The Veterinarian November 2021 Issue

TheVeterinarian ■ November 2021

■ www.theveterinarian.com.au

Vaccine rollout for koalas Koalas also joined vaccination queues during October with the rollout of Phase 3 of a chlamydia vaccine trial involving 200 animals at Queensland’s Australia Zoo Wildlife Hospital. Each of the koalas received a single dose of a vaccine that contains tiny slivers of the Chlamydia pecorum bacteria. Researchers hope the vaccine, that has been over 10 years in development, will prompt the animals’ immune systems to build a resistance to the sexually transmitted disease. Chlamydia is considered responsible for the severe decline in koala populations since its probable arrival into Australia via infected livestock that were brought by the early European settlers in the late 1780s.

Peter Timms, Professor of Microbiology, and Deputy Director at University of the Sunshine Coast’s Genecology Research Centre, and a key member of the vaccine collaboration project that includes researchers from several organisations, said the vaccine could play a significant role in the longer-term survival of koalas, especially in south-east Queensland and NSW where chlamydia affects over 50 per cent of the koala population.

“The vaccine has been evaluated in more than 200 koalas in eight smaller trials so far, both in captive and wild koalas entering wildlife hospitals and in koala populations

in the wild, and we’re now in the exciting stage of being ready to roll out the vaccine as part of large Phase 3 trials,” Timms said.

The trial will also focus on the protection koalas receive from the vaccine so inoculated animals will be compared with 200 unvaccinated koalas over a 12-month period to assess how many might require hospitalisation due to chlamydia symptoms. All the koalas will be microchipped, and the hospital will record any animals that return for any reason over the length of the trial.

Additional trials are planned for Moggill Koala Rehabilitation Centre, RSPCA Wildlife Hospital and for several wild populations including in the Moreton Bay region.

In addition to the AZWH’s involvement, community and care groups are being invited to help monitor the koalas that are returned to the wild in their areas, and in parallel to the rollout trials the vaccine is being progressed through government registration with the APVMA. “The vaccine team based at USC is already well advanced with this stage, including a pre-application with the APVMA, conversion of the research vaccine into a highly quality-controlled version and partnering with a vaccine manufacturer. Efforts are also now focussed on raising the funds to support this critical stage,” Timms said. To page 30

COVID-19 linked to heart Free online emergency disease in cats and dogs animal disease training

Luca Ferasin

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The results of a study published recently in Vet Record found the UK COVID-19 alpha variant known as B.1.1.7, estimated to have emerged in England’s southeast in September 2020, coincided with a ‘sudden and atypical increased number of domestic cats and dogs with myocarditis’ at The Ralph Veterinary Referral Centre, based near London.

Between December 2020 and March 2021 26 dogs and cats were diagnosed with suspected myocarditis at TRVRC,

many of which had owners or handlers who had tested positive with COVID-19 a few weeks before their pets became ill. The increase in cases with suspected myocarditis compared to other cardiac pathologies appeared to ‘mimic the curve and timeline of the COVID-19 human pandemic in the UK due to the B.1.1.7 variant’. None of the infected animals had any previous history of heart disease.

Two cats and one dog tested positive to the virus To page 30

NEWS Finding fur-ever homes

CLINICAL REVIEW Nicholas Kannegieter

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NEWS Abattoir cruelty footage

Emergency Animal Diseases are diseases of national significance because of the impacts they may have on animal health, human health, the environment and/or the economy. Veterinarians play a critical role in detecting, investigating, reporting, and managing cases where an emergency animal disease is suspected, but for many veterinarians in clinical practice, the investigation and reporting of emergency animal disease is unfamiliar territory. With new diseases continuing to emerge, it is vital that veterinarians are on the lookout for, and know how to investigate and report unusual outbreaks of disease in animals they are treating.

Emergency Animal Disease Surveillance Online Training is a free online training package for veterinarians that aims to provide a refresher on the significance of Emergency Animal Diseases, their detection, investigation, reporting and management. To page 30

FACE TO FACE Leo Biddle

ON THE INSIDE >>>>>>>> EAGLE POST

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VET ETHICS

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MANAGEMENT

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ABSTRACTS

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News

Australian start-up to combat puppy scams Australian company PETspot is using technology to battle an increasing number of puppy scammers who have emerged in the past 18 months to take advantage of soaring demand for pets due to COVID-19 lockdowns.

The Australian Competition and Consumer Commission (ACCC) reported that by the end of September 2021, there had been 2544 complaints of pet scams in the past year, with losses totalling more than $3m.

In 2019 there were 498 complaints.

PETspot allows safe pet transactions to take place through its online platform. The company independently verifies breeders on the platform and guarantees the buyer’s money once a payment is made, offering buyers a safe and simple way to find a companion responsibly.

Nick Figliano, the 23-year-old co-founder of PETspot said he came up with the idea for the company after he was nearly scammed out of thousands of dollars when trying to buy a puppy.

“I realised I was dealing with a scammer before I handed over any money, but many others aren’t so lucky.

“The industry is purely cash-based and there was no payment system that covers you for pet scams — until now,” he said.

There are now more than 200 authenticated breeders on the website and to date, $3 million dollars’ worth of dogs and puppies have found a home through the platform. The site features a strong code of ethics breeders must comply with, including providing proof of registration with regulatory bodies, showing health tests of the litter of puppies and an identity check.

For more information, visit www. thepetspot.com.au. Victims of a pet scam can report it to the ACCC at www.scamwatch.gov.au.

CVC out of Greencross bidding race It is reported by The Australian that Swedish private equity fund EQT is the frontrunner for TPG Capital’s Greencross after private equity firm CVC declined to enter a first-round bid for the business.

Greencross has a $4bn asking price. TPG Capital purchased Greencross in 2019 for around $1bn, including debt. At that time the business generated $100m, and is now generating around $220m before interest, tax, and associated costs.

CVC was considered a strong contender, but it is understood that the organisation is now out of the race.

At press time, no further announcements had been made.

Abattoir cruelty footage shocking but ‘unsurprising’

Sue Foster of VALE

New footage of animal cruelty alleged to have occurred in Indonesian abattoirs has been described as “the same old cracked record” by Vets Against Live Export (VALE).

VALE spokesperson Sue Foster told The Veterinarian the incidents depicted in the videos are unsurprising as “we have no control when animals leave our shore.”

“And as per usual the problem was exposed by animal activists,” she said.

The footage was taken in April and May by members of People for the Ethical Treatment of Animals (PETA) Asia, who visited seven abattoirs in Indonesia where Australian cattle are received and processed.

The team allege there were steers and bulls being forced into restraint www.theveterinarian.com.au

boxes and shot in the head with captive-bolt guns, and there were repeated instances of inadequate stunning.

In one shocking incident a steel rod was used to jab a steer over 60 times in the face and torso.

The alleged mistreatment was carried out to force the steer to stand and be shot for a second time, following an earlier unsuccessful attempt to stun the animal.

Footage shows the struggling steer’s tail was also twisted and yanked until it was broken.

Some cattle were simply restrained before their throats were slit, a practice which is legal under Australia’s Exporter Supply Chain Assurance Scheme (ESCAS).

PETA Australia said abattoir employees stepped on animals’ tails in an unprofessional attempt to check for consciousness.

“Some cattle still kicked, but they were butchered anywhere, with no further attempts at rendering them unconscious,” the organisation said in a statement.

“Steers who were still moving and whose heads dangled by only a strip of flesh after their throats had been slit were hung by the neck on metal hooks (and) their legs continued to thrash as they were dragged across the bloody floor and hoisted up.”

Foster said that such incidents will continue so long as the live export trade does. To page 30 NOVEMBER 2021 TheVeterinarian 3

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News

Conviction and fine for equine cruelty Finding fur-ever An RSPCA inspection has led to the at that time the horse’s weight was homes for seniors conviction of a Western Australian 284 kilograms. woman for animal cruelty.

The 72-year-old Jelcobine resident was convicted in the Armadale Magistrates Court.

For the cruelty offence, she received a $20,000 fine (suspended for 12 months) and was banned from owning or coming into contact with animals for 15 years.

She received a suspended jail term of six months and 15 days for failing to comply with a previous prohibition order.

In May of 2020 an RSPCA inspector went to the offender’s property in response to a cruelty complaint.

RSPCA Media reports that the inspector saw several horses on the property including one which was deceased, and another which appeared to be in very poor condition.

No food or water was seen in the laneway paddock.

Inspectors returned to the property with a veterinarian whose initial assessment was that the unwell horse, named Remi, was underweight due to a lack of food.

Inspectors were loading Remi on to a horse float to remove her from the paddock when the offender returned to the property.

The woman told inspectors the deceased horse had died six weeks earlier following a stomach bug.

She agreed to surrender Remi to the RSPCA and the horse was taken to Balvidis Vet Hospital, and

www.theveterinarian.com.au

After a regime of treatment and food, Remi’s weight increased to 350 kilograms.

Remi is in foster care and remains healthy.

RSPCA Inspector Manager Kylie Green acknowledged the excellent work of Dr Rob Davies at the hospital.

She added that the case was a frustrating one.

“We have prosecuted this person before, we have done everything we can under the Animal Welfare Act to protect these horses and still we were confronted with Remi in terrible condition,” Green said.

“Who knows how long Remi was standing in that paddock, looking for something to eat but unable to find anything.”

The sentencing comes in the wake of an October 2020 conviction, where the same offender was banned from contact with livestock and fined $18,000.

The ban was to begin at the end of 2020 to give the woman an opportunity to re-home her horses.

RSPCA visits in January, February and March of 2021 found the woman was still keeping cows and horses.

“To blatantly ignore the prohibition order handed down by the court last year defies belief,” Kylie said.

■ SAM WORRAD

Across the country the RSPCA cares for nearly 2000 senior animals every year. But the adoption chances for older animals are often lower due either to their age, or a need for more veterinary care, so a recent $100,000 donation from the Petbarn Foundation - given specifically to support older pets being cared for in RSPCA shelters will make a ‘huge difference’ to the lives of senior animals, according to RSPCA CEO Richard Mussell.

“It’s generally easier to find a new family for a puppy or kitten, but our shelters often have plenty of sweetly tempered, beautifully behaved, healthy and active adult and older animals who are there through no fault of their own,” Mussell said.

The Petbarn Foundation was established in 2012 and is the corporate arm of Petbarn’s retail stores. Following the decision to remove the sale of all puppies, kittens, dogs, rabbits, mice, and guinea pigs from its stores, Foundation manager Janelle Bloxsom said the organisation is now partnering with the RSPCA and other animal rescue centres to support adoptions and to date has rehomed 58,000 pets through its 153 Petbarn in-store adoption centres.

“Our rescue partners report that one of the main reasons senior pets are surrendered is because their elderly owners have either died or

have moved to a nursing home where they can no longer be together. We know how deeply the bond can be between pets and their parents so to think about an older animal being moved from a loving home at this late stage in life is incredibly sad,” she said.

