The Veterinarian Magazine December 2023

TheVeterinarian ■ December 2023

■ www.theveterinarian.com.au

Taronga Western Plains Zoo ends year on high note ON THE INSIDE

Taronga Zoo is ending the year with good news all round. On October 4 – International Zookeeper Day – lion keepers at Taronga Western Plains Zoo in Dubbo, New South Wales, welcomed three lion cubs, born late in the evening.

“The cubs are doing really well, they’re hitting all their milestones,” zookeeper Melanie Friedman said.

“They’ve had their first quick vet check and we can confirm there’s two boys and a girl, their eyes are open and they’re all weighing in around five kilograms.”

African Lions are currently classified as vulnerable in the wild, and Marion was imported, along with her sister, Evelyn, from the United States in 2018, to introduce diversity into the zoo’s conservation program, providing a new genetic bloodline.

October’s births were the second litter for the breeding pair, Marion and Lwazi, who last had cubs in April 2022.

In late November, the zoo announced it has released 15 endangered chuditch from Dubbo into Vulkathunha-Gammon Ranges National Park in South Australia.

Taronga’s conservation breeding program commenced in 2022, and in the eight months since, has since successfully bred 37 joeys, all of which the zoo intends to release back into the wild, a significant achievement given the species is now extinct in four states and territories.

“The mixed-age cohort of 15 individuals were carefully selected from the conservation breeding program to ensure we inject genetically robust and diverse individuals into the newly established wild population in South Australia,” Taronga Wildlife Conservation Officer Rachael Schildkraut said.

Chuditch are one of the top 20 priority mammals listed under the Federal Threatened Species Strategy with the species range reduced to five per cent of its former distribution.

The work is a collaboration between the Department for Environment and Water and Taronga Conservation Society Australia, with the released chuditch fitted with radio tracking collars to assist in ongoing research.

“While there are no quick fixes to rebuilding populations, VHF radio tracking collars will allow us to collect data, monitor changes to the ecosystem and carry out long term planning of how we can best sustain the species,” Department for Environment and Water’s Rob Brandle said.

5 NEWS Red fire ants march into NSW

7 NEWS Mange-fighting vets DAY IN THE LIFE

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PIGEON POST

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MANAGEMENT

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CLINICAL REVIEW

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■ JULIA GARDINER

Green sea turtles face additional threat to survival Federal government confirms Already known to be at risk from warming temperatures that are affecting the ratio of male and female eggs being hatched, a study published recently in the journal Frontiers in Marine Science has found the exposure of green sea turtles (Chelonia mydas) to heavy metal pollution in their foraging areas may be further impacting the species’ embryos.

Green sea turtles are listed as endangered on the International Union for Conservation of Nature’s Red List due to threats from poaching, boat collisions, habitat destruction and accidental capture in fishing gear.

Co-author Arthur Barazza, a marine ecotoxicologist at Griffith University’s Australian Rivers Institute, said researchers studied the effects of pollution on the development of green sea turtles at a long-term monitoring site on Heron Island, a small coral sand cay approximately 80 km off the coast of Gladstone in the southern Great Barrier Reef, where between 200 and 1800 females go to nest each year. The sex ratio at this study site is currently more balanced than nearer the equator, with two to three females hatching for every male.

“Our research shows that the risk of extinction due to a lack of male green sea turtles may be compounded by

contaminants that may also influence the sex ratio of developing turtles, increasing the bias towards females,” he said.

Contaminants have been found to disrupt a variety of endocrine and reproductive systems in reptiles but in sea turtles only one contaminant – dichlorodiphenyldichloroethylene (DDE) – has been investigated directly and found not to influence hatchling sex determination at the concentrations tested. However contaminants have been found to skew sex ratios of temperature-dependent sex determination reptiles such as alligators, freshwater turtles, and caimans. To page 30

commitment to phase out live sheep export trade One of the largest federal parliamentary e-petitions in history, that called for an end to the live sheep export trade, was tabled towards the end of November with Agriculture Minister Senator Murray Watt, confirming the government’s commitment to an ‘orderly and considered’ transition away from the trade.

In acknowledging ‘considerable community concerns about animal welfare in the trade of live sheep’, Watt said he understood the desire to see action.

“The government took the commitment to phase out live sheep exports by sea to two elections, and it’s my intention to deliver on this commitment, although the phase out won’t take place during this term of the parliament, giving time for individuals and businesses to prepare for a transition away from the trade,” he said.

Suzie Fowler, RSPCA Australia’s Chief Science Officer welcomed the government’s confirmation saying it was ‘on the right side of history’, but urged swift action be taken to introduce legislation in the current parliamentary term so the end of the trade was embedded in law before the next federal election.

“Now that the independent panel has provided their report to government there should be no impediment to introducing and passing legislation as soon as possible in this term to improve welfare for Australian sheep, meet the community’s expectations, and provide certainty for farmers,” she said.

■ ANNE LAYTON-BENNETT

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News

Kiwis’ historic return to Wellington In late November, Capital Kiwi Project announced two kiwi chicks had been born in the wild around Wellington on New Zealand’s North Island, for the first time in over 100 years.

At one point, there were an estimated 12 million wild kiwi in New Zealand, with numbers dropping to just 68,000 at the last estimate.

Capital Kiwi Project began its focus on reintroducing the species to the Wellington area after success in re-establishing the wild breeding of another native New Zealand bird, the k?k? parrot.

The organisation identified potential areas of habitat for the kiwi and were granted access by more than 100 landholders to over 24,000ha to roll out an eradication program to rid the area of stoats, rats and weasels, the birds’ biggest predators, before establishing kiwi breeding areas.

By late 2021, eradication of predators had reached levels where the reintroduction of kiwis could commence, and by late 2022, a permit was granted to transfer up to 250 North Island brown kiwi to the area over the following seven years.

As well as eradicating wild predators, Capital Kiwi Project is also working with domestic and working dog owners to educate them about keeping the kiwis safe, running kiwi avoidance

training for all dog owners surrounding the release sites of the kiwi.

While Capital Kiwi Project is celebrating the birth of the chicks in the wild, they acknowledge there is work to be done. “To have kiwi out there breeding is deeply, deeply satisfying,” Paul Ward, founder of the organisation said, adding that the births symbolise early days for the project.

“These chicks now need to fend for themselves in the wild. The coming months are vitally important as they grow and put on weight to the point that they can fend off stoats with their big claws.”

The project is monitoring only a quarter of the kiwi released around Wellington, meaning more chicks have possibly hatched since the initial release of the birds, but the group are not planning on giving updates on individual birds moving forward, as they hope to establish such a large wild population that such updates are unnecessary.

“This is a massive milestone for our goal of building a wild population of kiwi on Wellington’s back doorstep. It is a wonderful Christmas present for Wellingtonians,” Ward said.

■ JULIA GARDINER

Second successful breeding season for endangered red handfish For the second year running a captive breeding program for the critically endangered red handfish has successfully resulted in the birth of 21 hatchlings. The University of Tasmania’s Institute of Marine and Antarctic Studies hosts the conservation breeding program, which is co-led by IMAS researcher Andrew Trotter. He said the eggs took just over 50 days to hatch.

“Our aim now is to grow this year’s hatchlings into healthy sub-adults so we can release them and bolster the dwindling wild population.

Ultimately, we want them to breed in the wild,” he said.

Although only a small clutch Trotter said the hatchlings were the equivalent of a quarter of Tasmania’s known wild red handfish population, and two successful consecutive breeding seasons was encouraging.

He said the program had also enabled scientists to significantly improve their knowledge of red handfish biology (The Veterinarian: June 2023) with the young being raised in captivity at ‘handfish school’ for around a year. This was to help train the fish to survive and thrive in the wild before being released.

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Picture Capital Kiwi Project

With several sub-adults expected to mature next breeding season Trotter is optimistic more hatchlings will be produced next year.

Jemima Stuart-Smith, IMAS threatened species and ecosystems team co-leader, said the current red handfish would be held in captivity longer than usual due to predictions of a summer marine heatwave off south-eastern Tasmania.

“We’re taking cautious steps around the release program this summer but excited the captive population and breeding program is making good progress. We’re still behind where we need to be for habitat restoration and management at red handfish sites – and it’s these components that will be the deciding factor in the survival of the species,” she explained.

IMAS research into red handfish population recovery is carried out with support from Tasmania’s Seahorse World, and in consultation with the National Handfish Recovery Team and the Tasmanian Department of Natural Resources and Environment.

■ ANNE LAYTON-BENNETT

where the disease is easily Dog vaccine recalled areas, transmitted through urine of Treidlia Biovet announced the voluntary recall of Treidlia Auslepto Vaccine for dogs, following the death of one dog, and reports of adverse reactions in multiple others.

The Australian Pesticides and Veterinary Medicines Authority (APVMA) published the recall in November, noting that a dog suffered a suspected anaphylactic reaction and died approximately five hours after vaccination, with seven other dogs experiencing adverse responses including transient vomiting and diarrhoea within hours of being vaccinated.

Adverse reactions have been linked to batch number BN23126, with the recall also including batches BN23-131, BN23-132 and BN23-133.

The vaccine provides protection against a strain of leptospirosis commonly found in northern Australia. The recall is another setback in prevention of the disease following a shortage of the drug ongoing since 2022.

Before a vaccine was discovered, a 1990s leptospirosis outbreak had dire results for dogs in Queensland, particularly rural

infected animals including livestock and rodents.

“We had an explosion of rat population and we lost many, many dogs,” Mackay vet David Lemmon said.

New South Wales saw a surge in deaths from the disease earlier this year on the South Coast, with nine dogs dying of the 28 cases identified, with fears the vaccination shortage would increase the risks to dogs.

Dog owners have been advised to monitor their dogs’ environments to prevent infection.

“Make sure your dog is restrained, you're controlling rodents and don't let you dog drink from any water source other than the clean water bowl you put out,” Keith McKellar Stewart of Mittagong Veterinary Hospital said.

Vets are advised to immediately cease use of batch numbers BN23-126, BN23-131, BN23-132 and BN23-133 and to contact Treidlia Biovet to arrange return of unopened and partially used vials.

■ JULIA GARDINER

DECEMBER 2023 TheVeterinarian 3

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News

Red fire ants march into NSW Animals unable In late November, five red fire ant nests were identified in Murwillumbah in New South Wales, 13 kilometres south of the Queensland border, where infestations have been recorded since 2001.

NSW has been on high alert for the pests for much of the year as tracking showed them moving further south; however, experts suggest the nests in Murwillumbah are not new.

“We know they've been here for more than a few months, otherwise the nests wouldn’t be as developed as they are,” Graeme Dudgeon, of the National Red Imported Fire Ant Eradication Program said.

The insects cause painful bites on both humans and animals, which can lead to secondary infections. They also cause damage to electrical, irrigation and agricultural equipment, as well as feeding on seeds, other insects, spiders, lizards, frogs, birds and mammals, killing and displacing native plants and animals, with a risk that their damage can change ecosystems beyond repair.

The United States Food and Drug Administration (FDA) estimates red fire ants cost the US more than $5b each year, with Australian primary producers concerned they could have a similar impact on the industry here, after a 2021 report for Biosecurity Queensland found red fire ants could cut agricultural output by up to 40 per cent.

NSW Agriculture Minister Tara Moriarty announced a biosecurity order in the area, limiting businesses and people within a fivekilometre zone of the Murwillumbah nests from moving products known to potentially carry the ants, such as soil, mulch and plants, without a permit and having their loads checked by experts.

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to beat the heat

Those who breach the emergency biosecurity order could face significant penalties with fines for breaches reaching up to $1.1m for an individual and up to $2.2m for a corporation.

