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The Veterinarian provides product and industry news, expert columnists, clinical articles, practice management, research updates and nursing information together with lifestyle issues affecting your profession globally.

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Hyperthyroidism is the most prevalent endocrine disease in cats over 10 years of age. Excess thyroid hormone comes from a single benign adenoma or more commonly bilateral adenomas on the lobes of the thyroid gland. The aetiology behind these adenomas remains incompletely understood but the population of cats impacted as a percentage continues to grow. This rise has been driven by the implementation of feline geriatric monitoring programs that provide earlier diagnosis of diseases later in life through health screening, an indication that currently some level of under diagnosis for feline hyperthyroidism may be occurring. Most cases of hyperthyroidism will be straightforward to diagnose and treat, with current treatment options available including the chemotherapy treatment, radioactive iodine, surgical thyroidectomy, topical compounded medications or tablets. The challenge in practice is that tablet medication is most often prescribed and therefore most clients must learn to regularly tablet their cat to be compliant.

The team at Norbrook recently announced the launch of Thyronorm Oral Liquid for Cats to manage feline hyperthyroidism. Michael Dhar, Norbrook’s Technical Services Manager, comments “Cats with hyperthyroidism are difficult to treat initially because of the aggressive behavioural changes that occur with the disorder Medical treatment is common as either a precursor to other options or for the lifelong management of hyperthyroidism, successfully returning cats to a euthyroid state in over 95% of cases.

Thyronorm Oral Liquid now provides Australian vets with a registered alternative to making their clients tablet a cat with hyperthyroidism”. Thyronorm oral liquid contains 5mg/mL thiamazole (also known as methimazole in the US) that inhibits the production of thyroid hormone by the thyroid gland, in a palatable liquid formulation that has an ISFM (icatcare.org) Easy to Give award.

The liquid thiamazole formulation provides an alternative to any tablet version including the human carbimazole formulation as carbimazole is a prodrug of thiamazole.

“Carbimazole is immediately converted to thiamazole by the liver which is the active molecule. It is important to recognise that the molar equivalent of carbimazole is not the same as thiamazole, so when converting doses between the two some maths needs to be done,” Dhar said. “Thyronorm also provides an alternative to the compounded topical thiamazole formulations as a registered medication that also has the benefit of reducing the possibility of accidental exposure to other pets or humans that may occur with topical medicines when prescribed.”

“The thyroid hormone has an impact on many systems within the body. These include metabolism, body temperature, blood pressure, heart rate and gastrointestinal function. Practising vets will have hyperthyroidism on their differential list for a varied set of unwell geriatric feline clinical presentations.”

There are two thyroid hormones, thyroxine (T4) and triiodothyronine (T3), these are synthetised and released from the thyroid gland under the influence of TSH (thyroid stimulating hormone). Outside the thyroid gland there is further conversion of T4 to T3 in tissues. There is a negative feedback loop from the thyroid hormones to the hypothalamus reducing TRH (thyroid releasing hormone) and the pituitarygland reducing TSH to manage blood thyroid hormone levels. The impact of the benign adenoma in the thyroid gland is that the negative feedback loop to manage hormone levels no longer is effective. The adenoma continues to produce hormone in excess of requirements resulting in high blood levels.

Common clinical symptoms cat owners notice include:

■ Catabolic muscle wasting and weight loss PU/PD with proteinuria

■ Gastrointestinal symptoms of vomiting and diarrhoea

■ Polyphagia and increased appetite

■ Behavioural changes that include increased activity level, restlessness, agitation, or nervousness

■ Vocalisation

■ Unkempt hair coat

Clinical examination of the patient by the veterinarian may provide additional symptoms that increase the suspicion of hyperthyroidism and include:

■ Tachycardia and hypertrophic cardiomyopathy

■ Palpable goitre

■ Hypertension that may present as retinal detachment or hyphema (blood collecting within the eye)

■ Hindlimb paresis or paralysis where aortic thromboembolism is the diagnosis

Co-morbidities are common in cats that have hyperthyroidism with concurrent renal insufficiency occurring in as many as 20 per cent of cases. Tachycardia, volume overload through adrenergic stimulation and hypertension can artificially increase GFR (glomerular filtration rate) by 100 per cent when hyperthyroidism exists. “Hyperthyroidism results in renal damage through renal hypertension and glomerular sclerosis resulting in this population of cats having a higher incidence of renal disease.” Euthyroidism will limit on-going renal damage and if renal disease exists that should be managed concurrently. As renal insufficiency is present at such a high rate prior to hyperthyroid management, on-going monitoring of renal parameters when monitoring blood thyroid hormone levels is strongly recommended.

