Postgraduate Development in Practice Do You Know Where You Are Going?

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ONLINE EDITION VOLUME SEVEN I ISSUE FIVE I SEPTEMBER/OCTOBER 2019

Postgraduate development in practice Do you know where you are going?

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To ﬁnd out more about Workﬂow Manager tel: 01359 243 400 or email: [email protected] www.vetsystems.com Publisher Published six times a year by Vision Media, UP FRONT... a department of Central Veterinary Services Ltd. Elmtree Business Park Elmswell We live in uncertain times. Change, both in the world around us and within our profession, Bury St Edmunds is constant and exponential. Suffolk IP30 9HR

At the time of writing, Brexit still looms on the horizon without any certainty as to how it Tel: 01359 245310 will be achieved or the effect that decisions made by our politicians will have on us. The Fax: 01359 245253 country’s morale is suffering and this can so easily lead to dissatisfaction, destructive [email protected] behaviour and a disconnect between the population and those who represent them. www.veterinarypracticetoday.com Editorial Uncertainty and dissatisfaction are great bedfellows and sound breeding grounds Editors for the creation of demotivated and disillusioned employees in any kind of business, Maggie Shilcock including veterinary practice. In her excellent article on team morale and engagement, [email protected] Deborah Croyle emphasises the need to ensure that the culture of the practice matches Tel: 01359 245310 the climate. She suggests that rather than focusing on what motivates already engaged David Watson employees, concentrate on what causes employees to become disengaged and [email protected] demoralised and make the changes needed. Claire Newton-Ransom [email protected] This idea is mirrored on our Comment article, which looks at ways in which we can help and support the new graduate; keeping them feeling confident and motivated in Associate editor an environment that is inevitably stressful, but, with the correct help and guidance, can Sarah Kidby be manageable, exciting and fulfilling. The author, Paul Manning, talks about change [email protected] within the profession and asks if we are keeping up, and whether we know in which Tel: 01359 245310 direction we are heading. With change comes choices and decisions, consequences and some uncertainties. Change has brought new lifestyle choices and challenges to Design achieving aspirations for the new graduate, and our profession has to change to meet Graphic designers these new needs. Bradley Young Melody-Anne Neville Gemma West Kaz Strycharczyk is certainly not a new graduate who is disappointed or disillusioned [email protected] about moving into the world of veterinary work after graduating. His article on working in farm practice – both as a student and as a new graduate – makes Production thoughtful reading and he gives some excellent suggestions on how to prepare for Publications manager and ‘survive’ those first months in practice. It is a delight to hear from a young vet Clara Ashcroft who is enjoying their first years in practice. Kaz graduated just two years ago and it [email protected] is heartening to read in his article that he feels that he is now a competent veterinary Tel: 01359 245310 surgeon able to deal with routine and emergency complaints, although adding that he has no doubt that he still has plenty to learn and is far from ‘the finished product’ – if, Advertising [email protected] as he says – that exists. Tel: 01359 245310

Paul Manning says in his Comment article that change, both in the world around us Subscriptions and within our profession, is constant and exponential. By the time you read the next [email protected] issue of Veterinary Practice Today, our Brexit fate is likely to have been sealed, but Tel: 01359 245310 there again, in this uncertain world – perhaps not. ©2019 Vision Media Maggie Shilcock All rights reserved. Reproduction, in part or in full, is strictly Editor prohibited without the prior consent of the publisher. Veterinary Practice Today is a trade mark of Vision Media. All other trade marks are acknowledged. The content of this magazine is based on the best knowledge and information available at the time of publication. Every effort has been made to ensure that all advertisements and editorial are correct at the time of going to press. The views expressed by the authors are not necessarily those of the publisher, proprietor, or others associated with its production. © Images used under licence from Shutterstock, Inc., iStock.com and freepik.com.

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WWW.VETCOMMUNITY.COM | ONLINE EDITION @VPTODAY | WWW.VETERINARYPRACTICETODAY.COM 3 Contents Comment 20 Equine COVER STORY 33 Problems arising from inappropriate ownership and husbandry 6 Postgraduate development in practice Jane King Paul Manning The welfare problems arising from Do we have sustainable systems inappropriate horse ownership for the retention of vets in general and husbandry can be categorised practice? If PDP and, perhaps, routes according to three themes – to certificates were to be made 20 Anthropomorphism – a barrier to management, riding/training or compulsory in some form, this could client compliance? health care. Veterinary surgeons are encourage graduates to seek out Claire Newton-Ransom well placed to advise on all of these practices dedicated to the cause of If the tendency to anthropomorphize areas and it is our professional duty developing the next generation. is innate, we must recognise the to do so. opportunity to utilise this to our

advantage when attempting to inform COVER STORY our clients of the differences between 37 Equine polysaccharide 6 positive steps in animal welfare, and storage myopathy misguided attempts to increase their Sara Fleck pet’s happiness. PSSM is progressive, and early detection and institution of therapy 24 The role of the veterinary nurse in are vital. Diagnosis relies primarily ending the pet obesity crisis on recognition of characteristic Victoria Bowes clinical signs, especially in high-risk Pet obesity is a serious issue that is breeds, diagnostic work-up to rule seen globally and can result in lifelong out other causes of the signs observed issues and the exacerbation of current and interpretation of muscle biopsy clinical problems and there is evidence findings and genetic test results. of a significant parallel between owner and pet obesity 40 Insight: Save our Suffolks Small animal When we think of endangered species, 28 The dropped tablet – drugs acting we usually conjure up mental images on the central nervous system of the Amur leopard, the Sumatran COVER STORY Jane Ellison tiger or orang-utans. We may not 10 Bite wounds Most owners who take medication even consider the genuine threat to Kate Parkinson keep their tablets securely fastened a creature closer to home. However, Bite wounds are common injuries in and well away from the reach of their experts predict that we have less than first opinion and referral practices, inquisitive and determined pets. 10 years to save the Suffolk Punch, Most bite wounds are laceration However, accidents happen, and if the and that the breed could become or puncture wounds with crushing medicine box or handbag is raided, or extinct by 2027. components. Many patients have the tablet is dropped on the floor, the multiple wounds and are often rushed consequences of the animal ingesting in as emergencies in a state of shock. drugs that act on central nervous system must be considered. 33 14 Chronic pain in dogs and cats – part 3. Further complementary methods 31 Insight: The anti-vax threat: the time of management to act is now Joanna Potter The BVA recently reported that 98 This third article in the series covers per cent of veterinary surgeons had acupuncture and chiropractic experienced clients questioning the therapies, myofascial release, reiki, need for pet vaccination programmes, and the use of curcuminoids and while the World Veterinary Association cannabidiol in veterinary medicine (WVA) chose the ‘value of vaccination’ and will aim to determine where – and as the theme of this year’s World if – there is evidence for practitioners Veterinary Day – are we doing enough to consider the use of these methods. to counter this trend?

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™ 68 Keeping your team engaged at work Exotics and wildlife Deborah Croyle 41 Most managers focus on ™what they believe motivates a person, but, rather 53 A guide to common diseases than focusing on what might motivate affecting the reproductive tract an already engaged employee, think of rabbits and rodents about what causes these ™employees to Siuna Ann Reid become disengaged. With the increasing trend for rabbits and rodents to be kept as 71 How can LinkedIn benefit™ your practice? pets, the concomitant provision Clara Ashcroft of better health care for these When thinking about connecting with species – including more regular pet owners online, LinkedIn might not visits to the veterinary practice – is be the first social network that comes to putting veterinary professionals mind. But pet owners are professionals under more pressure to be able to too and there’s a good chance that Large animal provide up-to-date, cutting edge many of your clients will also be using advice and treatment. the website. COVER STORY COVER STORY 75 Lonely at the top 41 Practical approach to sudden 59 Tracking birds for research It can be daunting to take on a line death in cattle and conservation management position to those who Lee-Anne Oliver Mike Toms know ‘more’ than you do. But don’t lose Sudden or unexpected death of cattle Many birds undertake remarkable perspective – your role is unique and can be a challenging investigation journeys – moving between habitats essential to the practice. for the large animal veterinary and sites, crossing continents or surgeon. Many cases will involve an even vast expanses of ocean. Such 77 Insight: Letting go insurance claim, so accurate record journeys can make understanding A recent article in a veterinary journal keeping is imperative. their ecology a challenge for looked at the dilemma pet owners researchers and those involved in face when having to make the choice 47 Student experiences and choosing species conservation. farm animal practice to continue or stop treatment for their pet. It’s hard to know when to let go Kaz Strycharczyk 64 Insight: It’s all there ready to and clients need all the support the The most significant difference be discovered practice can give them. between farm and companion Our focus for new compounds animal practice must surely be the for the treatment of bacterial seasonality of workload. This article infections should be more outward shares a new vet’s experience of looking. Mother Nature may well venturing into farm work. already have the answers – our 77 challenge is to discover them, 50 Insight: Farm animal welfare – a without causing irreparable Catch-22 damage to the plants and animals Speaking at the BVA Animal Welfare from which they are sourced. Forum on 5 June, Professor Jim Reynolds from Western University of Health Sciences, California, warned Management the UK not to dilute its high animal welfare standards in order to secure trade deals with the US. 65 Reception sets the tone for client experience 51 Special insight: Livestock farmers Penelope Fox are an essential part of the solution As a client’s first interaction Industry The serious and economically with a practice will likely be at damaging issues of Brexit reflect reception, it’s vital that we don’t a bigger and wider debate on underestimate the importance of 80 Profile sustainability of livestock production training our front-of-house teams Sue Molloy BHSII Yard Manager as a whole, in the face of global to levels that match our high for the Retraining of Racehorses climate change. standards of clinical expertise. (RoR) Organisation.

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Postgraduate development in practice

The exponential growth in information about all the different Paul Manning species and disciplines in the field of veterinary medicine – taken MA VetMB MSc (VetGP) DProf MRCVS together with the all-pervading influence of ‘Dr Google’ – has had a major impact on the abilities and confidence of individual vets to Paul qualified from the University of Cambridge feel comfortable dealing with such a wide range of clinical topics. in 1979. He is a general practitioner with a wide variety of interests, both clinical and non-clinical. He At the same time, there is often a conflict between the available is a past member of SPVS Council, was a founder veterinary services and what animal owners are willing to pay participant of the RCVS CertAVP and is a director for them. This ‘tension’ does sometimes bring discomfort of the Vet Learning Organisation CIC, www. and uncertainty, together with anxiety for the vet dealing with vetlearning.org individual cases There is a very wide spectrum of differences between client expectations too – which leads to some practices Paul has specialised for 35 years in canine cruciate offering more ‘affordable’ levels of service and some providing a surgery using an original graft technique and much more costly and involved approach. has built a strong evidence base from practice experience to support his work. There has been a shrinking of the difference between the average lifetime earnings of graduates compared with non- graduates or apprentices. There are non-university routes into work – for example, in accountancy, engineering, Change has been happening all around us – and inside construction and veterinary nursing – through which there are our profession – at a pace that has been particularly some advantages in gaining real practical skills. Whereas the rapid during the past five years. Are we keeping up? university-trained veterinary surgeon has some Day 1 skills on Where is the sense of direction? Do you know where graduation, but she or he has a steep learning curve to acquire many more of the numerous and varied skills needed to work as you are going? a primary care vet.

With change comes choices and decisions, consequences and The RCVS Professional Development Phase (PDP) has helped some uncertainties. Modern times have brought lifestyle choices to give some structure to the first postgraduate year, but the and challenges to achieving aspirations, that have evolved over experience of vet graduates and their aspirations varies a great the years. The traditional concept of longevity in a particular job deal. So at the point of choosing what to do at one or two years has changed – with many people switching careers several times after qualification – for some maybe earlier – what thinking during their working lives. processes are there about the options?

It seems to me that PDP is not reinforced enough by the RCVS or appreciated by graduates who need the Year 1 skills to be achieving competence in their chosen field of work – be it small animal, farm or equine practice. Perhaps the opportunity to complete the PDP in a primary care practice could be termed an ‘internship’ or at least given the same importance?

Postgraduate options ‘Externships’ are, in reality, opportunities for graduates to work in some places as observers, doing what might be described as ‘work- experience’ without pay. These may be attractive to some graduates who want to gain experience in particular fields of work that they have hitherto not seen; or to which they feel they need more exposure in order to pursue their interest in the chosen discipline.

Internships are invariably regarded as low-paid jobs in which the graduate has an opportunity to see and experience more of the clinical areas in a specialist setting. This experience may help the candidate in applying for a residency at a later date if they choose this particular option. Technically, there should be a qualification associated with the term ‘internship’, but it is rare in the veterinary field.

There are one-year courses for postgraduate veterinary surgeons, that are effectively ‘studentships’ – where the participant pays standard university tuition fees of around £9,000 for the INTERNSHIP year, extends their student training and can gain a Diploma qualification at the end of the year.

organisations that have learned the hard way to appreciate that the skills of an experienced craftsman cannot be replaced by a three-week short training course.

There are many ways in which the links between training and its implementation can be evaluated.

Young vets’ perspectives There seems to be a misunderstanding about the need and timescale to progress from graduation through to Year 1 skills after the PDP is completed, and then onwards towards Advanced Practitioner status or perhaps specialisation.

Reasons given by some vets for believing in the ‘specialist Owning and managing a veterinary practice used to be something route’ include ‘it provides opportunity to see more gold of a traditional pathway for vets following graduation, and it still standard veterinary medicine, exposure to working with is within the scope of many today. However, aspirations have specialists is helpful to improve awareness of what is changed, the nature of practice challenges has altered and the possible, residencies are stimulating because they include skill set base requirement has broadened and deepened, making different learning styles which help rather than focusing much greater demands in areas – such as business management – on perhaps a more limited set of learning styles in the previously not considered a priority. certificate route.'

