders and border closures permitting – that he will finally be able to receive his award at Australian Small Animal Veterinary Association conference on the Gold Coast in August 2021. It has been a long wait, but Foreman has registered for the event and is looking forward not only to receiving his award, but also to attending a conference after such a lengthy break. “I think 2020 has been a blur for so many of us – crazy times,” he said. “None of us predicted the increased patient numbers on top of the massive practical difficulties that arose in safely dealing with our patients during a human pandemic.” Unfortunately, at the time of writing, millions of Australians are in lockdown as the highly infectious Delta variant of coronavirus wreaks havoc across the country, and it may well be necessary for Foreman’s award ceremony to be delayed and for his patience to be tried once again. Getting from his home in Adelaide to the Gold Coast may yet prove to be more challenging than cycling from Paris to Brest and back again.

Strangely enough for an avid cyclist and winner of the Veterinarian of the Year award, Foreman was not particularly sporty when he was a child and never contemplated becoming a vet. He grew up south of Adelaide in a small town called Willunga (Kaurna Country), in the same district where his parents and been born and raised. Ironically, Foreman’s childhood home was at the bottom of

PACING HIMSELF WARREN FOREMAN, 2020 VETERINARIAN OF THE YEAR

skillset and is that Foreman is now fortunate enough count zoo work as providing clinical highlights in his career, having performed orthopaedic work on orangutans and chimpanzees and done dental work on a lion and a sun bear.

Foreman counts establishing Adelaide Animal Hospital as another career highlight. Having founded the Hospital in 1999, he has subsequently has expanded the practice to include sites at Prospect, Goodwood Road and Stirling. True to form, to complement his growing business responsibilities he also completed a Graduate Certificate in Management, a qualification he deemed “important in managing the growth of the practice and being better able to understand the complexities of a veterinary business.”

In 2011, Foreman received a Meritorious Service Award for his dedicated service to the veterinary profession, including providing continuing education events to South Australian small animal veterinarians, as well as serving (at various times) as President of the then-called Australian Veterinary Practice Managers Association and of the South Australian division of the Australian Veterinary Association. “I have been an AVA member since my student days,” he said. “I have always been a firm believer in the value of the AVA to our profession and in collectively advocating for the areas of our expertise within the greater community.”

To Foreman’s “complete surprise”, Jenni Trewren, his colleague and partner at Adelaide Animal Hospital, nominated him for the 2020 Veterinarian of the Year award, an accolade he says it is “very humbling and totally unexpected” to be receiving. “There have been some very well credentialed and high

Willungra Hill – now famous for its inclusion as a hill climb in Australia’s premier cycling race, the Tour Down Under. His father worked at various jobs, starting out as a patternmaker for General Motors Holden before working as a carpenter and eventually starting his own plumbing business. His mother looked after the house, the kids – Foreman, his older brother and younger sister – and the books for the business. “Mum and Dad were not sports people, so neither were we kids,” he explained.

Nevertheless, Foreman and his siblings enjoyed what he describes as “a very outdoors upbringing”, largely due to them working with their father on weekends. “We would be assigned all sorts of plumbing tasks – digging, laying drains, roofing, and so on – it was a great way to learn practical skills.”

It was not until he attended a high school careers night and got talking to a couple of vets that Foreman considered studying Veterinary Science. “We always had a cat, a dog and some chickens at home,” Foreman recalled, but up until that point he had been planning to study

profession is that there are so many different career pathways and possibilities.” Although he describes his own career progression as being “rather linear” in comparison with some of his colleagues, Foreman has relished the opportunity to expand his veterinary knowledge and skills. “I have found great satisfaction in pursuing further studies and gaining new expertise in a variety of related fields and have been fortunate enough to use these in my day to day clinical work,” he said. “Learning skills and being able to apply them to help your patients is a real buzz.”

In 1985, Foreman gained membership

civil engineering at Adelaide University.

“The work the vets described was very different from anything I had experienced, it seemed a little exotic and challenging, and provided the prospect of an interesting career,” he said.

“I thought I would have a go at getting into the course, and ended up putting down civil engineering as my second choice.”

After applying to study Veterinary Science at both Melbourne and Sydney Universities, Foreman ended up being accepted into both courses but had already enrolled at Melbourne University by the time the Sydney University offer arrived. He graduated with Honours in 1979, also completing a Bachelor of Animal Science as a research degree halfway through his veterinary course. “The Animal Science degree was in ruminant physiology and certainly didn’t have any clinical applications,” Foreman said. “It was a good way to road test a research career, and while I found it very intellectually stimulating I learnt that I am more suited to clinical practice.”

Upon graduating, Foreman began working in clinical practice at Trinity Gardens Veterinary Hospital in Adelaide in 1980. He subsequently worked at practices in South Melbourne and the Riverland before returning to Adelaide in 1992.

“Working as a veterinarian has been both very rewarding and very challenging at times,” he commented. “One of the great things about this

of is that there are so many different career the pathways and possibilities.’

Australian and New Zealand College of achievers amongst previous awardees,” he said.

Veterinary Scientists in Canine Medicine and “I did not consider myself to be in this league!” developed a particular interest in dentistry and Even if circumstances prevent him from oral surgery after perceiving a need for a canine travelling to the Gold Coast to receive his dentistry practitioner in Adelaide. “The interest prize, Foreman has many plans for the future – in dentistry was sparked by a canine patient including spending the next few months who had broken a canine tooth who happened to be owned by a dentist,” he said. “This reducing his workload and road testing coincided with the beginning of the Australian retirement. “I do not feel quite ready to be on Veterinary Dental Society and the general the professional scrapheap yet,” he said. “If I upskilling of the profession in veterinary miss the buzz of solving clinical problems and dentistry pioneered by the late Dr Stephen seeing patients bounce back from illness and Coles, who was a class mate. I just ‘rode that injury, I will continue working part time in bus’: bought the equipment, made contact with some capacity.” Foreman would also like some human endodontists and started doing to have a crack at a third Paris-Brest-Paris some specialised procedures.” event, with the next competition slated to Over the years, Foreman has also pursued go ahead in 2023. studies in fields such as ultrasonography, “I would like to do another, just to do it ophthalmology and orthopaedic surgery. better!” he said. “In the meantime, there is “These areas of study fulfilled the needs of ballroom dancing, bike riding, resuming French our clinical caseload,” he explained. “I enjoy studies and tinkering with my Morgan cars to acquiring and using new skills and being able keep me busy. Who knows – one day soon to bring a broad range of expertise to the we may be able to travel again!” workplace.” An unexpected upshot of having ■ JAI HUMEL such a breadth of knowledge and diverse

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‘One of the great things about this profession

AUGUST 2021 TheVeterinarian 7

A GUIDE TO CONSUMABLES

Laminate this page for future reference!

iM3 iC Plaque Indicating Swabs

Oxyfresh Dental Gel & Water Additive

Order Code: L7466

Order Code: L7510

Order Code: H1001

Order Code: OFK01 & OF250

iM3 CLS Solution 250ml Concentrate

iM3 Airgid Haemostatic Sponge with Silver

iM3 Anaesthesia Endotracheal Tube Ties

iM3 Sterilizing Straw for Dental Unit

Order Code: C3150

Order Code: AIR10 & AIR20

Order Code: SILC50

Order Code: PS001

Crosscut Taper Fissure Burs These burs are used for sectioning teeth.

iM3 recommends disposing of dental burs between each patient to reduce turbine wear of the high speed handpiece.

Next order: Quantity

iM3 Pty Ltd

Size

1/4

1

2

4

6

8

Ordering D7910 C9050 C9080 C9110 C9140 D7930 Code

Size

699

701

701L 702

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|

iM3 recommends size 2 & 4 for cats and small dogs and size 4 & 6 for larger dogs.

FG Crosscut Taper Fissure Bur Pack of 5 autoclavable burs.

For sectioning teeth.

702L 703 703L

Ordering D8012 C9350 C9320 D7810 C7010 C7030 C4450 Code

Item

p: 02 9420 5766

FG Round Bur Pack of 5 autoclavable burs.

For removing bone and drilling holes.

Actual Size

Round Burs Round burs are used for removing bone and drilling holes.

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iM3 iClean Prophy Paste & Holder

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iM3 Oscillating Disposable Prophy Angle

e: sales@im3vet.com

iM3 recommends size 699 & 701L for cats and small dogs and size 702L for larger dogs.

Scan to order direct through the iM3 website

www.im3vet.com.au

Mark Bryan qualified in Glasgow in 1988, and moved to New Zealand in 1995.

Kiwi Post

It’s over two years now since the appalling terrorist attack in Christchurch which killed 51 people in 2 mosques.

One of the victims was a 16-year-old Syrian boy named Hamza Mustafa. His father was a farrier, and his mother a teacher, and Hamza had dreamed of becoming a vet. He was an accomplished horse rider, as were all the family, and had absorbed a lot of his father’s skills in handling horses.

The family had fled Syria nine years previously to Jordan, before leaving Jordan in 2018 to come to New Zealand, a “safe country”. For them, tragically, it wasn’t. Hamza and his father Khaled were murdered in the mosque on that day.

Hamza’s younger brother was seriously injured, and played dead to avoid further danger.

I can’t imagine the pain of losing a husband, father, brother, son on that terrible day.

But I absolutely can imagine being a young boy, dreaming of being a vet, working with animals, being outside and with farmers, or helping pets and their owners, or working with horses and building on the skills your father had.

The dream that Hamza had- not just for himself, but for his family- was cruelly and brutally extinguished that day. He would never live to get to vet school; his father would never live to feel the pride he undoubtedly would have felt

www.theveterinarian.com.au

when Hamza walked through those Massey doors. And his mother and siblings now had to navigate a bleak future in an unknown country while bearing their tragic loss.

I think all of us in those dark days felt the need to do something. To reach out and support somehow. Out of those sparks the idea of the veterinary community coming together to develop a scholarship in Hamza’s name was born, driven by some wonderful people at Massey University and the enthusiasm of vet clinics.

The scholarship is designed to be awarded to encourage inclusivity in the veterinary profession, particularly amongst under-represented ethnic groups or those who may be financially challenged.

This week the first Hamza Mustafa Memorial Bursary was presented to a fourth year Maori vet student. The ceremony was a remarkably moving event with a powerful weaving together of Maoritanga, the Muslim community, and the vet community. Hamza’s remaining family - his mother, and 2 younger siblings - travelled up from Christchurch for it.

It was an utter privilege to be able to be there and participate in some small way; and even more so to be called to say a few words. I think we all value the special community that is our veterinary community, and we know whenever we get together some special things can happen.

But coming together and raising over $30k was quite unique; and being able to keep the memory of Hamza alive was very special.

By all accounts, Hamza was a remarkable young man. Kind, gifted, gentle and caring, but with a burning dream to work with horses as a vet. His father Khaled was an exceptional farrier, who did work for the Syrian royal family, and travelled across the Middle East as a farrier. When they arrived in New Zealand Khaled quickly found work as a farrier, despite having limited English.

His ability with horses was sufficient.

Hamza’s mother, Salwa, is also a remarkable woman, and also an accomplished horsewoman.

It is impossible to understand her pain and even more difficult to comprehend how she bears it.

But she bears her loss with remarkable grace, choosing to believe that most people are not evil, nor racist, nor wish harm on others.

Salwa not only lost her husband and eldest son on that terrible day, but the dreams the family had to continue to work hard, to contribute to society, and build a stronger, safer future for themselves. One of Hamza’s motivations to study vet was not just the animals, but the people.

This was a family built on caring for others.

They cared for animals, they worked with animals, and they saw Hamza’s goal of becoming a vet in this bright, new country as the To page 30

AUGUST 2021 TheVeterinarian 9

The next generation in canine osteoarthritis pain relief is here

Available now from your preferred wholesaler Recommend Galliprant as first-line treatment FIRST-IN-CLASS non-COX inhibiting NSAID UNIQUE MODE OF ACTION specifically blocks the EP4 receptor, a key mediator of OA pain, but does not interfere with homeostatic mechanisms mediated through other prostanoid receptors FOR ALL STAGES of OA from the earliest clinical signs

For more information contact Elanco Ph: 1800 995 709 or email: ANZCustomerAdviceLine@elanco.com INDICATION For the treatment of pain and inflammation associated with osteoarthritis in dogs.

