VOLUME TWO I ISSUE FOUR I WINTER 2014

THE JOURNAL FOR PERSONAL & PROFESSIONAL DEVELOPMENT Bovine TB The debate continues...

10 hours PPD

Tortoise hibernation Canine atopic dermatitis Advice for a critical time Pathogenesis and target management plans

Equine neonatology Developing talent Common diseases of neonatal foals Finding the people to make your business succeed

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Elmtree Business Park As a zoologist I care about all animals and it’s hard to come to terms Elmswell with the culling of badgers that has recently begun again. It’s just as Bury St Edmunds know? hard to consider the thousands of cattle that have been slaughtered as Suffolk IP30 9HR reactors to TB testing. Tel: 01359 245310 Fax: 01359 245253 We’ve been providing Everyone has an opinion on this issue and it’s sometimes difficult to think clearly veterinarypracticetoday.com about the issues because of the emotions involved, including the fact that the badger Subscriptions is used as the symbol for the Wildlife Trust. This is why I hope that our comment successful financial [email protected] article, written by Robert Broadbent, will help to give you as many sides of the Tel: 01359 245310 argument as possible and provide food for considered thought. solutions to the veterinary Advertising It is rather ironic that as we have this debate we are also further exploring the link [email protected] between liver fluke in cattle and TB testing. This issue is discussed in our large animal Tel: 01359 245310 profession since 1998. insight article on page 49. Editorial We live in frightening times in terms of the spread of infection, with the big issue of Editors PPS Group, the only consultancy providing personal the moment being the Ebola crisis. 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Comments Equine

6 COVER STORY 28 COVER STORY TB: the debate continues Equine neonatology Opposing camp’s views and answers Common conditions affecting neonatal foals

39 Insight The perils of being an equine vet join the conversation If you have thoughts on any of the articles featured in Veterinary Practice Today please let us know by contacting [email protected]

Small animal

10 COVER STORY Canine atopic dermatitis Formulating a targeted management plan

14 Rabbit dentistry An overview for dental practitioners

18 Infection control A vital role for the veterinary nurse

22 Transfusion medicine today The shift from whole blood to safe and selective blood products

25 Poisons Winter hazards Large animal 27 Insight Dangerous dogs – cause and effect 40 Cattle lameness Part two of an 18-month study on lameness

45 Goat management Feeding, housing, behaviour and general management of goats

49 Insight Exploring the link between liver fluke and TB tests

4 VETERINARY PRACTICE TODAY WINTER 2014 Featured contributors

Mark Hedberg DrMedVet MRCVS

Mark began his career in a small animal/exotic veterinary hospital in Jeddah. He then spent two years in mixed practice in Dover. He Wildlife and exotics currently runs a CPD programme for the College of Animal Welfare, and completed a Certificate in Leadership and Management 50 COVER STORY in 2014. He has written extensively on new Tortoise hibernation and recent graduate support and personal A guide to hibernation methods development, and has given presentations at the BSAVA, LVS and NAVC conferences. 53 Insight Primates are not pets Laura Buckley BVetMed CertVD DipECVD MRCVS European Specialist in Veterinary Dermatology

Laura graduated from the RVC in 2003. After six years in general practice she achieved her RCVS Certificate in Veterinary Dermatology. She completed a three-year residency in veterinary dermatology at the Management University of Liverpool in 2012 and returned in 2014 as lecturer in veterinary dermatology and clinical skills, Laura’s clinical interests 54 Holiday entitlement include canine and feline allergic skin disease, An employer’s guide to annual leave antimicrobial resistance and chronic otitis. and holiday pay

56 Marketing plans Bettina Dunkel Encouraging your team to buy into DVM PhD Dip ACVIM Dip ECEIM Dip ACVECC FHEA your marketing plan MRCVS 60 COVER STORY After an internship and Developing talent a large animal internal A complicated balancing act medicine residency in the USA, Bettina attained 63 Insight her PhD from the University of London in PPD? CPD? What’s the difference 2008. Since then she has been employed as a senior lecturer in equine medicine at the and does it matter? Royal Veterinary College. Her main clinical and research interests are equine platelets, neonatology, respiratory diseases and equine Industry critical care.

64 Profile Graham Duncanson Claire Bressant, chief executive of BVSc, MSc (VetGP), DProf, International Cat Care FRCVS. Committee Member of the Goat Veterinary Society (GVS)

Graham qualified from Bristol in 1966. He spent eight years as a government veterinary officer in Kenya where he developed his interest in goats and disease control. Since 1975 Graham has been working at Westover Veterinary Centre in Norfolk. He has written five text books, including ‘Veterinary treatments of sheep and goats’.

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Bovine TB: the debate continues...

The majority of outbreaks comprise a single reactor – unlikely if Bob Broadbent cattle-to-cattle spread was common. Reactor cattle do not readily BVetMed MRCVS shed M. bovis (Vordemeier, 2007) and the same spoligotypes of cattle reactors are clustered geographically – difficult to explain My views stem from an avid interest in the diseases considering the widespread movement of cattle, if one assumes caused by Mycobacterium spp., especially in cattle-to-cattle transmission to be equally common. cattle and camelids. They have been formed after working for 32 years of my career in the TB hotspot Thomas explained that cattle are the disease sentinel not the that is Gloucestershire and seeing at first hand the reservoir (Veterinary Record, 28 June 2014). Unfortunately for devastation that is wreaked when cattle, camelids the badger, it does not ‘wall off’ the organism within tubercles and badgers are affected and in close contact. as cattle do; but rather develops a disseminated disease where the organism localises – notably in the kidneys and lungs – from whence it is excreted in large numbers. The expanding badger population within an underground home then provides an ideal Public awareness has been focused very much on the environment for its cultivation. badger cull, its progress and the attempt by various In addition to the discussion about ‘what’ to do, the ‘who’ and groups to stop it going ahead; yet the discussion about ‘how’ is also under discussion. The Animal and Plant Health the general problem has continued behind the scenes. Association (APHA), after several years of threatening, finally The two sides are still very polarised – witness these announced the introduction of a process of ‘competitive tendering’ to procure the services of vets to carry out TB testing recent quotes from two eminent scientists! in cattle herds – a job which historically has been carried out by local practitioners or Defra vets. For: (Veterinary Times, August 2014): “Why is it we seem so hesitant to tell the public what a thoroughly nasty Mrs Tiggy- Defra has protested for some years that this change is necessary Winkle, Larry the Lamb and Chirpy Chick eating, over-populous, to improve the delivery of the service and to comply with EU TB-ridden, silently suffering underground, verminous fellow working rules. The cynical large majority of farm vets in the UK Mr Brock really is? Until ‘Middle England’ comes to realise believe that it is a decision driven purely by the need to work with these truths, the Badger Trust and its witless followers will a smaller budget, and that the successful bidders will effectively continue to prevent this timorous vacillating Government from be the cheapest option available. undertaking the general and countrywide cull of badgers that is so desperately needed to rid us of TB.’’ The APHA has said that the changes in the system will be ‘really fundamental’. They are likely to produce a reduction in farm Against: (Scientific Review Team): “The scientific case is as clear animal veterinary practice numbers and in the relationship as it can be – this cull is not the answer to TB in cattle. I have not between practitioners and the State. Defra had 30 per cent found any scientists, who are experts in population biology or budget cuts imposed in 2010, and has now been advised that the distribution of infectious disease in wildlife, who think that it needs to show further savings of £37m by 2015. Its ability to culling is a good idea. People seem to have cherry-picked certain continue functioning and funding disease control is limited; it results to try to get the argument they want. Furthermore, all might find that honesty would engender more sympathy and the evidence shows that culling badgers increases the proportion support rather than hiding behind EU legislation and claims of of badgers that have TB. Culling badgers, as planned, is very cost sharing. unlikely to contribute to TB eradication.’’ ‘Team Badger’ launched a ‘Myth Busters’ document in June Warwick University published a paper in June 2014 suggesting 2013 claiming to refute many of the accepted connections that most herd outbreaks are caused by multiple transmission between badgers and TB. They highlighted the document routes, including cattle-to-cattle on farm and by movements, published by Smith et al, (2012) as one showing that ‘there is and that badgers play a relatively minor role in TB transmission. very little difference between the results of badger culling and Farm ministers dismissed the study, as it did not investigate all badger vaccination on TB in cattle’. However, the research the ways in which TB might spread. summary clearly states that the badger is partly responsible for the maintenance and spread of TB in cattle and against a background of existing control measures – where 144 herd incidents were expected in 10 years – limited badger culling prevented 26, while badger vaccination prevented 16. Culling plus ring vaccination prevented 40.

McGill et al (Veterinary Record, 7 July 2014) purport that the increase in TB is the result of flawed changes in farming systems, AI and farm genetics; while others – including a large number of BOVINE TB farmers and farm practitioners (Allen, 18 August 2014) – still think it absurd and depressingly ridiculous that Defra is trying to shoot a

6 VETERINARY PRACTICE TODAY WINTER 2014 BOVINE TB | COMMENT

nocturnal subterranean living animal in isolated pockets rather as gassing and allowing large areas to be targeted to prevent than carrying out wide-scale gassing with carbon monoxide or perturbation. carbon dioxide and then sealing off the infected setts. Cull protesters say that any killing of this wildlife population A recent survey of ‘roadkill’ badgers in Cheshire found seven of is needless and unjustified, farmers argue that wiping out 48 had TB. infected populations is the most humane way of dealing with them rather than leaving them to a slow death by starvation, Meanwhile because of the extremely poor performance of and that re-population does occur afterwards, as it did after the current TB skin test in alpacas and llamas, the camelid the Thornbury trials of the 1980s. industry – after spending hundreds of thousands of pounds of its own money – is well on the way to putting into use the Both sides agree that shooting large numbers of badgers Enferplex kit, a serological blood test which can be tuned humanely with only ‘clear shots to the heart and lung of to give very high specificity or sensitivity depending on the standing badgers and no head, neck or running shots’ (Defra) scenario. If it lives up to early expectations, then it may was going to be difficult or impossible, and unlikely to reach prove to be a useful adjunct to the skin test in cattle. Defra is the required target numbers. watching; but, as ever, slowly. Shooting 100 badgers a night for six weeks, while avoiding Current progress of the disease shooting other farmers, cullers and protesters was always likely According to Defra figures published in October 2013, the to be impossible; even ignoring the fact that the badger is a provisional incidence rate for cases of TB in cattle, the reasonably intelligent – if complacent – animal, that will almost numbers of new herd incidents and the number of cattle certainly become more wary and secretive and avoid the haunts slaughtered, were all slightly reduced. However, despite the from which one or more of its number has failed to return. renewed recent efforts the disease seems to be only on a plateau rather than a decline; and still costing 30,000 cattle Reports labelled the pilot culls as a ‘shambles’. their lives and the taxpayer £100m each year. Post mortems on shot badgers to prove humane killing are To be sure that there is a reduction in the frequency of bovine almost pointless, as by definition the sample is skewed. TB – independent of the cyclical trends – there would need to Wounded badgers are unlikely to turn up at the local be a sustained and marked downward trend for more than five veterinary practice asking for help and inclusion in the survey! years in both incidence and prevalence, and a reduction in the It has been reported by animal welfare groups that between incidence in cattle and other species throughout the UK. 7.4 and 22.8 per cent of badgers were still alive five minutes after being shot. The cull A recent BVA policy statement recognised that targeted and The future managed badger culling is necessary in areas where badgers Cattle TB testing are regarded as significant contributors to the persistent If left unchecked, bovine TB is predicted to cost the taxpayer problem of bovine TB. When the initial 2013 badger pilot cull £1 billion over the next decade. Government thrust is towards trials finished, 35 per cent of the Somerset target and 20 per a risk-based strategy on all fronts – splitting the country up cent of the Gloucestershire target had been met. into low-risk (north east) and high-risk (south west, West Midlands and Sussex) areas with an ‘edge’ area separating Defra extended the Somerset cull for three weeks, allowing them. The options put forward are said by Defra ‘most likely’ a further 10 per cent to be culled. Owen Paterson (Secretary to achieve OFT (Officially Free of TB) status in 25 years, while of State at Defra) announced in a ministerial statement on 9 maintaining a viable livestock industry. October that “current indications suggest that the pilot has been safe, humane and effective in delivering a reduction in the Dutch action has already halted the export of calves to badger population of just under 60 per cent”. One can only be Holland. UK farmers are unimpressed by the Defra proposals pleased that he is not working in the Treasury! and simply view the changes as likely to be no more effective, while blaming farmers for the deterioration and asking them A failure to kill 60 to 70 per cent of the population is accepted to foot more of the bill in future years. as a failure to impact on the long-term health of the occupiers of the sett, hence rendering futile the death of those badgers Annual testing of all cattle in Wales – introduced in 2009 which have been shot. The discrepancy in the figures has – has resulted in a 50 per cent reduction of cattle being been explained by an apparent change in the estimated slaughtered by 2012; the number of new herd breakdowns fell badger population in the pilot cull areas – down from 2,400 by 23 per cent and the numbers slaughtered by a further 35 in September 2012 in Somerset to 1,450 in August 2013; and per cent in the year to February 2014. from 3,400 to 2,350 in Gloucestershire. Badger vaccination Both pilot culls were postponed in 2012, after surveys The Welsh Assembly is currently inviting applications for a suggested that badger populations in the areas were Badger Vaccination Grant for privately delivered projects in significantly higher than the original estimates. This inability Wales up to 2019. to accurately describe a wildlife population is just one of the reasons why cull protesters and farmers alike have little faith The well-publicised cost of badger vaccination is around in the current cull process. Effectively, cull protesters would £600/animal, played up by the ‘pro cull’ community and down like to see the cull stopped completely, and farmers would by the Badger Trust. The delivery of vaccine to enough animals like to have a total cull of infected setts using a method such within a sett is not without its problems, although it does

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not seem to be too stressful – the same animals repeatedly cost of some welfare – a difficult compromise to arrive at as a returning to the traps for the bait! healthcare professional.

Smith et al (2012) purported that sustained badger vaccination We might remember that few badgers will experience a quick could be useful in reducing cattle TB in the contact area. death in the wild unless as the result of a road traffic accident. Most suffer a violent, traumatic death by predation, or a The 2014 AHVLA/Surrey University review found that miserable lingering one caused by starvation and/or disease. deployment of bait down every sett would need to be used A less-than-perfect death by gassing is probably better – and avoiding the risk of exposure to cattle and other wildlife. Colaco certainly no worse than – what ultimately awaits them, but and Birtles (Veterinary Record, April 2014) reminded us that in would require a change in the Badger Protection Act 1992. the original Medical Research Council human TB vaccine trial, there was no difference in response to vaccines made from M. In April, Defra tweeted that it was carrying out initial bovis or M. microti, and there is a lack of tuberculin sensitivity investigations into using gas as a culling method, but not including after using a ‘microti’ vaccine – a distinct advantage in the badger testing yet. Ironically, had the wildlife vector of bTB proved production of a DIVA (differentiating infected from vaccinated to have been the rat, we would not be having this discussion today animals) test. because the disease would have been eradicated many years ago. We would happily have agreed to rat poisoning despite the Meanwhile in Ireland, a five-year badger trial has just started undoubted inhumane end that warfarin often brings. (June 2014) on measuring the effects of a badger test and vaccinate/remove protocol on the incidence of TB in cattle in a The BVA has lent its support again to a second year of culling high prevalence area of 100 sq km. having been reassured that the recommendations of the Independent Expert Panel would be taken up, banning the Cattle vaccination use of shotguns (other than for close dispatch) and improving Defra has developed a BCG cattle vaccine against bTB and an contractor selection and training. The Association has also accompanying DIVA test and is currently looking for a ‘delivery agreed to Defra’s new Badger Edge Vaccination Scheme (BEVS) partner’ to help run the initial trials, expected to run for two to running to the end of November – for which Defra has invited five years. We can see from this time scale that we are still some applications for funding. way from having a TB vaccine in the surgery dispensary fridge. Government estimates are 10 years, assuming that the EU (and The Badger Trust has brought a challenge resulting in a judicial the World Organisation for Animal Health, OIE) will change the review starting in August into why Defra has chosen not to put in law to allow the trade of live cattle, meat and milk from BCG- place an expert panel for the second year of culling. The Trust lost vaccinated animals using the associated DIVA test. its first review in 2012 owing to a lack of scientific argument. This is all very last minute and subject to criticism from both sides. The EU prohibits the use of a cattle vaccine because of the incomplete protection offered by BCG and the sensitisation Conclusions of the vaccinated animals to the intradermal tuberculin test – Government commitment to the eradication of this disease currently the mainstay of the UK TB control/eradication scheme. is vital. Fortunately, the EU is firmly behind an eradication programme. If that were not the case, then probably neither Adoption of a cattle vaccine without trade restrictions is this nor any other UK political party would find the will or the not now expected until 2023, as so far all the work has been funds to carry it through. The EU also has a vision of sustainable confined to the laboratory (AHVLA Review, 2014). The design livestock production in the UK and a belief that, without human of the field trials complying with European Food and Safety interference, the badger population will be unable to survive its Authority (EFSA) regulations are to be completed this summer, own endemic TB outbreak. although Wales has looked at the use of a cattle vaccine in Ethiopia and may seek an EU derogation for its use in cattle to The complete eradication of TB from British cattle and badgers be sold in the UK food chain only. will probably only be achieved by a combined use of: „„ Continued total whole herd testing of cattle at annual intervals Vaccination of cattle and badgers are important components over as much of the country as we can afford of what needs to be a comprehensive multifaceted approach „„ Continued use of pre-movement testing and restrictions to TB eradication. BCG vaccine appears to behave in cattle on movement of infected or contiguous herds combined with and badgers as it does in other species, so some individuals compulsory biosecurity measures, including the exclusion of vectors are afforded no protection at all, some are partially protected „„ Rigorous post-mortem inspections of carcasses and the follow by having reduced severity of disease and the rest are fully up of source herds with detailed investigation as to how the protected – though no one has yet quantified the precise infected cattle have remained undetected to slaughter percentages and, although farmers are open to the idea of „„ The improved testing regimens (skin and blood tests) that are funding cattle vaccination, cost and effectiveness will play a available and that should be made mandatory to all infected herds, large part in convincing them that it is their role rather than not just those experiencing difficulties in clearing up infections Defra’s (Chambers et al, Veterinary Record 2014) „„ The identification of infected badger populations in contact with infected cattle and the targeted, humane culling of those Badger culling entire setts and others within a wide defined radius in line with This is likely to remain controversial, with people exercising historical successful cull strategies their legal rights to peacefully protest while being brought „„ The ring vaccination of badger populations around the cull areas into disrepute by extreme activists harassing, threatening and intimidating others carrying out legal culls. If a cull is to take Finally, as much as we may disagree on the route, we all want to place it must be carried out in the most effective way even at the end up in the same place. Healthy cattle and healthy badgers!

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An update on management of canine atopic dermatitis Canine atopic dermatitis (CAD) is a common skin disease affecting up to 10 per cent of dogs worldwide. It causes chronic, relapsing pruritus, dermatitis and otitis and a recent study demonstrated the detrimental impact on the quality of life of both the animals affected by CAD and their owners. This article reviews the pathogenesis of CAD and its importance in formulating a targeted management plan for affected individuals.

During the last 80 years, an response to environmental Laura Buckley increases the risk of allergic BVetMed CertVD DipECVD MRCVS improved understanding of the or other allergens cannot be sensitisation. Abnormalities European Specialist in Veterinary pathogenesis of this complex demonstrated’. are present in both lesional Dermatology skin disease has changed the and non-lesional atopic skin way in which we investigate In addition, the term food- and can be aggravated by Laura graduated from the and manage affected dogs and induced atopic dermatitis is allergen exposure. Royal Veterinary College in has promoted the development used to describe cases of CAD 2003. She spent six years in of novel therapies. in which food allergens can Immune dysregulation general practice where she cause disease exacerbation. and specific allergen achieved her RCVS Certificate The complexity of the sensitisation in Veterinary Dermatology. pathogenesis means that The widely recognised It is thought that affected In 2012, Laura completed a multimodal treatment breed associations with dogs are genetically a three-year residency in approach will provide the CAD highlight the genetic predisposed to the veterinary dermatology at the greatest chance of successful background of this disease. development of an abnormal University of Liverpool and management. Use of single immune response to various was subsequently awarded therapeutic agents will fail The West Highland white environmental and microbial the European Diploma in to target certain areas of terrier, bull terrier, Labrador stimuli, ultimately leading Veterinary Dermatology. pathogenesis and could result retriever and bichon frisé to a Type I hypersensitivity in the increased use of potent among others have been reaction and generation of Following her residency, drugs associated with risk of shown to be predisposed to allergen-specific IgE. Laura worked in private adverse effects. CAD. In addition, genetic practice where she provided studies have highlighted Aberrant regulatory a dermatology service for two Overview of pathogenesis widespread alteration of mechanisms lead to a referral clinics in Yorkshire and The pathogenesis of gene expression including failure of tolerance of London and for the Guide Dogs CAD involves a genetic genes associated with harmless environmental Centre at Redbridge in Essex. predisposition to skin barrier skin barrier function, IgE allergens and promotion Laura returned to the University dysfunction and immune function, regulation of cell of allergic sensitisation. In of Liverpool in 2014 as lecturer dysregulation. Environmental messaging, cell cycling and most affected dogs, specific in veterinary dermatology and factors also play a role in the inflammatory mediators. allergen sensitisation can be clinical skills, and teaches and development of the disease, demonstrated via serological or assesses the postgraduate and in many individuals Skin barrier dysfunction intradermal IgE testing. RCVS CertAVP dermatology specific allergen sensitisation The stratum corneum course there. and enhanced microbial forms the essential skin In the chronic stages of colonisation also contribute. barrier, preventing access CAD, there is a switch from Laura’s clinical interests include of microorganisms and a predominantly humoral canine and feline allergic This has lead to the disease other foreign substances to a cell-mediated immune skin disease, antimicrobial being redefined as‘a and reducing loss of water response. This process is likely resistance and chronic otitis. genetically predisposed and solutes. A number of to occur owing to skin damage inflammatory and pruritic abnormalities including and microbial toxin-associated allergic skin disease with increased transepidermal activation of skin cells, release characteristic clinical water loss, widened of inflammatory mediators features associated with intercellular spaces between and failure of regulatory IgE antibodies most corneocytes and deficiencies in mechanisms. It results in commonly directed against lipid content and organisation chronic epidermal thickening environmental allergens’. have been identified in the skin and further disruption of the of atopic dogs. epidermal barrier. However, environmental allergens are not always In human atopic dermatitis, it Microbial colonisation implicated and the term is theorised that a genetically Staphylococcus spp. and atopic-like dermatitis (ALD) determined increase in Malassezia pachydermatis *Suggested Personal & Professional is used to describe ‘an skin permeability leads to are thought to play a role in Development (PPD) inflammatory and pruritic increased allergen penetration, the pathogenesis of chronic skin disease with clinical which in combination with CAD. Atopic canine skin is DERMATITIS features identical to those a predilection towards an more prone to colonisation by seen in CAD, in which an IgE abnormal immune response, Staphylococcus spp. and there

10 VETERINARY PRACTICE TODAY WINTER 2014 SMALL ANIMAL | DERMATITIS DERMATITIS | SMALL ANIMAL

is increased carriage of S. Approach to management overgrowth or infection. enriched diets, and dietary pseudintermedius at mucosal The complexity of the An effective flea control supplements should be added to sites compared with healthy pathogenesis of CAD programme should be the dog’s usual food once daily. individuals. This increased means the use of single continued to eliminate flea susceptibility to bacterial therapeutic agents is unlikely infestation/hypersensitivity as a There are a large number of colonisation may occur as a to be successful in the clinical cause of further pruritic flares. topical shampoos and sprays consequence of the increased management of this disease. available for the management ability of S. pseudintermedius Skin barrier dysfunction of skin disease, none of which to adhere to inflamed skin A therapeutic plan, targeting It should be assumed that all has been proven to improve and abnormalities in the the following specific dogs suffering from atopic skin barrier function. Generally, amount – or function of – pathological processes, dermatitis, including ALD commercially available antimicrobial peptides. will give the best chance of and food-induced AD, have a shampoos which have less management success: defective skin barrier; and that antimicrobial activity and Colonisation by microbes results „„ Skin barrier dysfunction all areas of the skin – not just contain ingredients such as in a marked inflammatory „„ Cutaneous inflammation lesional areas – are affected. essential fatty acids, essential response that drives cell- and immune dysregulation oils and colloidal oatmeal are mediated immunity in the „„ Specific allergen sensitisation Products aimed at improving designed to cleanse the skin chronic phase of atopic „„ Microbial colonisation and skin barrier function include without causing irritation. inflammation. In addition, infection oral essential fatty acids ceramidases and proteases (EFAs), non-irritating and Sprays containing propylene produced by these microbes can Following diagnosis of CAD, moisturising shampoos and glycol are designed to further damage components of an initial management plan sprays, and topical lipid moisturise the skin. Shampoos the stratum corneum, resulting in incorporating these four complexes. A combination may be used twice weekly or further skin barrier dysfunction. treatment categories should of these products should as necessary and moisturising be devised based on the be considered based on the sprays can be used once daily. Recent studies have identified findings of a comprehensive individual animal and the the development of specific panel of investigations. These practicalities of application Topical lipid complexes aim to IgE to both staphylococci include assessment of the role of topical therapies, including restore the lipid deficiencies and Malassezia in atopic of food as a cause of allergic time and physical constraints within the skin barrier of atopic dogs, suggesting specific flares, assessment of the of the owner. dogs. Preliminary studies sensitisation can occur to presence of specific allergen have shown that some of the microbial antigens in addition sensitisation and cytological Oral EFAs are available as deficiencies can be reversed by to environmental allergens. assessment for microbial dietary supplements or EFA- a skin lipid complex containing

