The Veterinarian Magazine October 2021 Issue

TheVeterinarian ■ October 2021

■ www.theveterinarian.com.au

The survival chances for rescued wildlife

A study published recently in PLOS ONE looked at the rescue and rehabilitation outcomes in NSW for wildlife that were victims of vehicle collisions or animal attacks. It found the survival rate was about 55 per cent for the 469,553 animals that were rescued by wildlife organisations over a six-year period. Animals included birds, mammals and reptiles, and the study showed rescue numbers were lowest in winter, and highest in spring, with six-times more ‘abandoned/orphaned’ individuals rescued in spring than during winter.

The rescue and rehabilitation of wildlife is primarily supported by individual volunteers within their local communities, or by members of wildlife rehabilitation organisations, and the total value of their services in NSW was estimated to be in excess of $27 million. This has led to a significant investment in the development of minimum standards in the state’s wildlife rehabilitation sector and the development of Codes of Practice with standards, “being augmented with the training standards to ensure volunteers across the

sector are competent to implement Code of Practice requirements.”

Patterns of wildlife rehabilitation were investigated from a broad geographical region using data collated from over 50 wildlife rehabilitation providers, and although the protocols varied records were commonly kept for each individual animal rescued and rehabilitated. These reports included species identification, rescue location, reason for needing care, physical condition, and details of any trauma. It is information that has largely remained underutilised despite the value it offers for wildlife organisations and volunteers, enabling them to more readily recognise discernible trends, and where training and standards could be improved to ensure more positive outcomes can be realised for rescued animals.

In general, the study found causes for rescue, such as collisions or animal attacks that involved some physical trauma, resulted in relatively poor chances for a successful outcome.

In contrast, less physically traumatic situations, such as those for abandoned or orphaned individuals, tended to result in more positive outcomes.

■ ANNE LAYTON-BENNETT ‘Trends in wildlife rehabilitation rescues and animal fate across a six-year period in NSW’ is available at https://doi.org/10.1371/journal.pone.

0257209

ON THE INSIDE

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NEWS Something to crow about

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NEWS Not a load of bull

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New Hendra variant found in Newcastle Concerns over A seven-year-old unvaccinated Clydesdale from the Newcastle area has been euthanased following confirmation of a variant Hendra virus strain, the NSW Department of Primary Industries (DPI) reports.

The new variant (Hendra virus Genotype 2/HeV-g2) and most

A coloured transmission electron micrograph of the Hendra virus.

Picture Electron Microscopy Unit, Australian Animal Health Laboratory

■ www.theveterinarian.com.au

southern case of Hendra recorded was confirmed in early October by testing at the DPI’s Elizabeth Macarthur Agricultural Institute laboratory and at the Australian Centre for Disease Preparedness (ACDP).

A vet attended the West Wallsend horse in response to a report it was showing neurological symptoms, collected samples and informed the DPI. The other horses at the property have not shown signs of poor health.

For six months the DPI has routinely tested all Hendra submissions for the new variant after retrospective detection in a Queensland horse.

An Individual Biosecurity Direction was issued by a District Veterinarian from Hunter Local Land Services to control the movement of animals and people on and off the West Wallsend property for a 21-day period.

A CSIRO paper detailing the new genetic type (‘A new Hendra virus genotype found in Australian flying foxes’) was released just days after the latest infection was discovered. To page 30

drug rescheduling

The Therapeutics Goods Administration (TGA) has made an interim decision to expand the current Schedule 5 entry for lidocaine, to include specifically targeted injectable solutions, at up to 2 per cent concentration, for the pain relief of lambs or calves undergoing animal husbandry procedures.

The AVA made a submission opposing this, which was entered in January when submissions were first due. A second submission opposing the interim decision was made in August 2021.

The organisation has been informed that the decision will stand.

In response, the AVA has formed a working group involving a number of subject matter experts and special interest groups and will continue to oppose this decision.

The AVA has also asked all members to consider writing to the Minister for Health, Hon. Mr Greg Hunt MP to register their concern around the rescheduling of the drug. To page 30

VET TRAVEL Olivia Pozzan

23 CLINICAL REVIEW Acute laminitis MANAGEMENT

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VET ETHICS

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ABSTRACTS

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BUSINESS

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News

Export’s cattle’s dire conditions uncovered AVA works to

Concerning conditions on cattle voyages have been uncovered in research funded by Vets Against Live Export (VALE) and the RSPCA. Published in international peerreviewed journal Animals, the paper ‘Animal Welfare Risks in Live Cattle Export from Australia to China by Sea’ studies independent observer reports on voyages between July 2018 and December 2019, accounting for the transportation of 147,000 cattle.

The observers were appointed following the fallout from shocking footage taken aboard the Awassi Express in April 2018.

RSPCA Australia Senior Scientific Officer and study co-author, Di Evans, identified 10 key risk factors on the voyages.

“These are hunger, thirst, exposure to extreme temperatures, poor pen conditions, health issues, absence of veterinarians, rough seas, poor ship infrastructure, mechanical breakdown and mismanagement at discharge,” she said.

VALE spokesperson and study co-author, Sue Foster, said these problems were recurrent on many vessels, and the conditions were a long way from meeting guidelines set out by the World Organisation for Animal Health.

Foster said that Australia’s own standards for the export of livestock (ASEL) were also breached on several voyages.

“For example, ASEL food provisions were found to be inadequate with some ships needing to ration

Something to crow about A long-term international study led by a team from Scotland’s University of St Andrews, has not only found the answer to a puzzle that has mystified scientists for years, but has also helped to reinforce the importance of plants in ensuring the survival of many species of wildlife.

The New Caledonian crow (Corvus moneduloides) is the only natural tool user amongst the world’s 40 species of crows and ravens, and the only known nonhuman animal that selects and manufactures their own stick tools with hooked tips to forage and retrieve invertebrate prey from small holes and crevices in the wild.

Co-author and geneticist Linda Neaves, a research fellow at the Australian National University’s Fenner School of Environment and Society, said the birds put a lot of effort into making the tools utilising specific plants, but while the plants used at two of the study sites could be identified – an introduced shrub, and a variety of raw materials – because crows had never been observed making tools at the third study site, the plants they used had remained a mystery.

Field studies involved a range of approaches over the years and included behavioural observations in the wild and in field aviaries, radio-tracking, and working with local botanists to examine collected tools, but only after the scientists sought the assistance of Neaves, and Peter Hollingsworth from Edinburgh’s Royal Botanic Gardens, was the puzzle finally solved.

“The birds use specific plants with forked stems, which they remove www.theveterinarian.com.au

and then process into hooked tools for foraging. But they remove the leaves and much of the bark making it impossible to quickly identify the plant species. The field team were able to collect some tools and asked Prof Hollingsworth and myself if DNA could be used to work out what plant it was,” Neaves explained.

By matching DNA from the tools to the large, native Spanish cherry tree (Mimusops elengi), she managed to discover the answer, but she said it was a timely reminder that survival for some species may sometimes rely ‘on all the little things’.

“The answer was right in front of us the whole time. When the

food or running out of food altogether,” she said.

“In addition, the ASEL standards for space allocation do not allow cattle to simultaneously lie down and stretch their limbs on these three-week voyages, contrary to the Australian Animal Welfare Standards and Guidelines for Cattle.”

Foster emphasised the significance of the absence of veterinary care on 60% of the voyages.

“Veterinarians play an essential role in ensuring the welfare of imported livestock especially for extended journeys in difficult conditions,” she said.

“Stockpersons are simply not a substitute for veterinarians with respect to disease diagnosis and treatment.

“It is unlikely that it is commercially viable or even possible to adequately address these recurrent and significant animal welfare issues but unless they are fixed, cattle should not be exported to China.”

Evans added that the study exposes issues regarding transparency, with the Federal Government publishing summarised reports from independent observers, omitting “most of the photographs and all of the videos.”

“We have expressed these concerns before and had to use To page 30 crow researchers first explained this problem, it was difficult to know if we could provide an answer. Usually, you have a bit more to work with, and in this case, it felt like searching for a needle in a haystack as it could’ve been a large number of plants on New Caledonia.

“Clearly these crows have adapted their remarkable tool-making abilities over time to make use of introduced plant species, and it is exciting to find this population prefers a native tree. It raises a lot of interesting questions about how and why crows select the plants they use and how this may be influenced by changes in their environment.”

■ ANNE LAYTON-BENNETT

better mental health in vets

Warwick Vale

October is National Mental Health Month, an annual event which aims to raise awareness of mental health issues through education and advocacy. Of the estimated three million Australian adults who live with depression or anxiety every year, studies show that veterinarians are proportionally over-represented.

Far from being all about spending time with puppies and kittens, working as a veterinarian comes with long hours, staffing shortages, financial pressures, and increased expectations from pet owners – at times, leading to negative vet/client interactions, and in some cases, even abusive behaviour towards veterinarians – all of which take a significant toll on mental health.

“Veterinarians bring their compassionate and caring approach to working with all animals, great and small. This empathy, combined with long working hours, high workloads, the attitude of challenging clients, and poor work-life balance, are contributing risk factors to the high prevalence of anxiety, depression, stress, burnout and suicide seen within the veterinary profession”, Warwick Vale, President of the Australian Veterinary Association (AVA) said.

The AVA has partnered with SuperFriend, an organisation that specialises in designing workplace mental health initiatives, to assist them in developing a comprehensive veterinary wellness strategy for the profession. The project has completed an extensive research stage, collecting the thoughts and experiences of veterinarians, through extensive focus group discussions, one-on-one interviews and an industry-wide stakeholder survey completed by over 2,500 respondents.

“We are dealing with an extremely complex issue, so we have been acutely aware that the success of any wellness strategy developed, would be reliant upon the input of as many voices as possible from within our profession. The overwhelming response we have had To page 30 OCTOBER 2021 TheVeterinarian 3

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News

Not a load of bull It was during a radio interview in 2007 about the impact on the New Zealand environment from cattle excretion, and a quip by the host that suggested cows should be toilet trained, that first started Lindsay Matthews thinking.

A University of Auckland honorary academic and director of an independent research company, Matthews’ PhD research had focussed on learning and preference in cows – animals he grew up with on his family’s dairy farm - and he was aware of the negative environmental impacts from cow urine, and the high level of nitrogen it contains that contributes to excessive growth of weeds and algae in New Zealand’s lakes, rivers and aquifers that are a result of nitrate pollution. But it was while working with Lars Schrader at Germany’s Federal Research Institute for Animal Health during 2015 that the idea took hold. It followed the suggestion

by Prof Schrader that the ammonia emissions resulting from contact between faeces and urine could be controlled by toilet training cows, despite the limited success of previous international attempts. Matthews thought he might be able to do better, given his background and knowledge, and he approached Douglas Elliffe, Professor of Behavioural Psychology at the University of Auckland’s Faculty of Science to help.

With their German colleagues, Matthews and Elliffe worked with 16 calves at a farm operated by the country’s Research Institute for Farm Animal Biology, and initially demonstrated that most calves could be trained to ‘hold it’. If calves began to urinate in the wrong place the scientists made their collars vibrate and although the vibration did not hurt them, most calves soon learned to walk a short distance to a latrine pen.

“People’s reaction to the MooLoo is, ‘crazy scientists’, but actually the building blocks are there. Cows have bigger urinations when they wake up in the morning, which demonstrates they have the ability to withhold urination.

There’s nothing in their neurophysiology that radically differentiates them from animals, such as horses, monkeys and cats, that show latrine behaviour,” Matthews said.

Although the calves received only 15 days of training 11 of the calves had learned to use the full MooLoo skill set after 20 to 25 urinations, which compares favourably to toilet-training time for three- and four-year-old children.

“This is how some people train their children – they put them on the toilet, wait for them to pee, then reward them if they do it. Turns out it works for calves as well.

“Very quickly, within 15 to 20 urinations on average, the cows would self-initiate entry to the toilet. This is very exciting because it means they were paying attention to their bladder getting fuller. By the end, the majority were doing three-quarters of their urinations in the toilet,” he said.

Because the research was conducted in the Northern Hemisphere where cows spend much of their time in barns, the next step for Matthews and Elliffe is to adapt the research for regions like New Zealand and Australia where dairy cows spend most of their time outdoors. Although it will make toilet training more of a challenge, and it is unlikely they will use latrines as often as their European counterparts, cows still gather for milking and to receive supplements, and a reduction in pollution would have significant environmental benefits.

“We’ve shown proof of concept that we can train cows, and train them easily. Cattle urine is a major cause of our nitrogen problem, and any reduction would make a difference, so even if we collect 10 or 20 per cent of urinations it would be sufficient to significantly reduce greenhouse gas emissions and nitrate leaching,” Elliffe said.

An additional challenge lies in the feasibility of toilet training millions of animals although the researchers suggest this could be achieved by using urination-detection sensors and automatic reward systems. Trained cows could also be transitioned into not expecting a food reward after every urination.

The New Zealand dairy industry has expressed interest in the research as a potential way to avoid herd reductions that may otherwise be necessary to meet emissions targets.

“This is a new science, what we’ve done here, so there are many ways to push it,” Matthews said.

Viral kangaroo rescue results in tragedy

The spokesperson added that citizens met with any injured animal should call ACT Wildlife or Access Canberra.

“Due to safety concerns to both the animal and the public, we ask that the community do not attempt a rescue themselves,” the spokesperson said.

“Please give the animal space and keep an eye on them from a distance – maintain enough room for the animal to leave the area.”

A kangaroo pulled from Lake Burley Griffin has been euthanased by a government veterinarian, ABC News reports.

Footage of two men pulling the kangaroo from the cold lake gained international attention in September.

The ACT Parks and Conservation Service responded to a call after the animal was retrieved, however it was found to be in poor health and was euthanased a short time

later, an ACT government spokesperson said.

“Capture myopathy, or muscle damage resulting from extreme exertion or stress, is always a primary consideration in any rescue of a kangaroo,” the spokesperson said.

“Several factors contributed to the welfare concerns for this kangaroo, including the poor symptoms the animal was showing, the location where the animal was found, and the cold, windy weather.”

■ ANNE LAYTON-BENNETT

■ SAM WORRAD

Thinking of selling your veterinary practice?

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Please contact us to arrange a time to talk about your options.

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Australia’s leading veterinary practice brokerage 1300 282 042 | info@practicesalesearch.com.au | www.practicesalesearch.com.au

www.theveterinarian.com.au

Simon Palmer Managing Director

Kevin Koton National Account Manager

OCTOBER 2021 TheVeterinarian 5

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VET TRAVEL

THE WALLS OF JERUSALEM

It was mid-afternoon by the time we hit the trail. A cold wind was blowing and grey clouds loomed overhead. Hauling my pack I began the steep climb through the stringy bark forest trailing after my brother, Dorian.