Preparing an animal for adoption involves vet checks, behaviour checks, and sometimes rehabilitation measures, and with senior pets often overlooked in favour of younger animals, Mussell said such a generous donation to specifically assist older animals was greatly appreciated.

“Sadly, older animals can require quite a bit of veterinary attention due to some common health issues such as dental disease, arthritis and heart disease. We also know they often wait longer to be adopted, and in general might just need a bit more TLC,” he said, adding senior animals can also make great companions since they can be calmer and already well-adjusted to family life.

■ ANNE LAYTON BENNETT

NOVEMBER 2021 TheVeterinarian 5

FACE TO FACE

I L D L I W F O E N I L T N O R F E H ON T

L

eo Biddle has dedicated his life to saving animals. The founder and CEO of the charity, Project Borneo, he has spent the last 16 years working in partnership with Sarawak wildlife authorities at Matang Wildlife Centre in Malaysian Borneo to do just that. The centre is a rescue sanctuary for the countryís vulnerable and protected wildlife species including the iconic orangutan and sun bear. The goal is simple treat, rehabilitate and release animals where possible. But providing food, medical care, adequate shelter and enrichment to 600 or so mammals and birds is a mammoth task. The food and veterinary care alone costs AUD $25,000 -- $30,000 each month.

Prior to the lockdowns imposed by authorities in 2020 in response to the Covid situation, Project Borneo raised funds through a range of avenues including a popular volunteer program, guided tours and educational projects. Up to 700 paying volunteers each year worked at the sanctuary or in one of the many bars, cafes and businesses Biddle has established in Sarawak. However, for more than a year there have been no volunteers and staff numbers have dropped from 150 people to just four. Funds have dried up yet the number of animals rescued or surrendered to the 180 hectare Matang Wildlife Centre has not eased. Trying to keep the animals fed, healthy and alive has turned dire.

“I get angry,” Biddle said of the situation.

“I’m confident in my ability to look after animals but I don’t have the manpower. Lack of money and lack of staff have led to an increased mortality rate.”

Due to their injuries or circumstances a significant number of animals in the sanctuary can never be released. Biddle feels an emotional connection to many of them. This centre is where I have hand-reared the most animals.

When he first visited Borneo in 2006 to advise on a conservation project, he didnít realize the six-day trip would change his destiny. After helping save a baby orangutan and two rescued sun bears, and recognizing the ongoing issues faced by the centre, he knew these animals would likely die if he left.

“When you save an animal’s life you make a promise to look after that life. You feel compelled to follow through and not

abandon them. I felt a huge responsibility to these animals and I wouldnít have felt comfortable leaving. What would happen to them?”

Compassion and empathy compelled Biddle to set up Project Borneo but social justice has been a major theme throughout his life. As a child growing up in Britain he recalls feeling incensed by the lack of response from the adults he knew to children dying during the famines in Africa.

At university he studied zoology and psychology and, tangentially, set up a successful security business covering nightclubs, pubs and even a Rolling Stones gig. It was his involvement providing security for an humanitarian project in Rwanda that side-lined him into conservation.

For years he investigated wildlife trafficking in developing countries but for security reasons it is a topic he is reluctant to discuss in greater detail.

“We know bad things happen all around the world,” he said. “There’s a prescient need for someone to do something. When I first started this journey I thought ‘you lead the way and others will follow’. Truth is, some do but most don’t.

Biddle’s impressive knowledge on a vast array of subjects combined with a razor sharp intellect and passion for wildlife makes him a formidable presence in the conservation world. His unconventional journey has taken surprising twists (including a year spent in a Buddhist monastery) but since founding Project Borneo he has wrought great changes for animals at the Matang Wildlife Centre in Sarawak. He was instrumental in developing responsible wildlife tourism practices including a ‘no contact’ policy towards animals in the sanctuary, especially

E L D D I B O E L : N O I T A V R E S N IFE CO orangutans which are prone to zoonotic diseases and human habituation. Inadvertently training orangutans not to fear humans is never a good idea. Farmers shoot orangutans for food or to protect their crops and take the babies to sell as pets.

“In Borneo, the greatest threat to the orangutan population is hunting but forest fires and habitat loss are the greatest threats to wildlife in general,” he said.

Logging in Borneo began in the 1950s and as forests were cleared, roads built and villages spread, wildlife suffered. Hunters had easier access to previously inaccessible areas.

Agricultural crops claimed jungle lands. As the forests opened up they dried out and became even more susceptible to fire. Wildlife homes and territories rapidly shrank leading to increased human-wildlife conflict as both competed for land and resources. In the past 40 years over 30% of Borneoís rainforest has been destroyed and the greatest driver for deforestation is palm oil production.

Biddle doesn’t vilify palm oil plantations or advocate a boycott on palm oil by environmentallyconscious consumers. “Forest clearing and habitat destruction is the problem, not palm oil. Growing other crops instead, like soy or bananas, would have as great an impact. In fact, the amount of land space and forest clearing needed to grow soy is around seven times as great. So, in terms of space allocation and resources, palm oil is actually the best crop to plant. The problem isnít palm oil. What we need is sustainable agriculture.”

The major economical, cultural and environmental shift required to achieve this is unlikely to happen in the near future. As the threat to the countryís rich and diverse wildlife species from deforestation, illegal hunting and habitat destruction continues, Project Borneo’s role supporting Matang Wildlife Centre as a life-saving refuge and rehabilitation sanctuary is crucial.

But without funds, lives suffer. Itís a soul-destroying reality yet Biddle continues to do what he can for the wildlife in his care.

For over two decades, Biddle has worked on the front line of conservation, rescuing and treating thousands upon thousands of sick, orphaned, mistreated and injured animals. Many cases are disturbing, their stories haunting. Empathy for the suffering of others is a double-edged sword a often exacts a personal toll. Learning to cope with PTSD is the norm for front line conservationists and Biddle is no exception. He freely admits he drinks and smokes too much and doesnít slow down. “You can always do just a little bit more.

If I stopped maybe Iíd crash. But there’s always another patient coming in or another emergency.”

Not all the stories are sad. He fondly recalled Karmelo, the one-week old sun bear cub he hand-reared. The cub was rescued from the pet trade and was so small he fit into the palm of his hand. Biddle hand-fed him, kept him close and sang him lullabies. As Karmelo was orphaned at such a young age, he was never destined for release. But the care and attention he received kept him alive and he grew to thrive in captivity.

Then there’s Phantom, the long-tailed macaque with the incredible will to survive. Biddle rescued

her after her owner covered her in petrol and set her alight. She had total body burns and was in horrendous pain. Her prognosis was poor. Biddle anaesthetized her, set up an IV line then stepped out of the clinic to get medications. In the brief time he was gone, the macaque recovered and trashed the clinic trying to escape. Her fighting spirit saw her survive against all odds. When she eventually recovered from her ordeal, scarred and partially bald, she was released onto an island sanctuary where she still lives.

The success stories are what keeps him going.

There’s the orangutan finally freed from pain after removing the chain embedded in its neck.

The orangutan cured from chain-smoking 200 cigarettes a day to entertain tourists. The baby orangutan surviving bullet wounds to his tiny chest when his mother was shot.

“There’s no point in giving up,” Biddle said.

“I’m a bit jaded and a bit cynical but I can still be cheerfully optimistic about it all. Even if something seems hopeless, man up, shoulder the load and carry on. Hope will bring courage. Courage will bring hope.” He pauses for a moment.

“How do you keep hope alive? Be the change in the world you want to see.

As a deep thinker inspired by many of the great philosophers, he said he is just trying to do what’s right. Itís the reason a boy who dreamed of being a Jedi Knight has lived such an inspiring and extraordinary life dedicated to saving wildlife in the jungles of Asia.

To support Project Borneo, visit www.projectborneo.org.

■ OLIVIA POZZAN

Thomas Donnelly, BVSc, DipVP, DipACLAM reports from the US.

Eagle Post

Is veterinary medicine ready for a mid-level practitioner?

Driven by issues such as poor pay, lack of respect, underutilization, and few opportunities for career advancement, veterinary nurses or technicians as they are known in the US, according to the American Veterinary Medical Association (AVMA), have among the greatest turnover rates of any health care occupation. Technician turnover is seen widely as an important workforce test for the profession. Some educators, practice owners, and technicians believe establishing a mid-level role between veterinarians and technicians would help keep technicians in the field and advance efficiency on hospital teams. Even among veterinarians who once opposed creating something like a veterinary nurse practitioner are those who say they would welcome a new category of professionals as they struggle to fill openings for veterinarians.

Now, a proposed degree, a Master of Veterinary Clinical Care, from the new Lincoln Memorial University (LMU) College of Veterinary Medicine in Tennessee has become a new incentive in discussions about creating a midlevel practitioner role. LMU is proposing that courses for the new degree be online, with clinical work happening in the practices the university uses for student clinical rotations. Like many new US veterinary schools, LMU does not have a university hospital, and students do their clinical rotations in practices associated with the school. The proposed curriculum is similar to a veterinary one but “less in-depth,” with foundational courses in anatomy and physiology. It will also include high-level nursing-type training, such as advanced case management and care coordination. Initially, it would be offered only to credentialed veterinary technicians and is aimed at those who want to further their training but are not prepared to invest the money and time required to attend veterinary school. (Animal technicians who have met some state or professional standards for education and experience are known as “credentialed veterinary technicians, however, standards vary widely.) The proposed tuition is $25,000 for thirty credits, which could be completed in three semesters.

Although there is no national examination, job title, or credential associated with LMU's new degree, advocates see it as a step toward restructuring veterinary care teams. The nonprofit industry association, Veterinary Innovation Council (VIC), is promoting a mid-level role at state and national conferences between veterinary technicians and veterinarians to expand career opportunities for technicians and improve efficiency on hospital teams.

Interest in a midlevel position goes back at least a decade when it was presented as an extension of v Michigan State University's veterinary technology education planning. Since then, a number of papers, including a 2021 article,1 have identified support for a more advanced role on veterinary teams. An intermediate position 8 TheVeterinarian NOVEMBER 2021

was floated well before 2011. Vanderbilt University economist Malcolm Getz in the late 1990s, proposed a degree that would take fewer years of higher education than the eight it takes most veterinarians to earn a DVM in the United States. Getz proposed an intermediate degree as a way for veterinary schools to attract students by creating more balance between starting salaries and education costs. He believed it would improve practice efficiency to have nonveterinarians covering more routine services, allowing veterinarians to focus on tasks requiring specialized DVM training. There was significant pushback to his proposal when he wrote his book, driven chiefly by financially struggling veterinarians wanting to protect their positions.

Resistance seems to have diminished since then.

The research also determined that a midlevel practitioner would optimally have a separate role beyond what veterinary technician specialists

and veterinary technicians are trained and permitted to do. Getz advocated it as a means to free veterinarians from low-margin duties and permit them to concentrate on higher-margin activities to increase their revenue. Getz wrote, “The midlevel practitioner would be independent and able to lighten the veterinarians’ workload to bring the greatest value, and it is most viable if the volume of visits, the client satisfaction, and the overall clinic revenue increase.”