Table 1. Summary of the efficacy and safety of anti-inflammatory and immunomodulatory drugs used in the management of canine atopic dermatitis

Therapeutic intervention Summary of evidence

„„ Oral glucocorticoids Multiple high-quality *RCTs show consistent efficacy with minor and „„ Prednisolone, methylprednisolone predictable adverse effects „„ 0.5mg/kg once to twice daily and tapered as appropriate

„„ Oral calcineurin inhibitors Multiple high-quality *RCTs show efficacy and safety, apart from minor „„ Ciclosporin reversible adverse effects. The most common of these is minor, transient „„ 5mg/kg once daily and tapered following gastrointestinal disturbances. Efficacy is comparable to but slower than that of response oral glucocorticoids

„„ Topical glucocorticoids Several high-quality *RCTs confirm efficacy. Major safety risk is skin thinning „„ 0.0584% hydrocortisone aceponate with prolonged use. Intermittent application appears to prevent this problem and might delay the recurrence of flares if applied proactively (e.g. twice weekly even when lesions no longer visible) to previously affected sites

„„ Topical calcineurin inhibitors Three small *RCTs suggest efficacy, the highest of which seen with a 0.1% ointment „„ Tacrolimus ointment for localised skin lesions. Treatment of generalised lesions of lower benefit and also „„ Twice daily application impractical and costly. Appears safe, apart from application-induced licking

„„ Recombinant interferons Small number of intermediate-quality *RCTs show efficacy. However, protocols for optimal benefit and safety still unknown

„„ Oral tyrosine kinase inhibitor Appears to have a promising effect but currently low-quality evidence for „„ Masitinib efficacy and safety and further studies required. Monitoring for urine protein „„ 12.5mg/kg once daily loss is required to assess for protein – losing nephropathy Other interventions: Low-quality or number of *RCTs suggest: „„ Antihistamines „„ Poor efficacy, good safety „„ Misoprostal „„ Moderate efficacy, good safety „„ Pentoxifylline „„ Poor efficacy, good safety

*RCT = randomised controlled trial

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Figure 1. Impression smear cytology Figure 2. Acetate tape impression cytology Figure 3. Acetate tape impression cytology demonstrating bacterial infection – note the consistent with bacterial overgrowth – consistent with yeast overgrowth – note large number of degenerate neutrophils and note the absence of inflammatory cells, the large number of corneocytes and intracytoplasmic coccal bacteria. occasional corneocytes and the large budding yeasts (morphology consistent with number of bacteria. Malassezia pachydermatis). fatty acids and ceramides. immunomodulatory drugs been shown to effectively and and microbial infection Evidence of clinical benefit in available. Systematic reviews safely reduce pruritus through should be eliminated using the control of CAD is limited are extremely useful for selective Janus kinase inhibition. diagnostic tests. Treatment but an open study showed summarising the literature with anti-inflammatory or clinical improvement in atopic and providing us with the Individuals with severe, immunomodulatory agents dogs following twice-weekly information needed to practise generalised disease require should be given promptly to application of this product for evidence-based medicine. treatment with systemic re-stabilise the animal and 12 weeks. Two systematic reviews of anti-inflammatories or prevent the development of the efficacy and safety of immunomodulators. chronic lesions. In another small study in therapeutic interventions Daily treatment should be atopic dogs, a product for CAD have recently been continued until the disease is For localised flares, topical containing fatty acids and published (Olivry, 2010 and in remission; then treatment therapy can be used. For essential oils were shown to Olivr y, 2013). should be tapered to the more generalised flares, a reduce transepidermal water lowest effective dose that short course of systemic loss together with lesion Table 1 summarises the controls clinical signs. glucocorticoids (0.5 mg/kg and pruritus scores when results of these reviews for prednisolone once daily for applied once weekly for eight the various anti-inflammatory The level of treatment can 3-5 days) is very effective at weeks. These products need and immunomodulatory often be reduced by using re-establishing remission. to be distributed over all drugs used for the products to target the affected skin according to the management of CAD. other areas of pathogenesis Specific allergen manufacturer’s instructions. and also using additional sensitisation The evidence suggests topical anti-inflammatories, In animals diagnosed Cutaneous inflammation that the use of oral and such as hydrocortisone with CAD – and where and immune dysregulation topical glucocorticoids and aceponate and less potent sensitisation to environmental Control of skin inflammation the calcineurin inhibitors anti-inflammatories, such as allergens has been identified and pruritus is an extremely ciclosporin and tacrolimus antihistamines. via allergy testing – allergen important part of the provide consistent benefit avoidance and allergen- management of CAD; in the treatment of CAD. Animals with less severe specific immunotherapy however, it can be challenging Adverse effects are well – or localised – disease (ASIT) can be included in the as many of the drugs used to known and predictable can be managed by management plan. treat this component of the and can be monitored and means of regular use of disease can be associated managed accordingly. topical anti-inflammatory There are three small studies with side effects, particularly or immunomodulatory to suggest subcutaneous if used at high doses and/ There is poorer quality treatments, in addition to ASIT has a beneficial effect or long term. Control of evidence to support efficacy products used to target and carries a low risk of inflammation and pruritus of antihistamines. These other areas of pathogenesis. adverse effects. There is no is essential in the prevention drugs, however, carry a There is evidence to suggest standardised protocol for of chronic skin lesions which low risk of adverse effects that twice-weekly use of the administration of ASIT are more difficult to treat and can be considered for hydrocortisone aceponate and generally the procedure and cause considerable adjunctive therapy with the spray can reduce the recommended by the vaccine discomfort and debilitation in aim of reducing the use of frequency of atopic flares. supplier is undertaken. affected animals. other agents. The greatest concern with the For atopic animals on use of ASIT is the (low) risk of In terms of selecting Subsequent to these maintenance therapy that anaphylaxis at the beginning therapeutic agents, there reviews, the novel, targeted suffer an acute flare of of therapy. So it should only are a large number of immunomodulator oclacitinib, pruritus, precipitating be commenced on patients anti-inflammatory and has been developed. It has factors such as ectoparasites that are under the close

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supervision of a veterinary presenting with ALD, food- References surgeon. Treatment response induced AD and non-food Olivry T, Foster AP et al (2010). is slow and usually assessed (environmental allergen) Interventions for atopic dermatitis over six to nine months; induced AD. in dogs: a systematic review of therefore, treatment of the randomized controlled trials. other areas of pathogenesis As the nature and severity Veterinary Dermatology 21: 4-22. must be addressed while ASIT of lesions vary widely is taking effect. between animal breeds and Olivry T and Bizikova P (2013). A individuals of the same breed, systematic review of randomized Microbial colonisation and it is important to re-evaluate controlled trials for prevention or infection the animal frequently and treatment of atopic dermatitis in Microbial overgrowth and tailor treatment to meet its dogs: 2008–2011 update. Veterinary infection is common in CAD. individual needs. By targeting Dermatology 24: 97-117. The most effective way of the four areas of pathogenesis, managing animals prone to safe and successful long-term Further reading secondary microbial infection management of CAD patients Linek M and Favrot C (2010). is by controlling their skin is more likely. Impact of canine atopic dermatitis inflammation adequately on the health-related quality of and regular use of topical life of affected dogs and quality antimicrobials. of life of their owners. Veterinary Dermatology 21(5): 456-462. The presence of bacterial and PPD Questions yeast overgrowth or infection Marsella R, Santoro D et al (2012). should be assessed using skin Early exposure to probiotics in a surface cytology (Figures 1-3). 1. Which hypersensitivity reaction(s) are involved in the canine model of atopic dermatitis has pathogenesis of atopic dermatitis? long-term clinical and immunological Swabbing of the skin surface effects. Veterinary Immunology and for culture and susceptibility 2. Which of the following would be most appropriate Immunopathology 146(2): 185-189. testing is not helpful in for stabilising an acute flare of severe, generalised the diagnosis of microbial pruritus and cutaneous erythema in a dog with atopic Marsella R, Sousa CA et al (2012). overgrowth or infection dermatitis? Current understanding of the because the commensal pathophysiologic mechanisms of population is likely to be A. Ciclosporin canine atopic dermatitis. Journal sampled and this may lead B. Amoxycillin-clavulanic acid of the American Veterinary Medical to inappropriate use of C. Chlorhexidine-based shampoo and antihistamines Association 241(2): 194-207. antimicrobial agents. D. Prednisolone Meury S, Molitor V et al (2011). Role of the environment in the development of Affected animals can be 3. What are the indications for performing IgE serology? CAD in Labrador and golden retrievers. managed with topical Choose all that apply shampoos, sprays, gels and Veterinary Dermatology 22: 327-334. wipes containing chlorhexidine A. To make a diagnosis of atopic dermatitis and other biocides. These B. To identify food allergens for avoidance Nodtvedt A, Bergvall K et al products may be used C. To identify environmental allergens to include in an (2007). A case control study of risk once daily to treat existing immunotherapy vaccine where a diagnosis of atopic factors for CAD among boxer, bull overgrowths or superficial dermatitis has been made terrier and West Highland white infections, and two to three D. To make a diagnosis of food-induced atopic terrier dogs in Sweden. Veterinary times weekly to prevent further dermatitis Dermatology 18: 309-315. microbial overgrowths. Nodtvedt A, Guitian J et al (2007). The 4. How would you confirm the presence of bacterial Systemic antibiotics should spatial distribution of atopic dermatitis pyoderma? be reserved for the treatment cases in a population of insured Swedish of deep bacterial infections dogs. Preventative Veterinary that have been confirmed 5. Which of the following have been shown to provide Medicine 78: 210-222. cytologically. Culture and consistent benefit in the treatment of canine atopic susceptibility testing should dermatitis? Choose all that apply Nuttall T, Uri M et al (2013). Canine atopic be performed when systemic dermatitis – what have we learned? antibiotics have been A. Ciclosporin Veterinary Record 172(8): 201-207. deemed necessary in order B. Prednisolone to determine the narrowest C. Topical tacrolimus Olivry T, DeBoer DJ et al (2010). spectrum antibiotic to which D. Chlorpheniramine Treatment of canine atopic dermatitis:

the bacterium is sensitive. 2010 clinical practice guidelines

A B and C and B A 5. bacteria on cytology samples samples cytology on bacteria from the International Task Force

Consistent clinical signs and presence of neutrophils with intracytoplasmic intracytoplasmic with neutrophils of presence and signs clinical Consistent 4. C

Conclusion 3. on Canine Atopic Dermatitis.

D D 2. hypersensitivity cell-mediated) or (delayed IV type and (immediate) I Type This approach to management 1. Veterinary Dermatology 21: 233-

can be applied to dogs Answers 248. Open access online via Wiley.

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Rabbit dentistry: an overview for general practitioners Dental problems in rabbits can be diagnosed relatively easily but are always difficult to treat effectively. This article is directed towards general rabbit practice where expensive diagnostic methods, such as CT scanning, may not be available. Ivan Croatz BVetMed MRCVS Normal dentition disease. It tends to cause examination. Anaesthesia Rabbits are designed to severe incisor malocclusion in carries significant risks in Ivan graduated from the Royal eat a diet consisting almost young rabbits. Other issues anorexic or sick patients. Veterinary College and has been entirely of fibrous vegetation. such as neoplasia, non-dental Some of your anorexic, sick working in general practice Because of this, the teeth abscesses, mandibular or rabbits may have renal disease in the UK for the last 15 years. can grow continuously at maxillary fractures and tooth which will not be helped He developed a large rabbit about 4mm/week, (Moxham, fractures can also occur. by anaesthesia; however, caseload made up of first- 1979). Enamel is produced some dental diagnosis and opinion, second-opinion and continuously from the base treatment will be impossible rescue work. He also designs of the tooth, covering the without anaesthesia. and develops a variety of entire root and crown, and “Dental disease is veterinary products. wearing against the opposing generally easier to Clinical history taking teeth, forming ridges between This should include: Ivan is recognised as an enamel and dentine layers. manage in older „„ Husbandry, especially diet international teacher on and exposure to natural light rabbit airway management The teeth can be considered rabbits with slower (direct, not through glass) and anaesthesia, as well in two groups: ‘incisors’ and tooth growth and „„ Changes in appetite and as maintaining his general ‘cheek teeth/molars’ – maxillary food choice – hay is frequently practice and second-opinion cheek teeth 1-6 and mandibular hence often carries refused owing to tooth pain rabbit work. cheek teeth 1-5 (Figure 1). „„ Changes in behaviour a better prognosis” or droppings that might They are kept in shape during indicate disease feeding on fibrous vegetation, Dental disease may be seen „„ Other changes such as especially various grasses. as a complicating factor polyuria/polydipsia, coughing The molars are offset from or cause of other dental or sneezing that might indicate each other so that each lower diseases. Concurrent disease other disease cheek tooth occludes with two (consider Encephalitozoon upper cheek teeth, forming a cuniculi, multifocal bacterial Clinical signs series of sharp enamel ridges. infections and digestive Rabbits with dental disease system disease) is normal tend to present with some of Pathogenesis of dental with sick rabbits and should the following clinical signs: disease be considered as a possibility „„ Weight loss Acquired dental disease with every case. „„ Appetite change or anorexia accounts for the vast majority „„ Problems with prehension of cases seen in general Dental examination and of food practice. It is likely to be a diagnosis „„ Epiphora, dacrocystitis multifactorial condition, As always, the considerable „„ Oral or mandibular pain involving elements of: weight of your diagnosis „„ Facial (especially „„ Inadequate dietary fibre comes from a detailed clinical mandibular) abscesses (normally ad lib pellets/ history and careful physical „„ Retrobulbar swelling muesli and minimal hay/grass consumption) „„ Metabolic bone disease Figure 1. Normal rabbit dentition. (dietary calcium deficiency +/- vitamin D deficiency which can be the result of insufficient year- round exposure to natural light or lack of dietary vitamin D) Normal rabbit dentition: „„ Genetic predisposition and *Suggested Personal & Professional poor husbandry standards Development (PPD) = 28 ! ! ! ! Congenital dental disease NURSINGDENTISTRY CPD (prognathism) is an 𝐼𝐼: ! 𝐶𝐶: ! 𝑃𝑃: ! 𝑀𝑀: ! uncommon cause of dental

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if clinical signs return. Meloxicam can in some cases be continued for many years.

Management of incisor disease Three options currently exist for the management of incisor disease. With experience, regular trimming and incisor Figures 2-4. Rabbits are far calmer and easier to handle when placed on a towel rather than simply on reshaping can be performed the table top. Gently wrap them during the examination to give them a hiding place. without sedation or anaesthesia because sensitive tissue should (generally from maxillary identify the extent of dental In early cases of tooth root not be entered. Clippers should cheek tooth root disease) disease and is essential for changes, where the mandible not be used alone as they surgical planning. Two slightly is painful on palpation fracture the tooth root, causing Clinical examination oblique lateral views tend to but an abscess has not pain and infection. Rabbits are far calmer and be best to offset the cheek yet developed, meloxicam easier to handle when placed tooth roots (Figure 6). alone may be sufficient to Regular trimming/ on a towel rather than simply halt and control the disease shortening on the table top. Gently wrap Treatment and process (author’s experience), This should be carried out by them during the examination management options although radiographs are still using a water-cooled, high- to give them a hiding place In many cases, you may simply recommended. speed burr or cutting disc. Do (Figures 2-4). not have the funds available not use molar cutters or nail to diagnose or treat disease clippers – these cause painful The author prefers to examine accurately. Euthanasia should enamel fractures and make the the rabbit standing behind be discussed as an option in “Dental disease underlying disease worse. them and leaning over. This these cases. in rabbits is best generally means that no Incisor reshaping assistance is required as the Dental abscesses will not considered as This technique carries a rabbit naturally backs into you resolve easily – if owners are relatively low success rate and then tends to stay still. not prepared for potentially manageable, rather of about 40 to 50 per cent protracted treatment and than curable” in the author’s experience Dental assessment will not correct underlying (Figure 7). However, it This is a critical part of the husbandry problems, then Appetite should improve can be done instead of a diagnostic process: euthanasia may be the within two to five days, with normal trim, so little is „„ Visual assessment kindest option. emphasis placed on feeding lost if it is unsuccessful. It (abnormal face shape, of fibrous grasses and hays. does not tend to work on exophthalmos, epiphora, and The recent experience of the The author would normally cases of congenital incisor nasal or oral discharge) author is that far more cases maintain this level of pain relief malocclusion. „„ Incisor check – enamel present with molar root for three to six months, with ridging (a sign of tooth root disease than with the classic regular clinical examinations Trim once weekly – if the disease) or malocclusion tooth spur disease. If there and home weight checking tooth shape is not changing „„ Palpate the mandibles (and are no spurs coming from the to ensure that recovery is by week three or four, it is maxilla) – a common finding molars and root abscesses genuine. Once the rabbit has unlikely to work. Angled cuts is a painful bone bump are absent, it is worth been stable for several months, are made to both upper and corresponding to the root considering a medical – rather analgesia is gradually reduced lower incisors, allowing a of an overgrown mandibular than surgical – approach. and then stopped. sliding force between upper cheek tooth. This change and lower incisors, pushing is always significant and With respect to analgesia, Monitoring continues and the lower incisors caudally and requires treatment under the terms of the analgesia is re-established upper incisors rostrally. The „„ Otoscopic examination of ‘cascade’, meloxicam can molars – straight rostro-caudal be used. Various doses are Figure 5. Otoscopic dental Figure 6. Radiograph (oblique view, then diagonally towards recommended and the half examination. lateral view) of normal the lingual surface, then life is about eight hours dentition. straight towards the buccal (Turner et al, 2006). The surfaces (Figure 5). Look for author has good results from excessive salivation, gingivitis, oral meloxicam preparations blood and purulent discharge licensed for dogs, using the maintenance dog dose At this point, you can decide rate of 0.1mg/kg, but every whether a sedated dental 12 hours. Some clinicians examination is required recommend higher dose rates for further diagnosis. every 24 hours (Carpenter et Radiography is very useful to al, 2009).

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Incisor reshaping procedure Molar root disease management process „„ Normal incisors 1. Identify and start correction of underlying husbandry „„ Malocclusion factors „„ Angled cuts made to incisors 2. Begin analgesia (meloxicam) „„ Side cutting burr used for angled cuts 3. If analgesia is effective (early stage disease), monitor and „„ as teeth shift, step appears in lower incisor manage, if husbandry is corrected, no more treatment „„ End result, not perfect but generally sufficient for long may be necessary term care 4. If analgesia is not effective, radiograph before any treatment, identify offending tooth roots 5. Intra-oral or extra-oral extractions, marsupialise and Figure 7. Incisor reshaping procedure. treat abscesses 6. Culture and sensitivity testing should be performed on author finds it easier to work Management of molar pieces of abscess capsule without a tongue guard; disease cutting through 90 per cent A primary consideration in Figure 8. Molar root disease management process. of the tooth depth and using the management of molar molar clippers to remove disease is pain management, the last section, thereby even if the disease must under general anaesthesia. will cause catastrophic protecting the soft tissues. ultimately be managed They can re-grow rapidly; haemorrhage. Have a vial surgically (Figure 8). although good dietary and of adrenaline and a cotton Incisor extraction pain management can reduce bud on standby for all dental This is done under full Molar ‘crown’ disease the rate of spur formation. procedures – an adrenaline- general anaesthesia. It is best (‘spurs’) soaked cotton bud applied to to maintain the patient on This normally presents with Molar ‘root’ disease the artery immediately should gaseous anaesthesia via an acute anorexia and weight loss. The germinal epithelium grows save your patient. endotracheal tube or v-gel Other facets include: away from the ‘root’ of the airway device. Clean the „„ Occlusal surfaces flatten tooth through the surrounding Intra-oral extractions can be gingivae using dilute iodine, and elongate, forming (mostly) bone. Examination will reveal performed with the correct then use a scalpel to sever medial/lingual mandibular palpable bumps on the ventral instruments. Small right-angled the gingival attachment. spurs and lateral/buccal surface of the mandible luxators and forceps are Luxate all aspects of the maxillary molar spurs (mandibular cheek teeth), or essential, together with either a tooth using a Crossley „„ Vertical ‘spurs’ are almost facial swelling, exophthalmos, dental table or padded gag and incisor luxator or curved always a result of the normal epiphora, or nasal/sinus cheek dilators (Figure 11). hypodermic needles. occlusion of the molar teeth. disease (maxillary cheek teeth). Anything less than 2-3mm in Gently sever the root Once the tooth is loose, height and directly vertical is Mandibular root bumps are attachments with the luxator, rotate it back deeper into unlikely to be pathogenic simple to palpate and a pain rotate the tooth using the the socket to damage the „„ Spurs normally cut reaction is obvious during forceps until very loose, then germinal epithelium and into adjacent soft tissue, palpation (generally a head gently extract. Extraction may help prevent regrowth. If the thereby causing pain and tilt and jaw tremor) with an not be possible with angled germinal epithelium does hypersalivation active injury. Once formed roots. The ‘crown’ may be not come out as a pink plug „„ Can be hard to diagnose if these root bumps will not very short with the germinal inside the root, use a curette slim or caudal spurs present, regress spontaneously, so bud deeply involved with deep or similar instrument to needing anaesthesia and soft noting jaw shape is useful to abscesses, so the removal of all destroy the tissue at the base tissue retraction to confirm check for new changes later mineralised material may not of the socket. The author (Figures 9 and 10). completely solve the problem. flushes the socket with dilute Spurs may be removed using iodine and then sutures diamond rasps or molar burrs Be wary of the lingual artery Extra-oral extractions are the socket closed using (ideally use soft tissue guard at the back of the mouth relatively simple on mandibular absorbable suture material. to prevent tongue damage) which, if traumatised, molars but trickier for maxillary

Figures 9 and 10. Severe root changes resulting in penetration Figure 11. Small mammal Figure 12. Central abscess tract through the mandible, requiring complex dental surgery and dental kit. during dissection process. mandibular root penetration and abscess formation.

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molars. Gentle technique References and frequent reference to the Carpenter JW et al (2009). radiographs is very helpful. Single and Multiple-Dose PPD questions Pharmacokinetics of Meloxicam Abscess tracts normally lead After Oral Administration to the to the tooth root and are 1. Which one of the following factors is not likely to be Rabbit (Oryctolagus cuniculus). Journal of Zoo and Wildlife easy to follow (Figure 12). implicated in the development of acquired dental Medicine 40(4): 601-606. Draining bone tracts can be disease in rabbits? very narrow, often 0.5mm. The abscess top can be removed A. Percentage of fibrous food (grass and hay) in diet Moxham BJ (1979). Recording the and the capsule marsupialised B. Lack of exposure to natural sunlight eruption of the rabbit mandibular to the skin. Any overlying bone C. Dietary vitamin D content incisor using a device for can be removed with a low- D. Exposure to Encephalitozoon cuniculi continuously monitoring tooth speed burr or curette. movements Archive of Oral Biology 24(12): 889-899. 2. Which of the following is not likely to be a clinical sign Once the root is exposed, of dental disease in rabbits? either rabbit dental or cat Turner PV et al (2006). dental instruments can A. Weight loss Pharmacokinetics of meloxicam in be used, and extraction is B. Tachycardia rabbits after single and repeat oral extremely simple. Clean sites C. Changes in dropping size or shape dosing. Comparative Medicine, can be closed surgically; D. Epiphora 56(1): 63-67. abscesses should be marsupialised and treated as 3. Which of the following options might be open wounds. appropriate for treatment of molar root disease? Conclusion (Choose all that apply) Dental disease in rabbits is A. Oral meloxicam with re-checks, including weight manageable to the point where assessments the majority of patients can B. S/C injection of enrofloxacin followed by one week enjoy a good quality of life for of oral enrofloxacin long periods after diagnosis. C. Immediate analgesia, followed by general anaesthesia for radiography and molar root Treatment is always time extractions consuming and costs will add D. Oral meloxicam without booking any follow-up or up. It is best to be ‘up front’ re-checks about this in the early stages of treatment so that owners understand the complexity 4. Which of the following options is not appropriate for of the disease and the need treatment of incisor tooth malocclusion? for long-term care. With this A. Incisor shortening using a water-cooled, high- taken care of, the disease speed burr is rewarding to treat and B. Incisor shortening using a diamond cutting disc high-quality treatment can C. Incisor shortening using nail clippers or molar cutters be undertaken at the level of D. Incisor reshaping using a water-cooled, high-

veterinary general practice. speed burr

C 4. A&C 3. B 2. D 1. Answers

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Controlling infections in veterinary practice Infection control in the veterinary practice is a vitally important role for the veterinary nurse. The cleanliness of a veterinary practice can not only affect the health status of your patients but also the apparent client cleanliness rating. It is a role which should have equal time allocated and enough staff to ensure all areas are cleaned to the appropriate standard.