“We are prepared for this discovery of fire ants in northern NSW and have immediately implemented our response plan which is part of the $600m national program,” Moriarty said.

“I am in contact with our teams on the ground who are enforcing the emergency control order, tracing where this infestation may have originated from and monitoring the immediate chemical eradication of the fire ants.”

The NSW Department of Primary Industries is encouraging the public to report any potential sightings of the ants or their nests on the hotline at 1800 680 244.

The results of a major collaborative international study involving 460 cold-blooded animals and published recently in the journal Nature Ecology and Evolution, has found land and sea animals living in tropical climates around the world are struggling to adapt to climate change.

Co-author Joanne Bennett, from the Australian National University’s Fenner School of Environment and Society, said the findings spelled bad news for those marine species that call the Great Barrier Reef home. These animals were likely to be more vulnerable to climate change because they were already living on the borderline of temperatures their bodies could withstand.

“We know that oceans are heating at a surprisingly rapid rate and that will force marine wildlife to leave their homes in search of cooler pastures. If the places they call home get any hotter their bodies won’t be able to cope,” she said.

The widespread displacement of fish and other marine life was a likely outcome if creatures abandon habitats to seek cooler sanctuaries elsewhere. This would leave a lot of empty real estate on the GBR, which many species colonised due to it being rich in resources.

“Reef-reliant creatures rely on habitat structure to survive but if they’re forced to travel to new depths where it’s colder, they’ll be faced with a new environment and there’s no guarantee they’ll be able to source the food they need to survive,” Bennett explained.

In Queensland’s tropical rainforest regions the critically endangered neglected nursery frog (Cophixalus neglectus) is another animal caught up in the housing crisis. To page 30

DECEMBER 2023 TheVeterinarian 5

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News

Understanding why biodiversity matters Global biodiversity loss is now widely recognised as a serious issue, with at least one million animal, fungal and plant species potentially at risk of extinction within a few decades, according to a study published recently in the journal PLOS ONE. Researchers from Queensland’s James Cook University, and the Musée National d’Histoire Naturelle in Luxembourg analysed 14,669 European plant and animal species and found significant factors driving species decline included changes in agricultural land use and the overexploitation of biological resources.

In his recently published book Why Biodiversity Matters, ecologist Nigel Dudley also focuses on the importance of biodiversity protection, and the need for a careful rethink on conservation approaches. Dudley, who has worked with WWF International and UNESCO, and is an industry fellow at the University of Queensland’s School of Earth and Environmental Sciences, said the failure of some governments to respect biodiversity rights threatens the survival of many species and the future of the planet.

Although the authors of both the journal article and the book acknowledge the efforts being made by many governments and non-profit organisations to reduce the loss of biodiversity, both publications stated measures too often lacked a comprehensive understanding of the threats to different species in different locations and were too closely linked to economic benefits for humans, which limited their success.

In the European study the researchers found approximately one-fifth of the terrestrial, freshwater and marine species assessed were threatened with extinction - a number that exceeds the assumed extinction risk claims the Intergovernmental Platform on Biodiversity and Ecosystem Services made recently. As well as

changes in agricultural practices and associated habitat loss, the study’s results showed biodiversity loss was also due to overharvesting, pollution, and residential and commercial development.

Dudley’s book is both a call to action and a manifesto for policymakers and other influencers to ensure a balance is achieved between economic development and ecosystem survival, as well as recognising the rights of humans and the biodiversity rights of individual animals.

“It’s not that the ecosystem services are unimportant, far from it. But there has been a tendency for the utilitarian and economic values of wild plants and animals to dominate discussion to the exclusion of the basic rights that species have to live their natural evolutionary span,” he said.

The book discusses how three important ethical issues – human rights, animal rights and biodiversity rights – interact and sometimes clash.

An example is the emotive but complex issue of

Praise for mange-fighting vets WIRES has praised the contribution of veterinarians in the fight to treat sarcoptic mange in wombats.

Programs Manager Kristie Newton said the wildlife rescue organisation is pleased that many vets are aware of the prevalence of the disease and are willing to help.

“We really do rely on vets and appreciate all the help we get from them and their guidance,” Newton told The Veterinarian.

“We treat mange in the field and seek advice from vets using photos or videos we take.”

Newton said there has been a “huge” increase in cases of mange, probably due to a mixture of greater awareness and more wombats being affected.

Nearly 40 per cent of WIRES’ wombat related calls are for wombats with mange, and the organisation’s rescue office has seen a near tripling of wombat rescues over the past seven years.

“It’s a pretty horrendous disease and once they’ve been infected with the mite, it takes about two months for them to completely succumb,” she said.

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“The mites burrow under the skin and have an awful impact…the wombats lose fur, become very skinny and they get constantly hungry and thirsty.”

The skin then becomes hardened and cracked, creating open wounds and flyblown secondary infection, exacerbated by the summer heat.

“In the summer we find them in especially horrendous condition, sometimes with maggots in the wounds, and there is certainly a point when the disease is so far advanced that euthanasia is the most humane solution,” Newton said.

“They’re just suffering so much, and when the skin thickens over their eyes and ears it really impacts their ability to see and hear.”

WIRES volunteers have a few treatment options depending on the scenario.

One is Cydectin, a topical treatment with moxidectin as the active ingredient. The second is Bravecto with fluralaner, used in cases where disease is more advanced.

“The other thing we use is burrow flaps; basically an ice-cream lid that’s hung over a burrow, the wombat walks through, and the treatment pours out,” Newton said.

“That’s usually used when mange is less severe, but also if we’re doing a huge population treatment…and if we can’t locate the wombat we’ll treat its burrows.”

WIRES has had various organisations partner with them in recent years, and the NSW Government has created Curb Wombat Mange, a two-year program to implement a rapid response to the issue, via grants and targeted funding.

“To get support from corporates, vets, universities and governments has made a big difference,” Newton said.

“The University of Tasmania has done a lot of work, and it was them who made the

hunting in relation to biodiversity. Although Dudley personally abhors the practice, he said the decline in hunting in Germany had led to damaging wild boar levels, while in Scotland the deer populations, that are maintained for hunting purposes, have laid bare the country’s woodlands.

“Culling a population of non-native rabbits on an island to protect a unique species of plant doesn’t make sense from the perspective of animal rights but it does in terms of biodiversity rights. Conservationists haven’t always got the right balance, particularly when it comes to human rights,” he said.

Authors of the PLOS ONE study concluded that financial investment in activities detrimental to biodiversity far outstripped biodiversity-friendly investments, and to avoid and mitigate the impact of major threats to biodiversity urgent action was needed. Their research also showed a doubling of the extinction threat for European plant and animal species compared to the number IPBES assumed were at risk.

“Biodiversity is the foundation that underpins food security, human well-being and wealth generation, and to secure a future for Europeans, greener agriculture and fishing policies, and a rapid phasing out of incentives detrimental to biodiversity in agriculture, forestry, fisheries and energy production will be required.”

■ ANNE LAYTON-BENNETT References ‘A multi-taxon analysis of European Red Lists reveals major threats to biodiversity’ doi.org/10.1371/ journal.pone.0293083 ‘Why Biodiversity Matters’ by Nigel Dudley (Routledge, 2023) ISBN: 9780367365202 (pbk)

Kristie Newton

breakthroughs in figuring out that Bravecto is an effective treatment.

“Following that, the company that manufactures Bravecto has partnered with us and supplies a lot of rescuers with free Bravecto, which is very helpful because it’s quite expensive.”

Newtown said it has been difficult to get attention for the issue, as there is not the same level of empathy for wombats with mange as there is for domestic animal issues, or even koalas with chlamydia.

“It’s so easy to sell koalas [as an issue],” Newton said.

“I would like mangy wombats to get to that level of awareness, that’s my goal, because the sooner we get to the animal the more likely it is to survive, and to make that happen we really need the general public to be looking.”

Information about the Curb Wombat Mange Program can be found at environment.nsw.gov.au.

■ SAM WORRAD DECEMBER 2023 TheVeterinarian 7

News

Bedbug resurgence a global issue Vets on alert due to While the recent outbreak of bed bugs in Europe has been the focus of much media, a 2023 study conducted by researchers from Sydney’s Westmead Hospital and the University of California, suggests the resurgence of the bugs has been underway for the last two decades, and has become a global issue, including in Australia.

The insects, whose bites cause itchy welts, sense the carbon dioxide and body heat of their prey and thrive in hot conditions, and environments where people and animals are near one another.

Co-author of the research paper, Stephen Doggett, said Australia hasn’t had a large-scale outbreak in six or seven years, though the Australian Environmental Pest Managers Association (AEPMA) has reported numbers have been increasing recently.

Response to the insects varies throughout Australia, and in the Northern Territory, is not a notifiable health issue. Simon Quilty, a physician in the NT, believes a strategic approach is essential.

‘It’s just astounding that the [NT Health Department] doesn't see the need for early identification of a potentially serious public health, infectious disease," he said.

The report found that over time, bed bugs have developed immunity to many previously commonly used insecticides, making combating them difficult.

“Insecticides, especially the use of pyrethroids, are useless,” Chow-Yang Lee, co-author of the review said.

While bedbugs typically favour human blood to that of domestic companion animals, the insects can wreak havoc on poultry farms; however, a 2022 study found that two common drugs used by veterinarians to combat fleas and ticks may also be effective against bed bugs.

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feline vaccine shortage

“The last few decades have seen a resurgence of bed bugs in homes, and now we’re seeing bed bugs return to poultry farms,” corresponding author of the study, Coby Schal said.

“Since there is no proven method to stop bed bugs in commercial farms, the potential problems on poultry farms could be massive.

We’re trying to get ahead of it by developing technologies that can eliminate bed bugs.”

Researchers tested the mortality rates to the insects from both fluralaner and ivermectin, the former performing much more effectively on bed bugs that had showed resistance to common insecticides typically used to treat outbreaks and is already approved in Australia and Europe for use in the poultry industry.

■ JULIA GARDINER

In late October, Australia was hit by a sudden shortage of core cat vaccinations, causing interruptions to veterinarian services and cat rescue operations, with the Australian Veterinary Association (AVA) warning vets to prepare for potential outbreaks of respiratory viral diseases and feline panleukopenia.

The shortage of the combination F3 vaccination saw some vets run out of supplies in early November, reportedly receiving notice of the issue only weeks prior.

“Ordinarily you can order every day and it comes in 24 hours. Most vets don’t stockpile it,” Sydney vet Donna Schofield said.

There are no local manufacturers of cat vaccinations in Australia, which imports all supplies from overseas, with the availability of the products impacted in part when manufacturing plants were repurposed to produce COVID vaccinations, at the same time as an increase in kitten and cat ownership during the pandemic.

One supplier, Boehringer Ingelheim, said new technology and processes had caused delays, due to the complex nature of vaccine manufacturing, with batches currently in production expected to be delivered to Australia in the early months of 2024.

With kitten season underway, the AVA has advised vets to prioritise the vaccination of previously unvaccinated kittens and cats, as adult cats that have already received two to three kitten vaccinations and an annual booster are at a much lower risk of infection.

Across Australia, RSPCA shelters have been forced to tighten rules around surrendered or stay cats, placing a temporary hold on any unvaccinated felines. To page 30

DECEMBER 2023 TheVeterinarian 9

F

E F I L E H T N I D E A DAY E R B W E R D N OF A VETERINARY EPIDEMIOLOGIST

or the first time, A Day in the Life heads to our national capital, Canberra, to meet Andrew Breed. A veterinary epidemiologist, Breed loves living in Canberra because he is a big fan of birdwatching, camping, mountain biking and generally getting into the outdoors. His interest in epidemiology, zoonoses and disease investigation was sparked while he was studying for his veterinary science degree at Murdoch University between 1992-1996, which coincided with Hendra virus emerging in Queensland and Bovine Spongiform Encephalopathy (more commonly known as BCE or Mad Cow Disease) being linked to human disease in the UK. Now, this not-so-typical veterinarian is also a not-so-typical public servant, heading up the epidemiology team of the of the Australian government’s Department of Agriculture, Fisheries and Forestry (DAFF).