Read product leaflet for full instructions. The safety of Galliprant has not been established in dogs less than 3.6 kg or less than 9 months of age.

Galliprant is a trademark of Elanco or its affiliates. ©2021 Elanco or its affiliates. PM-AU-21-0160

VET ETHICS

Simon Coghlan has a PhD in philosophy.

His doctorate addressed human and animal ethics and he has published in this field in peer-reviewed journals.

He has a Masters in Bioethics and a Grad. Cert. in Higher Education. Currently he lectures in Health Ethics and Professionalism at the School of Medicine at Deakin University, Geelong.

He is also a Melbourne veterinarian.

www.theveterinarian.com.au

Compassion and community: some sanctuary considerations Farm rescue sanctuaries are founded on the idea that farmed animals deserve a good life and compassionate treatment. These sanctuaries rescue a range of animals, including pigs, chickens, cows, sheep, donkeys, and goats.

Farmed animal sanctuaries usually hold that animals in industrial agriculture are routinely treated badly. Animals in farmed animal sanctuaries may be rehabilitated from the physical and mental harms they may have suffered. For example, farmed pigs and chickens may need to be helped when genetic factors and cramped conditions have caused leg problems.

Furthermore, animals in farm sanctuaries are often allowed to engage in a variety of behaviours that were denied to them in agricultural confinement. Such sanctuaries aim to provide good veterinary medical care for each animal and refrain from agricultural practices that cause pain and suffering.

A significant element of farm sanctuaries is raising awareness of the harms they suffer in farming systems. Sanctuaries have the dual goal of providing refuge/rehabilitation and animal advocacy to stop exploiting animals.

Those who think that animals in agriculture are mostly treated ethically may find that farm animal sanctuaries have little value.

Nonetheless, the general public certainly has growing concerns about farmed animal treatment.

For the public, animal sanctuaries may also provide opportunities to interact with animal species that are mostly hidden from view in farming systems.

However, farmed animal sanctuaries themselves have received critique. For example, the political philosopher William Kymlicka and his collaborator Sue Donaldson have raised questions about the best form of farmed animal sanctuary. This critique of theirs is friendly, insofar as they believe that it is appropriate to help

farmed animals and to raise awareness of their routine abuse.

Kymlicka and Donaldson argue that although sanctuaries rightly aim to treat animals compassionately and decently, they do not always provide animals with the degree of freedom they need and deserve. This freedom, Kymlicka and Donaldson argue, has four components.

First, animals should not automatically be separated according to species. Instread, they should have the freedom (if they want to take it) to mix with both humans

and other animal species - even if there are some safety risks involved. Yet many sanctuaries, they say, are inclined towards segregation. To minimise risk, sanctuaries could allow animals to escape to safe zones when they choose to avoid others.

Second, sanctuaries are predisposed to overly strong environmental restrictions - such as smaller yards and a lack of trees or forest to make it easier to care for the animals and to increase their safety.

Kymlicka and Donaldson argue that animals should be allowed to choose whether to roam further afield (within some limits) and even to choose not to associate with humans - or to associate on their own terms.

Third, they argue that animals

should be given opportunities to engage in work. This could include, for example, carrying objects, ploughing fields, or producing wool or eggs. Kymlicka and Donaldson contend that animals, like humans, often have a desire to work and can find it rewarding. Hence, they should be given plenty of opportunities for work (without being coerced), even though work can be hard.

Fourth, farmed animals should not automatically be deprived of opportunities for sexual pleasure or for raising offspring (their own or others’). They acknowledge that this is not always possible.

But they do claim that we should not simply assume that animals do not benefit from these activities or that it is impossible in every case.

An important theme in Kymlicka and Donaldson’s argument is that even when we diligently try to give animals opportunities to flourish, we sometimes make assumptions about their wellbeing.

These assumptions can false, untested, or based more on convenience than on a careful understanding of the animals’ needs.

We can also tend to assume that all species have the same needs.

In truth, individuals can have more personal needs and desires which they do not necessarily share with conspecifics. For example, some pigs enjoy forming relationships with cows or goats, whereas others do not. And some animals love to work or want to care for offspring, whereas others don’t.

For Kymlicka and Donaldson, we need to be more attentive to individual animal differences.

Kymlicka and Donaldson believe that, suitably reformed, farmed animal sanctuaries could provide animals with truly flourishing lives.

They call this type of sanctuary “intentional communities.” Such mixed species communities, they argue, will be even more powerful at advocating for a better world for domestic animals.

AUGUST 2021 TheVeterinarian 11

Management

Stock valuation: some FAQs

Simon Palmer is the Managing Director of Practice Sale Search, Australia’s largest practice brokerage. If you’d like more information on practice sales or want to have a confidential discussion about your practice’s circumstances, email Simon Palmer at info@practice salesearch.com.au or call 1300 282 042.

When a practice is valued, it is often for goodwill and equipment, “plus stock”. That is to say, the stock levels will be determined closer to settlement and an amount added to the valuation to compensate the vendor for the stock that will be onsite at the date of transfer.

There are a lot of Frequently Asked Questions (FAQs) and misconceptions about how stock is treated in a valuation.

We have gathered these FAQs and asked Anne and Paolo Lencioni of ValuVet for their view of best practice in this regard.

Q1. How does a purchaser know how much to prepare to pay at the date of sale, when the amount of stock is a moving target? Should the vendor give the purchaser an

estimate of this value in early discussions about the sale?

the only time most practices do stocktake really well.

A1. Generally, stock doesn't vary a lot from year to year, unless the practice is showing good growth.

The seller should be able to give an indicative figure for stock during sale discussions, so that a buyer is prepared. A final stock take should be done at time of settlement and the result should not be drastically different from the figure previously given.

Sometimes their accountants simply leave the stock as zero when doing their end of financial year accounts, which can cause huge tax problems down the track when the client eventually does a stocktake - a 30k sudden write up of stock in one year can generate approximately $10k in tax!

Q2. When stock is appraised for the sale, is it at retail price or the price that they bought it for? (if they bought it at a discount, is this discount passed on?).

A4. There should be no need to change stock levels due to sale.

A2. The stock should be appraised using the price the practice paid to wholesaler. That is to say…yes, any discount paid by the practice should be passed on to the buyer.

Q5. Is all stock paid for by the buyer, regardless of age or likelihood of use? I.e., does a buyer pay for stock close to expiry or niche stock (jumbo sized gloves)?

Q3. How often should a practice value their stock?

A5. There should be no out-of-date and limited short-dated stock included in the sale. Stock should have at least a month before expiry.

If a buyer is reluctant to agree to take over some (niche) stock items, then this should be discussed in advance of contracts and agreed. If given enough notice, the seller can try to reduce levels of certain stock prior to sale.

A3. There is no right answer here.

It is a very time consuming and non-revenue producing exercise. I would say it is still necessary and worthwhile to perform once a year.

Unfortunately, many vet clinics rarely do regular or accurate stocktakes and a practice sale is probably

12 TheVeterinarian AUGUST 2021

Q4. Is there a Goldilocks level of stock that owners should try to have in their cupboards at the point of sale – i.e., one-two months?

■ www.theveterinarian.com.au

Dr Claire Adams Online now

Dr Henry Jones

I hear you guys switched to a mucosal vaccine?

Dr Claire Adams

Yes, we’re using Bronchi-Shield

Oral

Dr Henry Jones

What prompted the change?

Dr Claire Adams

We all agreed the benefit of increased mucosal immunity to protect against respiratory disease was worth it!

BTW, mucosal vaccines are also strongly recommended

by WSAVA for high risk environments such as shelters1

SHELTER

Dr Henry Jones

We considered it but it’s a hassle to change protocols Dr Claire Adams

We got the rep in, they sorted out the vaccination protocol and trained our staff. The new protocol worked out to be more cost effective too!

Dr Henry Jones

We’re also not sure if our clients would like it...

Dr Claire Adams

Hmmm...if the flu vaccine came out as an oral mucosal form, how many people would still stick with injections?

Dr Henry Jones

…

Simply administer 1 mL of Bronchi-Shield Oral in the buccal cavity for 12 months’ protection against Bordetella bronchiseptica. Protects puppies with a single dose from 8 weeks of age. Over 2 million doses sold in Australia2.

Reference: 1. Day, M., et al (2016) WSAVA Guidelines for the vaccination of dogs and cats. J Small Anim Pract, 57(1), E1-E45. 2. BIAH Data on file.

Boehringer Ingelheim Animal Health Australia Pty. Ltd. Level 1, 78 Waterloo Road, North Ryde NSW 2113. Toll Free 1800 808 691. ABN 53 071 187 285.

Bronchi-Shield® Oral is a registered trademark of Boehringer Ingelheim Vetmedica GmbH – used under license. All rights reserved. BI1547TA-03/20.

■ EDITED BY JENI HOOD BSc (Hons) BVMS PhD

Abstracts The effect of hessian and straw as nesting materials on sow behaviour and piglet survival and growth to weaning Sows are strongly driven to build a nest prior to farrowing, and the performance of this behaviour is linked to the environment in which the animal is housed. The aim of this study was to investigate the impact of two nest-building materials, hessian and straw, on periparturient sow behaviour, plasma cortisol concentration and piglet survival and performance in farrowing crates. In the first experiment, sows (parity 1.7 ± 0.1) were allocated to four treatments: (n = 15), straw provided in the lead up to farrowing in an open farrowing pen, with the pen closed after farrowing (STRAW OPEN); (n = 14), straw provided in the lead up to farrowing in a closed farrowing pen (STRAW CLOSED); (n = 15), a closed farrowing pen with hessian sacks provided in the lead up to farrowing (HESSIAN) and; (n = 13), a closed farrowing pen with no nesting materials provided (CONTROL).

A second experiment was performed on a separate farm to assess the effect of the same four treatments were applied to sows (parity 2.9 ± 0.1): SRAW OPEN (n = 68), STRAW CLOSED (n = 64), HESSIAN (n = 66) and CONTROL (n = 66), at a commercial level. The first experiment revealed that providing conventionally housed sows with straw or hessian in the lead up to parturition stimulated sows to perform nest-building behaviours similar to sows housed in an open pen with access to straw (nosing events; 16 ± 11 (CONTROL); 169 ± 36 (HESSIAN); 118 ± 29 (STRAW CLOSED); 199 ± 53 (STRAW OPEN); P < 0.05).

Additionally, crated sows provided with straw had reduced cortisol levels immediately after farrowing compared to all other treatments (21.9 ± 6.1 ng/ml vs CONTROL; 49.3 ± 8.6 ng/ml; P < 0.01). Piglets born to STRAW CLOSED sows displayed the highest colostrum intake levels (404.8 ± 22.7 g vs CONTROL 361.9 ± 21.9 g; P < 0.01). The second experiment demonstrated a reduced incidence of piglet mortality both prior to fostering (0.7 ± 0.2; P = 0.001) and after fostering (0.7 ± 0.2; P = 0.001) in litters born to sows which were housed in conventional farrowing crates and provided with straw compared to CONTROL (prior to fostering 1.3 ± 0.2, and postfostering 1.1 ± 0.2).

In conclusion, straw and hessian sacks are a suitable substrate for stimulating sows to exhibit nest-building behaviour under crated conditions. However, only the provision of straw in the crate environment improved piglet survival and positively affected sow welfare.

K J Plush1, L A McKenny2, T L Nowland2, W H E J van Wettere3 Animal. 2021 Jul;15(7):100273.doi: 10.1016/j.animal.2021.100273.

Epub 2021 Jun 23.

1SunPork Group, Eagle Farm, QLD 4009, Australia. Electronic address: kate.plush@sunporkfarms.com.au.

2South Australian Research and Development Institute, Roseworthy, SA 5371, Australia.

3School of Animal and Veterinary Sciences, The University of Adelaide, Roseworthy, SA 5371, Australia.

Free article

Intraspecific and interspecific attachment between cohabitant dogs and human caregivers In recent years there has been growing interest in uncovering evolutionary and lifetime factors that may contribute to the domestic dog's (Canis lupus familiaris) success in anthropogenic environments.

The readiness with which dogs form social attachments, their hypersocial focus, and social flexibility have all been areas of investigation.