A small percentage of feline hyperthyroidism cases are a consequence of a malignant thyroid adenocarcinoma rather than the more common benign adenoma.

“If response to medical management is not resulting in the expected reduction in blood thyroid hormone levels, consider the small risk of an adenocarcinoma being present.” Adenocarcinomas develop from benign adenomas generally over an extended period of more than 3 years as a consequence of further mutations. Outcomes in the treatment and management of adenocarcinoma cases is less predictable.

Thiamazole interferes with the production of thyroid hormone through limiting thyroid peroxidase activity whose action results in the incorporation of iodine onto the thyroglobulin protein in the creation of thyroid hormone. This reaction occurs within the thyroid follicular cells with thyroglobulin concentrated in the colloid of the thyroid gland and iodine uptake selectively entering these cells from the blood. Thiamazole is a dose dependent medication in its actions and this allows vets to manage a cat’s transition to euthyroid by adjusting the dose according to laboratory total thyroid hormone tests. The goal is for total thyroid hormone to reach levels in the lower half of the laboratory’s reference range. Thiamazole does not inhibit the effect of currently circulating thyroid hormone in the body or the release of previously produced thyroid hormone that remains within the thyroid gland. For this reason, measurement of the impact of thiamazole on reducing and normalising blood total thyroid levels should occur no sooner than 2–4 weeks after beginning medication or an alteration of dose.

“Thiamazole is a bitter tasting medication. In tablet form it needs to be covered in a casing to prevent the patient tasting the active ingredient,” Dhar said. “This creates challenges to a vet’s management plan of hyperthyroidism when minor dose adjustments are needed to reach target levels as we are either asking clients to then give two tablets or if they give a halved tablet there is the opportunity for cats to react to the bitter taste of thiamazole.”

With previous success in formulating liquid oral medications for cats the Norbrook research team were challenged by vets to create a liquid version of thiamazole. The feedback from practicing vets was that a liquid thiamazole medication would assist compliance and management plans greatly in the medical treatment of feline hyperthyroidism. The formulation created uses honey flavouring over the top of a solution that has removed the upfront bitter taste of thiamazole. He adds, “Feedback from our colleagues in the UK is to expect 70 per cent of cats will readily accept Thyronorm from the syringe after a little initial training to get them use to taste and the syringe,” Dhar said.

Thyronorm’s formulation allows dose adjustments of 1.25mg (0.25mL) to be made to ensure the dose given can more readily match the management plan resulting in blood total thyroid levels at the vet’s desired target range.

“[It] has been available in the UK for 5 years now and the positive feedback from vets on the benefits of a liquid formulation over the available tablets is overwhelming.” Asurvey of 200 practising vets was completed by Norbrook UK about the use of Thyronorm.

■ 99 per cent of vets are likely or verylikely to recommend Thyronorm.

■ 95 per cent found it successful as an alternative to tableting.

■ 84 per cent found the product easier to offer low or in-between doses.

■ 89 per cent expect Thyronorm to improve compliance compared to other options.

Thyronorm is expected to ensure the pet parent bond continues with him adding “Thyronorm has been available in the UK since 2016 and the vets have made it their number one prescription for feline hyperthyroidism. With this endorsement from our colleagues, we are sure that Australian vets and their clients will love the benefits of Thyronorm too.”

“This product was driven by vets voicing their frustrations at current therapy options, we are proud as a company to have developed and delivered Thyronorm. Wehave fielded many queries about when this product will arrive and I’m glad to say it’s here now,” Dhar said.

Thyronorm provides a simple solution to the complex problem of feline hyperthyroidism. It is the first and only registered oral liquid therapy for cats to manage hyperthyroidism in Australia.

This article was supplied by Norbrook.

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Any vet feeling a bit burnt out should consider volunteering in a way that is different from their normal job, either in a different location as we are suggesting with “Relief Vets”, or perhaps in a non-veterinary capacity.”