Unfortunately, such changes would require revising state practice acts, which restrict veterinarians to the jobs of diagnosing illness or injury, developing a prognosis, prescribing medication, and performing surgery. Creating an effective mid-level practitioner would require slicing out circumstances under which the new practitioner could perform some of these duties in certain circumstances. This practice model could have the additional benefit of lowering the costs of routine care, which could help curb the rising cost of veterinary services.

The midlevel professional could also help shave away at another challenge for the profession: lack of diversity. Individuals from underrepresented groups often look at the debt-to-income

ratio in veterinary medicine and forgo the profession despite their interest in the field.

A master's degree leading into a midlevel practitioner position could provide a more appealing entry point.

Many veterinarians are now stretched to their limit, unable to find an associate and tapping their veterinary technicians to the full degree of their training and experience. What some veterinarians feel is needed is someone who could share responsibilities restricted to veterinarians.

Amongst those need-to-do duties are surgery and complex cases. One practitioner said, “I would treat them like a vet. They would have their own patients and be available to consult or step in as needed.” Veterinarians in favor of mid-level practitioners would likely pay them similar to an associate. Current median annual salary for veterinary technicians is around $36,000 and for veterinarians is $99,250, according to the US Bureau of Labor Statistics.

Associates typically receive a base salary plus production, based on revenue a practitioner brings to the practice.

Suggested salaries for a credentialed mid-level practitioner might be $60,000 to $75,000, a range based on discussions with practice owners and managers.

In 2020, a working group was created by the AVMA to examine how to increase technician utilization ñ this meant allowing veterinary technicians to perform the full array of tasks in which they have been trained. The organization has also looked directly at the question if a mid-level professional and studied whether and where shortages may exist.

The AVMA cautions against allowing concerns about what feels currently like a workforce crisis to push for a new position prematurely.

In the Sept. 15 issue of JAVMA,2 Matthew Salois, the AVMA chief economist, and Gail Golab, the chief veterinary officer, said it is not clear a new mid-level position is needed or would help. It is because “Öno comprehensive examination has looked at the degree to which such professionals are needed and whether they would be used appropriately” under the heading “Avoiding Knee-Jerk Reactions.” They contend that “a thorough evaluation of the overall market is necessary before making any attempts to create any new position within the veterinary profession.”

References 1. Fults MK, Yagi K, Kramer J, et al. Development of advanced veterinary nursing degrees: Rising interest levels for careers as advanced practice registered veterinary nurses. J Vet Med Educ 2021;48:242-251. https://doi.org/10.3138/jvme.

2019-0041.

2. Salois M, Golab G. Are we in a veterinary workforce crisis? Understanding our reality can guide us to a solution. J Am Vet Med Assoc 2021;259:560566. https://dpi.org/10.2460/javma.259.6.559.

■ www.theveterinarian.com.au

VET ETHICS

Simon Coghlan has a PhD in philosophy.

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

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

He is also a Melbourne veterinarian.

www.theveterinarian.com.au

An ecological perspective in veterinary education A recent paper by Nieuwland and Meijboom argues that veterinary education should be more informed by an ecological perspective. Tradition-ally, veterinary education has focused on animal disease, and to some degree public health, rather than on the many interconnections between human, animal, and environmental wellbeing. They argue that veterinary ethics in particular needs to become more aware of these deep links.

Nieuwland and Meijboom’s paper* takes its cue from the new movement of One health.

As they remind us, the AVMA defines One Health as “the collaborative efforts of multiple disciplines working locally, nationally, and globally, to attain optimal health for people, animals, and our environment.”

One Health was spurred on by the emergence in recent decades of damaging zoonotic diseases such as West Nile Virus, Ebola Hemorrhagic Fever, Monkeypox, Mad Cow Disease and Avian Influenza. And of course, coronaviruses causing SARS and COVID19 have further raised the profile of pathogens with zoonotic potential, including those that leap to humans from wildlife and domestic animals.

The authors suggest an ecological approach could add value and depth to the teaching of veterinary ethics. This makes sense from their countryís perspective, since veterinary ethics appears to have a higher profile in the Netherlands than it does in other places.

Nonetheless, their position that teaching veterinary ethics is both important in itself, and could benefit from widening its field of interest, is interesting. Historically, vet ethics was mostly about professional ethics and animal ethics.

So, the introduction of environmental and ecological ideas about ethics would represent a change.

It might also be of interest to students who are becoming more focussed on major issues like global heating and biodiversity loss.

Nieuwland and Meijboom suggest that vet students could benefit from being invited to think critically about the values and implications of a multispecies perspective. For example, they might reflect on whether One Health should be primarily about zoonotic diseases that affect humans or whether it should also include One Welfare -- the idea that human welfare and animal welfare are linked in various ways.

For these authors, veterinary ethics and education should take

an “ecological turn.” A range of ethical issues are associated with this turn. They write: “If veterinarians already bear responsibility for public health by way of preventing and controlling the outbreak of zoonotic infectious disease, it does not appear far-fetched to attune veterinary moral agency to the upstream (for example, deforestation for the sake of growing crops destined to feed domesticated animals; use of animal research for pharmaceutical or food production) and downstream (emission of CO2, CH4, etc.; impact of free-roaming cats on bird and small mammal populations) ecological considerations of diverse human-animal interrelations.”

In adopting a more global viewpoint, Nieuwland and Meijboom think that veterinarians should become acquainted with the idea they call interdependence.

Interdependence means several things. It refers to the fact that there are disease interfaces between humans and nonhuman animals. It can also refer to the fact that human beings are partly constituted by nonhuman organisms, namely those that make up the microbiome.

To page 30

NOVEMBER 2021 TheVeterinarian 9

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Management

Reasons why the staff will stay

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

www.theveterinarian.com.au

It is quite common for practice owners to be fearful of how the staff will react if they learn that their practice is for sale.

While it is, of course, always possible that a practice could experience some staff attrition when it changes hands, it is, in fact, extremely rare.

Believing that the staff will quit when they hear that the practice is being sold is to believe that the only reason that the staff is there is because you are the owner, that your ownership is somehow so good that no one could fill your shoes and that staff will believe that they are better off leaving, rather than even trying to work for the new owner. This way of thinking is perhaps a little narcissistic.

As good a boss as you are, you can rest easy as there is probably a multitude of reasons why your staff work for you and will stay when you sell. For example: Financial Simply put, for most people, quitting your job usually represents more financial risk than staying.

Chances are that your staff are working for you, not for a love of the job or for a love of the business owner, but out of some financial necessity. While it may be the right time and financial conditions for the owner to retire or try something different, it would be a huge coincidence for your staff to reach

that same juncture at exactly the same time.

Staff who stay maintain their current salary There are no promises that they will get the same or better terms elsewhere.

Staff who stay maintain their current leave entitlement accruals Staff who quit could lose their long service leave entitlements (depending upon the state that you are in, how long you have worked for the practice and your reason you are leaving).

Sick leave (now called personal/carer's leave) is accrued at a rate of 10 days per year (For full time, pro rata for part time) and these days are cumulative. Any outstanding sick/personal/carers leave that an employee has on resignation is forfeited and not paid out. For long-term staff, this can be a huge amount to just give up.

Convenience People are often geographically restricted by where they can work.

It usually needs to be within a certain distance from where they live, and their kids go to school. It is rare that there will be an equivalent or better position, with equivalent or better pay available at the time, within the geographical limits of where they will consider.

Respect and job competence Staying at their current location means a transference of respect from their old boss and team to the new boss. They can continue to work in an environment where they are proficient with the tools/software that are available, how to use them and where everything is kept.

They know the strengths and weaknesses of the team, whom they can count on for assistance and whom they can’t. They are familiar with the equipment in the office, the patients, reps, suppliers, neighbouring businesses.

Starting at a new practice will mean “earning their stripes” from scratch, proving their worth and starting to earn the trust of their new boss and team, while at the same time learning how to do their job in a new environment, with new procedures, new tools, new unknown team-mates and, as a result, with compromised competence, at least initially.

In short, if your staff are currently happy with their jobs, leaving it would usually mean less financial security and losing leave entitlements, to work in a position that may not be as convenient and that they will most likely be less competent at.

Why would they put themselves through such an ordeal just because you are selling?

The truth of it is, that if your practice is for sale, most staff will be far more fearful of leaving their job than they are of the new owner.

NOVEMBER 2021 TheVeterinarian 11

■ EDITED BY JENI HOOD BSc (Hons) BVMS PhD

Abstracts

Ethical challenges posed by advanced veterinary care in companion animal veterinary practice Advanced veterinary care (AVC) of companion animals may yield improved clinical outcomes, improved animal welfare, improved satisfaction of veterinary clients, improved satisfaction of veterinary team members, and increased practice profitability. However, it also raises ethical challenges. Yet, what counts as AVC is difficult to pinpoint due to continuing advancements. We discuss some of the challenges in defining advanced veterinary care (AVC), particularly in relation to a standard of care (SOC). We then review key ethical challenges associated with AVC that have been identified in the veterinary ethics literature, including poor quality of life, dysthanasia and caregiver burden, financial cost and accessibility of veterinary care, conflicts of interest, and the absence of ethical review for some patients undergoing AVC. We suggest some strategies to address these concerns, including prospective ethical review utilising ethical frameworks and decision-making tools, the setting of humane end points, the role of regulatory bodies in limiting acceptable procedures, and the normalisation of quality-of-life scoring. We also suggest a role for retrospective ethical review in the form of ethics rounds and clinical auditing. Our discussion reinforces the need for a spectrum of veterinary care for companion animals.

A Quain1, MP Ward1, S Mullan2. Animals. 2021; 11(11):3010. https://doi.org/10.3390/ani11113010 1

Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, NSW 2006, Australia 2 School of Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland

Metagenomic investigation of potential abortigenic pathogens in foetal tissues from Australian horses Background: Abortion in horses leads to economic and welfare losses to the equine industry. Most cases of equine abortions are sporadic, and the cause is often unknown. This study aimed to detect potential abortigenic pathogens in equine abortion cases in Australia using metagenomic deep sequencing methods.

Results: After sequencing and analysis, a total of 68 and 86 phyla were detected in the material originating from 49 equine abortion samples and 8 samples from normal deliveries, respectively.

Most phyla were present in both groups, with the exception of Chlamydiae that were only present in abortion samples. Around 2886 genera were present in the abortion samples and samples from normal deliveries at a cut off value of 0.001 per cent of relative abundance. Significant differences in species diversity between aborted and normal tissues was observed. Several potential abortigenic pathogens were identified at a high level of relative abundance in a number of the abortion cases, including Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, Streptococcus equi subspecies zooepidemicus, Pantoea agglomerans, Acinetobacter lwoffii, Acinetobacter calcoaceticus and Chlamydia psittaci.