Prior research has demonstrated that many pet dogs form infantcaregiver type attachments toward human caretakers, even into adulthood. However, it is unknown if adult dogs form similar attachment bonds to other species, including cohabitant dogs, or if the dog-human relationship is unique in this respect. In the current study we used the Secure Base Test to evaluate behavioral indicators of stress reduction, proximity seeking and exploration, classifying doghuman and dog-dog dyads into attachment style categories. As in prior studies, we found that the majority of our dog-human dyads met the traditional criteria for infant-caregiver type attachment.

However, the majority of dogs did not display this form of attachment toward cohabitant dog partners. Instead, behaviors observed in dog-dog relationships better matched attachment classifications described in human sibling attachment research. Overall, companion dogs were significantly less likely than human caretakers to elicit behaviors associated with attachment security in a focal dog. To page 30

14 TheVeterinarian AUGUST 2021

Risk factors associated with pinkeye in Australian cattle Pinkeye is the most important bovine ocular disease worldwide and a major welfare and economic concern to the Australian cattle industry. Pinkeye can occur in epidemic proportions, but severity and susceptibility vary within and between herds, indicating that the disease is multifactorial. This study was conducted to identify the on-farm risk factors associated with pinkeye disease in Australian cattle. Data were gathered from cattle farmers using a custom designed online questionnaire. Farmer responses suitable for assessment (n = 999) were analysed with descriptive, univariable and multivariable logistic regression to evaluate the association of 26 explanatory variables with pinkeye within-herd prevalence. Results revealed that farm location, farm grazing area, farmer-reported dust levels, fly levels, rain levels, animal zebu content and cattle age were significantly associated with pinkeye prevalence. More specifically, having a farm located in southern Australia, of smaller grazing area with cattle < 2 years of age, was associated with a higher pinkeye prevalence. Pinkeye prevalence was also greater if respondents ranked their farms as having high fly levels compared to moderate and low fly levels, respectively and on farms ranked low for rainfall compared to moderate and high rainfall, respectively. Those that ranked their farms as having high dust levels had more pinkeye compared to moderate and low dust levels, but moderate dust levels were protective compared to low dust levels. The results confirm that pinkeye disease is multifactorial and is associated with a range of host and environmental factors. These findings should be used to assist in the control of the disease and improve pinkeye outcomes in Australian cattle.

Mac Kneipp1, Alexandra C Green1, Merran Govendir1, Michael Laurence2, Navneet K Dhand3 Prev Vet Med. 2021 Jul 13;194:105432.doi: 10.1016/j. prevetmed.2021.105432. Online ahead of print.

1Sydney School of Veterinary Science, The University of Sydney, Camden, NSW, Australia.

2Murdoch University, School of Veterinary Medicine, College of Science, Health, Engineering and Education, 90 South Street, WA, 6150, Australia.

3Sydney School of Veterinary Science, The University of Sydney, Camden, NSW, Australia.

Exploring horse owners' understanding of obese body condition and weight management in UK leisure horses Background: Equine obesity is considered one of the most serious welfare concerns in UK leisure horses, yet little is known about how horse owners conceptualise their horse's weight as part of its health, or how they plan and carry out weight management.

Objectives: This study aimed to further our understanding of leisure horse owners' perceptions of equine health and awareness of excess fat in order to clarify our understanding of successful strategies for managing equine weight.

Study design: This study used a qualitative research methodology.

Methods: Data comprised 16 threads from online UK equine discussion fora, 28 individual interviews with leisure horse owners, 19 interviews with equine professionals such as vets and nutritionists, and two focus groups with a further 21 horse owners. Data were anonymised and analysed using a grounded theory approach.

Results: Awareness of excess fat was a complex issue, with owners finding it difficult to differentiate equine obesity from the shape they thought the horse was "meant to be", particularly if the horse was a heavier breed such as a native pony or cob.

Owners were not necessarily "aware" or "unaware" of fat, but instead equine body fat was constructed as an integral part of the equine body. For example, owners might say that they thought their horse was an ideal weight yet describe their horse's overall body shape as "like a Thelwell". When owners became aware of fat as a changeable part of the horse's body, and/or a threat to health, the presence of fat was articulated To page 30

■ www.theveterinarian.com.au

Clinical Feature

How to keep your locum vets coming back for more It’s no news to anyone in the veterinary industry that locum cover has been harder and harder to come by in recent times. Prior to the COVID pandemic, many practice owners lamented the difficulties around finding experienced, reliable locum veterinarians who were able to hit the ground running and manage a busy caseload in a new environment. However, once the pandemic forced border closures, severely limiting even interstate travel and making the working holiday a distant pipe dream, veterinary practice owners began to look back fondly on those times when the main difficulties around finding casual relief lay in finding the ‘right fit’.

In this new world we find ourselves in, finding any cover at all to enable practice owners and permanently employed veterinarians to take time off has become a challenge. So, when a clinic does find a willing and available locum, how do they keep that professional coming back for more shifts? After all, having a small pool of locum vets to call on is every practice owner’s dream. All the better if these vets have worked at the clinic before and are familiar with the protocols, staff and clientele.

Many clinics are already offering flights and accommodation for longer stints to locums who are based interstate. But, is there more that can be done to help relief veterinarians feel comfortable and valued?

Here’s what experienced locums have to say about what draws them to a clinic: Good Communication ■ The pre-shift communication- Once the shift has been booked, get in touch with the locum to confirm hours, rates, type of shift (eg.

Consulting only vs requirements to perform surgery), billing protocol, professional indemnity insurance, names of support staff and anything else they may need to know for their shifts. At the same time, ask the locum what their comfort levels are with regards to handling particular types of animals, and for surgical or other complex procedures, if they are likely to have these booked in during their shifts.

■ Protocols- Construct a standard document containing the following protocols which is readily available to the locum, either via email or kept in the consult room. If the document is left in the clinic, inform them ahead of time where they can find it. You should include at least the following protocols and policies: - Vaccination protocols for all species treated by the clinic.

- Billing procedure and examples. This should include any additional charges for weekends or after-hours.

- Basic instructions on how to use the computer record system and login details.

- Expectations on whether the vet should bring their own stethoscope or can use the ones provided by the clinic.

- Details around access to S8 drugs.

- Referral policies and preferences.

- Policies or preferences around pathology, for example, preference for in-house versus external lab blood tests. Location of pathology sample tubes and request forms, as well as details of sample pick-up arrangements.

- Policies round booking in of complex procedures, particularly surgical procedures. For example, are there vets who excel at orthopaedic surgery and are happy to have these procedures booked in for them? Does the clinic prefer to only do dentals on Tuesdays and Thursdays?

- Any instructions around allowing client accounts, for example arrangements to pay in instalments. If there are exceptions to this policy for certain clients, this should be noted on the client file so that the locum is not left in the uncomfortable position of enforcing a policy that does not apply to that particular client.

- List of equipment available for use. www.theveterinarian.com.au

■ Label cupboards and draws with types of equipment they contain, particularly in the consultation room. Having to fumble through drawers for a syringe or cotton ball won’t help build a new vet’s confidence when they are trying to impress your clients.

■ Communicate in a timely manner with your permanent staff. Ensure they are aware there will be a locum vet on a particular day and the name of the veterinarian. Show the support staff where protocol documents are kept. Instruct them to provide a tour of the clinic on arrival and guidance to the locum vet on use of the computer system. Request that they avoid over-booking the schedule.

A Supportive Work Environment ■ Book a reasonable and manageable scheduleImagine walking into a new workplace on a busy day. You don’t know where anything is, you haven’t used any of the equipment before (X-ray machine, drip pumps, etc.), you have brand new colleagues and you are trying to build the

be on duty next before the end of the shift.

Case follow-up- Consider providing a follow up on more serious cases that your locum has been heavily involved in the care or work-up of.

This should help them feel valued by the clinic and provide some of the continuity that is normally lacking in locum work.

■

A few more little things ■ Offer competitive rates- Remember, securing a locum may be the difference between having to close the clinic or an entire vet’s schedule for the day, and generating a reasonable day’s income. In Australia, locum vet hourly rates start at around $50 but experienced locums tend to charge upwards of $65/hour.

■ It’s all in the packaging- Train your permanent staff to refer to the locum vet when talking to clients as the doctor or vet who is covering for whichever vet is away. Many clients don’t understand what a locum is and may not realise that ‘the locum’ is actually a qualified and often experienced veterinarian.

Nick Fewings, Unsplash

clients’ trust. On top of all these stressors, you are booked back to back with consultations, some slots are double-booked and the nurses have been instructed to accept all walk-in clients as well. The result is that the very clients you are trying to impress are already disgruntled when they walk into the consult room due to the long wait times. Do not do this to your locums! Try to fight the temptation to force your locum to ‘earn their keep’. Yes, hourly locum rates are higher than those you pay your permanent vets, but the rates are a function of the nature of the job, which brings with it instability, poor job continuity and the challenges of adapting quickly to new situations. Over-booking an already stressed out professional is a great way to ensure they think twice about coming back for more shifts.

■ Support staff- Try to schedule experienced, senior nurses to work with locum vets wherever possible. Having to work with junior or inexperienced support staff can add to stress levels of the locum vets as well as that of the support staff.

■ Professional indemnity insurance- Consider opting for an insurance policy that covers contractors, or locums. Many full-time locums do have their own cover, but some vets that take the occasional locum shift may not. If your policy does not provide this cover, make this clear before the shift is booked so that potential locums can make an informed decision.

■ Case handover- Leave instructions for handover of tricky or critical cases, whether it’s to just leave detailed notes or to call the vet who will

Dress-code- If there is a particular uniform or scrub-top that you would like the consulting locum vet to wear, inform them of this before the shift and provide a clean, ironed uniform or scrub-top for them to wear during the shift.

■ Be kind- Resist the temptation to book difficult clients or complex cases that you or the permanent veterinarians try to avoid for the locum.

If this must be done, take the time to call the locum prior to the shift and prepare them for the challenge.

■ Payment- Pay the locum in a timely manner.

■ One big family- If you have a long-term or regular locum, consider inviting them to the clinic end-of-year celebration. Not being part of a ‘work family’ can be the downside of long term locum work and including the locum this way can go a long way to helping them feel valued.

With some preparation and care, these are ways to not only retain good locum vets, but also to attract new locums. After all, the veterinary profession is a close-knit one and word gets around. While some vets may find a list of instructions to be too didactic, most will likely appreciate the guidance and care taken by their new employers. The guidance may also be useful for induction of new permanent staff.

■

Deepa Gopinath is a small animal veterinarian working in the pharmaceutical industry, as well as a freelance writer and social media content creator.

In addition to her veterinary degree, she has completed her membership qualification in small animal surgery and and MBA through MGSM, Sydney.

AUGUST 2021 TheVeterinarian 15

NEW

The first and only combination chew for dogs with moxidectin

Simparica Trio complements your vet-exclusive ProHeart® SR-12 business by allowing you to provide your clients with an annual injection or a monthly chew option for heartworm prevention, both with the efficacy of moxidectin.

• Protects against a trio of the biggest threats facing dogs: fleas and ticks; deadly heartworm; intestinal worms • Tasty monthly liver flavoured chew that can be given with or without food • Suitable for dogs from 8 weeks of age and 1.25kg

We welcome the opportunity to outline a program that will address many of your frustrations with this product category and will enable you to compete in a way that’s sustainable for your practice.

For more information please contact your local Zoetis representative or contact Zoetis Customer Service on 1800 022 442.

Now available to purchase on Zoetis Direct.

Zoetis Australia Pty Ltd. Level 6, 5 Rider Boulevard, Rhodes NSW 2138. © 2020 Zoetis Inc. All rights reserved August 2020. MM-10181

Clinical Feature

Paracetamol (acetaminophen) toxicosis in dogs and cats

Penny Linnett BSc(Hons) BVSc MPhil MACVSc is a Canberra-based mixed practice veterinarian.

Her qualifications include an honours degree in zoology, a Masters in the medical sciences and Membership of the Australian and New Zealand College of veterinary scientists in pharmacology.

Linnett has worked extensively in private practice and in animal biosecurity for the Commonwealth government.