Nosocomial infections, Victoria Bowes particularly Methicillin- RVN DipRSA MIfL QTLS resistant Staphylococcus “Effective methods and protocols for aureus (MRSA), in the human Victoria is a qualified medical field have been the sterilisation in the practice are vital” veterinary nurse with 15 subject of increased media years of experience in both attention in recent years and bacteria and fungi, are disease- Asepsis describes a complete small animal and emergency research has shown that causing microorganisms. It absence from infectious practice environments. MRSA can be a pathogen in is common to confuse them, material. The aim of the companion animals in the UK but they are as different as a veterinary nurse should be to She has been a lecturer at (Duquette and Nuttall, 2004). mouse and an elephant! achieve this wherever realistic Warwickshire College for the or practicable. past 10 years and is currently Pet owners have now become It is also critical to be familiar course manager for Veterinary more significantly aware with some basic terminology. Disinfection describes Nursing. As a practical of the risk of nosocomial the process of destroying examiner for the RCVS, infections (Polton and Sterilisation describes microorganisms on inanimate Central Qualifications and Elwood, 2006). the process of destroying objects, such as surfaces City and Guilds, she also has all microorganisms and or equipment. This may be the privilege and pleasure of First principles their pathogenic products. achieved using a suitable assessing the next generation To first understand the Effective methods and solution and cleaning routine. of veterinary nurses. control of infection in a protocols for sterilisation veterinary practice, you are vital in the practice Antisepsis describes the need to be familiar with environment, particularly process of destroying what could be the cause of in the operating theatre microorganisms on living any breakdown of sterility. where patients are extremely tissue. This is accomplished Pathogens, such as viruses, vulnerable to infection. by the use of an antiseptic

Figures 1 and 2. Clean hands protect against infection (WHO, 2014).

*Suggested Personal & Professional Development (PPD)

NURSINGINFECTION CPD

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to their preparation. Factors it is worth checking the data such as concentration, water sheet of a solution before “There is a wide range of antiseptic temperature, pH and volume use to establish its specific of solution will all affect the action (Table 1). and disinfectant solutions available to efficacy of the chemicals and, veterinary practices” therefore, the effect on the Terms used in relation to area to be disinfected. spread of disease solution to clean wounds, Antiseptics and The term infection refers to the prepare a surgical site or disinfectants The veterinary practice will invasion of the animal body by scrub hands before surgery. There is a wide range of play host to a range of different pathogenic microorganisms, antiseptic and disinfectant microorganisms, so it is such as bacteria, viruses, Setting and maintaining solutions available to veterinary important to select the most fungi, parasites, protozoa and correct protocols to ensure practices (Table 1). The most appropriate solution to deal prions. The disease caused by the risk of infection to appropriate product should with each specific pathogen. an infectious agent is called an patients and staff members be selected for each specific infectious disease. is reduced is an important disease, patient or situation. Solutions are said to be role of the veterinary nurse. Before choosing a solution bactericidal, fungicidal or Contagion refers to a Effective sterilisation, for use, consideration should virucidal. The suffix ‘cidal’ microorganism that may be disinfection and antisepsis be given to the reason for indicates that a chemical is transmitted to another living can be achieved if correct disinfection, the microorganism capable of killing the stated thing. Most infectious diseases codes of behaviour, to be eliminated, the surface microorganisms, whereas are contagious. procedure and routine are requiring disinfection and the the suffix ‘static’ indicates implemented. health and safety of those in that a solution will only Colonisation indicates the the vicinity. inhibit bacterial, fungal or settlement and replication When dealing with known viral growth and replication. of infectious agents in a or potentially infected Each available solution is This should be taken into particular area such as the patients, veterinary nurses classified with regard to its consideration when selecting skin, upper respiratory tract wear protective clothing active ingredients. Before a disinfectant for a particular or intestine. and carry out disinfectant being approved for sale, all circumstance. protocols to limit the risk disinfectants – including the Contamination is the of infection being spread domestic products found Generally speaking the term used to describe the by personnel or by faeces on supermarket shelves – are halogens, phenols, aldehydes introduction of infection into (Polton and Elwood, 2006). analysed in a laboratory to and alcohols are the most the animal body or on to Veterinary nursing staff assess their efficacy against effective against bacteria; the inanimate objects. should also be encouraged a range of pathogenic halogens and aldehydes are to wear normal clothes when microorganisms. the most effective virucidals; Endemic is the term for a travelling to and from work and the phenols, aldehydes disease which is present so as to minimise the risk of When using disinfectants, and halogens have the best at a normal level within a contamination. consideration should be given fungicidal action. However, population (Helps et al, 2012).

Table 1. Types of disinfectant agent, their mode of action and use in practice

Category Name Mode of action Application Warnings Alcohols Surgical spirit Bactericidal, not Skin preparation Do not use on open wounds virucidal or delicate structures. Rapidly evaporates Aldehydes Formaldehyde Bactericidal Environmental use May be irritant to tissues (Parvocide) Chlorhexidine Bactericidal, fungicidal Skin preparation Easily inactivated by organic (Hibiscrub) and virucidal material Halogens Iodophors Bactericidal, fungicidal Skin preparation (Pevidine) and some viruses Hypochlorite All pathogens Environmental use May be irritant to tissues. (Bleach) Discolours material Peroxide Bactericidal Environmental use (Virkon) Phenols (Jeyes Fluid, Dettol) Bactericidal, fungicidal Environmental use Toxic to cats and virucidal Quaternary Ammonium (Savlon) Bactericidal, fungicidal Skin preparation (Trigene, Vetaclean) and some viruses Environmental use

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Epidemic is the term for a disease which has had an observed increase within a “Effective hand washing is a key area of country or a geographical preventing the spread of infection” area. Enzootic refers to animal disease (Moreton, 2012). Sterilisation of surgical „„ The ratchets of hinged Pandemic is the term for an instruments instruments should be left epidemic disease which has Sterilisation is the process of open to ensure all surfaces then spread across many destroying all microorganisms are accessible to the steam countries or continents (Helps and their pathogenic or heat et al, 2012). products. The strictest „„ The instruments should be operating protocol will fail if placed into a suitable bag Importance of hand a surgical pack is not sterile. incorporating a sterilisation washing and correct Failure to use sterile materials indicator technique exposes the patient to the „„ The pack should be labelled The single measure that will risk of infection, which may with the date, included Figure 3. Hand washing have the greatest impact on impede its recovery. instrument/s and initials of efficacy can be checked by using infection risk is adherence to an the packer UV hand gels that ‘illuminate’ to effective hand washing policy Preparation of equipment recognise areas that have not been correctly cleaned. (Polton and Elwood, 2006). for sterilisation Methods of sterilisation Cleaning instruments Autoclave Effective hand washing is Once surgical instruments This is probably the most when a temperature of 121° C a key area of preventing have been removed from the common method of is reached. Its use is limited, the spread of infection. operating theatre, they should sterilisation used in veterinary as it will only indicate that All the veterinary practice be sorted to ensure that any practice. It works on the the desired temperature has team should be trained and sharp items are disposed of principle of steam under been reached, not that this encouraged to use correct safely – every practice should pressure. When steam is has been maintained for the hand washing protocols that have a protocol identified to pressurised, the temperature necessary length of time. should be displayed near ensure safety is guaranteed. will rise. The higher the the hand washing facilities pressure, the higher the Browne’s tubes are glass tubes (Figures 1 and 2). Blades and needles should temperature will be. filled with liquid that changes be discarded into a ‘sharps’ from red to green when the Veterinary nurses should container and any organic Hot air oven sterilisation cycle is complete. also be reminded that using material should be disposed This method of sterilisation There are a number of different sanitising gels does not replace of in a clinical waste works by maintaining very tubes for use with different the need to wash hands with container. Instruments and high temperatures to kill sterilisation methods and cycles. soap and water because drapes should be put into microorganisms. The higher some gels can be inactivated cold water to soak. This will the temperature, the faster TST strips are chemically by organic particles. When remove blood and debris the cycle works. impregnated paper strips moving between patients and make cleaning easier that change colour when the and areas of the veterinary (McHugh et al, 2012) Ethylene oxide desired temperature, pressure practice, the recognised hand This method of sterilisation and time have been reached. washing technique should Once the organic material has involves the use of gas to be implemented using soap dispersed, the instruments destroy microorganisms. Spore tests consist of a and water, then alcohol may be scrubbed in a suitable Adequate ventilation is strip of paper impregnated hand gel applied to finish the solution using a soft brush. required when using this with dried spores that is procedure. All areas of the items should method. It is potentially toxic autoclaved and then cultured be scrubbed, particularly the and irritant to living tissue. and incubated. If sterilisation Practices can also train teeth, serrations and ratchets. is effective, no growth of any all staff on the procedure Once clean, the instruments Gamma radiation microorganism should be using UV hand gels which should be rinsed thoroughly This method of sterilisation is evident (Brooks, 2012). illuminate to recognise areas and then dried before packing not used within the veterinary that have not been correctly (McHugh et al, 2012). practice, but many items used Thermocouples are electrical cleaned (Figure 3) (Poulton in the surgery will have been devices with temperature- and Elwood, 2008). The Packing instruments for sterilised in this way. These sensitive tips that are placed in importance of hand washing sterilisation include sterile gloves, suture different parts of the sterilisation procedures needs to be This part of the sterilisation materials and disposable chamber and give readouts of actively encouraged by all procedure is essential as sterile supplies. the temperature that has been members of the veterinary errors at this stage can reached (Brooks, 2012). practice team. lead to serious postsurgical Methods of monitoring the infections. sterilisation process Summary Further infection control „„ Sharp instruments should Bowie Dick tape is adhesive Media coverage about the vital protocols will be discussed in be protected to prevent the tape, impregnated with a nature of infection control future articles. edges piercing the packaging chemical that turns black is growing. This will impact

20 VETERINARY PRACTICE TODAY WINTER 2014 INFECTION | SMALL ANIMAL

on client knowledge and References expectations. It is paramount Brooks E (2012). Theatre Practice. that within the veterinary In: Aspinall V The Complete practice the infection control PPD Questions Textbook of Veterinary Nursing. 2nd protocols are set to a high ed. London: Saunders Elsevier. pp standard that is achievable. 1. The definition of a disinfectant is a cleaning product 399-420. used to clean: The veterinary nurse is a Duquette A and Nuttall J (2004). key figure in the maintenance A. Instruments Methicillin-resistant Staphylococcus and completion of these B. Animal skin aureus in dogs and cats: an protocols, so it is imperative C. Hands emerging problem? Journal of Small that the knowledge base and D. Surfaces Animal Practice 45: 591-597. understanding of procedures Emergency Medicines, Cork is encouraged and actively 2. The suffix ‘cidal’ indicates the: sought. (2013). Hand washing. Available: A. Death of a contagion http://www.emed.ie/Infections/ B. Colonisation of a contagion Hand_Washing.php. Last accessed C. Sterilisation of a contagion 8 August 2014. D. Spread of a contagion Helps J et al. (2011). Infection and immunity. In: Cooper B et al. BSAVA 3. Endemic refers to: Textbook of Veterinary Nursing. 5th A. Disease that is present at normal levels within a ed. Gloucester: BSAVA. pp125-135. population B. Disease that has had an increase in a specific McHugh D et al. (2011). Theatre geographical location Practice. In: Cooper B et al. BSAVA C. An animal disease that has had an increase in a Textbook of Veterinary Nursing. 5th specific geographical location ed. Gloucester: BSAVA. pp 738-767. D. An epidemic which has spread over different countries Moreton H (2012). Microbiology. In: Aspinall V The Complete Textbook of Veterinary Nursing. 2nd ed. 4. Bowie Dick sterilisation indicator tape indicates that London: Saunders Elsevier. pp the correct: 533-544. A. Time has been achieved B. Temperature and time have been achieved Poulton G and Elwood C (2008). C. Pressure has been achieved Keeping it clean: Further lessons D. Heat has been reached on infection control. In Practice 30: 167-169.

5. The skin disinfectant Hibiscrub is classified in which Polton A and Elwood C (2006). disinfectant group? First wash your hands! Control of A. Aldehydes nosocomial infections in practice. In B. Alcohols Practice 28: 548-550. C. Halogens D. Phenols World Health Organization (2014). Clean hands protect against

infection. Available: http://www.

A 5. D 4. A 3. A 2. D

1. who.int/gpsc/clean_hands_ Answers protection/en/. Last accessed 8 August 2014.

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Transfusion medicine today More and more veterinary professionals are making the shift from whole blood to safe and selective blood products as they recognise the advancements in veterinary transfusion medicine. Pet Blood Bank UK supports this ‘sea change’ with a reported average increase of 25 per cent in demand for blood and ancillary products year on year.

Pet Blood Bank UK (PBB) Jenny Walton National Blood Service, increasing number of veterinary was established in 2007 to visited in-house programmes professionals are recognising BVM&S MRCVS provide a canine blood bank in the UK, as well as visiting the benefits of quick and service for all veterinary many animal blood banks convenient access to blood. Jenny qualified from R(D)SVS practitioners across the UK. in the United States. Then in 1998. She worked in mixed It was the brainchild of Vets 2006 saw Jenny piloting the Blood types practice for four years before Now colleagues, Wendy initiative in the north east Blood type plays an moving into the field of small Barnett DipAVN(Surgical) of England in preparation important role in pet blood animal emergency and critical RVN and Jenny Walton for the launch of PBB the banking and transfusion care with Vets Now, where she BVM&S MRCVS who, following year. medicine because the use worked for 12 years. Through working in emergency and of type-specific blood is Vets Now, she ran the practical critical care, were constantly After almost 30 years, recommended to reduce the trial researching canine blood reminded of the need for canine – and indeed feline risk of transfusion reactions, banking in 2005-2006. quick and convenient access – blood banking is now well as well as ensuring the to blood. established in the US with demand for certain types of Jenny has been the veterinary over 20 regional and national blood is always met. supervisor for Pet Blood Bank UK The catalyst for their research animal blood banks; one (PBB) since its launch in 2007. into pet blood banking was of which is reporting that The different canine blood the UK legislation change it distributes over 35,000 types are described as dog Her role includes advising in 2005 that allowed the canine units every year. erythrocyte antigens (DEA). practitioners on the appropriate application for a licence to There are eight DEA antigen use of blood products, collect, process, store and Pet blood banking in the UK is systems 1.1, 3, 4, 5, 6, 7, overseeing the practical and supply blood within the still in its infancy, yet growing 8 and Dal with potentially VMD legislative veterinary veterinary profession. With at an exponential rate. Last more to be defined as aspects of blood collection the help of Vets Now, Wendy year, PBB supplied over 3,000 research continues. The DEA at PBB and leading research sought both practical and units of blood products to the 1.1 antigen has the most on future development feasibility advice from the profession, indicating that an transfusion significance in opportunities. Alongside this terms of acute immunologic role she works part time in transfusion reactions and general practice. Figure 1. Blood donor ‘Tarka’. this is the only canine blood type that has a commercial test kit widely available for use in practice.

Dogs are either described as DEA 1.1 positive – meaning the 1.1 antigen is present – or DEA 1.1 negative – meaning the 1.1 antigen is absent. It is important to note that a universal canine blood type does not exist and that DEA 1.1 negative dogs have been incorrectly termed universal in the past.

Research findings from PBB’s own data report that 70 per cent of dogs are DEA 1.1 positive – compounding the *Suggested Personal & Professional need to ‘blood type’ recipients Development (PPD) to ensure that DEA 1.1 negative blood is preserved BLOOD and only used when necessary. As awareness has grown, so

22 VETERINARY PRACTICE TODAY WINTER 2014 BLOOD TRANSFUSION | SMALL ANIMAL

has the split in supply of DEA The following overview covers 1.1 positive versus DEA 1.1 in brief the PBB collection negative packed red blood process, storage and cells (PRBC). Last year, PBB administration of canine blood. reported an encouraging 14 per cent increase in positive Collection PRBC orders last year, The selection of suitable indicating the veterinary canine blood donors is critical profession is helping to to a successful donation protect the minority DEA 1.1 programme. Dogs should: negative blood supplies. „„ Be over 25kg body weight „„ Be between one and eight PBB also reports an years old Lateral recumbency A correctly placed increased demand in fresh „„ Have a friendly disposition Figure 2. Figure 3. is the most comfortable position needle in the jugular vein of frozen plasma (FFP) with „„ Have no prior medical more and more veterinary conditions for donor and operator alike. a donor. practices storing this useful „„ Not be on any medications product. FFP has a shelf life apart from routine worm and routinely. Scales are tared placed and left in situ for a of one year from the date it flea treatments with the collection bag placed further 30-60 minutes. was collected when stored „„ Be up to date with their on them or their weight at -20°C or below; and when vaccinations is added to the final draw Donors are checked for it has expired, it can be re- „„ Have never travelled outside volume. Both methods ensure normal mucous membrane labelled as frozen plasma the UK the correct volume to be colour, heart rate, demeanour, (FP) with a further shelf life „„ Never have received a collected is known before the and rewarded with treats, of four years. previous transfusion themselves needle is placed. Collection food, and attention (Figure volume for a 450ml unit of 4). Collected blood units are Having this product available The donation procedure is whole blood weighs 477g (1ml labelled to allow identification can, in severe haemostatic similar to that of the human = 1.06g weight) and can be +/- and placed in boxes ready disorders, make the blood service, with donors 10 per cent of this weight to for transportation to the difference between life and giving 450ml of blood every be useable. processing centre. Normal death and its long shelf- 12-16 weeks. All donor dogs activity is resumed for all life makes it suitable for all have a full history taken It is mandatory if blood is to be donors after blood donation. veterinary practices to store and undergo a thorough stored that a closed collection for such emergencies. clinical examination. Blood system is used. This is achieved Processing screens are performed which by ensuring the collection line The collected blood units are Under licence from the include blood typing (on first is clamped prior to uncapping centrifuged at 3,800 rpm for Veterinary Medicines donation only), complete the phlebotomy needle. 15 minutes to separate the Directorate (VMD), PBB collects blood count, platelet count plasma and erythrocytes. A blood from canine donors and full chemistry profile Prior to venepuncture the manual plasma separator is who meet a set of criteria and (first donation and annually) phlebotomy area is cleaned used to remove the plasma are registered on the donor and packed cell volume/total and the jugular vein raised, into the attached satellite bags programme by their owners, solids (PCV/TS) is performed the needle is placed caudally, within the collection system, classifying it as a volunteer at every donation. bevel up into the vein and thus making two separate programme (Figure 1). advanced to the hub so products of packed red blood Blood samples are taken that as much of the needle cells and fresh plasma (Figure PBB is working to provide a from the cephalic vein or lies within the lumen of the 5). Further processing and substantial and sustainable opposite jugular vein to the vein as possible (Figure division can be performed to blood supply for the UK’s site of donation. 3). The collection tubing is allow one donation potentially canine population. With unclamped, and the desired to aid in the treatment of up to almost 10 years of knowledge Collections take place in a amount of blood collected four recipients. and expertise, it continuously quiet room with donors lying with careful agitation of the aims to bring advancements on a full-sized, raised table for collection bag every 50ml to Three aliquots (samples) of in pet blood banking and gravity flow blood collection. ensure a good mix with the each product produced are transfusion medicine by A lateral recumbency position anticoagulant. retained at this stage for running long-term veterinary is preferred for both donor cross-matching and quality education programmes. and assistant’s comfort, When the desired amount has control purposes. With the help of nearly 5,600 which in turn increases the been collected, pressure on registered canine donors likelihood of a successful the vein is released and the Storage nationwide, it holds over donation (Figure 2). collection line re-clamped. Plasma that is separated and 200 collection sessions a The needle is then removed frozen at a temperature of year; and with increased A collection system with and sheathed to prevent -20°C or below within 24 hours recognition from dog owners, a 450ml collection bag injury. Firm digital pressure is of collection maintains all its the veterinary profession and primed with 63ml of citrate applied over the phlebotomy coagulation properties and is the media, it is able to invest in phosphate dextrose (CPD) site for one to two minutes called fresh frozen plasma (FFP) ongoing research initiatives. anticoagulant is used prior to a bandage being with a shelf life of 12 months.

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„„ Plasma doses vary according to the condition being treated. The most common use is to treat haemostatic disorders. Recent human literature suggests a dose of at least 20ml/kg of plasma is likely to be required in a symptomatically bleeding patient „„ Initial rates of transfusion should be slow for the first 30 minutes of a transfusion. A suggested dose of 1ml/ kg of product should be administered. After that 30-minute period, if no acute adverse reactions have been noted, the rest of the breached Checking the heart rate of a donor. Plasma separation Figure 4. Figure 5. product transfusion volume in progress. should be administered within a four-hour time scale Plasma frozen after 24 hours route can also be utilised as the desired clinical effect is described as frozen plasma an effective and rapid method is achieved. In a normovolaemic animal, a (FP) owing to a reduction in of administration. maximum transfusion rate of coagulation properties. It has When considering volume 20ml/kg/hr is suggested. a shelf life of five years. Packed All blood products must be requirements to prepare for red blood cells can be stored administered via a filtered a transfusion these general Monitoring at 4°C +/- 2°C for up to 42 giving set to reduce the risk of guidelines to initial transfusion Parameters routinely days because of the addition micro-thrombi and given to dose rates can be considered: monitored are demeanour, of a nutrient solution (SAGM) a calculated dose to prevent „„ A rate of 1ml of PRBC/kg mucous membrane colour, within the collection system hypervolaemia in small or recipient body weight would heart rate and rhythm, that helps preserve the red compromised patients. Patients be expected to raise the temperature and respiratory blood cell life. be monitored closely before, recipient PCV by 1% rate. If after 30 minutes no during and after transfusion, „„ In an anaemic but concerns have arisen and Administration of blood and regular diagnostic tests normovolaemic dog, a continuous monitoring is not products carried out to assess the general dose rate of 10ml of possible, regular checks of 15- Blood products have a response to transfusion. PRBC/kg can be utilised as a 30 minutes are appropriate. limited life span and must be starting dose rate and then prepared carefully for use. Transfusions must not be adjusted according to the Once breached, they must be administered through the required response fully used within four hours same intravenous line that and any remaining product has any solutions containing after this time discarded. Prior calcium or glucose. Normal to transfusion the warming 0.9% saline can be used to of blood products to at flush giving sets and bags PPD Questions least room temperature is of remaining PRBC or to recommended, although they administer concurrent should never be warmed to crystalloid requirement. 1. What two routes of administration can be used for more than 37°C. blood products? Plasma transfusions can be Warming can be achieved by administered via an infusion 2. How old should an ideal canine blood donor be? placing the blood product in pump or syringe driver, but it a waterproof zip-lock bag and is advisable to check with the placing this in a temperature- manufacturer for accuracy of 3. How many millilitres of whole blood do we collect in monitored water bath. Gentle the equipment and giving sets ‘one unit’ and how many grams does that weigh? and slow warming of products beforehand. Following recent is sensible if time allows. studies, it is recommended 4. What is the shelf life of fresh frozen plasma (FFP)? that PRBCs are transfused by Blood products should be gravity alone. given intravenously and can 5. What temperature should plasma products be stored at? be given via both a peripheral Dose rates and volumes or central (jugular) line. In Transfusions in essence have

very moribund patients, if no ‘dose rate’. Blood products

-20°C or below below or -20°C 5. year One . 4 477g and 450ml 3. old years 1-8 2. IV/IO intravenous access is not should be administered and 1.

possible, the intraosseous the recipient monitored until Answers

24 VETERINARY PRACTICE TODAY WINTER 2014 POISONS | SMALL ANIMAL

The holly and the ivy... and other festive hazards Christmas brings much joyous hustle and bustle and, for the curious pet, it usually means the presence of items not normally encountered around the house – or in the case of food, greater quantities than usual! Busy owners may be unaware of the risks these items pose and will often have their usual focus distracted by all the inherent festive planning and organising. Chocolate Jane Ellison BSc (Hons) Chocolate poisoning is particularly common in dogs Jane is an information scientist over the Christmas period, who has worked for the with the severity of the effects Veterinary Poisons Information being influenced by the Service (VPIS) and the human amount and type of chocolate poisons service at Guy’s consumed. Milk and dark Hospital, on and off since 1984, chocolate differ greatly in and has also worked in the the amount of theobromine pharmaceutical industry. – a methylxanthine similar to caffeine – that they contain, Jane was a founder of the which in turn is reflected in the veterinary service in the 1980s toxic dose (Table 1). and has recently returned to work for the service in the 24- The initial clinical effects are hour rota team. vomiting and diarrhoea, which may lead to dehydration, especially as theobromine is also a diuretic. Theobromine doses (four-hourly) of stimulates the myocardium activated charcoal to enhance and the central nervous elimination is particularly “Grapes - and their system (CNS), leading to useful, as theobromine animals becoming hyperactive undergoes enterohepatic dried products and hyperthermic, and recirculation and is well bound (currants, sultanas developing hypertension by charcoal. Fatal cases of and severe tachycardia – in chocolate poisoning – even in and raisins) - are extreme cases muscle rigidity, dogs – are rare. tremors and convulsions may toxic to dogs” be seen. Onion family Onions, garlic, leeks, shallots Grapes and dried fruits Chocolate is also toxic to and chives all belong to the Grapes – and their dried cats, rodents and rabbits, Allium species of plants. They products (currants, sultanas but there are insufficient can cause toxicity even when and raisins) – are toxic to data to determine a toxic cooked, so foods to keep dogs. Ingestion of even a dose. Cats seem less inclined away from dogs include sage small quantity can cause to eat chocolate. and onion stuffing. Initially acute kidney injury and there may be gastrointestinal possibly failure. Don’t forget Treatment is supportive with signs; but the main effect is this will include food items the emphasis on rehydration, damage to red blood cells that contain dried fruits, reducing the stimulant effects resulting in anaemia. This such as Christmas pudding, with sedatives and monitoring may not be apparent for Christmas cake and mince vital signs. The use of repeated several days after ingestion. pies. Chocolate-coated raisins

Table 1. VPIS Rough Guide to Chocolate Poisoning in Dogs

Type of chocolate Suggested treatment threshold White No treatment required, as insufficient quantities of *Suggested Personal & Professional theobromine present Development (PPD) Milk Amounts over 9g/kg Dark Amounts over 1g/kg POISONS Cocoa powder Amounts over 0.77g/kg

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pose the additional risk of (including yoghurt, bread, Mistletoe (Viscum album) tract. Homemade dough chocolate toxicity. cheese and rice) can contain The plant is considered to is sometimes used to make toxins produced by the be of low toxicity. Reports Christmas decorations Xylitol mould that cause rapid-onset of alarming effects refer and its high salt (sodium Xylitol (E967) is a naturally convulsions in dogs. to American mistletoe chloride) concentration can occurring, sugar-free (Phoradendron flavescens) cause severe – even fatal – sweetener and is found in Poinsettia (Euphorbia and not European mistletoe hypernatraemia. sugar-free chewing gums pulcherrima) (Viscum album). Ingestion and sweets, and some Poinsettia has the reputation of the berries of European Wrapping and crepe paper pharmaceuticals including of being a toxic plant, but this mistletoe may cause Ingestion may cause staining nicotine-replacement has been greatly exaggerated. gastrointestinal upset. of the mouth which may chewing gums. Xylitol is It may cause irritation to look alarming; but this extremely harmful to dogs the mouth and stomach Christmas trees material is considered to and can cause rapid onset with hypersalivation and These trees are considered be of low toxicity. Ingestion hypoglycaemia and, in larger sometimes vomiting. to be of low toxicity. of a large amount might doses, liver damage. Ingestion may cause a mild cause obstruction of the Holly (Ilex species) gastrointestinal upset, gastrointestinal tract. Alcohol Although the plant is accompanied by a mechanical Dogs may help themselves considered to be of low obstruction or physical injury Candles to any unattended alcohol, toxicity, it is not edible, and from needles. Although candles – even including wine and liqueurs, ingestion of holly berries (Ilex scented ones that contain and it can cause similar aquifolium) may result in Ivy (Hedera species) low levels of perfume oils signs (unsteadiness and gastrointestinal upset. The ivy used in wreaths – are considered to be of drowsiness) to those seen in and decorations is Hedera low toxicity, ingestion could their owners when drunk to helix (not Toxicodendron potentially cause obstruction excess. In severe cases, there radicans, the American or a choking hazard. is a risk of hypothermia, low “Dogs may help poison ivy). Hedera species blood sugar and coma. cause many gastrointestinal Pot pourri themselves to any upsets when ingested. Ingestion of pot pourri causes Macadamia nuts unattended alco- significant gastrointestinal Macadamia nuts can cause Where there is significant or effects in dogs. These may last lethargy, increased body hol, including wine prolonged skin contact, they several days – even after the temperature, tremor, lameness can cause both irritant and material has passed through and stiffness. Chocolate- and liqueurs, this allergic contact dermatitis. the gut. It is more likely that coated macadamia nuts can cause similar this is related to the highly pose the additional risk of Lilies (Lilium species) mechanically irritating nature chocolate toxicity. signs to those seen Many households will have of the dried material rather lilies at Christmas and all parts than any toxic effects. Leftovers in their owners of this plant – even the pollen – If there is any food left over when they have are extremely toxic to cats and at Christmas, be careful to cause acute kidney injury and dispose of it promptly and drunk to excess” possibly, failure. Lilies are not appropriately. Mouldy items hazardous to dogs but might cause mild gastrointestinal upset if ingested.