Breed began his veterinary career in private practice in Australia and the UK and branched into zoo and wildlife clinical work before moving onto research and epidemiology. He completed a Masters degree in Wild Animal Health at the Royal Veterinary College and Institute of Zoology in London in 2001-02, though was able to spend part of this degree in Queensland doing field and laboratory work on Hendra virus. A PhD followed, when Breed was awarded a scholarship with the Australian Biosecurity Cooperative Research Centre (CRC) to study the epidemiology of Hendra and Nipah viruses at the University of Queensland in 2005. “I had wonderful supervision and support from Joanne Meers, Hume Field and Steve Donnellan,” Breed said.

“I learned a huge amount about science, research and government animal health work.”

Following his PhD, Breed spent eight years working in the epidemiology team at the UK’s Central Veterinary Laboratory. “I also had exciting opportunities to work with colleagues in northern Australia, Papua New Guinea, Timor-Leste, Indonesia, Malaysia and Thailand,” he said. “I was awarded diplomate status by the European College of Zoological Medicine in 2010, specialising in wildlife population health, and then became a Member of the Australian and New Zealand College of Veterinary Scientists Epidemiology Chapter in 2019.

In 2017, Breed moved to Canberra with his wife and two children and took up his current role at DAFF. “We provide national leadership and coordination for animal health epidemiology and surveillance, working closely with colleagues in jurisdictional governments, academia and industry,” he explained. “This involves generating and interpreting evidence to inform decision making and policy development for animal disease outbreak preparedness and response.”

A typical day for Breed begins with him checking in with colleagues located at their main office in Canberra, and also with team members working for DAFF in rural Victoria and NSW, along with Sydney and Brisbane. He then moves on to working on one of the projects currently being tackled by the team, such as making epidemiological models for diseases like lumpy skin disease, African swine fever, and foot and mouth disease. Breed might then turn his attention to analysing data on avian influenza with colleagues from overseas to develop guidelines for outbreak response. He cycles home at the end of the day which, he said, “gives me some fresh air and exercise, and allows me to forget about work before arriving home to my family.”

Much of Breed’s work requires him to take an epidemiological perspective, which is quite different from the individual case by case diagnostic approach required by regular veterinary practice. “I’m generally trying to solve health and disease problems at the ■ www.theveterinarian.com.au

population level, which means taking in the ‘big picture’ and delivering longer-term projects and programs,” he said. “However, there are times, when I’m required to contribute to outbreak responses, which can be pretty intense and very fast-paced.”

Occasionally, Breed finds the slower pace of long-term projects to be challenging. “The rewards and impacts of these programs are not always apparent on a daily basis,” he said.

“I’ve had a love of nature and an interest in animals for as long as I can remember, but I no longer get to save lives the way vets do in clinical practice.” That said, Breed finds combining his veterinary experience with his current projects ultimately rewarding.

“I love using epidemiological science to

seek out the truth about the cause and pattern of disease in animal populations, and then using this information to improve animal health,” he said. “Most of my work is very collaborative, and we can share the results via meetings and publications so anyone can benefit from our investments and hard work.”

And now, as always, we conclude our Day in the Life of Andrew Breed with our Creature Questions: Do you currently have any pets?

Yes, quite a few! We have two dogs, a cat, two rabbits, three guinea pigs, a carpet python, a tree frog, three chickens and a pony. Luckily, my wife

and kids love animals and they do much of the animal care.

What is your favourite animal?

If I had to choose a favourite animal, it would probably be one of the flying-foxes or other fruit bats. I’ve been so fortunate to observe and learn about these highly intelligent animals through my work in Australia, Asia, Africa and Europe. I love the way their complex social behaviour can be easily observed at their roost sites.

If you could transform into any animal, what would you be and why?

I’d choose to be a dolphin. I love surfing and fishing but am not very good at either, so it’d be great to be a dolphin for a while and be naturally adept at both!

■ JAI HUMEL

■ www.theveterinarian.com.au

DECEMBER 2023 TheVeterinarian 11

Pigeon post from the UK

Ian Neville BA(Hons) BVSc MRCVS reports from Britain.

My last Pigeon Post from the UK in the September issue of The Veterinarian discussed, amongst other things, several recent Competition and Markets Authority (CMA) investigations into corporate veterinary groups.

This proved to be remarkably prescient, because a week after my copy was submitted to Sydney the CMA announced, on 7th September, that it was going to launch a blanket review of the veterinary services market for household pets.

The UK veterinary services market is estimated to worth around £2 billion (A$3.8 billion ) and the regulator is concerned that veterinary charges are consistently rising above the rate of inflation and that owners, ‘may not find it easy to access the information they need about prices and treatment options to make good choices about which vet to use and what services to purchase.’ The CMA is also still concerned about corporate group growth citing that the number of independent practices had halved from 89 per cent in 2013 to 45 per cent in 2021. They felt that ‘in some cases a single company may own hundreds of practices and it may be unclear to people whether their vet is part of a large group.’

They were also concerned clients could be unaware that corporates which own practices, labs and specialist referral centres were providing all their services within the group business umbrella. The CMA said this could, ‘impact pet owner choices and reduce the incentives for local vet practices to compete.’ Responding for the British Veterinary Association (BVA), President Malcolm Morley said that the association, ‘had not seen any hard data or real evidence to suggest that corporatisation is driving up prices or negatively impacting the quality of care.’ The CMA investigation will look at the experiences of pet owners, veterinary suppliers and vets around: service pricing and payment, how prescriptions are issued and medicines sold, choosing a vet, awareness of

clinic ownership and using out-of-hours services when the options are limited. The consultation period with interested parties lasted six weeks and a preliminary report and any further steps are expected to be announced early in 2024.

Within days of the CMA announcement most veterinary interest groups, corporate businesses and animal welfare organisations professed support for the investigation, though the shares of two large corporate groups fell sharply on the stock market. The share price of CVS Group fell by a third and the Pets at Home Group price fell by a quarter. Neither share has so far recovered the value lost following the CMA announcement, though CVS reported a robust performance for the year to June with a 50 per cent rise in pre-tax profits to £53.9 million (A$102 million).

The other controversial veterinary news item over here is the addition of XL Bully dogs to the banned dogs list in England and Wales following an increase in fatal dog attacks on people.

American Bully dogs are thought to have originated in the USA in the late 1980s when American Pit Bull Terriers were crossed with American Staffordshire Bull Terriers. The Bully became a recognised breed in America with four variants: standard, pocket, classic and XL. Bully dogs first appeared in the UK around 2014-15 but their numbers mushroomed during the pandemic. The United Kennel Club in the USA characterises the Bully as …’ an excellent family dog,’ saying, ‘despite their powerful appearance their demeanour is gentle and friendly,’ though it also states that, ‘dog aggression is a characteristic of this breed.’ The profile of these dogs in the UK, where they are not recognised as a breed by the Kennel Club, seems to be more of the latter as the Bully XL which can weigh over 60kg and stand 60cm at the withers is big enough and strong enough to overpower an adult and has been involved in a

disproportionate number of dog attacks leading to fatalities of toddlers, children and healthy adults. The number of attacks reported seems to vary between sources, but there has been an increase in fatalities since the pandemic with XL Bully dogs accounting for around 50 per cent of the deaths. The journal Public Health reported a spike in dog attack fatalities in 2022 with 10 recorded compared to an average of 3 in previous years.

Faced with widespread reporting of attacks in the popular media, the government decided to ban the XL Bully. The banned list derives from the Dangerous Dogs Act (1991) which prohibits the breeding, selling or gifting of banned breeds and imposes conditions on persons keeping a banned dog including: registration, neutering, microchipping and wearing a muzzle and lead in all public places The act permits the banning of any breed appearing to, ‘be bred for fighting or have characteristics of a type bred for this purpose.’ The other breeds already on the list are the: American Pit Bull Terrier, Japanese Tosa, Dogo Argentino and Fila Brasileiro. However, the addition of the Bully XL to the list has not met with universal approval. With around 10,000 - 50,000 XL Bully type dogs in the UK some vets have expressed doubts that a depleted workforce will be able to carry out the procedures the act requires. Additionally the expense of complying with the law will force some owners to request euthanasia. Many vets have expressed an unwillingness to euthanise healthy dogs without any aggression history at the owner’s request. Other owners may of course prefer to simply abandon their dogs. Another criticism is that the physical appearance and size parameters laid down for identifying which dogs are XL Bullys is difficult to perform and open to subjectivity and inconsistency. As with all government measures of late every step seems mired in controversy and confusion – the general election is due next year!

DO YOU HAVE SOMETHING TO SAY? Is there a topic you’ve wanted to tell everyone about?

Have you ever thought you would like to write a clinical review but don’t know where to start? Do you have a hobby or history that you think vets everywhere would like to learn more about? Then don’t delay – email The Veterinarian at editor@vetmag.com.au and let us know – because your words could be in the pages of next month’s issue!

12 TheVeterinarian DECEMBER 2023

■ www.theveterinarian.com.au

Dilated cardiomyopathy (DCM) is the second most common form of acquired heart disease in dogs1

Treating early with VETMEDIN® is proven to delay the onset of clinical signs by 63% and extend life in preclinical DCM.1 To learn more about identifying preclinical DCM in dogs, scan the QR code to visit Boehringer Ingelheim Cardiology Hub. If you do not have an Animal Health Academy account, please register using the access code “myAcademy”.

For more information talk to your Boehringer Ingelheim Territory Manager today or call our Customer Care Team on 1800 808 691.

Reference: 1. Summerfield N.J., Boswood A., O’Grady M.R., et al. (2012) Efficacy of pimobendan in the prevention of congestive heart failure or sudden death in Doberman Pinschers with preclinical dilated cardiomyopathy (the PROTECT study). J Vet Intern Med, 26(1):1337–1349.

Boehringer Ingelheim Animal Health Australia Pty. Ltd. Level 1, 78 Waterloo Road, North Ryde, NSW 2113. Toll Free 1800 808 691. Vetmedin® is a registered trademark of Boehringer Ingelheim Vetmedica GmbH – used under licence. AU-CAN-0058-2023

■ EDITED BY JENI HOOD BSc (Hons) BVMS PhD

Abstracts

Current knowledge on the transportation by road of cattle, including unweaned calves

Policies to prevent zoonotic spillover: a systematic scoping review of evaluative evidence

Transport conditions have the potential to alter the physiological responses of animals to the psychological or physical stress of transport. Transportation may introduce multiple physical and psychological stressors to unweaned calves and adult cattle, including noise, overcrowding, food and water deprivation, extreme temperatures, commingling with unfamiliar animals, handling by unfamiliar humans, and being placed in a novel environment upon arrival.

Apart from these factors, the type of road and even driving skill may affect the welfare of animals. One of the concerns regarding cattle transport is that the handling and marketing of animals prior to a journey may lengthen the period of feed withdrawal. Furthermore, feed withdrawal can impact animal welfare through hunger and metabolic stress. Transportation is also associated with a decrease in animal performance as well as an increase in the incidence of bovine respiratory disease. It is well established that the transportation of cattle is a stressor that causes a quantifiable response; however, excessive stress during transport resulting in physiological or pathological changes can be reduced with best management practices. The objective of this review was to analyse the available scientific literature pertaining to the transport by road of cattle, including unweaned calves.