Although not as famous as the Overland Track, the Walls of Jerusalem is no less spectacular. Located in the Tasmanian Wilderness World Heritage Area, the trail passes through a wild land where craggy dolerite peaks tower over pristine lakes, highland meadows and pencil pine forests. We planned to hike a 34km circuit to Dixon’s Kingdom then loop back via Lake Ball and Lake Adelaide, hiking through remote wilderness in one of the few alpine landscapes to be found in Australia.

We reached Trappers Hut an hour into the climb. Built in 1946, this simple wood cabin is one of three historic huts on the circuit and was used as a base by hunters and snare trappers. The huts are far from cosy and not for overnight use. Not that I would want to sleep here. I imagined the walls covered in bloodied skins from animals dying a cruel death and was grateful snaring was banned many years ago.

The wind moaned through the trees and I imagined the loneliness and isolation trappers faced through the bleak and long winter nights. It was a sobering thought and with a dark sky threatening rain I was keen to reach Wild Dog Creek, our campsite for the night.

A short steep climb after leaving the hut the trail leveled out and crossed a plateau dotted with a necklace of small tarns, or mountain lakes. With a silvery sheen reflecting off the water, the tarns lived up to their poetic name of Solomon’s Jewels. We followed a long boardwalk across a picturesque valley to reach the Wild Dog Creek campsite.

Dark-faced wallabies watched incuriously as we set up camp on one of the wooden platforms. Bennett’s wallabies are common in the Walls of Jerusalem NP and weren’t fazed by our www.theveterinarian.com.au

proximity. Safe from the hunting and snaring of half a century before, wildlife here has flourished and the park is home to wallabies, possums, wombats, devils, quolls and more. It was heart-warming to see wild creatures grazing peacefully and contentedly beside our tent.

As night fell the temperature plummeted and it began to sleet.

I woke suddenly to the sound of thumping, tearing and ripping fabric, the noise so loud I thought a full grown bear was after our blood.

Nearby campers, jolted from sleep, spied a Tasmanian devil intent on raiding the tent for our food stash. Sliding the food bag out of reach thwarted the cheeky devil and when morning dawned I found the ground blanketed with snow, a ragged hole in the tent and icicles on my head.

With frozen fingers we dropped camp.

Soon after setting off we reached a pass, Herod’s Gate, and the entrance to the Walls of Jerusalem proper. Below the imposing face of King David’s Peak and the towering West Wall with its fluted dolerite columns, a long boardwalk stretched across the highland valley.

We hiked past silver lakes, wild heath, and lime-green cushion plants. A month or so earlier we might have caught the flowering scoparia with their brilliantly coloured blooms.

The Walls of Jerusalem were so named for their apparent resemblance to the old walls of Jerusalem city and every knoll, grove and outcrop drips with biblical references. We veered off track to the Pool of Bethesda, an idyllic tarn in a small clearing, before continuing on the main trail to the pass at Damascus Gate. From here tracks led upwards to Solomon’s Throne on our right and The Temple on our left, but we decided to push on to Dixon’s Kingdom Hut and pitch the tent.

While a blustery wind dried the tent of last night’s icy blanket we would retrace our steps to Damascus Gate and climb the summits.

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VET TRAVEL

The path to Dixon’s Kingdom passed through a grove of gnarly pencil pines. Sculpted by centuries of ice and wind, some of these trees are more than 1000 years old and form the largest surviving tract of pencil pines in Tasmania. It felt like stepping into an enchanted ancient forest. Bent roots knotted the ground.

Straggly old man’s beard hung from twisted branches. Even the air beneath the silent, watchful trees fizzed with magic.

Dixon’s Kingdom Hut sat in a grassy clearing on the edge of the pine forest near a bubbling mountain stream that supplied the camp’s drinking water. The rustic log cabin was built in the 1950s by the Dixon family, for use when droving cattle into the high country for summer grazing. In place of cattle, tents sprawled around the hut and into the shelter of the trees. Although we were in remote wilderness, there were plenty of hikers about and I found it difficult to sense the isolation and disconnection the mountain cattlemen must surely have experienced.

Wind gusted through the saddle as we made our way back to Damascus Gate. Grey clouds rolled in, the temperature dropped and I swore dry snowflakes brushed my face. The hike to Solomon’s Throne was a steep climb up a jumble of rocks and boulders – made manageable by a Herculean effort from Tasmania Parks & Wildlife to position rocks to form a natural stone staircase – before tracking through a rocky cleft to the summit plateau. It took more than the alleged six steps to the biblical throne where King Solomon passed judgment but, at 1469m, the summit effort to Solomon’s Throne was rewarded with regal views. Below us the boardwalk zigzagged through a green plateau but, in all directions, a tapestry of alpine shrubs, pine thickets and silver tarns spread towards layers of hazy ridges and peaks.

A strong wind deterred us from the trackless scramble across a boulder-strewn ridge to King David’s Peak and drove us down from the Throne. The stonemasons (aka Tasmanian Parks & Wildlife) had also worked their magic on the hill opposite, fashioning a stone staircase through the scree and rubble to The Temple summit. For an unimpressive looking hill, The Temple delivered sensational views of the Walls.

The wind turned icy. Rain slushed to sleet.

Dorian and I huddled behind the relative shelter of a boulder until the air dried and a weak sun broke through the clouds. As a creature from a warmer clime I was new to Tassie mountain weather and when another rain-burst chased the sun away we left The Temple to the whims of nature and re-traced our steps to Dixon’s Kingdom. It was still early afternoon so we turned north to follow the track as it gently climbed up a saddle and veered east towards Mount Jerusalem.

The hike was a long but pleasant gradual climb on a narrow track beside crystal clear pools www.theveterinarian.com.au

and low-lying shrubs to a rocky peak. Pale fingers of light broke through a dramatic sky of rain-swollen clouds, transforming the landscape below. About 10,000 to 20,000 years ago glaciers scoured this region, leaving behind the 4000 or so alpine lakes that twinkled and shone like scattered glass as far as I could see.

I counted ten Bennett’s wallabies grazing contentedly near our tent. Our grassy campsite beneath the pencil pines was picture-perfect.

An underground stream burbled to the surface close by but our site was high and dry, unlike most of the ground around Dixon’s Kingdom which was wet and boggy. It was a frosty night but drama-free without nocturnal wildlife visits and I was glad to wake to blue skies and the promise of a sunny day.

We skirted in and out of the pencil pine forest, following a track that led downhill from Dixon’s Kingdom towards Lake Ball. Once we reached the lake, the landscape changed. We ambled beside serene blue waters - as blue as the sky above - scrambling over tangled tree roots and dolerite boulders. I recognized

the fagus, or deciduous beech, a relic from Gondwana and one of Australia’s only native deciduous trees but autumn was still a week away and the leaves had yet to turn.

In the forest, a wooden hut nestled in the trees above the lake. It was built in 1968 by local legend and solitary recluse, Boy Miles, who also helped build Trappers Hut. His story, documented inside, was touching and poignant. I read, "Here he left behind the cares of the lowlands and found a relationship with the land that he was unable to replicate in the human world."

During WWII, Boy Miles spent three harrowing years as a prisoner of war on the Burma railway, an experience that affected him deeply. When he finally returned home, he retreated to his beloved mountains to heal his wounded soul. I imagined him sitting on the log I sat, drawing comfort from the ancient trees and tranquil lake waters before me.

The healing force of nature is powerful, especially in wild places. I had never faced the horrors of war but ‘a relationship with the land’ is what spurs me, and many hikers, to don a pack. On long multi-day hikes I feel this connection strip away the clutter and busy-ness

of my mind. The longer I’m in the wild, more of life’s problems and issues lose their intensity and drop away. It’s a subtle process of letting go, of aligning with the rhythms of the earth, and being present in the moment.

As we continued along the track I thought of Boy Miles and hoped he found the peace and liberation he sought.

The forest transitioned as we approached Lake Adelaide. Descending a steep hill covered in grey boulders and dry eucalypt trees, we merged onto the Junction Lake Track. A wide grassy clearing beside the lake made for a splendid campsite. We ate lunch, relaxing in the warmth of the sun. We had arranged for a friend to pick us up from the trailhead that afternoon and we were both regretting we wouldn’t be pitching a tent in this sweet spot.

Leaving the lake behind we followed the track along a swampy valley, through tall grass and bushes that scratched and grabbed our clothes and shallow tarns filled with golden reeds.

The track was muddy in places but not bad.

We were lucky as it can often get boggy and unpleasant.

Looking eastward, the back of the West Wall was an unremarkable hill with no indication of its dramatic cliff-face within the inner sanctum.

We zigzagged through a patchwork of brilliant green cushion plants, careful not to spike them with our trekking poles. Birds chirped in the trees. The sun shone in a glorious sky. My mind turned to the connections of the past few days - the powerful land energies, ancient forests, devils in the night and ghosts from the past.

A couple of hours after leaving Lake Adelaide we completed the circuit, reaching the main track we had hiked in on two days before.

From there, it was a short walk to Trappers Hut then a long, steep, seemingly never-ending descent to the trailhead and the end of the walk.

Long hikes can lead to amazing personal transformations but every hike fosters an appreciation for the simple things in life. I knew I would soon take them for granted again but right now I could think of nothing more divine than a hot shower, warm meal and soft bed.

Olivia Pozzan is an adventurer with a passion for travel and animal welfare. She has travelled to more than 40 countries, trekked mountain ranges on six continents, worked for an Arabian prince in the Middle East and led veterinary outreach projects in Asia. She has researched and written over 25 Lonely Planet guidebooks exploring destinations in Europe, Asia, Australia and the Middle East.

Her travel articles have appeared in numerous publications including BBC Travel, Australian Geographic, Wild, World Nomads and Great Walks. Her book, Energy Healing for Your Dog and Cat, is a practical hands-on guide for pet owners.

OCTOBER 2021 TheVeterinarian 9

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Management

Confidentiality agreements: some FAQS If you are looking at buying a veterinary practice, it is likely that you will be asked to sign a Confidentiality Agreement or Non-Disclosure Agreement at some stage.

There are a lot of misconceptions about these agreements, what they mean and if they are enforceable.

In this article, we address some of the frequently asked questions that arise from these agreements.

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.

Harry Nicolaidis is a partner at K&L Gates and has acted for veterinary professionals in numerous matters involving the sale and purchase of businesses, and in the preparation of a range of contracts for their practices.

For more information call 07 3233 1268 or email harry.nicolaidis @klgates.com

1. Why are confidentiality agreements necessary in a practice sale transaction?

During a practice sale, it is likely that a seller will share information with a buyer that they would not like shared in a wider context.

This confidential information might include the financials of the practice, the details of its marketing efforts, payroll information about the staff, etc.

For the seller to feel comfortable about sharing this information, the purchaser needs to agree to treat these disclosures confidentially.

2. Does signing a confidentiality agreement mean that you cannot share the information with your spouse or advisors?

Buying a business will almost never be completed without the buyer discussing information regarding the deal with spouses and advisers (bank, accountant, lawyer).

A confidentiality agreement usually has provisions to reflect that the confidential information may be used and shared in specific circumstances. That is, shared with their necessary advisors (bank, accountant, lawyer, business partner, etc.), for the purposes of considering a specific opportunity.

If they don’t, then the buyer should either seek an amendment or get a separate NDA for their spouse and advisors.

For this reason, every Practice Sale Search practice for sale also includes a separate confidentiality agreement from the seller, to give a buyer peace of mind that the buyer's identity will be treated confidentially.

5. Is there a difference between a confidentiality agreement and a Non-Disclosure Agreement (NDA)?

In a business sale interaction, there is unlikely to be any material difference between a confidentiality agreement and a Non Disclosure Agreement. Irrespective of what they are called, both have the effect of protecting confidential information provided by one party to another.

6. I have heard that NDAs and Confidentiality agreements cannot be enforced. Is this true?

This is incorrect; significant penalties can absolutely be incurred if people misuse or inappropriately disclose information provided under a confidentiality agreement.

However, I think this question misses the point of these agreements.

The principal purpose of putting a confidentiality agreement in place is to guide appropriate behaviour. The fact that it creates legally

enforceable obligations is ancillary to that purpose.

If you are sharing sensitive information, you would want a confidentiality agreement for four reasons.

1. First and foremost, it is a written acknowledgement from the recipient that they recognise that the information received is commercially sensitive.

2. Secondly, you want acknowledgement that the information should not be shared. unnecessarily, should be kept securely and that unauthorised disclosure could cause harm.

3. Thirdly, you want it to act as a deterrent in place for people who would otherwise be careless by disclosing this sensitive information.

4. Finally, so that if there is unauthorised disclosure or misuse of this confidential information such that a loss flows from it, there is a legal pathway to appropriate compensation and recourse for that loss.

Hopefully the first three points will mean that the confidential information is secure and the fourth point – recourse- is rarely if ever necessary.

3. What happens if the confidential information that you have received becomes public knowledge – are you still bound by the agreement?

Typically, a confidentiality agreement will have exclusions for information that is or becomes publicly available or generally known to the public.

4. Is a confidentiality agreement only in place to protect the seller?

In a business sale transaction, con-fidentiality agreements are usually in place to protect the seller alone.

However, there are many reasons that a buyer will also want a confidentiality agreement in place.

A vet looking at a veterinary practice to buy may be reluctant for their current boss to find out that they are looking, as there may be an implication that they intend to stop working at their current job to pursue the purchase.

www.theveterinarian.com.au

OCTOBER 2021 TheVeterinarian 11

VET ETHICS

The ethics of Ehrlichia canis

By Simon Coghlan with Dr Megan Pickering. Dr Pickering works as a vet in livestock biosecurity and is currently the Northern Territory E.canis Co-ordinator.

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.

12 TheVeterinarian OCTOBER 2021

Ehrlichia canis was detected in dogs in northern WA in May 2020.

Since then, it has been found in virtually every urban and remote community in the Northern Territory where dogs have been tested. E. canis is now established in northern Australia and the far north of SA. Acute ehrlichiosis can involve fever, lethargy, joint pain, swollen LNs, ocular discharge, and blood dyscrasias. Some dogs clear the bacteria while others do not.

Dogs with chronic ehrlichiosis may or may not have presented with acute illness and/or received treatment.

Problematically, a proportion of infected dogs show no clinical signs. It is not known how many of these dogs will clear the organism through natural immune system defences, and how many will show no signs of acute infection but will subsequently develop chronic (and likely fatal) disease in later months or years.

In the NT, a combination of PCR testing (to detect DNA of the organism in circulation) and ELISA antibody testing are used to determine infection status.

Additionally, IFAT testing at the Australian Centre for Disease Preparedness (ACDP) may be undertaken in borderline cases.

The long-term status of a dog that tests positive to any test is difficult to determine.