The practice CEO is a new – mostly non-veterinary – breed, There are plenty of different learning styles that a candidate who may have an MBA and experience in running larger can include in the CertAVP, it is just that achieving it involves organisations or groups of practices. Practising vets can acquire taking responsibility for personal clinical case demonstration these management and leadership skills through many different of how it improved the candidate’s professional practice. A real CPD routes – including the RCVS C modules and those of other example from my own practice involved a graduate working providers – or find internships offering training. towards the A module in the CertAVP who went on a CPD course in surgery and came back able to put new skills into Work-study programmes in primary care practice practice by performing a colopexy on a pedigree kitten with a There is now a wide variety of business models in practice, prolapsing colorectum. ranging from the independent to the joint venture partnerships and large corporate employers. Vets in any of these practices Special interest groups within our own professional can embrace a learning and development programme, through organisations serve an important purpose too; but it seems to to Masters and Doctorate level, if academic qualifications are take many graduates a long time to realise the value they can attractive to them, in a route towards improving problem- obtain from joining these groups from the practice base. solving skills for clinical and non-clinical issues. There has been much debate about whether or not there should Work-study in primary care practice can be hard work and be a postgraduation pre-registration year. After about 10 years challenging for various reasons, including the fact that the of thinking about this in a negative way, my opinion now is that graduate is learning on the job whilst being paid a salary to there is a stronger case to be made for putting this in place, to make actual clinical decisions and living by them – ideally with bring us in line with other professions. support from senior colleagues. However, at the same time, real practical skills are being reinforced physically, such that Outcomes-based approach dexterity of hand and mind are developed simultaneously. Evaluating the outcomes from the learning acquired through practical work in a forward-thinking primary care practice is a By acquiring these unique skill sets, the graduate can not only keystone for client and patient care. There is a growing demand grow their career opportunities on an academic basis, but also for experienced practitioners and the skills they can have now work towards acquiring the RCVS CertAVP, which is a acquired and developed, but an internship on its own does not Masters level qualification with transferable academic credit, equip the vet for a senior role. recognised by the inclusion of these post-nominals in the RCVS Register of Veterinary Surgeons. Evaluating the outcomes from an internship includes the acquisition of measurable awareness of clinical work in most Transition to an advanced practitioner usually a referral environment, but the practical skill acquisition In order to become a competent, proficient and rounded may not be so evident compared to a primary care vet actually practitioner, it is necessary to put into practice the theory building their own portfolio, rather than just an awareness of learned through the undergraduate course, and actually practise other people’s skills and competencies. the real skills required over some years in the interesting, varied, challenging and fulfilling role of practitioner. “The university-trained veterinary surgeon There is a special joy in becoming a highly skilled craftsman, a surgeon, a nurse practitioner, a teacher or a primary care has some Day 1 skills on graduation, but practitioner. Yet there has been a tendency in society to she or he has a steep learning curve to undervalue the learning journey of the general practitioner in the widest sense of its meaning, and there are many examples of acquire many more”

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To acquire the RCVS CertAVP does involve the actual personal “We need a system that deals responsibility of the veterinary surgeon for their own cases, doing their own work-ups and operations, for which they are accountable. with these challenges in practice; Recognition and reward but this system must recognise and Recognition is one part of a system of encouraging team harness the wealth of expertise that members to develop and contribute; another is the way those team players are rewarded by the system. So, for example, there already exists” are often grades within a job description along the lines of ‘new’ to team A, ‘more effective’ member of team A; through to ‘line manager’ for team A. Concluding thoughts The universities have said for many decades that they are Differences exist in contribution to a practice or to there to provide an education that enables graduates to learn; understanding a complex problem between generalists and but they do not aim to deliver competencies. Employers are ‘specialists’. The modern-day veterinary healthcare professional often disappointed that they cannot find graduates with the faces a multitude of diverse challenges, not least being the competencies they need, and frustrated that they are expected to difficulty of being an expert generalist when everybody else is deliver training in those competencies themselves. Professional ‘purely an expert’. development left to chance results in casualties in both graduates and practices, often with serious consequences. The next generation of experienced vets has a large number of choices to make that may be different from those the existing Graduates and practices vary enormously in their abilities to do senior vets made in their life times – and for different reasons. the job, learn proactively and skilfully coach and support. Some However, the old values of commitment, skill development over graduates cope well with minimal support, while others collapse time enabling the ability to take responsibility, and leadership and leave the profession – for example, even when having the skills are, in principle, not so much changed. It seems more support of five experienced team members. likely that a graduate gaining a broad base of experience is likely to have a longer and more sustainable career in the profession, The profession is beginning to look at the resistance to change and this would be an interesting area to survey. from ‘have attended a CPD course’ to ‘demonstrated actual learning outcomes of benefit in the workplace.’ There has been Comparison between VetGP and medical GP a resistance to this change from what graduates want and what One of the considerations for career development in the human they need to thrive – which are not necessarily the same thing. medical sector is the length of time and number of hours worked to achieve consultancy or senior level work in either It is time to establish better ground rules to support and encourage primary care or a clinical speciality – both requiring a great deal graduate development. Within this remit is the need for recognition of skill development. In the field of human general practice, and respect of skilled, experienced GP vets who are well qualified doctors have to complete their undergraduate studies, then in the real world of the workplace, but are often forgotten in the two years involving four, six-month rotations in hospitals, and pursuit of advice from recognised clinical specialists. The colleges then a further three-year period in a general practice before need to do more to support the experienced GP vets. they can become a Member of the Royal College of General Practitioners (MRCGP). Only at that point in time are they If PDP and, perhaps, routes to certificates were to be made eligible to become a partner in a practice or take a more senior compulsory in some form, this could encourage graduates to role if partnership is not what they are seeking. seek out practices dedicated to the cause of developing the next generation. Whilst there are unlikely to be sufficient numbers of Care is needed to address the complex issues in these ‘learning practices to support all the graduates in such a formal capacity journeys’ to avoid crises of confidence in physicians and clients at the outset, this could be started through a small group of or patients. The RCVS has embraced this in the advanced practices with a new RCVS Practice Standards Award in ‘training practitioner programme and associated qualifications. and coaching’, with a set of criteria to be met. A reward for the collaboration of the practice and the graduate could be a Is it about ‘you’ or the ‘organisation’ or the ‘service’? recognition and celebration by RCVS of that achievement and The exposure to a wide field is a useful starting in the outcome in a more powerful way than is currently seen and done. undergraduate years, but to become a master craftsman in the art and science of veterinary practice takes many years. Change, both in the world around us and within our profession, is A good example is the development of surgical skills, which constant and exponential. The shortage of vets and an increasing often require painstaking attention to detail and repetition to rate of attrition in practice, exacerbated by other complex become highly proficient and consistently successful. political, economic and societal issues, are inescapable facts.

Organisation and administration are often hidden from We need a system that deals with these challenges in practice; the view of those who are unconsciously unaware of what but this system must recognise and harness the wealth of is being done to provide a workplace in which they can expertise that already exists ‘at the coal face’ and direct experience the joy and excitement of practising medicine and graduates to the places where it is carried out – and shared – to surgery. Mutual appreciation and commitment from both the highest standards. Only by adopting such a plan will we the employed vet and colleagues sharing the system in the succeed in our aims of assuring the future for the profession. practice is crucial for skill maintenance and development in our profession.

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Bite wounds Bite wounds are common injuries in first opinion and referral practices. One-third of all traumatic emergencies presented to the Royal Veterinary College involved penetrating injuries and half of those were bite wounds (Halfacree, 2017).

Most bite wounds are Minimal surface damage may laceration or puncture hide severe traumatic wounds wounds with crushing (Grambow Campbell, 2013), Kate Parkinson components, and many and apparently stable patients BVSc MRCVS patients have multiple wounds may re-present with sepsis (Griffin, 2001). Perforating or systemic inflammatory Kate graduated from the wounds may be associated response syndrome (SIRS) University of Bristol in with extensive tissue days later (Grambow 2006. Since graduating, disruption and/or visceral Campbell, 2013). This is she has travelled to over damage (Risselada, 2017). called the iceberg effect. thirty countries and worked Photographs taken at the time as a veterinary surgeon in Bite wounds are more common of injury may aid subsequent Australia, New Zealand and in dogs than cats. Cats are wound assessment and may the United Kingdom. She less likely to engage in physical be required for any subsequent currently lives in East Anglia confrontation and are quicker legal action by the client and works as a freelance small to escape, though, if caught, (Grambow Campbell, 2013). animal locum for her company, they are more likely to be Assessment may be aided by Bite wounds may appear as Lend a Paw Locums. seriously injured. Dog-on-cat a trauma triage scale such as relatively small punctures. encounters often cause more the Penn State Animal Trauma damage than cat-on-cat and Triage Scale. Wounds should dog-on-dog fights (Halfacree, be covered by sterile dressings 2017), while the prognosis for following assessment. cats with thoracic trauma is particularly grave. Laboratory testing such as a CBC, chemistry panel and, Assessment and triage ideally, urinalysis should Animal bite patients are often be obtained at this time to rushed in as emergencies and monitor patient progress are often in a state of shock. (Grambow Campbell, 2013). Stabilise the airway and give oxygen if required. Assess Analgesia circulation and administer Bite wounds can be extremely fluids before giving pain painful. This pain may not relief and, if appropriate, always be appreciated by antibiotics. Remember that examining the outside of the impressive injuries may not be wound. A pure opioid agonist Bruising and other damage may immediately life-threatening. should be used. Response be revealed by clipping. should be closely monitored, Initial assessment and further pain relief used Shaving is often required as appropriate. to reveal the full extent of wounds. There may be Non-steroidal anti- significant crushing injuries inflammatories reduce that are not immediately swelling and discomfort, and apparent. This is often may be used once patients are indicated by bruises which may clinically stable. However, in 0.75 appear well after the trauma. patients with hypoperfusion, hours* “Minimal surface damage may hide severe traumatic wounds, and apparently *Suggested Personal & Professional Development (PPD) stable patients may re-present with sepsis or systemic inflammatory response Bite wounds may look impressive but remain relatively superficial. BITE WOUNDS syndrome days later”

“The main cause of post-operative mortality in trauma patients with animal bite wounds is sepsis, SIRS, and subsequent multiple organ failure”

explore the wound before with animal bite wound giving empirical antibiotics. cases (Abrahamian, 2011). A sample may be taken but submitted only if there are Surgery clinical concerns. However, Bite wound patients with plating delay may decrease penetrating thoracic, head, likelihood of a representative neck or abdominal wounds Equipment for wound flushing. A pressure cuff in use. culture (Halfacree, 2017). should be imaged once stable. Radiography or there is an increased risk of The main cause of post- Post-operative antibiotics ultrasonography may help adverse effects such as renal operative mortality in trauma may not be required for veterinary surgeons decide injury (Halfacree, 2017). patients with animal bite immunocompetent patients whether surgical exploration is wounds is sepsis, SIRS, and with fresh, shallow, non- indicated, but imaging will not Antibiotics subsequent multiple organ crushed and uninfected always indicate if penetrating Bite wounds are often heavily failure. Antibiotics should not wounds where only healthy injury has occurred. Even if contaminated. Infections are be withheld in severe cases. tissue remains after there are no radiographic signs often polymicrobial with a debridement and lavage such as free abdominal gas or broad mixture of anaerobic Wounds should be sampled (Grambow Campbell, 2013). pneumothorax, it is easy to and aerobic bacteria. This for culture and sensitivity miss a deep penetration. often reflects the oral flora of prior to antibiotic treatment. In addition, bite wounds the biting animal, the victim’s A sample of deep tissue may involving the limbs may lead It is recommended to own skin or the environment yield more representative to fractures, which may be anaesthetise or sedate the at the time of injury results than a skin swab stabilised initially and treated patient – once stable – in order (Abrahamian, 2011). (Grambow Campbell, 2013). as appropriate. Joint taps are to thoroughly explore the recommended in bite wounds wounds (Halfacree, 2017). Bacterial strains involved in Empirical treatment with a involving the joints, owing to dog bites include the aerobes broad-spectrum antibiotic the high risk of joint infection. In cases of thoracic bite Pasteurella, Streptococcus such as potentiated wounds, the severity of and Staphylococcus; and amoxicillin-clavulanate may Viruses abnormalities seen on anaerobes Fusobacterium and be instituted as appropriate Cats bitten by other cats imaging correlates directly Bacteroides (Abrahamian, – pending results. Higher should ideally be tested for with the decision to perform 2011), as well as a host tier antibiotics, such as FIV and FeLV 60 days plus exploratory thoracotomy of less frequently found fluoroquinolones, should after the bite (Grambow (Halfacree, 2017). A visible organisms. Cat bite wounds only be used if culture and Campbell, 2013). In penetrating injury, more are also polymicrobial, with sensitivity results indicate. foreign countries, the risk than three bite wounds, or a high risk of infection with of transmission of viruses several bite wounds close Pasteurella species being the If owner finances are limited, such as rabies must be together increases the risk of a most common. it is vital to lavage and considered while dealing thoracotomy being required.

Owing to this risk of polymicrobial infection, antibiotics are often administered at the time of injury. However, it is possible for bite wounds to yield no growth on bacterial culture, with between half (Ateca, 2014) one-third (Griffin, 2001) and 16 per cent (Meyers, 2008) of cultured wounds yielding negative cultures, depending on the study. However, it is important to remember that in vitro results Delayed closure may not always The same wound may not always reflect the be possible. following clipping. The wound post-closure. behaviour of wounds in vivo.

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Penrose drain may be more effective (Halfacree, 2017).

Factors influencing outcome deep muscle injury: increased mortality is seen in patients with deep muscle injury when compared to patients with superficial bite wounds involving skin only. If deep muscle structures are involved, mortality increases to approximately 20 per cent. Hasty surgical closure may lead The same wound one This wound healed well by However, if wounds extend to wound breakdown. week later. secondary intention. to the thoracic cavity, no increase in mortality is seen Although hospitalisation time bag and cuff pressurised It is important to ensure (Halfacree, 2017) may be longer in patients to 300mm Hg (Gall, 2010). that patients requiring prolonged anaesthesia time requiring a thoracotomy, Alternatively, a 25ml syringe sedation or anaesthesia for (Ateca, 2014) mortality has not been found and 21g (green) needle repeated dressing changes presence of SIRS: there to increase (Cabon, 2015). attached to a three-way-tap receive adequate nutrition is a 24 per cent increase and giving set may be used between fasted periods to in mortality rate in dogs Timing (Halfacree, 2017). provide adequate proteins developing SIRS (Ateca, Patients should be stabilised and albumin for healing 2014) prior to anaesthesia. However, Non-viable tissue should (Halfacree, 2017). multiple organ dysfunction: some injuries must be be removed. Bruised tissue in a referral situation, a addressed immediately – for of uncertain viability may Drainage nine per cent mortality example, a protruding lung be retained in situ and If any significant questionable rate was seen in dogs with lobe or sucking chest wound reassessed in 36-48 hours tissue remains following dysfunction of one organ that cannot be managed with if the circumstances permit. debridement, surgical closure system, and a 67 per cent a dressing. Any septic focus may lead should ideally be delayed post- mortality rate was seen in to wound infection and dressing. However, this may not patients with dysfunction Increased time to anaesthesia increase the risk of sepsis, so always be possible owing to of more than four organs has been associated with if the tissue is not essential, surgical or financial limitations. (Ateca, 2014) a longer recovery (Ateca, it is appropriate to debride increased trauma score is 2014), and surgical patients more tissue than less. Staged Tissue fluid may accumulate associated with decreased should be ideally addressed evaluation should be carried beneath the wound and outcomes. Every point within four to six hours of out every 24-48hrs with may lead to infection if left. increase on an animal presentation; also known as debridement as required Surgical drains may be used trauma triage scale the so-called ‘golden hour’. (Halfacree, 2017). to reduce fluid build-up corresponds approximately However, a 12- to 24-hour (Halfacree, 2017). to two times decrease in delay in surgery may allow Wet-to-dry dressings are the likelihood of survival patient stabilisation and for important debridement Penrose or active suction (Rockar, 1994). tissues to declare as viable tools. These are open weave drains may be used in wound or non-viable when fresh sterile gauze swabs soaked in care. There are advantages Conclusion wounds are concerned in saline before being wrung out and disadvantages to each. It is vital to stabilise the stable patients (Grambow and applied directly to the Active suction drains are patient, if possible, before Campbell, 2013). wound bed. The swab dries a closed system, with less attempting surgical repair. onto tissue and is removed risk of ascending infection Opioid analgesic is effective Debridement without being soaked away. than passive systems such and safe in trauma patients, Antibiotics do not replace Non-viable tissue is removed as Penrose drains. However, while non-steroidal anti- thorough debridement and attached to the swab; leaving active drains can block inflammatories may be used lavage. Once anaesthetised a viable bleeding surface. Dry and may lose suction. in patients with optimal or sedated, thorough wound swabs may be applied directly If the wound is already hydration to reduce swelling lavage should be performed onto exudative wounds. This contaminated and drainage and inflammation. Wounds using sterile sodium lactate dressing should be covered from the site is optimal, a should be sampled if possible, or 0.9 per cent sodium with more dry swabs and a passive system such as a and empirical treatment with chloride under pressure. The bandage, and re-evaluated in flushing pressure required 24 hours. This debridement to dislodge bacteria exceeds – while undoubtedly effective “If owner finances are limited, it is vital seven pounds per square inch, – can be painful and requires to lavage and explore the wound before which is effectively achieved daily sedation or general using a one litre plastic anaesthesia (Halfacree, 2017). giving empirical antibiotics”