Background: Emerging infectious diseases of zoonotic origin present a critical threat to global population health. As accelerating globalisation makes epidemics and pandemics more difficult to contain, there is a need for effective preventive interventions that reduce the risk of zoonotic spillover events. Public policies can play a key role in preventing spillover events. The aim of this review is to identify and describe evaluations of public policies that target the determinants of zoonotic spillover. Our approach is informed by a One Health perspective, acknowledging the inter-connectedness of human, animal and environmental health.

Kelly Buckham-Sporer1, Bernadette Earley1, Sonia Marti2 Animals (Basel). 2023 Nov 1;13(21): 3393.doi: 10.3390/ani13213393.

Results: Our review found 95 publications evaluating 111 policies. We identified 27 unique policy options including habitat protection; trade regulations; border control and quarantine procedures; farm and market biosecurity measures; public information campaigns; and vaccination programmes, as well as multi-component programmes. These were implemented by many sectors, highlighting the cross-sectoral nature of zoonotic spillover prevention. Reports emphasised the importance of surveillance data in both guiding prevention efforts and enabling policy evaluation, as well as the importance of industry and private sector actors in implementing many of these policies.

Thoughtful engagement with stakeholders ranging from subsistence hunters and farmers to industrial animal agriculture operations is key for policy success in this area.

1Animal & Grassland Research and Innovation Centre (AGRIC), Teagasc, Grange, Dunsany, C15 PW93 Co. Meath, Ireland.

2Ruminant Production Program, IRTA, Institut de Recerca i Tecnologia Agroalimentàries, Torre Marimon, 08140 Caldes de Montbui, Barcelona, Spain.

Free PMC article

Effect of surgical simulator training on student and live animal outcomes in a feline ovariohysterectomy teaching laboratory Objective: To evaluate the effect of training with a high-fidelity surgical simulator on outcomes of live animals and students participating in a feline ovariohysterectomy teaching laboratory.

Study design: Nonrandomized controlled trial.

Sample population: Cats (n = 186) and students (n = 146).

Methods: Live animals were paired with student surgeons.

Outcomes for animals and students were evaluated over two consecutive years before (year 1: NO SIM) and after (year 2: SIM) the introduction of a graded student teaching laboratory conducted on a high fidelity surgical simulator. Live animal surgical times and postoperative pain scores using the Glasgow Composite Measure Pain Scale - Feline acute pain scale as well as self-declared student confidence were assessed and the scores of the two groups were compared.

Results: The duration of the live animal surgical procedure was on average 6 min shorter in the SIM group (p = .04). A pain score triggering intervention (> = 5/20) occurred less frequently in the SIM group (n = 1/82) than in the NO-SIM (n = 16/104) group (p < .01). Similarly, rescue analgesia was administered less frequently (4/82 vs 16/104, p = .03) in the SIM group. Student confidence prior to the live animal procedure was higher (median = 7/10 [IQR = 6-8]) in the SIM group than in the NO-SIM group (median = 6/10 [IQR = 4-7]) (p < .01).

Conclusion: Surgical simulator training prior to live animal procedures improves live animal outcomes and student confidence.

Clinical significance: Surgical simulator competency should be considered a prerequisite to participation in live animal To page 30

14 TheVeterinarian DECEMBER 2023

Methods: In this systematic scoping review, we searched Medline, SCOPUS, Web of Science and Global Health in May 2021 using search terms combining animal health and the animal-human interface, public policy, prevention and zoonoses. We screened titles and abstracts, extracted data and reported our process in line with PRISMA-ScR guidelines. We also searched relevant organisations' websites for evaluations published in the grey literature. All evaluations of public policies aiming to prevent zoonotic spillover events were eligible for inclusion. We summarised key data from each study, mapping policies along the spillover pathway.

Conclusion: This review outlines the state of the evaluative evidence around policies to prevent zoonotic spillover in order to guide policy decision-making and focus research efforts. Since we found that most of the existing policy evaluations target 'downstream' determinants, additional research could focus on evaluating policies targeting 'upstream' determinants To page 30

Aquatic and terrestrial invertebrate welfare Invertebrates are a diverse group of animals that make up the majority of the animal kingdom and encompass a wide array of species with varying adaptations and characteristics. Invertebrates are found in nearly all of the world's habitats, including aquatic, marine, and terrestrial environments. There are many misconceptions about invertebrate sentience, welfare requirements, the need for environmental enrichment, and overall care and husbandry for this amazing group of animals. This review addresses these topics and more for a select group of invertebrates with biomedical, economical, display, and human companionship importance.

Gregory A Lewbart1, Trevor T Zachariah2 Animals (Basel). 2023 Oct 31;13(21):3375. doi: 10.3390/ani13213375.

1College of Veterinary Medicine, NC State University, Raleigh, NC 27607, USA. 2Brevard Zoo|Sea Turtle Healing Center, 8225 North Wickham Road, Melbourne, FL 32940, USA. Free PMC article

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INSEPARABLE

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RECOMMENDED BY SPECIALISTS “PEXION has provided a vital new tool for the treatment of epilepsy in dogs. As a neurologist, I now use it as my first choice anticonvulsant in drug-naive patients, because of its improved side effect profile over more traditional drugs, its improved hepatic safety, and its short half-life (which means I know whether it’s working fairly quickly). It is also one of the few anticonvulsants that has a sound body of evidence to support its use and it gives us one more option to use in our never-ending quest for that most elusive of things: perfect seizure control.” – Dr Sam Long BVSc PhD DipECVN, Veterinary Referral Hospital. *If you are registering with Animal Health Academy for the first time, please use access code: myAcademy For more information, please contact Boehringer Ingelheim Animal Health on 1800 808 691 References: 1. Bhatti, SFM, et al. (2015) International Veterinary Epilepsy Task Force consensus proposal: medical treatment of canine epilepsy in Europe. BMC Vet Res.;11:176. 2. Tipold A, et al. (2015) Clinical efficacy and safety of imepitoin in comparison with phenobarbital for the control of idiopathic epilepsy in dogs. J Vet Pharmacol Ther.;38(2):160-168.

Boehringer Ingelheim Animal Health Australia Pty. Ltd. Level 1, 78 Waterloo Road, North Ryde, NSW 2113. Toll Free 1800 808 691. ®PEXION is a registered trademark of the Boehringer Ingelheim Group. All rights reserved. AU-CAN-0003-2023

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Wellness

The importance of a good night’s sleep

Sarah Howard graduated as a veterinarian from the University of Sydney in 2012. She worked for five years in a combination of mixed and small animal practices, before joining the team at PAW by Blackmores as a Technical Services Veterinarian. She now works as Head Vet for PAW, and works on product development, education, and the technical advisory services. Howard has two young children, a horse called Flora and a very human-like Whippet called Winnie. She is passionate about natural health and studies Naturopathy in her (very sparse!) spare time. Howard lives in the Southern Highlands of NSW.

In this month’s edition of The Veterinarian, our fifth and final article in our mental health series explores something fundamental to health and wellbeing - sleep.

Without quality, restorative sleep, all other attempts at improving health, particularly mental health, can fall short. This article explores stress, poor sleep, insomnia, sleep hygiene and nutritional and herbal supplements proven to enhance sleep.

Sleep and stress Insufficient sleep can affect up to 35% of adults1. The quantity and quality of sleep is critical to both a healthy body and a healthy mind. Not sleeping enough or experiencing disrupted sleep can directly increase the presence of, and perception of stress. Additionally, physiological, and psychological stress increases stress hormones, such as cortisol, and this directly impacts sleep duration2.

Insomnia can present as difficulty falling to sleep or staying asleep long enough to feel refreshed and physiologically restored. Prolonged insomnia has been linked with decreased immune function, and poor cognitive dysfunction, focus and productivity issues2. In regard to mental health, research has shown there is a bidirectional relationship between insomnia and mood disturbances3.

In combination with dietary interventions, nutritional supplements, lifestyle modifications and mind-fulness strategies, quality, adequate sleep forms a critical part of mental wellbeing.

We hope you have been able to implement some of the advice and tips as we have explored together this year in The Veterinarian’s mental wellbeing series. Wishing you all a wonderful festive season, full of delicious and nutritious food, plenty of sunshine and movement, good quality rest and sleep and a peaceful end to 2023.

Sleep hygiene Sleep hygiene is often recommended to improve sleep quality and can be a starting place for many who are experiencing sleep issues. Evidence has shown that the top 18 behaviours that have the biggest impact on sleep quality are:

Table 1: Herbs and nutrients which support healthy sleep4

References 1. McAlpine T, Mullan B, Clarke P. Re-considering the role of sleep hygiene behaviours in sleep: associations between sleep hygiene, perceptions and sleep. International Journal of Behavioral Medicine [Internet].

2023 Sep 6; Available from: https:// doi.org/ 10.1007/s12529-023-10212-y 2. Merrill RM. Mental health conditions according to stress and sleep disorders. International Journal of Environmental Research and Public Health [Internet]. 2022 Jun 29;19(13):7957. Available from: https://doi.org/10.3390/ijerph19137 957 3. Walsh N, Rodriguez N, Repa LM, King E, Garland SN. Associations between device use before bed, mood disturbance, and insomnia symptoms in young adults. Sleep Health [Internet]. 2020 Dec 1;6(6):822-7.

Available from: https://doi.org/10.

1016/j.sleh.2020.04.004 4. Braun L. Mental Wellbeing: The Essential Guide to Using Herbs and Nutritional Supplements. Blackmores Institute; 2021.

Worrying about falling asleep while in bed ■ Spending different amounts of time sleeping each night ■ Medications promoting sleep ■ Spending time in the day worrying about sleep ■ Stress before bed ■ Checking the time in the middle of the night ■ Being hungry before bed ■ Little to no sun exposure during the day ■ Being thirsty before bed ■ Not having a set bedtime ■ Using the bed for activities other than sleep ■ An uncomfortable sleeping surface and pillow ■ Not having set wake times ■ No wind down time before bed ■ Napping ■ Having a difficult conversation before bed ■ Poorly ventilated environment ■ Ruminating on unresolved matters in bed1 ■

Nutritional and herbal support for sleep There are several well researched herbal, and nutritional supplements that can improve sleep (see Table 1).

Sleep is the final piece of the puzzle we have put together to support mental wellbeing and reduce stress.

16 TheVeterinarian DECEMBER 2023

■ www.theveterinarian.com.au

brand

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‘... we reinforce our brand advantages both in-clinic and online’ - Rebecca Porter

Marketing Manager, Manly Road 24Hr Veterinary Hosptial

Vetplus provides a program to build a digital brand presence that perfectly aligns with your in-clinic brand. Featuring Australia’s #1 veterinary website creator and customisable mobile apps, Vetplus makes it easy to deliver an integrated digital brand experience for your clients.

To find out more, scan the QR code or talk to your Boehringer Ingelheim Territory Manager.

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

Vetplus ® is a registered trademark of Boehringer Ingelheim Animal Health Australia Pty Ltd. Protech ®, Duramune ® and Fel-O-Vax ® are registered trademarks of Boehringer Vetmedica Inc. All rights reserved. BI1716TA-VAC-04/23.

Proudly supported by Australia’s leading canine and feline vaccine range: Protech ®, Duramune ® and Fel-O-Vax ®

Management

Why buy the practice premises?

Every vet practice has a premises to operate out of that they either lease from the premises owner or own themselves.

Occasionally, a practice owner that is leasing is given the opportunity to buy their premises at a reasonable/fair price …

If you, as a business owner, have this opportunity: ■ What are the relevant considerations that you should take into account?

■ Why should you buy when you can rent?

Simon Palmer is the Managing Director of Practice Sale Search, Australia’s largest vet 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@practicesalesearch. com.au or call 1300 282 042.