The organism may be successfully cleared from the circulation and be undetectable with PCR testing.

However, because the organism can sequester in the spleen and bone marrow, it is not always detectable using conventional testing methods.

The current approach is to regard a positive case as potentially infected for life and at risk of developing chronic disease. This applies to dogs that have been diagnosed and treated with antibiotics in the acute phase, as well as the sub-clinically infected that are diagnosed through screening tests. Treatment includes extended antibiotic therapy (doxycycline). Hospitalisation and supportive care like blood transfusions may be required.

In Australia, the zoonotic potential of this E.canis strain is uncertain, but considered unlikely.

A widespread serological survey is proposed for northern Australians who live in close contact with infected dogs, and where effective tick control is limited, to inform this knowledge gap.

When dogs receive effective treatment while acutely infected, they can have a good prognosis.

However, end-stage disease is the result of an untreatable immunemediated pancytopaenia. Such dogs may waste away and die slowly, with or without further veterinary therapy. Unfortunately, many communities in northern Australia lack timely access to veterinary services and resources to treat the disease. No vaccine exists.

Rhipicephalus sanguineus is endemic in northern Australia.

Preventing the tick and E. canis becoming established in southern Australia is important, and requires good tick control measures for travelling dogs, including collars or spot-on products that repel ticks and prevent attachment.

Many dogs in northern Australian communities are in a vulnerable environment with no established ownership. An ethical issue arises for organizations looking to rehome dogs from E. canis risk areas. There are a number of rescue and rehoming groups that accept dogs from northern Australia. No nationally agreed regulatory conditions exist for

the movement of dogs from areas with confirmed or high-likelihood of infection with E. canis to areas with an unknown or low-likelihood of infection. There is also no obligation for the health status of infected dogs to be disclosed between rehoming groups or from rescue groups to the adopting new owner.

Suppose a dog without a home from an E.canis risk area is tested and is positive or is not tested at all prior to movement and rehoming. Should that dog be rehomed to, say, adopters in Melbourne or Adelaide? How much information around the dog’s history should be communicated to the new owners?

‘Acute ehrlichiosis can involve fever, lethargy, joint pain, swollen LNs, ocular discharge, and blood dyscrasias’.

The NT government recommends testing of dogs prior to interstate movement and notifies interstate authorities where there are plans for infected dogs to move to another jurisdiction. The owner or person in charge of the dog at the time of testing is notified about the infection status, and offered advice and support concerning treatment for unwell dogs and possible risks and outcomes for chronic disease.

Not knowing that a dog has tested positive or comes from an endemic area may result in delayed diagnosis or misdiagnoses, especially since many veterinarians in disease-free areas are not on the lookout for ehrlichiosis. The disease, in its later stages, can also be difficult or impossible to treat.

In the absence of an accurate diagnosis, this can mean ineffective interventions and suffering.

The challenge for veterinarians in disease-free areas is to include ehrlichiosis in exclusion testing, because the disease can mimic a wide variety of other conditions.

What should be done if an unowned dog from endemic areas tests positive for E. canis?

If the dog does not have a severe or end-stage form of ehrlichiosis, it may be treated and/or have a good welfare outcome.

Furthermore, if prospective owners are informed of the risks of taking on a dog from an area of high likelihood of infection and know whether the dog has tested positive or negative, this may help them decide whether to adopt and how to respond should the dog become ill.

■ www.theveterinarian.com.au

Dr Claire Adams Online now

Dr Henry Jones

I hear you guys switched to a mucosal vaccine?

Dr Claire Adams

Yes, we’re using Bronchi-Shield

Oral

Dr Henry Jones

What prompted the change?

Dr Claire Adams

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

BTW, mucosal vaccines are also strongly recommended

by WSAVA for high risk environments such as shelters1

SHELTER

Dr Henry Jones

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

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

Dr Henry Jones

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

Dr Claire Adams

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

Dr Henry Jones

…

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

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

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

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

■ EDITED BY JENI HOOD BSc (Hons) BVMS PhD

Abstracts

Trends in wildlife rehabilitation rescues and animal fate across a six-year period in New South Wales, Australia Globally, millions of animals are rescued and rehabilitated by wildlife carers each year. Information gathered in this process is useful for uncovering threats to native wildlife, particularly those from anthropogenic causes. However, few studies using rehabilitation data include a diverse range of fauna, cover large geographical areas, and consider long-term trends. Furthermore, few studies have statistically modelled causes of why animals come into care, and what are their chances of survival. This study draws on 469,553 rescues reported over six years by wildlife rehabilitators for 688 species of bird, reptile, and mammal from New South Wales, Australia. For birds and mammals, 'abandoned/orphaned' and 'collisions with vehicles' were the dominant causes for rescue, however for reptiles this was 'unsuitable environment'. Overall rescue numbers were lowest in winter, and highest in spring, with six-times more 'abandoned/orphaned' individuals in spring than winter. Of the 364,461 rescues for which the fate of an animal was known, 92 per cent fell within two categories: 'dead', 'died or euthanased' (54.8 per cent of rescues with known fate) and animals that recovered and were subsequently released (37.1 per cent of rescues with known fate). Modelling of the fate of animals indicated that the likelihood of animal survival (i.e. chance of: being released, left and observed, or permanent care), was related to the cause for rescue. In general, causes for rescue involving physical trauma (collisions, attacks, etc.) had a much lower likelihood of animals surviving than other causes such as 'unsuitable environment', 'abandoned/orphaned', and this also showed some dependence upon whether the animal was a bird, reptile, or mammal. This suggests rehabilitation efforts could be focused on particular threats or taxa to maximise success, depending on the desired outcomes. The results illustrate the sheer volume of work undertaken by rehabilitation volunteers and professionals toward both animal welfare and to the improvement of wildlife rehabilitation in the future.

Alan B C Kwok1, Ron Haering2, Samantha K Travers34, Peter Stathis2 PLoS One. 2021 Sep 10;16(9):e0257209.doi: 10.1371/journal.pone.0257209. eCollection 2021.

1Independent consultant, Bensville, Australia.

2New South Wales Department of Planning, New South Wales National Parks and Wildlife Service, Industry and Environment, Parramatta, Australia.

3New South Wales Department of Planning, Industry and Environment, Parramatta, Australia.

4Centre for Ecosystem Science, School of Biological, Earth and Environmental Sciences, University of New South Wales, Sydney, Australia.

Free PMC article

Discomfort period of fattening pigs and sows stunned with CO 2: Duration and potential influencing factors in a commercial setting SARS-CoV-2, a betacoronavirus of likely zoonotic origin, was first reported in December 2019. Its rapid worldwide spread precipitated a range of interventions, including by veterinarians, due to impacts on human health and well-being as well as animal health and welfare.

We conducted 36 key informant interviews to explore the responses of Australian veterinarians, their engagement in One Health collaboration and cooperation, and their existing and developed insights to the COVID-19 pandemic. Responses were analysed using thematic analysis.

Australian veterinarians provided valuable contributions to the national COVID-19 response by protecting animal welfare, maintaining local food security, providing essential veterinary services while mitigating human health risks in clinical settings and providing both key skills and surge capacity to the human health response. This was all guided by skills in scientific literacy and evidence-based comDespite raising animal welfare concerns, stunning of pigs with CO2 prior to slaughter remains the most widely applied method in commercial settings.

The aim of this study was to assess the discomfort period and its influencing factors in fattening pigs and sows in a commercial slaughterhouse. The discomfort period was defined as the first reaction to the gas or the environment from the point the animal enters the gondola, until complete relaxation of its head. To page 30

14 TheVeterinarian OCTOBER 2021

The impact of lamb and ewe mortality associated with dystocia on Australian and New Zealand sheep farms: A systematic review, meta-analysis and bio-economic model Dystocia contributes to lamb and ewe mortality in the periparturient period but impacts for extensive sheep production systems remain poorly understood. Here we show that lamb and ewe mortality associated with dystocia has important impacts on sheep production in Australia and New Zealand, and quantify financial impacts for the Australian sheep industry.

A systematic review of the literature identified 11 publications published since 1990 that reported sheep mortality due to dystocia in Australia or New Zealand. Assumptions for ewe breeding flock structure and reproductive performance were based on Australian sheep industry data. The proportion of lamb mortality attributable to dystocia (including stillbirths and perinatal deaths with evidence of hypoxic injury) pooled across all studies (pooled proportional mortality ratio) was 47 per cent (95 per cent Confidence Interval (CI): 38, 55). Pooled proportional mortality ratio for Australian studies was 53 per cent (95 per centCI: 47, 60), and for New Zealand studies was 35 per cent (95 per centCI: 19, 51). Pooled proportional mortality ratio was similar for lambs born to Merino and non-Merino ewes, although more data are needed to determine effects of ewe breed independent of other factors. Pooled proportional mortality ratio was higher for single lambs (59 per cent; 95 per cent CI: 55, 63) than twin (47 per cent; 41, 54) or triplet (49 per cent; 46, 52) lambs. However, the number of dystocia-associated mortalities is higher for twin-born lambs than for singles because total mortality is higher for twin-born lambs. It is estimated that approximately 7.7 million lamb deaths and 297,500 ewe deaths per year are attributable to dystocia in Australia for the national flock of 38 million breeding ewes.

The whole-farm bio-economic Model of an Integrated Dryland Agricultural System (MIDAS) was used to determine the impacts of dystocia-associated ewe and lamb mortality on Australian farm profit. Dystocia is estimated to reduce Australian national farm profit by AU$780 million or $23.00 per ewe mated based on an assumed lamb sale price of AU$6.50 per kg carcass weight. These estimates do not include the costs of reduced productivity for surviving ewes and lambs, intervention, postfarmgate impacts, delayed genetic progress, or impacts on animal welfare and access into sheep meat and wool markets.

Reducing dystocia through improved genetics and sheep management will improve animal welfare and farm profit.

Mieghan Bruce1, John M Young2, David G Masters3, Gordon Refshauge4, Andrew N Thompson1, Paul R Kenyon5, Ralph Behrendt6, Amy Lockwood1, David W Miller1, Caroline Jacobson7 Prev Vet Med. 2021 Sep 2;196:105478.doi: 10.1016/j. prevetmed.2021.105478. Online ahead of print.

1Centre for Animal Production and Health, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia.

2Farming Systems Analysis Service, 476 Tindale Rd, Kentdale, WA, 6333, Australia.

3School of Agriculture and Environment, M085, University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.

4New South Wales Department of Primary Industries, Cowra Agricultural Research and Advisory Station, Cowra, NSW, 2794, Australia.

5International Sheep Research Centre, Massey University, Palmerston North, 4410, New Zealand.

6Agriculture Victoria Research, Department of Jobs, Precincts and Regions, Hamilton, Victoria, 3300, Australia.

7Centre for Animal Production and Health, Murdoch University, 90 South Street, Murdoch, WA, 6150, Australia. Electronic address: C.Jacobson@murdoch.edu.au.

■ www.theveterinarian.com.au

ESSAY

Artificial structures: A practical solution to the problems of uneven hen distribution on free-range layer farms Explores possible solutions to difficulties relating to hens’ use of free-range areas available to them.

Introduction There is a growing trend among consumers to demand products derived from animals reared in welfare-friendly environments (Gilani et al., 2014). In the case of egg production, this has effected a steady decline of caged or barn systems in favour of ostensibly more welfarefriendly free-range systems, in which hens have access to free-range areas (Gilani et al., 2014).

This is supposed to decrease the average indoor stocking density, providing hens with more space to perform natural behaviours and decreasing risk factors that may compromise the health and welfare of the birds (Bestman, 2005). Nevertheless, these systems are not flawless, as use of the outdoor range varies among hens, and consequently many health issues arise related to stocking density (Sherwin et al., 2013). Therefore, it is in the interests of free-range poultry farmers to develop better housing solutions to help strike a balance between steady financial returns and meeting the welfare demands of consumers.

This review discusses the welfare issues facing free-range producers and examines how the introduction of artificial structures on the range could provide a solution to assuage both economic and welfare concerns.

Discussion Botreau et al. (2007) defines production animal welfare as the level of fulfilment of four criteria: adequate food and water, proper housing, health, and behaviour reflecting optimised emotional states of the animal. The free-range system seeks to improve all these criteria, but it faces certain challenges when it comes to the distribution patterns of the hens and this, in turn, has effects on factors such as health and the display of natural behaviours.

Recent studies focused on the distribution patterns of free-range poultry have found that hens tend to stay close to the shed and perimeters of the enclosure, and do not venture far from these structures (Zeltner & Hirt, 2003). The reasons for this could be fear of aerial predators, fear of novelty, or breed predispositions. The result is a non-uniformity of distribution across indoor and outdoor areas, which increases the stocking density in certain areas, leading to a higher incidence of feather pecking and parasite infestation exacerbated by the accumulation of droppings, especially nematodes that can cause severe gastrointestinal tract diseases (Rault et al., 2013; Sherwin et al., 2013; Van de Weerd et al., 2009; Zeltner & Hirt, 2003).

Furthermore, an investigation into the effects of housing and husbandry on nematode infections in 19 free-range egg-laying flocks has shown links between increased stocking density and an increasing severity of parasite infestation, resulting in a higher faecal egg count (Sherwin et al., 2013). As more hens used the outdoor range, Heterakis faecal egg count decreased, confirming the advantages of encouraging increased range■ www.theveterinarian.com.au

use to decrease the density of faeces indoors, thereby lowering the risk of parasite contamination (Sherwin et al., 2013).

There are several factors that may influence ranging behaviour, for example, light intensity, weather, and the presence of structures or cover (Gilani et al., 2014). Controlled higher indoor light intensity has been shown to encourage birds to range outside, possibly due to reduced variation between indoor and outdoor light intensities (Gilani et al., 2014).

Increasing pop-hole sizes also has a positive effect, but the enlarged pop-holes can cause problems under wet conditions, allowing rain to worsen litter quality indoors and to create muddy areas outside the pop-holes, both of which increase the risk of disease (Gilani et al., 2014). While natural cover, such as trees and bushes, provides shelter that appeals to the anti-predatory instincts of poultry, such vegetation grows slowly and can act as perching for predatory birds (Rault et al., 2013). Hence, introducing artificial structures on the range is a practical solution with fewer drawbacks (Singh & Cowieson, 2013).

Two recent studies have investigated the effectiveness of this possible solution by examining the influence of artificial structures on ranging behaviour. First, a study by Gilani et al. (2014), using 33 flocks of laying hens of different breeds and flock-sizes, observed a considerable increase in birds ranging at a greater distance from the shed where cover and artificial structures were present. However, more information is needed to establish a thorough understanding of the reasons the birds were attracted to these structures (Gilani et al., 2014).