a broad-spectrum antibiotic instituted pending culture and References sensitivity results. PPD Questions Abrahamian, FM and Goldstein, EJC (2011). Microbiology of Diagnostic imaging is helpful 1. An acute animal bite case is rushed in. What is the Animal Bite Wound Infections. Clin in decision-making, but first thing you should do? doesn’t always give you good Microbiol Rev, 24(2) 231-246. information; so wounds ideally A. give pain relief should be explored within four B. clip and lavage wounds Ateca, LB (2014). Organ to six hours of presentation. C. check and stabilise airway dysfunction and mortality risk Lavage with a pressure exceeding D. administer IV fluids. factors in severe canine bite wound seven psi is recommended to trauma. J Vet Emerg Crit Care 24(6) 705-14. dislodge bacteria. 2. What percentage mortality is seen in animal bite cases with dysfunction of more than four organs in a Cabon, Q et al (2015). Thoracic Should wounds prove fatal, referral situation? post-mortem by a certified bite trauma in cats and dogs: a pathologist is recommended A. 67 per cent retrospective study of 65 cases, in case the client proceeds B. 25 per cent Vet Comp Orthop Traumatol 28(6) with legal action against the C. 9 per cent 448-54. attacker’s owner. D. 80 per cent. Gall, TT and Monnett, E (2010). Evaluation of fluid pressures Acknowledgement 3. Which kind of dressings should be used to debride a of common wound-flushing The author would like to thank patient with very moist, exudative bite wounds? Ardmore Veterinary Group, Mr techniques. Am J Vet Res 71(11) and Mrs Kibble, Mrs Ferguson A. wet to dry 1384-6. and Niamh Lingley MVB B. dry to wet. BSAVA PGCertSAM MRCVS Grambow Campbell, B (2013). Bite Wounds, Clinician’s Brief [online]. for their assistance and 4. Bacterial strains cultured from dog and cat bite https://www.cliniciansbrief.com/ photography, as well as Tom wounds include: Southgate BVetMed MRCVS article/bite-wounds for reviewing the article. A. Staphylococcus B. Streptococcus Griffin, GM and Holt, DE (2001). C. Pasteurella Dog bite wounds: bacteriology and D. Bacteroides treatment outcome in 37 cases. J E. all of them. Am Anim Hosp Assoc 37(5) 453-60.

Halfacree, Z and Barfield, D (2017). 5. An increase of one point in the animal trauma triage RVC Clinical Podcast 35: Bite scoring system leads to approximately how many Wounds [online]. https://www. times decrease in survival? rvc.ac.uk/small-animal-referrals/ A. one news-events/clinical-podcasts/bite- B. two wounds-35 C. ten D. five. Meyers, B et al (2008). The

bacterial and antimicrobial

B 5. E 4. B 3. A 2. C

1. susceptibility of infected and

Answers non-infected dog bite wounds: fifty cases. Vet Microbiol 127(3-4) 360-8.

Risselada, M (2017). Perforating cervical, thoracic, and abdominal wounds. Vet Clin North Am Small Anim Pract, 47(6) 1135-1148.

Rockar, RA et al (1994). Development of a scoring system for the veterinary trauma patient. Journal of veterinary emergency and critical care, 4(2)77-83.

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Chronic pain in dogs and cats – further complementary methods of management This third article in a series covers acupuncture and chiropractic therapies, myofascial Joanna Potter release, reiki, and the use of curcuminoids and cannabidiol in veterinary medicine and BS BVMS BMus MANZCVS MRCVS Dip ECVAA will aim to determine where – and if – there is evidence for practitioners to consider the use of these methods. Joei graduated from Murdoch University in 2005 and spent One of the biggest challenges the evidence is less conclusive, as well as vague inclusion some time in mixed and small facing veterinary professionals primarily owing to a lack of criteria (dogs with ‘painful or animal practice in Western interested in providing robust clinical trials. The last restricted movement’). Australia, before moving to complementary therapies to review of the then-available Bristol to complete a residency in their patients is the lack of data was performed in Another study investigating anaesthesia. She qualified as a evidence available to support 2006, and concluded that pain and quality of life by Silva specialist in 2016 and has moved their use. What is lacking acupuncture could neither be and colleagues (2017) used to University College, Dublin, are large-scale randomised, recommended nor rejected the Helsinki Chronic Pain where she is now able to expand controlled clinical trials, based on the evidence available Index (HCPI), the health- one of her main interest areas while noting that a true (Habacher et al, 2006). related quality of life scale which is pain management in control group is often not for dogs, and visual analogue veterinary practice. possible for both financial More recently, a paper scores in order to monitor and ethical reasons (Rose et by Rose and colleagues response to treatments. They al, 2017). However, despite (2017), stated that they determined that acupuncture these limitations, there are could not determine the (and ancillary techniques) some studies that have been efficacy of treatments alone – or in combination published that look at the owing to heterogenous with conventional analgesics efficacy and utility of some data and variability in ways – improved the quality of life of these treatments for of measuring treatment and reduced pain in their management of chronic pain outcomes. Therefore, cohort of dogs. in domestic species. further studies with robust clinical design are needed However, this study included Acupuncture and and warranted. This is other complementary electroacupuncture particularly true given that techniques in addition In a recent review, it has been owners are increasingly to acupuncture – the shown that acupuncture and interested in pursuing health-related quality of electroacupuncture can lead complementary therapies. life questionnaire was to the production of a variety designed to monitor cancer of neuroendocrine mediators Lane and Hill (2016) pain and the HCPI was at peripheral inflammatory investigated the response validated for osteoarthritis, sites, can inhibit inflammatory of owners of dogs with therefore meaning that their mediators in the spinal cord, naturally occurring lameness measurement tools may and release endogenous to treatments of combined not have been evaluating endomorphins at supra-spinal acupuncture and manual the cases appropriately. levels to alleviate pain (Zhang therapy. This study used the The authors did manage to R et al, 2014). Thus, there is pre-treatment period of each recruit 181 dogs to the study, evidence for acupuncture and dog as the control group and and did so using a clinical electroacupuncture at the used owner questionnaires population, which means 1.25 cellular level causing measurable encompassing play behaviour, it is quite heterogenous. As * hours changes in inflammatory walking, trotting, use of a result, the acupuncture mediators in the tissues, both stairs, mood and attitude treatments and the ancillary centrally and peripherally. (among other metrics) to modalities were not gather data. They determined standardised across the *Suggested Personal & Professional For a more veterinary-directed that the combined therapies subjects, although the results Development (PPD) approach, Fry and colleagues did provide short-term are encouraging. (2014) have reviewed the improvement, but the study mechanisms of acupuncture is limited by the small sample Another study looking at PAIN and some of the available size and an inability to perform cervical spinal cord diseases literature. However, clinically, double-crossover analysis, has recently been published

(Liu et al, 2016). The authors electroacupuncture reduced “One of the biggest challenges facing Chronic pain in dogs and cats – aimed to develop acupuncture both the end-tidal isoflurane treatment options for neck concentrations and the need veterinary professionals interested in pain, hemiparesis and for postoperative opioid tetraparesis. They conducted analgesia compared to the providing complementary therapies to further complementary a retrospective review of control group; however their patients is the lack of evidence their caseload, and cases the use of butorphanol, a that met their inclusion kappa-receptor agonist, as available to support their use” methods of management criteria were referred for the control is questionable, Traditional Chinese Veterinary since this would no longer Medicine treatments. Only be considered best practice. 31 dogs and divided them whole chapter devoted to the 19 patients were included in The results in pain scores into two groups, one receiving role of physical manipulation the study, thus the sample between the two groups are conventional treatment and in rehabilitation in dogs in a size is a limiting factor for this encouraging and do indicate one receiving acupuncture recent sports medicine text paper, however there were the need for further clinical as well as conventional (Jurek, 2013). improvements documented in trials of this nature. treatment. In the acupuncture all cases. Additionally, there group, 93 per cent of cases The history of chiropractic was no control group and Another study by Cassu and were free of relapses for the begins in 1895 and centres signs of improvement were colleagues also achieved one-year follow-up period, around DD Palmer and his assessed as improvements in similar results with a similar compared to 50 per cent in son, BJ Palmer. Together they neck mobility and ambulation, protocol (Cassu et al, 2012). the control group. formed what is now known but weren’t standardised It should be noted that the as the Palmer School of across the patient population. exact frequency of electrical It is outside the scope of this Chiropractic and they believed It is not possible to say, stimulation to cause analgesia article to discuss the ‘how’ that the spine was the origin based on this study alone, if has not been determined; and ‘why’ of the science of of – and focus for – treatment acupuncture was the reason however research to date acupuncture: specific training for all disease (Jurek, 2013). these patients improved. indicates a frequency of 2Hz is required and readers should It was not until some 100 and high intensity (1mA) is note that only a qualified years later that chiropractic The work by Gropetti beneficial in experimental veterinary surgeon may perform was applied in animals and and colleagues (2011) rodent models. acupuncture on an animal in the American Veterinary used acupuncture versus the UK. Clinicians interested in Chiropractic Association butorphanol for analgesia One final study looks at receiving appropriate training (AVCA) was founded in 1989 in a population of healthy recurrent otitis and the use of in this modality are directed by Sharon Willoughby (Kjellin dogs undergoing elective acupuncture as a treatment to the Association of British and Kjellin 2012). Both Palmer ovariohysterectomy. This (Sánchez-Araujo and Puchi, Veterinary Acupuncturists, and Willoughby identify study demonstrated that 2011). The authors examined the International Veterinary metabolic, neurologic and Acupuncture Society and musculoskeletal causes of other such associations for spinal subluxation which must further advice. then be ‘adjusted’ back into the correct position. From the patient perspective, however, it seems that The research of Kjellin and acupuncture is well tolerated Kjellin (2012) evaluating (Figure 1) and as an adjunct chiropractic courses on to conventional techniques, it offer to veterinary surgeons is included in the 2015 AAHA/ determined that chiropractic AAFP Guidelines on Pain methods are based on Management in Dogs and a system of beliefs that Cats (Epstein et al, 2015). can neither be proven nor disproven, and loosely Chiropractic manipulations surrounds the idea that the and adjustments body can heal itself after General practitioners should an adjustment, without be familiar with the work of any scientific evidence to Epstein and colleagues (2015) substantiate these claims regarding the guidelines for in the veterinary field. An management of pain in dogs example given by Kjellin and and cats. They document that Kjellin (2012) to cite the there is currently insufficient inadequacy of chiropractic is evidence for the use of ‘…the illusion that examiners chiropractic care in animals, can feel a craniosacral and but that in human medicine cerebrospinal fluid pulse’ – Figure 1. A cat demonstrating good tolerance of acupuncture (red there are many applications a statement that is clearly arrows indicate placement of two needles). that are supported by not supported with modern research. However, there is a biomedical understanding’.