Linnett also manages a 212 hectare Dorper sheep breeding property ‘Wallaby Hills’ in the Southern Tablelands of New South Wales, running 60 breeding ewes with plans to increase to 300 ewes over the next 2-3 years.

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During the cooler months, it is not uncommon for well-meaning owners to give their animals a “little bit of pain relief” for conditions like arthritis with a tablet of say aspirin, naproxen, ibuprofen or paracetamol. Also, accidental ingestion of human nonsteroidal anti-inflammatory (NSAID) tablets by pets – especially dogs – is quite common.

Paracetamol (also known as acetaminophen) is a very common painkiller in humans and while it can be used by itself (or with codeine) to help manage chronic pain in dogs, for example, it can be deadly for cats even in very small doses.

Introduction Acetaminophen is a synthetic nonopiate derivative of p-aminophenol.

It is a common household analgesic/antipyretic registered for human use that may be used alone or in combination with other drugs (e.g. codeine, anti-histamines) in flu, cold and allergy preparations. It is available in capsule, tablet, liquid suspension, suppository, intravenous and intramuscular forms. Acetaminophen has largely replaced the use of salicylates (e.g. aspirin) because of the reduced risk of gastric ulceration.

Acetaminophen is a cyclo-oxygenase-3 inhibitor. It has little anti-inflammatory activity, is a weak prostaglandin inhibitor and may inhibit chemical mediators that sensitise pain receptors in the brain. The COX-3 inhibition produces an anti-pyretic effect at the level of the hypothalamus in the brain.

Dogs and cats are usually exposed through well-meaning owners, but accidental ingestion of a toxic dose is not uncommon especially in dogs.

Paracetamol (acetaminophen) toxicosis is most commonly reported in cats who are extremely sensitive to its toxic effects. For example, there is a report of a kitten that played with an empty packet of acetaminophen and developed severe poisoning. The essential features of acetaminophen toxicosis and treatment are summarised in Tables 1 and 2.

Pharmacokinetics After oral administration, acetaminophen is rapidly absorbed from the gastrointestinal tract, with peak plasma concentrations usually seen within 30-60 minutes but it can be delayed with extended-release formulations.

Table 1. The essentials of paracetamol toxicosis

Peak plasma concentrations occur 4 hours after ingestion in cats. It is uniformly distributed into most tissues in the body; protein binding varies from 5 per cent to 20 per cent, and even up to 50 per cent.

Metabolisation occurs in the liver via three metabolic pathways: glucuronidation, sulfation and the cytochrome P-450 pathway. In most species, low doses of acetaminophen are metabolised primarily through capacity-limited glucuronidation and sulfation pathways, with the resulting non-toxic conjugates excreted primarily in the urine with some in the bile. In humans, less than 5 per cent is excreted as the parent compound.

The rate of elimination is dependent on species and dose.

Although the amount of acetaminophen metabolised by the cytochrome P-450 pathway is usually small, the product produced – N-acetyl-parabenzoquinoneimine (NAPQI) – is toxic.

Under normal conditions, NAPQI is conjugated with glutathione (a compound essential for cellular protection) to form non-toxic cysteine and mercapturic acid conjugates, which are excreted in the urine. Cats have lowered ability to metabolise acetaminophen (about one-tenth that of dogs) because they are deficient in glucuronyl transferase (specifically a high-affinity acetaminophen glucuronyl transferase that conjugates acetaminophen with glucuronic acid).

This means that this pathway becomes

rapidly saturated in cats, resulting in more metabolism by sulfation and oxidation. Sulfation produces nontoxic conjugates that are excreted in bile and urine, and saturation of this metabolic pathway also occurs more readily in cats than in other species.

Once this pathway is saturated, more acetaminophen is metabolised by cytochrome P-450 enzymes and toxic metabolites are produced.

The conjugation of acetaminophen to form glucoronide in ferrets is as slow as in cats, which may also make them similarly susceptible to toxic adverse effects.

So, increasing doses of acetaminophen leads to saturation of the sulphate and glucuronide pathways, and increased metabolism of the drug by the cytochrome P-450 system. High doses of acetaminophen result in glutathione depletion in the liver and red blood cells, which raises concentrations of NAPQI. When hepatocellular stores of glutathione become depleted to less than 70 per cent of normal values, the unconjugated NAPQI covalently binds to cellular macromolecules and proteins, resulting in cell death and tissue necrosis through disruption of protein function and damage to cellular membranes. Cells are also rendered susceptible to oxidative injury. In addition, other oxidising metabolites are produced that cause oxidation of cell components resulting in methaemoglobin and Heinz body formation, and erythrocyte oxidation which itself leads to increased red blood cell fragility and haemolysis.

Erythrocytes are the cells most susceptible to the effects of NAPQI in cats, and the two sites in erythrocytes that are most susceptible to oxidative injury are the iron in heme and the sulfhydryl groups of the globulin chains. Feline haemoglobin contains 8 sulfhydryl groups compared to 2 or 4 groups in other species and is thus more prone to oxidative injury.

Methaemoglobin is formed by the oxidation of ferrous iron (Fe2+) to ferric iron (Fe3+) which converts haemoglobin to methaemoglobin, which does not carry oxygen. So, when glutathione is depleted, methaemoglobin accumulates within the erythrocytes, AUGUST 2021 TheVeterinarian 17

Clinical Feature and as it cannot bind oxygen, tissue hypoxia results. Methaemoglobin also moves the oxygenhaemoglobin dissociation curve to the right, so oxygen will remain bound to existing haemoglobin, which further exacerbates the tissue hypoxia.

Oxidation of haemoglobin may also cause Heinz body formation. Heinz bodies are denatured chains of haemoglobin with oxidised sulphydryl groups. They migrate toward cell membranes, rendering them more fragile and susceptible to haemolysis in the microcirculation, and via splenic phagocytosis. Feline haemoglobin is highly susceptible to oxidative damage.

Cats have a relative lack of methaemoglobin reductase in erythrocytes. So methaemoglobinaemia occurs much earlier than in dogs.

While the erythrocyte is the most susceptible to the toxic effects of acetaminophen in cats, in dogs, it is the liver. The NAPQI metabolite binds to the hepatic cell membrane and damages the lipid layer, causing hepatocyte injury and death.

Toxicity Toxicity can occur from a single dose or repeated cumulative doses, noting the intraspecies sensitivities to acetaminophen. Cats, and young and small dogs have a higher risk for toxicity.

All body systems are affected.

The toxic dose in dogs is reportedly 75-100 mg/kg, while for cats the toxic dose is 50-100 mg/kg. However, clinical signs have been observed in cats at doses as low as 10 mg/kg or 65 mg/kg/day for 3 days. Repeat doses in cats that have received non-toxic doses can be rapidly fatal. The use of paracetamol in cats is contraindicated due to their unique sensitivity; there is no safe dose.

In dogs, paracetamol has been used for analgesia at 10 mg/kg PO BID and at 15 mg/kg PO TID. Clinical signs of acute toxicity are not usually seen unless the dosage exceeds 100 mg/kg.

Consider: emesis (early on), gastric lavage, activated charcoal, oxygen, IV fluids, blood transfusion.

Standard is N-acetylcysteine (5% sterile solution) at 140 mg/kg PO or IV, then 70 mg/kg q 4-6 hours for about 7 (may be more) treatments. If not available: * Sodium sulphate * S-adenosylmethionine (18 mg/kg PO for 1 to 3 months) Also useful: * Ascorbic acid (30 mg/kg PO q 6 hours for 6 treatments) * Methylene blue (1mg/kg IV of a 1% solution for 2 to 3 treatments) * Cimetidine 5-10 mg/kg PO, IM or IV q 6-8 hours (dog only) Table 2. Treatment summary

However, adverse reactions (depression, vomiting and methaemoglobinaemia) have been seen at 0.1 mg/kg; toxicity can be seen at lower dosages with repeated exposures.

Methaemoglobinaemia may occur in up to 75 per cent of dogs who have ingested 200 mg/kg. Most dogs will recover if dosed with less than 500 mg/kg. Doses greater than 1 g/kg can cause unconsciousness and cyanosis within hours, and death within 12 hours.

Judicious use of paracetamol in dogs is required as they do not metabolise paracetamol as effectively as humans. Even at published dose rates, there is the potential for adverse effects.

There is a possible dietary link as well.

Research has shown a higher incidence of acetaminophen-induced methaemoglobinaemia in cats fed a diet high in propylene glycol than in those fed diets low in propylene glycol.

Wet cat food contains 7 per cent to 13 per cent propylene glycol, which may induce methaemoglobinaemia or Heinz body formation in cats.

The pre-existence of erythrocyte injury due to propylene glycol consumption may contribute to increased sensitivity of erythrocytes to oxidative stress caused by acetaminophen ingestion.

Drug interactions Paracetamol may interact with other drugs such as doxorubicin (depletes hepatic glutathione), and certain anaesthetics (e.g. halothane) and analgesics (can cause renal pathology).

Clinical signs Acetaminophen toxicosis is characterised by methaemoglobinaemia and hepatotoxicity.

Cats primarily develop methaemoglobinaemia within a few hours, followed by Heinz body formation.

Acute signs of toxicity may develop as early as 1 to 4 hours after ingestion, and usually within 12 hours. From 24–72 hours post-ingestion, clinical signs relate to hepatic necrosis, haemolytic anaemia, methaemoglobinaemia and renal dysfunction.

In cats, the most common signs are depression, weakness, tachypnoea, dyspnoea, cyanosis, vomiting, methaemoglobinaemia, facial and/or paw oedema, and death. Haematuria and haemoglobinuria may appear first, when blood methaemoglobin levels are around 20 per cent.

Methaemoglobinaemia causes the mucous membranes to appear brown or muddy in colour and is usually accompanied by tachycardia, tachypnoea, weakness, and lethargy. Dyspnoea may be seen as methaemoglobin levels reach or exceed 35 per cent.

Affected animals may have depression, weakness, hyperpnea, hyperventilation, tachycardia, colic, vomiting and ptyalism and anorexia. Other clinical signs include icterus, hypothermia, facial or paw oedema, cyanosis, dyspnoea, dark urine, discoloured faeces, hepatic necrosis, and death. Liver necrosis is more common in dogs than in cats. Liver damage in dogs is usually seen 24–36 hours after ingestion but can be delayed for up to a week. Renal injury is also possible.

Centrilobular necrosis is the most common form of hepatic necrosis seen with acetaminophen toxicity. Acute keratoconjunctivitis sicca has also been reported in dogs.

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Diagnosis Usually through a suspected or confirmed history of exposure to the drug, and/or correlation of clinical signs, haematological and biochemical abnormalities.

The diagnosis of acetaminophen toxicity is most often made by the exposure history and development of associated clinical signs. A rapid bench-top test that may be helpful entails placing a drop of the patient’s blood next to a drop of normal blood on white filter paper.

Blood containing excess methaemoglobin appears chocolate brown in contrast to normal blood. Diagnostic differentials for methaemoglobinaemia include toxicoses associated with propylene glycol, nitrates, phenazopyridine, naphthalene, and local anaesthetics (e.g. benzocaine).

Paracetamol concentrations in plasma, serum or urine concentrations can be measured.

Human hospitals offer qualitative assays with short turn-around times; 4 hours post exposure levels are recommended.

Differential diagnoses include: pancreatitis, infectious hepatitis, nitrites, naphthalene, phenol and cresol, local anaesthetics (benzocaine), benzimidazole anthelmintics, pyrrolizidine alkaloid-containing plants and blue-green algae.

Treatment Treatment is recommended if a dose of 10 mg/kg or greater has been ingested (cat) or 50 mg/kg has been ingested (dog). No specific antidote exists but several medications are available that can slow the production of the toxic metabolites, with some helping to reduce the rate of, or reverse, oxidation resulting from the toxic metabolites.

The goals of treatment are to firstly stabilise the patient, prevent additional absorption of the drug, replenish glutathione, convert methaemoglobin to haemoglobin, and prevent/treat hepatic damage, and provision of general supportive care with oxygen therapy, fluids (IV and/or SC with or without dextrose), and blood transfusions as needed to maintain adequate haemoglobin concentrations and medications to support liver anti-oxidant function. A Schirmer tear test to confirm keratoconjunctivitis can be used if necessary.