In addition to supporting the wellbeing of veterinarians, Hall sees the AVA as having an important role in ensuring animal welfare. “I believe the AVA should be the leading voice in animal welfare conversations,” he said. “Vets care deeply for all animals, and as a group we can apply our training and knowledge to improve the lives of animals and promote the importance of the human-animal bond.”

Hall’s passion for animal welfare has also led him to take on other roles, including as a Board Member of the Royal Agricultural Society of WA. While he freely admits that his involvement was partly fuelled by fond childhood memories of attending the Ekka in Brisbane, where he loved seeing the animals even more than the showbags, and also by his later experiences as a young graduate working as the Ekka vet in 2007 and 2008, Hall’s guiding principles align closely with those of the RASWA. “I really resonate with the mission and values of RASWA, and when a friend suggested that Inominate for a position on their Council, I jumped at the chance,” he said “I believe that animals are such an important part of our lives, and Iwant to ensure we live in a society that values animals and maintains the link between people and agriculture.”

This same belief in the importance of animal-human bonds has also seen Hall become an ambassador for the Western Australian branch of Greyhounds as Pets. “I adore greyhounds! They are such friendly, goofy, loving things,” he enthused. “Greyhounds are super low maintenance and fit into many different home environments. The team at Greyhounds as Pets do a wonderful job finding them homes after their racing careers, so I am happy to do my part promoting this wonderful cause.”

Service to others underpins many of Hall’sroles – as a veterinarian, an ArmyReserve Officer, AVA division President, board member and ambassador. “Giving back to the community is important for everyone, not just vets,” he said. “The human species is capable of compassion, foresight and complex planning, and we should be using these skills to be improving the world in every way.”

Hall could easily add communication skills to his list of capabilities, particularly since he frequently combines his roles with a strong media presence to promote veterinarians’ wellbeing and animal welfare. “I enjoy promoting the importance of animals in our lives, and I’m really grateful for the opportunity to sharethese stories in any way,” he said. His earliest television appearance coincided with his time as a rural vet in Dayboro, on Channel 10’s children’s program Totally Wild.“The plan was to show a day in the life of a country vet, and I had a great time taking Pip Russell and the TV crew to see a local dairy herd, then go and worm a few camels before racing back to the clinic to perform an emergency spleen removal on a dog,” he recalled. “I’ve since found myself in front of a camera or microphone many times, usually accompanied by some sortof animal.”

While Hall cites taking a cow into Channel 9’s Perth studio as one of the highlights of his media outings, he is excited to be filming an upcoming episode of the ABC science show Catalyst. “This has always been one of my favourite shows, and it has covered an incredibly diverse range of topics at the forefront of science and technology,” he said. “We will be looking at the role that parasites play in modern medicine, and we have found some amazing scientists who are using parasites to treat disease and improve the lives of humans.”

Technology and its intersection with veterinary practice is a subject dear to Hall’s heart, not least because he is one of the founders of biotech company VetChip. Given that animals are unable to communicate that they are running a temperature or have experienced a fluctuation in their blood pressure, for example, or where they are located if they have wandered off, Hall wanted tofind a way to use technology to give them avoice. VetChip has developed implantable biosensors for animals aimed at providing proactive monitoring systems, data analytics and disease detection. Once installed, the VetChip it can alert owners and veterinarians of any abnormal events that could indicate possible injury or illness and, when used in conjunction with VetChip’s VetTag devices, can also track an animal’s location and movements in real time.

“The concept for VetChip had been swimming technology is extremely difficult but I feel it is vitally important to the future of animal health. If we get it right, we can really change the world.”

When Hall won the This Is Freemantle Aspire Award in 2021, therefore, he knew exactly what he would do with the scholarship funds, which must be used to assist personal and professional development by attending an overseas conference of the winner’s choice. Once international travel was possible, he immediately opted to attend the Singapore Vet Show, the largest annual veterinary conference in the Southern Hemisphere, in order to network with likeminded professionals and to showcase VetChip. “Every vet loves helping animals and owners, but the challenge that really compels me is trying to design the technology and systems that improve outcomes across the world,” Hall said.