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Thus, they and the task The pain that emanates from “… these therapies should not be used as force behind the AAHA Pain a trigger point can be referred Management Guidelines, have to as myalgia; and while first line or solo treatments and should found no evidence to support veterinary patients cannot the use of chiropractic describe referred pain, judicious only be considered to be an adjunct to therapies in veterinary physical examination will often conventional pain management strategies” medicine (Epstein et al, 2015; result in the identification of Kjellin and Kjellin, 2012). It pain behaviours when these is worth pointing out that trigger points are palpated. the future for chiropractic Specific features of trigger great interest in the treatment, TNF-α, interleukins and nitric in veterinary medicine will points include a taut band but no understanding of its oxide at peripheral sites as depend upon the generation of muscle radiating from the unproven status for pain well as in the spinal cord, of appropriate robust focus of pain, and a local management (Heuberger et with only minor side effects. scientific evidence. twitch response when the al, 2016). In human research, Additionally, pain caused surrounding muscles are people seek out ‘healing’ as by osteoarthritis has been Myofascial/trigger manipulated (Wall 2014). a complementary therapy extensively researched with point therapy for pain and mental health very positive outcomes. A trigger point is a physical There are several different problems, and it is perhaps Different preparations of entity within a muscle that is mechanisms described for only natural that this will curcumin are available, and painful on compression and trying to relieve the pain caused extend to their pet. Indeed, it is important to recognise resistant to free movement by trigger points – acupuncture, while many clinicians don’t that poorly bioavailable of the surrounding structures physical therapy including ‘buy into’ the claims of Reiki compounds will not elicit the (Wall, 2014). There is a good ischaemic compression practitioners and spiritual same positive results. correlation between the and stretching, laser and healers, it is wrong to say that location of trigger points electrotherapy, though none of these treatments are worthless. Clinical studies in veterinary and acupuncture points, these have evidence to suggest patients are lacking; however and these points have been one is superior over another Reiki uses the hands of a review by Comblain and objectively identified using (Wall, 2014). the practitioner to treat/ colleagues, and the trial of pressure algometry, histology touch the physical body curcumin-containing diets by and magnetic resonance While complete data are while using ‘energy’ to act the same group do highlight thermography (Janssens, lacking in support of these on the ethereal, mental and that pain responses are 1992). Diagnostic criteria for therapies, there are some spiritual wellness of the improved with the addition of the presence of trigger points studies demonstrating good body and strengthening the these compounds (Comblain have been applied to dogs and results. One article looks at immune system. There are F et al, 2016; Comblain F et al, it has been found that human dogs with hind limb muscle no scientific papers that can 2017). The authors conclude myofascial pain syndromes strain over a four-year describe what this ‘energy’ that such supplements should are good models for similar period managed with rest, is or how it works; but for be used alongside conventional syndromes in veterinary conventional medications chronic disease, anxiety and medications for osteoarthritic patients (Frank, 1999). and physical therapy, and stress disorders in the human pain, even if further reports good outcomes field, there are reports of investigations are required to (Nielsen and Pluhar, 2005). reiki reducing the suffering prove their efficacy. However, prospective, experienced by these patients. blinded, randomised clinical There are no such studies Turmeric has also been used trials are required. in animals, so it cannot be in cats for pain relief after said that there is evidence to limb amputation (Forster et Additionally, there are support its use in the veterinary al, 2010). However, despite specialist courses for veterinary industry at this time and the existence of these papers, surgeons and veterinary nurses further research is needed. there is no defined dose or to train and become animal treatment regimen for the physical therapists. The Curcuminoids inclusion of turmeric in pain usefulness of these cannot be The rhizomes of Curcuma management in veterinary overemphasised – primarily longa (turmeric) contain species. At this stage these because it gives clinicians phenolic curcuminoids, products are not regulated, and nurses an avenue to of which curcumin so it is important for monitor health and well- (diferuloylmethane) is the practitioners to investigate being of pets and may also principal compound (Figure the oral bioavailability of a build a future for monitoring 2). This compound has been product and possible dosages response to therapies and studied extensively in humans before recommending them to publishing wider scale and found to have anti- a client. studies on these modalities. inflammatory, hypoglycemic, antioxidant, wound-healing, It is also important to Figure 2. The rhizomes of Reiki and energy healing antimicrobial and pain- identify that curcumin turmeric (Curcuma longa) Reiki and other forms of reducing properties. Tumeric can inhibit the function contain phenolic curcuminoids. ‘energy healing’ are modalities has been shown to reduce the of various cytochrome where owners appear to have production of prostaglandins, P450 enzymes in vitro and

recognise that this may Schedule 3 category and that have drug-drug interactions cannabidiol not be scheduled and alter speeds of drug at all and, therefore, not metabolism (Appiah-Opong be subject to international et al. 2007). However, this control as a drug of potential same study states that the abuse. Readers are advised liver experiences only low to consult their local exposure to curcumin and, legislative authorities before therefore, the ability of it to prescribing cannabidiol- cause major drug interactions containing products. Note remains to be seen. that products containing cannabidiol are not subject Cannabidiol to any regulatory oversight Cannabidiol is found in the and often do not contain plant known as marijuana the amounts of active or hemp and is the second ingredients they purport most common extract after on the label (Brutlag and tetrahydrocannabinol (THC). Hommerding, 2018). The hemp plant, its oils and dietary extracts, have The paper by Brutlag and been receiving a great deal Hommerding (2018) provides of media attention recently a good overview of THC Figure 3. The hemp plant, its oils and extracts, have been receiving (Figure 3), and there are and cannabidiol-containing a great deal of media attention recently. reports in human medicine products and the associated of cannabidiol being used risks of use in animals. to treat a wide variety of They caution that earlier applications appears to have defined number of times. chronic conditions, including papers have determined the best bioavailability in Succussing is a method of pain, anxiety, depression and that the use of cannabidiol dogs (Bartner et al, 2018). mixing that is thought to seizure conditions. can inhibit cytochrome Based on the available impart further efficacy to P450 enzymes and interfere evidence, including an the treatment, and the more Cannabidiol as a substance with metabolism of other article exploring cannabidiol dilute a solution is the more on its own has not achieved medications in people, for cancer palliation in ‘energised’ with healing force consistent world-wide but that this hasn’t been veterinary medicine (Repetti (Whitehead et al, 2018). The regulatory status. In Europe, extrapolated to dogs. et al 2019), it is reasonable treatment is then supposed individual countries determine Despite this, there are a to add cannabidiol to the to transmit the healing force whether or not cannabidiol is few clinical trials that show list of agents that may assist to the patient. legal in their state, and most promise for the use of pain management of chronic will allow prescription of cannabidiol for arthritic pain conditions in veterinary According to Whitehead and cannabidiol products, as does in animals. patients. Once again, this colleagues (2018) the dilution Australia and New Zealand. should only be used as is so great that the resultant In the UK, the Veterinary A study by Gamble and complementary therapy, liquid contains no molecules Medicines Directorate states colleagues (2018) used not as first line or solo of the starting treatment. that since there are no licensed client-owned dogs and results therapy, until there is more It is not surprising then to veterinary preparations, are encouraging – with compelling evidence for its discover that there is not a vets may prescribe a legally owners reporting that dogs utility in pain management. single clinical trial that has obtained human product demonstrated an increase in demonstrated any efficacy of (Veterinary Medicines comfort and overall activity Homeopathic medicine homeopathy, beyond that of Directorate, 2018). (Gamble et al, 2018). However, Homeopathy was developed placebo (Lees et al, 2017). there were increases in alkaline by a German doctor, Samuel The World Health phosphatase values but this Hahnemann in the early Homeopathic remedies Organisation’s Expert cannot be directly attributed 1790s (Campbell, 2009). cannot be recommended Committee on Drug to the cannabidiol (Gamble et as a possible chronic pain Dependence has recently al. 2018). Practitioners of homeopathy management strategy for advised that preparations use information about the animals, and this statement containing THC be classified Oral dosing of the infused patient’s present complaint is supported by both the in the less restrictive oil versus transdermal to select treatments that American Animal Hospital have no scientific or medical Associations guidelines on application for the illness. pain management and the These treatments or remedies Royal College of Veterinary “It is worth pointing out that the future are prepared by choosing Surgeons (Epstein et al, 2015; the ingredient, grinding it up Whitehead et al, 2018). If for chiropractic in veterinary medicine in water or alcohol, diluting homeopathy is to be employed will depend upon the generation of and ‘succussing’ the liquid at all it should only be as an and then further diluting ancillary to western medical appropriate robust scientific evidence” and succussing for a non- diagnostics and treatments.

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“It is vital that clinicians are aware of the legalities surrounding new agents and PPD Questions treatments and their application in the 1. How does reiki work in animals? veterinary field” A. we have no scientific proof that reiki works in animals, therefore it should be avoided B. by using ‘energy’ to act on the ethereal, mental and Conclusion It is vital that clinicians spiritual wellness of the patient Complementary therapies are aware of the legalities C. it is very successful for managing pain, but no one do have a place in veterinary surrounding new agents knows how it works medicine, but it is important and treatments and their D. it has a placebo effect that helps owners think their to know what evidence application in the veterinary pet is improving there is to support their field. It is also mandatory E. it works in humans by ‘strengthening’ the immune use. Clinicians should also that clinicians are aware of system, therefore it does this in animals. refer to the relevant pain the possible negative impact management guidelines when of some of these therapies; 2. What sorts of pain may benefit from the addition of making recommendations and that improvements or turmeric to the treatment trial, as shown in previous about the use of deteriorations in their patients reports and studies? complementary therapies. are monitored closely. A. none. Turmeric doesn’t work, it is curcuminoids It is the author’s opinion Where possible, clinicians that work that where there is a lack of should seek to practise B. osteoarthritis and limb amputation evidence and risk of harm that evidence-based medicine. C. fibromyalgia and lower back pain those therapies be avoided Where there is evidence of D. pancreatitis and other visceral pain – chiropractic adjustments efficacy (other than placebo) E. rheumatoid arthritis and immune-mediated disease. of the spine, for example. it is reasonable to apply these However, for therapies therapies to the veterinary 3. The preparation that shows the best bioavailability for that have been shown to population; however, where cannabidiol in dogs is… have some measurable evidence is lacking, clinicians improvements in outcomes are advised to seek an A. capsules for pain management, such alternative method of B. tablets as acupuncture, then it is pain management. C. transdermal applications reasonable to offer these D. infused oil modalities to the client. E. alcohol emulsion.

It is important to state that 4. How are homeopathic remedies made? these therapies should not be used as first line or solo A. by a sequential process of dilution and succussion treatments and should B. by praying over the dilution of the remedy five times only be considered to be an C. by energising a solution (tapping it three times with adjunct to conventional pain a wand) management strategies. D. by grinding up the treatment into a powder and sprinkling it over the patient’s head E. by diluting a substance to the point that there is no original substance left.

5. Of the complementary chronic pain management strategies presented in this article series, which may not be employed alongside conventional therapies, as advised by the AAHA? A. laser and extracorporeal shock wave therapy B. acupuncture and cannabidiol C. homeopathy and chiropractic D. myofascial therapy and turmeric

E. thermotherapy and cryotherapy.

C 5. A 4. D 3. B 2. A 1. Answers

References Appiah-Opong R et al (2007). ‘Inhibition of Human Recombinant Cytochrome P450s Kjellin RE and Kjellin O (2012). ‘An Appraisal of Courses in Veterinary by Curcumin and Curcumin Decomposition Products’ Toxicology 235(1-2): 83-91. Chiropractic – Science-Based Medicine’ Science-Based Medicine. 2012. https:// https://doi.org/10.1016/J.TOX.2007.03.007. sciencebasedmedicine.org/an-appraisal-of-courses-in-veterinary-chiropractic

Bartner LR et al (2018). ‘Pharmacokinetics of Cannabidiol Administered by 3 Delivery Lane D and Hill S (2016). ‘Effectiveness of Combined Acupuncture and Manual Methods at 2 Different Dosages to Healthy Dogs’ Canadian Journal of Veterinary Therapy Relative to No Treatment for Canine Musculoskeletal Pain’ The Canadian Research (Revue Canadienne de Recherche Veterinaire) 82(3): 178-183. https://www. Veterinary Journal (La Revue Veterinaire Canadienne) 57(4): 407-414. http://www. ingentaconnect.com/content/cvma/cjvr/2018/00000082/00000003/art00002. ncbi.nlm.nih.gov/pubmed/27041759.

Brutlag A and Hommerding H (2018). Toxicology of Marijuana, Synthetic Lees P D et al (2017). ‘Comparison of Veterinary Drugs and Veterinary Homeopathy: Cannabinoids, and Cannabidiol in Dogs and Cats’ Veterinary Clinics of North America: Part 2’ Veterinary Record. https://doi.org/10.1136/vr.104279. Small Animal Practice 48(6): 1087-1102. https://doi.org/10.1016/J.CVSM.2018.07.008. Liu CM (2016). ‘Retrospective Study of the Clinical Effects of Acupuncture on Cervical Campbell A (2009). Homeopathy in Perspective; a Critical Appraisal. 1st ed. E-book: Neurological Diseases in Dogs’ Journal of Veterinary Science 17(3): 337-345. https:// Self published. doi.org/10.4142/jvs.2016.17.3.337.

Cassu RN et al (2012). ‘Electroanalgesia for the Postoperative Control Pain in Nielsen C and Pluhar GE (2005). ‘Diagnosis and Treatment of Hind Limb Muscle Strain Dogs’ Acta Cirurgica Brasileira 27(1): 43-48. https://doi.org/10.1590/S0102- Injuries in 22 Dogs’ Veterinary and Comparative Orthopaedics and Traumatology 86502012000100008. 18(04): 247-253. https://doi.org/10.1055/s-0038-1632962.

Comblain FS et al (2016). ‘Review of Dietary Supplements for the Management Repetti CSF et al (2019). ‘Perspectives in Veterinary Medicine on the Use of of Osteoarthritis in Dogs in Studies from 2004 to 2014’ Journal of Veterinary Cannabinoids as Complementary Palliative Therapy for Pain in Cancer Patients’ Pharmacology and Therapeutics 39(1): 1-15. https://doi.org/10.1111/jvp.12251. Ciência Rural 49(2): 1-7. https://doi.org/10.1590/0103-8478cr20180595.

Comblain F et al (2017). ‘A Randomized, Double-Blind, Prospective, Placebo- Rose WJ et al (2017). ‘A Scoping Review of the Evidence for Efficacy of Acupuncture Controlled Study of the Efficacy of a Diet Supplemented with Curcuminoids Extract, in Companion Animals’ Animal Health Research Reviews 18(2): 177-185. https://doi. Hydrolyzed Collagen and Green Tea Extract in Owner’s Dogs with Osteoarthritis’ BMC org/10.1017/s1466252317000068. Veterinary Research 13(1): 395. https://doi.org/10.1186/s12917-017-1317-8. Sánchez-Araujo M (2011). ‘Acupuncture Prevents Relapses of Recurrent Otitis in Dogs: Epstein M et al (2015). ‘2015 AAHA/AAFP Pain Management Guidelines for Dogs and A 1-Year Follow-Up of a Randomised Controlled Trial’ Acupuncture in Medicine 29(1): Cats’ https://doi.org/10.5326/JAAHA-MS-7331. 21-26. https://doi.org/10.1136/aim.2010.002576.

Forster L M et al (2010). ‘Owners’ Observations of Domestic Cats after Limb Schoen AM (2001). Veterinary Acupuncture : Ancient Art to Modern Medicine. Mosby. Amputation’ Veterinary Record 167(19): 734-739. https://doi.org/10.1136/vr.c5893. Silva N et al (2017). ‘Effect of Acupuncture on Pain and Quality of Life in Canine Frank EM (1999). ‘Myofascial Trigger Point Diagnostic Criteria in the Dog’. Journal of Neurological and Musculoskeletal Diseases’ The Canadian Veterinary Journal (La Musculoskeletal Pain 7 (1–2): 231-237. https://doi.org/10.1300/J094v07n01_22. Revue Veterinaire Canadienne) 58(9): 941–51. http://www.ncbi.nlm.nih.gov/ pubmed/28878418. Fry L et al (2014). ‘Topical Review Acupuncture for Analgesia in Veterinary Medicine’ Topics in Companion Animal Medicine 29: 35-42. https://doi.org/10.1053/j. Veterinary Medicines Directorate (2018). ‘VMD Statement on Veterinary Medicinal tcam.2014.03.001. Products Containing Cannabidiol - GOV.UK’ 2018. https://www.gov.uk/government/ news/vmd-statement-on-veterinary-medicinal-products-containing-cannabidiol. Gamble L-J et al (2018). ‘Pharmacokinetics, Safety, and Clinical Efficacy of Cannabidiol Treatment in Osteoarthritic Dogs’ Frontiers in Veterinary Science 5(July): Wall R (2014). ‘Introduction to Myofascial Trigger Points in Dogs’. Topics 165. https://doi.org/10.3389/fvets.2018.00165. in Companion Animal Medicine 29(2): 43-48. https://doi.org/10.1053/J. TCAM.2013.11.001. Groppetti D et al (2011). ‘Effectiveness of Electroacupuncture Analgesia Compared with Opioid Administration in a Dog Model: A Pilot Study’ British Journal of Whitehead M et al (2018). ‘Veterinary Homeopathy Regulation in the UK – A Cause for Anaesthesia 107: 612-618. https://doi.org/10.1093/bja/aer199. Concern’ Regulatory Rapporteur 15(11): 21-25.