Second, Rault et al. (2013) examined in more detail the effects of vertical structures on a flock of 17,000 Hy-Line brown hens. The vertical structures were placed in three zones on an outdoor range, while control zones were set up without these structures, and video cameras were set up to observe density and behaviours of the hens at certain time intervals after an initial 10-day adaptation period (Rault et al., 2013).

The results showed that significantly more hens were attracted to the zones containing the vertical structures in comparison to the control zones, and that the presence of structures encouraged hens to venture further from the shed (Rault et al., 2013). Hens were seen pecking at the structures 40% of the time, suggesting that they may be attracted to the structures as a form of environmental enrichment (Rault et al., 2013).

Additional research is needed to clarify whether the type of material used for the structures affects their success. Also, the findings revealed that birds were gathering at the structures at particular times, which may reflect other factors that are appealing to them, such as insects harboured near the structures during the evenings. The crowd of birds around the structures may also simply

relocate the problem of high stocking density (Rault et al., 2013), but further investigation into the factors that draw hens to the structures will elucidate these uncertainties.

Conclusions Resolving the issue of stocking density in free-range hens is a complex process, but artificial structures on the range could be a practical and economical solution to improve the welfare and productivity of egg layers by encouraging a more even distribution across the yard. This will help prevent conditions that are unfavourable to the wellbeing of poultry, and play a significant role in the continuing improvement of animal welfare in poultry farming.

■ WESLEY CHEUNG

References Bestman, M. 2005 Welfare in outdoor poultry and strategies to keep them healthy.

Proceedings of European Workshop for Scientists, Farmers, Environmental Specialists, Policymakers and Consumer Organisations – Should Hens Be Kept Outside, Sustainable Animal Production, Nijmegen, The Netherlands.

Botreau, R., Veissier, I., Butterworth, A., Bracke, M.B.M., Keeling, L.J. 2007 Definition of criteria for overall assessment of animal welfare.

Animal Welfare, 16, 2, 225-228.

Gilani, A.M., Knowles, T.G., Nicol, C.J. 2014 Factors affecting ranging behaviour in young and adult laying hens. British Poultry Science, 55, 2, 127-35.

Rault, J.L., Van de Wouw, A., Hemsworth, P. 2013 Fly the coop! Vertical structures influence the distribution and behaviour of laying hens in an outdoor range. Australian Veterinary Journal, 91, 10, 423-426.

Sherwin, C.M., Nasr, M.A.F., Gale, E., Petek, M., Stafford, K., Turp, M., Coles, G.C. 2013 Prevalence of nematode infection and faecal egg counts in free-range laying hens: relations to housing and husbandry.

British Poultry Science, 54, 1, 12-23.

Singh, M., Cowieson, A.J. 2013 Range use and pasture consumption in free-range poultry production. Animal Production Science, 53, 11, 1202-1208.

Van der Weerd, H.A., Keatinge, R., Roderick, S. 2009 A review of key health-related welfare issues in organic poultry production. World’s Poultry Science Journal, 65, 4, 649-684.

Zeltner, E., Hirt, H. 2003 Effect of artificial structuring on the use of laying hen runs in a free-range system. British Poultry Science, 44, 4, 533-537.

This essay is one of a number selected for The Veterinarian magazine Prize for Written Communication for Sydney University third-year veterinary science students.

OCTOBER 2021 TheVeterinarian 15

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Clinical Feature

Long-lasting Bravecto: A game-changer for dogs in remote Indigenous communities

Deepa Gopinath is a Technical Services Veterinarian (Companion Animals) for MSD Animal Health in Sydney.

She has previously spent many years in small animal practice in both Australia and in the UK, including a rotating internship at the University of Glasgow and a small animal surgery teaching registrar position at The University of Sydney, Faculty of Veterinary Medicine.

Gopinath obtained her membership to the ANZCVS in small animal surgery in 2008. She holds an MBA from Macquarie Graduate School of Management and is also a freelance writer and social media manager.

This article was supplied by MSD Animal Health.

■ www.theveterinarian.com.au

Provision of veterinary care and maintenance of optimal animal health in rural and remote Indigenous communities around Australia has long been a challenge. Access to resources such as funding, qualified professionals, veterinary equipment, and medications is limited at the best of times, with seasonal factors adding complexity to the problem. “During the wet season, many of these areas are inaccessible by road for three to four months per year,” Bonny Cumming, Program Manager-Strategic Delivery, for Animal Management in Rural and Remote Communities (AMRRIC) said.

The small animal population is mainly made up of dogs, with a small and slowly growing population of cats in some communities, likely an effect of better control of the dog population. While the animals that live within these communities are often cherished by members of those communities, regular veterinary care and prophylaxis is simply not an option due to limitations in accessibility and affordability. Events such as the COVID pandemic as well as the recent rapid spread of canine ehrlichiosis, a tick-borne disease, have further added to these challenges.

The nature of diseases seen among the communities’ dogs has evolved over time. “Twenty to thirty years ago, the diseases seen were related to uncontrolled breeding and intense competition for resources” Cumming said “Among these were malnutrition, parvovirus and intestinal worm infestation. Brown and colleagues’ publication in 2006 showed that in a few years earlier in one community, up to 74 per cent of dogs had alopecia attributable to mange, prior to commencement of ectoparasiticide treatment.”1 Samantha Phelan, a veterinarian with Roper Gulf Regional Council who works closely with AMRRIC, agrees with these observations.

“Whilst there is still a scabies threat from fringe dwelling semi-feral dogs, scabies is all but gone from the pets in communities where I work.

Ringworm, parvovirus, dog fight wounds and now sadly Ehrlichia canis spread by brown dog ticks are the most commonly encountered sicknesses” Phelan said.

The work of AMRRIC and other organisations in providing prophylactic treatments such as desexing, vaccination and parasite control has certainly had a positive impact on reducing diseases such as mange and transmissible venereal tumour in dogs.

In addition to the impact of poor health on dog populations, public health effects cannot be understated.

“It is difficult to assess the true impact of the many potential zoonotic threats as there is a paucity of good research in this area” Phelan said. “Certainly, some intestinal worm infestations and Dirofilaria immitis have been implicated as worms of zoonotic potential in remote communities. Protozoal diseases of giardia and cryptosporidium can be shared between animals and

humans and close contact environments favour the spread of bacterial diseases such as Streptococcus spp.

Staphylococcus spp. and Salmonella enterica. Ticks, fleas, and scabies all cause local irritation. Skin breaks due to itching in people can quickly result in streptococcal infections in tropical environments. Skin infections and those related to tonsillitis are largely responsible for the high rates of rheumatic heart disease experienced by people living in remote communities.”

“The mental health burden of living with sick or dying animals in a home can also not be overlooked,” Phelan – who has been working in the area for more than 20 years – said.

Veterinarian Nicole Laing of Murdoch on the ROAD (Remote Outreach Animal Desexing) organises regular veterinary trips to regional and remote Western Australia. Like

and now to some extent, dogs, are regarded as sacred animals in some Aboriginal cultures. Certain dogs are formally included into family units by being given ‘skin names’, which automatically gives the dog a status as a family member.

Understanding animal and public health issues also requires some understanding of Aboriginal and Torres Strait Islander cultures and the changes brought to Indigenous communities by Western culture.

“One of the impacts of colonisation is that Aboriginal and Torres Strait Islander people have lost aspects of their traditional lifestyles within one or two generations,” Cumming said.

“The transition to permanent residence in one area leads to more densely population areas, which in turn can facilitate higher parasite burdens within animal and human populations.”

Puppy with brown dog ticks attached in ear canal. Picture Nicole Laing

the work of AMRRIC, the trips have a significant animal welfare benefit as well as positive impacts on the local Indigenous community and regional towns through education, control of free roaming dog populations and preservation of the pure dingo genetic pool. However, in addition to these benefits, the program also enables final year veterinary students to build skills in surgery, anaesthesia, and preventative medicine, while being closely supervised by qualified veterinarians.

Apart from logistical challenges, Laing identifies gaining trust of the communities as a significant hurdle.

“We gain trust by employing transparent practices such as an open-door policy for anyone in the community who wants to observe the surgeries, using local liaisons, and trying to return to the same communities with some familiar staff,” Laing said.

AMRRIC has a profound understanding of the importance of building trust within the communities they service, with new volunteers undergoing cultural orientation prior to working with the organisation. The organisation recognises and respects the human-animal bond within these communities. For example, dingoes

Canine ehrlichiosis is a reportable disease that was first confirmed in Australia in May 2020. Brown dog ticks, widespread in the Northern regions of Western Australia, Northern Territory and Queensland, act as vectors of the bacterial infection. While there is no extensive prevalence data yet, AMRRIC's collated observations and reports from veterinary service providers and community stakeholders suggest that in the Top End region of Australia, 70–100 per cent of dogs may be infected.

“The mortality we are seeing and hearing in remote communities seems to be greater than that reported internationally,” Cumming said. “The acute phase of the disease appears to have a 10–30 per cent mortality rate.

Mortality rate is likely higher than this when deaths during the chronic phase are considered. Often in the communities we service, treatment options are limited as treatment involves a 28-day antibiotic course and for various reasons, compliance can be a challenge.”

Phelan agrees that the effects of the emerging tick-borne disease have been devastating. “With the high tick burdens experienced in many OCTOBER 2021 TheVeterinarian 17

Clinical Feature communities the spread of E. canis through our region has been shockingly rapid. Losses of 20–50 per cent of dogs over a 12-month period have appeared as the new normal in this naïve dog population. It has been tragic.”

Much of disease control in these communities lies in instituting regular and timely prophylactic interventions such as desexing, vaccination and parasite control. In addition to long-standing geographical, cultural, financial, and logistical challenges faced by the organisations servicing these communities, the current COVID pandemic has added another layer of complication.

“Initially, internal borders to communities closed for a 3-month period. Severe welfare cases were brought to police checkpoints for assessment in non-contact consultations,” Phelan explained “Council have managers in each community, many of whom stepped up to a paraveterinary role where required. The setback of visits over the next six months unfortunately also coincided with the spread of E. canis through communities, which led to the tsunami of cases communities experienced from October through to January this year.”

Administering regular, effective parasite control to dogs in remote communities has been a long-standing challenge for AMRRIC, local councils and outreach programs that service the communities. Many parasiticides require at least

Dog being treated with Bravecto Spot-on for Dogs. Picture Julia Salt, Mimal Land Management

Puppies being treated for ringworm. Picture Nicole Laing

monthly application to achieve optimal efficacy and monthly access to each community is often not possible due to geographical factors and limited resources. Bravecto (Intervet Australia Pty Ltd trading as MSD Animal Health) is a longlasting ectoparasiticide which contains the active ingredient fluralaner, a member of the isoxazoline class of compounds. The long duration* of Bravecto Chew and Bravecto Spot-on for Dogs makes it ideal for use in situations where monthly dosing, a requirement of other isoxazolines on the Australian market, is difficult or not possible.

In the last two years, MSD Animal Health has worked with organisations such as AMRRIC, Mimal Land Management and Department of Primary Industries and Regional Development (DPIRD) to make Bravecto much more accessible for use in the areas they service. Under the Bravecto Cares corporate social responsibility program, large volumes of Bravecto have been provided as samples and otherwise at heavily subsidised rates. The company has provided comparable benefits to smaller groups such as Murdoch on the ROAD. Sam Phelan describes Bravecto as a ‘game changer’ in its’ ability to control tick populations in an area where ehrlichiosis is endemic. While Bravecto does not specifically have a claim against E canis infection, its ability to effectively control fleas, brown dog tick and paralysis tick simultaneously with administration every 2 months for Bravecto Chew and every 12 weeks for Bravecto Spot-on for Dogs makes it a parasiticide of choice to use in such programs*.

“We are in desperate need of Bravecto in many of the communities I service” Phelan said. “We have approximately 2500 dogs in our region.

In some of these communities I would estimate E. canis prevalence of 80 per cent. Bravecto has certainly been the most valuable product in reducing overall tick burdens in houses. I feel the most important thing now is to drastically decrease brown dog tick populations across our region. The aim is to prevent it becoming an intergenerational dog illness.”

Aside from its dramatic effect in reducing tick burdens carried by community dogs, Bravecto has had a profound effect on dogs who suffer flea infestations and mange. “When we’ve used Bravecto in mange cases, the results have been almost miraculous,” Cumming said. Sarcoptic mange in particular is a zoonotic disease, and effective treatment of this disease in dogs will no doubt have positive public health impacts.

MSD Animal Health hopes to continue its relationship with the organisations who provide veterinary care to remote communities around Australia. The long-lasting features of Bravecto products make the products uniquely suited to positively impacting animal health in these communities.

“The use of Bravecto in these communities is likely lifesaving. I am very thankful for the support from MSD,” Nicole Laing said – truly feedback which makes it particularly worthwhile to continue the Bravecto Cares program. *See product label for full claim details.

This article was provided by MSD Animal Health.

References Brown GK., 2006. Dogs, Dwellings and Disease: A Study of Free-Roaming Dogs in a Remote Aboriginal Community. Thesis. School of Environmental and Life Sciences, University of Newcastle.

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

Have you ever thought you would like to write a clinical review but don’t know where to start? Do you have a hobby or history that you think vets everywhere would like to learn more about?

Then don’t delay – email The Veterinarian at editor@vetmag.com.au and let us know – because your words could be in the pages of next month’s issue!

18 TheVeterinarian OCTOBER 2021

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Case Study

Buttercup’s big week -- lambing over 72 hours!

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

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

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Clinical history Buttercup is a healthy five-year-old Dorper cross White Dorper ewe. She was joined with a Dorper ram for four weeks and had a condition score of four at the time of joining. Buttercup is known to be a very fertile ewe, who usually lambs around 147-149 days post-joining. In 2018 and 2019 she had single female lambs, and in 2020 she had a single male lamb. At each lambing, Buttercup lambed uneventfully and without assistance.

Buttercup has been vaccinated with a 6-in-1 vaccine annually, had Gudair at eight weeks of age and has been drenched with a registered anthelminthic periodically according to a strategic drench plan. Her owners also have two other Dorper cross White Dorper ewes, who live with Buttercup in a well-grassed paddock.

All three ewes were joined with a Dorper ram at the same time, and do not receive any supplementary feed apart from some sheep pellets.

Presentation The owner reported that Buttercup had delivered one lamb at 7:00am on Tuesday 28 September 2021, and that both she and her lamb were doing well. Buttercup had cleaned the (male) lamb well and was not displaying any further signs of lambing; she had passed the placenta and the lamb was bright and alert and drinking from the ewe’s udder well.