Silica gel Silica gel comes in small sachets and is often found in the packaging of new shoes, handbags, cameras or electrical equipment. Although it is labelled ‘Do Not Eat’, it is considered to be of low toxicity.

Christmas decorations Decorations made of plastic, paper or foil are of low toxicity; although they can obstruct the gastrointestinal tract. Glass decorations pose the risk of a mechanical injury to the mouth and gastrointestinal

26 VETERINARY PRACTICE TODAY WINTER 2014 INSIGHT | SMALL ANIMAL

Dangerous dogs – cause and effect Every year, 6,000 people are injured as a consequence of dog attacks; with a large percentage occurring on private property. Recent changes to the Dangerous Dogs Act (13 May 2014) require dog owners to ensure that their dogs do not bite or display threatening behaviour towards people while in the home, as well as in public places.

Before the amendment, dog owners could from the hard image with which they have every month are attacked by other dogs. only face criminal prosecution if their been unfairly tarnished. The performance or behaviour of guide dog displayed aggressive or threatening dogs is affected in half of these cases and, behaviour towards a person in a public So do these dogs have an unfair in some instances, the guide dog has to be place; but this has now been extended to reputation? The Staffordshire bull withdrawn from service. private property, with dog owners facing terrier has an unpleasant history. It’s criminal charges even if their dogs commit ancestors were bred specifically to be It has been recorded that 40 per cent of the offences in their own home. aggressive so that they could perform well the attacks on guide dogs were by so- in bear and bull baiting and the like. These called bull breeds, such as bull terriers, The decision to extend prosecution to early ‘proto-Staffords known as a ‘bull and bull mastiffs and Staffordshire bull incidents that occur on private property terrier’ provided the ancestral foundation terriers, despite the fact that these breeds coincides with other tougher dog laws stock for the Staffordshire bull terrier, the make up a much lower percentage of the brought in as part of the amended bull terrier, the American pit bull terrier dog population. Dangerous Dogs Act. Under the new law, and American Staffordshire terrier. owners whose dogs attack a person could There is nothing surprising about this face five years in jail – raised from the statistic bearing in mind the history of previous maximum of two. Owners whose Staffies; although what should also be dog kills someone could now go to prison “Currently, one-third of considered is that if you look at dog bite for up to 14 years. statistics, the majority of bites on humans the dogs in Battersea are inflicted not by bull breeds, but by It is likely that these new amendments Dogs and Cats Home are common breeds, such as collies, spaniels, have helped to increase the already rising terrier breeds, German shepherd dogs, and number of so-called aggressive dogs Staffordshire bull terriers” golden retrievers. being abandoned or left to be rehomed by animal charities. Currently, one-third Any dog can be aggressive to humans, all of the dogs in Battersea Dogs and Cats In the mid-19th century, as Britain began to dog ownership carries a risk, and all dogs Home are Staffordshire bull terriers and introduce animal welfare laws, proponents – regardless of their breed – need to be the charity has seen a “huge increase” in of blood sport turned to pitting their dogs trained and kept under control. the numbers of this breed coming into its against each other and used this both as a care – a third of the dogs taken in being blood sport and a way to continue to test So where do we go from here? The Staffie ‘Staffies’ or ‘Staffie-crosses’. the quality of their stock. The Staffordshire has the bad ‘street cred’ yet, in reality, bull terrier breed attained UK Kennel Club all breeds of dog have the potential for This situation is commonplace recognition in 1935. Many were imported aggressive behaviour and all owners throughout many of the rehoming centres into the US by pit fighters and used in have the potential to harness or unleash in the UK. It is highly likely that some their breeding programmes to produce this in their pet. This is not a cry in the owners – possibly those who are not in the American pit bull terrier and American defence of Staffordshire breeds, but more total control of their pet – have decided to Staffordshire terrier. a question to the veterinary professions – err on the side of caution and let someone asking how can they help to educate the else cope with the problem. Modern Staffies are naturally muscular public better in the training and control and may appear intimidating, while the of their ‘best friend’. Staffies or Staffie-crosses personify the dog’s origins as a fighting breed can image of the ‘aggressive/dangerous dog’. make them prone to taking on any other Responsible ownership, knowledgeable However, their negative public image can dog that seeks to fight. Most, however, owners and support in the care and be put down in a large part to ownership exhibit a natural fondness for people and understanding of their dogs surely will go according to Laura Jenkins, head of animal are much loved by owners. The Staffie’s some way to make dog ownership safer services at Battersea, which is working history and uncertain reputation has sadly and, by default, more pleasurable. And with other animal welfare trusts to help attracted some less-than-responsible even perhaps stop the rise in the number of change the perceived image of this breed. owners resulting in the breed’s reputation abandoned Staffies. suffering even further. One such organisation is Hull Animal Welfare Trust, and centre manager, Amy When we first consider dangerous Bryan, has launched a campaign to dogs, we tend to think only about dogs challenge the negative image Staffies have attacking humans; yet there are just as acquired – commenting that responsible many instances of ‘out-of-control’ dogs owners will tell you that Staffies are gentle, attacking other dogs, including attacks friendly dogs and a million miles away on ‘guide dogs’ – in fact, three guide dogs

@VPTODAY WWW.VETERINARYPRACTICETODAY.COM 27 EQUINE | NEONATAL Equine neonatology Neonatal foals are very susceptible to a variety of diseases that can be acquired after birth or even in utero. This article discusses some of the most common conditions affecting foals of this age group, including brief discussion of treatments.

Newborn foals, less than Bettina Dunkel are discharged from neonatal sepsis and perinatal asphyxia DVM PhD Dip ACVIM Dip ECEIM Dip seven days old (‘neonatal intensive care units around the syndrome (PAS), are not ACVECC FHEA MRCVS foals’), are very vulnerable to world with excellent chances acquired after birth but exogenous influences causing of becoming healthy and well- actually begin in utero. After a fellowship, internship illness and injury. A foal’s performing adults – even elite Examination, monitoring and and a large animal internal condition can deteriorate athletes (Toth, Slovis et al, treatment of the pregnant medicine and an emergency within hours and timely and 2014). Neonatal intensive care mare is, therefore, an essential and critical care residency efficient veterinary attention has improved greatly over the component of neonatology. (alternate track) in the USA, is essential to ensure last 30 years and significant Bettina attained her PhD from complete recovery. advances have been made in Bacterial or viral infections the University of London in understanding, diagnosing and can be transferred to the 2008. Since then she has been Fortunately, even severely ill treating neonatal disorders. foal via the placenta. In employed as a senior lecturer foals can survive if appropriate addition, any maternal in equine medicine at the care is provided and up to 80 Many diseases affecting disease process that Royal Veterinary College. Her per cent of foals recover and neonatal foals, such as compromises perfusion of main clinical and research interests are equine platelets, neonatology, respiratory Table 1. Differential diagnoses for compromised neonatal foals diseases and all aspects of Clinical signs Differential diagnosis equine critical care. „„ Lethargy/listlessness, increased time sleeping „„ Perinatal asphyxia syndrome (PAS) „„ Slow to stand/nurse „„ Sepsis „„ Difficulties standing/nursing „„ Other systemic diseases „„ No interest in mare/failure to follow mare „„ Colic „„ Meconium impaction „„ Abdominal distension „„ Enterocolitis „„ Straining to defaecate „„ Uroperitoneum „„ Intussusception „„ Small intestinal volvulus „„ Other strangulating/non-strangulating lesions „„ Congenital malformation (atresia ani/coli) „„ Diarrhoea „„ Infectious or non-infectious enterocolitis „„ Sepsis „„ Lactose intolerance „„ Changes in respiratory rate or pattern „„ Rib fracture „„ Neonatal isoerythrolysis „„ Aspiration pneumonia/other pneumonia „„ Anaemia „„ Central hypoventilation (PAS) „„ Prematurity „„ Persistent foetal circulation „„ Choanal atresia „„ Neurological signs „„ PAS „„ Head tilt „„ Sepsis „„ Blindness „„ Severe electrolyte abnormalities „„ Abnormal vocalisation „„ Bacterial meningitis „„ Collapse „„ Hepatic disease „„ Seizure „„ Congenital malformation „„ Coma *Suggested Personal & Professional „„ Abrasions on limbs/over joints „„ PAS (abrasions) Development (PPD) „„ Lameness „„ Sepsis – infectious arthritis/osteomyelitis/physitis „„ Joint distension „„ Trauma NEONATAL „„ Rupture of gastrocnemius muscle „„ Prematurity

28 VETERINARY PRACTICE TODAY WINTER 2014 NEONATAL | EQUINE

Figure 1. Foal with failure of passive transfer secondary to perinatal Figure 2. Foal with perinatal asphyxia syndrome. asphyxia receiving a plasma transfusion. the placenta can affect the or colic. A list of differential the mare. Foals may also fail Perinatal asphyxia foetus negatively. diagnoses based on clinical to absorb immunoglobulins syndrome (PAS) signs can be found in Table 1. if colostrum is given too late Perinatal asphyxia describes Examination of the (>12-24 hours after birth). a syndrome that has long pregnant mare includes Failure of passive transfer been thought to derive from ultrasonographic evaluation Foals are born with a The diagnosis is established by inadequate availability of oxygen of placenta, foetal fluids functional – but naïve – measuring IgG concentrations to the tissues of the body. and the foetus itself. If immune system and rely in the foal’s blood; an IgG New research suggests that problems with the pregnancy entirely on the maternal concentration >8g/L is imbalances of the foal’s steroid are identified – or if a mare antibodies provided in the indicative of successful passive hormone profile might be either had trouble foaling in the colostrum for protection from transfer. Treatment consists responsible for – or at least past (so-called high-risk infectious diseases for the first of oral colostrum if the foal contribute to – clinical signs pregnancy) – referral of the weeks of life. Lack of passive is less than 12-18 hours of (Madigan, Haggett et al, 2012; mare to a hospital prior to transfer predisposes the age. Oral colostrum should Aleman, Pickles et al, 2013). delivery might be indicated. foal to infectious diseases, not be given if the foal also However, further research is This allows continuous especially bacteraemia/ suffers from a systemic disease needed to confirm and further monitoring and regular sepsis, septic arthritis, process (sepsis, PAS, severe describe these findings. assessments of the pregnancy, diarrhoea or pneumonia. prematurity) that compromises foaling can be supervised haemodynamic function. Regardless of the exact and immediate care can be FPT can occur as a aetiology, several diseases delivered, if necessary. consequence of lack of If the foal is >12-18 hours that affect the mare’s colostrum or poor quality old or suffers from systemic placenta can predispose a The majority of neonatal colostrum – for example as a disease, intravenous foal to development of PAS foals requiring veterinary result of premature lactation administration of plasma with placental insufficiency, attention suffer from one of or failure of the foal to nurse is indicated (Figure 1). placentitis or partial placental the following diseases: failure which could be caused by One litre of commercial separation being some of passive transfer (FPT), underlying diseases such as PAS plasma will increase examples. Severe diseases of sepsis, PAS, prematurity, or sepsis (foal unable to get up), the IgG concentration the mare during pregnancy neonatal isoerythrolysis (NI), orthopaedic problems (tendon by approximately 2g/L, causing hypotension, enterocolitis, pneumonia contracture) or rejection by consequently often two hypovolaemia or hypoxaemia, litres are necessary to can also compromise the achieve the required developing foetus. Foals antibody concentration. that experience difficulties “Foals are born with a functional – but naive – Sick foals can use up large during the birth process – quantities of IgG, making particularly prolongation of immune system and rely entirely on maternal repeated measuring and stage 2 and any foal requiring potentially repeated plasma resuscitation – are also antibodies in colostrum for protection” transfusions necessary. predisposed to develop PAS.

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PAS affects all organ uncontrolled activation of the systems. Clinical signs vary immune system and release depending on the severity of of inflammatory mediators “Clinically it is almost impossible to the underlying damage and into the systemic circulation the primary organ system (McKenzie and Furr, 2001). distinguish between PAS and sepsis and most severely affected Clinical signs vary depending the two conditions may be coexistant” and range from very mild on the severity and extent of behavioural abnormalities the underlying infection and to complete cardiovascular the resulting inflammatory (NI) is an immune-mediated RBCs (Polkes, Giguere et al, collapse. Neurologic signs response from mild haemolytic anaemia of foals 2008). A diagnosis can often often cause the most abnormalities to cardiovascular caused by antibodies present be made based on clinical signs noticeable symptoms (Figure shock and death. in colostrum that are directed or by performing a cross- 2) but frequently other against the foal’s red blood match between the mare’s organ systems are equally Clinical signs in neonatal foals cell (RBC) antigens. It occurs plasma and the foal’s RBCs. compromised, particularly the are frequently subtle, such as the result of a blood group gastrointestinal and urinary as hyperaemia of mucous incompatibility between If the foal is less than 24 to system, and meconium membranes, conjunctiva and mare and foal when the foal 48 hours of age, any further retention, colic, diarrhoea and coronary bands, petechiae has inherited the stallion’s colostrum ingestion must inability to tolerate enteral in ears and on mucous RBC antigens which must be be prevented as it could feeding may occur. membranes or the presence different from the mare’s. It aggravate the disease. Plasma of uveitis. Foals may have a usually occurs in multiparous and/or blood transfusions There is no specific normal, high or low body mares that are assumed to may be necessary to provide treatment against PAS but, temperature, heart and have been sensitised against the foal with antibodies in the majority of cases, respiratory rates and peripheral the foal’s RBC antigens during (prevent or treat failure of dysfunctions are reversible white blood cell counts; earlier pregnancies. However, passive transfer) and treat and resolve with time and although a low white cell count the disease can also occur in the anaemia, if indicated. supportive care. Foals that is strongly suggestive of sepsis. maiden mares. Mares with a history of NI do not stand within two foals should be examined for hours after birth or do not Clinically, it is almost impossible The RBC antigens the foal has the presence of antibodies in nurse within three hours, or to distinguish between PAS and inherited from the sire must late gestation. The newborn foals that are born during sepsis, and the two conditions be strongly antigenic – usually foal must then be prevented a dystocia or via Caesarean may be coexistent. PAS and blood group Aa or Qa. Mule from nursing for the first 24 section, require immediate sepsis must be suspected in foals (donkey sire x horse to 48 hours and provision veterinary attention. Early any compromised neonatal dam) suffer from NI more of alternative colostrum referral of these cases, where foal unless proven otherwise frequently owing to the so- and nutritional sources appropriate, can reduce and appropriate antimicrobial called donkey factor – a RBC are necessary. The mare’s the severity of the disease therapy and supportive care, as antigen present on donkey but colostrum must be discarded. and the costs involved for necessary, should be initiated not on horse RBCs (Traub- intensive care. as quickly as possible (Corley Dargatz, McClure et al, 1995; Prematurity and Hollis, 2009). Boyle, Magdesian et al, 2005). Normal gestation length Sepsis for a horse is approximately Sepsis is defined as an Neonatal isoerythrolysis Once the mare has been 335-365 days; however, the infective process that provokes Neonatal isoerythrolysis exposed to foreign RBC normal gestational length antigen, antibodies against varies greatly between breeds those antigens are produced and individuals. The length of Figure 3. Incomplete ossification of carpal bones in a premature foal. and accumulate in the gestation is, therefore, not a colostrum. The foal ingests good indicator as to whether and absorbs the antibodies or not a foal has been born into its blood where the prematurely. Dysmaturity antibodies coat and destroy is a term used to describe the foal’s own red blood cells. foals that are inappropriately premature for their Such foals are often normal gestational age (Lester, at birth but then develop 2005). Foals born at a clinical signs within the first gestational age of <275 days four days of life. Weakness, are unlikely to survive; while lethargy, increased heart and prematurity or dysmaturity respiratory rates, icterus and are rare, but possible, after pale mucous membranes are 320 days of gestation. the most prominent features. Time of onset and severity of The prognosis for foals born clinical signs are dependent prematurely from a grossly primarily on the amount of infected uterus is assumed antibodies ingested and the to be better compared affinity of the antibodies to the to foals born from an

30 VETERINARY PRACTICE TODAY WINTER 2014 NEONATAL | EQUINE

apparently normal uterus, and life-threatening. Supportive care for For foals suffering from particularly if the birth was Many infectious and non- compromised neonates orthopaedic conditions induced or occurred via infectious causes can induce Regardless of the (multiple infected joints or a Caesarean section. It is diarrhoea. Some of the underlying disease process, incomplete ossification of the speculated that physiological infectious causes (Salmonella compromised foals are cuboidal bones), prognosis stresses associated with spp. Cryptosporidium, often unable to maintain for athletic performance, in development in an infected Clostridium difficileand their normal vital functions. particular racing, is more uterine environment lead to rotavirus) are highly Hypotension, hypoxaemia difficult to predict (Neil, Axon faster foetal maturation and contagious and potentially and intolerance to enteral et al, 2010). enhanced readiness for birth. zoonotic agents (Magdesian, feeding are common problems 2005). To protect staff encountered in more severely Prevention/early Clinical signs of prematurity working with the foal and affected foals. recognition include a small size (normal other horses – in particular Recognition of risk factors foal weight is approximately other foals – affected foals Supportive care can range during pregnancy enhances 10 per cent of the dam’s should be isolated and from relatively simple the chances to detect and weight), short, silky haired have their faeces tested for intermittent or continuous treat any abnormalities before coat, floppy ears, a domed common pathogens. intravenous fluid therapy and significant problems occur. forehead, weakness, tendon provision of intranasal oxygen Referral prior to parturition laxity and incomplete Foals with diarrhoea can lose to advanced haemodynamic might be contemplated ossification of the tarsal and/ large quantities of water and support, parenteral nutrition if problems during/after or carpal bones (Figure 3). electrolytes and can become and mechanical ventilation parturition are expected or Many foals will seem relatively dehydrated quickly. The foal (Dunkel, 2008). Continuous have repeatedly occurred in strong and vigorous for the becomes weaker and less nursing care is essential for the past. first 12 to 24 hours of life, but willing to nurse, which quickly the recovery of any recumbent then rapidly deteriorate. leads to a vicious cycle of foal. Frequent turning, Education of owners with progressive deterioration. If cleaning and prevention of respect to proper hygiene and The two major limiting diarrhoea persists for several self-inflicted injury are as neonatal foal care is essential factors that influence survival days, severe – and sometimes important as medical therapy to guarantee that veterinary are: insufficient surfactant life-threatening – electrolyte for the recovery of neonatal attention is sought promptly production leading to imbalances can develop. intensive care patients. to allow timely identification progressive lung atelectasis of foals at risk. and ultimately respiratory The disease also enhances Prognosis failure, and incomplete intestinal permeability, The ability to treat Prophylactic use of ossification of the cuboidal thereby allowing absorption compromised foals has antimicrobials in all foals bones. This can lead to of toxins – and even bacteria increased significantly during has not been shown to deformation of the tarsal – into the blood stream. In the last 30 years and most decrease the incidence of or carpal bones, greatly two studies, between 49 studies report about a 50 disease and, in the light of reducing chances of a future and 63 per cent of foals with to 80 per cent survival of increasing antimicrobial athletic career. Many foals are diarrhoea were found to be all neonatal intensive care resistance, should be strongly euthanased for this reason. bacteraemic (Hollis, Wilkins unit admissions. Success of discouraged (Wohlfender, et al, 2008; Frederick, Giguere treatment is largely dependent Barrelet et al, 2009). Treatment for foals with et al, 2009). Foals that stop on timely institution of However, early recognition prematurity is mainly nursing quickly become treatment and, if necessary, of warning signs during/ supportive, including dehydrated and lose weight, speed of referral to a tertiary following birth by the owner/ respiratory, cardiovascular and leading to a vicious circle of care facility. foal handler and quick and nutritional support. Exercise progressive weakness. efficient consultation with may need to be restricted until Unfortunately, no single factor the veterinarian and referral ossification in the cuboidal Fortunately, many foals or combination of factors can by the attending veterinarian, bones has progressed, in order recover quickly if the vicious reliably predict whether a foal if appropriate, are key to to avoid compromise of the circle is disrupted by giving will survive. Few studies have increasing chances of survival immature bones. intravenous fluids, electrolytes investigated long-term survival for the foal. and, if necessary, enteral or and athletic performance, Enterocolitis (diarrhoea) parenteral nutrition. Foals and very few surviving Please turn over for PPD Diarrhoea can occur in are also treated with broad- foals display permanent questions foals of all ages and the spectrum antimicrobials deficits. Although conflicting severity varies from mild to prevent haematogenous information is present in the and self-limiting to severe spreading of infection. literature with regards to future athletic performance, it is probably safe to say that once a foal has recovered “Diarrhoea can occur in foals of all ages from neonatal illness, there are few limitations to its and the severity varies from mild and self- future use – including athletic limiting to severe and life-threatening” performance – at a high level (Axon, Palmer et al, 1999).

@VPTODAY WWW.VETERINARYPRACTICETODAY.COM 31 EQUINE | NEONATAL

References Aleman M, Pickles KJ et al. (2013). ‘Abnormal plasma neuroactive progestagen derivatives in ill, neonatal foals presented to the neonatal intensive care unit’. PPD Questions Equine Vet J 45(6): 661-665.

Axon JE, Palmer J et al. (1999). ‘Short- and long-term athletic outcome of 1. Which of the following infectious agents is not a cause neonatal intensive care unit survivors’. Proc Am Assoc Equine Pract 46: 224-225. of diarrhoea in neonatal foals? A. Salmonella Boyle AG, Magdesian KG et al. (2005). ‘Neonatal isoerythrolysis in horse foals B. Clostridium perfringens and a mule foal: 18 cases (1988-2003)’. J Am Vet Med Assoc 227(8): 1276-1283. C. Clostridium difficile D. Lawsonia intracellularis Corley KTT and AR Hollis. (2009). ‘Antimicrobial therapy in neonatal foals.’ E. Cryptosporidium Equine Vet Educ 21(8): 436-448.

Dunkel B. (2008). ‘Supportive care for the critically ill neonatal foal’. 2. Which equine red blood cell antigens are most Pferdeheilkunde 24(4): 540-548. commonly associated with neonatal isoerythrolysis? A. Aa and Qa Frederick J, Giguere S et al. (2009). ‘Infectious agents detected in the feces of B. Ab and Qb diarrheic foals: a retrospective study of 233 cases (2003-2008)’. J Vet Intern Med C. C and D 23(6): 1254-1260. D. Ha and Hq E. Aq and Qq Hollis AR, Wilkins PA et al. (2008). ‘Bacteremia in equine neonatal diarrhea: a retrospective study (1990-2007)’. J Vet Intern Med 22(5): 1203-1209.