Habacher G (2006). ‘Effectiveness of Acupuncture in Veterinary Medicine: Systematic Zhang R et al (2014). ‘Mechanisms of Acupuncture-Electroacupuncture on Review’. Journal of Veterinary Internal Medicine 20(3): 480-488. https://doi. Persistent Pain’ Anesthesiology 120(2): 482-503. https://doi.org/10.1097/ org/10.1111/j.1939-1676.2006.tb02885.x. ALN.0000000000000101.

Heuberger R et al (2016). ‘Companion Animal Owner Perceptions, Knowledge, and Beliefs Regarding Pain Management in End-of-Life Care’ Topics in Companion Animal Medicine 31(4): 152-159. https://doi.org/10.1053/J.TCAM.2017.02.001.

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Anthropomorphism – a barrier to client compliance? In 2015, the term ‘fur baby’ was added to the Oxford English Dictionary. Our clients are no longer registering a cat or a dog, but a member of their family. While this devotion to animals most likely always has good intentions, we need to make sure Claire Newton-Ransom that anthropomorphic trends are not to the detriment of our patients. BSc (Hons) Ten years ago, you may have struggled in the hunt for a Claire has worked in the equine Halloween outfit for your and veterinary industry for over cat, or have been met with a 10 years, and her passion for the confused look if you ordered welfare of animals (including the a ‘puppucino’ alongside your human variety) led her to a career morning takeaway coffee. Not in practice management. She has so much anymore, and this worked in the UK and Australia, is evident in our expenditure and has a particular interest in – consumer spending on pets utilising emotional intelligence in in the United Kingdom has business and leadership. almost doubled since 2005 (Statista, 2019). A keen interest in the therapeutic effects of the human-animal We now have ‘pet influencers’ bond inspired her research into on social media, and videos equine assisted psychotherapy of cats continue to be some at university, for which she was of the most viewed online. awarded first-class honours. She So-called luxury pet brand has written for industry journals retailers are advertising gift and UK pet magazines, and is guides for new pet ‘mothers’ now part of the editorial team at and ‘fathers’ – it’s never been It is not uncommon for owners to assume that what is preferable for Veterinary Practice Today. easier to purchase a matching them is also preferable for their pet. dog carrier and handbag to carry both your belongings animals with deformities client expectation. It is not and your new fur baby. such as protruding jaws and uncommon to be met with teeth and, unsurprisingly, multiple requests to return Thirty per cent of pet owners brachycephaly (ABC News, lengthy client telephone stated that they like to keep 2018). Research has shown calls, or for primary care their pets up-to-date with the that faces that are interpreted practitioners to feel pressured latest fashions in pet clothes as cute induce a caretaker to offer referral-level services. and grooming styles (Mintel, response in humans – also 2018), and one of the biggest referred to as the ‘baby schema’ Method in madness consumer trends of 2018 was (Borgi et al, 2014). However, We must not immediately the growth of spending on pet RSPCA veterinary surgeon Dr criticise this fashion costumes (Forbes, 2018). Bronwyn Orr suggests that this but instead attempt to only encourages people to seek understand. It is intrinsic for However, all trends can develop out breeds with abnormalities humans to anthropomorphize hidden dangers. It could be (ABC News, 2018). subjects and objects in their suggested that with a rise environment, and animals are in peer pressure to invent Additionally, never before by far the most frequent target 0.5 progressively quirky pet-related have veterinary surgeons for this mindset (Urquiza- * hours hashtags on social media, pets strived to manage so much Haas and Kotrschal, 2015). are faced with an increased risk of harm in a misguided attempt at ‘adorable’ humour and popularity. Australian “It is intrinsic for humans to *Suggested Personal & Professional Veterinary Association Development (PPD) president, Dr Paula Parker, anthropomorphize subjects and objects in recently stated that veterinary one’s environment, and animals are by far ANTHROPOMORPHISM surgeons are “very concerned” by the “cute” portrayal of the most frequent target for this mindset”

Look around you while in any Mintel, has revealed that “It is not uncommon to witness retail establishment or at an 54 per cent of Britain’s online advertisement, and it millennials (people aged owners dramatically imagining the won’t be long before you are 19- 38) would prefer to presented with an image of an spend money on their pets process of castration as if it were anthropomorphized animal. as opposed to themselves happening to themselves” Singing cats attempt to sell us (Mintel, 2018). mobile phones, images of dogs in spectacles adorn t-shirts, Barriers to client compliance characteristics which appeal and destructive behaviour and, earlier this year, there was While it is of course a positive to the owner – but it is better through lack of correct uproar amongst the veterinary development that owners are to encourage your client to training and sensible industry when a leading becoming more committed to question what they can offer boundaries. Although an confectionery company chose their pets, it could be argued a pet. Sadly, it is estimated owner’s intention to not to use a brachycephalic dog that not all developments that 19 per cent of dogs are be a disciplinarian towards dressed in a child’s bunny-eared are in the animals’ best left alone for five hours or their pet is completely hairband to advertise chocolate interests. It is important, too, more on a typical weekday understandable, the Easter eggs. With concern for to question if it is a genuine in the UK. Furthermore, 1.4 assumption that canine this growing trend, The British advancement in pet welfare million dogs (16 per cent) are psychology is identical to Veterinary Association (BVA) or just owner convenience. now walked less than once the workings of the human recently published guidelines Similarly, it is not uncommon a day, and 89,000 dogs (one psyche may lead to the for responsible use of animals for owners to assume that per cent) are never walked exacerbation of anxiety- in advertising. what is preferable for them is at all; with time restrictions rooted behaviour in pets. also preferable for their pet. being cited as a challenge by We must not forget either This is certainly not helped 13 per cent of dog owners Neutering that we are conditioned to by the anthropomorphized (PDSA Animal Wellbeing Nine per cent of cats in anthropomorphize animals in images in advertising (PAW) Report, 2018). the UK are not neutered – childhood. We are encouraged previously described. equating to around 999,000 to be soothed by cuddling a toy Training unneutered felines – and 29 animal while listening to a story It should not be surprising, In pattern with seeing pets per cent of dog owners report about bears eating porridge. therefore, that we may also meet as members of the family, it that they have not neutered Likewise the mere act of naming with challenges when trying to can be a natural response their dog (PAW report, 2018). our family pets instantly advise clients on best practice. to embrace dogs with an Of the dog owners surveyed, establishes a ‘human’ identity. Some situations that may be emotional and pronounced 14 per cent stated that they presented are as follows: ‘goodbye’ when leaving the did not ‘believe’ in neutering As the cost of living house (who hasn’t hugged (this was higher for owners of continues to rise and the Poor owner-pet match their pet and showered male dogs than bitches). It is chance of home ownership is Clients may ask veterinary them with fuss?). While certainly not uncommon to an unrealistic dream for most surgeons and nurses for we would never want to witness owners dramatically ‘millennials’, particularly advice on a particular discourage affection (and imagining the process of those living in London, it is breed before deciding the many mutual emotional castration as if it were unsurprising that pets are on a new pet. Common and physiological benefits happening to themselves, quickly becoming family questions may originate in that come with it), it is not and to subsequently declare substitutes. A study by aspects of temperament unusual to encounter dogs that they would never market research provider, and appearance – typically, with separation anxiety subject their pet to what they consider barbaric torture. Their pity, although well- intentioned, may prevent their pet from receiving the health and behavioural benefits of neutering, as well as unwanted litters.

Diet There has been a recent trend for owners to feed cats a plant-based diet (without the understanding that cats are obligate carnivores) and to feed dogs homemade diets (which carry the risk of being nutritionally imbalanced without appropriate guidance). In addition, the BVA has Twenty-seven per cent of dog owners regularly feed their dogs human food. recently warned that pet owners should consult a

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“A medication regimen may be more ‘naughty’ behaviour in their References pet may originate in fear. We strictly adhered to if the owner can liken can equate the threatening Borgi et al (2014). Baby schema in their pet’s discomfort to a condition that situation to emotions that human and animal faces induces they, too, may have felt, cuteness perception and gaze they have also experienced” but explain that animals do allocation in children. Frontiers in not have a voice in which to Psychology. 07 May 2014. logically communicate the veterinary surgeon before this to our advantage when perceived threat. Burton-Bradley, R (2018). Behind feeding a raw meat-based diet attempting to inform our the fluffy faces of Instagram cat (RMBD) after a study of 60 clients of the differences Ideally, we want to encourage and dog fame, vets warn of an ugly RMBD frozen samples from between positive steps in our clients to see their pet’s reality [online]. www.abc.net.au/ 10 different manufacturers animal welfare, and misguided situation from the perspective news/2018-12-09/behind-the-fluffy- were all found to contain attempts to increase their of their pet. The concept of surface-of-insta-pet-fam-lies-a-darker- bacteria belonging to the pet’s happiness. puppy training may seem reality/10581276 family Enterobacteriaceae less daunting if it is first (Hellgren et al, 2019). It is far easier to encourage explained that a lack of early Danziger, P.N (2018). The Pet Retail client compliance if we socialisation is a leading cause Market Is Hot and Getting Hotter by Pet obesity, too, continues to can effectively humanise a of fear and aggression in dogs The Day [online]. www.forbes.com/ be a major welfare concern, situation. For example, an in later life (and that such sites/pamdanziger/2018/10/18/the- with 59 per cent of dogs owner may appreciate the measures won’t stop their dog pet-retail-market-is-hot-and-getting- now considered overweight importance of an annual from loving them). hotter-by-the-day/#6b9af8227ecd (German et al, 2018). The shift vaccination for their pet if towards including pets in family they first understand that a In most cases, it would be safe German et al (2018). Dangerous eating habits has resulted in successful human vaccination to assume that the motive trends in pet obesity. Veterinary 27 per cent of dog owners programme – such as the one behind anthropomorphising Record 182(1). regularly feeding their dogs they most likely received as pets is well-meaning and, human food and 13 per cent of a child – largely eradicated indeed, even subconscious. PDSA (2018). PAW Report 2018 cat owners frequently feeding fatal diseases. Similarly, a What is needed, however, [online]. www.pdsa.org.uk/ cheese (PAW report, 2018). medication regimen may be is friendly guidance for our media/4371/paw-2018-full-web- more strictly adhered to if the clients so that their pets can ready.pdf Using anthropomorphism owner can liken their pet’s live happily and healthily to our advantage discomfort to a condition that – which is, ultimately, the Hellgren et al (2019). Occurrence If the tendency to they have also experienced. common goal. of Salmonella, Campylobacter, anthropomorphize is Clostridium and Enterobacteriaceae innate, we must recognise We can also help our clients in raw meat-based diets for dogs. the opportunity to utilise to understand how so-called Veterinary Record 184(1)

Mintel (2018). UK pet care buyers would rather cut back spending on themselves than on their pet [online]. www.mintel.com/press-centre/retail- press-centre/uk-pet-care-buyers- would-rather-cut-back-spending-on- themselves-than-on-their-pet

Statista (2019). Consumer spending on pets and related products in the United Kingdom (UK) from 2005 to 2017 [online] www.statista. com/statistics/308266/consumer- spending-on-pets-and-related- products-in-the-united-kingdom-uk/

Urquiza-Haas, E and Kotrschal, K (2015). The mind behind anthropomorphic thinking: attribution of mental states to other species. Animal Behaviour, 109, 167–176.

As the cost of living continues to rise... it is unsurprising that pets are quickly becoming family substitutes.

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K Joining an independent veterinary practice could be your best career move.

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The role of the veterinary nurse in ending the pet obesity crisis As veterinary nurses, we are often responsible for running pet weight clinics and communicating weight concerns to clients. Pet obesity is a serious issue that is seen globally and can result in lifelong issues and the exacerbation of current clinical problems. There is evidence of a significant parallel to owner and pet obesity (Lyons, Victoria Bowes 2015) and this can be a big hurdle for staff in the clinic to overturn and not offend. RVN Dip. RSA MIfL QTLS Another issue to consider is the intelligent and emotive advertising for pet foods.

Victoria is a qualified This can influence owners on a selection of diets. This article will explore the role of veterinary nurse with 15 years’ the veterinary nurse in ending the pet obesity crisis. experience in both small animal and emergency practice Weight management clinics, environments. She has been and supporting the client to a lecturer at Warwickshire understand why their pet is College for the past 10 years overweight, is one of the key and is currently course roles of the veterinary nurse. manager for veterinary nursing. An animal can be classified as obese when the bodyweight As a practical examiner for the exceeds 10–20 per cent of RCVS, Central Qualifications the recommended weight and City and Guilds she also (German, 2006). A survey by has the pleasure of assessing the Pet Food Manufacturers the next generation of Association (PFMA) of 215 veterinary nurses. veterinary professionals highlighted a rise in obesity among cats and dogs, which now stands at 52 per cent of dogs and 47 per cent of cats. This is three per cent higher than 2016 levels. Small mammals and birds fare slightly better, with vets you could set up your own how much exercise the confirming that 32 per cent practice-based one. Let’s animal gets per day and 12 per cent respectively discuss some of the elements what the animal’s body are overweight or obese of a weight clinic and weight condition score is (PFMA, 2017). management programme: what the animal’s current weight is. What can veterinary Setting up the clinic nurses do to address the Firstly, the practice will It is also useful to invest in a obesity issue? need to invest in some measuring tape so that you First of all, we need to set up equipment needed to set up can record the pets’ abdomen a weight clinic and weight the programme. You will need and chest circumference. management programme, to devise paperwork and and this requires careful registration forms to start Clients and understanding thought and advertising. the collection of pet details, pet obesity We all love to have a good and this needs to include the It is important that the weight noticeboard within the client’s details. You then need programme is open to all 0.75 practice, so use this to to start mapping the animal’s clients. They need to be made hours* advertise and make this bright weight and daily feeding aware that every programme and colourful. You could try rations. Ensure that you ask is holistic and individual. approaching some of the the most basic questions on However, we must remember food companies to see what your paperwork, such as: that every client has a advertising information they what, and how much, the different economic status. *Suggested Personal & Professional have available to add to it. animal is fed and at what Development (PPD) time of day To first understand the best You may want to choose a whether the animal is fed way to tackle pet obesity, WEIGHT CLINICS pre-set weight management any additional food we must look at the reasons programme, or alternatively, or treats why owners are over-feeding