18 TheVeterinarian DECEMBER 2023

1. Capital growth through paying your rent As a practice owner, you are already paying rent to someone else – if you buy the premises and put that rent towards premises interest repayments, you would be able to a get the capital growth through the increased premises value over time.

2. Asset Diversification A lot of business owners would like to build some assets outside of their home and business. Commercial real estate can be a good asset class to diversify into especially if you have a chance to buy commercial real estate with a solid tenant.

What is security of tenure?

Simply put, it is your assurance of the legal right to continue using the space that your business is in.

While it is possible to get security of tenure by leasing premises…even the longest leases are usually not as long as a long career as a veterinarian.

Poor security of tenure can compromise the value of your practice in multiple ways.

4a. A veterinary practice isn’t the type of business that is easily moved The further you need to move a client base, the greater the practice attrition if your practice becomes less ‘convenient’ for them to get to.

If your lease ends and you need to relocate, veterinary practices aren’t easily moved when you compare them to other businesses. You aren’t just talking about tables, chairs and a sign on the door, like an accountant or law firm.

If a veterinary practice is moving to a new premises, you will usually need special council permissions and radiation licenses for the new premises, organisation of council waste removal, non-standard fit-out, radiation shielding and plumbing.

3. Practice renovation costs improve capital When you are renting and you pay money to renovate, that renovation will either need to be undone at the end of the premises lease or it will improve the value of the landlord’s asset.

However, if you own the real estate and you pay money to renovate, the renovation should improve the value of both your business and your premises, such that both assets are increasing in value.

4b. Existing client goodwill attached to the location As much as all veterinarians want to think that they are irreplaceable in their clients' eyes, there are usually clients in any practice who are only coming back because it is close to where they live or their work, their children’s school, the train station, etc. The percentage of client goodwill attached to the location varies from practice to practice, but it is usually significant, and needing to move a practice’s location, therefore, will usually result in some client attrition.

4. Security of tenure Security of tenure is perhaps the best reason for a veterinarian to buy their own real estate

4c. New client goodwill attached to the location New clients come to a practice for many reasons.

One of the reasons why a new client To page 30

■ www.theveterinarian.com.au

The complete parasite protection, all in one tasty chew

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Clinical Review

Using drugs in pregnancy

Penny Linnett BSc (Zool Hons) BVSc MPhil MANZCVS Penny has worked extensively in private mixed practice, and in animal biosecurity and welfare for both government and not-for-profit organisations.

She manages a 212 hectare Dorper sheep breeding property in NSW, and is co-Director of Your Hobby Farm Success, helping hobby farmers enjoy their lifestyle, and reap the benefits of having healthy and happy animals.

Introduction The use of pharmacological agents in pregnant females poses a major clinical challenge and judicious use of all drugs during pregnancy is advisable. Pharmacotherapy during pregnancy has the potential to adversely affect the developing foetus and consequently, is best avoided unless needed. Maternal bacterial infections, for example, can be a serious risk to both the mother’s health and that of the foetus and therefore, treatment is indicated.

When deciding on appropriate drug therapy in the pregnant animal, there are two criteria which must be met: it should be the best treatment for the mother, and it should represent the less risk for the foetus. Administration of medication to lactating animals requires consideration of the excretion pathway/s of the drug or its metabolites in milk and of possible effects on the suckling neonate/s.

The treatment of mother and foetus should be considered independently, together with the product information and label directions, stage of pregnancy and overall health of the mother, with the final decision based on a balanced risk/benefit analysis that optimises maternal and foetal outcomes.

Important physiological changes occur in the maternal cardiovascular, gastrointestinal, pulmonary and renal

An unusual finding, five wombat foetuses, cause/s not known

systems, as well as in the body water compartments during pregnancy.

These changes can alter the absorption, distribution, metabolism and elimination of a drug (Table 1).

In addition, the amniotic fluid, placenta and foetus are extra distribution compartments for drugs. In sheep, for example, maternal or foetal administration of ivermectin resulted in an increase in the volume of distri-

Table 1: Summary of pharmacokinetics during pregnancy Absorption – maternal gastrointestinal absorption may be altered due to changes in gastric pH, gastric secretion and small intestinal motility. For a great many drugs, absorption is decreased and elimination increased. For example, the high progesterone concentration during pregnancy induces reduced gastrointestinal motility and increases intestinal blood flow.

Thus affecting the oral absorption of a drug (i.e. increase, decrease or no change) and hence its bioavailability.

Distribution – the volume of distribution is greater (up to 50% at the third trimester in humans), protein binding due to ‘diluted’ serum proteins is decreased, tissue deposition of fat-soluble drugs is increased (due to increased body fat), and there is greater permeability of the neonatal blood-brain barrier. In the adult, there is increased sensitivity to local anaesthetics due to decreased α1-glycoprotein levels.

Metabolism – can be altered on the maternal side due to increased levels of endogenous hormones such as oestradiol and progesterone. Drugs metabolised by select cytochrome P450 isoenzymes (e.g. CYP3A4, CYP2D6 and CYP2C9) and uridine diphosphate glucuronosyltransferase isoenzymes are cleared more rapidly during pregnancy. Synthesis of enzymes such as plasma cholinesterase decreases. The neonate has decreased ability to metabolise drugs. Hepatic blood flow decreases (as a proportion of total cardiac output) which can decrease the metabolism of high extraction ratio drugs. Competition for hepatic enzymes slows the metabolism of some drugs such as rocuronium and vecuronium. Induction of some hepatic enzymes can increase the rate of metabolism for certain drugs such as phenytoin. Some metabolic activity takes place in the placenta but it is not clear exactly how, or if, this contributes to the overall picture.

Excretion – there is a substantial increase in the clearance of unchanged drugs eliminated by the renal system. The increased glomerular filtration rate (GFR) affects drugs such as cephazolin and clindamycin which are cleared solely by GFR. Tubular resorption of substances also increases, counteracting the increased GFR. Consequently, renal clearance for any specific drug is difficult to predict. Renal clearance doubles for lithium, increases by 30% for digoxin, but only increases 12% for atenolol. GFR and renal plasma flow are much lower in the neonate. As the body composition changes with development, the relative volume of distribution also changes. Hepatobiliary clearance of drugs is reduced by the cholestatic effects of oestrogen.

■ www.theveterinarian.com.au

bution and in the half-life elimination in the maternal compartment.

Exposure of the foetus to drugs is determined by transplacental transfer; the rate and degree of which is influenced by the same principles and factors that affect transfer across other cellular barriers. As a general rule, if a drug is absorbed through the maternal gastrointestinal tract, it will usually cross the placenta.

Physiological changes in pregnancy Significant anatomical and physiological changes occur in the maternal body systems during pregnancy. These changes may mean that side effects or toxic effects can be initiated by the administration of normal doses of a drug. The foetus is at greater risk because of the developing organs and the greater proportion of body water capable of holding drugs in solution.

During the early part of pregnancy, the changes are due partly to the metabolic requirements of the foetus, placenta and uterus, and partly to the increasing levels of pregnancy hormones, in particular progesterone and oestrogen. Later, the changes become more anatomical due to the pressure exerted on the organs by the continually expanding uterus.

1. Cardiovascular system Cardiac output and blood volume tend to increase by about 30% to 50% primarily due to an increase in plasma volume. The magnitude of the increase varies according to maternal size, number of pregnancies, and number of foetuses present. During parturition, cardiac output rises an additional 30% and falls to about 15% to 25% after delivery. By six weeks postpartum in humans, cardiac output has returned to normal levels.

Most of the additional blood volume is accounted for by increased capacity of breast, uterine, renal, striated muscle and cutaneous vascular systems. The additional blood volume helps facilitate the exchange of nutrients, metabolites and respiratory gases between mother and foetus, and helps reduce the impact of maternal blood loss at parturition.

DECEMBER 2023 TheVeterinarian 21

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Clinical Review 4. The renal system The renal system undergoes significant changes during pregnancy; renal dysfunction during human-pregnancy is a common and serious complication. Increased cardiac output during pregnancy causes an increase in renal plasma flow, which increases the glomerular filtration rate (GFR) by about 50% to 60%, and there is a corresponding increase in renal excretion.

Therefore, urea and creatinine levels will be lower.

Renal plasma flow and GFR begin to increase during the first trimester, resulting in increased creatinine clearance. Plasma osmolality decreases; over the gestational period, there is retention of water and sodium. Progesterone can induce dilation and atony of the renal calyses and ureters. In addition, the enlarging uterus can compress the ureters, causing further dilation by obstructing urine flow.

Renal volume increases by up to 30% and haemodynamic alterations occur, including responsiveness to vasopressors, which are related to both systemic cardiovascular changes and renal adaptation. Pregnancy also affects tubular function, renal solute handling, and acid-base balance.

Sheep placenta

Blood constituents - red cell mass increases by 20% to 30% and there is a decrease in fibrinolytic activity with increased fibrinogen, and factors VII, X and XII. These changes help prevent excessive bleeding at parturition. Leukocyte counts vary but generally increase to the upper limits of the normal range for the species in question.

Both cardiac size and position can change, leading to changes in the ECG. In humans, the size of the heart increases by about 12% due to dilation and hypertrophy. Vascular tone becomes more dependent on sympathetic control.

Total body water increases by 5% to 8% due to expansion of the extracellular fluid space and growth of new tissue. Body water also accumulates in the amniotic fluid, foetus and placenta which contributes to a greater volume of distribution.

2. The respiratory system Under the influence of the pregnancy hormones, the mucosal vasculature of the respiratory tract changes, leading to capillary engorgement and swelling of the nasal mucosa, oropharynx, larynx and trachea. The bronchial musculature relaxes, resulting in reduced airway resistance.

Oxygen consumption increases gradually in response to the needs of the foetus while expiratory reserve volume, residual volume and functional residual volume decrease. These changes have clinical relevance for the use of gaseous anaesthetic agents.

The increase in resting ventilation delivers more inhalational agent into the alveoli per unit time, while the reduction in functional residual capacity favours rapid replacement of lung gas with the inspired agent. There is also a reduction in anaesthetic requirements, with a fall in the minimum alveolar concentration (MAC) of halogenated vapours. When measured in ewes, the MAC of halothane, isoflurane, methoxyflurane and desflurane was 25% to 40% lower in pregnant animals compared with their non-pregnant counterparts.

3. The gastrointestinal system Mechanical and physiological changes occur in the maternal gastrointestinal system during pregnancy. Gastrointestinal absorption is altered due to changes in gastric pH, secretion and motility.

From a clinical perspective, the pregnant patient can be viewed as a patient having a full stomach with an increased risk of aspiration.

So, airway protection during general anaesthesia using a cuffed endotracheal tube is mandatory.

■ www.theveterinarian.com.au

The placenta The placenta is formed as a result of interaction between foetal and maternal tissues within the pregnant uterus. Between species, the placenta has a wide variety of structural modifications and functional differences. The placenta connects the developing foetus to the uterine wall, allowing gas exchange, metabolic transfer, nutrient uptake, waste elimination, hormone production/secretion, and foetal protection via the mother’s circulatory system.

The placenta is able to metabolize xenobiotics from early on in pregnancy as it expresses various drug metabolising enzymes; this ability changes with the stage of pregnancy. Phase I enzymes, such as CYP1A1, CYP4B1 and CYP19 (steroid aromatase, responsible for the placental conversion of androgens into oestrogens) contribute to the oxidation of some xenobiotics in the placenta. Several phase II enzymes, including glutathione transferases, N-acetyltransferase, sulfotransferase, and UDP-glucuronosyl transferase have also been described in the placenta.