“Monitoring individual health and detecting abnormalities is just the beginning, as we can analyse patterns of abnormalities to detect complex disease processes in individual animals or groups of animals. This technology gives us the ability to detect problems sooner, provide more effective treatments, and give owners the peace of mind that their animal’s health is being monitored in the best way possible.” around in my head for years, and I’d written up a high-level overview of what that technology might involve and what it might be able to do,” Hall said. “But the vision was so expansive I knew I’d need to find some great co-founders.” Roping in his brother and fellow vet Max was relatively easy, but it wasn’tuntil Hall heardabout some talented electrical engineers who were interested in working on health devices that would connect to the internet that the project really took off. “After a brief phone call turned into an hour-long chat about all the possibilities, I knew I’d found the right team,” he said. “VetChip is deliberately intended to work in all mammals, and maybe other species eventually.The real-time health monitoring is going to be incredibly useful, but the potential to diagnose – or perhaps even predict – diseases is going to be a real game changer.”

Hall has set himself and the VetChip team several challenges, but one practical application that stands out for him is to create technology that will prevent dogs from dying in hot cars. “I want us to be able to determine when a dog is exposed to this situation using our VetChip’s thermometer and location services, and then to alert the owner or nearby responders to intervene before the animal suffers a slow and horrible death,” he explained. “Developing this

It is hard to resist Hall’s passion for the VetChip project and its myriad possibilities for animal health and welfare, and I sincerely hope he fulfils his aspirations. Writing about Hall’s many achievements and his varied roles providing service to animals and humans has reminded me of the old adage – that if you want to get something done, you should ask a busy person to do it. That said, Hall is quick to point out that the growth of the business and his numerous other ventures would not be possible without the support of his wife. “Basically, the only way I managed to achieve as much as I have is because Sally has been willing to give up some of her own career aspirations so that I could take on these challenges,” he said. “She is quite a clever cookie and an incredibly hard worker who not only assisted with the set-up of our clinics, but oversaw the entirefit-out and put in the majority of effort to raise our three kids while having a part-time career in medicine –and that was after completing vet school!”

Having attempted to unravel the intricate tapestrythat is Garnett Hall, I also suspect that he does not necessarily see himself as a busy person, but as someone living life to its fullest. As he himself said, “We live in an interesting world with a lot of opportunity. To me, animals are a big part of what makes our world so wonderful, and I’ve always wanted to see and experience as much of the world as possible. Being a vet has allowed me to understand not just the animal world, but also biology,medicine and disease, and the reason I love technology is that it enhances our ability to understand or improve all of these things, leading to better outcomes for animals and people everywhere.”

I, for one, am looking forward to seeing what Garnett Hall will accomplish next.

■ JAI HUMEL

Funding for world-first malaria test in East Asia

From page 1

Our test is the closest the scientific world has come to tracking and predicting these ‘hidden’ infections.”

A high-throughput laboratory version of the test would be used to confirm whether the asymptomatic underlying P.vivax infections are contributing to outbreaks, to detect areas with ongoing transmission, and to treat people with these dormant infections.

Chief Investigator Rhea Longley said this information is critical for outbreak containment. “These insights will enable us to get ahead ofthe parasite to predict where it may be silently hiding, who its next target is and when it is likely to attack,” she said.

Longley said the team hoped its findings could be used to fuel malaria eradication across East Asia.

Live export phase out briefing attended by AVA, VALE

From page 1

24-hour lighting and 90dB noise for 20 plus days, faecal ‘bedding’ and head stress,” she said.

“Even with the changes implemented since 2018, 38 out of 41voyages accompanied by inde-

There’s hope for handfish

From page 3

Although it took five years to perfect the necessary breeding environment Fawke is confident Sea Life Aquarium can successfully breed more handfish so that eventually there will be enough to enable some individuals to be released back into Tasmanian waters.

“We’ve all the right parameters in place and we know the trigger points now so we shouldn’t have any issues once these juveniles get to be adults, or if we manage to source some more adults from the wild in the future. They’re a fantastic little fish, full of character and we don’t want to lose them,” he said.

Tasmania’s equally endangered red handfish is also the subject of a recent project designed to restore the species’ habitat. With an estimated 100 adult fish left, the species is on the brink of extinction and while the red handfish breeding program has also been successful, researcher Jemina StuartSmith, a research fellow and marine ecologist at the University of Tasmania’s Institute for Marine and Antarctic Studies, said red pendent observers have reported heat stress … the ships are not air-conditioned, and no amount of ventilation helps when the ambient conditions exceed a sheep’s heat stress threshold.”