Conclusions: This work revealed the presence of several potentially abortigenic pathogens in aborted specimens. No novel potential abortigenic agents were detected. The ability to screen samples for multiple pathogens that may not have been specifically targeted broadens the frontiers of diagnostic potential. The future use of metagenomic approaches for diagnostic purposes is likely to be facilitated by further improvements in deep sequencing technologies.

R Akter1 2,C M El-Hage1,F M Sansom1,J Carrick3, J M Devlin# 1, A R Legione# 4 BMC Genomics.†2021 Oct 2;22(1):713.Rdoi: 10.1186/s12864021-08010-5. https://doi.org/10.1186/s12864-021-08010-5 1Asia Pacific Centre for Animal Health, The Melbourne Veterinary School, The University of Melbourne, Parkville, Victoria, 3010, Australia.

2 Department of Medicine (Royal Melbourne Hospital), The University of Melbourne, Parkville, Victoria, 3010, Australia. To page 30

12 TheVeterinarian NOVEMBER 2021

The Five Domains model and promoting positive welfare in pigs Public concern for the welfare of farm animals has increased over recent years. Meeting public demands for higher animal welfare products requires robust animal welfare assessment tools that enable the user to identify areas of potential welfare compromise and enhancement. The Five Domains model is a structured, systematic, and comprehensive framework for assessing welfare risks and enhancement in sentient animals. Since its inception in 1994, the model has undergone regular updates to incorporate advances in animal welfare understanding and scientific knowledge. The model consists of five areas, or domains, that focus attention on specific factors or conditions that may impact on an animal's welfare. These include four physical/ functional domains: nutrition, physical environment, health, and behavioural interactions, and a fifth mental or affective state domain. The first three domains draw attention to welfare-significant internal physical/functional states within the animal, whereas the fourth deals with welfare-relevant features of the animal's external physical and social environment. Initially named "Behaviour" Domain 4 was renamed "Behavioural Interactions" in the 2020 iteration of the model and was expanded to include three categories: interactions with the environment, interactions with other animals and interactions with humans. These explicitly focus attention on environmental and social circumstances that may influence the animal's ability to exercise agency, an important determinant of welfare. Once factors in Domains 1-4 have been considered, the likely consequences, in terms of the animal's subjective experiences, are assigned to Domain 5 (affective state). The integrated outcome of all negative and positive mental experiences accumulated in Domain 5 represents the animal's current welfare state. Because the model specifically draws attention to conditions that may positively influence welfare, it provides a useful framework for identifying opportunities to promote positive welfare in intensively farmed animals. When negative affective experiences are minimised, providing animals with the opportunity to engage in species-specific rewarding behaviours may shift them into an overall positive welfare state. In domestic pigs, providing opportunities for foraging, play, and nest building, along with improving the quality of pig-human interactions, has the potential to promote positive welfare.

N J Kells1. Animal. 2021 Oct 22; 100378.†https://doi.org/10.1016/j.animal.2021.100378 1Animal Welfare Science and Bioethics Centre, School of Veterinary Science, Massey University, Private Bag 11-222, Palmerston North 4442, New Zealand. Electronic address: N.J.Kells@massey.ac.nz.

A method for assessing sustainability, with beef production as an example A comprehensive approach to decisions about the use of land and other world resources, taking full account of biological and other scientific information, is crucial for good decisions to be made now and in future. The sustainability of systems for producing food and other products is sometimes assessed using too narrow a range of component factors. A production system might be unsustainable because of adverse effects on a wide range of aspects of human welfare, animal welfare, or the environment. All factors should be included in sustainability evaluation, otherwise products or actions might be avoided without adequate consideration of key factors or of the diversity of production systems. A scoring method that is based on scientific information and potentially of general relevance is presented here, using beef production as a example with a review of each of its sustainability components. This includes an overall combined score and specific factors that make the system unacceptable for some consumers. The results show that, in this example, the sustainability of the best systems is very much better than that of the worst systems. By taking account of scores for a wide range of components of sustainability To page 30

■ www.theveterinarian.com.au

Dr Claire Adams Online now

Dr Henry Jones

I hear you guys switched to a mucosal vaccine?

Dr Claire Adams

Yes, we’re using Bronchi-Shield

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Dr Henry Jones

What prompted the change?

Dr Claire Adams

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

BTW, mucosal vaccines are also strongly recommended

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Dr Henry Jones

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

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

Dr Henry Jones

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

Dr Claire Adams

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

Dr Henry Jones

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

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Clinical Review

Equine upper limb fractures - can any be saved?

Nicholas Kannegieter Following his 1984 Sydney University graduation, Kannegieter spent a year at Camden completing an intership then four years at New Zealand’s Massey University completing a Residency in Equine Surgery and a PhD in laryngeal hemiplegia.

He obtained Fellowship of the ACVSc in 1990.

Kannegieter spent six years at Sydney University as an Equine Surgeon before moving into private consultancy.

He now works with Hadley Willsallen, also a specialist Equine Surgeon.

Kannegieter has had places on AVA and Equine Veterinarians Australia (EVA) executives, and often appeared as an expert witness for Guild Insurance.

He presented the Distance Education course in Equine Surgery for many years for CVE and was appointed Adjunct Associate Professor at Charles Sturt University in 2010.

Kannegieter spent 11 years presenting a weekly vet program on Racing Radio 2KY (now Sky Sports Radio) discussing veterinary problems and issues in the racing industry.

He has also published scientific papers along the way.

Kannegieter’s time is spent in 22 equine hospitals throughout Australia.

He has travelled to Turkey on several occasions to teach Jockey Club of Turkey vets how to perform equine surgery and lameness exams.

www.theveterinarian.com.au

Equine upper limb fractures present a major challenge to the equine clinician. Horses, and owners, are often presented in severe distress and the veterinarian is faced with a very difficult situation in which rapid decision making is often required.

Despite a very poor prognosis being associated with certain upper limb fractures others can be successfully managed depending on a number of issues.

Key issues to consider for long bone fractures: - Stability - Age, size and temperament of the horse - Fracture location and configuration - Compound fractures - Money

One of the most important issues with any fracture is the degree of stability present. Many upper limb fractures can have a high degree of stability despite having quite dramatic radiographic findings and this stability greatly assists the healing process. For such horses, despite presenting with severe lameness, attempts should be made to manage the case in the short term, using appropriate analgesics and confinement, until an accurate diagnosis and prognosis can be obtained. Unstable fractures generally present with severe distress and rapidly deteriorate so that the veterinarian has very little time for decision making or obtaining second opinions.

Stability is the most crucial aspect of any fracture repair process.

The age, size and temperament of the horse are also factors determining survival rates. Younger and smaller horses have a much better prognosis due to faster healing and importantly less weight on not only the fractured limb but also contralateral limbs.

Horses with a poor temperament are far less likely to tolerate longer term treatment, in particular full limb casting and slinging, which require a high degree of cooperation from the patient.

There is a great variety of potential fracture locations and configurations.

One advantage that upper limb fractures have over lower limb fractures is that many of them have far greater soft tissue support and protection.

While an extensive muscle covering may complicate surgical access it can also provide some stability.

The extensive soft tissue covering also means that less fractures become compound fractures. Unfortunately any compound fracture has a greatly decreased chance of survival due to the much higher risk of contamination and infection associated with open wounds, particularly if internal fixation is utilised. Bone has a poor blood supply at the best of times so that traumatised and contaminated bone becomes a haven for bacterial proliferation. Once infection becomes established in equine fractures then management and resolution can be extremely challenging, expensive and often unrewarding.

Unfortunately the finances of the owner are also a major contributing

factor to survival rates. There have been great advances in equine fracture management and repair however this can come at considerable cost with no guarantee of a successful outcome. Even those fees covered by equine insurance can be rapidly depleted so owners need to be fully advised on the potential costs before commencing any treatment and should be regularly updated.

Conservative treatment or surgery?

Conservative treatment has the benefit of greatly reduced costs compared to surgery as well as decreased complications. There are a few issues to consider.

Issues to consider with conservative treatment of fractures - All fractures want to heal - All fractures should eventually heal (in theory) - Horse may fail before fracture healing can occur - How long is it humane to continue treatment?

■

All fractures want to heal

The natural reaction to any trauma to bone is a response by the body to attempt to heal. This involves laying down new bone which firstly provides stability and then a more rigid repair.

■

All fractures should eventually heal

Given time in the right conditions all fractures would eventually, in theory, heal. The aim of conservative therapy is to maximise the potential to heal which is primarily achieved by minimising movement at the fracture site and ensuring no infection is present.

■

Horse may fails before fracture healing can occur

Unfortunately in equine patients is often the horse that fails first before the fracture can heal. This is a direct result of the size of the horse and the weight this often puts on contralateral limbs. The difficulty in achieving good stability at fracture sites is also a major complicating factor. The very high risk of laminitis in the contralateral limb must be stressed to owners and they should be advised that it can happen very suddenly and at any time during the treatment period, almost invariably with a fatal outcome.

■

How long is it humane to continue treatment?

The welfare of the horse must always be the first priority. Pain management of horses with upper limb fractures can often be difficult however the aim is that sufficient appropriate analgesia can be given to ensure the horse is sufficiently comfortable and coping with the degree of pain inevitably associated with fracture healing. If the horse continues to eat well, maintain adequate condition and appears bright it would seem reasonable to continue treatment. One of the first signs of the horse becoming more

comfortable with the fracture is that it will be able to lie down regularly.

Providing good flooring and bedding is essential as regular periods of recumbency can greatly relieve the stress on contralateral limbs. Concrete surfaces in stables, while very practical in many ways, may not be the best flooring for a horse recovering from a fracture. In my experience horses rarely exacerbate the fracture by getting up or down when they are ready to do so. Cross tying of horses to prevent them from lying down is often advocated as part of the conservative management of equine fractures. It is not something I recommend as I have found it to be of little or no value and may actually compromise the longer term outcome.

Surgery Surgery can potentially add tens of thousands of dollars to the treatment cost and is only really indicated in very select cases of upper limb fractures.

Surgical access is hindered by the soft tissue covering of the upper limbs while the structure and shape of the bones, which results in extreme and complex mechanical forces, are not conducive to successful internal fixation. The risk of sepsis, even in closed fractures, is incredibly high and can compromise the outcome despite technically excellent surgical repairs.

Sepsis can have a slow and insidious onset which results in a steady increase in costs mirrored by a steady decrease in prognosis for survival.

There have been good increases in fracture repair technology over the years, the latest being locking screw plates, as well as in anaesthesia and analgesic techniques, so that fractures that may not have been repairable previously may have a better prognosis today. Despite this surgical repair of upper limb fractures is a major challenge and not always the best option for some cases.

Surgery will usually greatly hasten the time taken for resolution of the problem, one way or another.

Scapula Fractures of the scapular are not common. Most often the supraglenoid tubercle is fractured resulting in a large loose and displaced fragment with an intra-articular component.