Different classification systems have been developed to distinguish between the types of placentae. These are based on anatomical and morphological characteristics. For example: ■

placental shape

There are four types of placenta in eutherian mammals: diffuse (horses and pigs; almost the entire surface of the allantochorion is involved in the formation of the placenta), cotyledonary (ruminants; cotyledons are formed by the interaction of patches of allantochorion with endometrium), zonary (dogs, cats, seals, bears and elephants; the placenta is a complete or incomplete band of tissue surrounding the foetus) and discoid (rodents and primates; a single placenta is formed and is discoid in shape).

■

tissue and uterine endothelium are retained ■ Endotheliochorial (cats, dogs and ferrets) where the uterine endothelium is retained ■ Haemochorial (rodents, humans, apes and monkeys) where no maternal tissue is retained.

Foetal vessel endothelium, villus connective tissue and trophoblasts are always present on the foetal side. On the maternal side, either the entire uterine epithelium or only the maternal vessel endothelium is intact, or as in humans, both are absent.

At term in humans, the placenta weighs almost 500g, has a diameter of 15cm to 20cm, a thickness of 2cm to 3cm, and a surface area of almost 15m2. In horses, the normal placental weight at term is approximately 11% of the weight of the foal.

In sheep, placental weight is a primary factor determining size at birth in many species.

Placental weight peaks at approximately midgestation, with structural remodelling occurring over the second half of pregnancy to meet the increasing nutritional demands of the growing foetus.

Transport across the placenta Nutrient and drug transfer across the placenta are by passive diffusion, facilitated diffusion, active transport, and pinocytosis. The transfer of glucose across the human placenta is directly proportional to maternal glucose concentrations and is mediated by glucose transporter family proteins.

Most drugs can cross the placenta (except for those with high molecular weights such as heparin and insulin) by simple or facilitated diffusion, or by active transport. Most drugs cross by simple diffusion, which is the passive transfer of solutes driven by concentration and electrical gradients. Almost all anaesthetic drugs can cross the placenta easily, with the exception of the neuromuscular blocking agents.

The placenta also contains water-filled channels which may serve for the transport of water-soluble substances. These pores vary in size between species; the pore radius has been estimated to be 0.5nm in sheep, and 15nm to 30nm in rabbits.

Numerous tight junctions exist between the cells which makes this route harder for transplacental movement of certain drugs. Invariably, almost all drugs administered on the maternal side will eventually cross the placenta.

There are several factors which affect the movement of drugs across the placenta and subsequent effects on the foetus. These include: 1. Physical (e.g. placental surface area and thickness, placental metabolism, uteroplacental blood flow, presence of placental drug transporters)

the number of maternal membrane layers retained

There are six layers of tissue separating maternal and foetal blood before the placenta is formed.

The three layers of foetal extraembryonic membranes in the chorioallantoic placenta of all mammals are retained as components of the mature placenta. There are also three layers on the maternal side, but the number retained in the mature placenta varies among species.

One classification system for placentas is based on which maternal layers are retained in the placenta.

■ Epitheliochorial (horses, pigs, ruminants) where the endometrial epithelium, connective

Close-up of the sheep placenta DECEMBER 2023 TheVeterinarian 23

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Clinical Review 2. Physiochemical properties of the drug (e.g. molecular weight, lipid solubility, degree of ionisation, protein binding, concentration gradient across the placenta) 3. Rate at which the drug crosses the placenta (e.g. foetal and placental blood flow) 4. Amount of drug reaching the foetus (e.g. pH of maternal and foetal blood) 5. Duration of exposure to the drug 6. Drug distribution in foetal tissues stage of placental and foetal development at the time of exposure to the drug; and 7. Compounding effects of drugs when used in combination.

Drugs may be deliberately administered to the mother in order to treat specific foetal conditions. For example, steroids can be given to the mother to promote foetal lung maturation prior to birth and cardiac drugs can be given to control foetal arrhythmias.

However, transplacental passage of drugs can have detrimental effects on the foetus, including teratogenicity or impairment of foetal growth and development. The greatest risk of adverse drug effects on the foetus is during organogenesis. The effects of administered drugs on the foetus may be direct or may be mediated via the alteration of uteroplacental blood flow.

Three types of drug transfer across the placenta have been described: 1. Complete transfer (type 1 drugs such as thiopental) ● These drugs transfer rapidly cross the placenta with pharmacologically significant concentrations equilibrating in the maternal and foetal circulatory systems 2. Exceeding transfer (type 2 drugs such as ketamine) ● These drugs cross the placenta and reach higher concentrations in the foetal circulatory system compared with the maternal circulatory system.

3. Incomplete transfer (type 3 drugs such as succinylcholine) ● These drugs cannot cross the placenta completely, which results in higher concentrations in the maternal circulatory system compared with the foetal circulatory system.

Drugs are carried in the maternal circulatory system in one of three ways: in free form dissolved in plasma, or bound to carrier proteins, or bound to red blood cells.

Solute levels in each compartment (maternal blood, cytoplasm of the syncytiotrophoblast and foetal blood) play key roles in controlling the rate/s by which substances cross the placenta. They are dependent to a large degree

on initial absorption of the drug into the maternal bloodstream.

Alterations in protein binding affinity and changes in the concentration of specific proteins (especially albumin) influence the maternal plasma concentration of free drug available to cross the placenta. On the foetal side, there is a lower concentration of specific binding proteins (e.g. albumin and á1-acid glycoprotein) and altered binding affinity, and less fat. This means that if unbound drug crosses the placenta, the foetus will be subject to higher concentrations of free drug.

Drugs that are very lipid soluble, such as the anaesthetic gases, are minimally affected by protein binding as they diffuse across the placental membranes so quickly that their overall rates of equilibrium do not depend on the free drug concentration becoming equal.

Transfer of these drugs and their overall rates of equilibrium are more dependent on (and proportional to) placental blood flow.

Some drugs (e.g. barbiturates, local anaesthetics, sulfonamides and phenytoin) have a higher protein binding affinity in maternal plasma that in foetal plasma. Most antibiotics carried in a non-protein bound form in the maternal plasma are capable of moving across the placenta into the foetal circulation where the concentration may be substantially greater than that on the maternal side.

The molecular size influences the rate and amount of the drug transferred across the placenta. Depending on lipid solubility and degree of ionisation, drugs with molecular weights of below 600 Da can cross the placenta easily. High molecular weight drugs such as insulin (6000 Da) are not transported in significant amounts. Generally, lower molecular weight, uncharged, un-ionized molecules with high lipid solubility penetrate cell membranes more readily than hydrophilic ionized drug molecules. Lipophilic drugs such as thiopental diffuse readily across the placenta and enter the foetal circulation, whereas highly ionised drugs such as succinylcholine cross the placenta slowly and achieve very low concentrations in the foetus.

The transfer of weak acids and bases is influenced by the pH gradient between the maternal and foetal circulations and by the ionization constant (pKa) of the drug. Foetal plasma and amniotic fluid are more acidic than maternal plasma. For weak (basic) bases, this means that the un-ionized free drug crossing the placenta becomes ionized and is trapped (also called ion-trapping) in the foetal circulation, leading to drug concentrations within the foetus that may exceed maternal plasma concentrations.

The syncytiotrophoblast When a molecule crosses from the maternal to the foetal circulatory system, the solutes must (in many species) cross the syncytiotrophoblast either by passing through the cytoplasm of the trophoblast or via a network of transporters. The syncytiotrophoblast is a continuous, generally uninterrupted syncytial layer that completely lines the intervillous space. It facilitates the passive exchange of material between the mother and the foetus.

In humans, the surface area of syncytiotrophoblasts is about 5sqm at 28 weeks gestation and can be up to 11sqm to 12 sqm at term.

The syncytium acts as a giant cell so there are no gaps for immune cells to “squeeze” through which is important as the white blood cells in the mother's immune system can migrate into tissues literally by "squeezing" in-between cells. If these cells were to reach the foetal side of the placenta, many foreign proteins would be recognised and an immune response would be triggered.

In haemochorial placentation, syncytiotrophoblasts can be divided into three types depending on the number of trophoblast layers – monochorial (humans), dichorial (rabbits, beavers and bats) and trichorial. Syncytiotrophoblast cells are not formed in bovidae; instead, through acytokinetic mitosis, the trophectoderm forms binucleate cells (BNCs) which migrate and fuse with the epithelial cells, resulting in the formation of trinucleate cells (TNCs) localised in the uterine stroma. These TNCs can function similarly to syncytiotrophoblasts.

In animals with epitheliochorial placentation such as horses, camels and pigs, the syncytiotrophoblast layer is not formed; however, BNCs have been found in horse placentae.

■ www.theveterinarian.com.au

The placenta and umbilical vein help protect the foetus from drugs in the maternal circulation. The placenta has an important role as a protective semipermeable barrier, and in normal foetal development. The ATP-binding cassette proteins perform crucial functions in the distribution of nutrients and exchange of waste metabolites across the placenta. They also protect the developing foetus from xenobiotics to which the mother is/has been exposed.

The placenta also acts as a site of metabolism of some drugs (e.g. ethanol and pentobarbital) passing through. It possesses metabolizing enzymes capable of oxidation, reduction, hydrolysis and conjugation which can potentially convert an inactive drug into an active metabolite and vice versa.

Drugs which have crossed the placenta pass through the umbilical vein before entering the foetal circulation. About 40% to 60% of umbilical venous blood flow enters the foetal liver with the remainder bypassing the liver and entering the general circulation. A large proportion of drug present in the umbilical artery (returning to the placenta) may be shunted through the placenta back to the umbilical vein and into the liver again.

Drugs may have a direct effect on maternal tissues with secondary or indirect effects on foetal tissues. Continued exposure may produce cumulative effects or may affect several organs going through varying stages of development.

Furthermore, the metabolites of some drugs may be more active than the parent compound.

Adverse effects can be delayed until after birth. Female human foetuses exposed to diethylstilboetsrol in utero are at increased risk of developing vaginal adenocarcinoma after puberty.

Gestational age During the first two weeks of development, the foetus is thought to be resistant to any teratogenic effects. However, embryonic death may still occur during implantation. The critical period of development is when the organ systems are developing, and exposure to certain drugs during this period can cause varying degrees of birth defects.

Drugs administered during middle to latter parts of pregnancy may also interfere with functional development, and this is especially so with the central nervous system which has a long period of histiogenesis and functional maturation. Deafness and mental retardation are examples. Renal dysfunction can be caused by acetylcholine esterase inhibitors.

Treatment during pregnancy: gaps in our knowledge The use of drugs during pregnancy is extremely common but there remain significant gaps in our knowledge around the safety, dosage and long-term effects of drugs used in human and veterinary medicine. The reasons given for this are multi-factorial and in human medicine include: the exclusion of pregnant women from clinical trials of treatments for conditions that may occur concurrently with pregnancy; minimal available information on the pharmacokinetics of many existing treatments; and limited long-term outcome data to help inform choices.

Stock and Norman (2019) concluded there remains a need for investment and legislation to boost inclusion of pregnant women in clinical studies, capture high-quality information on medication use in pregnancy in general, and encourage new medicinal product development for obstetric conditions. Bookstaver et al (2015) cited a paper (Adam et al 2011) where it was estimated that only 10% of medications marketed since 1980 have sufficient data regarding infantile risk in pregnancy.

Earlier, Mattison and Zajicek (2006) summarised the gaps in human medicine and while advances have definitely been made, it is worth DECEMBER 2023 TheVeterinarian 25

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Clinical Review being cognisant of these gaps as the principles were, and still are, equally relevant to veterinary medicine: ■ most drugs used in women and during pregnancy have not been tested in either nonpregnant or pregnant women ■ frequency of drug use in pregnancy. For example, broad multi-agent exposure to treatment, over-the-counter and herbal treatments in women of reproductive age and pregnancy.