If the animal is asymptomatic, emesis should be induced unless otherwise contraindicated by underlying conditions. Gastric lavage may be necessary if emesis is contraindicated or unsuccessful. Activated charcoal (ideally with a cathartic) should be administered and repeated because acetaminophen undergoes enterohepatic recirculation. Many forms of activated charcoal contain a cathartic, such as sorbitol, and when repeated doses of activated charcoal are administered, the cathartic should be given with every third charcoal dose.

Recommended dose rates for activated charcoal are 1-3 g/kg PO or 0.5-1 g/kg PO once, and it should be administered within the first 6 hours after ingestion to help prevent further absorption. As mentioned above, the activated charcoal should be administrated in combination with a cathartic such as sorbitol unless the animal is dehydrated or has diarrhoea. As paracetamol undergoes enterohepatic recirculation, a second dose of activated AUGUST 2021

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Clinical Feature charcoal is indicated. Two to three hours after the activated charcoal, oral N-acetylcysteine (NAC) can be given; activated charcoal may reduce the effectiveness of NAC. Administration of activated charcoal is still under debate by some authors.

The development of methaemoglobinaemia or hepatic injury may be minimised by administering N-acetylcysteine (NAC). NAC is a sulphur-containing amino acid and is the most commonly recommended treatment; it can reduce the extent of liver injury or methaemoglobinaemia. It provides sulfhydryl groups, directly binds with acetaminophen metabolites to enhance their elimination (i.e. acts directly on N-acetyl-p-benzoquinoneimine to form an acetyl-cysteine conjugate which is excreted in bile), and serves as a glutathione precursor.

NAC is oxidised in the liver to form sulphate, increasing capacity of the sulfation pathway.

A 30 per cent decrease in the half-life of acetaminophen in cats treated with NAC has been reported. It should be administered in all suspected poisonings even if the time until treatment has been delayed (more than 18 hours).

NAC may be administered at a loading dose of 140 to 280 mg/kg PO or IV every 4 hours for at least three to five treatments. The NAC is diluted to a 5% solution before administration.

Because of the extended half-life of acetaminophen in cats, NAC should be given to cats with clinical signs regardless of the time since ingestion. An alternative treatment is the combination of cimetidine with NAC and ascorbic acid. This combination has been shown to be more effective than any one agent alone in minimising acetaminophen-induced hepatotoxicity.

NAC is available as a 10% or 20% solution.

NAC as a 5% solution (diluted in sterile water or in 5% dextrose solution) is given IV or PO (to non-vomiting dogs and cats) at a loading dose of 140 to 280 mg/kg, followed by 70 mg/kg PO every 4 to 6 hours for at least 3 to 5 treatments; 7 treatments are not uncommon and more may be required (some authors recommend up to 17 doses). Some authors recommend continuing the loading dose every 4 hours for at least 3 to 5 treatments. Vomiting may occur with oral NAC. NAC can also be given as a slow IV over 15 to 20 minutes in life-threatening situations by using a 0.2 micron bacteriostatic filter at an initial dose of 280 mg/kg (can also be given PO). Another regime is 280 mg/kg IV infusion over 6 hours, then 70 mg/kg PO every 6 to 8 hours for 36 to 72 hours. Antihistamines are usually effective in countering any signs of anaphylaxis with IV administration.

If NAC is not available other sources of sulphate are: ■ S-adenosylmethionine (has been used with some success for hepatic injury due to acetaminophen) - dogs should be given 4 mg/kg PO then 20 mg/kg daily for 7 to 9 days. Protocols for cats include 180 mg/kg PO every 12 hours for 3 days and 90 mg/kg PO every 12 hours for 14 days. It is a useful adjunct to manage acute or chronic hepatic injury in dogs and cats at 18 mg/kg PO, for 1 to 3 months.

■ Methionine can be used at a dose rate of 70 mg/kg PO every 6 to 8 hours for 24 hours.

Sodium sulphate – may increase sulphate available for conjugation at 50 mg/kg of a 1.6% solution IV every 4 hours for 12 to 24 hours

■

Ascorbic acid (vitamin C) at 30-40 mg/kg PO or IV or SC every 6 to 8 hours for 72 hours provides a reserve system for the reduction of methaemoglobin to haemoglobin, but it is slow acting. Another recommended dose rate for cats is 30 mg/kg every 6 to 12 hours PO or IV. It may also scavenge N-acetyl-p-benzoquinoneimine before it binds to proteins, reducing it back to the parent compound.

■

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Another alternative is methylene blue which increases the reduction of methaemoglobin and has a more rapid onset of action than ascorbic acid. Recommended dose rates are: 1 mg/kg IV of a 1% solution for 2 to 3 treatments; 1-5 mg/kg slow IV injection; 10% methylene blue in sterile saline (100 mg/1 ml saline) is prepared and given IV at a dose of 1.5 mg/kg).

However it must be used with caution as it is known to induce methaemoglobinaemia and Heinz body haemolytic anaemia in cats.

Use of methylene blue concurrently with NAC in cats should probably be avoided, at least in males.

Cimetidine, a H2-receptor antagonist is a cytochrome P-450 inhibitor and may help reduce the formation of toxic metabolites and prevent liver damage in dogs; it is no longer recommended for use in cats. In vitro evidence indicates that use of cimetidine in cats can produce more toxic metabolites of acetaminophen. The use of cimetidine in combination

with NAC and ascorbic acid has been shown to be more effective than any of the agents alone in preventing acetaminophen-induced hepatotoxicity. The dose rate for cimetidine is 5-10 mg/kg PO, IM or IV every 6 to 8 hours; 2.5-5 mg/kg IV or IM every 8 hours, and it should be used cautiously in geriatric patients or patients with impaired renal or hepatic function.

Supportive care may include: oxygen therapy, intravenous fluid therapy to maintain hydration and perfusion, blood transfusion if required to manage anaemia, fresh frozen plasma or whole blood to manage coagulopathy resulting from hepatic necrosis, vitamin K1 in acute hepatic necrosis, and antibiotic therapy (beta-lactam +/metronidazole) in acute hepatic necrosis.

Physical activity should be limited and stress avoided.

Duration of treatment depends on the dose of paracetamol ingested and the presenting signs.

The prognosis for survival is good if the animal is treated early, aggressively and has good supportive care - provided that severe signs of methaemoglobinaemia or hepatic damage are not present. Hepatic damage can require

weeks of treatment. Cats with severe signs of methaemoglobinaemia or with hepatic damage have a poor to guarded prognosis.

Monitoring Liver enzymes should be monitored and rechecked at 24 and 48 hours later. The animal should also be monitored for methaemoglobinaemia, Heinz body anaemia, and haemolysis.

Serum chemistry parameters should be monitored. Haematological changes include methaemoglobinaemia, anaemia, and haemoglobinaemia. Laboratory evidence of hepatotoxicity generally develops 24 to 36 hours post ingestion. Increases in ALT may be seen in both dogs and cats. In the first 24 hours, ALT and AST increase, with an extreme (more than 1500 times higher than normal) increase evident by 48 hours. Progressive increases in blood urea nitrogen, cholesterol and albumin and increase in serum bilirubin are considered indicative of impaired hepatic function.

In cats, hyperbilirubinaemia occurs within 48 hours secondary to haemolysis with increases in liver enzymes possible 3 to 6 days after ingestion. In animals with severe liver injury, there may be evidence of marked hepatic failure accompanied by prolongation of prothrombin (PT) and partial thromboplastin (PTT) times.

Large doses of acetaminophen can cause nephrotoxicity with increases in BUN and creatinine levels and decreases in glomerular filtration rate. There may be evidence of haemoglobinuria or haematuria.

Facial and paw oedema in cats usually resolves without medical intervention, so corticosteroids and antihistamines are not indicated. As some dogs develop transient keratoconjunctivitis sicca after ingesting doses well below the amounts previously considered to be of concern, tear production should be monitored and artificial tears and cyclosporine administered as required.

Most dogs will need to continue medications for several weeks to protect the liver and with regular monitoring of liver enzymes. The liver can be permanently scarred which can affect long-term liver function in dogs who have recovered.

Selected references.

1. Aaronson LR. (2000) Acetaminophen Toxicosis in 17 Cats. Journal of Veterinary Emergency and Critical Care. 6(2): 65-69.

2. Allen AL. (2003) The diagnosis of acetaminophen toxicosis in a cat. Canadian Veterinary Journal. 44(6): 509-510.

3. Court MH. (2001) Acetaminophen UDPglucuronosyltransferase in ferrets: species and gender differences, and sequence analysis of ferret UGT1A6. Journal of Veterinary Pharmacology and Therapeutics. 24:415–422.

4. Judge PR. (2018) Protocol for Management of Paracetamol/Acetaminophen Toxicity in Dogs and Cats. Available at https://veteducation. com.au/wpcontent/uploads/2018/05/ Paracetamol-Toxicity-Protocol.pdf 5. Khan SA. (2014) Analgesics (Toxicity).

Available at https://www.msdvetmanual.com/ toxicology/toxicities-from-human-drugs/ analgesics-toxicity.

6. Meadows I. and Gwaltney-Brant S. (2006) The 10 most common toxicoses in dogs. Veterinary Medicine. March. pp. 142-147.

7. Ponnusamy P et al (2018) Paracetamol positioning in a cat and its treatment. Available at https://www.researchgate.net/publication/ 328064093_PARACETAMOL_POISONING_IN_ A_CAT_AND_ITS_TREATMENT. 8. Richardson JA. (2000) Management of Acetaminophen and Ibuprofen Toxicoses in Dogs and Cats. Journal of Veterinary Emergency and Critical Care. 10(4); 285-291.

9. Sellon RK. (2001) Acetaminophen. Peterson, M.E. and Talcott, P.A. (eds.) Small Animal Toxicology.

W.B. Saunders Company, Philadelphia. pp. 388-395.

AUGUST 2021

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Clinical Review

The oxygen pathway

Naomi Hansen BVSc MACVSc graduated from Queensland University in 1997.

She worked in mixed animal practice in Queensland after graduation, before moving to Canberra to work for John Aspley Davis at Kippax Veterinary Hospital. She has completed a residency in emergency and critical care at Melbourne University and was a resident in the same field at the Pennsylvania University Veterinary Hospital in the US. She is Veterinary Emergency & Critical Care in Sippy Downs, Qld. Hansen is a member of the Emergency and Critical Care Chapter of the ACVS.

The cardiopulmonary system is designed to deliver oxygen (O2) to the tissues and remove the carbon dioxide (CO2) that has been generated by cellular metabolism.

The oxygen pathway describes a series of steps by which atmospheric oxygen reaches the tissues.

We are often presented with patients who are suffering from failure of one or more of the steps involved in the oxygen delivery pathway (i.e. hypoxemia) . To accurately manage these patients we need to be aware of each step in this pathway and the means by which we can assess each of these steps.

Ventilation Ventilation is the mechanical process of gas flow in and out of the lungs.

The synchronised contraction of the intercostal muscles and the diaphragm acts to expand the thoracic cavity. During this process of inspiration, a pressure gradient is generated between the outside air (atmospheric pressure) and the intrathoracic space (sub atmospheric pressure). Air/gas flows passively along the gradient into the lungs.

There are four (4) different thoracic pressures involved in breathing: 1. Pressure at the mouth 2. Pressure in the alveoli (intrapulmonary pressure): approximately 0cm H2O at end expiration 3.Pressure in the pleural space (intrapleural pressure): approximately 5cm H2O at end expiration 4. Pressure at the body cavity ■ The transrespiratory pressure gradient (between the mouth/atmosphere and the alveoli) is responsible for the movement of air/gas into the alveoli ■ The transpulmonary pressure gradient (between the alveoli pressure and pleural space pressure) is responsible for maintaining alveolar inflation: approximately 5cm H2O at end expiration and 10cm H20 at end inspiration.

■ The transthoracic pressure gradient (between pleural space and body surface) is the total pressure required to expand/contract the lungs and chest wall.

These figures for pressure gradients are usually human in origin and very approximate. They are known to vary with the ‘height’ of the lung (i.e. the top of the thorax has a different pressure difference to the bottom of the thorax). They are used here as a guide to provide perspective.