“Owners will have different ideas on what complete diets: this is considered to contain the they consider appropriate feeding. It is the necessary nutrients and calories to support the daily requirements of animals. It is designed to be fed on its role of the veterinary nurse to support own without the need for any other foodstuff. Treats should be worked out at a calorific level and removed them – not berate them – if their selection from the daily diet is incorrect or inadequate” complementary: this is when the diet is to be combined with another diet to meet the daily requirements. This is commonly the combination of a dry mixer and wet diet or feeding incorrectly. It feeding at present. If you dry food: these have a very low moisture content and is evident and well-known notice that the diet they are on can be measured to a calorie-controlled diet. These that one of the identified is high in fat or not a reliable diets can vary significantly in quality and price. It is issues of owners and pet diet, consider alternatives important to consider the economic status of the client dietary management is ‘guilt that are relative in cost. It is when discussing food types for their pets as this will feeding’. Owners may have really important that you do have considerable impact on the client’s motivation to jobs which take them away not force the client into a very succeed on the weight management programme from the home environment, expensive dietary management semi-moist food: these are typically processed and and, when they return, they food if they have given you packed in a form of sachet or tray. They contain more will provide the animal with subtle hints about the cost. water content than the dry food and can be more a delicious treat to try to palatable for the animal assuage some of the guilt Ensure that you advise the wet food: these commonly have a high water and meat from leaving their pet alone. client to change the diet slowly content. They can be considered expensive to feed owing over a period of time and to the amount that needs to be fed daily. Wet food can Owners will have different that portions are measured generate more interest in clients as it can encourage an ideas on what they consider accurately. This is especially anthropomorphic view point for the owners, considering that appropriate feeding. It is the important for cats that are fed the animal must be eating well with all the different flavours role of the veterinary nurse ad lib. raw: this is becoming a more popular method of food to support them – not berate provision. It is important that if a client wants to feed them – if their selection is The animal needs to be this diet that they are aware of meeting all their pet’s incorrect or inadequate. We weighed on regular occasions nutritional needs, as well as how to maintain hygiene should have full and clear to ensure that the client is and safety for owners and animals. understanding of the different following the plan, and also types of diets available to to make sure that the animal Figure 1. Different types of diet. provide the required support. is not losing weight too fast as Food can be provided in a this can have serious effects variety of methods and it is on the animal’s health. starting with small walks, increasing from 10 to important that we familiarise 30-minute periods. These should begin on flat surfaces ourselves with them (Figure 1). It is well-known that owners with the possibility of changing terrain over time may commonly provide their free-run periods if these are not contraindicated Diet management and animals with leftover food hydrotherapy could be in a pool or underwater treadmill lifestyle changes as treats. This can make it – if the cost is a problem, natural water sources may be Owners may have a limited extremely difficult to work suitable depending on the area. understanding of the correct out the calorific content of diet that their pet should have, the food. The PMFA reports Figure 2. Dog exercise suggestions. or the calorie content of the a 28 per cent increase in different foods. This is where dog and cat owners feeding it is so important that, as a leftovers. Feeding treats can veterinary nurse, we have this be seen as a kindness gesture encourage engagement with a play toy on a stick understanding and can fully from the owner, but it is encourage the cat to walk around support the owner to make important to raise awareness offer ‘treat’ toys but monitor the cat, as some cats are an informed dietary choice and understanding of the very intelligent and figure out they can get the treat just by for their pet (Bowes and calorific impact (PMFA, a flick of their leg and a roll of the ball. Coleman, 2019). 2015). It is beneficial to feed treats from the daily food Figure 3. Cat exercise suggestions. When discussing changes to allowance as this can help a pet’s diet, the programme the client to understand the becomes very specific to the calorific impact of treats. involved in the programme for You can start the tracking of client. You must ensure that a central appointment. Allow individual pet weight loss on you consider the economic Community clients to socialise and talk, a weight clinic programme status of the client. Listen to It is hard to discount the and to discuss how their weight leaflet or tracking sheet, but them and ask very carefully positive effect of the community programme is going. Be sure to be ready to convert weights in regard to their pet food on desirable outcomes. Take provide information to view via into pounds and ounces as budget. This can sometimes the format of puppy clinics and extensive use of notice boards many clients will want to know be judged by what they are invite all the clients that are and leaflets. it in imperial measurements.

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“You must ensure that you consider the economic status of the client”

After every client has had the team, such as veterinary their appointment, put on physiotherapists and an additional presentation hydrotherapists (Bowes and discussing how to feed Coleman, 2019). animals healthily along with exercise requirements. Supporting the client to Hopefully, your clients will change their approach feel valued and involved to feeding in their pet’s weight You could educate the client programme. Compliance on the methods used in the is the answer – allow the creation of clever and subtle owners to get passionate advertising for pet food. You about their pet’s weight loss. see it on the television and You could even include prizes in every shopping aisle – the to encourage weight loss food looks succulent and with a competition. juicy and appeals to the anthropomorphic viewpoint. Owner and pet health We tend to think, ‘I would love The increase in pet obesity to eat that, so will my pet’. may be linked to a sedentary lifestyle with a reduced We may need to support the level of exercise. It is good owner to fully acknowledge to encourage owners to get that their pet is obese, and to their pet into a routine for inform them of the dangers of exercise (Figures 2 & 3), the condition (Figure 4). One and to also allow them to big area for consideration is acknowledge and understand the term that we may use to exaggeration of osteoarthritis the importance of regular inform the client that the pet exaggeration of hip dysplasia symptoms and controlled exercise as is overweight. There could be sagging undercarriage/belly part of a healthy pet and quite a negative impact with the excessive fat over bony areas owner lifestyle. A good use of ‘obese’ with an owner. dyspnoea method could be to arrange a Consideration for the owner, as lethargy practice dog walk – ensuring well as suitable wording, should lack of grooming – especially genital areas and tail base. all preventive and health be your first priority. measures are in place. This Figure 4. Some of the key clinical signs of pet obesity (Bowes and can encourage a feeling of It is very important that each Coleman, 2019). community, and would allow pet and owner is treated as an the client to feel supported. individual case (BVA, 2019). A plan will then need to be It is clear that this is not of the best methods for doing You could also consider linking produced, but do not be upset an issue that is going away this is to encourage them to with a human health fitness if the first plan fails. Reflect quickly – if anything, there measure or weigh their pet programme and creating on where the plan went wrong is an increase in overweight on a regular basis. To see a pet and owner weight and start again – assess it pets being presented in the the weight reducing can be a management clinic. Think from a new angle or involve veterinary clinic. We must try strong motivator. outside the box – talk to another member of the team. to break this cycle with careful human health dieticians and support, education and see if they would like to get Conclusion guidance at an early point in involved in a novel ‘animal and We need to recognise the the animals’ journey in life. human’ weight clinic. This will importance of the veterinary need multiple levels of input nurse in the role of managing Owners should not be made and research to ensure that and preventing pet obesity. to feel bad for the choices animal and human health is they have made. Focus on maintained at all times during Veterinary nurses are a guiding the positive, and encourage the programme. help for owners and advocates them to get involved in the of animal welfare. Could we weight loss programme. One You also need to ensure that possibly consider the role of you are fully aware of any a district veterinary nurse to pre-existing medical issues in visit animals in their home “The PMFA reports a 28 per cent increase your patients. You may need environment to help owners to involve wider members of with the crisis of pet obesity? in dog and cat owners feeding leftovers”

References

PPD Questions Bowes, V. and Coleman, H. (2019). The management of pet obesity. Portland: 5m Publishing. 1. What is meant by the term ‘complete diet’? A. needs additional nutrition supplements BVA (2019). Pet obesity epidemic is B. is used as a complement to tinned food top welfare concern for vets [online] C. contains all the required nutrients D. needs to be combined with a complementary diet. www.bva.co.uk/news-campaigns- and-policy/newsroom/news- releases/pet-obesity-epidemic- 2. An animal can be classified as obese when bodyweight exceeds what percentage of the is-top-welfare-concern-for-vets/ recommended weight? [Accessed 30 Apr. 2019]. A. 10–20 per cent B. 5-15 per cent German, A.J. et al (2018). C. 8-12 per cent Dangerous trends in pet obesity. D. 20-30 per cent. Veterinary Record 182, 25.

Harvey A. and Taylor S. (2012). 3. What percentage of cats are currently considered to be obese? Caring for an overweight cat. A. 52 per cent Roslin, Vet Professionals. B. 39 per cent C. 26 per cent Lund, E. M., et al. (2006). D. 47 per cent. Prevalence and risk factors for obesity in adult dogs from private US veterinary practices. 4. What is a key clinical sign of pet obesity? International Journal of Applied A. dyspnoea Research in Veterinary Medicine 4: B. exaggeration of hip dysplasia symptoms 177–186. C. exaggeration of osteoarthritis D. all of the above. Montague, J. (2019). Our pets:

the key to the obesity crisis?

D D 4. D 3. A 2. C

1. [online] www.bbc.com/future/

Answers story/20190109-what-we-can-learn- from-overweight-pets-about-human- obesity [Accessed 9 Jul. 2019].

PFMA (2017). Pet obesity report ‘Five Years On’ [online] www. pfma.org.uk/news/pfma-releases- pet-obesity-report-five-years-on [Accessed 30 Apr. 2019].

Raffan, A. (2014). The big problem: battling companion animal obesity. Veterinary Record 287–291.

RSPCA (2019). Pet obesity - causes of animal obesity, treatment & prevention [online] www.rspca.org. uk/adviceandwelfare/pets/general/ obesity [Accessed 30 Apr. 2019].

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The dropped tablet – drugs acting on the central nervous system Most owners who take long or short-term medication keep their tablets securely Jane Ellison fastened and well away from the reach of their inquisitive and determined pets. BSc (Hons) However, accidents happen, and if the medicine box or handbag is raided, or the tablet is dropped on the floor, the consequences of the animal ingesting drugs that Jane is one of the senior information scientists at the act on the central nervous system must be considered. Veterinary Poisons Information sertraline work by blocking Service, having started her the uptake or reabsorption career in human toxicology of serotonin – thereby at the National Poisons providing higher levels of the Information Service at Guy’s neurotransmitter at the brain Hospital. In addition to receptor sites. working on the 24-hour team, she provides CPD courses The onset of clinical effects, on small animal poisonings, depending on the individual lectures at conferences and SSRI involved, is generally to veterinary practices and one to six hours, with these their clients, and writes for a effects lasting between 12-24 number of publications. hours, or in severe cases, 48 hours. In overdose, vomiting, diarrhoea, lethargy, hyper or hypotension, twitching and convulsions are seen.

The treatment dose will There are many drugs and there is a great deal of also vary with each SSRI. acting on the central individual variation which does Treatment will consist of gastric nervous system for various not seem to be dose-related. decontamination (emetic indications and conditions, The clinical effects most and activated charcoal) if it is such as depression, epilepsy, commonly seen are safe to do so, and thereafter, Parkinson’s disease, ADHD, drowsiness and ataxia, symptomatic and supportive anxiety, and bipolar disorder. although in some cases, measures – with diazepam being tremor, weakness, administered if required. Anxiety vomiting and hypothermia One of the most commonly may be present. Some Serotonin syndrome can prescribed medications to animals, however, might occasionally occur following treat anxiety or panic attacks display hyperactivity, overdose of an SSRI. This is a is the benzodiazepine, agitation, aggression and spectrum of clinical findings, diazepam. Benzodiazepines hyperthermia. Treatment is generally presenting within act by enhancing the essentially supportive and is 10 minutes to four hours, effect of the inhibitory recommended for any dose which may include behavioural neurotransmitter gamma- above 5mg/kg, although changes, neuromuscular aminobutyric-acid (GABA), other benzodiazepines have activity, dilated pupils, vomiting, 0.5 and, in therapy and different treatment doses. diarrhoea and cardiac changes. hours* overdose, are considered to Treatment, once again, is be of low toxicity. Depression supportive, but it is important There are now many drugs to avoid phenothiazines, The rapid absorption from used to treat depression, with metoclopramide and the gastrointestinal tract leads the key being to find the right propranolol, as these drugs *Suggested Personal & Professional to clinical effects occurring drug for the right patient. could exacerbate the Development (PPD) within 30 minutes to two clinical picture. hours. They can paradoxically Selective serotonin reuptake POISONS and unpredictably cause CNS inhibitors (SSRIs) such as Venlafaxine – another commonly stimulation or depression, citalopram, fluoxetine and prescribed antidepressant

Treatment is supportive, and required. Propofol may be “Encourage owners to keep all medications any symptomatic animal used if convulsions occur out of the reach of animals. This should should have renal function and and any tachycardia should electrolytes monitored. be controlled with a beta- include securing letterboxes” blocker such as propranolol. ADHD Many children and adults Another drug used in – inhibits the reuptake of frequency of mania and may with attention deficit the treatment of ADHD noradrenaline in addition to also help relieve or prevent hyperactivity disorder (ADHD) is dexamphetamine, or serotonin; although the onset, bipolar depression. The are prescribed medications lisdexamfetamine, which is a duration, characteristics and mechanisms by which lithium to help reduce and relieve potent stimulant of both the treatment of clinical effects is stabilises mood are not well symptoms of hyperactivity, cardiac and central essentially the same as the SSRIs. understood, although it is inattentiveness and impulsivity. nervous system. known to increase inhibitory One of the mainstays of Tricyclic antidepressants – (GABA) neurotransmission treatment is the centrally Onset of initial effects is rapid, such as amitriptyline and as well as reducing levels of acting sympathomimetic, often within 30 minutes to clomipramine – are an older dopamine and glutamate. methylphenidate. one hour; in some VPIS cases, class of drugs and are rarely clinical effects have been used now as the first-line The exact mechanism of The VPIS has had over 300 reported as early as 15 minutes treatment for depression action in lithium intoxication cases involving this drug post ingestion, with recovery as they can cause more is equally poorly understood, and it is clear that individual taking up to 48 hours. unpleasant side effects than although studies in response is very variable, the SSRIs. They are also experimental animals have and effects may occur at low Hyperthermia and tachycardia considered more dangerous shown that the target organ of doses. Common clinical effects are the most frequently seen in overdose. However, they toxicity is the kidney (Radomski include agitation, pacing initial presenting signs, but may be prescribed for patients et al, 1950; Evan and Olelrich, or circling, disorientation, dilated pupils, hyperactivity, with bipolar disorder or OCD. 1972). Renal failure results tremor, hyperthermia and hypersalivation, twitching In addition to blocking the in a depletion of sodium and hypertension. These effects and ataxia are also commonly reuptake of noradrenaline, water, and an accumulation will generally be seen within seen. Some dogs have these drugs block the reuptake of potassium (Radomski et al, three hours, but again, may displayed neurological signs of 5-hydroxytryptamine 1950). Vomiting is commonly take longer for sustained or such as apparent blindness, and the parasympathetic seen within two hours, with controlled-release preparations. circling, and behavioural nervous system. They also other clinical effects including changes, in addition to have a stabilising effect on ataxia, depression, lethargy Administer an emetic, if safe vomiting and diarrhoea. the myocardium, and it is and tremor. to do so, and administer the combination of these activated charcoal if the It has been proposed that actions which leads to the If more than 200mg/kg dose involved is over 1mg/ fatalities occur as a result of clinical picture in overdose of has been ingested, give kg for dogs, or 0.5mg/kg in disseminated intravascular anticholinergic effects such as an emetic if the exposure cats. Monitor vital signs for coagulation secondary to gastric stasis, urinary retention, was within two hours, or a minimum of four hours, hyperthermia and respiratory dry mucous membranes, longer if the product is a using cooling measures if failure (Davis et al, 1978; Diniz tremors and convulsions. The sustained-release formulation. appropriate. This is another et al, 2003). effect on the myocardium is Activated charcoal is not situation where acepromazine responsible for the development recommended as there is is to be preferred over Treatment is recommended of ventricular arrhythmias. no advantageous binding. diazepam if sedation is for any amount of

Following gastric decontamination for any amount exceeding 5mg/kg, animals should be closely observed for a minimum of nine hours. Hydration status should be monitored, as should electrolytes – particularly potassium, blood gases, and ideally, ECG. Diazepam may be required if tremors or convulsions develop.