■ sex differences in pharmacokinetics. For example, gastrointestinal transit time is less in females than males and it also varies with progesterone levels. Also, pregnant females have a larger minute ventilation, whereas it is smaller than males for non-pregnant females. about 75% of drugs used in paediatrics have not been tested on children ■ sex differences in drug safety. Females reportedly experience more adverse reactions to drugs than do males.

The relatively limited information on pharmacological treatments during pregnancy in veterinary medicine has been attributed to, for example, ethical concerns in using pregnant females in research protocols; in vitro research in cell cultures or isolated organs only (i.e. not in vivo research); the marked interspecies differences which makes extrapolation of data from one species to another difficult; and lastly, changes during pregnancy are dynamic, and there marked differences between individuals of the same species and even in the same individual during different stages of pregnancy.

The best treatment for the mother means choosing an appropriate drug at an appropriate dose rate, with maximal efficacy and few or no adverse side-effects. In small animal practice, dose rates are usually calculated in mg/kg body weight so there is less risk of subtherapeutic doses than in human medicine, where fixed adult doses are prescribed, even in pregnant women. In both human and veterinary medicine, a conservative approach to medical treatment during pregnancy is advised.

The pregnancy category for human pharmaceuticals The pregnancy category of a pharmaceutical agent is an assessment of the risk of foetal injury due to the pharmaceutical when used by the mother during pregnancy according to the manufacturer’s directions. It does not include any risks conferred by pharmaceutical agents or their metabolites that are present in breast milk.

In 1979, the United States Food and Drug Administration introduced a classification of foetal risks due to pharmaceuticals. This was based on a similar system that was introduced in Sweden in 1978. The Australian categorisation system and database for prescribing medicines in pregnancy have been developed by medical and scientific experts based on available evidence of risks associated with taking particular medicines while pregnant. This information is presented for the use of health professionals prescribing medicines to pregnant women. It is not presented as medical advice to health professionals or the public.

The Australian categorisation system differs from the US FDA categorisation. The categorisation of medicines for use in pregnancy does not follow a hierarchical structure.

Due to legal considerations in Australia, sponsor companies have, in some cases, applied a more restrictive category than can be justified on the basis of the available data.

For pharmaceutical products containing two or more active ingredients, the categorisation of the combination is based on the active ingredient with the most restrictive pregnancy categorisation.

The Australian categorisation consists of the following categories (some veterinary examples are used for illustration purposes). To note that for drugs in the B1, B2 and B3 categories, ■ www.theveterinarian.com.au

human data are lacking or inadequate and subcategorisation is therefore based on available animal data. The allocation of a B category does not imply greater safety than the C category.

Drugs in category D are not absolutely contraindicated in pregnancy (e.g. anticonvulsants).

Moreover, in some cases, the D category has been assigned on the basis of ‘suspicion’.

Category A Drugs which have been taken by a large number of pregnant women and women of childbearing age without any proven increase in the frequency of malformations or other direct or indirect harmful effects on the foetus having been observed. Examples are: amoxicillin, codeine, diphenhydramine, lignocaine, nystatin and thiopentone.

Category B1 Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human foetus having been observed. Studies in animals have not shown evidence of an increased occurrence of foetal damage. Examples are: cimetidine, and ondansetron.

Category B2 Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human foetus having been observed. Studies in animals are inadequate or may be lacking, but available data show no evidence of an increased occurrence of foetal damage. Examples are: omeprazole, phenylephrine.

Category B3 Drugs which have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human foetus having been observed. Studies in animals have shown evidence of an increased occurrence of foetal damage, the significance of which is considered uncertain in humans. Examples are: acetazolamide, isoflurane, naltrexone, and spironolactone.

Category C Drugs which, owing to their pharmacological effects, have caused or maybe suspected of causing harmful effects on the human foetus or neonate without causing malformations.

These effects may be reversible. Accompanying texts should be consulted for further details.

Examples are: prochlorperazine, propofol, rifampicin and tubocurarine.

NSAIDs inhibit prostaglandin synthesis and should not be used in the latter part of pregnancy because they can delay labour and birth, and cause developmental abnormalities such as closure of the foetal ductus arteriosus, foetal renal impairment and inhibition of platelet aggregation.

Flunixin meglumine, caprofen and meloxicam are contraindicated in pregnancy.

Category D Drugs which have caused, are suspected to have caused or may be expected to cause, an increased incidence of human foetal malformations or irreversible damage. These drugs may also have adverse pharmacological effects.

Accompanying texts should be consulted for further details. Examples are: albendazole, enalapril, hydroxyprogesterone, phenobarbitone and phenytoin.

Category X Drugs which have such a high risk of causing permanent damage to the foetus that they should not be used in pregnancy or when there is a possibility of pregnancy.

Examples are: dienoestrol, raloxifene and ribavirin.

During parturition Drug use at or during parturition can cause premature parturition, abortion or prolonged delivery. Abortion can be induced by corticosteroids, some prostaglandins and xylazine, for example. Clenbuterol will reduce uterine contractility. Prostaglandins are used to terminate early pregnancy in cattle, and to induce parturition in cattle, pigs and humans.

When inducing parturition, careful thought must be given to the length of gestation to minimise the risk of non-viable offspring.

Nonsteroidal anti-inflammatory drugs may delay or prolong parturition and may cause premature closure of the foetus’s ductus arteriosus.

Some examples of drugs to be avoided or used with caution at parturition are: α2-adrenoceptor stimulants, barbiturates, chlorpropamide, corticosteroids, NSAIDS, opioid analgesics, progestogens and tolbutamide.

In summary careful drug selection and adherence to the manufacturer’s directions is essential. The need for maternal treatment must be weighed against the generally uncertain risk to the foetus, and modification of dosage may be required and should be based on factors such as bioavailability, clearance, volume of distribution and half-life.

Reports in the human medicine literature indicate that antibiotics are the most commonly prescribed medication during pregnancy. Antibiotic exposure in pregnancy may have negative short-term and long-term effects on infant weight.

The fluoroquinolones such as ciprofloxacin and enrofloxacin are contraindicated during pregnancy due to the risk of spontaneous abortions and birth defects. They cross the bloodplacenta and blood-milk barriers quickly, and are extensively distributed into the foetal tissues.

Macrolides are considered to be low risk during pregnancy but tylosin is contraindicated for use in horses. Sulphonamides in therapeutic doses appear to be relatively safe during pregnancy but their administration near term can result in neonatal jaundice, as they compete with bilirubin for plasma albumin-binding sites, and haemolytic anaemia. Tetracyclines are contraindicated because of their effects on the teeth and bones, as well as causing hepatopathy in the pregnant bitch. In humans, they are reportedly safe for use for the first 18 weeks of pregnancy, after which they cause discolouration of the baby’s teeth. Aminoglycosides such as gentamicin readily cross the placenta and because of their water solubility in the presence of a higher proportion of foetal body water, they should not be used in pregnancy to avoid foetal nephrotoxicity, ototoxicity and congenital malformation. Effects on the eighth cranial nerve or interference with neuromuscular function have also been reported.

DECEMBER 2023 TheVeterinarian 27

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Clinical Review Selected References 1. Anderson GD (2005) Pregnancy-induced changes in pharmacokinetics: a mechanisticbased approach. Available at https://pubmed. ncbi.nlm.nih.gov/16176115.

2. Behravan J and Piquette-Miller M (2007) Drug transport across the placenta, role of the ABC drug efflux transporters. Expert Opinion on Drug Metabolism and Toxicology 3(6): 819-830.

Available at https://pubmed.ncbi.nlm.nih.gov/ 18028027.

3. Bookstaver PB et al (2015) A Review of Antibiotic Use in Pregnancy. Available at https://accpjournals.onlinelibrary.wiley.com/ doi/10.1002/phar.1649.

4. Ciliberto CF and Marx GF (1998) Physiological changes associated with pregnancy.

Available at https://www.researchgate.net/ publication/267821406.

5. Cox BJ (2014) Systems Biology Analyses of the Placenta. Available at ttps://www.sciencedirect.com/book/9780123944450/the-guideto-investigation-of-mouse-pregnancy.

6. Feghali M, Venkataramanan, R and Caritis S (2015) Pharmacokinetics of drugs in pregnancy.

Available at https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC4809631.

7. Kepley JM, Bates, K and Mohiuddin SS (2023) Physiology, Maternal Changes. Available at https://www.ncbi.nlm.nih.gov/books/NBK539766.

8. Landsbergen N, Pellicaa CH and SchaefersOkkens AC (2001) The use of veterinary drugs during pregnancy of the dog. Available at http://www.ncbi.nlm.gov/pubmed/11758478.

9. Lobstein R, Lalkin A and Koren G (2001) Pharmacokinetic changes during pregnancy and their clinical relevance. Available at https://pubmed.ncbi.nlm.nih.gov/9391746.

10. Mattison D and Zajicek A (2006) Gaps in knowledge in treating pregnant women. Gender Medicine 3(3): 169-182.

Post-mortem gravid uterus

11. Okutomi T, Whittington RA, Stein DJ and Morishima HO (2009) Comparison of the effects of sevoflurane and isoflurane anaesthesia on the maternal-fetal unit in sheep. Journal of Anesthesia. 23(3): 392-398.

12. Palahniuk RJ and Shnider SM (1974) Maternal and fetal cardiovascular and acid-base changes during halothane and isoflurane anesthesia in the pregnant ewe. Anesthesiology.

41(5): 462-471.

13. Stock SJE and Norman JE (2019) Medicines in pregnancy. Available at https://research-

information.bris.ac.uk/ws/portalfiles/ portal/200689907/Medicines_in_ pregnancy.

14. Therapeutic Goods Administration (2011) Australian categorisation system for prescribing medicines in pregnancy. Available at https://www.tga.gov.au/australian-categorisation-system-prescribing-medicines-pregnancy.

15. Wang Y, Zhao S and San Rafael, CA (2010) Vascular Biology of the Placenta (Chapter 4).

Available at https://www.ncbi.nlm.nih.gov/ books/NBK53245.

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BUSINESS

Mediquip acquires Medical Plus ANZ Bravecto Quantum Mediquip has acquired the Australia and New Zealand businesses of leading veterinary imaging provider Medical Plus.

Mediquip CEO Daniel Berndt said Medical Plus’ holistic approach including sales, installation and ongoing service and technical support provides terrific synergies with Mediquip’s veterinary business MQ Vet. “Welcoming Medical Plus Australia and New Zealand as part of Mediquip not only provides existing Medical Plus customers with a stronger support network, but also will help make world-leading veterinary imaging solutions more accessible to local vets.”

Medical Plus Group owner Andreas Winterhalter said becoming part of Mediquip across ANZ with access to Mediquip’s resources opens great opportunity to scale the local business and enhance services for veterinary professionals.

“Over the past couple of decades, Medical Plus has been delivering the latest in diagnostic imaging technology to make veterinary care and diagnosis a simpler process for vets with a range of ultrasound, x-ray, fluoroscopy, CT and MRI systems from some of the world’s leading manufacturers.

“Veterinary hospitals are enhancing their in-house advanced diagnostics with our fluoroscope, CT and MRI systems to assist with a range of applications including orthopaedic, lung, brain, spinal and trauma cases.”

Medical Plus ANZ will now operate as part of Mediquip, which launched in 1983 providing servicing of medical equipment. Mediquip’s technical team and field service engineers remain core to its position today as a diversified medical business across sales and service,

offers year-long protection

Daniel Berndt and Andreas Winterhalter

with offices around Australia and support into New Zealand.

Mediquip’s veterinary business MQ Vet has built a strong reputation over several decades, particularly in oxygen generation, medical gas, anaesthesia, sterilisation, fit out and project management.

Andreas said he and his team look forward to continuing to grow Medical Plus ANZ as part of Mediquip and will continue their calendar of invaluable veterinary imaging workshops.