While several techniques are described for internal fixation of these fractures, they are better removed. The main difficulty with internal fixation is getting perfect alignment on the articular surface, which is incredibly difficult to do due to the size of the fragments and extensive soft tissue attachments as well is the poor surgical exposure.

Further screw placement and holding capacity is compromised by the size and location of the fracture and the structure of the scapular. Internal fixation has a high failure rate, high complication rate and a high incidence of long term DJD as the articular component is impossible to accurately align. It is not recommended.

If surgery is performed a large incision is made over the supraglenoid tubercle and sharp dissection continued for 10 cm or more down to the fragment. The fragment can be quite large, often 10 - 12cm in diameter.

NOVEMBER 2021 TheVeterinarian 15

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Clinical Review Removal can be difficult as access to the deeper portion of the fragment can be difficult and exposure is poor. Haemorrhage can be considerable. Despite these problems wound healing is usually satisfactory, although good closure is required and post op drainage allowed for. Even though the biceps brachii tendon is transected and the joint capsule and articular surface disrupted, these horses can be moderately useful. A racing career may be optimistic for all but the smaller fractures but a reasonable level of athletic activity may be successfully achieved.

There may be a long term cosmetic blemish (slight atrophy evident and a scar) and low grade residual lameness in some cases.

Slinging of horses can reduce the weight placed on the limbs and in theory should reduce the risk of contralateral laminitis. They do require constant supervision and intensive management as well as appropriate harnesses and support structures. Unfortunately there are insufficient good studies demonstrating the benefits of slinging enhancing the success rate of equine fracture repair.

Supraglenoid tubercle fractures of the scapula are usually best treated by removal rather than internal fixation.

Fracture of the neck and body of the scapular are less common. The muscle covering of the scapular can result in some fractures healing with conservative therapy. Unfortunately the scapular does move considerably which can delay healing and result in a non-union. Some fractures in appropriately sized horses can be stabilised using bone plates. However the scapular is quite weak at this point so fixation should only be considered in selected cases (i.e. appropriate size and sufficient bone proximal and distal to enable good screw fixation).

Neck fractures are not very amenable to surgery due to insufficient distal bone for fixation.

In selected cases sufficient stability may be provided by surrounding muscle to allow some form of healing. Complications would include post fracture swelling as well as complications relating to prolonged non-weight bearing on the leg.

Humerus (Mid body shaft) The best thing to do for a horse with humeral fractures is to keep them away from a surgeon.

There are various heroic descriptions of internal fixation where the horse miraculously survived.

However horses with these fractures stand a better chance of survival if left alone. The humerus is not a good candidate for internal fixation given its shape, structure and location.

In younger foals the bone is too weak to support screws while in older horses they are too heavy to support implants resulting in catastrophic breakdown in recovery. The exposure is poor so there is a high incidence of post-op infection.

Left alone all humeral fractures want to heal, even if they appear severely displaced. Younger horses will heal quite quickly. Affected horses can go on to lead an athletic career.

The best thing to do for a horse with humeral fractures is to keep them away from a surgeon. Left alone all humeral fractures want to heal providing the good leg holds together and the pain can be managed

The main complications relate to pain control and non-weight bearing. Some horses will not tolerate the pain and require euthanasia however most will get used to the pain and cope quite well. The size and age of the horse are important factors with larger, older horses more likely to have slower healing and more complications.

Once a horse starts to lie down for long periods it is a positive sign as the horse feels capable and confident of getting up and down. Prolonged recumbency should be encouraged. There is no simple means of controlling pain, with PBZ still being the most effective medication. Most horses will be non-weight bearing for about 6-8 weeks.

This seems to be a reasonably consistent time period. After this time there is usually some improvement as the fracture has stabilised.

Often within weeks after this the horse will be taking full weight on the leg. If the horse and www.theveterinarian.com.au

Displaced supraglenoid tubercle fracture.

Internal fixation is very challenging and usually unrewarding

Slinging a horse with a humeral fracture.

These cases require excellent nursing care and pain management

Access is limited due to the extensive soft tissue covering

Large fragments can be removed resulting in freedom from lameness

owner can get through the initial 6-8 week period the long term prognosis is reasonable.

Many owners get frustrated at the apparent lack of progress in the initial 6-8 week period.

It is important to reassure them not to expect anything for this time followed by a relatively rapid improvement if appropriate healing is taking place.

Complications relate to a long period of nonweight bearing. In the affected leg contracted tendons can develop, particularly in young horses. There is no way of preventing this but hopefully the problem will improve once weight bearing commences. Surgery may be required in severe cases of tendon contraction.

In the opposing leg laminitis is a constant risk, the development of which usually has a fatal outcome. The other problem, primarily in younger horses, is the development of ligament laxity or stretching, particularly about the carpus, which results in hyperextension. This can also be severe enough to be life threatening. Support bandages may help in the short term, but the problem can only be resolved effectively once weight bearing occurs in the fractured leg.

Humerus - proximal growth plate These are not uncommon in young horses.

Horses present with severe lameness which can be difficult to localise. Initial radiographs may appear unremarkable but careful evaluation may reveal slight mal-alignment of the humeral head.

After several weeks sclerosis and new bone formation will be clearly evident radiographically.

Providing there is not too much displacement, which is usually the case, the prognosis can be quite good.

These often do not become completely displaced. This fracture will heal. Good weight bearing will take approximately 6 weeks from the time of injury. Up until that point the horse will be non-weight bearing lame. One of the biggest complications of these fractures, particularly in young horses, is tendon contraction in the affected leg and collapse of the weight bearing leg. Once stability is achieved affected horses usually make rapid progress.

Proximal humeral growth plate fracture NOVEMBER 2021 TheVeterinarian 17

Clinical Review Humeral - stress fractures These can be an intermittent cause of severe lameness and can be difficult to localise. Any horse with recurrent severe lameness after exercise that resolves quite quickly and that cannot be localised to other sites should be suspected of having a stress fracture, often being the humerus. They can progress to full fracture with continued work. There is data to suggest that most if not all catastrophic humeral shaft fractures occur secondarily to pre-existing stress fractures.

Accurate diagnosis is best achieved by scintigraphy but can also be detected by radiographs once sclerosis and new bone formation occur.

Prognosis is good if the fracture has a chance to heal.

Olecranon fractures Most olecranon fractures benefit from internal fixation, even those that are not intra-articular.

If good stabilisation can be achieved there is rapid healing of the fracture and early return to full weight bearing (within days of surgery).

However the incidence of complications following olecranon surgery is grossly underestimated and under-described in every equine text. When they go well they go very well, when they go badly they are usually a disaster. There is a multitude of different combinations and permutations in regard to olecranon fractures so that each case must be assessed individually.

Classic dropped elbow in an olecranon fracture. These should not be confused with radial nerve paralysis

There is often severe soft tissue trauma associated with olecranon fractures

Many olecranon fractures are compound.

Despite this good healing can be achieved due to the stability that internal fixation can provide

Radius Fractures of the radius can be a major problem.

Proximal radial growth plate fractures are best stabilised by plate fixation down the caudal aspect of the radius and ulna. It is usually possible to get one screw in the epiphyses, several screws in the proximal portion of the olecranon then 6-8 in the radius. Alignment of the fracture can at times be difficult but usually sufficient apposition can be achieved to result in good stability and subsequent fracture healing. If very good alignment is achieved then good long term athletic activity can be expected.

Displaced mid-body radius fractures have a very poor prognosis and except in lighter horses and foals are not generally considered candidates for surgical repair

Displaced mid-body radius fractures have a very poor prognosis. Unless the horse is small (less than 250-350 kg) repair is usually not successful.

Conservative treatment is usually not successful due to the lack of soft tissue or muscular support and the inability to provide external support, such as a cast. Double plate fixation can be successful in smaller or younger horses but has a very high complication rate, in particular catastrophic breakdown on recovery and longer term infection even if the horse does stand up successfully.

Intra-articular olecranon fracture Radius fracture in a 9 mth old TB

Tension band plating on the caudal aspect of the olecranon provides good mechanical support and stability

Dropped elbow and reluctance and inability to properly weight bear

18

TheVeterinarian NOVEMBER 2021

Olecranon fractures should be repaired as soon as possible as flexor contracture can rapidly develop and greatly compromise the outcome, particularly in younger horses

It is a race between implant failure and fracture repair in this case. The use of locking plates today has decreased the risk of screw loosening as is occurring here

■ www.theveterinarian.com.au

Clinical Review A common fracture of the radius, which results in severe lameness, are non-displaced or minimally displaced fractures. These may not immediately be clearly apparent radiographically and are often accompanied by an open wound or evidence of direct trauma. Once these fractures are identified radiographically they can look very dramatic, often with multiple fracture lines that appear to be many millimetres apart. These horses may initially be non-weight bearing lame. However if the fracture pieces are even vaguely in the same area and there is no obvious gross instability of the limb, then conservative treatment is indicated.

Such fractures will heal quite quickly and the horse will resume limited weight bearing more quickly than might be expected.

Some of these horses may also have concurrent wounds or sequestration. These need to be managed under local anaesthesia if needed.

Otherwise they should be treated conservatively until fracture repair has been sufficient to allow a GA. This may be 3-4 months following injury.

The outcome for such fractures, despite their often dramatic appearance both clinically and radiographically, can be very good.

Minimally displaced radius fracture extending into the carpal joint. The horse was grade 2/5 lame. Clearly the fracture has been present for at least 4-6 weeks before diagnosis

Despite suspecting a radial stress fracture it was four weeks before it could be clearly seen

These Salter-Harris type fractures can have a good prognosis if treated conservatively

At follow up at 3 mths the extensive callous more proximal in the radius indicated the fracture was more complex than could be originally diagnosed. The horse made a full recovery

www.theveterinarian.com.au

There had been considerable purulent discharge from a wound associated with this fracture. The radiographic and clinical findings were highly suggestive of a sequestrum forming. This can only be treated once the fracture has resolved unless it is removed standing-which is not encouraged

Foal lame for at least 4-6 weeks. Referred for lameness evaluation. Tendon contracture in the affected leg is the biggest issue, more so than contralateral laminitis, in this case

NOVEMBER 2021 TheVeterinarian 19

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Clinical Review

Healing Salter-Harris proximal radius fracture.

These often heal well due to excellent blood supply to growth plate and the cell types present at this location. This case could be successfully treated conservatively due to the age and size of the horse, fracture configuration (minimally displaced and sufficient stability)

The filly made a full recovery from the fracture but..

Displaced and unstable distal radius fracture in a yearling Arab

Femoral fracture Proximal and mid-shaft femoral fractures are not meant to be surgical cases. As with humoral fractures most will heal if the horse can survive long enough. The muscle mass about the femur can be sufficient to stabilise the fracture. This fracture can be extremely painful and many horses will not be able to cope. Severe anxiety, sweating, not eating, non-weight bearing and an inability or reluctance to move at all are indications that euthanasia is required.