Relaxation of the intercostal muscles and diaphragm (elastic recoil) expels the gas from the lungs during the process of expiration.

a. Anatomical dead space: The portion of the airways that is not involved in gas exchange (ie. the conducting airways) and do not receiving pulmonary blood flow. This is a fixed volume of dead space. b. Physiological dead space: The portion of the alveoli that are ventilated but not receiving pulmonary blood flow.

This volume varies with the number of functional alveoli.

Physiological dead space = VT (PaCO2-PETCO2/PaCO2) The arterial carbon dioxide minus the expired (or end tidal) carbon dioxide divided by the arterial carbon dioxide gives a fractional equivalent of the lung that is not contributing to gas exchange.

The partial pressure of carbon dioxide: Hypercarbia (also known as hypercapnia) is the major driving factor of the respiratory centre. There are both central and peripheral chemoreceptors that are responsible for the detection of CO2.

Central chemoreceptors: Central chemoreception refers to a change in ventilation attributed to a change in CO2/H+ that is detected within the brain. The respiratory response to hypercarbia/acidemia is to elevate the respiratory rate (hyperventilate) and ‘blow-off’ the excess CO2.

■

Peripheral chemoreceptors: Peripheral chemoreceptors are stimulated by hypercarbia and/or hypoxia to increase the respiratory rate.

■

The central respiratory centre drives the VA (alveolar ventilation) by increasing the respiratory rate to try and maintain a PaCO2 of 40mmHg.

The total volume of ventilation (VT) equates to the dead space ventilation (VD) + the alveolar ventilation (VA)

Hypoventilation: VA fails to match the carbon dioxide output (VCO2) and PaCO2 rises above 40mmHg

1. Alveolar ventilation (VA) is the volume of gas entering the respiratory zone per minute. The volume of gas exchanged between the alveoli and the external environment.

Hyperventilation: VA exceeds the carbon dioxide output (VCO2) and PaCO2 falls below 40mmHg

Alveolar ventilation = (tidal volume dead space volume) x breaths per minute ■ www.theveterinarian.com.au

2. Dead space ventilation (VD) can be further divided into anatomical and physiological dead space.

Hypoventilation Hypoventilation is more clinically significant than hyperventilation so we will focus on hypoventilation more than hyperventilation.

Adequate ventilation requires the following pathways to be intact: 1. Central respiratory centres (medulla respiratory centre and central chemoreceptors) 2. Spinal pathways 3. Peripheral respiratory nerves 4. Primary respiratory muscles 5. Pleural-pulmonary coupling 6. Pulmonary mechanical function Hypoventilation may result from a failure of any one or a combination of these pathways.

The most common causes of hypoventilation include depression or damage to the central respiratory centre, neuromuscular disease and/or ventilatory fatigue.

How do we assess ventilation in a clinical situation?

1. Breathing patterns Animals typically adopt a breathing pattern that minimises respiratory work and is a balance of elastic force, lung compliance and airway resistance. This means that assessing a breathing pattern can provide a lot of direction to the underlying cause of the cardiopulmonary problem.

A restrictive breathing pattern: A rapid and shallow breathing pattern. A restrictive breathing pattern is supportive of pulmonary oedema, interstitial pneumonia, pulmonary fibrosis, pleural space disease etc.

An obstructive breathing pattern: A slow and deep breathing pattern. An obstructive breathing pattern maybe accompanied by a noise on inspiration and/or expiration that can help to localise the disease process. An obstructive breathing pattern is supportive of laryngeal paralysis (upper respiratory), bronchoconstriction (lower respiratory) etc.

Upper airway obstruction: An exaggerated effort during inspiration and may be accompanied by a stridor.

Lower airway obstruction: An exaggerated effort during expiration.

2. Hypercarbia An arterial blood gas sample (PaCO2) is the best clinical assessor of alveolar ventilation (VA). A PaCO2 > 45mmHg suggests inadequate alveolar ventilation. A venous blood gas sample can be used as a guide if an arterial sample cannot be attained.

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Clinical Review Arterial blood gas samples are collected from the femoral or dorsal pedal artery with a 22G-25G needle. They are generally collected into specific arterial blood gas syringes. It is important that samples are processed immediately with minimal contact with atmospheric/room air.

Hypoventilation causes a respiratory acidosis and hypoxemia.

Gas exchange at the level of the alveoli occurs across a diffusion gradient that exists between the pulmonary capillary blood (venous) and the gas in the alveoli. During hypoventilation, there is a reduction in alveolar ventilation that will this will impact on the diffusion gradient between the alveoli and pulmonary capillary (there will be an increase in alveolar carbon dioxide and a decrease in alveolar oxygen).

It is therefore true that the administration of supplemental oxygen will correct the hypoxemia but not the respiratory acidosis as it will improve the oxygen diffusion gradient but will not assist in the expulsion of the carbon dioxide.

3. Venous admixture occurs when there is inequality in the gas exchange across the global lung causing changes (usually decreases) in the gas concentration of the arterial sample.

How do we ascertain if there is a gas exchange problem in a clinical situation?

1. The Alveolar-arterial gradient (A-a gradient or alveolar gas equation) Alveolar oxygen level: PAO2 = PiO2 -PaCO2/R PiO2 = 150mmHg (at room air and at sea level, calculated by the following equation: PiO2 = FiO2 x (PB -PH2O) PiO2 is a factor of inspired O2 (FiO2 = 21mmHg at room air), barometric pressure (PB = 760mmHg at sea level) and the vapour pressure/partial pressure of water (PH2O = 47mmHg at 100% saturation and body temperature).

Arterial oxygen level: this can be attained from an arterial blood gas at a known FiO2

3. Capnography: Capnography is the measurement of the partial pressure of carbon dioxide in inhaled and exhaled gases during phasic breathing.

The diffusion of CO2 from the pulmonary capillaries to the alveoli (along the concentration gradient) is very efficient so PaCO2 (arterial carbon dioxide partial pressure) approximates PACO2 (alveolar carbon dioxide partial pressure).

The degree of gas exchange can therefore be quantified and monitored using the alveolararterial O2 difference. Ideally the A-a gradient should be <10-15mmHg (this is representative of the gradient between the alveolar oxygen and the capillary oxygen and should vary only due to anatomical dead space)

PETCO2 (end tidal carbon dioxide) levels therefore closely approximate arterial carbon dioxide levels and are a good indicator of alveolar ventilation.

Air in the Earths atmosphere contains 21% oxygen, 78% nitrogen and 1% other (including argon, carbon dioxide, neon, helium and hydrogen)

If there is a discrepancy between the arterial carbon dioxide level and the end tidal carbon dioxide level this is suggestive of a reduction is effective gas exchange. There is normally a small difference (2-5mmHg) between arterial and alveolar carbon dioxide levels that is attributed to anatomical dead space. If the gradient is elevated above this value, an increase in physiologic dead space causing significant ventilation/perfusion mismatch would be suspected.

This discrepancy suggests there is ventilation to an area of lung that is not being perfused, causing an increase in the physiologic dead space (i.e. PTE).

The A-a gradient should be less than 10mmHg for animals breathing room air (FiO2 21%) and the normal A-a gradient increases 5-7mmHg every 10% increase in FiO2

A normal capnogram consists of four (4) distinct phases: i. Beginning of exhalation: zero baseline as the air from the anatomical dead space is eliminated. ii. Exhalation: gradual increase in exhaled carbon dioxide as the carbon dioxide air is exhaled from the lower airways. iii. End-exhalation: The plateau that dictates the ETCO2 reading as all the air is expelled from the alveoli iiii. Inhalation: a rapid drop in carbon dioxide levels as the next breath begins and fresh gas rushes past the sensor.

2. Pulmonary gas exchange Pulmonary gas exchange occurs at the level of the alveoli. Gas diffuses across a very small distance from the alveoli to the tiny network of capillaries. The diffusion of gases at this level occurs along a concentration gradient that exists between the alveoli and the capillary blood.

The exchange of oxygen and carbon dioxide between the alveolus and the capillary blood is affected by the following factors. All these factors will cause alterations in the arterial blood gas samples.

1. The diffusion from the alveoli to the capillary.

This may be affected by the gas concentration gradient and/or the diffusion distance.

2. Matching of ventilation and perfusion to enable an ideal gas exchange. Ventilation-perfusion mismatching will affect the exchange of gases and the arterial blood gas concentrations.

■ www.theveterinarian.com.au

Impaired gas exchange results in an A-a gradient >10-15mmHg and can be attributed to: 1. Diffusion impairment Diffusion impairment is identified when there is a discrepancy (>10-15mmHg) between the PAO2 of the alveolar gas and the pulmonary capillary blood (PaO2).

■ Diffusion ∝ oxygen concentration gradient across the membrane and membrane area available for diffusion ■ Diffusion 1/∝ membrane thickness ■ Carbon dioxide diffuses 20 times more rapidly than oxygen

The process of gas exchange is extremely efficient and generally completed by the time the blood has traversed 1/4 of the alveolar capillary bed.

Pulmonary Thromboembolism (PTE): One of the most important causes of impaired gas exchange is pulmonary thromboembolism (PTE). PTE causes an occlusion to the blood supply to a region of lung that is still undergoing ventilation. This drastically decreases the total membrane area that is available for gas exchange and increases the dead space ventilation as the area of lung that is ventilated and not perfused can be deemed physiological dead space.

The administration of supplemental oxygen should resolve the hypoxemia associated with a PTE and a measure of the ET CO2 will support an increase in dead space when compared to the arterial oxygen.

Shunting occurs under the following circumstances: 1. Cardiac pathology causing shunting (i.e. ventricular or arterial septal defects) 2. Intrapulmonary pathology causing ventilation/perfusion mismatch (i.e. the perfusion of collapsed or fluid filled alveoli resulting in zero or poor gas exchange).

■ The severity of the hypoxemia is a function of the ratio of shunt flow to total cardiac output (shunt fraction Qs/Q) ■ Shunt hypoxemia is non responsive to supplemental oxygen therapy ■ Shunts do not effect the PaCO2 unless very severe (i.e. shunting does not result in hypercapnia) ■ Patients with shunts may have hypoxia driven hyperventilation resulting in a low PaCO2

3. Ventilation-perfusion mismatch Ventilation (V) – perfusion (Q) mismatch occurs when V-Q are not closely matched in gas exchange units (inefficient gas exchange) resulting in hypoxemia Normal V/Q is approximately 0.8-1.0 (PACO2 approximates 40mmHg and PAO2 approximates 100mmHg) High or infiniti V/Q (dead space): This occurs when regions of lung are ventilated but not perfused resulting in a decrease in the total lung area available for gas exchange. In this situation V/Q will approach infiniti and the PAO2 of the alveolus would be similar to the external air where the PACO2 would be zero (i.e. no gas exchange). This alveolus is therefore considered part of the physiological dead space of that lung.

Low and /or zero V/Q (shunting): This occurs when regions of lung are perfused but not ventilated resulting in venous admixture (i.e.

Intrapulmonary shunting). The alveolar PAO2 and PACO2 pressures are similar to their respective pressures in the venous blood. Low V/Q is associated with any pulmonary condition that results in partial alveolar collapse or poor ventilation. The affected alveolus is therefore contributing to a right to left shunting of blood.

How do we assess pulmonary gas exchange?

1. A-a gradient ■ Normal: <10mmHg [FiO2 21% and sea level (PB 760mmHg and PH2O 47)] ■ Abnormal: >30mmHg suggests significant gas exchange impairment 2. Oxygen saturation and oxygen content Oxygen is predominantly carried on the haemoglobin (Hb) molecule, one haemoglobin (Hb) molecule can transport 4 oxygen molecules.

Oxygen that is bound to haemoglobin does not exert a partial pressure (i.e. the PaO2 is the amount of oxygen that is dissolved in the plasma) Oxygen saturation (SaO2) is a percentage measure of the number of Hb binding sites actually bound with oxygen. The relationship between SaO2 and PaO2 is the oxygen-haemoglobin saturation curve. This curve is sigmoid in shape as the affinity for oxygen increases as more oxygen is bound.

■

SaO2 is 97% when PaO2 is 97mmHg

Shifts of the sigmoid curve reflect alterations in the affinity of Hb for oxygen (i.e. a right shift decreases O2 affinity and left shift increases O2 affinity).