Medical Plus entities in countries outside of Australia and New Zealand are not part of the Mediquip acquisition and remain under Medical Plus Group.

Medical Plus ANZ day-to-day operations and contact details remain the same. Visit www.medicalplus.com.au for more information.

Australia will soon be one of the first countries in the world to have Bravecto Quantum available - the only injectable parasiticide to provide year-long flea and paralysis tick protection for dogs.

The active ingredient in Bravecto Quantum is fluralaner, an isoxazoline that has been used by Australian veterinarians to protect dogs from fleas and ticks since 2014. It is a ground breaking injectable suspension of fluralaner crystals. Following subcutaneous injection, the innovative crystal structures slowly dissolve and fluralaner is continuously released from the injection site, allowing it to be sustained over a 12-month period. The product is well tolerated with the only treatment-related finding limited to transient, non-painful injection site swellings that resolved over time, with no further treatment required.

To page 30

National Winner – Greencross Vets Veterinary Greencross announces award winners Director of the Year: Victoria Lawrence of Greencross Port Macquarie

National Winner – Specialist and Emergency Veterinary Director of the Year: Liam Donaldson of Greencross Vet Hospital at the University of Melbourne National Winner – Greencross Vets Practice Manager of the Year: Kelly McKay of Greencross Stud Park and Narre Warren Better Together Award: Sarah Wandel, Diane Whatling and Nathan Nimmo of Greencross South Australia and AEC/AAERC/AVSARC

George Wahby CEO, Scott Charters COO, Sarah Wandel, Diane Whatling, Nathan Nimmo and Michelle Dries COO

The Greencross Pet Wellness Company has announced the award winners from its 2023 National Clinical Symposium and leadership conference.

Held at the Royal Pines Gold Coast, this year’s symposium was the largest event in the company’s history, bringing together more than 1600 vets, vet nurses, Petbarn and Animate team members, sponsors and exhibitors across vet and retail.

Over the two days, vets and vet nurses had the opportunity to attend industry-leading education sessions, gain Continuing Education (CE) points and engage with a range of suppliers and sponsors.

This year’s Clinical Symposium brought together specialists representing the largest network of specialty and emergency animal hospitals, covering a range of specialty areas from dermatology, neurology, oncology, and critical care and surgery.

“This year’s Clinical Symposium was an

■ www.theveterinarian.com.au

outstanding success,” Michelle Dries of Greencross said. “It was so wonderful to see so many of our vets, specialists, and vet nurses together to learn and share their knowledge.

It was also a great opportunity for our vet team leaders to collaborate and develop their leadership skills.

“The clinical sessions were carefully curated for our entire network to bring worldclass knowledge and expertise to our teams.

We had a fantastic mix of internal vets, vet nurses and specialists as well as external partners deliver sessions including Advanced Anaesthesia: Head, Haemorrhage and Hot tips for experienced nurses; Managing the small animal patient with poly-trauma for ECC Vets and Connecting pets to good outcomes, how every conversation counts. Every Pet Every Time leadership session.”

Dries congratulated the award winners for their hard work and dedication to the provision of excellent animal health care.

The Clinical Symposium complements the company’s ongoing investment in team development which includes scholarships for external education and learning opportunities for vets, as well as the recently launched Greencross Growth Scholarship for nurses.

Throughout the year the company holds more than 70 learning and development opportunities for team members to engage in ongoing professional growth and skill enhancement. These opportunities encompass a wide range of subjects and formats, including workshops, online courses, mentorship programs, and hands-on training sessions. Greencross is committed to fostering a culture of learning and development, ensuring that team members have access to the resources and support they need to excel in their roles and advance their careers.

Details for the 2024 Greencross Clinical Symposium will be announced shortly. For further information regarding sponsorship or exhibition, email conference@ gxltd.com.au.

DECEMBER 2023

TheVeterinarian 29

News Green sea turtles face additional threat to survival From page 1

recorded the temperature every hour inside the nest and at the beach surface. When the hatchlings emerged their sex was determined as well as levels of heavy metals like cadmium and antimony, and organic contaminants known, or suspected, to function as ‘xenoestrogens’ or molecules that bind receptors for female sex hormones.

Senior author Jason van de

Animals unable to beat the heat

temperatures than those they generally experience. However, they’re probably more susceptible to other more climate-related factors such as extreme weather events, including drought.”

Bennett explained that during periods of drought animals must compete for food and water and as these resources become increasingly scarce some animals perish because they are unable to compete.

The study’s findings will help researchers better understand how sensitive different cold-blooded animal species might be, both to future temperature changes and more frequent climate-driven disasters such as droughts.

“These results will help scientists predict how the global distribution of species might change as Earth continues to get hotter and as the climate continues to change,” Bennett said.

Supported by funding from the World Wildlife Fund for NatureAustralia as part of the Turtle Cooling Project that researches ways to counter the occurrence of female-bias nests at warm beaches due to climate change, the scientists collected 17 clutches of eggs within two hours of being laid, and reburied them next to probes that From page 5

The species’ inability to adjust to rising temperatures has pushed the frog to its physical limits forcing it to leave home.

“Australia’s tropical regions are rich in biodiversity despite only taking up about one per cent of our land mass. Ultimately, we’ve a lot to lose but the problem isn’t just confined to Australia, it’s a global issue,” Bennett said.

The researchers found species living in more temperate climates were not living as close to the edge of their physiological thermal threshold, but the reason was not that these animals were unable to withstand heat, it was due to their being unable to compete with other animals for food and other resources that are plentiful in more temperate regions.

“We found species in temperate environments can deal with higher

■ ANNE LAYTON-BENNETT

Vets on alert due to feline vaccine shortage From page 9

“The illnesses covered by these vaccines can spread rapidly in a shelter, leading to large-scale mortality, which is a scenario we are committed to avoiding,” RSPCA SA Chief Veterinarian Gayle Kothari said.

The AVA has advised vets to consider giving kittens two vaccinations, rather than three, and

Business - Bravecto Quantum From page 29

Poor owner compliance such as missed doses, incorrect redosing intervals or prematurely discontinuing treatments poses a significant challenge for the veterinary profession when it comes to achieving optimal flea and tick control.

However, with the introduction of Bravecto Quantum, the responsibility for ensuring compliance and effective flea and paralysis tick control now rests in the capable hands of veterinarians. As this innovative solution is specifically indicated for use by or under the supervision of a veterinarian, it empowers veterinary professionals to take charge of the entire process, guaranteeing year-long flea and paralysis tick protection for treated dogs.

Practice management From page 18

may choose your practice over others is that, when they had a veterinary issue, they remembered seeing your sign or passing your practice when they were in the area.

The percentage of new clients received by this method will vary from practice to practice. Those in a prominent street front will usually get more business this way than a 30 TheVeterinarian DECEMBER 2023

keeping them in a safe environment until supplies stabilise, before providing the final vaccination at 16 weeks of age.

Cat owners are advised in the meantime to keep their cats indoors as the most effective way to limit potential infection.

■ JULIA GARDINER The product is a prescription animal remedy, for use in dogs from 6 months of age, at any weight. It is sold to veterinarians in a multiuse vial, with a dose rate of 0.1 mL per kg body weight.

Extractable volume per vial is approximately 14 mL to 15 mL depending on the number of doses used. Therefore, one vial can be used to treat approximately 14 dogs weighing 10 kgs. The constituted vial can be stored at room temperature and should be discarded after 20 punctures to the stopper, or if the product has been suspended for more than three months.

Bravecto Quantum is expected to be available in Australia in early 2024.

Please ask your MSD Animal Health representative for more information. veterinary practice in a suite in a commercial building. Moving a veterinary practice will also mean a loss in community familiarity associated with that location, and could therefore mean a loss of new clients.

4d. Selling a practice with poor security of tenure is hard When the time comes to sell your practice, good security of tenure reinforces the value of your goodwill and practice as a whole.

Merwe, an ecologist and ecotoxicologist at ARI said the accumulation of these contaminants by female turtles occurs at foraging sites, and as the eggs develop within them the embryos absorb the accumulated contaminants. They are sequestered in the liver where they can stay for years after hatching. Although the final sex ratio varied between clutches, most nests produced predominantly female hatchlings. The greater amount of estrogenic trace elements found in the hatchlings’ liver, particularly antimony and cadmium, the greater

Abstracts - simulator training From page 14

teaching laboratories. This would improve both animal welfare and the student experience.

Aly1,

Hayes1,

Ali M Galina M Jordyn Marie Boesch1, Nicole Buote1, Jodi Korich1 Vet Surg. 2023 Nov 1.doi: 10.1111/ vsu.14044.

1Cornell University College of Veterinary Medicine, Ithaca, New York, USA.

Abstracts - zoonotic spillover From page 14

of zoonotic spillover, such as land use change, and policies impacting infection intensity and pathogen shedding in animal populations, such as those targeting animal welfare.

Chloe Clifford Astbury1 2 3, Kirsten M Lee1 2, Ryan Mcleod1, Raphael Aguiar2, Asma Atique1, Marilen Balolong4, Janielle Clarke1, Anastassia Demeshko1, Ronald Labonté5, Arne Ruckert5, Priyanka Sibal6, Kathleen Chelsea Togño4, A M Viens1 3, Mary Wiktorowicz1 2, Marc K Yambayamba7, Amy Yau8, Tarra L Penney9 10 11 Global Health. 2023 Nov 8;19(1): 82.doi: 10.1186/s12992-023-00986-x.

1School of Global Health, York University, Toronto, ON, Canada.

2Dahdaleh Institute for Global Health Research, York University, Toronto, ON, Canada.

3Global Strategy Lab, York University, Toronto, ON, Canada.

4Applied Microbiology for Health and Environment Research Group, College of Arts and Sciences, University of the Philippines Manila, Manila, Philippines.

5School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.

6School of Health Policy and Management, York University, Toronto, ON, Canada.

7School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo.

8Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK. 9School of Global Health, York University, Toronto, ON, Canada. tpenney@yorku.ca.

10Dahdaleh Institute for Global Health Research, York University, Toronto, ON, Canada. tpenney@ yorku.ca.

11Global Strategy Lab, York University, Toronto, ON, Canada. tpenney@yorku.ca.

the female bias within the nest.

“Determining which specific compounds can change the hatchling sex ratios is important for developing strategies to prevent pollutants from further feminising sea turtle populations. Since most heavy metals come from human activity such as mining, runoff, and pollution from general urban waste, the best way forward is to use science-based long-term strategies to reduce the amount of pollutants going into our oceans,” van de Merwe said.

■ ANNE LAYTON-BENNETT

TheVeterinarian Sydney Magazine Publishers Pty Ltd ACN 102752787 ISSN 1447-9768 PO Box 6130 West Gosford NSW 2250 Tel: 0432 575 877 Publisher - James Martin Email: james.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 Designer - Anne Norrell Email: annenorrelldesign@gmail.com To have your say, email editor@vetmag.com.au 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

SUBSCRIBE NOW! Mail PO Box 6130 West Gosford NSW 2250 Phone (02) 9487 6627 www.theveterinarian.com.au Subscriptions Australia $93.50 for 1 Year $138.60 for 2 Years $182.60 for 3 Years New Zealand $105 (AUD) 1 Year $160 (AUD) 2 Years $210 (AUD) 3 Years USA/Canada (airmail) $135 UK/Europe (airmail) $135 .

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Free PMC article ■ www.theveterinarian.com.au

Picture: J.J. Harrison

A passerine bird native to much of southern and northeastern Australia, the Australian raven is distinguished from the Australian crow by its throat hackles. The bird was first described in 1827, and has range strongly correlated with the presence of sheep.

Australian raven (Corvus coronoides)

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