If the horse tolerates the pain, then healing can begin to occur in 6-8 weeks, depending on the age and size of the horse. Again, little progress will be made in the first 6 to 8 weeks followed by more rapid progress. Older horses may take longer. Complications of such fractures are severe haematoma formation, the haemorrhage involved sometimes can be so severe as to be fatal.

Laminitis in the opposing leg is a continual problem.

Distal femoral fractures, particularly involving the growth plate are usually poor candidates for treatment. They are usually too unstable making the horse very distressed. Reduction of displaced growth plate fractures is extremely difficult, if not impossible. The overriding caused by muscle tension usually cannot be overcome to allow adequate reduction. These are very poor to hopeless candidates, irrespective of what treatment is used.

Treated with carpal arthrodesis

Femoral head dislocation Although not a fracture, dislocation of the femoral head can present as an acute onset of severe lameness that may be confused with a fracture of the femur. There are several differences in the clinical appearance. Firstly fractures of the femur are usually excruciatingly painful, far more so than a dislocated femoral head.

A dislocation also improves quite quickly and can present as a chronic lameness. Secondly many horses with a dislocation will bear some weight initially and again this can rapidly improve. Characteristically they will stand with the toe of the affected leg turned out quite noticeably. Conservative therapy carries a poor prognosis while successful surgical reduction and stabilisation has proved elusive in horses.

The best option is a femoral head resection, which is relatively straight forward to perform.

The best results are in smaller horses and ponies although I have not yet attempted the procedure in a horse above 400kg.

Proximal and mid-shaft fractures are not meant to be surgical cases. Most will heal if the horse can survive long enough, although pain and haemorrhage can be a real problem

Succumbed to chronic laminitis nearly 2 years post-op. A venogram demostrates lack of blood supply to dorsal lamina www.theveterinarian.com.au

Distal femoral growth plate fractures usually have a very poor prognosis unless minimally displaced

Characteristic stance of a horse with a femoral head dislocation

NOVEMBER 2021 TheVeterinarian 21

Clinical Review Tibial fractures Tibial Stress fractures These are known to have a higher incidence in young racing horses, particularly TBs. The history can often be one of intermittent lameness, often being very severe for a short time after fast exercise but making a rapid improvement to the point of not being obviously lame. Many of these horses continue in training despite these fractures, which is why by the time a diagnosis is made and radiographs taken there is often evidence of chronic new bone formation. It is also possible for the horse to suffer from complete breakdown of the tibia either during fast exercise or even recovering from anaesthesia.

The best treatment is rest with return to exercise once the repair process has been completed.

This can take 3-6 mths.

Displaced Tibial Fractures Displaced tibial fractures are possibly the worst fractures to have in a horse. They are grossly unstable are there are virtually no successful treatment options. Biomechanically it is a very poor candidate for plating except in the smaller horse. If the fracture is very distal, internal fixation or trans-fixation pins may provide some hope. The prognosis is pretty guarded to absolutely hopeless.

Displaced tibial fractures are possibly the worst fractures to have in a horse.

They are grossly unstable are there are virtually no successful treatment options

Very turned out right hind leg

Radiographs can be obtained standing, even in larger horses

Non displaced distal tibia fractures can heal with conservative therapy

Despite the muscle covering good visualisation of the femoral head can be obtained. A single firm blow with an osteotome and heavy hammer is usually sufficient to shear the femoral neck

Post operative appearance

22

TheVeterinarian NOVEMBER 2021

Severe fracture of the distal tibia. Surgical repair is extremely difficult if not impossible and invariably unrewarding

The removed femoral head. The round ligament is invariably torn making surgical access easier

■ www.theveterinarian.com.au

Clinical Review

Wound just distal to top of tibia

Yearling with fracture of proximal tibial growth plate

Fractured tibia. This occurred during recovery from anaesthesia

Following preparation for surgery

Radiographs indicate a displaced fracture of the tibial crest

Radiograph of horse above

This is the tibia at left dissected out. These are poor candidates for surgical repair (particularly now)

Tibial crest fractures Care must be taken not to confuse the normal appearance of the proximal cranial tibia with a fracture. Many tibial crest fractures are not intra-articular or are minimally displaced so that conservative treatment can be effective.

Displaced fractures, particularly with an intraarticular component, can be treated surgically with tension band plating.

Fracture repair using a T plate. T plates are generally too thin for routine equine use and need to be supported by additional plates www.theveterinarian.com.au

Acute onset lameness following direct trauma to stifle

Note extent of displacement, the forceps are holding the end of the fragment

Post-operative view NOVEMBER 2021 TheVeterinarian 23

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Advertorial

Does the term ‘Dietary Elimination Trial’ send chills up your spine?

Dietary elimination trials (DET) are commonly discussed in clinical environments with our client base as best practice1 to diagnose Cutaneous Adverse Food Reactions (CAFRs)2 or Food-Induced Atopic Dermatitis (FIAD)3 in dogs and cats. However, have you considered DETs are a diagnostic test that we rely completely on the client to perform and interpret the results allowing us to determine a diagnosis? Additionally, this is one of the longest diagnostic assessments for a condition, typically spanning eight to twelve weeks, in order to accurately diagnose 90 per cent of cases (Figure 1 & 2)2. Combine these two factors, and it is no wonder that many of us have an overwhelming feeling of anxiety when we see an itchy patient in our appointment schedule for the day.

With all of that in mind we can clearly see why the main reason for failings in a DET either in general practice or referral would boil down to client compliance. So how do we set them up for success in managing this complex process in order to be the best patient advocates that we can be as veterinarians? The reality is that it isn’t captured within a fifteen-minute consultation period and will require a team effort from the practice with plenty of follow up and communication. Two-way communication and collaboration is essential in obtaining the most valid data set for interpretation which will lead to a final diagnosis (Figure 3).

Figure 1. Cumulative percentages of clinical remission in 209 dogs with CAFRs over time (in weeks)2 SOURCE FILE: Critically appraised topic on adverse food reactions of companion animals (1): duration of elimination diets | BMC Veterinary Research | Full Text (biomedcentral.com)

Figure 2. Cumulative percentages of clinical remission in 40 cats with CAFRs over time (in weeks)2 SOURCE FILE: Critically appraised topic on adverse food reactions of companion animals (1): duration of elimination diets | BMC Veterinary Research | Full Text (biomedcentral.com)

Figure 3. Recommended Key Communication Points for Dietary Elimination Trial Patients

• Pre-appointment comprehensive dietary and clinical history questionnaire • 1-week check to ensure transition of diet went well • Reminder this is when the feeding trial commences • 3-weeks to check on compliance and answer any questions • 5-weeks re-check appointment to assess if any additional management interventions are required • 7-weeks to continue compliance and answer any questions and book re-check • 9-weeks re-check appointment to consider results and start challenge • 10-weeks to check in and ensure no clinical signs have appeared with the challenge diet • 11-weeks recheck appointment to consider results and settle on a diagnosis of food related disease or not, and longterm management options

www.theveterinarian.com.au

Taking one step back, what is required for a DET? The most important piece of information, again relying on the pet owner, is a full and detailed history of all proteins that the pet has likely been exposed to. This can be by means of primary diet (i.e., commercial pet foods), as well as treats (including table-scraps), medications and supplements to build a complete data base of the different meat and carbohydrate-based proteins that the patient has consumed throughout its life. This is complicated for pets feeding commercial diets as most commercial pet foods will contain a mix of protein sources leading to multiple exposures within a single diet4.

Ideally to manage a DET, a diet would be formulated for that individual patient avoiding all these protein sources, and therefore identifying a ‘novel’ protein diet5 for that patient. This is where the concept of ‘home-cooked’ diets was founded for DETs. By individualising the elimination diet to that

patient, we achieve the best chance to determine the trigger for that individual. The other approach is to use hydrolysed proteins, ideally less than 10kDa in size2. These can be novel or ones that the patient might have previously been exposed to in order to reduce the chance of an allergenic response to those proteins. Hydrolysed diets have been produced by commercial pet food operators for many years using commonly known allergic proteins like chicken or beef6, or more uncommon sources of allergens like soy. More recent innovations, and gold standard, with extensively hydrolysed proteins using even more unique sources like feather protein hydrolysate (Royal Canin ANALLERGENIC) where 95 per cent of the protein composition for the diet is <1kDa in size, and 88 per cent is free amino acids, further reducing risk of immunologic reactions to the trial diet.

How do we then convey what is best for our patients to the pet owners?

As a reminder, the outcomes rely completely on client compliance.

Therefore placing ourselves in their shoes is important for the overall result for that patient.

The absolute best practice for the patient from the diagnostic standpoint would be an individualised, complete and balanced novel protein home-made diet. The reality is, however, that this is more complicated than it sounds. A 2013 study demonstrated that home-made diets for maintenance (not with an added complexity of novel proteins and ingredients) were more often than not ‘unbalanced’ or ‘incomplete’ by AAFCO and NRC guidelines. Of the 200 recipes evaluated, 95 per cent had at least one nutrient not meeting the appropriate guidelines, and 85 per cent with 2 or more7. Of the 5 per cent that were appropriately complete and balanced, these were all formulated by veterinary nutritionists, and the reason it is best practice to enlist their support when formulating a novel home-cooked diet for DET. NOVEMBER 2021 TheVeterinarian 25

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This all sounds great right? But how practical is it again for the pet owner who is at the centre for success with this diagnostic test?

There are limited veterinary nutrition referral sources around the globe, and even more so within the Asia-Pacific region. Majority of these services are based at Veterinary Universities where boarded Veterinary Nutritionists are employed. The cost for a digital nutrition consult for a home-cooked elimination diet will range anywhere from $230AUD – $630AUD at cost (not including any potential mark-up for these services) to get one or two recipes.

Home-made diets have proved problematic at times for palatability8, and commonly multiple additional recipes might be required at further costs averaging an additional $215AUD per recipe. This is just for obtaining the recipe itself.

The requirement then is to follow through with the formulation, purchase the ingredients and have owners commit to daily food preparation for the patient. Majority of the formulated diets will utilise the only nutritionist developed vitamin and mineral supplement for cats and dogs from a company called BallanceIT© out of the USA. This therefore requires importing these supplements for the recipes, as well as purchasing locally several additional sources of essential fatty acids and micronutrients. A recent formula that I assisted a clinic with obtaining required an outlay cost of $400AUD per month for ingredients, working out at $13.25AUD per day for the ingredients alone. These costs currently match previous evaluations in the UK finding on average it cost 3.60€ more per day for a home-cooked diet compared to an extensively hydrolysed elimination diet like ROYAL CANIN® Anallergenic9 (Figure 4).

Circling back to the purpose of a DET and the reliance on pet owners for a complete, consistent approach during the elimination phase, this begins to shed light on the pressures that we place on our clients. While this would be a gold standard approach, we need to ask is it practical? How likely are we to achieve a diagnostic data set at the end of this trial period?

And is it sustainable for the pet owner?