3. Complete transfer of passive immunity is often Lester GD. (2005). ‘Maturity of the neonatal foal’. Vet Clin North Am Equine Pract defined as a plasma IgG concentration of: 21(2): 333-355. A. >8.0mg/L B. >0.8g/L Madigan JE, Haggett EF, et al. (2012). ‘Allopregnanolone infusion induced C. >8.0g/L neurobehavioural alterations in a neonatal foal: is this a clue to the pathogenesis D. >80g/L of neonatal maladjustment syndrome?’ Equine Vet J Suppl(41): 109-112. E. >800g/L Magdesian KG. (2005). ‘Neonatal foal diarrhea’. Vet Clin North Am Equine Pract 21(2): 295-312, vi. 4. Based on recent research, what percentage of neonatal foals with diarrhoea might be bacteraemic? McKenzie HC 3rd and Furr MO. (2001). ‘Equine neonatal sepsis: the pathophysiology of severe inflammation and infection’. Comp Cont Educ Pract A. Bacteraemia is rare in foals with diarrhoea Vet 23: 661-670. B. <5% C. 5-10% Neil KM, Axon JE et al. (2010). ‘Retrospective study of 108 foals with septic D. 10-20% osteomyelitis’. Aust Vet J 88(1-2): 4-12. E. 50-60%

Polkes AC, Giguere S et al. (2008). ‘Factors associated with outcome in foals with neonatal isoerythrolysis (72 cases, 1988-2003)’. J Vet Intern Med 22(5): 1216-1222.

Toth B, Slovis NM et al. (2014). ‘Plasma Adrenomedullin Concentrations in Critically Ill Neonatal Foals.’ J Vet Intern Med.

Traub-Dargatz JL, McClure JJ et al. (1995). ‘Neonatal isoerythrolysis in mule foals’. J Am Vet Med Assoc 206(1): 67-70.

Wohlfender FD, Barrelet FE et al. (2009). ‘Diseases in neonatal foals. Part 1: the 30-day incidence of disease and the effect of prophylactic antimicrobial drug

treatment during the first three days post partum’. Equine Vet J 41(2): 179-185.

E 4. C 3. A 2. .D 1 Answers

32 VETERINARY PRACTICE TODAY WINTER 2014 AT VETERINARY SYSTEMS FEATURE

BSAVA congress team 2011 with Grant Petrie, BSAVA president (centre).

AT VETERINARY SYSTEMS Celebrating 25 years of partnership

Twenty-five years ago veterinary surgeon Martin Barrow, recognising that good management was crucial to the delivery of quality veterinary services, started AT Consultants. The company would be instrumental in the conversion of many practices from paper-based client records, accounting and payroll to fully computerised systems. It soon became apparent there was a need for an easy-to-use, reliable and modern practice management system backed by a 24-hour support network and AT Veterinary Systems was born.

With 100 percent veterinary ownership, wholesalers, manufacturers, equipment and commitment to the veterinary suppliers, accountants and other third profession, AT developed the ATVantage parties. In the rapidly changing veterinary practice management system, the marketplace, this independence and rock forerunner of its current flagship solid commitment has been welcomed by product the Spectrum Release 5 practice AT’s customers. management system. With 25 years of continual development, A social enterprise before the term AT’s range of products and services became popular, AT ploughs profits has expanded considerably to provide back into research and development practical and easy-to-use solutions for for the benefit of its customers and is the everyday issues facing veterinary committed to the long-term support and practices as well as creating new development of veterinary practices. opportunities for practice development.

AT is a UK Company with its headquarters AT’s combined expertise and experience in Suffolk and it serves practices all cover the complete spectrum of computer over the UK and Ireland. Innovative and technology. Its programming team cover progressive, with a strong research and software applications for Windows, development team, the company prides Linux, UNIX and Apple computers while itself on listening to what clients want its web development team produces Apps now and in the future, incorporating these for mobile phones, tablets and internet requests and ideas when developing new based software solutions. >> systems and above all, doing the right thing for veterinary practices.

The continuous improvement and development of software and systems ensures that veterinary practices can harness the power of modern technology for the benefit of their practice with a completely integrated solution. AT VETERINARY As an independent company, AT Veterinary Systems is able to work with all SYSTEMS We’re here to help SPONSORED FEATURE WWW.VETSYSTEMS.COM 33 AT VETERINARY SYSTEMS FEATURE

Spectrum R5 Practice Management System This fully featured practice management system can be customised to meet the needs of practices of all types and locations. Over the years AT has worked with several start-up practices, installing their first systems and assisting with their growth into much larger ventures.

Managing the more complex needs of multi- seamlessly integrate and function as one site, multi-species, first opinion and referral system. As the performance of each node practices, as well as veterinary colleges and is independent of the others, this cluster universities, is all part of a day’s work for AT architecture has a number of advantages Veterinary Systems. for practices.

With continuous improvements and A single server system is inevitably prone development by software engineers at AT, to hardware failure. While this is a rare Spectrum Release 5 is a substantial suite of occurrence the effect can nevertheless be software with several million lines of hard disruptive for the practice. With Spectrum working programming code. DDS, multiple servers ensure continuity of service takes priority. A major development over the last five years has been the inclusion and integration of Spectrum DDS branch surgeries can now cluster technology into Spectrum R5, to run at network speeds of over 1000 MB produce Spectrum R5 DDS, which brings per second. While central database, cloud “In the early 1990s huge benefits to practices using AT practice and data replication systems can be limited management solutions. by the connection speeds and reliability no one used to worry of their internet connections, Spectrum too much about batch SR5 DDS™ DDS is much less dependent on this. With Spectrum DDS uses protocols and Spectrum DDS, when the ‘internet is down’, number accounting, but techniques found in large high branch practices continue to function now it’s essential. Our performance mission critical data systems. normally with data transactions resuming This landmark release is the result of when the line is restored. The cost of systems are continually over five years research and development opening and managing branch surgeries is changing to meet the by the software laboratories at AT thus considerably reduced. Veterinary Systems and brings new levels needs of practices.” of computing performance and resilience The benefits of accessing data anywhere to veterinary practices of all types. and anytime is a key benefit of Spectrum. Rob Tillyard, For mobile and out of hours veterinary head of programming, Spectrum DDS allows practices to create services, having clinical and prescribing AT Veterinary Systems any number of computing “nodes” which information at hand can be useful if

Developments through the years 2003 First practice 1989 to get the AT Spectrum Consultants 1991 PMS goes live started Linux kernel 1997 released Callbacks 2002 1989 system Vision VBox Tim Berners 1992 introduced launched Lee invents AT Veterinary 1993 the World Systems First 1995 1998 2001 2002 Wide Web starts with Microsoft Vision Eight million Apple More than 33 development Windows Information users of the moves to million users 1990 of ATvantage browser System internet in the UNIX based of the internet Windows 3.0 systems on ‘Cello’ launched on UK operating in the UK launched UNIX released CD ROM system OS X

34 WWW.VETSYSTEMS.COM SPONSORED FEATURE AT VETERINARY SYSTEMS FEATURE

not essential. With a laptop computer running as a Spectrum DDS node, this problem is resolved. “AT’s continued success Digital communication – Vision email and text messaging can be attributed to AT recognised the importance of electronic the experience and communications and developed the first integrated email and text messaging server expertise of its team for veterinary practices – the VBox. This product enables veterinary practices to in producing powerful have powerful managed email solutions world class internet- that comply with national regulations, for a fraction of the cost of alternative solutions. ready products, its first class customer service Internet and network security – Vision Sentinel and the commitment Maintaining the reliability and business it has to veterinary continuity of management systems, as well as the professional reputation of practices.” veterinary practices, is of paramount importance to AT Veterinary Systems. Through years of investment and research it developed the Vision Sentinel service for practice security and the Visionline ID service for online security.

Personal cloud solutions – Vets Anywhere With strong security an integral part of its systems, AT installs servers in practices, on the internet or at other locations to produce “personal cloud solutions”. This flexibility gives practices the ability to choose what’s best for their needs.

2014 Spectrum R5 full release in 2003 2014 Equine and January Apple launch large animal 2007 OS X Yosemite Daybook Rota Manager 2010 2014 in October system makes staff VetStation First launched scheduling and Spectrum easier VetStation 2013 DDS Cluster Spectrum goes live on 2003 2005 and more Pro terminals 2009 R5 second 12 Februar y Number of Automated accurate launched text messages AT releases release to text 2006 sent in a 2007 first iPhone 2010 practices 2014 messaging via 57 percent single day Apple’s app First practice Spectrum Spectrum is of UK in the UK iOS mobile to get IRIS 2011 R5 for OS X introduced households exceeds 100 operating 2009 digital Spectrum Yosemite in have internet million for the system Windows 7 imaging goes runs fully on October access first time unveiled released live OS X

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Staff planning and scheduling other practice management system. is not exhaustive, with developments software – Rota Manager A fully DICOM compatible system, continuing apace, adapting and changing With staff rotas being a continual source IRIS is a great addition to any practice with both technical developments and the of problems for many practices, AT’s computer system. needs of practices. programmers rose to the challenge and produced Rota Manager, a fully featured Veterinary workstations – In this climate of economic change, flexible system that could deal with VetStations it is even more important to choose everything that was thrown at it. VetStation and VetStation Pro terminals a technology partner that truly have been specially designed by AT understands your practice and is Rota Manager addresses the whole to provide practices with robust, committed to the long term future of concept of managing staff time standardised and powerful workstations your business. With an impressive track efficiently and it receives excellent that require minimal practice record, AT is here to help you. reviews wherever it’s implemented. administration. Running on either Windows or Apple OS X these are the Digital imaging - Picture Archive terminals of choice for veterinary practices. and Communication Systems (IRIS PACS) Mobile phone, web and If you would like more information please call 01359 243400, AT Veterinary Systems produces the tablet applications email AT Veterinary Systems at IRIS PACS which fully integrates digital AT produces software apps for iPhones, [email protected] X-rays, MRI and CT with the Spectrum iPads, as well as web-based content or visit www.vetsystems.com. R5 practice management system, or management systems and applications. can be used standalone alongside any The list of products and services here

“In this climate of economic change, it is even more important to choose a technology partner that truly understands your practice and is committed to the long term future of your business.”

36 WWW.VETSYSTEMS.COM SPONSORED FEATURE The fast and easy way to manage staff rotas

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Seeing is believing Access DICOMs through multiple terminals.

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Talk to us about the benefits of networking your Digital X-ray and Ultrasound systems. www.vetsystems.com/iris | 01359 243400 | available from 38 VETERINARY PRACTICE TODAY WINTER 2014 INSIGHT | EQUINE

The perils of being an equine vet ‘Equine vets’ receive more injuries during their working life than any other civilian profession, including people working in construction, the Prison Service and the Fire Brigade. This is according to the results of a survey commissioned by the British Equine Veterinary Association (BEVA) and conducted by leading medical professionals at the Institute of Health and Well-being and Glasgow’s School of Veterinary Medicine.

A total of 620 equine vets completed a work-related questionnaire which indicated that during a working life of 30 years, they sustained an average of seven to eight work-related injuries that impeded their ability to practise. Data from the Health and Safety Executive (HSE) suggests that, compared with other civilian occupations, this is a very high number of injuries.

Key findings were: „„ Most injuries were described as bruising, lacerations and fractures „„ The leg was the most common site of injury (29 per cent), followed by the head (23 per cent) primary consideration for equine vets „„ The main cause of injuries was a and horse owners alike, every time kick from the horse’s hind limb (49 per a horse is examined or treated. In “ ‘Pleasure’ horses cent) addition, the experience of the horse accounted for 38 per cent of „„ Eleven per cent were injured by a handler should be considered when strike from a forelimb, and five per undertaking riskier procedures.” the worst injuries” cent sustained crush injuries „„ A quarter of injuries resulted in Former BEVA president, Keith Chandler, to equine vets. The survey indicates the hospital admission commented: “We were shocked to need for extra and specialist training for „„ In seven per cent of cases, the vet discover the extent of the injuries all those practice staff involved in working reported loss of consciousness owing sustained. Of greatest concern is the not just with horses but also with large to the injury number of vets who suffered head injuries animals generally. „„ ‘Pleasure’ horses accounted for 38 and unconsciousness.” per cent of the worst injuries It is important that practice owners „„ In 48 per cent of all responses, the He added that those injuries appeared have all the necessary health and safety horse handler at the time of the injury to be more common during certain measures in place to protect their staff. The was the owner or the client; whereas procedures; for example while changing HSE recognises that working with horses is the number of laypersons or handlers bandages or during wound management a potentially dangerous occupation. injured at the same time was low – when the vet is crouched down next to the patient for a long period – or during Employers have to be able to endoscopy of the respiratory tract, demonstrate that they have taken all Prior to this survey, evidence of equine when vets are partly unsighted and using real and practical steps to minimise the vets sustaining frequent injuries was examination equipment. hazards and risks existing in all working largely anecdotal – the prevalence and situations with horses. type of injuries have never before been quantified, though it is widely believed This means that a very stringent risk that some equine vets are forced to give “The experience of the assessment needs to be carried out for all up work as a result of injuries and that staff involved in equine work, risks addressed there had been some fatalities. horse handler should be and minimised as far as is practical, and considered when undertaking staff fully trained in equine handling. Tim Parkin, veterinary surgeon and lead researcher, pointed out: “This riskier procedures” It also begs the question – just as in the work should act as a wake-up call to all small animal world – about allowing involved in the training, employment The BEVA is now looking to work with owners to hold their animals rather than and engagement of equine vets. The its members, HSE, veterinary schools trained practice staff. risks associated with handling and and large employers of vets to develop working with horses should be the strategies for reducing the risk of injury

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Understanding lameness in dairy cows: part two

This second article follows on from the previous one (VPT, Autumn 2014) in which the findings of an 18-month study on lameness in 11,800 dairy cows across 44 herds in north-west England during 2012/13 were discussed (RADA, 2013).

The project concluded which might be useful to help cows’ health and welfare. that three key qualities of producers reduce lameness. Part of the reason for this dairy producers appear is, perhaps, that lame cows Owen Atkinson to be important for good Health and welfare hide their lameness very well BVSc DCHP MRCVS mobility on their dairy farms: aspects of lame cows – an essential aspect of their accurate awareness of their When interviewed, it was evolution. To avoid attack by Owen has worked in farm herd lameness prevalence; almost universal that predators, a cow has evolved animal practice since 1994, an understanding of foot producers in the study to always stay with the herd, mainly with dairy cows. His diseases, lesion recognition felt lameness was “very preferably hiding somewhere interests in rumen health, and aetiology; and a positive important” for the British in the middle, so as not to cattle foot care and lameness attitude towards their personal dairy industry. The top three show signs of weakness yet to reduction led him to do an ability to influence lameness. reasons for this were: public be able to run as fast as her increasing amount of training perception (of British dairy herd mates. and advisory work. It also found that those farms); reduced production; producers engaging with and concern for the health DairyCo mobility score 3 In 2013, Owen left the practice the DairyCo Healthy Feet and welfare of cows. cows, by definition, can not to found Dairy Veterinary Programme (23 of the 44 keep up with their herd mates. Consultancy Ltd, to better pursue herds) were more likely to Even so, the study showed In Darwinian ‘survival of the his vision for preventive health reduce their herd lameness that farmers consistently fittest’ terms, they would be management and strategy. levels in 12 months (by an under-estimated to what the lions’ breakfast or the Owen’s goal is to help farmers average of 20 per cent) extent lameness affects jackals’ supper. In terms of make changes on their farms compared to those producers that benefit the cows, the quality which were not. of life and their bank balance. This article discusses health, “Farmers consistently under-estimate to welfare and economic aspects what extent lameness affects cows’ health of lameness, as well as considering behavioural models and welfare”

Figure 1. Lame cows are often in poor body condition, like this one; but does a lame cow become thin or a thin cow become lame?

*Suggested Personal & Professional Development (PPD)

LAMENESS

40 VETERINARY PRACTICE TODAY WINTER 2014 LAMENESS | LARGE ANIMAL

than their herd mates who never went lame.

Lameness, in its own right, is a significant reason for premature culling. For some herds, culling owing to lameness can account for over 10 per cent of the milking herd per year. These cows usually have a higher economic loss associated with them than other forced culls – infertility or mastitis, for instance – because they have the lowest ‘trade in’ value (Figure 2). For some producers, it is only these very lame cows to which they attribute losses; but in reality they are only the tip of the iceberg.

Economic effects of lame Figure 2. The economic effects of lame cows are difficult to assess. Claw horn lesions, such as this sole cows ulcer, are likely to have a greater economic consequence than less severe or short-lived lameness; but all So what of producers’ abilities lame cows are likely to have altered lying and feeding behaviour which can affect production, as well as to estimate the economic an increased risk of premature culling. effects of lameness? No wonder – as the academics what farmers see, this five to inducing rumen acidosis. In Weight loss means these and researchers cannot 10 per cent of the herd are both grazing and housed individuals are less fertile agree on the true costs of the ones that they perhaps herds, their total dry matter too. This and the fact they lameness – that producers notice – this might account for intakes might be less – so they want to ‘hide’ means that find estimating losses very the large discrepancies found produce less milk than their they come into heat less difficult. In the north-west between the true prevalence of potential. They “milk off their strongly (if they are cycling England study, an interesting lame cows and producers’ own backs” and lose weight. at all) and they take a longer agreement amongst farms estimates (see previous article). time to conceive and have a engaged in the DairyCo Body condition and lameness higher chance of being culled Healthy Feet Programme But what of the less severely appear to have a complex as barren. Willshire (2012) (DHFP) and the control lame cows? The mobility interaction (Figure 1). Do found that lame cows, even farms was that many felt that score 2 cows are lame – you thin cows get lame or lame if lame for a short period of the costs of lameness were can spot them if you try, but cows get thin? time, took on average over significant, but ‘not as high as they have not yet lost their 60 days longer to get in calf my vet says!’ ability to stay ‘hidden’. They In answer to this debate, will most likely have lesions there is increasing evidence Figure 3. Three types of producer and the likely lameness prevalence. though, only observable that thin cows are more likely if their feet are lifted for to become lame (Bicalho et close inspection. They will al, 2009), probably through also be feeling pain; and, having thinner fat pads importantly, they will be within the hoof that cushion Unknowingly experiencing consequences to the pedal bone – think air- unknowing their ability to function well. cushion soled trainers, and cows’ hooves have a similar Lame cows, even these anatomical mechanism with ‘hidden’ ones, have altered fat instead of compressed feeding behaviour (Cook et air. Nevertheless, once a cow Knowingly al, 2007). In housed herds, has become lame, her altered unknowing they get up to feed less feeding behaviour is very often, so their meals are likely to contribute to further larger and more prone to weight loss.

Knowing “There is increasing evidence that thin cows are more likely to become lame”

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“If producers had a more realistic view of the economic costs of lameness, would that knowledge stimulate them to take more actions to improve cow mobility?”

However, there is a strong of lameness. However, they case that as long as farmers do not recognise this as find it difficult to evaluate a factor in their ability to the true cost of lameness, prevent lameness, instead the economic argument to having a greater tendency reduce lameness is not being to blame external factors harnessed to its potential. for their cows being lame – One recommendation coming from “poor tracks”, to “the Figure 4. How fair is it to say that the extent of lameness in a herd out of the project was for the weather”, to “genetics”, to is largely the farmer’s choice? In this well-managed housed Jersey development of an industry- “not enough money”. They herd, a zero tolerance to lameness has contributed to lameness recognised ‘ready reckoner’ overestimate their own prevalence remaining consistently very low. for costs associated with understanding of lameness. lameness, in much the same Producers ranked infertility, and a relationship between way as there is for days not in The ‘knowingly unknowing’ milk loss and cost of culls as prevalence and incidence calf (poor fertility). producers have improved the main reasons for financial being approximately 1:2.5 awareness and are better losses, followed by treatment (Clarkson et al, 1996). Lameness as a choice able to recognise their costs, time and labour, loss of A way of stratifying producers own shortcomings. They condition, foot trimmer costs If producers had a more with respect to their herd begin to place value on and foot-bathing. However, realistic view of the economic lameness prevalence is better knowledge/training/ compared to the study’s costs of lameness, would summarised in Figure 3, information about lameness, estimates of economic losses, that knowledge stimulate reflecting the project’s and can better estimate the farmers underestimated the them to take more actions findings that greater lameness levels in their herd. total by a mean factor of to improve cow mobility? awareness and understanding They begin to take control three – if the study estimated Cost was certainly found is often accompanied by of their own herd’s lameness the cost to be £300/cow/year, to be a motivating factor reduced prevalence. and are more likely to the farm estimate was £100/ in the study, but not the identify things they can do to cow/year. only one. Producers were The ‘unknowingly unknowing’ reduce lameness. also concerned about – and producers tend to have the The study estimate was based motivated by – care for their most lameness, have the The ‘knowing’ producers have on an average cost of a lame animals, public perception poorest ability to estimate the best understanding of cow incident being £330 and the morale of themselves their herds’ lameness levels, mobility in their herds. They (Willshire and Bell, 2009) and their employees. and the least understanding have an action plan and are

Figure 5. The Theory of Planned Behaviour (Azjen, 1991).

Attitude Behavioural towards Beliefs the behaviour

Normative Subjective Beliefs Norm Intention Behaviour

Perceived Control Behavioural Actual Beliefs Behavioural Control Control

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„„ Perceived behavioural are encouraged to accept control, which reflects responsibility for their own 6. Habitual confidence that a behaviour speed and are given simple behaviour I am going to can be performed tools to alter their inherent make this work habits, both of which can Before change occurs, increase their perceived behaviour must alter. The behavioural control. 5. Experimental theory examines the beliefs which govern intent and, Producers accepting behaviour I really hence, behaviour change. responsibility for lameness intend to make some Before a producer has an within their own herds is changes now intention to reduce lameness, probably a prerequisite before he or she first has to believe expecting them to implement 4. Making a lameness is not a good thing any technical advice (Atkinson choice (behavioural belief); believe and Fisher, 2014). Developing What options they have more lameness a producer’s belief in their have a got? than they should (normative own ability to control What can I do? belief); and believe that it is in lameness, and then providing 3. Perception of their control (control belief). simple practical tools to options do so, might increase the Actual behavioural control likelihood of their choosing to I am in control may differ from perceived reduce lameness. of this behavioural control if, for 2. Accepting example, a person lacks key The steps involved are responsibility skills or understanding to summarised in Figure 6. influence the change. Summary What is my herd For an intention to reduce The North West Mobility mobility score? lameness, a producer must Project showed that while 1. Awareness of believe that lameness is not the DairyCo Healthy Feet Problem a good thing (attitude to Programme can help lameness); believe that he individual farms reduce or she has more lameness lameness, there are many than they should (compared challenges yet to be overcome. Illustration of six phases a producer might go through to Figure 6. with their subjective For example, there is a reduce lameness. norms); and believe that widespread mismatch reducing lameness is within between perceived and actual measuring and monitoring Taking steps to reduce their control (perceived lameness prevalence on farm, their progress closely. They lameness behavioural control). and reducing lameness is are less likely to identify Theoretical models of seldom prioritised. barriers to reduce lameness human behaviour are useful Working to increase as things out of their own when devising strategies to producers’ perceived Clearly identifying the control and show the motivate producers. One behavioural control is likely to economic impact of greatest motivation to reduce such model is the Theory of be beneficial. lameness, motivating lameness. These farms have Planned Behaviour (Ajzen, producers to reduce lameness the least lameness (Figure 4). 1991) (Figure 5). It is useful to look beyond and providing effective, veterinary science for simple tools to do so, are The previous article discussed Briefly, the theory suggests experience of successful areas where more can be how the project indicated that that intentions (to do programmes for changing done. Vets in practice have an intrinsic ‘can-do’ attitude something) are a function of behaviours. An example is the an important role not towards lameness control three factors: Department of Transport’s only in raising producers’ appeared to be beneficial. It „„ Attitude, which is formed ongoing campaign to understanding of lameness, might be said “lameness is a from an overall evaluation of reduce deaths associated but in facilitating the farm choice”, and producers’ self- a behaviour with speeding motorists team to adopt changes. A belief towards their ability to „„ Subjective norm, which (Department of Transport brief appreciation of human control it influences their herd reflects perceived social report, 2006). psychology, and models of lameness prevalence. pressure; behavioural change, can be In this instance, speed useful in this regard. awareness workshops have resulted in measured Please turn over for PPD “Theoretical models of human behaviour success by adopting simple questions principles of behavioural are useful when devising strategies to change, including the Theory of Planned Behaviour motivate producers” (McKenna, 2007). Delegates

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References Ajzen I (1991). The Theory of PPD Questions Planned Behavior. Organizational Behavior and Human Decision Processes. 50: 179-211. 1. Which of the following statements most closely reflects current thinking on the most significant effects of nutrition on lameness in dairy cows? Atkinson OCD and Fisher G (2014). Choosing to reduce lameness. In A. Nutrition of the cow is unlikely to influence lameness significantly proceedings of Cattle Lameness B. Rumen acidosis, such as is common with high concentrate diets of high-producing dairy Conference 2014, pp 63-64. cows, causes changes in the blood flow in the claw, affecting suspension of the pedal bone C. High concentrate feeds cause laminitis but the mechanism is uncertain Bicalho RC et al. (2009). Lameness D. Cows losing weight, or in poor body condition, such as is common in high-producing in dairy cattle: A debilitating disease dairy cows early in lactation, have a thinner digital cushion (fat pad) and so are more or a disease of debilitated cattle? A prone to claw horn disruption cross-sectional study of lameness E. Mineral supply is the most significant effect the diet has on hoof disease prevalence and thickness of the F. Biotin deficiency, which is common in high-producing dairy cows with acidic rumen digital cushion. Journal of Dairy conditions, is the most likely reason why claw horn disruption occurs Science 92(7): 3175-3184. G. High concentrate diets result in more liquid slurry, which creates the wet environment so important for both claw horn diseases and digital dermatitis Clarkson MJ et al. (1996). Incidence and prevalence of lameness in dairy cattle. Veterinary Record 138: 2. Which of the following statements about the costs of lameness do you agree with? 563- 567. A. The economics of lameness are particularly hard to calculate because cost per case is the usual measure available in the literature, yet prevalence is the more usual data set Cook NB et al. (2007). The effect available on farm of heat stress and lameness on B. Because producers do not rate costs of lameness as being their main motivating factor time budgets of lactating dairy for lameness reduction, the economics of lameness are less important cows. Journal of Dairy Science C. The costs of lameness are obvious for producers because lame cows produce less milk 90:1674-1682. D. There is no published evidence that lame cows take longer to get back in calf than their non-lame herd mates Department of Transport (2006). E. Lameness probably costs a typical UK dairy farm an estimated £264/cow in the herd/year Road Safety Research Report No. 66. Effective Interventions for Speeding Motorists. DfT 3. According to the Theory of Planned Behaviour, which of the following statements is correct: Publications, PO Box 236, Wetherby A. Producers will respond best to a direct approach of advisers telling them what actions LS23 7NB or online via www. they should take publications.dft.gov.uk B. Producers who have an accurate appreciation of their herd’s lameness prevalence are more likely to act to reduce it RADA (2013). Cattle mobility: C. Producers who believe lameness is controlled by their own actions are more likely to changing behaviour to improve act to reduce it health and welfare and dairy D. If a producer is told they have a high lameness level, they will be more likely do farm businesses. Accessed online something about it 11/06/2014 at http://www. E. Producers who have a plan will, in theory, be more able to control lameness levels reaseheath.ac.uk/businesses/rada/ F. A producer’s behaviour can be influenced by giving them a plan research-trials-and-demonstrations/

McKenna FP (2007). Do attitudes

and intentions change across a correct because a producer being told their lameness is too high does not necessarily alter their belief. their alter necessarily not does high too is lameness their told being producer a because correct

norms) are more likely to act to reduce it, but simply knowing their herd’s lameness prevalence is not enough. Answer D is not not is D Answer enough. not is prevalence lameness herd’s their knowing simply but it, reduce to act to likely more are norms) speed awareness workshop?