■ SAMWORRAD

handfish were literally running out of habitat, and unless it was restored there was little point releasing captive-bred fish into the wild.

“We’re trying to restore lost habitat by translocating seaweedcovered boulders to areas that have been decimated by an increase in native urchins, and seaweed provides the necessar y structure and shelter on which handfish can lay their eggs.” she said.

Stuart-Smith described urchins as resembling garden pests eating the vegetables, and the removal of natural urchin predators like large lobsters had probably contributed to an increase in urchin numbers. Although the ‘sea-gardening’ project is still in its early stages, there are encouraging indications it is proving beneficial.

“We’re hoping to know mid-year, but we think the seaweed is surviving and, assuming we can keep on top of urchin numbers, we’ll be able to increase the amount of habitat available to the handfish. The long-term solution though is to restore a balanced ecosystem,” she said.

■ ANNELAYTON-BENNETT

Health benefits of keeping pets in aged care facilities

From page 3

Young said a significant issue now was funding because although many aged care facilities are keen to try new innovations they are limited by resources and funding, so the researchers are calling for the federal government to mandate financial support for pets in aged care to help improve the mental health and wellbeing for thousands of residents.

“We need the federal government to stand up to fund pets in aged care. Just like exercise facilities have become a core part of aged care facilities – and are proven to boost movement capabilities and wellbeing – so too should pets be considered an essential part of aged care. It’s no longer good enough for people to simply live longer. They need to be assured of happy, healthy, and meaningful older years, and for pet-loving older people, this means including their beloved pets.”

■ ANNELAYTON-BENNETT

‘A qualitative Analysis of Management Perspectives on Seeking to Implement the Foster Cat Project in Residential Aged Care in the Context of COVID-19’ is available at doi.org/10.3390/ doi.org/10.3390/ijerph20010752.

Avian influenza on the rise

From page 5

Beer stressed the virus was now a global panzootic in birds and had reached areas in the world where this type of virus had never been seen before.

“We’re talking about a whole new continent with a lot of different bird species which have never had contact with this kind of virus. We have to follow the situation closely and be aware that this virus can occur in non-bird species. It’s a highly dynamic situation and surveillance monitoring measures are needed all over the globe,” he said.

■ ANNE LAYTON-BENNETT

Management

From page 17 to move in the future are often devalued in the eyes of buyers and the banks that lend to them.

One of the pitfalls that many business owners fall into in their final years in practice is to only negotiate a lease for the duration that they wish to practice. Any buyer of their practice (and the bank lending them money) will need a lease with options for 10 years at the point of sale to feel secure.

Ability To Assign

6. Assignment

Most leases will contain an assignment clause, which compels a landlord to act reasonably if the assignment of an existing lease is requested. If the new prospective tenant is someone of good character and sound financial standing, they should meet these criteria.

The Impact of 6

An assignment clause is vitally important if you ever want to sell your business. Without it, there is no obligation on your landlord to assign your lease to the buyer and, without the lease, you may find that your practice is unsellable.

Abstracts - vet burnout

From page 14

2School of Computer Science, College of Engineeringand Physical Sciences, University of Guelph, Guelph, Ontario, Canada.

3American Association of Veterinary Medical Colleges, Washington, District of Columbia, USA.

4Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.

Abstracts - epilepsy in cats

From page 14 Medicine Vienna, Austria.

5Department of Veterinary Clinical Sciences, Small Animal ClinicNeurosurgery, Neuroradiology and Clinical Neurology, Justus-LiebigUniversity,Germany.

6University Clinic for Small Animals, University of Veterinary Medicine, Vienna, Austria.

7Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, UK.

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TheVeterinarian

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CREATURE Feature Donskoycat ( Feliscatus )

TheDonskoy(alsoknown astheDonsphynxorRussian hairless)isahairlesscatbreed ofRussianorigin.Itisnot relatedtothebetter-known sphynx:theDonskoyís hairlessnessiscausedby adominantmutationofthe keratin71gene,whereas sphynxhairlessnessiscaused byarecessivemutation. Inspiteoftheirlackofa coat,Donskoyrequire frequentgrooming. PictureNickolasTitkov