There is an unspoken fear of using commercial DET products in the veterinary community.

Some are founded, however others have been extrapolated from human medicine without an evidence based assessment. For example, there is a demonstrated connection in human medicine in which food additives have been attributed to food reactions, however this hasn’t been established as a definitive link in cats and dogs10.

A more appropriate concern we should consider is how do we confirm that what is prescribed for your patients is exactly what it says it is?

Some studies have found that up to 75 per cent of commercial diets, primarily non-prescription diets, have found discrepancies between protein declaration on pack compared to protein analysis11 on those products. This indicates 26 TheVeterinarian NOVEMBER 2021

risk of cross contamination in these products, and a potential to lead to a false-positive reaction. This is reasonable when we consider the financial investment required to have dedicated processing lines, stringent cleaning and decontamination procedures as well as release criteria like a negative ancillary protein PCR test on every batch produced. These are the criteria needed to be met for the distribution for the ROYAL CANIN® Anallergenic diet with dedicated research ensuring the absence of cross-contaminating proteins12. This presents another opportunity for discussion with your pet owners about the importance of acquiring a reliable source of food for the DET to prevent the risk of undeclared ingredients that could lead to a failed elimination trial.

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

■ DR. COREY REGNERUS-KELL BVSc, BSc Royal Canin Australia & New Zealand Scientific Services Veterinarian References 1. Mandigers, P. J., Biourge, V., van den Ingh, T. S., Ankringa, N., & German, A. J. (2010). A randomized, open-label, positively-controlled field trial of a hydrolyzed protein diet in dogs with chronic small bowel enteropathy. Journal of Veterinary Internal Medicine(24), 1350-1357. doi:10.1111/j.1939-1676.2010.0632.x 2. Biourge, V. C., Fontaine, J., & Vroom, M. W. (2004). Diagnosis of Adverse Reactions to Food in Dogs: Efficacy of a Soy-Isolate Hydrolyzate-Based Die. The Journal of Nutrition, 134(8), 2062S-2063S. doi:https://doi.org/10.

1093/jn/134.8.2062S 3. Cadiergues, M. C., Muller, A., Bensignor, E., Heripret, D., Yaguiyan-Colliard, L., & Mougeot, I. (2015). Cost evaluation of home-cooked and an extensively hydrolyzed diets during an elimination trial: a randomized prospective study.

Veterinary Dermatology(32), 302.

4. Guilford, W. G. (1996). Adverse reactions to food. In W. G. Guilford, S. A. Center, D. R. Strombeck, D. A. Williams, & D. J. Meyer,

Strombeck’s Small Animal Gsatroenterology (pp. 436450). Philadelphia, PA: W.B. Saunders.

5. Horvath-Ungerboeck, C., Widmann, K., & Handl, S. (2017). Detection of DNA from undeclared animal species in commercial elimination diets for dogs using PCR. Veterinary Dermatology, 28(86), 373.

6. Lesponne, I., Naar, J., Planchon, S., Serchi, T., & Montano, M. (2018). DNA and protein analysis to confirm absence of cross-contamination and support the clinical relaibility of extensively hydrolysed diets for adverse food reaction-pets.

Journal of Veterinary Science, 5(3), 63. doi:https://dx.doi.org/10.3390%2Fvetsci5030063 7. Mueller, R. S., Olivry, T., & Prelaud, P. (2016).

Critically appraised topic on adverse food reactions of companion animals (2): common food allergen sources in dogs and cats. BMC Veterinary Research, 12(9). doi:https://doi.org/10.1186/s 12917-016-0633-8 8. Olivry, T., Mueller, R. S., & Prelaud, P. (2015).

Critically appraised topic on adverse food reactions of companion animals (1): duration of elimination diets. BMC Veterinary Research(11), 225. doi:https://doi.org/10.1186/s12917-0150541-3 9. Rosser, E. J. (2013). Diagnostic work-up of food hypersensitivity. In C. Noli, A. Foster, & W. Rosenkrantz, Veterinary Allergy (pp. 119-123).

Oxford, UK: John Wiley & Sons.

10. Stockman, J., Fascetti, A., Kass, P. H., & Larsen, J. A. (2013). Evaluation of recipes of home-prepared maintenance diets for dogs.

Jounal of American Veterinary Medical Association, 242(11), 1500-1505. doi:10.2460/javma.242.11.

1500 11. Tapp, T., Griffin, C., Rosenkrantz, W., Muse, R., & Boord, m. (2002). Comparison of a commercial limited-antigen diet versus homeprepared diets in the diagnosis of canine adverse food reaction. Veterinary Therapeutics, 3(3), 244-251.

12. Verlinden, A., Hesta, M., Millet, S., & Janssens, G. P. (2006). Food Allergy in Dogs and Cats: A Review. Critical Reviews in Food Science and Nutrition, 46(3), 259-273. doi:10.1080/ 10408390591001117 Footnotes 1 (Verlinden, Hesta, Millet, & Janssens, 2006) 2 (Olivry, Mueller, & Prelaud, 2015) 3 (Rosser, 2013) 4 (Mandigers, Biourge, van den Ingh, Ankringa, & German, 2010) 5 (Biourge, Fontaine, & Vroom, 2004) 6 (Mueller, Olivry, & Prelaud, 2016) 7 (Stockman, Fascetti, Kass, & Larsen, 2013) 8 (Tapp, Griffin, Rosenkrantz, Muse, & Boord, 2002) 9 (Cadiergues, et al., 2015) 10 (Guilford, 1996) 11 (Horvath-Ungerboeck, Widmann, & Handl, 2017) 12 (Lesponne, Naar, Planchon, Serchi, & Montano, 2018) ■ www.theveterinarian.com.au

The Veterinarian Product Review

Advanced Ultrasound Imaging With The Vetus E7 BCF Ultrasound is proud to present the all new Vetus E7 from Mindray - the first ever portable ultrasound system powered by the new cuttingedge Zone Sonography Technology (ZST+) platform and featuring the iScanHelper, a unique smart scanning assistant.

Since its founding, Mindray Animal Medical has been dedicated to developing innovative and accessible ultrasound solutions for the animal care environment. It is this commitment to excellence that has now brought you Zone Sonography Technology (ZST+), evolving industrial designs and comprehensive multi-species ultrasound imaging solutions.

Smart features include: ■

Dedicated animal imaging presets.

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Sealed and waterproof keyboard.

■

LED touch screen for easy workflow with a large LED screen making image viewing easy while scanning.

■

A Large 128 Gb capacity steady state hard drive.

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A 90-minute battery scan time that can be extended to 8 hours with the Ubank add on portable battery.

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Magnesium alloy body -- durable and sleek, equally at home in the field or in a modern veterinary hospital setting.

iScanHelper: The Vetus E7 also features the unique iScanHelper, a built-in tutorial software providing real time, easy access to reference images and technical ultrasound tips while you scan.

A great tool for both beginner or experienced professionals.

Features include: With a large range of transducer options (including multiple phased array cardiac probes), this system can accommodate all animal species, from large horses to tiny reptiles (and cats and dogs in between). Included in the system is a Shared Service Package which allows imaging options for abdomen, cardiac, small parts, vascular and reproduction work.

■

Anatomical diagram illustrations with annotations, transposed on actual ultrasound images.

■

Standard sonogram comparison with real-time scanning.

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Scanning reference picture demonstrating appropriate patient position & probe placement.

Available in both a Basic and an Advanced configuration with standard features in both including Colour Doppler, Power Doppler, Pulse Wave Doppler as well as iNeedle (for needle visualization enhancement) and iScape View (real time Panoramic Imaging).

The Vetus E7 Advanced also includes advanced cardiac software, such as Continuous Wave Doppler (CWD), Tissue Doppler Imaging (TVI, TEI, TVD, TVM), Tissue Tracking with Quantitative Analysis, Automatic Ejection Fraction Measurement and Free Xros M (Anatomical M-mode).

The revolutionary, software-based beamformer technology, ZST+, ensures the Vetus E7 System combines best-in-class image quality with an intuitive user experience to help ensure reliable and efficient diagnosis during the most challenging exams in the most challenging of patients. It allows for finer image detail at faster frame rates, better and deeper penetration and eliminates the need for focal zones by producing a completely focused image on screen.

The Vetus E7 is a next generation portable ultrasound machine that is packed with advanced features previously only seen in advanced cart based systems. Packaged with a simple workflow, dedicated design and complete veterinary solution, the Vetus E7 is the ideal ultrasound system for your everyday practice.

For more information on the Vetus E7 go to https://www.bcfultrasound.com/product/vetus-e7-mindray/ or contact us sales@bcfultrasound.com +61 3 9874 7543

www.theveterinarian.com.au

NOVEMBER 2021

TheVeterinarian

27

The next generation in canine osteoarthritis pain relief is here

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

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

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

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

BUSINESS

Business Agility Part 1: Your Clients Remaining agile is a key tactic for success in any business. The external and internal forces that impact our businesses are ever present and constantly changing. As such, it’s become a necessity to have a scaffold for change management within any business strategy.

Failing to prepare for change, or to embrace change will ultimately result in poor business performance.

We know that change is here to stay, but how can we identify it early? How can we prepare for it? How do we manage it?

While we all know the market or industry we work in, how proactive are we with our ongoing research and understanding of the space?

There are specific areas that you can look at to get a better understanding of your market, and I have provided some examples below to help guide you.

Using these four key stakeholders, we will cover some basic market research tactics over four articles.

■ ■ ■ ■

Client Your industry (and associated governing/ regulatory bodies) Your suppliers Your community

This month, weíll delve into how we can best serve our clients by being agile and adaptable.

Your clients You can understand what your client wants through analyzing their purchasing behavior, client surveys, and requesting specific feedback on their experience. However, we don’t often delve much deeper than what our client wants in the immediate term.

So that we can be prepared for the client’s future needs, it’s essential that we try and pre-empt what these needs may be. Preparing for their future demands will not only place your business in the prime position to be their first-choice provider; but it also helps strengthen the bond between you and the client.

Identify their future needs As an expert in your field, you are most likely best positioned to know what your clients may need in six months, 12 months, or two years!

However, it’s also useful to look for trends in the way they are engaging with your services.

As an example, let’s look at the engagement of a new client and their new puppy with your practice. We’re using a micro example here, but in reality, you will need to apply this to your client group.

A new pet parent will likely come with many questions on that initial appointment -- and you are all very familiar with these appointments and what your clients and patients need (so I won’t go into detail here!) However, let’s look at how and why they engage with us: ■

How did they initially engage with your business e.g., online booking or phone call?

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How do they like to receive information e.g., SMS reminder or phone calls?

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What additional (non-clinical) information have they requested e.g., puppy school

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Why did they seek your service above others e.g., location, reputation, referral?

Answering these questions can help you preempt their future needs. For example, if they initially connected with your business through an online booking app, and they prefer to receive SMS or email reminders, digital

■ www.theveterinarian.com.au

communication will likely be an important part of your service for them. Appreciating this, consider what other ways you can engage with them via this medium, and how you can make it easier for them to work with you.