On Thursday, 30 September 2021 in the afternoon, the owner was surprised to see Buttercup acting like she was lambing again – and at 4:30pm (approximately 57 hours after the first lamb was born), another healthy lamb was born – this time a small female. Again, Buttercup cleaned the lamb well, passed the placenta without incident, and the lamb was bright, alert and drinking from the ewe’s udder. Buttercup settled down with her twins before nightfall and the other two ewes in the paddock watched-on, showing no signs of lambing. The owner did one final check later that night and all was well with the ewes and both lambs.

The following morning (Friday, 1 October 2021), the owner went out to feed Buttercup early and was astonished to see Buttercup with the original two lambs, and now an additional set of twins! They were clearly hers, and when the owner looked at the two other ewes, it was obvious that they hadn’t lambed.

Buttercup had cleaned both new lambs well and was very attentive to them too. The new twins were both males, non-identical, bright and healthy.

The owner later admitted that she had been flabbergasted – and took a lot of photos!

While quietly watching the new family, the owner noticed that the second born lamb – the female – didn’t have a ‘milk tummy’ and seemed fairly hollow in the abdomen. She was also fairly quiet. The owner thought that Buttercup may not be letting her drink but there were no obvious signs that Buttercup had rejected the lamb as she was happy to nuzzle her.

But she noticed that Buttercup was

not interested in letting the little ewe-lamb feed. Suspecting that the little lamb might not be drinking and knowing how quickly lambs can ‘go down-hill’, the owner decided to try and bottle feed the lamb (now called Pip) with some milk replacer (Profelac) and see if she was hungry.

Pip took to the bottle instantly and drank over 60ml, which confirmed the owner’s suspicions. The owner decided to keep Pip in the house and bottlefeed her every 3-4 hours for a couple of days. Pip was about half the size of her siblings so no-one was overly confident that she would survive being so small – but she did!

Another ewe in the paddock (named Green Tag) gave birth to a single (female) lamb a week after Buttercup, and the following week (i.e., a fortnight after Buttercup had given birth to her quads), the third ewe in the paddock (named Big Bertha) gave birth to twin girls. The owner said that these twins were the same size at birth as the two-week old lambs.

Discussion 1. Similar reports?

A search of the internet revealed some similar occurrences. That’s Farming’s Catherina Cunnane spoke to a farm family in 2020, after they had a ewe give birth to twin lambs ten days apart.

Christina Brady, who runs Graune Pet Farm and Play Centre in Ballyhaunis, Co. Mayo, said: “It was a big surprise when I came across this lady giving birth ten days after her first lamb… she is doing well and looking after both lambs”.

A sheep farmer from Anglesey in Wales, Rhys Peters, had a Lleyn Suffolk cross ewe gave birth to a single health lamb before having three more lambs 18 days later. The Daily Post in the UK reported that two small lambs survived and were doing well.

Mr Peters was worried that as the ewe first gave birth two weeks ago her first milk, which contains anti-bodies, would not be there for the new lambs, but he was reassured this should be okay. Farmers and vets described it as a “very unusual” case. Mr Peters said that “the vet was very surprised at what had happened as were more experienced farmers who I phoned – many had never heard of it happening while someone else only remembers one case 25 years ago in Rhosgoch, which shows how unusual this is.”

Mis-mothering is a possible explanation for such events, but Mr Peters insisted it was the same mother who gave birth to the all the lambs.

Anglesey vet Facundo Gil, from the Bodrwnsiwn veterinary group, said: “This is very unusual indeed – normally when the lambing process starts the ewe will give birth to all the lambs... I’ve never come across a case like this before. It is also unusual that two of the remaining ewes survived but that is very good news.”

On the Accidental Landholder website, there are similar stories.

In 2011, AndyR wrote We have an unusual happening. One of our Llanwenog ewes produced a ewe lamb, which suckled OK but unfortunately died a day later for no obvious reason. This same ewe then produced twin ram lambs 8 days later both of which are doing well. Talking

Tuesday 28 September 2021, 7:00am.

First lamb (a male)

Tuesday 28 September 2021.

Buttercup and her first lamb

Thursday 30 September 2021, approximately 57 hours after the first lamb was born. A second lamb (a female)

70 hours after the first lamb was born – new twin lambs. Buttercup and her 4 lambs OCTOBER 2021 TheVeterinarian 19

Case Study to our local expert, who is lambing 400 ewes, he has seen it very occasionally, but our sheep bible only mentions delays of up the 12 hours (not 8 days).

Beewyched (2011) wrote: We don't have sheep at the moment, but I remember my parent's sheep - a "speckle face" cross-breed used to have triplets most years & on one occasion had the smallest, again a ewe lamb, & then had the 2 boys the next day (a gap of at least 20 hours if I recall).

SallyintNorth (2011) wrote: A few years ago we had a pair of unclaimed but licked lambs appear overnight in well-walled field in which there were only lambed ewes and their lambs! The only possible xplanations were (a) that a ewe had produced a pair of lambs several days after producing one or more lambs, (b) a ewe had pinched another ewe's lambs and produced milk for them several days before having her own lambs - and then licked and then ignored her own lambs, or (c) an alien spacecraft had abducted a pair of newborn lambs for investigation and then returned them to the wrong field. They were nice ewe lambs who were initially known as The Alien Twins. I still have Starlight, who got fostered onto another ewe; I can't remember whether we fostered Moonlight and whether she got kept on or sold as a breeding ewe lamb.

Starlight will have her second crop in a week or two.

Her first lamb was a corker, wish we knew how we'd bred its mother!

FreddiesFarm (2011) wrote: I have had a similar thing where the ewe aborted one lamb a week early and then lambed the others successfully a week or so later. The other weird thing we had was picked up first by the scanner. He said quads and he said two large and two small. She lambed twins and all seemed well and I thought the scanner had got it wrong or she had reabsorbed the other two and then 17 days later (so next cycle) she produced another pair. She had been kept in with her lambs for some reason, so there was no doubt about who they belonged to. To make things more interesting the first lambs where lleyn on lleyn and the second ones where Hampshire on lleyn as we had changed the ram over in between!

The Farmers Journal (2020) ran a story about a Co Derry sheep farmer who helped his Lleyn ewe give birth to triplets 17 days after she had triplets. And in the Farmers Guardian (2019) a sheep farmer spoke of her surprise after an in-lamb ewe gave birth to two sets of twins 24 hours apart.

2. Twinning Multiple pregnancies can occur if the ewe releases more than one egg during her cycle and each egg is fertilised by a sperm, and implants in the uterus. The two embryos that result are dizygotic, not genetically identical, and can be the same or different sex. This is called fraternal twinning or non-identical twinning. Fraternal multiples are siblings conceived at the same time, and may look very similar. Fraternal multiples each have a separate placenta and amniotic sac.

Quite often this is the type of twinning that occurs from assisted reproduction procedures.

Sometimes, one egg is fertilised and then splits into two or more embryos. This is called identical twinning. Each embryo is monozygotic, genetically identical, and both will be the same sex. Depending on when the division occurs, identical twins may have separate (individual) placentas and amniotic sacs, or they may share a single placenta but have separate amniotic sacs.

Most share a placenta with separate sacs. Rarely, identical twins share one placenta and a single amniotic sac.

In twin and multiple pregnancies, the birth of the first fetus is usually followed by the birth of the second and subsequent fetuses in a short-time interval. Twin pregnancies almost always deliver early. Multi-fetal pregnancies are often complicated by spontaneous preterm delivery. As the number of fetuses increase, the expected duration of the pregnancy decreases.

In humans, the average duration is 40 weeks for singles, 35 weeks for twins, 33 weeks for triplets, and 30 weeks for quadruplets.

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In humans, in selected cases, preterm delivery of one fetus may not require the immediate birth of the remaining fetus. Delayed-interval delivery is characterised by an unusually long time after the birth of the first fetus, allowing the remaining fetus to stay in utero until reaching viability. Delayed-interval delivery is regarded as being a rare, ‘exceptional circumstance’ procedure (The Royal Women’s Hospital, 2020); it has been used in conditions such as cervical incompetence, and premature labour when the underlying pathology will not place the remaining fetus or fetuses at risk (Umstad, 2021); it can be highly effective.

Buttercup and her 4 lambs

Pip in her ‘night room’

Pip with two of her brothers

Buttercup feeding her lambs

3. Uterus didelphys In humans, uterus didelphys is essentially a double uterus. It is a type of Müllerian duct anomaly (class III) where there is complete duplication of uterine horns as well as duplication of the cervix, with no communication between them. It is surprisingly common, with an estimated 1 in 2000 women having it. The odds of conceiving one twin in each uterine horn are 1 in 25,000, and the odds of a pregnancy developing in its own womb are miniscule at 1 in 50 million. Given Buttercup’s known reproductive history, it is unlikely that she has any reproductive abnormalities, such as a double uterus.

4. Superfetation A rare phenomenon, in which two fertilised eggs are implanted in the uterus at different times, is known as superfetation; so there is the simultaneous occurrence of more than one stage of developing offspring in the same animal. Upregulation of the hypothalamic – pituitary – ovarian axis by luteal and then placental progesterone in the first trimester of pregnancy suppresses ovulation and makes the possibility of spontaneous superfetation a very unlikely phenomenon (Umstad and Craig, 2019).

5. Implantation and placenta In sheep there is close attachment between the embryonic membranes and the endometrium overlying the caruncles at 3 weeks and shortly thereafter, the placenta is formed.

Ruminants have a cotyledonary placenta which consists of the cotyledon (fetal side of the placenta), caruncle (maternal side of the placenta) and the placentome (a cotyledon and caruncle together). Pregnant sheep, goats and cattle have between 75 and 125 placentomes. The caruncles are round or oval thickenings in the uterine mucosa and are the only site in the uterus to form attachments with the fetal membranes. Patches of chorioallantoic membrane become cotyledons by developing villi that extend into crypts in the caruncular epithelium.

During parturition, there is considerable loosening of the cotyledonary villi from the caruncles, and the placentomes expand laterally.

After expulsion of the fetus and loss of fetal circulation to the cotyledons, capillaries within the villi collapse, leading to a reduction in size. The uterus contracts and the caruncles shrink, augmenting separation of the cotyledons from the caruncles. Usually, fetal membranes with cotyledons are delivered within 12 hours of birth. Ruminant placentation is non-deciduate, as there is no significant loss of maternal tissue.

6. Gestation Gestation in sheep varies from 142 to 152 days, with the average being 147 days. Individual pregnancies may vary from 138 to 159 days.

During this time every part of the reproductive system shows some changes. The uterus shows the most striking changes, increasing its weight 15-fold; indeed 100-fold if its contents are included. Physiologically, uterine and umbilical blood flows increase continuously during OCTOBER 2021 TheVeterinarian 21

Case Study pregnancy to meet the increases in nutrient demand for fetal and placental growth.

While the majority of fetal growth occurs in the final 60 days of gestation, poor nutrition throughout pregnancy can affect growth and development of the lamb by restricting the growth of the placenta and the foetus itself.

The placenta and fetus are most susceptible to maternal nutritional restrictions during the periods when their growth is most rapid.

For the first 50 days of pregnancy, growth of the placenta and fetus is minimal, while in midpregnancy (days 50-100), growth of the placenta is rapid while fetal growth is minimal. In late pregnancy, from days 100-150, growth of the placenta has finished but growth of the fetus increases rapidly until birth.

Consequently, inadequate or poor maternal nutrition in mid pregnancy can reduce the size and function of the placenta, while nutrient restrictions during late pregnancy can reduce the growth rate and size of the fetus.

Interestingly, a Merino lamb's future wool production is affected by the ewe’s nutrition during pregnancy. The effects of early and late pregnancy nutrition on progeny wool production and quality are permanent throughout the animal's lifetime and they can never be fully compensated for by improved nutrition after birth.

Pip with her older brother

Big Bertha and her twin girls

Primary follicles (broad fibres) develop in the fetus from around day 60 postconception and are completed by about day 90. Secondary follicles (fine fibres) develop from around day 90 through to birth, with some follicle maturation occurring in the first month of the lamb's life. The density of follicles is determined prior to birth and will not change for the entire life of the lamb.

A reduction in nutrient supply to the developing fetus at the time of secondary follicle development (e.g. because of poor nutrition or because there are multiple foetuses competing for the available nutrients) will lead to less secondary fibres, resulting in broader fibre diameter and lower fleece weight. These effects persist throughout the lamb’s life. There are linear relationships between changes in ewe condition and the amount and quality of wool produced by single and twin lambs.

The major hormones of ruminant placentae are progesterone and other progestins, ostrogens and placental lactogen. The sheep placenta produces enough progesterone that, by about day 70, the corpora lutea can be removed and pregnancy will continue uninterrupted.

In contrast, luteal progesterone is required throughout gestation in cattle and goats because their placentae secrete much smaller quantities of progesterone. In reality, in goats, a large amount of progesterone is synthesised by the placenta, but most is converted to a biologically inactive pregnane before secretion. Sheep placental lactogen is secreted in very large quantities, beginning at about day 50 and remaining high throughout gestation. It also accumulates to high concentrations in the serum of fetal sheep (Bowen, 2000).

7. Parturition (labour) Pre-parturition is the period before labour begins, when the balance of the hormones, oestrogen and progesterone, changes and the 22 TheVeterinarian OCTOBER 2021

placenta is at the point of decreased viability and slows down in the production of progesterone.

There is some evidence to support the theory that the fetus releases surfactant, a substance secreted by the fetal lungs, which causes a shift in hormone levels. There is a protein within the lung surfactant that serves as ‘a hormone of parturition’ that signals to the uterus when the fetal lungs are sufficiently mature to withstand the transition to air breathing. Interestingly the mother’s body, as it nears parturition, increases the production of endorphins. Endorphins can alter the perception of pain and stress, and are also associated with a feeling of wellbeing.

The body naturally produces endorphins to help the mother cope with the pain and stress of labour.

In addition, increasing fetal plasma cortisol concentrations result in an increase in ostrogen and a decrease in progesterone in maternal plasma through induction of the P450c17 α hydroxylase enzyme accompanied by increased uterine prostaglandin production. These changes lead and contribute to: efficient and coordinated myometrial contractions, cervical dilation, and fetal and placental delivery. Estrogen can stimulate all the essential steps required to bring about the onset of parturition but by itself, it cannot complete the parturition process. Other mechanisms have to interact with ostradiol to carry parturition to completion; progesterone, for example, facilitates separation of the placenta and fetal membranes (Wu et al, 2004).

The uterus contracts as soon as it is emptied and undergoes a very rapid atrophy in which one-third of its weight is lost within a couple of days, and a second-third before the end of the first week. Involution of the vulva, vestibule and vagina is slower.

Conclusion Why, and what physiological mechanisms/ environment permitted Buttercup to have her four lambs over a period of 70 hours, with two singles being born first approximately 57 hours apart followed by a set of twins approximately 70 hours after the first lamb, is unknown.