Bipolar disorder Lithium, one of the most widely used medications in treating bipolar disorder, helps reduce the severity and

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“Accidents happen, and if the medicine box charcoal is beneficial as References there is evidence that this will or handbag is raided ... the consequences enhance elimination (Keranen Bates, N et al (2017). Lamotrigine is et al, 2010). cardiotoxic to dogs [abstract]. Clin of the animal ingesting drugs that act on Toxicol 55(5):42-43. central nervous system must be considered” Cardiac monitoring is essential, with additional Bellis, TJ and Gibeon, L (2018). The intensive supportive care. The use of intralipid emulsion therapy to dexamphetamine; the aims of preparation is involved. Clinical early use of intravenous lipid treat severe cardiotoxicity secondary the treatment are to prevent signs consist of drowsiness, infusion is recommended to to lamotrigine ingestion in a dog. Clin absorption of the medication, lethargy, ataxia and vomiting. treat lamotrigine-induced Case Rep. 2018;6(10):1982-1988. control the stimulatory signs, Treatment – essentially cardiotoxicity (Bellis and treat hyperthermia, treat supportive – with diazepam Gibeon, 2018). Davis,WM et al (1978). Acute cardiovascular effects and if required, is only necessary toxicity and gross behavioural protect the kidneys (Stern for doses of 40mg/kg or over. Parkinson’s disease effects of amphetamine, four and Schell, 2012). All animals Seventy per cent of VPIS cases The debilitating effects of methoxyamphetamines, and should be monitored initially remain asymptomatic (dose Parkinson’s disease are due mescaline in rodents, dogs and for four hours, and if signs range 2.5—167mg/kg) with an to dopamine deficiency monkeys. Toxicol Appl Pharmacol develop within this time, the average dose for symptomatic of the nigrostriatal 45: 49-62. monitoring period should be animals being 200mg/kg (range pathway. Pergolide, a well- increased to at least 12 hours. of 66.7—700mg/kg). established treatment of Diniz, PP et al (2003). Amphetamine Parkinson’s disease, acts by poisoning in a dog: case report, ECG and renal functions By contrast, lamotrigine – a stimulating the activity of literature review and veterinary should be closely observed, phenyltriazine anticonvulsant striatal adenylate cyclase, medical perspectives. Vet Hum with the administration of – is more problematic. This which mimics dopamine. Toxicol 45(6):315-7. intravenous fluids, taking is because, unlike humans, Vomiting within 30 minutes care to keep animals quiet dogs metabolise the drug to two hours is the most Evan, AP and Ollerich, DA (1972). and calm. Hyperthermia extensively, and the resulting common effect in overdose, The effect of lithium carbonate on the may require aggressive metabolites cause pronounced accompanied by hypotension, structure of the rat kidney. Am J Anat management. Diazepam is the cardiac effects, prolonging the hypersalivation and collapse. 134(1):97-106. first line drug of choice for CNS PR interval, widening the QRS stimulation or hypertension; complex and, at higher doses, Activated charcoal is Keranen, T et al (2010). Effects of acepromazine should be causing AV block. required for doses above charcoal on the absorption and used with extreme caution 0.1mg/kg; the animal should elimination of the antiepileptic drugs as phenothiazines have been Clinical effects are seen within be observed for at least lamotrigine and oxcarbazepine known to lower the threshold four hours and can last between four hours, with supportive [Randomized Controlled Trial in susceptible animals. 24-48 hours. Vomiting, treatment if required. Research Support, Non-U.S. diarrhoea, drowsiness and Arzneimittelforschung 60:421–426. A recent VPIS case involved lethargy are the presenting By contrast, levodopa, often Cited in: Alyahya, B et al (2018) Acute a six-month old, 14kg signs, but there is also the given with carbidopa or lamotrigine overdose: a systematic Samoyed who had ingested potential for convulsions, ECG benserazide, is well tolerated review of published adult and an unknown quantity of changes and hypokalaemia. by dogs, and supportive pediatric cases. Clin Toxicol (Phila) dexamphetamine ADHD treatment would only be 56(2):81-89. medication, and developed The VPIS has had over 60 required for doses above pyrexia, tachycardia, cases where follow-up data 60mg/kg. Radomski, JL et al (1950). The toxic convulsions and later was obtained: there were two effects, excretion and distribution of became comatose. Despite fatalities and in both of these Conclusion lithium chloride. J Pharmacol Exp intensive care, the dog died cases the dogs developed Encourage owners to keep all Ther 100:429-444. with cardiac arrest being the bradycardia and arrhythmias medications out of the reach suspected cause of death. (AV block in one dog). The dose of animals. This should include Stern, LA and Schell, M (2012). of lamotrigine ingested in the securing letterboxes, as the VPIS Management of attention-deficit Epilepsy two fatal cases was 40.1 and has many cases on file where disorder and attention-deficit Epilepsy affects both young 360.5 mg/kg. Death occurred medicines delivered by post hyperactivity disorder drug and old and in most cases between eight and 15.5 hours in from a helpful local pharmacist intoxication in dogs and cats. Vet Clin the cause is unknown. the dog that ingested 40.1 mg/ have been responsible for cases Small Anim 42:279-287. Drug therapy includes kg, and 12 hours after ingestion of toxicity. carbamazepine following 360.5 mg/kg (Bates et Thomas, DE et al (2012). and lamotrigine. al, 2017). Retrospective evaluation of toxicosis from selective serotonin reuptake Carbamazepine is rapidly Treatment is recommended for inhibitor antidepressants: 313 dogs metabolised in dogs, with a half- any dose exceeding 5mg/kg. (2005-2010). J Vet Emerg Crit Care life of only 1.5 hours. Clinical 22(6):674-681. effects are generally seen within An emetic should be given two hours, although longer if a (if ingestion was within the modified or sustained release hour); repeat dose activated

The anti-vax threat: the time to act is now The BVA recently reported that 98 per cent of veterinary surgeons have experienced clients questioning the need for pet vaccination programmes, while the World Veterinary Association (WVA) chose the ‘value of vaccination’ as the theme of this year’s World Veterinary Day. As the UK loses its measles-free status, there is no doubt that a concerning ‘anti-vax’ campaign is gaining popularity, but are we doing enough to stop this trend from infiltrating pet care and preventing what could result in a serious disease outbreak?

In 2018, breakfast television programme Good Morning Britain published a tweet “The PDSA has revealed that 25 per cent of dog owners asking pet owners to contact them if they and 35 per cent of cat owners have not enrolled their believed that their dog had developed ‘canine autism’ as a result of vaccination. pet on a primary course of vaccinations ... the belief that As well as the issue that the tweet was deemed highly offensive for comparing the programme ‘is not necessary’ is cited by owners as a a human developmental disorder to main reason to not vaccinate” poorly-trained dogs, it highlights the worrying influence of the anti-vax movement. With numerous scientific the authors discuss how ‘present- In their 2018 PAW report, the PDSA studies proving that vaccination does not day discourses centre around moral revealed that 25 per cent of dog owners cause autism, the tweet prompted much outrage and structural oppression by and 35 per cent of cat owners have not criticism from both the veterinary and institutional government and the media, enrolled their pet on a primary course human medical professions. suggesting a strong logic of ‘conspiracy- of vaccinations; equating to 2.2 million style’ beliefs and thinking,’ and unvaccinated dogs and 3.9 million How did the anti-vax concluding that, ‘social media may have unvaccinated cats respectively. The belief movement start? a role in spreading anti-vaccination ideas that the programme ‘is not necessary’ is In 1998, a British study published in The and making the movement durable on a cited by owners as a main reason to not Lancet claimed to link the MMR vaccine global scale’ (Smith and Graham, 2017). vaccinate (PDSA, 2018). to autism in humans. Despite the fact that the study has been continuously From humans to pets Speaking to The Guardian about discredited since, it has not prevented In April of this year, the BVA announced owners who refuse to vaccinate their global mass hysteria over the so-called concerns that the anti-vax sentiment pets, Sydney-based veterinary surgeon ‘danger’ of vaccinations. was infiltrating pet care. The association Sam Kuvoc commented: “They are stated that 90 per cent of veterinary sentencing their dog to death from one In addition, the anti-vax movement has surgeons felt that clients were gaining of the most shocking, horrible viruses gained a wide following in recent years, information regarding pet vaccination you can imagine. owing to the rapid sharing of misleading from non-veterinary sources, and that 98 information on social media. In the per cent of vets had experienced clients “If a disease as contagious, as horrific research paper ‘Mapping the anti- questioning the very need for vaccination and with a high mortality rate as vaccination movement on Facebook’, in the first place (BVA, 2019). parvovirus existed for humans, this conversation would be so different.

“Most of the time people are OK, they’re not staunchly against it once you tell them the science and the statistics [but] we have had people walk out in hysteria, saying that there is absolutely no way their dog is getting [vaccinated] because they believe it causes auto-immune diseases or, specifically, autism.”

A warning from human healthcare The World Health Organization (WHO) confirmed that cases of measles in Europe tripled between 2017 and 2018, and stated that, in many countries, vaccination coverage is not high enough to prevent circulation of the virus. The WHO has now listed ‘vaccine hesitancy’ as one of the top 10 threats to global health in 2019. >>>

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Earlier this year, New York City References experienced its worst measles outbreak in twenty years, which resulted in BBC (2019). Instagram blocks vaccine hoax a first-of-its-kind temporary ban of hashtags [online]. www.bbc.co.uk/news/ unvaccinated minors from public areas technology-48227377 in Rockland County. BVA (2019). ‘Anti-vax’ sentiment creeping into Could we soon be witnessing similar pet care, warn vets [online]. www.bva.co.uk/ disasters in pet health if our clients do news-campaigns-and-policy/newsroom/news- not comply with vaccination guidelines? releases/-anti-vax--sentiment-creeping-into-pet- Currently, we would be hard-pushed care,-warn-vets/ to state that we have achieved herd immunity to fatal, yet preventable, feline PDSA (2018). PDSA pet wellbeing report 2018 and canine diseases. [online]. www.pdsa.org.uk/media/4371/paw- 2018-full-web-ready.pdf Looking to the future The World Health Organization has listed If we are to win the war on vaccination, ‘vaccine hesitancy’ as one of the top 10 Smith N, and Graham T (2017). Mapping the then we need to concentrate on the threats to global health in 2019. anti-vaccination movement on Facebook. solution – not the problem – and there Information, Communication & Society. doi: is reason to believe that there is hope. A veterinary focus 10.1080/1369118X.2017.1418406 Instagram has already blocked social media The winner of the 2019 World hashtags that contain anti-vaccination Veterinary Day Award was Uganda The Guardian (2019). ‘Sentencing their dog to claims such as #vaccinescauseautism and Veterinary Association (UVA) for their death’: how the anti-vax movement spread to pets #vaccinesarepoisons, and has vowed to strong commitment to the ‘value of [online]. www.theguardian.com/society/2019/ block more general hashtags that could be vaccination’. Included in UVA’s various apr/06/sentencing-their-dog-to-death-how-the-anti- used by anti-vaxxers. vaccination campaigns are: television vax-movement-spread-to-pets and radio interviews to highlight the Similarly, Twitter users who search for benefits of vaccination; publications The Independent (2018). Good Morning Britain associated words such as ‘measles’ and of news items in leading national condemned for spreading anti-vaccination myths ‘vaccine’ are met with a ‘Know the facts’ journals; school guidance programmes; with ‘offensive’ canine autism debate [online]. bookmark and a link to an NHS article and One Health workshops with www.independent.co.uk/news/health/autism- detailing the safety and importance of local government. vaccine-piers-morgan-gmb-dog-pets-good- vaccination. If social media appears to morning-britain-a8322051.html be so effective in widening the anti- We would do well to follow UVA’s lead vax opinion, could we also utilise the and propose a national campaign to World Veterinary Association (2019). World platform for our own message? challenge the verifiably incorrect anti- Veterinary Day Award 2019 [online]. worldvet.org/ vax messages and promote the benefits uploads/news/docs/world_veterinary_day_2019_ In August, Prime Minister Boris Johnson of a pet vaccination programme. report.pdf stated that he will set out a plan for Britain to reclaim its previous measles- Certainly, we don’t want to wait for the free status. Mr Johnson announced re-emergence of deadly, yet preventable, that the government will use the NHS diseases for owners to realise the website to discuss misleading claims consequences of choosing not to regarding vaccination, and that GPs will vaccinate their pets. be encouraged to promote ‘catch-up’ vaccinations for children who may have missed out on the recommended two-dose approach used in the MMR vaccination programme. The government’s call was prompted after it was revealed that 231 diagnosed cases of measles were recorded in the first three months of 2019 in the UK, and that half a million children went unvaccinated between 2010 and 2017.

While this approach is of course centred on human health, we can hope that this focus will change the overall anti-vax rhetoric which should, in effect, improve the uptake of pet vaccination programmes.