As mentioned above, we’re using a micro example here. However, you will need to apply this same analysis to your entire client base to determine what the majority of your clients are likely going to need from you in the future.

Preparing for change Agility is a skill that needs practice. As individuals we react to change in our own unique way, and we often improve our reactions to change as we get more experience with it. As a leader or business owner, you will be the driver of any required change in your business. So how can you prepare yourself, your team, and your business for change?

■ Understanding what is likely to change As we have just discussed, identifying what your clients’ future needs may be is key in preparing for change, and ensuring your business will remain agile in the future.

■ Research Once you have identified what you need to prepare for, start researching. Look into what the operational requirements are, the costs, any impact to services or lost time as a result of implementing a change.

■ Consolidate your research and plan Summarize and prioritize your findings. Detail timelines and estimated costs. Don’t forget to include any additional revenue or profit growth which may be associated with these changes.

■ Communicate your findings With a clear plan (including your key actions prioritized), communicate to your team and stakeholders. Outline your expectations and assign tasks and responsibilities as appropriate.

Remember that you don’t have to do this preparation alone. Lean on other senior stakeholders and share the jobs. Seek a variety of opinions and insights during this phase.

This is a preparation phase -- it may be 6 months or 12 months before you begin any change process. However, preparing is key to remaining nimble in a fast-moving industry.

Managing change There are many wonderful books and articles about change management, and it’s easy to get lost down rabbit holes in this topic. To stay on topic, we shall stick within the context of this article. Specifically, let’s look at how agility can be achieved and sustained through effective change management.

■ Building a positive change culture Creating a culture of agility and adaptability starts well before we identify the future needs of our clients. Before we can commence on the change journey, we need to foster a positive attitude towards change within our teams.

Once this foundation is laid, you can build strategies and coping mechanisms to help support the change process; and in addition, build resilience and flexibility within your team. There are many articles and books on managing teams through change and building resilience. I strongly encourage you to review a few of these before proceeding with any large change projects.

■ Resilience in your business Believe it or not, not all plans work out as intended! You will need to ensure your business is operationally and financially resilient to withstand any negative impacts that internal or external changes may have on your business.

To some extent this requires having an adequate cash flow and savings to cover you for any lost time, or potential loss in revenue.

Operationally, you should ensure your processes and teams are able to adjust quickly to any unexpected changes.

Being agile requires constant review of your operational practices and remaining open to changing if it is in the best interest of your client, team and business. Businesses often have great success initially but may stagnate after some time. This can be because there has not been a proactive approach to reviewing operational changes and looking out for potential changes required.

Next month we’ll discuss how you best prepare your business for any changes related to industry trends or demands. For more information you can reach me via email info@graycounsel.com. You’re also welcome to send through any requests for specific article topics to the same email address. I’ll do my best to accommodate your requests.

Michelle Gray My journey into the veterinary industry began with nursing.

Now, many years later, I am privileged to lead multidisciplinary teams across Australia. I have worked in leadership roles within universities, corporate human health care, and media industries in addition to my work in the veterinary field. I have an MBA (research) and am on my way to commencing a PhD next year in veterinary business and not-forprofit industry. When I’m not working my day job, I also support small business through my consulting firm Gray Counsel. Email me at info@graycounsel.com

NOVEMBER 2021 TheVeterinarian 29

News Vet Ethics From page 9

Vaccine rollout for koalas From page 1

Project collaborators and partners have included both the Queensland and NSW state governments, the federal government, wildlife hospitals, the RSPCA, Lone Pine Koala

Sanctuary, and CSIRO Manufacturing, with support and donations coming from individuals, community and carer groups, and overseas partners.

Donations to the research can be made at www.usc.edu.au/koala.

■ ANNE LAYTON-BENNETT

COVID-19 linked to heart disease in cats and dogs From page 1

Free online emergency animal disease training From page 1

The package includes six self-paced interactive case studies, each taking approximately 30 minutes to complete and featuring a variety of species including horses, backyard chooks and a dog.

This continuing education package was collaboratively developed with contributions from all of the Australian veterinary schools, IT partner Epi-Interactive and members of the veterinary profession. Funding from the Australian Government’s Agricultural Competitiveness White Paper – the Government’s plan for stronger farmer and a stronger economy – and the Australian Biosecurity Response Reform Program has ensured this valuable resource is freely available to the veterinary profession.

To brush up on emergency animal disease management, please visit eadonline.com.au.

on a rectal swab, and two other cats and a dog displayed antibodies two to six weeks after they developed signs of cardiac disease.

Lead author Luca Ferasin, TRVRC’s Head of Cardiology said while the study reported the first cases of cats and dogs affected by the COVID-19 alpha variant, it also highlighted the risk that companion animals could also become infected.

“We also reported the atypical clinical manifestations characterised by severe heart abnormalities, which is a well-recognised complication in people affected

by COVID-19 but has never described in pets before.

However, COVID-19 infection in pets remains a relatively rare condition, and based on our observations, it seems that the transmission occurs from humans to pets, rather than vice versa,” Ferasin said.

All affected animals made a ‘remarkable improvement’ with cage rest, oxygen therapy, acute diuresis and, in some cases, antiarrhythmic therapy with sotalol and fish oil supplementation before being discharged on oral medications after a few days of intensive care.

■ ANNE LAYTON-BENNETT

Abattoir cruelty footage shocking but ‘unsurprising’ From page 3

“The only encouraging aspect is that there is now stunning in so many more Indonesian abattoirs,” she said.

However, Foster added that there is a dispiriting lack of desire from the industry to effect change.

“Change only occurs after activists expose a well-known problem; think Awassi Express where industry representatives, shipboard vets, stockpersons and the department all knew it happened and even filled out or received the appropriate shipboard reports but none did anything,” she said.

“None tried to change it or prevent it or suggest that it be reviewed and it took a horrified Pakistani sailor to raise the alarm bells.”

30 TheVeterinarian NOVEMBER 2021

The Department of Agriculture, Water and the Environment (DAWE) received a report from PETA Asia alleging breaches relating to the non-compliant handling and slaughter of Australian cattle in approved ESCAS abattoirs in April and May. A DAWE spokesperson told The Veterinarian that an investigation was commenced on receipt of the report and is ongoing.

“Since July, the department has required exporters to introduce corrective procedures to prevent reoccurrence and has applied a higher level of auditing oversight to the implicated facilities,” the spokesperson said.

■ SAM WORRAD

Another type of interdependence is what they call “inter-being.” Interbeing relates to the way humans are ecologically embedded in webs of relations amongst various other species.

Appreciating this could lead to reconceptualizing our place in the world.

Some kinds of environmental ethics could give us this view. So too, say the authors, could non-Western views such as “African, Asian, South American, and a multitude of indigenous ethical views.” Obviously, teaching elements of these other ethical views, which are sometimes at odds with Western ideas about humans and the natural world, would be a significant alteration to veterinary curricula.

Finally, Nieuwland and Meijboom suggest that veterinary ethics teaching could be more “contemplative,” as they put it. In their own teaching of vet ethics, for example, they have had learning activities where students developed food recipes and considered their environmental impact. Their students have also visited farm animal sanctuaries, where they interacted with the animals and were invited to reflect in a less abstract way than in the classroom on “what makes an animal’s life good.” *Nieuwland, J., & Meijboom, F. L. (2020). One health: How interdependence enriches veterinary ethics education. Animals, 10(1),13.

Abstracts - horse abortion From page 12 3Equine Specialist

Consulting, Scone, New South Wales, 2337, Australia.

TheVeterinarian Sydney Magazine Publishers Pty Ltd ACN 102752787 ISSN 1447-9768 PO Box 305 Millthorpe NSW 2798 Tel: 02 9487 6627 Director - Clem Martin Email: clem.martin@vetmag.com.au Editorial Advisory Board Thomas Donnelly BVSc DipVP DipACLAM Nicholas Kannegieter BVSc DipVetClinStud PhD FACVSc David Lidbetter BVSc MVS FACVSc DipECVS Dip ACVS Angus Martin BVSc Mary Porter BVSc (Hons) MACVSc Jeffrey Smith BVSc FACVSc Dip ACVO David Vella BSc BVSc (Hons) DABVP Editor - Luke Martin Tel: 0418 698 228 Email: luke.martin@vetmag.com.au National Sales Manager James Martin Tel: 0432 575 877 Email: james.martin@vetmag.com.au Designer - Anne Norrell Email: annenorrelldesign@gmail.com Printed by Newstyle Printing 41 Manchester St, Mile End SA 5031 Post Print Approved PP255003/06488 All material in The Veterinarian is subject to copyright and must not be reproduced wholly or in part without the written permission of the Editor.

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

4Asia

Pacific Centre for Animal Health, The Melbourne Veterinary School, The University of Melbourne, Parkville, Victoria, 3010, Australia. legionea@unimelb.edu.au. #Contributed equally.

Abstracts - beef production From page 12

in comparing beef-production systems, better quality policies about beef use can be formulated than when statements referring only to one system are considered. The least sustainable beef-production systems are extensive grazing that causes land degradation and the use of feedlots or indoor housing with grain feeding. Semi-intensive silvopastoral systems are the most sustainable beef-production systems, and well-managed pasture-fed beef from areas where crop production is uneconomic is also sustainable. This simple, scientifically based scoring system could be modified to use positive as well as negative scores and is of value for policy makers, researchers, producers, organisations aiming to improve sustainability, and the general public.

D M Broom1.Biol Rev Camb Philos Soc. 2021 Oct;96(5):1836-1853.doi: 10.1111/brv.12726 https://doi. org/10.1111/ brv.12726 1Department

of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 0ES, U.K.

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Secretarybird (Sagittarius serpentarius) Endemic to sub-Saharan Africa, the secretarybird is a generally non-migratory bird found from Senegal to Somalia, and south to Cape Province, South Africa. Unlike most birds of prey, the secretarybird hunts on foot, often stamping on snakes ñ†though there have been reports of the bird taking down young gazelles. Credit Hispalois

F e a t u r e

CREATURE

Who’s in favour of liquid formulation?

Semintra® (telmisartan) is a liquid formulation for use in cats with chronic kidney disease (CKD) that can help make life easier for owners and cats alike. With research showing that more than 90% of cat owners preferred using a liquid compared to a tablet formulation for long-term treatment,1 it’s clear that Semintra® is meeting owners’ expectations.

Reference: 1. Zimmering, T. (2015) Ease of use of Semintra® and its effects on quality of life – update on cat owner feedback (“EASY Programme”). Poster presentation at Southern European Veterinary Conference. Boehringer Ingelheim Animal Health Australia Pty. Ltd. Level 1, 78 Waterloo Road, North Ryde, NSW 2113. Semintra® is a registered trademark of Boehringer Ingelheim Vetmedica GmbH – used under licence. PET-0254-2021