But, the adventure Buttercup and her owners had makes for an interesting journey.

Ewe with afterbirth

The placenta after being expelled

natural level of prostaglandin increases. This increases the sensitivity of the cervix to oxytocin; oxytocin is released from the pituitary gland and levels rise at the onset of parturition, causing regular contractions of the uterus and abdominal muscles which push the fetus out.

Another hormone released during parturition is prolactin.

What stimulates this change in hormone production prior to parturition? It could be the

Selected references 1. https://thatsfarming.com/farming-news/ ewe-gives-birth-to-twin-lambs-10-days-apart https://thatsfarming.com/farming-news/ ewe-gives-birth-to-twin-lambs-10-days-apart/ 2. www.dailypost.co.uk/news/local-news/ ewe-miracles-lambs-born-three-2636726 3. www.accidentalsmallholder.net/forum/ sheep/lambing-delayed-birth/ 4. www.farmersjournal.ie/watch-lleyn-ewe-hastwo-sets-of-triplets-born-17-days-apart-533447 5. www.fginsight.com/news/news/ewe-expecting-twins-has-two-sets-of-miracle-lambs-24hours-apart-82206 6. www.reproductivefacts.org/ 7. Bowen R (2000) Placentation in Ruminants.

Available at www.vivo.colostate.edu/hbooks/ pathphys/reprod/placenta/ruminants.html 8. Larsen (2021) www.msdvetmanual.com/management-and-nutrition/management-of-reproduction-sheep/reproductive-physiology-of-sheep 9. Umstad MP and Craig JM (2019) Twins and twinning. In: Emery and Rimoin's Principles and Practice of Medical Genetics and Genomics (Seventh Edition).

11. Umstad M (2021) Delayed interval delivery in multiple pregnancy. Australian Multiple Birth Association. Available at www.amba.org.au.

12. WA AGRIC (2018) Managing pregnancy in ewes (2018). Available at www.agric.wa.gov.au/ management-reproduction/managing-pregnancyewes?page=0%2C1 13. Wu WX et al (2004) Prostaglandin Mediates Premature Delivery in Pregnant Sheep Induced

by Estradiol at 121 Days of Gestational Age. Endocrinology, Vol 145(3): 1444–1452.

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Clinical Review

Management of acute laminitis

Tania Sundra BSc.(Hons) BVMS MANZCVS (Equine Medicine) Avon Ridge Equine Veterinary Services, Brigadoon, WA, Australia Tania Sundra graduated from Murdoch University in 2009 and completed an equine internship at a busy performance horse hospital in the USA. Upon returning home she spent a few years working in racetrack and repro clinics in Western Australia. In 2015, Sundra founded Avon Ridge Equine Veterinary Services – an ambulatory equine practice servicing Perth and surrounding regions.

In 2019, she successfully completed examinations to become a member of the Australian & New Zealand College of Veterinary Scientists, Equine Medicine chapter.

Sundra has a keen interest in all things related to equine medicine, particularly gastroenterology, endocrinology and emergency and critical care.

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Introduction Acute laminitis is a painful and severely debilitating condition commonly encountered in equine practice (Figure 1). Recent studies in Australia estimate that at least 15 per cent of horses and ponies had been diagnosed with laminitis, and more than half those animals had suffered recurrent episodes1. Laminitis can be defined as inflammation of the lamellae within the foot which causes disruption and weakening of the structures between the distal phalanx and hoof capsule and may potentially lead to lamellar failure2. The acute phase of laminitis begins at the onset of clinical signs which may include varying degrees of lameness in one or more hooves, increased digital pulses, stiff gait, weight shifting, reluctance to move or sensitivity to hoof testers over the sole, particularly toward the toe3.

Three distinct forms of laminitis have been identified; inflammatory/sepsis related laminitis, supporting limb laminitis and “endocrinopathic” laminitis2. Endocrinopathic laminitis accounts for the vast majority of cases of laminitis4,5 in equine practice and the increasing prevalence of this condition likely parallels the rise of obesity in equids6. Acute laminitis should always be considered a medical emergency and treatment should be instituted immediately at the onset of clinical signs. Irrespective of the underlying cause, the principles of therapy are threefold: treat the underlying cause, provide analgesia and provide biomechanical support to minimise structural damage within the hoof. Regular assessment of the patient is imperative to gauge clinical response, adjust treatment and minimise suffering.

Endocrinopathic laminitis Equine metabolic syndrome (EMS) and pituitary pars intermedia dysfunction (PPID) are the two endocrinopathic disorders associated with laminitis4.

The central features of EMS (Figure 2) are insulin dysregulation, obesity (regional or general) and a predisposition for laminitis7. Recent studies were pivotal in demonstrating that protracted increases in insulin led to the development of laminitis8,9 and reduction in hyperinsulinemia has therefore become fundamental to both the prevention and management of laminitis in horses with EMS. Dietary management is critical in limiting hyperinsulinemia and thus the prevention and management of endocrinopathic laminitis. At the onset of clinical signs, the patient should be removed from pasture and placed on a diet low in non-structural carbohydrates (NSC) with the aim of preventing elevations in insulin levels in response to high dietary sugars.

This may be achieved by feeding a forage-based ration consisting of <10 per cent NSC (eg. rhodes grass or lucerne hay) totalling approximately 1.5 per cent body weight7. A ration balancer should also be fed to ensure adequate intake of protein, vitamins and minerals7.

Figure 1. 10yo Welsh pony, shifting weight caudally in the typical laminitic stance

Figure 2. 12yo Paint mare displaying the typical obese EMS phenotype

In addition to dietary management, medical intervention may also hasten the recovery from laminitis.

Metformin has historically been used in an attempt to limit hyperinsulinemia but oral bioavailability in horses is poor and studies showing its effectiveness at improving insulin sensitivity have yielded inconsistent results10–12. Recent studies have demonstrated that the administration of levothyroxine (0.1mg/kg PO SID) to obese horses with a history of laminitis results in both weight loss and improvements in insulin sensitivity compared to controls13,14. A number of reports have also shown that levothyroxine is safe and well tolerated even when used for very long periods or at high doses13,15,16. There are levothyroxine tablets and liquids registered in Australia for human and canine use but these products have limitations in horses and a compounded flavoured levothyroxine paste is also available. Whilst not registered for use in horses, sodium-glucose cotransporter 2 inhibitors (SGLT2i) offer a novel treatment option for hyperinsulinemia. SGLT2i promote urinary glucose excretion, thereby lowering blood glucose levels and reducing

serum insulin concentrations17,18.

Recent experimental studies have demonstrated the effectiveness of the SGLT2i in the treatment of hyperinsulinemia19–21. Ertugliflozin (Steglatro: Merck, Sharpe & Dohme) is the newest SGLT2i developed for human medicine. A recent case series demonstrated that ertugliflozin significantly reduced insulin concentrations and improved laminitis scores in eleven horses and ponies with laminitis22.

Whilst larger clinical trials are warranted, this study suggests that ertugliflozin may be an effective pharmacological aid for the treatment of hyperinsulinemia and the prevention of endocrinopathic laminitis in horses. In addition to being available as a human tablet preparation, ertugliflozin is also compounded as a palatable paste (BOVA Aus) for horses, overcoming compliance issues that may occur with the tablets.

Pituitary pars intermedia dysfunction (PPID) is a condition affecting aged horses and results from loss of dopaminergic inhibition at the pars intermedia23,24. The link between PPID and laminitis remains to be elucidated. Studies suggest that insulin dysregulation occurs in approximately OCTOBER 2021 TheVeterinarian 23

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Clinical Review

Christopher Beggs CPF APF-I Farrier The Biomechanic Vet, Swan View, WA, Australia Working as a fulltime farrier since 2012, Chris Beggs travelled to the USA to further his education with internationally renowned farriers before attaining his certified professions farrier accreditation with FITS (Farrier International Testing System) in 2018.

In 2019, Beggs was accepted into the Doctor of Veterinary Medicine degree at Murdoch University.

Due to graduate in 2023, he looks forward to combining his farrier experience with his DVM and hopes to increase interdisciplinary collaboration between the professions. Beggs is also actively involved with Animal Aid Abroad and provides voluntary consultancy farriery services to working equids in the developing world.

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30-60 per cent of PPID cases24,25 and those with concurrent PPID and hyperinsulinemia may be at a higher risk of developing laminitis25.

Whether the two conditions are linked has not yet been determined and it has been proposed that EMS and PPID may simply occur concurrently without any causal association25.

These findings would therefore strongly suggest that insulin dysregulation should be investigated in all cases of PPID-associated laminitis26.

Pergolide, a dopamine agonist, has been the mainstay of PPID treatment for over two decades. Whilst pergolide use is associated with improvement in many of the clinical signs of PPID, there is currently no evidence which suggests pergolide reduces the incidence of laminitis or improves insulin dynamics27. A study in Australia demonstrated that the administration of pergolide was strongly associated with survival,26 however compliance associated with daily, oral administration can be poor. A recent report highlighted that more than 50 per cent of horses did not receive the recommended dose of pergolide28.

Cabergoline has a similar mechanism of action to pergolide and is available as a compounded, long-acting intramuscular injection (BOVA Aus).

Cabergoline has been used in the USA (Cabergoline: BETPharm) for a number of years with reportedly good anecdotal response to treatment.23 The results from a small number of horses with PPID treated with the long-acting cabergoline injection in Australia demonstrated that it is effective in suppressing pars intermedia output for an extended period of time. Cabergoline may be a therapeutic alternative for horses that are refractory to daily pergolide administration.

Inflammatory/Sepsis-related laminitis Laminitis associated with inflammation/sepsis accounts for approximately 12 per cent of owner-reported cases29.

Ingestion of excessive amounts of carbohydrate (e.g. grain overload)4 leads to a drop in pH in the large colon which causes the lining of the hindgut to deteriorate and absorption of toxins into the systemic circulation occurs30. These toxins and subsequent systemic inflammatory response may be important factors in lamellar injury and the development of laminitis25.

If inadvertent grain overload is recognised early enough, gastric lavage to prevent ingested contents from reaching the large colon may prevent clinical progression. Mineral oil administered by nasogastric tube may encourage intestinal transit of grain, although evidence to support its use is lacking.

Laminitis may also develop as a consequence of diseases which cause a systemic inflammatory response syndrome such as colitis or pneumonia. This tends to be more commonly seen when gram-negative bacteria or endotoxins are driving the sepsis31.

One study also suggested that insulin resistance will be exacerbated in horses or ponies that develop endotoxemia, with the administration of levothyroxine for 15 days beforehand, being protective against endotoxin-induced insulin resistance32.

Theoretically reduction in insulin resistance may reduce the risk of laminitis.

Horses exhibiting clinical signs of endotoxemia should be considered high risk for developing laminitis and preventive measures such as foot supports and digital cryotherapy (see below) should be considered as pro-active measures that may prevent or limit laminar damage27.

Supporting-limb laminitis Supporting limb laminitis develops due to increased loading on a single limb as a result of reduced loading of the contralateral limb. In horses, cyclic loading and unloading plays a role in promoting blood flow through the foot, so if there is a prolonged mechanical overload on one digit without sufficient periods of unloading, inadequate perfusion and ischaemia may develop33. Horses with poor hoof quality and those with a long-toe, low-heel are considered to be at increased risk34.

Therapy should be aimed at increasing the level of the comfort in the lame limb whilst supporting the contralateral, weightbearing limb. This can be achieved by raising the heels and loading the palmar aspect of the foot to decrease tension on the deep digital flexor tendon. This support should ideally be initiated early in treatment, prior to the development of laminitis in the supporting limb.

Pain management Failure to adequately control pain is one of the primary reasons laminitic horses are subjected to euthanasia35.

Pharmacological intervention should provide analgesia without encouraging excessive movement. Non-steroidal anti-inflammatories (NSAIDs) are the most commonly used, first-line analgesics for horses with laminitis35.

Phenylbutazone (2.2mg/kg) or flunixin (0.5-1mg/kg) will provide effective analgesia in most cases of acute laminitis. COX-2 selective NSAIDs (firocoxib, meloxicam) may also be utilised, although anecdotally their effectiveness for controlling pain associated with acute laminitis is inferior to the non-COX selective NSAIDs. Experimental evidence also suggests that non-selective cyclooxygenase inhibition produces superior analgesia than inhibition of either alone36.

Paracetamol is a commonly used analgesic in humans and may be considered as an adjunctive analgesic in patients who require additional pain relief. Although evidence is lacking for its use in horses, the use of paracetamol in one laminitic pony has been described37.

Opioids are typically used as an adjunct to NSAIDs in horses with severe pain35. The use of morphine, methadone, buprenorphine and tramadol have all been documented in horses35. A recent study also demonstrated that fentanyl, applied as transdermal patches was rapidly absorbed and no adverse effects were noted25.

Side effects associated with opioids include increased locomotion, excitation and impaction colic38 and the potential for misuse should be carefully considered. However, used appropriately the risk of adverse effects is low and opioids are able to provide potent analgesia and alleviate considerable

suffering in acute laminitis. Constant rate infusions of ketamine, lidocaine, acepromazine, xylazine and combinations thereof35 provide further options for analgesia, however their use necessitates hospitalisation which may pose practical challenges in some cases.

Strict confinement in deep bedding or provision of alternative solar support is essential to minimise stress placed on the dorsal lamellae during ambulation. Turning further increases shearing forces between the lamellae and the consequences of excessive movement should be emphasised to owners.

Stabling or confinement to a small fenced-off section of the paddock is required and if this is not available, then hospitalisation of the patient during the acute phase may be necessary and allows for close monitoring and improved case management.

Frequent assessment of the horse is important to monitor progression of disease and response to therapy.

A new laminitis grading scale has been recently developed by researchers in Australia39. The Meier scale provides veterinarians with a more reliable and consistent method to quantify the degree of lameness associated with laminitis and is a useful tool to monitor the clinical status of the patient.

Cryotherapy Digital hypothermia initiated during the developmental phase has shown to be an effective preventive measure in experimentally induced laminitis40.

Ideally, cryotherapy should be initiated early and continuously in the case of carbohydrate overload and sepsisrelated laminitis. To be effective, the entire distal limb should be submerged in a slurry of water and ice which may present practical challenges in both a hospital and field setting. However, given the proven benefits of cryotherapy in both endotoxemia-driven laminitis, clinicians should commence cryotherapy prior to the onset of laminitic signs. In the authors opinion, cryotherapy should be seen as a preventative rather than curative measure and it therefore has limited application in insidious endocrinopathic laminitis cases.

Mechanical-Support Remedial farriery of the laminitic patient focuses on improving comfort and providing mechanical support to prevent or limit displacement of the third phalanx41. Numerous methods have been described, with no single approach being suitable for all horses.