3.

C. Answer B is almost correct – producers who believe their lameness prevalence is too high (compared to their own subjective subjective own their to (compared high too is prevalence lameness their believe who producers – correct almost is B Answer C. In proceedings of Behavioural

Thus, Cost = 0.32 x 2.5 x 330 = £264/cow in herd/year in £264/cow = 330 x 2.5 x 0.32 = Cost Thus, Research in Road Safety 2007, other work which suggests a cow is lame for an average of 5 months (12/5 = 2.4). = (12/5 months 5 of average an for lame is cow a suggests which work other

To convert prevalence to incidence, multiply by 2.5. This figure is derived from Clarkson et al, 1996, but is also consistent with with consistent also is but 1996, al, et Clarkson from derived is figure This 2.5. by multiply incidence, to prevalence convert To Seventeenth Seminar, Department

A simple lameness cost calculation: Typical prevalence = 32% Cost per case (average) = £330 = (average) case per Cost 32% = prevalence Typical calculation: cost lameness simple A of Transport. pp 265-276. lameness may be preventing them from reaching their true potential, but this is an entirely hidden loss. hidden entirely an is this but potential, true their reaching from them preventing be may lameness

is a complicated one – higher yields are a risk factor for increased lameness, so the lame cows may be the highest yielding. The The yielding. highest the be may cows lame the so lameness, increased for factor risk a are yields higher – one complicated a is Willshire JA (2012). The use of cows continue to produce saleable milk, and often in very large quantities. The relationship between lameness and milk yield yield milk and lameness between relationship The quantities. large very in often and milk, saleable produce to continue cows

motivate some producers to invest time and effort in reducing lameness. The problem is perhaps worsened because lame lame because worsened perhaps is problem The lameness. reducing in effort and time invest to producers some motivate mobility score to predict dairy cow

A & E. While remains so difficult to estimate costs of lameness, the economic argument is a lost potential opportunity to to opportunity potential lost a is argument economic the lameness, of costs estimate to difficult so remains While E. & A

2. 2. reproductive performance. DCHP

leading to more claw horn diseases, and increase the risks of infectious diseases, such as digital dermatitis. digital as such diseases, infectious of risks the increase and diseases, horn claw more to leading Dissertation, RCVS library. lameness aetiology, but as yet are not quantified. Excess liquid slurry can both reduce horn quality (high moisture), potentially potentially moisture), (high quality horn reduce both can slurry liquid Excess quantified. not are yet as but aetiology, lameness

can be beneficial in some herds to a small degree. The dietary effects on slurry consistency are likely to be significant factors in in factors significant be to likely are consistency slurry on effects dietary The degree. small a to herds some in beneficial be can

Dietary mineral availability is likely to affect horn quality, and there is some evidence that supplementation, particularly of zinc, zinc, of particularly supplementation, that evidence some is there and quality, horn affect to likely is availability mineral Dietary Willshire JA and Bell NJ (2009). An in abundance in healthy rumens). However, this isn’t thought to be the main nutritional effect on claw horn disruption. disruption. horn claw on effect nutritional main the be to thought isn’t this However, rumens). healthy in abundance in economic review of cattle lameness.

some herds, particularly white line disease, and biotin deficiency is more likely with acidic rumen conditions (biotin is synthesised synthesised is (biotin conditions rumen acidic with likely more is deficiency biotin and disease, line white particularly herds, some Cattle Practice 17(2): 136-141. diet, body condition score, and the digital cushion. There is strong evidence that biotin supplementation reduces lameness in in lameness reduces supplementation biotin that evidence strong is There cushion. digital the and score, condition body diet,

bonds, the more significant effects of nutrition on claw horn disruption is now thought to be exerted by the interactions between between interactions the by exerted be to thought now is disruption horn claw on nutrition of effects significant more the bonds,

D. While rumen acidosis/high concentrate syndrome is quite likely to affect pedal bone suspension via changes in the laminae laminae the in changes via suspension bone pedal affect to likely quite is syndrome concentrate acidosis/high rumen While D. 1. Answers

44 VETERINARY PRACTICE TODAY WINTER 2014 GOAT HUSBANDRYCPD | LARGESMALL ANIMAL

Essential goat husbandry This is the first in a series of articles prepared by members of the Goat Veterinary Society (GVS). It should be stressed that these express the views of the individual authors and do not necessarily reflect the policy of the GVS. This article will contain information on feeding, housing, behaviour, general management issues and legal implications. Graham Duncanson BVSc MSc (VetGP) DProf FRCVS General management If we want to control the of farmed livestock are presently Graham is a sheep farmer’s There are fewer than 100,000 risk of unaffected animals crafted in the UK – all farm son who qualified from Bristol goats in the UK. Perhaps a becoming infected, we need animals must be given access Veterinary School in 1966. quarter of these are in large to stop contact with other to proper nutrition. Goats are He spent eight years as a milk-producing herds, with the individuals and not import included under this umbrella. government veterinary officer remainder in small herds or any new animals. This may working in all districts of being kept as pets. The small occur at the farm level or at Kenya, where he developed his herds produce milk, fibre and the national level. Physiological values interest in goats. He returned meat, and individuals from these for goats to the UK to work in general herds are often exhibited at If we have to introduce new „„ Temperature: practice in Norfolk in 1975 and agricultural shows and farms individuals, we need to have 101-103°F (38.3-39.5°C) has been working at Westover open to the general public. pre-movement testing, pre- „„ Heart rate: Veterinary Centre, Hainford, movement certification, and 70-80 beats/min Norfolk ever since. The principal geographical quarantine and vaccination „„ Normal resting area where goats were strategies in place. We must respiratory rate: Graham is a committee developed for milking was in also be aware that there is 15-35 breaths/min member of the Goat Veterinary the European Alps (Figure 1). cross-over of infections from „„ Oestrous cycle: Society (GVS) and has written The main dairy breed is the other animals, mainly from 21 days (September to five text books, including British Saanen; although there other ruminants (foot-and- March in the UK). It ‘Veterinary Treatments of Sheep are six other breeds: Anglo- mouth disease, for instance); should be noted that it and Goats’. Nubian, British Alpine, British but also from non-ruminants is possible to manipulate Toggenburg, Golden Guernsey, (toxoplasmosis from cats, for the breeding pattern to Saanen and Toggenburg. example) and even wildlife ensure all-year-round (bovine TB from badgers). milk production in the Angora goats are kept for commercial sector mohair production and Boer Finally, we must be aware that „„ Duration of oestrus: goats for their meat. Pygmy some infectious diseases are 32-96 hours goats are very common pets spread by vectors, such as „„ Age at puberty: (Figure 2). bluetongue spread by midges. 4-5 months

Biosecurity needs to be Feeding addressed by goat keepers To satisfy the Five Freedoms It is vital to be aware that and, in the majority of cases, – the ethical framework goats are ‘browsing’ rather disease comes from other around which the codes of than ‘grazing’ animals. This animals of the same species. recommendation for the welfare means not just that forage and water must be offered at all times, but also that Figure 1. Goats in Austria. Figure 2. Pygmy goat. the total nutrient balance is such that the animals do not suffer from hunger, thirst or malnutrition. In the UK and in the EU there are strict rules regarding the feeding and watering of animals in transit.

Sadly, most of the welfare problems in the UK result from overfeeding, leading *Suggested Personal & Professional to obesity, acidosis and Development (PPD) urolithiasis. Most pet goats, that are not lactating, do GOATS not require any concentrate feeding – this is particularly

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of mineral supplements. Behaviour There is very little research General on goat nutrition published In many parts of the world, in English. Most values sheep and goats are kept of requirements are together in large flocks/herds extrapolated from dairy cows with no problems. Goat or sheep. One of the main social behaviour in these problems in feeding goats is circumstances is very similar the limited numbers in a herd to that of sheep, in that they and the wide range of milk tend to ‘bunch’ when danger yields – 600 to 1,500 litres per threatens (Figure 3). lactation. When goats are kept just Often goats have long as goat herds, they tend lactations when they fail to to scatter – and the young Figure 3. Sheep and goats in Iran. ‘get in kid’ yet are run with either tend to hide or freeze – the higher milking animals in at any sign of danger. Horns important when feeding difficult concept for pet goat the milking herd. Such goats tend to play a more major Pygmy goats. keepers who like to give either require much lower energy role in male goat behaviour concentrates or titbits – they density diets. They are thus than with horned rams. In Body weights for normal would be far better providing over-fed and become fat. fact, this is a good trait as adult goats span a wide branches of ‘browse’. Some injuries in bucks are less range. They are: dairy females experienced goat keepers Goats have a very short common because they tend 55-105kg, dairy males 75- advise cheap pasta shells from pregnancy compared to to stand on their hind legs 120kg, Angora females 35- the supermarket as a good cows. Everything, therefore, and wrestle with their horns 55kg, Angora males 50-70kg, ‘pocket’ treat – and 80g of tends to happen at the end of rather than charging from a Pygmy females 22-27kg and coarse mix or sugar beet pulp pregnancy. It is very difficult distance like rams. Pygmy males 28-32kg. twice-daily would be a good to manage kidding dates; this addition to hay. is even worse if the does are Large numbers of goats in the The diet of animals must allowed to run with the buck. UK either do not have horns match their production needs In an intensive situation, or they have been disbudded and overcome any potential attention to stocking A useful figure is that a goat’s as young kids. Disbudding dietary shortcomings, such as rates and the monitoring dry matter (DM) intake of kids will be covered in a mineral deficiencies, energy of sward height will allow should be 2.8 per cent of its subsequent article. shortfall or constituent the best use of grazing, body weight; thus, a middle imbalance. Feeding practice, with optimal swards of range goat of 75kg will require Specific behaviour in particular, must be good to four to six centimetres to 2.1kg of DM daily. This will problems optimise the health, welfare be maintained. Properly decrease to 2.7 per cent in Behaviour problems are rare and productivity of the managed grazing patterns, early lactation, such that a in goats, except for ‘self- animals whether they are kept coupled with good forage ‘light’ dairy doe will require suckling’ – defined as an for meat, milk, fibre or even preservation, are the goal. 1.75 kg of DM daily. animal sucking on its own ‘lawn mowers’ as pets. teats – and ‘inter-suckling’, Complications to diets start Housing defined as one animal sucking Judicious use of browsing and as soon as supplements Goats should be given the udder of another. These grazing can be used to satisfy are introduced. Balanced access to shelter at all are abnormal behaviours the nutrient demands for a diets do not need ad libitum times. This can be simple observed in dairy goats large part of the year. The mineral blocks or powder and inexpensive, provided (Martinez-de la Puente et grazing should be managed supplements; indeed, some it is large enough to al, 2011). Their occurrence to maintain sward height and of these act to cause dietary accommodate all the goats. may be affected by feeding ensure that fresh grazing is imbalance by either competing Goat keepers need to be management or nutrient available to the animals as with nutrients in the diet or made aware that dominant deficiencies and can lead needed or, alternatively, the by indirect competition. An goats may bully others and to udder and teat damage, animals should be allowed to example is the rich red mineral so, ideally, there should be causing economic losses roam to find new pasture. The supplement that is often two entrances to the shelter, owing to reduced milk yield. roaming may be timed to make supplied by farm wholesalers. which should give protection best use of the grazing to fit in It contains high levels of iron from rain, wind and snow. Self-suckling increases the with the weather, the altitude, and will effectively lower the width of the teat and reduces the harvesting of crops or even absorption of copper from Young kids should be the milk yield. Its frequency the use of the garden. the gut, maybe even leading to provided with a ‘kidding box’ can be reduced significantly marginal or deficient status. in which they can stay secure by feeding wheat straw ad lib It should be stressed that while their mothers are eating in addition to the ordinary to attain a maintenance Similarly, imbalances elsewhere. Goatlings enjoy feed. However, it is a habit weight, a pet goat should be of calcium, magnesium playing, so safe climbing toys that is difficult to break and fed good quality hay ad lib and phosphates can be should be provided. Goats may ultimately require culling and nothing more. This is a precipitated by injudicious use must never be fed from nets. of affected animals.

46 VETERINARY PRACTICE TODAY WINTER 2014 GOAT HUSBANDRY | LARGE ANIMAL

Legal considerations abortion products may not that of a farm animal, they can Reference Every goat is considered by the be buried; there are only a few arrange for it to be cremated Martinez-de la Puente J et al. (2011) Department for Environment, very specific remote areas in as for a companion animal, Effects of feeding management Food & Rural Affairs (Defra) as Scotland and Wales where it is except that the ashes may not and time of day on the occurrence a farm animal and is covered allowed. If owners do not want be returned. of self-suckling in dairy goats. by animal health and welfare the carcase to be treated as Veterinary Record 168(14): 378. legislation. Owners should contact their local divisional Further reading veterinary manager (DVM) Duncanson GR (2012). Veterinary if they have any problems. PPD Questions Treatment of Sheep and Goats. Owners – and, indeed, their CABI Nosworthy Way, Wallingford, veterinary surgeon – have a Oxford OX10 8DE. ISBN 978-1- duty to report any suspicion of 1. What is the main dairy goat breed in the UK at the 78064-004-4. a notifiable disease: anthrax, present time? bluetongue, brucellosis, Harwood D (2006). Goat Health A. British Alpine C. British Toggenburg contagious agalactia, foot and Welfare: A Veterinary Guide. B. British Saanen D. Anglo-Nubian and mouth disease (FMD), The Crowood Press, The Stable goat pox, pestes des petits Block, Crowood Lane, Ramsbury, ruminants, rabies, rift valley 2. What is the duration of oestrus? Marlborough, Wiltshire SN8 2HR. fever (RVF), scrapie and ISBN 978-1-8612-6824-2. A. 12-24 hours C. 32-96 hours tuberculosis. B. 24-36 hours D. 72-96 hours Matthews JG (2009). Diseases of Goats must be kept on land the Goat (3rd edn) Wiley-Blackwell, that has been allocated a nine- 3. As ‘a rule of thumb’ what percentage of a goat’s body 9600 Garsington Road, Oxford OX4 digit County Parish Holding weight of dry matter should it consume daily? 2DG. ISBN 978-1-4051-6136-7. (CPH) number; goat flocks A. 0.8% C. 2.8% The reader is also directed to are given a six-digit mark. B. 1.8% D. 3.8% Goats may not be moved off a the British Goats Society (BGS) holding – except for slaughter website at www.allgoats.com – within six days of any cattle, 4. There are several notifiable diseases found in goats. This contains much practical and sheep or goats being moved on Which statement below is correct? useful information on management, to the holding. This is known A. Bluetongue and C. Tuberculosis but feeding and breeds of goats. as the ‘six-day standstill’. malignant catarrhal not brucellosis is fever are both notifiable All goats must have an ear notifiable tag with a unique numerical B. Neither brucellosis D. Tuberculosis and identification number; if nor tuberculosis are bluetongue are they are breeding goats, they notifiable notifiable have to be double-tagged. The legislation for tagging is complex and owners are urged 5. Which statement below is correct? to consult the Defra website. A. Single pet goats do C. All goats require a not require a County CPH number There is very little movement Parish Holding (CPH) of goats into or out of the UK. number Practitioners should discuss B. Only milking goats D. Pygmy goats do not any intended movement with require a (CPH) require a CPH number the local Defra office. number Straying of goats is a real problem in certain parts of 6. Which statement below is correct? the UK and is a likely cause A. All goats must have D. Goats may not of spreading disease, as well a unique numerical be allowed off for as the more obvious road identification number slaughter if goats have traffic accidents. Good B. All goats need to be been brought on to fencing should thus be double-tagged the holding within six encouraged; tethering on C. Goats may not be moved days of other goats the other hand should be off a holding within six being moved on strongly discouraged as there days of other goats being are a large number of welfare moved on to the holding implications. in any circumstances

Goats are farm animals;

A 6. C 5. D 4. C 3. C 2. B therefore, in England, 1.

carcases, parts of carcases and Answers

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Exploring the link between liver flukeand TB tests Alison Howell and Diane Williams from the University of Liverpool are conducting a two-year study to find out the extent to which liver fluke infection in cattle affects the reliability of TB skin test results. Research has identified a link between the presence of liver fluke in cattle and reduced reactions to TB skin tests (Claridge et al, 2012).

The team will be looking for UK dairy – impair their host’s immune response; dairy and cattle herds in England and and beef herds that have large numbers increasing susceptibility to infection Wales are exposed to liver fluke, which of reactors or a persistent TB problem to while also affecting the sensitivity of in itself has a huge effect on production take part in the study. immunologically based diagnostic tests. costs in the dairy and beef industry. The organisation for the British beef and Whole herds will be blood sampled and It is possible that bTB could be spreading sheep industry, EBLEX, estimates that fluke tested at the time of the TB test, across Britain because the most widely liver fluke costs the beef industry £8- using an enzyme-linked immunosorbent used test to identify the disease is 9.5 million each year with a significant assay test (ELISA), to test for fluke ineffective when cattle are infected with decrease in milk yields in dairy cows. infection. This will be done on ‘day the common liver parasite, Fasciola one’ of the TB test to minimise any hepatica. Work carried out by Claridge inconvenience. Researchers will also and others in 2012 – which noted that analyse the results of the herd TB test the prevalence of F. hepatica increased “In the presence of F. and farmers will be asked to complete a substantially between 2000-2009 in the short questionnaire about TB and fluke UK – showed that a significant negative hepatica, the SICCT test risk factors. Farmers will receive payment association existed between exposure to was compromised” for their time as well as having access to F. hepatica and diagnosis of bTB. the results of the fluke test. The effectiveness of the single intradermal Eradicating liver fluke from cattle may comparative cervical tuberculin (SICCT) seem the obvious option in terms of test used to diagnose bTB was reduced obtaining more reliable TB test results; “Research has identified a in cattle experimentally co-infected however, this has its own difficulties. with M. bovis and F. hepatica. The Keeping cattle away from damp fields link between the presence results indicated that, in the presence that are home to the fluke’s snail host of liver fluke in cattle and of F. hepatica, the SICCT test was clearly helps. compromised. The authors concluded reduced reactions to TB from their study that their findings may, in Treating infected dairy cattle is more part, explain the continuing spread of bTB complicated owing to the 2010 European skin tests” and the failure of the current eradication Union ban on most flukicidal agents programme in the UK – they estimate that because they leave potentially toxic The diagnosis of bovine tuberculosis around a third of bTB cases in England residues in milk. The milk from cows that (bTB) in cattle requires detection of and Wales are undiagnosed. receive the two drugs that are licensed for the host’s immune response to the use against liver fluke has to be withheld causative agent. It is known that some These findings are significant because it from human consumption for three days pathogens – notably helminth parasites is estimated that around 70 per cent of after treatment, thereby impacting on the economics of an already financially strained dairy industry.

It will be two years before the results of the current study are available; but the issue clearly plays a not insignificant role in the whole bTB debate.

References Claridge J et al. (2012) Fasciola hepatica is associated with the failure to detect bovine tuberculosis in dairy cattle. Nature Communications 3(853): 1-8.

@VPTODAY WWW.VETERINARYPRACTICETODAY.COM 49 EXOTICS and WILDLIFE | TORTOISE Tortoise hibernation It is important to appreciate that not all species of tortoise kept as pets hibernate. Temperate terrestrial species such as Testudo marginata, T. hermanni, T. graeca and T. horsfieldii are all commonly kept in the UK and should be hibernated. African spur thigh (Centrochelys sulcata), Indian star tortoise (Geochelone elegans) and red- footed tortoises (Chelonoidis carbonaria) are commonly kept species that should Tom Dutton BVM&S, MRCVS, Resident ECZM(avian) not hibernate. Other less-common species of tortoise are also kept in the UK and a thorough review of their natural husbandry and habitat will allow you to determine Tom is a 2011 graduate of the University of Edinburgh. After if hibernation is appropriate. finishing his veterinary degree he completed a one-year rotating For a successful hibernation, (Testudo marginata). Using that a tortoise has a pre- internship at NorthWest Surgeons tortoises should be in the Jackson Ratio in these hibernation check from in preparation for his residency correct body condition, with species will produce an an experienced reptile vet. training. He started his ECZM adequate stores of fat, energy entirely misleading result. This should include a faecal residency training in avian and body fluid. The Jackson parasite check (pooled medicine and surgery in May 2012. Ratio (and its variants) is a When measuring the sample of three consecutive useful method for estimating carapace length for the motions). If in doubt, the body condition of a Jackson Ratio, it is vital that tortoises can be over-wintered tortoise. This is a ratio of a ‘straight carapace length’ with artificial heating and straight carapace length to is measured and the curve lighting. There is no evidence body weight of tortoise. The of the carapace is excluded to show that missing one graph is widely available (Figure 1). Female tortoises hibernation will have any ill online for reference. which appear overweight effect on a tortoise. (especially if they are The Jackson Ratio must only anorexic) could be carrying be used with the Hermann’s eggs – if this is suspected it tortoise (Testudo hermanni) should be investigated with a “The age a tortoise and Mediterranean spur- radiograph. is first hibernated is thighed tortoises (T. graeca Neil Forbes BVetMed, DipECZM(avian), FRCVS and T. ibera). Other body Under no circumstances cause for debate” weight: carapace length ratios should a tortoise that is Neil qualified from the RVC are published for Horsfield’s under weight, ill – or recently The age a tortoise is in 1983. He gained his RCVS tortoises (Testudo horsfieldii) been ill – be hibernated. first hibernated is cause Specialist Status (Zoo and or marginated tortoises It is always recommended for debate. In the wild, Wildlife [avian]) in 1992. environmental conditions He received his FRCVS by Figure 1. Correct technique for measuring the straight carapace determine that a first-year examination in exotic bird length in a tortoise. tortoise must hibernate; medicine in 1996 and became however, these animals will a Diplomate of the ECAMS in have lower body reserves and 1997. Neil heads the avian and will be more susceptible to exotic department at Great any errors in hibernation. Western Exotic Vets. When advising clients who have no previous experience of hibernating tortoises, we recommend that healthy tortoises (Testudo spp.) are hibernated annually once they reach an appropriate age (two to three years) and size (at least 100mm plastron length).

Many breeders and herpetologists do have success in hibernating *Suggested Personal & Professional younger tortoises and the Development (PPD) debate as to which age is best practice will continue NURSINGTORTOISE CPD until further research is carried out.