A shift in the sigmoid curve has a profound effect on the uptake of oxygen at the lungs and the offloading of oxygen at the tissu es.

P50 (PaO2 at 50% saturation) is used to help interpret Hb physiology and ‘shifts’ ■ Increase in P50 indicates a decreased O2 affinity (oxygen is less likely to attach at the lung level and more likely to unload at the tissues) ■ Decreased in P50 indicated an increased O2 affinity (oxygen less likely to unload at the tissues) What causes a right shift?

Increased CO2, increased H+, increased temperature What causes a left shift?

Decreased CO2, decreased H+, decreased temperature AUGUST 2021 TheVeterinarian 25

You slog it through the mud. We’ll wade through the numbers

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Clinical Review

Oxyhaemoglobin dissociation curve 3. Oxygen content The arterial oxygen (CaO2) content is the amount of oxygen present in the arterial blood One (1) gram of haemoglobin is capable of carrying 1.34ml of molecular oxygen when fully saturated.

■ One (1) of the four haemoglobin subunits contains a heme moiety (iron containing).

Iron will only bind oxygen in the ferrous state (Fe 2+). Iron that is in the ferric state (Fe 3+) is methemoglobin (MetHb) and does not bind oxygen.

A dog generally has between 12 and 15g Hb/dl blood ■

CaO2 = (SaO2 (%) x Hb (g/dl) x 1.34) + PaO2 x 0.003 (Normal CaO2 = 16-20 ml/dl) At sea level with PaO2 97mmHg (SaO2 97%) and Hb content 15g/dl, CaO2 will approximate 19.8 mlO2/dl In practice, the contribution of dissolved O2 to the arterial oxygen content is negligible (at an arterial PO2 of 100mmHg, 100mL blood contains 0.3ml of dissolved oxygen) 4. Oxygen delivery Aerobic metabolism requires a steady stream of oxygen to maintain normal biochemical processes.

Oxygen consumption under normal metabolic conditions equates to 5ml/kg/min.

Under normal circumstances, the oxygen requirement is never high enough to deplete the oxygen reserves on the Hb molecules but in the presence of low Hb levels, poor perfusion or high metabolic demands, assuming a fixed oxygen delivery, the state of critical oxygen delivery may be reached.

VO2 is limited by DO2 not metabolic demand.

Oxygen delivery (DO2) is the amount (ml) of oxygen delivered to the peripheral tissues each minute. This value is a function of the cardiac output (CO) and the arterial oxygen content (CaO2).

DO2 = CO x CaO2 The rate of oxygen consumption at the tissues can be calculated as the difference between the arterial and venous oxygen content (ml O2/min) 5. Carbon dioxide transport Carbon dioxide is the major end-product of oxidative metabolism The body is extremely sensitive to CO2 and the ventilatory systems are designed to regulate CO2 levels and facilitate its clearance from the lungs.

Carbon dioxide diffuses from the tissues into the plasma and is transported as carbonic acid CO2 transport mechanisms 1. The tissue level: i. Carbon dioxide is produced at the tissues during the aerobic metabolism of glucose.

■ www.theveterinarian.com.au

ii. A small percentage (5%) of the carbon dioxide is maintained in the physical solution due to its water (plasma) solubility. This will facilitate the direction of diffusion. iii. 10% of the CO2 diffuses into the red blood cells and combines with Hb as carbamate iv. The majority (85%) of CO2 undergoes chemical conversion to carbonic acid (facilitated by the carbonic anhydrase (CA) of the erythrocyte cytoplasm) CO2 + H20 < > H2CO3< >H+ + HCO3 Hydrogen ions bind to sites on Hb (buffered) Bicarbonate ions diffuse out in exchange for chloride ions (chloride shift) 2. The lungs: a. The carbonic anhydrase (CA) catalysed reaction is reversed and the carbon dioxide molecule reassembled. b. The carbon dioxide molecules are released from the Hb molecule in exchange for oxygen. c. The released carbon dioxide diffuses into the alveolus and out through the conducting ducts of the respiratory tree.

Haemoglobin is an important buffer in the blood (6 x that of plasma protein) Arterial and venous blood gases Blood gas samples are obtained to determine ventilation, oxygenation and acid-base status pH The pH is an inverse logarithmic expression of the hydrogen ion concentration and reflects the balance between bicarbonate (HCO3) and carbon dioxide (CO2) pH = pKa + log [HCO3]/total CO2 The ratio (not absolute values) of HCO3 : CO2 is important in determining pH, a ration of 20:1 equates to a normal pH (7.4) The pH is regulated through a series of mechanisms and buffering systems 1. Plasma proteins and bicarbonate buffering 2. Respiratory system (CO2 elimination) 3. Renal system (H+ and HCO3 elimination) The respiratory response is immediate and is completed within hours but the renal response begins within hours but requires 2-5 days for maximal effect An increase in extracellular hydrogen ions (H+) initiates an ion shift from the extracellular space to the intracellular space for buffering in exchange for potassium ions (K+) H2O + CO2 < > H2CO3 < > H+ + HCO3 Normal pH range 7.35 – 7.45 (pH < 7.35 acidemia and pH > 7.45 alkalemia)

PaCO2 The partial pressure of carbon dioxide dissolved in the plasma of arterial blood (mmHg) PaCO2 = 35-45mmHg (sea level) The PaCO2 reflects a balance between the alveolar minute ventilation and the metabolic carbon dioxide production PaCO2 < 35mmHg (hypocapnia) reflects a respiratory alkalosis or hyperventilation PaCO2 > 45mmHg (hypercapnia) reflects a respiratory acidosis or hypoventilation HCO3 / Base balance The metabolic component of acid-base balance can be assessed using two values ■ HCO3 18-24mmol/l ■ Base balance (base excess or deficit) 0+/- 4mEq/l The base excess/deficit reflects the amount of surplus acid/base present. This reflects the titratable base/acid to achieve a pH of 7.40 under standard conditions.

Metabolic acidosis HCO3 < 18mmol/l or BD < 4mEq/L Metabolic alkalosis HCO3 > 24mmol/l or BD > 4mEq/L PaO2 The partial pressure of oxygen dissolved in arterial blood (mmHg) PaO2 = 80-110mmHg (sea level) PvO2 = 40-50mmHg (sea level) PaO2 < 80mmHg is considered hypoxia and a PaO2 < 60mmHg is considered severe and may require ventilatory support.

Venous sampling ■ There is good correlation between venous and arterial pH ■ Venous PCO2 is approximately 3-6mmHg higher than arterial samples ■ Venous PO2 is a reflection of tissue PO2 and does not correlate to PaO2 Assessing acid/base status (easy as 1…2….3!)

1. Assess the pH (normal/academia/alkalemia) 2. Assess the respiratory component (normal/ hypocapnia/hypercapnia) 3. Assess the metabolic component (normal/acidosis/alkalosis) 4. Which component is the primary contributor?

(Generally the pH will vary in the direction of the primary disorder) 5. Assess the PaO2 for hypoxemia and the A-a PO2 gradient (For FiO2 > 21%, the expected PaO2 generally equates to 5 x FiO2) AUGUST 2021 TheVeterinarian 27

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BUSINESS

Reptile masterclass series launched Kellyville Pets, Australia’s largest independent pet store and animal welfare advocate, has launched Petopia, an online pet education, conservation and exploration platform, featuring the world’s first ever online Reptile Masterclass Series.

The Petopia online Reptile Masterclass Series includes courses covering bearded dragons, pythons and turtles and soon will cover frogs. Each teaches prospective and existing reptile carers how to successfully look after these fascinating animals in captivity.

Each Masterclass includes more than two hours of engaging, cinematic content and is divided into easily digestible chapters focussing on topics including natural history, anatomy, habitat, general husbandry, diet, and conservation.

According to Kellyville Pets General Manager, Richard Sheen, the Reptile Masterclasses fill a demand in the market, recently created due to COVID-19.

“Reptiles have always been a popular pet as they don’t require

Ben Dessen

a large space to live, they leave no mess, they don’t smell, and make no noise. But over the past year and a half, we have seen a huge increase in the interest surrounding these unique pets.”

“Unfortunately, because of the covid-19 pandemic, new reptile keepers couldn’t partake in our in-store reptile courses that we have been operating for the past 25 years. There was also

no similar course offered online.”

“As strong advocates of animal welfare and responsible pet care we wanted to create an educational platform that delivered the most accurate and up-to-date information on how to look after animals, that could be accessible to pet parents of all ages, and not only in Australia but on a global level. So, petopia and our online pet Masterclasses

were born,” Sheen said.

The masterclasses are professionally shot with cinematic, high-definition visuals and are presented by reptile expert and conservationist, Ben Dessen.

Dessen holds a Bachelor of Natural Science and has dedicated his life to animal welfare and conservation. He manages the Reptile Department at Kellyville Pets, having developed and presented the reptile masterclasses for the past 10 years. He is also a resident teacher at the Future Vet Kids Camp, is Sanctuary Manager and Director of the Zambi Native Wildlife Sanctuary and is a member of Sydney Wildlife Rescue.

Dessen has also lived in the jungles of Borneo establishing an orangutan orphanage and rehabilitation centre and worked with Bob Irwin and Harry Cooper.

“My vision is to encourage the responsible treatment of animals and nurture the conservationists of tomorrow. I believe these Masterclasses help do exactly that and I’m so excited that I can share my knowledge and passion for reptiles with the world.”

For further information visit www.kellyville pets.com.au/pages/reptile-masterclasses.

Dassiet and OrthoPets join forces Trifecta of triple breed average Material innovation company Dassiet, and leading US-based pet orthosis manufacturer OrthoPets have begun collaboration to create sustainable, safe and user-friendly pet healthcare products. Both companies want to first tackle the issues surrounding veterinary casting, splints, and bandages, and to provide safe and sustainable orthopedic treatment options.

“Treating injuries in pets is hard.

Pets cannot tell if their bandages are too tight, or if their skin starts

to macerate. Currently, the casting process takes long and has multiple steps, and the available materials expose pets to allergic reactions and other complications. With our materials proven with human patients, and the incredible expertise the OrthoPets team has in animal orthoses we can bring pet trauma care to the modern day”, Dassiet CEO Jimmy Takki said.

“I’ve dedicated my career to making animals’ lives better, and

■ www.theveterinarian.com.au

since 2003 [the] OrthoPets team has helped over 30,000 animals with custom made orthoses.

Collaborating with Dassiet was an obvious next step for us. With their material innovations we can provide pets with even higher quality treatment they deserve and innovate on a sector of veterinary sciences that lags decades behind the corresponding human medicine”, OrthoPets Founder Martin Kaufmann said.

The new collaborative line of fracture and wound care products, called UPETS, utilises Dassiet’s remouldable, non-toxic and lightweight Woodcast material and a newly patented breathable, selfcohesive fabric that makes old-fashioned bandages obsolete.

Combining the two companies’ expertise, UPETS products will not only be a biomechanically superior treatment option, but also fast to apply, made from eco-friendly materials and place focus on patient comfort and safety.

The two companies are looking to answer the growing demand of quality care for animals, as the number of pets soars with 12.5M new pets adopted last year in the US alone. The teams are already conducting clinical trials on their new products. Early results as well as leading veterinarian and researcher feedback has been extremely positive, and the companies hope to announce some of the new products by the end of this year.

To read more about Dassiet’s mission, products and team, visit www. dassiet.com.

in reach thanks to genomics

The power of DNA testing and genomic analysis has put within reach the triple crown of achieving threetimes the breed average for growth, carcass weight and marbling for Circle 8 Bulls’ Jeremy Cooper.

The Marulan, NSW, based wagyu breeder says the incredible milestone would not have been possible without an early decision to adopt Neogen’s genomic selection technologies, which have rapidly accelerated the rate of improvement in his herd.

And now the inclusion of these elite wagyu genetics in a commercial angus breeding group for F1 wagyu production is generating new possibilities for advanced genomic analysis, through new a customised DNA testing program being developed by Neogen.

“My first use of genomics was in the late 1990s when I was solely breeding angus cattle and when I learnt about DNA testing I knew I needed to start using this technology for verifying my animals’ parentage and giving them pedigree integrity,” Cooper said.