Peer-reviewed data documenting the efficacy of different farriery interventions is also lacking42. The greatest chance of a successful outcome relies on a cohesive team-based approach between the owner, the veterinarian and the farrier. The farriery plan has to be adaptable and a degree of trial and error is often required depending on each patient’s comfort levels.

Typically the dorsal laminae are the most severely compromised so it is necessary to redistribute load to the caudal half of the foot and reduce lever forces on the toe and tension from the deep digital flexor tendon41,43. Farriery “first-aid” should include the application of a supporting material such as dental impression material, foam pads or urethane pads OCTOBER 2021 TheVeterinarian 25

Clinical Review Figure 3. Step-by-step guide demonstrating the application of dental impressions material (DIM) and casting material to a laminitic hoof

David Rendle BVSc MVM CertEM(IntMed) DipECEIM FRCVS RCVS and European Specialist in Equine Internal Medicine EMT Consulting, Tiverton, Devon, UK Following graduation from The University of Bristol in 2001, David Rendle worked in farm animal and equine practice before and completing an internship at Liphook Equine Hospital.

After a three-year Horserace Betting Levy Board residency at The University of Glasgow and Liphook Equine Hospital, Rendle spent a number of years at Liphook Equine Hospital with a break to work in the Westcountry and Australia. He moved to Rainbow Equine Hospital in Yorkshire where he became a director prior to the hospital’s acquisition by the VetPartners group. In 2019, Rendle returned to his roots and now lives near family on the edge of Exmoor. He works as an independent equine medicine and therapeutics consultant around tending his sheep and is actively involved in clinical research.

Rendle has lectured and published on a broad range of topics but has particular interests in gastrointestinal and endocrine diseases. In 2019, he was made a Fellow of the Royal College of Veterinary Surgeons in recognition of his contribution to clinical practice. Rendle is Vice President of the British Equine Veterinary Association and is chair of their health and medicines committee.

26 TheVeterinarian OCTOBER 2021

1. The hoof should be cleaned thoroughly and antimicrobial clay is used to fill the collateral groves and a thin layer over the frog

2. Two-part impression material agents are then mixed together by hand until blended

4. DIM can also be extended around the toe rim, leaving a clear area over the tip of P3. A pad may be used over the DIM (not shown)

5. Casting tape is then applied by wrapping at 50 per cent overlap over the dorsal wall and bulbs. Working distally the cast will be folded over at the end to encase the foot

held in place with gaffa tape or casting material (Figure 3). Care should be taken if the sole is protruding or there is pain at the position of the tip of P3 padding material may need to be position to alleviate pressure in this region. This can be achieved by cutting the pad or working the impression material around the area. Commercial boots (eg. Softride, Easycare) are useful in the immediate relief of solar pain. The boots have pads of differing densities and thickness and both a shod and an unshod foot can be placed into the boot.

Standard shoes tend to distribute loading around the periphery of the foot which may potentiate laminar damage. Conventional shoes are better removed but the hoof capsule can be damaged inadvertently when removing the shoe and shoe removal should be performed as atraumatically as possible. This can be aided by removal of nails individually after rasping/buffering the clinches. In the case of an overgrown foot, it should be trimmed to bring the horses load under the foot while preserving sole depth over the tip of P3 (forward of the true tip of the frog). Wherever possible, trimming should be done via radiographic guidance.

High quality radiographs (LM, DP and DPrPaDiO views) provide useful information as to what kind of trimming/shoeing will be best suited for

each case44 (Figure 4). Use of perineural anaesthesia may help facilitate imaging in a painful horse. Softer x-ray blocks (SURE FOOT Comfort X-ray Block) are also available at a cost.

Remedial farriery can commence as the horse becomes more comfortable45. There are an overwhelming number of shoeing options available on the market and the number of materials and styles on offer are matched only by the number of claims each manufacturer makes of their product. When discussing the shoeing

Figure 4. Lateral radiograph of the foot showing rotation of the distal phalanx in relation to the hoof capsule

3. Apply DIM over the caudal foot to create a 8-10mm pad, extending over the bulbs at 2-3mm thickness to provide cushioning from the casting material

6. Place hoof on a rubber mat and allow horse to stand. Once set (time depends on brand) trim any cast impinging onto soft tissue, leaving the proximal third of the capsule free of cast. Cut any tags and rasp any unwanted edges

plan, it will pay dividends to use each farriers’ strengths and experience to achieve the desired goals. Importantly, before embarking on any remedial farriery, expectations and cost need to be discussed with the owner. The shoeing materials alone start at around two to three times that of regular materials and will be required at more frequent intervals (every two to four weeks). The condition and health of the feet along with the horse’s level of work prior to the laminitic episode will contribute to the prognosis and expected recovery time.

Traditionally, Heart Bar Shoes (HBS) have been a mainstay for laminitic horses with the basic premiss being a plate covering the frog provides support to P3. However, modern materials allow for a wider range of fitting options and may provide more effective support compared to traditional HBS46. A recent study47 demonstrated increased comfort levels when a thermoplastic, mouldable, glue-on frog-supportive shoe (Imprint Shoe) was applied to the hooves of hyperinsulinemic Shetland ponies. Another therapeutic shoeing option are clog-style shoes which can be preformed plastic or can be made onsite with wood (Figure 5). The Steward Clog creates a full roller motion with a firm base, reducing shear forces on the laminae while creating a solid caudal base and providing much needed stability.

■ www.theveterinarian.com.au

Clinical Review A major advantage with wood/plastic is the ability to adjust the shoe to meet the patients’ needs even after application48. Used with impression material in the caudal region these highly modifiable shoes can allow increased support and comfort to be provided earlier than would otherwise be possible.

Substitutes to traditional nailing should also be considered. Striking of the hammer on an already the inflamed laminae can be very painful for the horse. Modern adhesive materials (eg. Equibond, Equilox) provide an excellent alternative to nails, with cost and availability being the only setback. Aluminium should be considered over steel due to better bonding with glue as well as weight reduction.

Conclusion Acute laminitis is a medical emergency and whilst three distinct forms have been identified, endocrinopathic laminitis associated with hyperin-sulinemia is most frequently encountered in general practice. New medications such as ertugliflozin and velagliflozin offer promising altern-atives to specifically target hyperin-sulinemia and may hasten recovery in acute cases.

The treatment of laminitis can be challenging but strategies should be aimed at providing pain relief and halting the progression of the disease. In addition to medical management, a team-oriented approach between the owner,

clinically normal ponies. Vet J 2007;174:530–535.

9. de_Laat MA, McGowan CM, Sillence MN et al.

Equine laminitis: Induced by 48h hyperinsulinaemia in Standardbred horses. Equine Vet J 2010;42:129–135.

10. Durham AE, Rendle DI, Newton JR. The effect of metformin on measurements of insulin sensitivity and â cell response in 18 horses and ponies with insulin resistance. Equine Vet J 2008;40:493–500.

11. Hustace JL, Firshman AM, Mata JE. Pharmacokinetics and bioavailability of metformin in horses. Am J Vet Res 2009;70:665–668.

12. Tinworth KD, Boston RC, Harris PA et al.

The effect of oral metformin on insulin sensitivity in insulin-resistant ponies. Vet J 2012;191:79–84.

13. Sommardahl CS, Frank N, Elliott SB et al.

Effects of oral administration of levothyroxine sodium on serum concentrations of thyroid gland hormones and responses to injections of thyrotropin-releasing hormone in healthy adult mares. Am J Vet Res 2005;66:1025–1031.

14. Frank N, Elliott SB, Boston RC. Effects of long-term oral administration of levothyroxine sodium on glucose dynamics in healthy adult horses. Am J Vet Res 2008;69:76–81.

15. Frank N, Buchanan BR, Elliott SB. Effects of long-term oral administration of levothyroxine sodium on serum thyroid hormone concentrations, clinicopathologic variables, and echocardiographic measurements in healthy adult horses.

Am J Vet Res 2008;69:68 75.

Figure 5. Clogs are a highly adaptable easy to use system that can be tailored to each foot to maximise comfort. In easing breakover in all directions they minimise shearing forces in the laminae reducing the potential for further laminar damage

veterinarian and farrier is imperative to limit further lamellar damage and provide biomechanical support. Horses suffering from acute laminitis should be closely monitored and response to therapy should be frequently assessed and adjusted based on clinical response.

References 1. Potter S, Bamford N, Harris P et al. Incidence of laminitis and survey of dietary and management practices in pleasure horses and ponies in southeastern Australia. Aust Vet J 2017;95:370–374.

2. Eps AW van, Burns TA. Are There Shared Mechanisms in the Pathophysiology of Different Clinical Forms of Laminitis and What Are the Implications for Prevention and Treatment?

Vet Clin North Am Equine Pract 2019;35:379–398.

3. Eps AW van. Acute Laminitis: Medical and Supportive Therapy. Vet Clin North Am Equine Pract 2010;26:103–114.

4. Patterson-Kane JC, Karikoski NP, McGowan CM. Paradigm shifts in understanding equine laminitis. Vet J 2018;231:33–40.

5. Donaldson M, Jorgensen A, Beech J. Evaluation of suspected pituitary pars intermedia dysfunction in horses with laminitis. J Am Vet Med Assoc 2004;224:1123–1127. https://go.exlibris. link/3RGW5YJw. 6. Potter S, Bamford N, Harris P et al. Prevalence of obesity and owners’ perceptions of body condition in pleasure horses and ponies in southeastern Australia. Aust Vet J 2016;94:427–432. https://go.exlibris.link/QXN4S2ps.

7. Durham A, Frank N, McGowan C et al. ECEIM consensus statement on equine metabolic syndrome. J Vet Intern Med 2019;33:335–349.

8. Asplin K, Sillence M, Pollitt C et al. Induction of laminitis by prolonged hyperinsulinaemia in ■ www.theveterinarian.com.au

16. Bertin F, Forsythe LE, Kritchevsky J. Effects of high doses of levothyroxine sodium on serum concentrations of triiodothyronine and thyroxine in horses. Am J Vet Res 2019;80:565.

17. Nauck M. Update on developments with SGLT2 inhibitors in the management of type 2 diabetes - ProQuest. Drug Design, Development and Therapy 2014;8:1335–1380.

18. Kalra S, Singh V, Nagrale D. Sodium-Glucose Cotransporter-2 Inhibition and the Glomerulus: A Review. Adv Ther 2016;33:1502–1518.

19. Meier A, Reiche D, Laat M de et al. The sodium-glucose co-transporter 2 inhibitor velagliflozin reduces hyperinsulinemia and prevents laminitis in insulin-dysregulated ponies.

Plos One 2018;13:e0203655.

20. Meier A, Laat M de, Reiche D et al. The efficacy and safety of velagliflozin over 16 weeks as a treatment for insulin dysregulation in ponies.

BMC Vet Res 2019;15:1–10.

21. Frank N. Safety and Efficacy of Canagliflozin and Octreotide for Managing Insulin Dysregulation in Horses. JVIM 2018;32:2123–2143.

22. Sundra T, Kelty E, Rendle D. Efficacy of ertugliflozin in the management of hyperinsulinemia and laminitis in horses: a case series. In Press 2021.

23. Durham AE. Endocrine Disease in Aged Horses.

Vet Clin North Am Equine Pract 2016;32:301–315.

24. McFarlane D. Equine Pituitary Pars Intermedia Dysfunction. Vet Clin North Am Equine Pract 2011;27:93–113.

25. Skrzypczak H, Reed R, Brainard B et al. The pharmacokinetics of a fentanyl matrix patch applied at three different anatomical locations in horses. Equine Vet J 2021;44:738–740.

26. Horn R, Bamford NJ, Afonso T et al. Factors associated with survival, laminitis and insulin dysregulation in horses diagnosed with equine

pituitary pars intermedia dysfunction. Equine Vet J 2019;51:440–445.

27. Valencia NA, Jr DLT, Oberhaus EL. Long-term and Short-term Dopaminergic (Cabergoline) and Antidopaminergic (Sulpiride) Effects on Insulin Response to Glucose, Glucose Response to Insulin, or Both in Horses. J Equine Vet Sci 2017;59:95 103.

28. Hague N, Durham A, Menzies-Gow N. Pergolide dosing compliance and factors affecting the laboratory control of equine pituitary pars intermedia dysfunction. Vet Rec 2021;189:no-no.

29. USDA. Laminitis in US Horses. System NAHM, editor. 2000.

30. Katz LM, Bailey SR. A review of recent advances and current hypotheses on the pathogenesis of acute laminitis. Equine Vet J 2012;44:752–761.

31. Parsons C, Orsini J, Krafty R et al. Risk factors for development of acute laminitis in horses during hospitalization: 73 cases (1997–2004).

Journal of the American Veterinary Medical Association 2007;230:885–889.

32. Tóth F, Frank N, Geor R et al. Effects of pretreatment with dexamethasone or levothyroxine sodium on endotoxin-induced alterations in glucose and insulin dynamics in horses. Am J Vet Res 2010;71:60–68. https://go.exlibris.link/ bP5jYMQT. 33. Eps A van, Collins SN, Pollitt CC. Supporting Limb Laminitis. Vet Clin North Am Equine Pract 2010;26:287–302.

34. Redden R. Preventing laminitis in the contralateral limb of horses with nonweight-bearing lameness. Clin Tech Equine Pract 2004;3:57–63.

35. Hopster K, vanEps A. Pain management for laminitis in the horse. Equine Vet Educ 2019;31:384–392.

36. Martinez R, Reval M, Campos M et al.

Involvement of peripheral cyclooxygenase-1 and cyclooxygenase-2 in inflammatory pain. J Pharm Pharmacol 2002;Receiv Receiv May 18, 2001, Accept Accept October 26, 2001:405–412.

37. West E, Bardell D, Morgan R et al. Use of acetaminophen (paracetamol) as a short-term adjunctive analgesic in a laminitic pony. Veterinary Anaesthesia and Analgesia 2011;38:521–522.

38. Price J, Marques J, Welsh E et al. Pilot epidemiological study of attitudes towards pain in horses. Vet Rec 2002;151:570–575.

39. Meier A, McGree J, Klee R et al. The application of a new laminitis scoring method to model the rate and pattern of improvement from equine endocrinopathic laminitis in a clinical setting.

Bmc Vet Res 2021;17:16.

40. Eps AW van. Therapeutic Hypothermia (Cryotherapy) to Prevent and Treat Acute Laminitis.

Vet Clin North Am Equine Pract 2010;26:125–133.

41. Pollitt C. Equine laminitis. Clin Techniques Equine Pract 2004;3:34–44. https://www.sciencedirect.com/science/article/pii/S1534751604000290.