50 VETERINARY PRACTICE TODAY WINTER 2014 TORTOISE | EXOTICS and WILDLIFE

Winding down for weeks for adults. Tortoises must be able to monitor attained. Even in modern hibernation should naturally reduce their and maintain temperature fridges with an accurate Environmental triggers intake as temperatures drop. accurately – the best way is thermostat, it is possible for initiate hibernation in Enforced starvation is not with a maximum/minimum the back of a fridge close to late summer and early recommended thermometer. A ‘datalogger’ refrigeration pipes to attain autumn. Reduced ambient „„ Bathe your tortoise for 20 can be used to allow sub-zero temperatures. temperatures, reduced light minutes daily to ensure good even closer monitoring of intensity and shorter day hydration and encourage temperature. The hibernation box should lengths all play their part defaecation and urination – be placed in the centre of the in stimulating the start of ensure the bath temperature The optimum temperature shelves away from the back hibernation. is the same as the core body for hibernation is around and sides. Placing bottles temperature 5°C (41°F) (range 4-7°C of water in the fridge helps To prevent early onset of „„ Once body temperature (39-44°F)). The environment maintain a closer temperature hibernation in the UK – is around 15°C (55°F), the must be frost-free, remaining range – especially after especially if we have poor tortoise should be inactive above 0°C (32°F) at all times. opening the door to perform summer weather – an owner and can now be moved to Tortoises kept below this daily checks. needs to provide artificial light its hibernation box (usually range may suffer frost damage and heating to encourage early November) to their eyes and toes, suffer Duration continued feeding until the serious metabolic compromise Adult tortoises (Testudo spp.) early autumn. The further north or even die. should be hibernated for 12 you are situated, the more to 14 weeks. As with the ‘age often this problem occurs. It “It is very dangerous Tortoises may be kept in a to first hibernate’ debate, is very dangerous to suddenly to suddenly place refrigerator in a single box there is much discussion place an active feeding tortoise – generally high-sided with over the appropriate length straight into hibernation an actively feeding no lid. Substrate, such as of time juvenile tortoises because the gastrointestinal shredded paper, soil/sand should be hibernated. Of tract will be full of semi- tortoise straight into mix should be placed inside course, wild juvenile tortoises digested food which will cause hibernation” the plastic box (a small drinks will hibernate for the same problems during hibernation. fridge is perfect for a single length of time as the adults tortoise). It is important of the species. However, A method for hibernation wind- Hibernation methods to realise most fridge juvenile tortoises have lower down is summarised below: The author’s preferred thermostats are designed to reserves than the adults and „„ Reduce thermostatically method for hibernation is work at room temperature. hibernation errors could, controlled heat gradually refrigeration. This method comparatively, be of greater (approximately 1°C/day until allows far closer control Placing a hibernation fridge consequence. temperatures are around of temperature than an in a garage or outbuilding 15°C (59°F)) outside hibernaculum. It also will not prevent freezing if The author currently „„ As temperatures drop, provides protection against prolonged cold weather is recommends hibernating two feeding decreases, which predators and rodents experienced. We recommend to three-year-old tortoises is vital for hibernation – it and allows quick and easy the use of fridges without for six to eight weeks initially. takes two to four weeks for a monitoring of the hibernating freezer compartments – if The length of hibernation can tortoise’s gut to empty, so do reptile (Figure 2). thermostat failure were to be increased in subsequent not hibernate a tortoise that occur, it is more likely that years until a full 12-week has eaten within two weeks Temperature is the key to with these units, dangerously hibernation is achieved by the for young tortoises and four success in hibernation. You low temperatures could be age of around six years.

Figure 2. Rodent bite wounds in a tortoise hibernated in an Figure 3. Pharyngostomy tube in a tortoise with post- inappropriate hibernaculum. hibernation anorexia.

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Monitoring Summary It is important to weigh a Artificial heating and lighting hibernating tortoise twice are vital to enable the weekly. At each check, extension of summer and PPD questions look for signs of significant reduction of hibernation movement or urination. time; a major consideration 1. An owner rings reporting a tortoise weighing 976g at If either has occurred, is to ensure the tortoise has the start of hibernation has lost 112g by week eight of the tortoise should be emptied its stomach prior to hibernation. What steps should you advise? woken immediately. An hibernation. adult tortoise will lose A. Continue hibernation as planned until 14 weeks but approximately one per cent Monitor temperature lower the temperature of its body weight per month constantly throughout B. Recover the tortoise early from hibernation and during hibernation. If a hibernation – using a fridge is present for examination tortoise loses significantly most reliable but doesn’t avoid C. Continue hibernation but increase the temperature more than two per cent this requirement; weigh the per month or more than tortoise twice-weekly during 2. An owner brings a four-year-old African spur thigh six to seven per cent over hibernation and bathe it to tortoise for a pre-hibernation check. What is the the hibernation period, the facilitate rehydration before appropriate advice for length of hibernation? animal should be brought out and after hibernation. of hibernation immediately A. Hibernate the tortoise but only for eight weeks and seen by a vet. owing to its age B. Do not hibernate the tortoise Waking up C. Hibernate the tortoise for 12-16 weeks The hibernation period can last 12 weeks from the 3. An owner presents a tortoise with post-hibernation start, but may be as short anorexia. You discover it has been hibernated in a box as six to seven weeks in in the shed. You examine the tortoise and see white juveniles. Fridge-hibernated opacity in both eyes. What is the likely cause of the tortoises need to be anorexia? woken up proactively by maintaining them at warmer A. Freezing during hibernation temperatures. B. Mature cataracts affecting vision

At the end of the hibernation 4. On checking his Hermann’s tortoise during period, move the tortoise hibernation, the owner noticed a serous ocular and to an area at a room nasal discharge. What should you recommend? temperature of 18°C to 20°C. It should then be placed in A. The tortoise should be recovered from hibernation a lukewarm bath for at least B. The tortoise should be taken to a vet for 30 minutes before moving examination it to an area with artificial C. A swab should be taken for herpes virus and light and heat sources – for mycoplasma PCR instance, a tortoise table. D. All of the above

Bathing should be performed

D 4. A 3 hibernation require not does that species a is This B 2. B

daily for around 10 days to 1. encourage hydration and Answers for the tortoise to excrete toxins accumulated during hibernation. Normal foods should be offered during this period, and supplemental heating is important during the spring as temperatures can be highly variable and frost can kill hibernation/ post-hibernation tortoises.

If the tortoise does not drink within 48 hours, is not eating within five days or has not urinated within the first week, it should be examined by a vet as a matter of urgency (Figure 3).

52 VETERINARY PRACTICE TODAY WINTER 2014 INSIGHT | EXOTICS and WILDLIFE

Primates are not pets In January this year, the British Veterinary Association (BVA) called on the Government to implement a ban on the keeping of primates as pets, after it concluded it was ‘almost impossible’ for private owners to meet the needs of these animals to the extent laid down in the Animal Welfare Act 2006. The keeping of – or trade of – pet monkeys is already outlawed in seven European countries, including Austria, Belgium and the Netherlands.

Robin Hargreaves, who was BVA president implementation of the existing regulatory which need to be prioritised, to undertake at the time, explained: “Primates cannot framework have been exhausted’. independent research on the number and be kept on their own. They need at least type of primates being traded and kept as one companion in order to express natural Ten arguments were listed in favour of a pets in the UK”. behaviour. They require both an indoor ban; these included recognition that ‘a and outdoor enclosure to ensure adequate domestic environment is incompatible It also responded to the call for a review of exercise and exposure to UV light, and each with their complex social, behavioural, the Pet Animals Act 1951, saying that the species has specific dietary requirements. environmental and dietary needs’, and that Act still provides appropriate protection These animals are not domesticated ‘most people lack the expert knowledge and that Defra would be working with companions like dogs and cats, or even required to care properly for primates”. the Pet Advertising Advisory Group to livestock, and are extraordinarily difficult encourage advertisers to adhere to its to care for properly. Very few people can minimum standards for advertising pets provide the necessary resources to meet for sale online. Among other things, the their welfare needs.” “The exotic pet trade causes standards state primates should not be advertised for sale. While it was considered that changes to suffering to millions of existing legislation and licensing could animals, disrupts ecosystems Defra will also ensure that guidance on improve primate welfare, the Association the potential use of zoo inspectors or says its members did not feel these and may even be driving vets for accommodation inspections options went far enough. Mr Hargreaves involving primates – prior to licences added: “We appreciate that many people species to extinction” being granted or renewed – will be who keep primates privately care deeply published within the next 12 months. In for their pets and do their utmost to All this was welcomed by the BVA, as was Britain, licences are needed to keep some provide for them appropriately. However, the recommendation for a review of the species, but some of the most popular – primates are long-lived, intelligent, Pet Animals Act 1951. The current Act was including marmosets and tamarins – are socially complex animals and we can think drafted at a time before internet sales were not included in the scheme. of no circumstances where they would possible, and when there was less interest in benefit from being kept as a pet.” primate keeping and animal breeding. Pet Primates that have highly-specialised monkeys, including baby chimpanzees, are needs are being bought and sold to The BVA did recommend, however, that increasingly advertised and sold online, where grandmothers, young men and even individuals who are working with accredited they can be bought for as little as £750. children, because there is absolutely no zoos should be allowed to breed primates regulation covering their sale, distribution for conservation purposes. MPs called for the Government to “ensure and care afterwards. It is a ‘huge and that legislation governing the Act is fit for significant’ problem and is claimed to be In June, the Environmental, Food and the internet age”. MPs also recommended ‘growing exponentially’. Rural Affairs Committee (Efra) called that the Department for Environmental, for urgent action to establish how many Food and Rural Affairs (Defra) issue The RSPCA, the BVA and other animal primates were being kept in the UK. local authorities with guidance on welfare groups are calling for the practice Committee chair, Anne McIntosh, said: implementing the Dangerous Wild to be banned. “We were surprised to find that so little is Animals Act 1976, without delay. known about the types and numbers of primates being kept or traded by private In September, the Government published individuals in the UK and about the its response to the calls for independent manner in which they are being kept”. research into the number and type of primates being kept as pets in the UK. The committee also felt that, although a Estimates have varied regarding the number future ban was still possible to address of privately kept primates – evidence given the welfare problems associated with by Andrew Greenwood of the British primate ownership, it preferred to Veterinary Zoological Society states that the recommend registration of primates as number of primates kept as pets in the UK is an initial step, stating: “While we support ‘probably fewer than 1,000’, whereas other the adoption of a ban in principle, estimated figures were as high as 9,000. this is a draconian step that must be based on solid evidence and only after The Government considered that, “it attempts to improve the operation and would be the best use of public resources,

@VPTODAY WWW.VETERINARYPRACTICETODAY.COM 53 MANAGEMENT | HOLIDAY PAY

Annual leave and holiday pay For most UK workers, the statutory right to paid holidays only came about when the Working Time Regulations came into force in 1998. These Regulations were the UK’s implementation of the EU Council Directive ‘concerning certain aspects of the organisation of working time’ – the EU ‘Working Time Directive’. This article looks at the background, the current position and the possible future of holiday pay and leave. David Hewitt Annual leave As the additional annual Note that it is unlawful to Under the original leave was introduced by UK treat a part-time worker less David Hewitt has been involved Regulations the annual leave legislation and is not EU- favourably than a full-time in employment law for more entitlement was three weeks, driven, the rules governing worker. A part-time worker than 40 years. He has held which only arose after a additional annual leave do who works three days a week senior HR roles in industry worker had completed 13 not have to comply with is still entitled to 5.6 weeks’ and has been employed in weeks of service with their any EU requirements. The leave a year even if the three personnel and employment law employer. A year later, the main difference between worked days are Tuesday, consultancy roles since 1990. entitlement increased to annual leave and additional Wednesday and Thursday, four weeks and annual leave annual leave is that, with the and the worker doesn’t need He joined Citation Ltd in 1999 subsequently became a ‘day employer’s agreement, up to reserve any of the leave for and is currently their Head of one’ right. to 1.6 weeks of additional bank holiday Mondays. Employment Law Information. annual leave can be carried The entitlement has always forward, once, into the next ‘Accruing’ leave been expressed in weeks; so holiday year. The old idea of workers a five-day week worker was accruing holidays with entitled to 20 days’ leave, a Part-time workers service is now a thing of the three-day worker to 12 days, Part-time workers have past. If a worker joins an a six-day worker to 24 days, exactly the same leave employer at the beginning and so on. The EU regards entitlement as full-timers of the employer’s holiday the taking of annual leave as – 5.6 of ‘their’ weeks. Thus year, they have an immediate a health and safety issue, so a part-time worker who entitlement to a full year’s under normal circumstances works five mornings a week leave. If they join a quarter of any leave remaining at the is entitled to 28 mornings’ the way through the holiday end of one leave year cannot leave each year; and someone be carried forward to the next who works three days a week leave year (the ‘use it or lose is entitled to 16.8 days’ leave it’ principle, to encourage (5.6 x 3) each year. For many ‘The old idea of workers to take their annual part-time workers this will entitlement), and days of leave a part-day of leave workers accruing leave cannot be ‘bought remaining at the end of the holidays with out’ by pay in lieu except on leave year, and the easiest termination. way to deal with this is to service is now a carry it forward into the next Additional annual leave leave year. thing of the past’ The four weeks of annual leave was for all leave, including any leave for bank/ public holidays. This meant that a five-day week worker who took the eight public/ bank holidays only had 12 days left for ‘annual’ holidays. This changed in October 2008 when the UK Government introduced ‘additional annual leave’. It was expressed as an additional 1.6 weeks’ leave *Suggested Personal & Professional (eight days for a five-day Development (PPD) week worker), giving a total leave entitlement of HOLIDAY PAY 5.6 weeks, but subject to a maximum of 28 days.

54 VETERINARY PRACTICE TODAY WINTER 2014 HOLIDAY PAY | MANAGEMENT

year, they are entitled to three following leave year with a quarters of a year’s leave, and double leave entitlement of so on. 11.2 weeks.

The obvious problem with a worker having all the leave ‘up front’ is that, ‘Part-time workers for example, a new starter could take two weeks’ paid have exactly annual leave early on in their the same leave employment, never to be seen again! To prevent this entitlement as from happening, although workers have an immediate full-timers’ entitlement to the full annual leave remaining in the This rarely suits the employer employer’s holiday year – for or the new mother, and one instance, three-quarters of way to avoid this situation notice required to request been called into question, the annual leave if three- is for the expectant mother leave; but in the absence of with a UK employment quarters of the leave year to still have the 52 weeks of any such rules, the fall-back tribunal case being referred is remaining – the employer absence they had planned for, position is that workers must to the European court for can restrict the taking of but to take the first five weeks make the request in advance determination. The case this entitlement during the (as an example) as annual at least twice the length of concerns a British Gas worker first year of employment to leave and to only take 47 the leave, before the leave whose earnings comprise 40 one-twelfth of the full leave weeks as maternity leave. This date, and the employer must per cent basic salary and 60 entitlement for each month way the expectant mother give an answer to the request per cent commission, such of service. gets five weeks’ full pay at least the length of the that this worker only receives (holiday pay), then Statutory leave, before the leave date. 40 per cent of his normal pay A five-day week worker can, Maternity Pay (SMP) for when he takes leave. therefore, be restricted to six weeks at 90 per cent of For example, a worker who one-twelfth of 28 days’ leave earnings and 33 weeks at the wants to take one week’s The worker argued that (2.33 days) each month. The basic rate of SMP – 44 weeks’ leave must request it at least – because of the drop in leave is rounded up to the pay in total instead of just 39 two weeks before the leave pay – the current practice nearest half day, so at the weeks’ pay. date and the employer must discourages workers from beginning of month one this respond to the request at exercising their statutory right equates to 2.5 days (2.33); at For the employer, the new least one week before the to take annual leave, and that the beginning of month two, mother will only be on leave leave date. Similarly, an holiday pay should be based it is five days (4.67) minus any for an additional 0.6 of a employer can impose leave on on normal remuneration. The leave that has been taken; week in the new holiday year, a worker or workers by giving European Court has found at the beginning of month a total of 6.2 weeks, instead notice of the leave which is in his favour, so at some time three, it is seven days minus of 11.2 weeks. at least twice as long as the in the future holiday pay will any leave that has been taken, period of leave. inevitably have to be based and so on. One further exception is with on a yet-to-be-determined regard to sickness. An EU Holiday pay definition of ‘normal Carry-forward exceptions Court judgement has ruled Holiday pay is currently based remuneration’ rather than on Although annual leave that, if a worker is unable to on ‘a week’s pay’, using a ‘a week’s pay’. from one leave year cannot take leave because of sickness, formula that has been around normally be carried forward the leave can be taken at a since the 1960s. For salaried Workers who leave their to the next leave year, and later date. This includes taking workers, this just involves employment with untaken additional annual leave from the leave in a subsequent leave continuing to pay their leave have a statutory right one leave year can normally year if the worker runs out of normal basic salary while to be paid in lieu of that only be carried forward once time to take the leave in the they are on leave. For hourly leave on termination. There into the next leave year, there current year. paid workers – with a set is, however, no equivalent is an exception if the worker basic hourly rate of pay and statutory right for the is already on a different type Just to complicate matters, contractual weekly hours – a employer to recover holiday of leave, such as maternity, this judgement only applies week’s pay is the hourly rate pay for any leave taken in adoption or parental leave. to the EU entitlement to four multiplied by the contractual excess of the entitlement. weeks’ annual leave, and the hours. Where there are no This is a matter of contract In this situation, any untaken UK’s 1.6 weeks’ additional contractual hours, a week’s between the employer and leave rolls over into the next annual leave is still restricted pay is the average earnings the worker and, unless there leave year which means that, to one ‘carry-forward’. over the previous 12 weeks in is a provision in the worker’s theoretically, an employee which there were earnings. contract permitting the who goes off on maternity Requesting leave deduction of ‘overtaken’ leave at the start of a leave Employers can determine This method of calculating holiday pay, any such year will return to work the their own rules regarding the holiday pay has recently deduction will be unlawful.

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How do you encourage the team to buy into your marketing plan? So your marketing plan is written, you are happy with it, and life can move on. Or can it? Developing a marketing plan is one thing, but encouraging the team to buy into it is quite another. This article will highlight the importance of ensuring a collective team Kristie Faulkner approach to practice marketing, as well as exploring ways to help you achieve it.

Kristie is the business manager right? If your marketing plan for Onswitch and has over is aligned with your practice 18 years of experience in vision, then the end result is the veterinary sector – with surely in the bag? Whether previous roles including head that end result is to increase nursing, practice management turnover by x per cent or client and working within the numbers by z. pharmaceutical industry. Yet Onswitch research shows Having seen the industry that two words in particular from all angles, Kristie stand out (the size of the has developed a passion word once again reflects its for excellent customer and Figure 1. The key characteristics that pet owners look for in a frequency of use) when vets veterinary care provided veterinary practice. (Onswitch Vox Pop data, 2014) were asked what they found by efficient and motivated most challenging about team members within a well- Before starting work on practice, the answers they give marketing – the words team run business. writing and implementing a are clear and consistent. and resources (Figure 2). marketing plan, it’s useful to remind ourselves of the point Figure 1 illustrates these What you want to do, and of marketing. findings, with the largest words what you are able to do are being those most often quoted. not always the same. Marketing is defined by the Chartered Institute So, owners want you to be Consistency is key of Marketing as: ‘The friendly, caring and helpful. Unless you are master of all management process Not (as you might have trades, chances are it will responsible for identifying, imagined) to be cheap. be your team dealing with anticipating and satisfying Because ‘cheap’ is probably the customers who contact customer requirements not a word you have included the practice following your profitably’. Or re-phrased in your vision statement marketing efforts – the ‘team’ more specifically for the anyway – with words such being made up of every single veterinary profession, as caring, friendly and person you employ, not just ‘marketing is the art of professional being used those front of house. That communicating the services instead. Which means that the includes the vets, nurses and value that your practice two pretty much match up, and admin staff, who each provides for the customer, in a way that delivers healthy client numbers and finances’ (your Figure 2. What you want to do, and what you are able to do, are not always the same. (Onswitch Practice Managers’ Survey, 2014) marketing plan should include a target annual net profit). Whichever definition you prefer, the fundamental point is the same – the customer’s needs are paramount.

So what is it that customers want? Onswitch regularly undertakes *Suggested Personal & Professional ‘vox pop’ research with pet Development (PPD) and horse owners across the UK and Ireland. When we ask MARKETING what the key things are that they look for in a veterinary

56 VETERINARY PRACTICE TODAY WINTER 2014 MARKETING | MANAGEMENT

have a vital role to play in ensuring that every point of client contact is a great one – from a phone call picked up in prep, to every type of consultation, including admission and discharge.

Imagine a potential customer contacting the practice as she – 68 per cent of clients are female – has received an eye-catching mail drop with an exciting offer. Or she may have seen your lovely, interactive Facebook page, or had one of her ‘nearest and dearest’ recommend you. But the person who picks up the phone comes across as abrupt, rushed and has no idea what the leaflet offer is all about.

How does this customer feel now? That the practice is organised, professional, Figure 3. Each of the four stages on the journey of customer experience requires focus. interested in her and on the ball? That this is the practice yet deliver a hit-and-miss steps that might go along the committed to doing quality she will choose above others? service depending on who the following lines: work. What would your team Probably not. customer sees that day? score in these areas? Alignment of all team National Index data find It’s crucial that your team members to the practice vision Communication is key. that the average practice understand your vision and by sharing with everyone what So team members – vets, score for telephone customer engage with it; that they it is that you are trying to nurses, front of house and care is just 44.98 per cent, understand the importance achieve, and why. admin staff – must all receive taking into account the level their own actions play in regular, clear and concise of engagement and interest its success or failure. Sadly, Ensuring that all team information detailing the shown, the offer of an the question “What is your members have up-to-date, marketing plan’s latest appointment and whether practice vision?” is almost relevant job descriptions and content and results, with additional information is always met with a blank face. regular appraisals. These a level of detail that allows given, such as directions to the job descriptions should every employee to see how practice website. The customer journey detail how each individual their own actions impact on Starting way before that role contributes towards its success. And remember, Practices that routinely customer walks through the achieving the practice vision; ‘The communication process measure the ‘phone door, the customer journey because in order to be itself may be more important experience’, however, see begins with an awareness fully productive, each and than the content of the scores consistently sitting of the practice – and this is every employee needs to process’ (Richardson and between 80 and 100 per where your marketing plan understand his or her own Denton, 1996). cent month on month. The comes in. responsibilities, as well as difference in these scores being able to visualise how The type of communication can mean a potential client The marketing plan will the marketing plan aligns medium used is important choosing your practice or your feature many different ways to with the practice vision. too – face-to-face discussion competitor – food for thought connect to the customer; and is much richer than putting I am sure you will agree. once this connection is made, National Onswitch TeamTrack up a memo on the staff your team members then data show that, on average, room notice board, and Your team must be both aware play a key role in converting only 64 per cent of employees meetings to detail the plan of – and fully behind – your awareness into business, receive regular praise or in full facilitate a two-way practice vision in order for ensuring that the customer recognition (within the last communication where the it to become reality. Are you chooses you and not one of seven days); yet without team can ask questions and currently an average practice the many other practices in this, motivation levels voice concerns, as well as but have ambitions to be the the area. are in danger of slipping. determine how best these best in the town (or region – Fortunately 81 per cent of plans are executed. why not think big?) Do you Thus any marketing plan employees feel that their promise an excellent customer needs an action plan to job is important and 88 per Connecting the team to the and pet/horse experience accompany it, with clear cent say their colleagues are four stages of the customer

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journey, each of which needs The consult room is the see that marketing activity is into an appointment, but also focus (Figure 3): heart of the practice, where working and having a positive retains the client and – most your vets and nurses provide effect in order to lend their importantly – gives them a Getting noticed. This stage owners with the individual support to future marketing reason to recommend you to relates to the marketing time and focus that underpins activities. their friends and family and so plan, where it all starts! great veterinary care. the footfall cycle begins again. Using social media and the internet, speaking with local Think about that booster Customer experience is key opinion leaders (KOLs), appointment – it is not just “Team members the key to every successful holding community events, a catch-up appointment, it business, and your team carrying out mail drops and is probably the one time this must all receive are fundamental in creating mobile advertising, such as owner will be in your building regular, clear an experience that has handing out branded ‘bag-for- in the whole year; so a two- people talking, for all the life’ or ‘dogdanas’ and other minute in and out will not and concise right reasons. The time and awareness-building activities, help ensure their retention effort you put into giving are all important here. or recommendation any information” the guidance, tools and more than it will improve the information to each individual Filling the funnel. How easy healthcare status of the pet. Equally, the management on the payroll will always is it for potential customers team must demonstrate their prove to be a wise investment. to contact you? What is the In a nutshell, does the commitment to the marketing In this way the marketing likelihood that they will choose customer’s experience meet plan in order to continue to plan you so carefully created you based on the experience the expectations raised by motivate the team towards will be at its most effective, they have on the phone? Your the marketing activity that delivering their goals. Using a dovetailing perfectly with your marketing has taken effect, brought them here in the balanced scorecard approach practice vision and delivering now it is down to your team first place? to measure practice data in tangible results. members to demonstrate that four core areas allows both they are friendly, interested Word of Mouth. As many management and the team Acknowledgement and have all the information as 80 per cent of new clients to keep a track of business The author wishes to express her required in order to convert will hear about their chosen performance and monitor the sincere thanks to Hazlewoods that enquiry into custom. practice through word of success of the marketing plan. Accountants for supplying financial data mouth. Essentially, there is used in this article. Customer experience. How no better marketing than Recommended targets to aim easy is the practice to find? Is a customer telling a friend for in each of the four areas the reception space clean and or family member to go are shown in Table 1. tidy? Do the team members there! Your team are key Reference acknowledge and engage with to promoting this positive Marketing shapes practice Richardson and Denton (1996). the customer as soon as they word of mouth through the success walk in? Does the vet make experience they create for In conclusion, the role the customer feel that they every customer. of marketing is to create too are interested in the pet/ awareness and drive people horse? Do they communicate Measure, measure, to pick up the phone. After effectively and does the client measure that it is over to your team feel he or she has received Then measure some more! to create an experience that value for money? The team must be able to not only converts the enquiry