“It was expensive at the time, but I knew that as the technology moved forward that one day we would be able to look inside the animal at key genetic traits. I’ve been with Neogen ever since.”

Circle 8 Bulls currently supplies about 50 wagyu bulls to a NSWbased supply chain, which runs 5000 angus cows, with plans to increase the herd to 8000 in the future.

Working with Neogen, they are implementing the first Igenity Enhanced testing program.

Neogen’s Igenity Beef test is designed to provide commercial cattle breeders with an objective genetic selection tool for within herd ranking.

It utilises DNA to predict genetic variation in both heifers and steers, providing an additional selection tool to commercial producers to use when culling, joining or supplementary feeding.

By applying the Igenity testing system across the various commercial cows that are bought for the breeding group each year, the breeders will be able rank the female population for joining or culling, with only the top females selected for mating with the elite Wagyu bulls.

“We’ll then collect DNA from the progeny, along with feedlot and carcase data, and through the Igenity Enhanced analysis, we’ll have a comprehensive set of rankings for a range of production traits to use in when making selection decisions for the next generation,” Cooper said.

“With the Igenity Enhanced rankings we will be able to accelerate the rate of genetic improvement, increasing marbling and decreasing days on feed. This whole process has only been made possible through the use of genomics.”

For more information, visit genomics. neogen.com/au

AUGUST 2021 TheVeterinarian 29

News

Investigating wellbeing at work From page 1

a, ‘potentially exciting, unexplored and less acknowledged yet highly pleasurable aspect of vet work’ that went beyond the joy of working with animals. The results also showed experiencing certain positive beliefs about oneself, such as flexibility, having a positive attitude and accomplishment are associated with pleasure at work.

“They showed opportunities to highlight the variety of positive and varied experiences professionals in veterinary medicine can draw upon to provide pleasure in their work.

These could include introducing an informal and formal recognition system and increasing time spent with colleagues. Further benefits could include the introduction of a peer supervision or mentoring program to support veterinary expertise and increase connectedness across the profession. Further developing personal resources, for example in the university curriculum or as an ongoing professional development, could increase the overall wellbeing of vets,” McArthur said.

There were some negatives cited by respondents but McArthur said they tended to refer to an absence of a negative in order for a positive experience to result, for example: ‘when I don’t…‘, or ‘when there’s not…’, while some included job demands such as injuries, for example: ‘when I’m not bitten’. Negative workplace and client experiences, poor work-life balance, stress, and fatigue were also listed as negatives.

McArthur said future studies were planned to explore how pleasure at work can be better developed and measured to strengthen resilience and wellbeing. Further research will also explore workplace relationships and interactions with clients, which although are sources of joy and pleasure for vets, can also prove challenging.

“Veterinarian work is such a rewarding profession and it’s important we share the many positives with new vets, and those in training, both as reassurance and to encourage others to join the profession,” she said ■ ANNE LAYTON-BENNETT

Fears of toxic chemical overload in pinnipeds From page 4

This includes adult seals and sea lions, their pups, fish, and humans.

“Because PFAS last a long time, they can become concentrated inside the tissue of living things. This increases the potential for exposure to other animals in the food chain, particularly top marine mammal predators like seals and sea lions.

There’s also the potential for humans to be exposed to PFAS

by eating contaminated seafood, drinking contaminated water, or even through eating food grown in contaminated soil,” she said.

■ ANNE LAYTON-BENNETT “Per and polyfluoroalkyl substances (PFAS) at high concentrations in neonatal Australian pinnipeds’ is available at doi.org/10.1016/j. scitotenv.2021.147446

Supporting good mental health in vets across Australia From page 5

As another part of the campaign, Zoetis has designed a leave-behind containing practical tips and providing details of support networks that is being distributed nationally.

“The aim is to start having the conversations,” Wilks said, and with the COVID-19 pandemic continuing to impact the private and professional lives of many Australians – particularly when coping with intermittent or sustained lockdowns – the campaign to safeguard the wellbeing of veterinarians could not be more timely.

“Veterinary teams are used to pushing through when it’s busy, but we can’t do that anymore. The high workload has been ongoing for over a year now, and teams are exhausted,” Wilks said. With her ‘Veterinarian Hat’ on, she recommends taking breaks during the workday to ensure people and performance are not detrimentally impacted. “There’s no point working past capacity every day and missing breaks. Allowing such behaviour is short term thinking that will cause significant long term problems and attrition in the workplace.”

Similarly, with her ‘Coach Hat’ on, Wilks highlighted the importance of flexibility and of letting go of perfectionism to maintain wellbeing. “Perfectionism has no 30 TheVeterinarian AUGUST 2021

place in this pandemic. We are dealing with situations that are constantly changing and the uncertainty of what may occur next, which leads to significantly more stress,” she said. “The ability to be flexible and adaptable is really important in dealing with rapidly changing situations. Recognise what really needs to be done and what can wait: cleaning the house can wait, so can the washing, and there’s nothing wrong with toast for dinner! Use self-compassion to give yourself the permission for self-care to rest, recharge and recover.”

When asked if there is one resounding message she would like to communicate to vets and vet nurses as part of the Beyond Blue/Zoetis Mental Vet Health Campaign, Wilks’ response was full of hope and support. “It won’t be like this forever,” she said.

“While we don’t know how long the pandemic will last, it will end. Being hopeful and optimistic about the future is important. You will get through this. At times it won’t be easy or fun, but you will learn things about yourself that will increase your resilience for future challenges. The veterinary profession does such important work in the community, and you make a tremendous different in your clients’ lives. You do matter.”

■ JAI HUMEL

TheVeterinarian Sydney Magazine Publishers Pty Ltd ACN 102752787 ISSN 1447-9768

Kiwi Post From page 9

natural culmination on their difficult journey.

Remarkably, Hamza’s younger sister, who is now 13, also wants to be a vet. After the ceremony, the family and supporters went for prayers and were then shown around the vet school, before travelling back to Christchurch. I really hope that Salwa’s youngest continues her path towards vet and I hope our community may be able to help her along the way somehow too. And whilst nothing brings Hamza back, for us as veterinarians this was a very humbling day, with a very special family, to celebrate a very special young man.

Abstracts - equine obesity From page 14

as a strong-willed adversary, and weight management was considered a “battle” or “war”. Owners found weight management difficult because they perceived that it had immediate negative welfare implications for the horse, and this therefore interfered with their preferred ownership practices and the horsehuman relationship.

Main limitations: Interview data are self-reported, and people may not always do what they say they do.

Conclusions: This study has provided valuable insight into how owners conceptualise weight and weight management, yielding important information about communicating with owners about weight, tailoring weight management strategies, and promoting positive welfare.

Tamzin Furtado1, Elizabeth Pinchbeck1, Perkins2, Gina Catherine McGowan1, Francine Watkins2, Robert Christley1 Equine Vet J. 2021 Jul;53(4):752762.doi: 10.1111/evj.13360. Epub 2020 Oct 30.

1Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst Campus, Neston, UK. 2Institute of Population Health, University of Liverpool, Liverpool, UK.

Abstracts - cohabitant dogs From page 14

Dog-human attachment may play a distinct and important role in the success and resilience of adult dogs living in at least some anthropogenic environments. Bonds formed with other adult dogs, while important, likely serve a different function.

Nicole Sipple1, Lauren Thielke1, Arden Smith1, Kristyn R Vitale2, Monique A R Udell1 Integr Comp Biol. 2021 Jul 23;61(1):132-139.doi:10.1093/icb/ icab054.

1Department of Animal and Rangeland Sciences, Oregon State University, Corvallis, OR 97331, USA. 2Animal Health and Behavior Program, Unity College, Unity, ME 04988, USA.

PO Box 305 Millthorpe NSW 2798 Tel: 02 9487 6627 Director - Clem Martin Email: clem.martin@vetmag.com.au Editorial Advisory Board Thomas Donnelly BVSc DipVP DipACLAM Nicholas Kannegieter BVSc DipVetClinStud PhD FACVSc David Lidbetter BVSc MVS FACVSc DipECVS Dip ACVS Angus Martin BVSc Mary Porter BVSc (Hons) MACVSc Jeffrey Smith BVSc FACVSc Dip ACVO David Vella BSc BVSc (Hons) DABVP Editor - Luke Martin Tel: 0418 698 228 Email: luke.martin@vetmag.com.au National Sales Manager James Martin Tel: 0432 575 877 Email: james.martin@vetmag.com.au Designer - Anne Norrell Email: annenorrelldesign@gmail.com Printed by Newstyle Printing 41 Manchester St, Mile End SA 5031 Post Print Approved PP255003/06488 All material in The Veterinarian is subject to copyright and must not be reproduced wholly or in part without the written permission of the Editor.

Views expressed in The Veterinarian are not necessarily those of The Veterinarian or Sydney Magazine Publishers Pty Ltd. Subscriptions - Clem Martin Tel: 02 9487 6627 Email: clem.martin@vetmag.com.au

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Domestic yak (Bos grunniens) Found throughout the Himalayan region of the Indian subcontinent, the Tibetan Plateu, Northern Myanmar, Yunnan, Sichuan and as far north as Mongolia and Siberia, the domestic yak is a long-haired domesticated animal which seems more closely related to bison than to other members of its designated genus. Primarily kept for their milk, fibre and meat (or as beasts of burden), the animals are also raced in countries such as Tibet and Pakistan. Picture travelwayoflife

F e a t u r e

CREATURE

The Murmur Initiative

Test Yourself VLAS module When referral to a cardiologist is unavailable or declined, the Australasian Veterinary Cardiology Advisory Board (AVCAB)† recommend the use of vertebral left atrial size1 (VLAS) to assist in the diagnosis of Stage B2 MMVD2, to determine when it is appropriate to commence treatment with Vetmedin®.

Proudly developed with the assistance of: Associate Professor Fiona Meyers BVSc(Hons) PhD MANZCVS DACVIM,

Specialist Veterinary Cardiologist; Dr Brad Gavaghan BVSc(Hons) MANZCVS FANZCVS,

Specialist Veterinary Cardiologist;

This interactive VLAS module allows you to practice measuring the VLAS on six thoracic radiographs and to then compare your results to the experts.

Dr Christopher Lam BA BVSc (Hons),

Cardiology Resident.

† The Australasian Veterinary Cardiology Advisory Board: Dr Brad Gavaghan BVSc (Hons) MANZCVS FANZCVS (Cardiology), Dr Jacqui Huxley BVSc DVC MVM MRCVS, Associate Professor Fiona Meyers BVSc (Hons) PhD MANZCVS Dip ACVIM (Cardiology), Dr Rita Singh BSc BVMS (Hons) Dip Vet Clin Stud FANZCVS Dip ACVIM (Cardiology), Dr Richard Woolley BVetMed Dipl ECVIM-CA (Cardiology).

Step 1: Select the centre of the most ventral aspect of the carina.

Step 2: Now select the most caudal aspect of the left atrium where it intersects with the dorsal border of the caudal vena cava The

line will be your VLAS measurement.

Step 3: Select the cranial edge of T4 just ventral to the vertebral canal.

Step 4: Use the virtual calipers to produce a line of equal length beginning at the cranial edge of T4 and extending caudally just ventral and parallel to the vertebral canal.

Step 5:

YOUR VLAS MEASUREMENT

YOUR VLAS MEASUREMENT

3.1

The VLAS is defined as the length of this line expressed in vertebral-body units to the nearest 0.1 vertebra. One vertebral-body unit extends from the cranial edge of one vertebra to the cranial edge of the next, and includes the inter-vertebral disc space.

EXPERT MEASUREMENT

3.2

Once you identify the VLAS measurement, enter it into the field opposite.

Simply go to: www.animalhealthacademy.com.au/murmurinitiative When registering for Boehringer Ingelheim Animal Health Academy the first time, please use the access code: myAcademy

References: 1. Malcolm, E.L., et al. (2018) Diagnostic value of vertebral left atrial size as determined from thoracic radiographs for assessment of left atrial size in dogs with myxomatous mitral valve disease. J Am Vet Med Assoc, 253(8), 1038-1045. 2. Keene, B.W., et al. (2019) ACVIM consensus guidelines for the diagnosis and treatment of myxomatous mitral valve disease in dogs. J Vet Intern Med, 33(3), 1127-1140.

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