42. Bamford NJ. Clinical insights: Treatment of laminitis. Equine Vet J 2019;51:145–146.

43. Reilly P, Dean E, Orsini J. First aid for the laminitic foot: therapeutic and mechanical support. 26:451–458.

44. Sherlock C, Parks A. Radiographic and radiological assessment of laminitis. Equine Veterinary Education 2013;25:524–535.

45. Ritmeester A, Blevins W, Ferguson D et al.

Digital perfusion, evaluated scintigraphically, and hoof wall growth in horses with chronic laminitis treated with egg bar-heart bar shoeing and coronary grooving. Equine Veterinary Journal 1998;30:111–118.

46. Taylor D, Hood D, Wagner I. Short-term effect of therapeutic shoeing on severity of lameness in horses with chronic laminitis. American Journal of Veterinary Research 2002;63:1629–1633.

47. Sleutjens J, Bragança FS, Empelen M van et al.

Mouldable, thermoplastic, glue-on frog-supportive shoes change hoof kinetics in normal and obese Shetland ponies. Equine Vet J 2018;50:684–689. https://doi.org/10.1111/evj.12814.

48. Steward M. How to construct and apply atraumatic therapeutic shoes to treat acute or chronic laminitis in the horse. Proceedings of the 49th Annual Convention of the American Association of Equine Practitioners, New Orleans, Louisiana, USA, 21-25 November. American Association of Equine Practitioners (AAEP), 2003:337–346.

OCTOBER 2021 TheVeterinarian 27

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BUSINESS

Infection control and prevention of zoonotic diseases AR Digital Interactive - Veterinary Industry Guide to Workplace Safety 2021/22 Veterinarians, their staff, and clients have inherently high risks of exposure to and infection with zoonotic diseases. It is estimated that of the 1,415 agents causing disease in humans, 868 (61 per cent) are zoonotic (capable of transferring between humans and animals).

Moreover, of the 175 pathogens defined as emerging infections, 75 per cent are zoonotic.

The newly released AR Interactive – Veterinary Industry Guide to Workplace Safety 2021/22 focuses on risks associated with Zoonosis and Antimicrobial Resistant (AMR) Microbes with best Practice Control Measures optimised through augmented reality (AR) experiences to maximise WHS compliance performance based on the updated AVA Guidelines for Veterinary Personal Biosecurity which details the zoonotic diseases present in Australia and dealing with high-risk situations.

The Pro-Visual (AR) Interactive – Veterinary Industry to Guide to Workplace Safety 2021/22 in collaboration with Industry Associations, Australian Veterinary Association (AVA), Veterinary Business Group (VBG) and endorsed by the National Safety Council Australia (NSCA) highlights Infection Prevention Control AVA guidelines recommended to mitigate the transmission and spread of potentially highly infectious zoonotic diseases and emerging threats such as Q fever and MRSA in veterinary settings and adapted to individual practices in alignment with State and Federal Government WHS legislation

via a modifiable word document; with ongoing training to establish consistent and cohesive implementation.

Developed with advanced technologies such as interactive augmented reality (AR) capabilities for use with a smartphone or tablet, upon installation of the free Pro-Vis AR App available from the App Store or Google Play, virtual WHS can be downloaded and viewed at any time.

Designed to be displayed in the workplace, the AR Interactive - Veterinary Industry Guide to Workplace Safety 2021/22 is a key resource to support the Veterinary Industry and is also available to students, graduates, and educators in applying complex WHS regulatory documentation via a suite of interactive visualisations, such as 3D animation and videos, is a targeted response to a digital landscape.

It reflects a shared interest of the AVA, VBG and regulators to ensure safety is at the forefront through clarity, accessibility, and consensus to veterinary practices of all types.

Together Pro-Visual Publishing and their partnering Associations have carefully selected additional subject matter that addresses WHS issues pertinent to the industry, which include: ■

Sharps and needlestick injury prevention

■ Surgical and therapeutic lasers: best practice control measures inclusive of state and territory regulatory compliance

Compressed gas cylinders: risk assessment, best practice control measures inclusive of storage and handling.

■

“We are continuing to make leaps and bounds by improving WHS education and training supported by advances in digital technology and AR,” Pro-Visual CEO John Hutchings said. “The biggest impact of digitisation can be seen in how it can revolutionise engagement, which underpins success and effectiveness, by reducing risk to improve health and safety performance overall.”

“I would like to thank our corporate sponsors and industry associations in promoting specific, practical guidance on how to institute and evaluate WHS standard operating procedures (SOPs) that will safeguard staff from the hazards associated with individual work duties and prevention of zoonotic disease exposure.”

For free Guides email marketing@provisual.com.au

FIV awareness campaign launched Celebrate 150 years of the Cat and new kitten owners are being cats can support their cat, allowing urged to speak with their veterinarian many to live a relatively normal life.

RSPCA with new stamps about feline immunodeficiency Advocating for prevention to be a virus (FIV). FIV has a high prevalence in Australia compared to most other countries and can cause serious and potentially fatal disease in cats by depressing the immune system.

It has also been linked to kidney disease, neurological disease, chronic gingivostomatitis, skin disease and weight loss.

Boehringer Ingelheim Animal Health is behind the mission to support veterinarians to minimise the impact of FIV in our cat population – and has assembled the Australian Feline Retrovirus Advisory Panel, an independent panel of feline medicine and veterinary infectious disease experts. The panel have developed guidelines to help veterinarians with diagnosing, preventing, and managing FIV. Primarily transmitted via bite wounds that introduce saliva containing virus and FIV-infected white blood cells, the virus can leave cats predisposed to chronic and recurrent infections of various types and has been shown to increase the risk of some cancers.

While FIV infection in some cats can have devastating health impacts, it is important to stress to owners that FIV is not a death sentence and does not constitute grounds for euthanasia.

Some FIV-infected cats can live a relatively normal life for a protracted period, with a near-normal lifespan.

With management and housing conditions impacting the outcomes of FIV infection, owners of FIV-infected

■ www.theveterinarian.com.au

priority, Mark Westman, chairperson of the Australian Feline Retrovirus Advisory Panel said.

“Infection with feline immunodeficiency virus (FIV) can have serious consequences. Vaccination to prevent infection with FIV is recommended for pet cats whose owners are unable to, or cannot be persuaded to, keep their cats away from the risk of being bitten by an FIV-infected cat,” “Sadly, once a cat has been infected with FIV, there is no cure which is why it is important for cat owners to adopt a prevention protocol to ensure cats are safe and protected. Australia has one of the highest rates of FIV infection in the world, however it is also one of the few countries that has access to an effective vaccine,” Westman said.

Boehringer Ingelheim Animal Health manufactures a polyvalent FIV vaccine to prevent FIV infection.

The primary vaccination course of 3 doses given 2-4 weeks apart can be administered to healthy kittens or cats from eight weeks of age to aid in the prevention of infection with FIV, followed by annual boosters.

Additional resources on FIV are available from Boehringer Ingelheim Animal Health Territory Managers. Further information for veterinary staff can be found on www.animalhealthacademy com.au or www.vetplus.com.au. If registering for Animal Health Academy for the first time, use access code myAcademy.

Australia Post is celebrating 150 years of the Royal Society for the Prevention of Cruelty to Animals (RSPCA) with the release of five stamps representing their mission and practice: research, shelter, protection, certification, and advocacy.

With the RSPCA’s history in Australia dating back to a public meeting to discuss the ill treatment of horses in Victoria in 1871, this stamp issue commemorates the organisation’s 150 years of caring for and protecting animals in Australia.

Australia Post Group Manager Philatelic Michael Zsolt said the RSPCA deserves to be celebrated for their tireless work towards preventing animal cruelty.

“The RSPCA’s long history of advocating for animal welfare issues is something all Australians are proud of,” Zsolt said.

“The stamp designs really show the breadth of the RSPCA’s work across companion animals, farm animals, animals in sport, recreation and industry, and wildlife.

RSPCA Australia Chief Executive Officer Richard Mussell said the stamps were a fitting addition to the 150th anniversary commemorations.

“It’s wonderful to see the RSPCA’s work over many years acknowledged in this way by Australia Post,” Mussell said.

“These stamps are a wonderful opportunity to reflect on our great breadth of work and what has been achieved in what is an important milestone year for us.”

The stamps and associated products, including a minisheet, stamp pack, first day cover and maxicard set, are on sale at participating Post Offices, via mail order on 1800 331 794, and online while stocks last.

For more information visit auspost.com.au/stamps.

OCTOBER 2021 TheVeterinarian 29

News

Drug rescheduling From page 1

In September, the TGA also proposed amendments to the Poisons Standard, due for decision in November. Of particular concern to vets is the proposed amendment to meloxicam.

The proposal is to create a new Schedule 6 entry for meloxicam that captures injectable preparations, at up to 2 per cent concentration, for the pre-surgical treatment of sheep undergoing husbandry procedures.

This would mean that injectable meloxicam (currently S4, and thus prescription-only) would be available

New Hendra variant found in Newcastle From page 1

Previous studies had detected the virus in flying foxes in Queensland and parts of NSW, however after monitoring samples from 20132021, ACDP researchers found the new genetic type was present in Victoria, South Australia and Western Australia.

CSIRO scientist and study coauthor, Kim Halpin, said transmission of the disease from flying foxes to horses has still only been reported in Queensland and NSW. “However, because Hendra virus Genotype 2 is so genetically similar to the original Hendra virus, there is a potential risk to horses wherever flying foxes are found around Australia,” she said in a statement.

“It is important to note that Hendra has never been reported to spread directly from flying foxes to humans – it’s always been transmitted from infected horses to humans…we expect this new genetic

type would behave the same way.”

Halpin said the discovery of the new variant demonstrates the importance of research into flying foxes in order to protect humans and animals from the viruses they carry.

President of Equine Veterinarians Australia, Steve Dennis, said the findings demonstrate that there is a risk of Hendra wherever there are flying foxes and horses.

“Owners and any people who interact with horses can reduce the risk of infection from Hendra virus and other zoonotic viruses through vaccination of horses or humans where available, wearing appropriate PPE, and seeking veterinary attention for sick horses,” he said.

There have been 24 horse deaths in NSW as a result of Hendra virus on 23 properties since the first case 15 years ago.

■ SAM WORRAD

Export’s dire cattle conditions uncovered From page 3

freedom of information requests to get more detail, and what was revealed then was very worrying,” she said.

“Also, from 49 live cattle voyages from Australia to China during the period of the study, only 37 had independent observers on board at all.

“Australians deserve to know exactly what is happening on board live export ships, especially when there are ongoing and preventable animal welfare risks.”

The Department of Agriculture, Water and the Environment told The Veterinarian it takes animal welfare seriously, and that it is conducting its own review (the Bos taurus) into heat and cold stress during long haul cattle exports by sea.

ASEL was recently subject to review by an independent technical advisory committee, and submissions were considered from a variety of stakeholders including animal welfare groups, a Department spokesperson said.

Under the revised ASEL, veterinarians are not required on all voyages, and ASEL specifies when an accredited veterinarian is required to accompany a voyage of livestock.

With regard to the summarised independent observer reports, the Department said the primary use of the reports is as an information source for the regulator.

“Given the community interest in reports, summaries are prepared by the department for publication,”the spokesperson said.

“The summary reports provide the public with an accurate account of what has been observed and 30 TheVeterinarian OCTOBER 2021

reported to the Department, from the loading of each vessel through to discharge at the destination port.

“Where issues or instances of non-compliance are identified in the observers’ reports, procedural fairness processes are undertaken by the department with right of reply provided to relevant parties prior to publication.”

The Department spokesperson said independent observers were not deployed on voyages during the period of the study where the vessel could not accommodate an observer and noted that in October 2019 the policy was revised to “better target the deployment of observers.”

The spokesperson added that it has reviewed the findings of the paper, “which were drawn from the department’s published summary observer and summary notifiable mortality investigation reports for 37 voyages.”

“Some of the Department’s findings are consistent with those reported by VALE … for example, the Department identified instances of insufficient contingency feed provisions for unplanned extensions to voyage times and the occurrence of heat stress,” the spokesperson said.

“The VALE paper focuses primarily on shipboard hazards noted in the observers’ reports, rather than the actual impact of those hazards on animal welfare during the voyage and therefore overstates the severity and frequency of some issues, such as space allocation, unloading and feed.”

■ SAM WORRAD

over the counter for anyone to access.

The AVA opposes this amendment for several reasons, including the fact that veterinary knowledge and oversight are required to prescribe appropriately and mitigate the risks involved with animal use of the substance.

There is a potential for significant human toxicity if meloxicam is accidentally or deliberately misused, and it is believed that the risk of rescheduling the veterinary injectable product to S6 is that it will become a readily available and inexpensive substitute for human prescriptiononly products.

AVA works to better mental health in vets From page 3

from all corners of the veterinary community will help us to produce a strategy with the power to create the positive, meaningful and sustainable change we so desperately need,” Vale said.

Currently, the AVA provides member access to a range of initiatives to support veterinary mental health and wellbeing. This includes access to the AVA’s confidential counselling service, an HR advisory service, the AVA’s Mental Health First Aid Training program and Graduate Mentoring Program, as well as seminars around resilience, wellness, and mental health.

“This complex problem requires a collaborative approach by not only the profession, but greater society, as vets are essential to the health and wellbeing of the whole community. In order for vets to look after the animals of our communities, we need to assist them to look after themselves,” Vale said.

Abstracts - pigs and sows From page 14

Results showed that the discomfort period lasted 11 s longer in sows than in pigs, and that certain behaviors occurred distinctly later in sows as compared to pigs. Furthermore, higher humidity and temperature in the pit could prolong the duration of the discomfort period. Further research is needed to better understand the underlying physiological processes for both the differences seen between sows and fattening pigs as well as the influence of ambient parameters.

Isabel Lechner1, Anaïs Léger2, Aurelia Zimmermann3, Sophie Atkinson4, Manon Schuppers2 Meat Sci. 2021 Sep;179:108535.doi: 10.1016/j.meatsci.2021.108535.

1SAFOSO AG, Waldeggstrasse1, 3097 Liebefeld, Switzerland. Electronic address: isabel.lechner@safoso.ch.

2SAFOSO AG, Waldeggstrasse1, 3097 Liebefeld, Switzerland.

3Micarna SA, Dept. Sustainability and Animal Welfare, 1784 Courtepin, Switzerland.

4Smart Animal Handling, Hagaberg 110, 74020, Vänge, Uppsala, Sweden.

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.

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With a wingspan of roughly two-and-a-half metres, the magnificent frigatebird is the largest species of frigatebird. Males have a striking red guar sac which they inflate to attract a mate. Christopher Columbus encountered the birds when passing the Cape Verde islands on his first voyage across the Atlantic in 1492. Picture Andrew Turner

Magnificent frigatebird (Fregata magnificens)

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