Table 1. Recommended targets in the four key areas of the customer journey

Customer Finance

„„ New client registrations per month: Target 20 per FTE vet „„ Annual turnover per FTE small animal vet: Target £230,000 small animal, 8-10 per FTE equine vet „„ Per FTE equine ambulatory vet: Target £150,000 „„ Record ‘How did you hear about us?’ data to identify which „„ Gross profit: Target 73% of turnover elements of the marketing plan are working best „„ Spend per new client: Target >£250 per year „„ Net Promoter Score: Target 85% „„ Consult Index: Target 85% „„ Phone Index: Target 85% Operational Effectiveness Staff

„„ Number of inbound calls per FTE vet: Target 1,000 per month „„ Team track results: Target >80% „„ Consults admitted for imaging, work up or surgery: Target „„ Collect staff feedback relating to every aspect of the >25% of first consults marketing plan, what went well and what didn’t go so well? „„ Call conversion rate: Target 40% „„ Make time for two-way conversations and feedback with regards to future plans

58 VETERINARY PRACTICE TODAY WINTER 2014 CPD | SMALL ANIMAL Looking for a job? Jobfinder [email protected]

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Developing talent in veterinary practice

‘Talent management’ is an increasingly popular term in today’s business world; yet it is not widely used – or even understood – in the veterinary world. Most businesses do their best to keep the good people that they find, although the fact of the matter is that developing talent in the veterinary practice can be an exceedingly complicated balancing act. Mark Hedberg DrMedVet MRCVS Just what is talent, effective. Ideally, they should practices don’t achieve their anyway? eventually be able to form a staffing goals is because, quite Mark began his veterinary The Chartered Institute of team that can cover for any often, they don’t actually have professional career in Saudi Personnel and Development staff absence – even yours. any goals set. Arabia in a small animal/ (CIPD, 2014) defines talent exotic veterinary hospital in as ‘…those individuals who This may seem an obvious Jeddah. Following this he spent can make a difference to statement, but in a 2012 survey two years in mixed practice organisational performance by the Institute of Leadership “The easiest way in Dover where, in addition either through their immediate & Management (ILM), it was to make your team to his clinical work, he served contribution or, in the longer- found that only 57 per cent of as regional secretary for the term, by demonstrating the surveyed workplaces had any aware of your goals BSAVA Kent region. highest levels of potential’. kind of plan in place to develop Essentially, they are the people a pool of leaders and managers is simply to tell them He currently runs a CPD who have the technical or for their business (ILM, 2012). what they are” programme for the College management skills – or the of Animal Welfare, and potential – to really make a Planning, recruitment, training completed a Certificate in difference in your team. and management are all key It is fashionable in some areas Leadership and Management parts of developing the talent to denigrate key performance in 2014. He has written The two basic goals of talent in your workplace. All too indicators (KPIs) as holding extensively on new and management are to find those frequently these areas of good vets hostage to numbers; recent graduate support people you need to make business practice are ignored but in actual fact a KPI can as well as personal your business succeed, while or under-resourced as being be anything you choose to development, and has given investing the time, training and ‘soft skills’ unworthy of a measure that is the result of presentations at the BSAVA, effort in them to make sure ‘proper’ veterinary surgeon’s a business’s (or employee’s) LVS and NAVC conferences. they succeed just as much as attention, so the proportion function. It’s not necessarily you do. The long-term goal of of veterinary practices with a measuring money – it can be good talent management is ‘talent pipeline’ is probably far the number of times a specific to create a sustainable ‘talent lower than in the rest of the UK activity takes place. After all, pipeline’ that will help you business world. how can you develop talent identify, train, and promote when you don’t know what the your staff members. ‘Talent planner’ talent needs to do, or be? The ‘talent planner’ is the This will result in your having a first of many hats you need to The first important step is to team that has the management wear when you are managing develop a talent plan – what and technical skills to make your practice’s personnel you intend to do with your your business more productive development. The number people once you’ve hired them. and your practice more one reason that veterinary This doesn’t mean mapping out

*Suggested Personal & Professional Development (PPD)

TALENT

60 VETERINARY PRACTICE TODAY WINTER 2014 TALENT | MANAGEMENT

a rigid timetable for a person Heel of every business. is difficult; but you can build Once you’ve done that, you who doesn’t yet exist. It means Nothing is more frustrating a personal and professional will have an effective job and mapping out the people and than not being able to attract profile that helps predict the personnel profile that you support you intend to use to the best and the brightest, type of person who will do well can use to screen applicants improve your employee’s skills other than hiring the best in your environment. A very and add to your talent plan. and (hopefully) yours as well! and the brightest, only to see simple step is to review your Interviewing and hiring is them hand in their notice six most successful staff members much easier once you have Lacking a talent plan months later. (past and present) who were a good sense of what your frequently means that many – and are – highly productive business needs. It is better to new employees are left to ‘sink There is no shame in not being and effective in your business. hunt for someone, rather than or swim’ when they’re brought good at hiring, as very few vets Write down their memorable fish for anyone. on board – their inductions receive any kind of training traits or abilities, as well as any and training left to chance, the in good hiring practice. The qualifications or background ‘Talent manager’ luck of the rota, and whoever shame is in accepting that you that helped your team. Richard Branson famously doesn’t happen to be too busy. are not good at hiring, and not said that you should: “Train It is up to an employer and working to fix the problem. Naturally, you are not people well enough so they their talent plan to develop a expected to hire clones of your can leave, treat them well schedule for ensuring the new Most of a practice manager’s past staff, so don’t even try. If, enough so they don’t want employee learns what he or she recruiting issues stem from however, a certain style or skill to”. Dealing with people is needs to know. not knowing who or what they set worked well in a particular a key part of being a ‘talent want the employee to be. A position, it is not unreasonable manager’; so to invoke the old For those of you who true ‘all rounder’ employee to try to replace them with a cliché, people don’t leave bad recognise this and have a simply doesn’t exist, although similar individual. jobs, they leave bad managers. solid and effective induction this hasn’t stopped veterinary process for new employees, practices from looking for Conversely, while it’s tempting There are many reasons why congratulations – you’re them. A ‘jack of all trades’ is to erase memories of your small businesses struggle with on the right path. But what master of none – nobody is less successful employees, management issues. Many happens after the induction is uniformly good at everything. it’s worth recalling them clinicians find management complete? Even team members who are dispassionately. Did you have difficult because employee or consistently good will have their any ‘hires’ that turned out to business issues don’t always A good and flexible talent strengths and weaknesses. be disappointments, or even have a single ‘right’ answer. plan will help your people to outright disasters? Take the When managers have little or proceed further in their career, Before you start advertising for time to write down what it was no training in management, once they’ve been ‘induced’. your next team member, it is about them that ‘didn’t work you can end up with a very The end of their learning well worth deciding on exactly out’ and try to avoid it. Be poorly performing workplace journey is not the consult table who it is you are seeking. careful here because if it was indeed. There is even evidence or the surgery table. If you help Typically, the top three types of a personality clash, it may not to support this. your staff discover and plan employee veterinary practices always be their fault. their future, you’ll find they will wish to hire are: The 2012 ILM survey reported follow you ‘through hell and „„ Someone just like the last Sit down with your current that 93 per cent of respondents high water’. one that left team members and gather were worried “that low levels of „„ Anyone except the last one their views. Your new member management skills are having a ‘Talent recruiter’ that left of staff will be working direct impact on their business Once you’ve devised your „„ We don’t care – we simply with them as well as you, achieving its goals”.The same talent plan on paper, you can need to fill the hole in the rota and sometimes the way you study found that only 18 per start looking for people with remember things may not cent of respondents expected whom to use it. The ‘talent Identifying talent when you have been quite the way their managers to have recruiter’ role is the Achilles’ haven’t even met the person yet things happened. management training.

To put that in perspective, that’s like only 18 per cent of veterinary practices expecting their veterinary surgeons to go to veterinary school, and then hearing 93 per cent of them saying their vets aren’t very good!

Entire books have been written about the benefits of good management and the perils and pitfalls of bad management; yet the brief summary is this – finding the best people is one thing, keeping them is another.

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to make things happen. It is See how their training has References like lifting a particularly heavy influenced your business. www.cipd.co.uk/hr-resources/ “The easiest way patient – they are more easily Investigate your business factsheets/talent-management- moved when you are both processes and facilities at the overview.aspx to make your team pulling in the same direction. same time, to see where the aware of your goals bumps in the road are that www.i-l-m.com/~/media/ILM%20 ‘Talent trainer’ need fixing. Not everything is Website/Downloads/Insight/ is simply to tell them It is a common misconception a question of staff training – if Reports_from_ILM_website/ that training only starts when your induction plan includes Research_talentpipeline_ what they are” you authorise the first CPD reminding staff to prop open july2012%20pdf.ashx course the employee attends. a faulty door to prevent them The 2013 Royal College of This is very far from the truth. being locked in the isolation www.rcvs.org.uk/publications/ Veterinary Surgeons (RCVS) Training starts the minute room overnight, you need to fix rcvs-survey-of-recent-graduates- survey of 1,406 recent graduates your staff member walks in the the door! ies-2013 showed that 179 (17.2 percent door. This is the time your new of those who responded) left employee ‘learns the ropes’ ‘Talent pipeline’ their first job because of ‘poor at your business, whether It is important to remember management’. Although 179 it’s the name of Tuesday’s that you will not miraculously people may not sound that part-time receptionist, the solve all your problems with a many, when you consider the discount policy, or where the talent pipeline. Staff will come costs incurred in recruiting and endoscopes are kept. and go, some of your ideas will training them, that does add up. work, and some won’t. People Indeed, the veterinary profession Once they have ‘made will have good days, bad is well-known for having themselves at home’ in your days, sick days, and holidays. turnover issues – staff seem to building is the time you begin Sometimes the staff member either stay for a few years, or working with them to map you earmarked as having high decades. out their employment path. leadership potential just won’t It doesn’t end with the CPD work out. So what is to be done if you wish certificate – a mistake that to retain staff? The answer is many practices make is to train By integrating your planning, to give them a chance to make staff and then not let them management, recruiting and a difference to themselves implement the lessons in their training, you will be taking and your practice. ‘Employee daily work. If you won’t let proactive action to make engagement’ is a popular them make changes, why even management happen. Your buzzword in today’s business let them learn? talent plan is your plan for the world, but a distilled definition future – because veterinary is useful – an engaged employee Periodically assess your team practice isn’t just something is someone who is aware of your members to find out in which that happens between consults goals and works enthusiastically areas they need to improve. and phone calls. to make them happen.

The easiest way to make your team aware of your goals is simply to tell them what PPD Questions they are. When it’s a goal that meshes with their values 1. What percentage of UK businesses have a talent plan and ambitions, you may find to develop leaders and managers? they’ll move heaven and earth to make them happen. So find out what motivates your 2. What is a simple definition of employee engagement? team and help them to see how your goals complement 3. What are the two basic goals of talent management? their aspirations. You may even consider having team members influence your goals. 4. List the attributes of your best employee or colleague that made them successful in your practice. Targets set ‘from above’ are useful to a point; but having 5. What percentage of UK businesses expect their colleagues working towards managers to have any management training? a goal they’ve suggested is a

powerful motivator. The same

18% 5. answer correct no exercise, Reflective 4. applies to a ‘talent plan’ – when success a business your and

Find and invest in people who will make you you make will who people in invest and Find 3.

both you and your employee happen them make to enthusiastically

An engaged employee is someone who is aware of your goals and works works and goals your of aware is who someone is employee engaged An 2. % 57

agree on a development plan, 1.

you are both going to work Answers

62 VETERINARY PRACTICE TODAY WINTER 2014 INSIGHT | MANAGEMENT

PPD? CPD? What’s the difference and does it matter? You will have noticed in the last issue of Veterinary Practice Today our move from the term CPD (continuing professional development) to PPD (professional and personal development). We think that PPD more closely reflects what our journal represents – scholarly articles in all areas of veterinary practice, mixed with critical and thought-provoking comment on current veterinary topics. We ask you to join in our discussions, create debate and give opinions – all part of the professional development process.

CPD is an essential part of being a to maintain and develop the knowledge good vet, nurse or manager, but to be and skills relevant to their professional a fully-rounded professional, personal practice and competence. “Reflection helps to drive development within work is essential. In change, is the key to effective his article, ‘Developing talent’, on page 60 The recommended minimum CPD for of this issue of Veterinary Practice Today, veterinary surgeons is 105 hours in any performance and should Mark Hedberg writes: ‘It’s a common three-year period with an average of 35 misconception that training only starts hours per year; and for veterinary nurses, be integral to any personal when you authorise the first CPD course 45 hours in any three-year period with an development planning” the employee attends’. average of 15 hours per year.

The RCVS has defined what it considers the value of reflection in attaining it. It to be the activities vets and nurses considers that reflection helps to drive “Getting the CPD certificate might undertake in order to further change, is the key to effective performance their professional competencies and and should be integral to any personal is simply not enough” has produced a very flexible list of ways development planning. of achieving the required number of It is the training and development of staff CPD hours (rcvs.org.uk). In addition, Reflecting on – and including in your that leads to a successful workforce. Getting the RCVSs new online system – the records – what you have learnt not the CPD certificate is simply not enough; Professional Development Record just from clinical CPD, but also from empathy, compassion and understanding (the PDR) – is now available for vets to complaints and compliments, significant are also an essential component of being a record and reflect on their professional events, discussion with others and good vet, nurse or manager. development plans and objectives. reading about current veterinary issues, is an important part of PPD. Reflection CPD is the means by which people So CPD is undoubtedly vital for the helps to highlight future training and maintain and increase the knowledge and maintenance of current knowledge and development needs. skills related to their professional lives technical skills; but equally important is and is usually based upon a structured the development of personal skills. To be Taking time out simply to think is not approach to learning to help ensure truly competent, vets and nurses also need always easy in a busy professional life; competence in the individual’s field of to develop their ability to communicate however, it is this thinking and reflective work. The RCVS Code of Professional and discuss cases and techniques with process that enables us to see how we Conduct for Veterinary Surgeons makes colleagues and clients. It is important have developed and where we need to it very clear that veterinary surgeons and that not only are they up to date with develop further. veterinary nurses have a responsibility their specialist area, but that they are also aware of the current veterinary issues, So what’s in an acronym and does it the ‘big debates’, and are able to think really matter what we call our method objectively about controversial industry of learning and personal development issues. In this way the individual becomes within our chosen profession? Perhaps a more rounded professional. the main thing to say is that CPD conjures up the connotation of tick boxes – been Veterinary managers also need a full there done that, fulfilled the necessary training and development programme. requirements. One would hope that a good manager has already acquired the necessary ‘people The term professional personal skills’, yet equally they need to be aware development offers a more modern, of what is going on in the veterinary proactive perspective. It is a softer, industry, because this inevitably affects more reflective, all-embracing term the workings of their practice and, in placing an emphasis on the ‘personal’. some cases, the management decisions We believe it represents the complete that need to be made. development of the individual as a person and encompasses their relationships with The medical profession – including medical colleagues and clients. schools – is placing more emphasis on personal professional development and

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Industry Profile

are. We need to get these accurate messages out to the general Your name: Claire Bessant public and this is something iCatCare feels passionate about. Position: Chief executive What do you consider to be the major breakthroughs in treatment and control of feline disease? Charity: International Cat Care (iCatCare) In the early days of the Feline Advisory Bureau (as iCatCare was previously called) there was little information on cat health and disease. The charity funded Charles Povey to look at infectious disease in cats and he discovered the cat flu viruses and developed a vaccine for calicivirus. This was really a first in spending some Our role is to benefit: money to take cat health seriously. „„ Cat owners and cat professionals worldwide by collating, interpreting and disseminating the best possible evidence- What has still to be done in this respect? based knowledge on the understanding of domestic and pet Moving forward is not necessarily about great breakthroughs; it cats, and their physical and emotional well-being is also about taking what we already know and making it relevant, „„ The public, and cats, by providing evidence-based practical and implementing it. For example, ISFM’s ‘Cat Friendly information, protocols, procedures and practical training Clinic’ programme is not based on new or difficult principles, to enable sustainable and ethical solutions to be developed but taking what we know and making the veterinary approach to to manage unowned domestic cat populations worldwide, cats logical, sensible, empathetic and effective. For example, we while maintaining cat welfare and human health as the know that hypertension can be a serious problem in cats – taking highest priorities blood pressure is not complex compared to many other veterinary „„ Veterinary surgeons, nurses/technicians and the public who procedures and the equipment is not expensive, it just requires use their services, by providing evidence-based information patience, a little time and a positive approach to cats. Just and educational resources to enable better understanding of getting this right could improve cat health much more than a new – and improved veterinary healthcare for – domestic and pet procedure for treating a much less common (but perhaps more cats worldwide dramatic) problem.

How well do you feel that UK veterinary practices deal with What are the significant milestones in our understanding of feline patients? the needs of cats? Probably a great deal better than in many other countries – but I’m not sure there are obvious milestones – rather a continual with large individual variations. There is no doubt that most improvement in knowledge from research, which is picked up practices now know that they need to consider the cat ‘experience’ and integrated into practical advice from organisations such as in the waiting room and how to improve that, in the hospital (the iCatCare and our veterinary division, International Society of Feline size and design of the cages, for instance) and the fact that good Medicine (ISFM). However, I think we have reached the state where handling needs time and patience. this advice is taken on board more readily now in professional The ‘cat is out of the bag’ now and once the public are also aware circles and there is much interest in cat behaviour, both in the home there will be a strong demand for such cat-minded practices, which and in the other situations in which we keep them. will be appreciated greatly by cats and their owners and practice We now know that to treat cats in the veterinary arena you staff who will also see the difference and enjoy the changes. need to understand their behaviour and how the environment and stressful situations can impact on health and on veterinary What are the essential features of a ‘cat-friendly’ practice? measurements, diagnosis and treatments. In our homes things In the UK there are almost 200 Cat Friendly Clinics and we have changed for cats too – where people may only have kept now have them in 15 other countries – China, Japan, Spain, one cat with free access in and out, we now have more multi- Italy, Australia and New Zealand, Czech Republic, Denmark, cat homes and probably a greater density of pet cats outside in Germany, Greece, Portugal, Hong Kong, Norway UAE and Poland. many areas. Some cats are kept indoors all the time, and this too The American Association of Feline Practitioners license the can impact on their health and well-being. programme from ISFM and they have over 500. Understanding how cats function in situations where they are There are basic principles in the scheme about reducing stress in confined can also have a large impact on whether they are re- the different parts of the clinic, from the ‘cattitude’ of the staff and homed, how well they survive the process and how well we can how they handle the cats, to the waiting room, consultation room best match them with new owners. and the hospitalisation of cats. What we have done is provide the first ideas. As clinics take these on board, see how effective they Has this been reflected in the way we look after them? are and begin to think about cats in a whole different way, they People are fascinated by cat behaviour, especially that of their own will come up with more ideas and approaches and we hope we can cats; but there are many assumptions and myths about cats which learn from people out there in practice as well. are ingrained in our beliefs and it takes a long time to replace these. Recently, there have been some great BBC Horizon programmes Does veterinary treatment sometimes go too far? that used brilliant footage to get over some of the key messages Treating animals is a little different to treating people, because we want owners to take on board and hopefully rethink how they owners have the option of deciding when their cat “has had understand what their cats are doing and what their cats’ needs enough”. There are also limits to what people can afford – so we

64 VETERINARY PRACTICE TODAY WINTER 2014 PROFILE | INDUSTRY

are very much in support of insuring cats to prevent the situation science and, as always, the art of veterinary medicine is equally where money limits what treatment the owner might want their as important as the science. This is especially true for cats – they cat to receive. However complex or expensive treatments are are people’s secret pleasure. They are not a pet taken outside sometimes not in the best interests of the animal if the benefits for a walk to meet everyone, they are home-based and personal. to the cat are not obvious. The relationships between people and cats can vary considerably It is easy to give some cats tablets; for others it is a struggle – from feeding a feral in the garden to having an over-attached beyond the patience of both owner and cat. Some owners will do pedigree cat which is anxious if its owner is not around. anything to keep an animal alive and others will not wish to treat We are good at the science and the treatments, but are only just at all; so each case needs to be considered on an individual basis. catching up with the importance of the relationship issues and As improvements in veterinary care take leaps and bounds, vets how owners feel about the way their cats are approached and may be keen to try new treatments and there is nothing wrong handled in veterinary practice. Clinics which get this right will keep with that; however, they need to advise clients in a way that their cat clients forever and attract many more. Getting this right explains that – even though treatments are available – owners will bring far more benefits to all concerned than the advancement are not coerced into taking them and should not be made to feel of treatment for rare conditions. guilty that they have not gone to the limits of treatment. At other times, of course, vets may feel that owners are trying to Where does ISFM and iCatCare fit into the picture? keep their cats alive when from a professional perspective they feel We ‘think cat’ all day every day! We work with cat experts and the cat has had enough. It is all about quality of life and this must enthusiasts around the world. Our Journal of Feline Medicine and be the major consideration in all decisions. Surgery is unique in its combination of Clinical and Classic issues – understanding the need for both scientific research and discovery Similarly, do you have concerns about the direction that cat along with the practical implementation of the research and the breeding is heading? value of expert opinion produced in a way busy practitioners can International Cat Care has strong feelings about breeding cats keep up with their CPD. based on an ethos of ‘first do no harm’. Cats are beautiful Because, historically, the charity has worked with everyone creatures and we have been able to manipulate their coat colour, involved with cats – from vets through to owners – we length and pattern to give large variety – something that is part of understand the need to use good information across a variety human nature. But the human trait of pushing too far, of making of communication outlets, ‘translating’ it as necessary for the something too extreme, has occurred in some breeds. different groups of people to understand and gain benefit. If body conformation makes the cat’s life more difficult than We strive to understand the ‘whole’ cat – not just as a body that that most perfect design, the ‘moggie’, then we should be asking can go wrong, but taking into account its natural history and serious questions. behaviour, and how these affect how, why and when we treat it. Faces so flattened that breathing is difficult, eyes that continually We work with owners to help them understand behaviour and water, teeth that are so displaced that eating is difficult, are not health – our website icatcare.org provides vast quantities of acceptable. ‘Designs’ that bring with them pain or discomfort information and is accessed by millions of people. from cartilage problems or movement problems are completely at odds with the naturally lithe and athletic cat. Cats with coats that are too long or non-existent, require a great deal of human intervention and often humans are not up to the job. “The art of veterinary medicine is equally Many body conformation problems are the result of pushing to as important as the science. This is the extreme or taking a genetic mutation in one cat and making a new breed from it – and all of these can be avoided. There are also especially true for cats” issues with diseases which are inherited and can become common within a breed because of small gene pools – these were not Although it is only one species, it is a complex one which lives intended but have to be tackled for the individual cats. Keeping a with us closely yet is hardly domesticated. It is brilliant at hiding line or breed absolutely ‘pure’ is no excuse for not doing whatever illness and pain and requires time and patience in handling and is necessary to tackle the problem. Cats don’t care if their parents hence is a challenge in the veterinary setting. have complied exactly with a breed standard – they ‘care’ about Many cats in owners’ homes are stressed because of density of living with pain or discomfort or illness, and under the Animal population or a misunderstanding of what a cat is and what and Welfare Act that should have this freedom. how it behaves. Cats reproduce extremely efficiently and thus There are some good breeders and breed clubs with an ethos population control is a big issue in many places. The answer is not which avoids extremes and looks to the health and well-being going to rely on neutering every cat surgically but in a better solution of the cats they produce. These are to be congratulated and that lies beyond surgery, so we are working with the Alliance for encouraged. The public needs to understand that a certain look Contraception in Cats and Dogs to try and find that ‘bigger’ solution. may mean that cat well-being is compromised and make their Our veterinary division, ISFM, has national partners in many choices based on health. different countries who are taking the care of the cat seriously and developing CPD and advice for growing numbers of interested vets. How well does the present education of vets and vet nurses Through them, we need to ensure that people understand what match the needs of cats and their owners? a cat is, that suitable veterinary treatment is available for these As is most often the case, education is the key to the well-being of creatures that are becoming part of the family all over the world, cats. Teaching veterinary students and nurses is vital to give them and that we can find a humane solution for population control to the right approach as they go out into practice. Some teaching ensure that the suffering of many unowned cats is reduced. hospitals and courses are good, others have not yet taken on As a charity we would so appreciate the support of the profession board the cat friendly principles and there is certainly room for when they consider worthy charities for their fundraising activities improvement in many cases. – there is much to do and we try to give back a great deal. I think Pet keeping is a complex and emotional thing. It is more than a we will be in work for some time!

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Central College of Animal Studies specialises in education and training for the veterinary profession. With a clear focus on both practical skills and academic knowledge our courses are designed to provide the skills necessary to succeed in practice. We provide hands-on experience in a professional environment using experienced clinical tutors, mentors, educators, behaviourists and practice managers. With our new teaching hospital opening in 2015, there are a number of exciting opportunities for veterinary surgeons and nurses to practise in brand new facilities, as well as tutoring and mentoring the next generation of veterinary professionals.

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We will be recruiting for other specialisms in the near future and welcome CVs from all applicants. We are able to provide flexible working and accommodate a range of full, part-time and shared working arrangements. We provide an attractive remuneration package reflective of experience.

For further information, or to apply, please write to: Personnel Department, Central College of Animal Studies, Elmtree Business Park, Elmswell, Suffolk, IP30 9HR Alternatively email: [email protected] www.ccoas.org.uk

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Talk to us about developing the skills to succeed in your professional career NURSING CPD Central College of Animal Studies, Elmswell, Suffolk, IP30 9HR Tel 01359 243405 Email [email protected] www.ccoas.org.uk 68 VETERINARY PRACTICE TODAY WINTER 2014