“The World Health Organization has listed ‘vaccine hesitancy’ as one of the top 10 threats to global health in 2019”

Problems arising from inappropriate ownership and husbandry Do welfare problems arise from inappropriate husbandry and ownership? Is it an Jane King issue? I am sure we all think of the main welfare concerns as being the RSPCA cases BVetMed MRCVS to which we are called – along with the abandonment of unwanted colts, abject Jane graduated from the Royal cruelty, ‘fly grazing’ and the uncontrolled, often irresponsible, breeding of gypsy cobs Veterinary College in 1987 – as the most commonly encountered problems. I would suggest the actual issues and has worked ever since in are far wider ranging. mixed and equine practice in Worcestershire, Cumbria and Dorset. She is one of three Anyone can buy a horse; and “Anyone can buy a horse; and education directors at North West Equine education on horse care is not on horse care is not a compulsory Vets, and enjoys being part a compulsory requirement of XLVets*, a member-owned for horse ownership. Figures requirement for horse ownership” cooperative of independent from the British Equestrian veterinary practices from Trade Association (BETA) in across the UK. 2015 put the number of horse- can now be purchased for any one person in charge with owning households in the UK very little and are advertised horse-keeping qualifications, *XLVets is a community at 446,000 and the number widely on many social media knowledge or experience. of independently-owned, of horses in the country at sites (Figure 1). progressive veterinary 944,000. Furthermore, horse This has changed from previous practices that work together to owner knowledge on the Many horses are now kept at times when more people rode achieve the highest standards biology of the horse is very DIY livery yards, where the weekly at a riding school, or of veterinary care, variable and welfare problems owner can rent a stable on kept their own horse on full www.xlvets.co.uk are commonly encountered a weekly basis for very little livery, or at home on yards where horses are housed, money. At these yards, owners employing grooms. Horses were trained or fed inappropriately. visit their horses once or twice cared for then by people who a day and care for their own made their living from looking There has been a significant animals. These yards are often after horses; whereas now change in the demographic on farms that have diversified many owners look after their of horse ownership during from traditional stock- own animals and fit in the time the last 30 years; horses keeping, and there may not be required around work.

It is my experience that welfare problems arising from inappropriate ownership are common and can be placed in one of four categories: inability of the owner to care for the horse because of their lack of knowledge or experience inadequate funds to provide for all aspects of the horse’s needs, including 0.75 veterinary care * hours inappropriate training methods mismatch between the owner’s expectations and the horse’s capability. This *Suggested Personal & Professional can relate to the horse being Development (PPD) asked to perform a task inappropriate to its age/size WELFARE or breed, or may relate to Figure 1. A pony abandoned in a back yard (Photo: RSPCA). the rider's ability or weight.

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“I would suggest the actual issues are far wider ranging”

with requirements to live on Allowing stallions to run with a fibre-based diet and to eat groups of mares can lead to little and often. Their specific welfare problems through the individual nutritional needs, irresponsible breeding of low however, are quite different. value, unwanted animals.

In my opinion, overfeeding Protection from pain, or feeding of inappropriate suffering or disease diets, is a far more commonly In other parts of the world, encountered welfare problem working equids may suffer than underfeeding and significant pain and have their malnutrition. I see more welfare compromised through fat horses than thin ones. being asked to carry heavy Inappropriate feeding loads whilst using bits and may result in behavioural harness manufactured from problems, and specific inappropriate materials. This Figure 2. Shetland ponies at pasture. diseases – such as equine can cause significant wounds gastric ulcer syndrome or and harness sores. colic – are often related to Why does this matter? extensive areas. In the UK, diet. But, by far the greatest At the other end of the Under UK animal welfare some of our native breeds welfare problem I encounter spectrum, we can see welfare legislation, there is a legal duty of ponies still live in this on a day-to-day basis is the problems in high value of care for all animal keepers natural way, as seen on the overfeeding of horses and racehorses and sport horses to meet the five animal welfare Welsh mountains, Dartmoor, ponies resulting in an absolute (Figure 3). There is a debate, needs (The Five Freedoms) Shetland Isles, New Forest and ‘epidemic’ of problems, for instance, over the use of and avoid causing unnecessary the uplands of Cumbria and such as laminitis and equine ‘crank’ nosebands forcing suffering. Different countries North Yorkshire. However, metabolic syndrome. the horse to keep its mouth in the UK have different there is incredible diversity in closed; use of ‘rollkur’ in legislation – Animal Welfare the breeds of horse kept in the Normal behaviour patterns dressage, where the horse Act 2006 in England and UK and there can be no ‘one- Keeping horses stabled for is ridden with the neck in Wales, Animal Health and size-fits-all’ approach. long periods can lead to hyperflexion; and the use of Welfare (Scotland) Act 2006 an increased incidence of the whip in the racehorse. and Welfare of Animals Act Welfare problems can arise stereotypic behaviours, such (Northern Ireland ) 2011. where, for example, a ‘thin- as weaving, box-walking, At least with these sports, skinned’ Thoroughbred is cribbiting and wind sucking. the governing bodies – such The five animal welfare needs expected to live outside Many horses will spend 24 as the Fédération Equestre are defined as the need: at high altitudes without hours a day housed in a 12’ Internationale (FEI) and for a suitable environment appropriate shelter or rugs. x 12’ stable and may only be British Horse Association for a suitable diet Conversely, native ponies, taken out for short periods (BHA) – have disciplinary to exhibit normal selected to survive by foraging of exercise one or two times committees to safeguard behaviour patterns extensively on poor quality a week. Owners are then horse welfare. Reassuringly, to be housed with, or apart grazing, frequently suffer surprised when the horse a study of the FEI website from, other animals welfare problems when behaves like an ‘unexploded shows the actual number of to be protected from pain, kept on lush grazing, or are bomb’ and reprimand the transgressions for overuse of suffering, injury and disease. stabled and rugged, because animal for bad behaviour! the whip are actually very low. owners anthropomorphize So it can be seen from the list rather than heed the real Housing with, or apart In the UK, many horses are above that animal welfare needs of their animals. from, other animals kept for leisure purposes or relates to both the physical and Horses are herd animals and as pets. As we keep horses mental well-being of horses. Diet generally are happiest when for longer into their old It is recognised that horses As described above, the kept in company, with at age, there can be welfare are sentient beings – that diversity of breeds of horse least sight of other horses. problems arising from are capable of experiencing seen in the UK is enormous; (Figure 2). There are welfare inappropriate end-of-life care. positive and negative feelings so is the age range of animals issues to consider if a horse, This can be through owner and so deserve consideration and the purposes for which used to living with other horses, reluctance to say “goodbye” and respect. they are kept. The elderly is kept in isolation. Conversely, to an old friend, or a lack of pet Shetland pony and the keeping large groups of shod appreciation of the specific Environment two-year-old Thoroughbred, horses together in small fields nutritional or medical needs of In their natural state, horses are both equids. They are, with little grazing can result in a the geriatric horse. Compared live as herds grazing over therefore, hind gut digesters high incidence of kick injuries. to companion animal clients,

there is often a reluctance Useful Resources from horse owners to put their animals onto long-term Equine Industry Welfare Guidelines painkillers, partly from a Compendium for Horses, Ponies perception that there may and Donkeys published by National be side effects from Equine Welfare Council. http:// extended medication. www.newc.co.uk

Why does any of this Horses in Our Hands. A 4-year matter to a vet? research study, led by academics at Rights and responsibilities go University of Bristol and funded by hand in hand. For this reason, World Horse Welfare can be found on admission to membership at: www.worldhorsewelfare.org of the RCVS, and in exchange for the right to practise Current Welfare Problems Facing veterinary surgery in the UK, Horses in Great Britain as Identified every veterinary surgeon by Equine Stakeholders. Susan makes a declaration, which V Horsman et al, research article since 1 April 2012 has been: published 08 Aug 2016, http://doi. org/10.1371/journal.pone.0160269. ‘I promise and solemnly declare that I will pursue the work of my profession Figure 3. A dressage horse in action. with integrity and accept my responsibilities to the public, my clients, the profession and the Royal College of Veterinary Surgeons, and that, above all, PPD Questions my constant endeavour will be to ensure the health and 1. What did the BETA survey of 2015 estimate the number welfare of animals committed of horses in the UK to be? to my care’. A. 82,000 B. 944,000 So it can be seen that the C. 1,570,000. veterinary profession has a responsibility to help protect the welfare of animals. Almost 2. When were the Animal Welfare Acts updated in England every day as equine vets we and Wales? will come across situations A. 1964 where animal welfare B. 1995 is compromised. C. 2006.

Summary 3. Which of these is not classified as an animal welfare need The welfare problems arising according to animal welfare legislation? from inappropriate horse A. the need for a suitable environment ownership and husbandry can B. the need to reproduce be categorised according to C. the need to be protected from pain, suffering, injury three themes – management, or disease. riding/training or health care. Veterinary surgeons are well placed to advise on all of these 4. Which of the following is the governing body for areas and it is our professional international equestrian sporting disciplines? duty to do so. A. APHA B. FEI C. BHA

D. WHW.

C. 4. B 3. C 2. B 1. Answers

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Equine polysaccharide storage myopathy

Equine polysaccharide storage myopathy is a metabolic disorder resulting in abnormal storage of glycogen within skeletal muscle. Sara Fleck BVSc CertAVP(EM) MRCVS Although myopathies have been described in horses for hundreds of years – Sara graduated from the synonyms include Monday-morning disease, set-fast, tying-up, azoturia and University of Liverpool in 2010. exertional rhabdomyolysis – it was not until 1979 that a myopathy was first She completed an internship in recognised, which was associated with abnormal storage of glycogen in an Arabian orthopaedics and diagnostic imaging at the Animal Health crossbred horse with exercise intolerance. Trust before working in practices in both Newmarket In 1992, similar changes were found in muscle from Quarter Horse-related breeds and now, Bishopton Equine in with recurrent exertional rhabdomyolysis (ER), and were reported for the first time North Yorkshire – a member practice of XLVets*. Sara as a polysaccharide storage myopathy. holds the RCVS Certificate in Advanced Veterinary Practice Equine polysaccharide storage (Equine Medicine) and has a myopathy (PSSM) has been particular interest in cases of characterised by clinical signs poor performance. of exertional rhabdomyolysis and the accumulation of *XLVets is a community excessive glycogen and of independently-owned, abnormal diastase-resistant progressive veterinary practices polysaccharide inclusions that work together to achieve within skeletal muscle fibres the highest standards of (Valberg et al, 1992). Unlike veterinary care, normal glycogen stored www.xlvets.co.uk in muscle fibres, these polysaccharide inclusions are resistant to digestion with diastase and, therefore, are not broken down in the normal manner.

The discovery of a mutation in the glycogen synthase 1 (GYS1) gene in some – but not all – horses with the disease (McCue et al, 2008) led to Figure 1. Hind limbs are often more severely affected than forelimbs. the reclassification of PSSM. Type 1 PSSM (PSSM1) refers be minimal in severe cases, most severely affected to individuals that possess results in acute segmental are those with a high the gene mutation and Type 2 muscle fibre necrosis concentration of Type 2 PSSM (PSSM2) to individuals accompanied by pain, stiffness muscle fibres – such as the that have the characteristic and muscle swelling (Valberg gluteal, semimembranosus, 1.0 histopathology in their skeletal et al, 1992). Weakness, spasm semitendinosus and hours* muscle but do not possess the and muscle atrophy may also longissimus muscles. mutant allele. be seen, along with increased Therefore, the hind limbs are serum activities of creatine often more severely affected Clinical signs kinase (CK) and aspartate than the forelimbs. Clinical signs of PSSM are aminotransferase (AST). *Suggested Personal & Professional extremely variable. The most An abnormal hind limb gait is Development (PPD) obvious clinical sign of muscle Urine in severely affected commonly reported and poor dysfunction is exertional horses may be a dark performance and/or exercise METABOLIC DISEASE rhabdomyolysis (tying- rusty colour as a result of intolerance may also be up). Exercise, which may myoglobinuria. The muscles associated with PSSM. In all

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correlate with the severity of clinical signs or with the increase in CK or AST blood levels after exercise (Valentine et al, 1998).

Response to dietary therapy can be considered presumptive evidence of underlying PSSM in a horse with appropriate clinical signs; although pathological evaluation of a muscle biopsy sample is the only definitive diagnostic test. Figure 2. A normal biopsy (left) and a biopsy from a horse with PSSM1 (right) stained with PAS. Note the lack of a uniform texture in the PSSM1 biopsy. The darker areas in the PSSM1 biopsy indicate the Genetics accumulation of excess glycogen and abnormal polysaccharide. (Photo: S Valberg). The mutation causing PSSM1 is a point mutation in the gene cases a thorough clinical work bloodlines – such as Quarter negative biopsy results are glycogen synthase 1 (GYS1) up to rule out other disorders Horses, American Paint possible in young horses. that codes for the skeletal is essential. Horses and Appaloosas – and muscle form of the glycogen in draught and warmblood It has also been shown that synthase enzyme (McCue et al, Muscle weakness resulting breeds with continental the severity of the skeletal 2008). The mutation causes in inability to rise is most European bloodlines, such muscle pathology correlates this enzyme to be overactive common in affected draught as Belgian and Percheron with the number of copies – especially in the presence of breeds; however, determining (Valentine, 1999). of the mutant allele with insulin – resulting in constant that the cause of recumbency homozygotes having more production of glycogen. When in a horse is the consequence Diagnosis severe histopathology than glycogen is being produced, of muscle weakness, rather In horses with clinical signs those that are heterozygous the reciprocal breakdown than musculoskeletal or of myopathy, a diagnosis of for the GYS1 mutation (Naylor of glycogen is impaired, neurological disease, can be PSSM is commonly made on et al, 2012). potentially resulting in a deficit difficult (Valentine, 1999). histopathology of muscle of energy in the muscle cell. biopsy samples (Figure 2). As the disease affects Type 2 In some breeds, horses with This technique, however, is muscle fibres, muscles that Type 1 PSSM is inherited as the genetic mutation for unable to differentiate between contain a high proportion an autosomal dominant trait. PSSM1 are asymptomatic PSSM1 and PSSM2. Following of these – such as the Only one parent needs to pass (McCue et al, 2008). This the identification of the semimembranosis or gluteal the genetic mutation to its may relate to differences in GYS1 mutation, a restriction muscles – are usually selected offspring for clinical signs of diet, exercise and the impact fragment length polymorphism for biopsy (Ledwith and PSSM1 to occur. No matter of different genotypes in (RFLP) assay has been McGowan, 2004). Biopsy what animal is selected as the different breeds. developed to diagnose Type 1 samples are best preserved breeding partner, there is a 50 PSSM (McCue et al, 2008). when placed in an empty per cent chance – or greater – Signalment and breed sterile pot and transported that a PSSM1 horse’s offspring susceptibility Genetic testing of blood or hair immediately on ice packs to the will develop the disease and, Males and females appear samples is a less invasive method laboratory (Stanley et al, 2009). therefore, breeding from to be equally likely to have than the traditional muscle affected animals is ill advised PSSM (Valentine et al, biopsy and is particularly useful Abnormal subsarcolemmal to (McCue et al, 2008). 2001). However, exertional in breeds known to have a high intracytoplasmic aggregates rhabdomyolysis is more prevalence of the GYS1 mutation. of amylase-resistant complex Nutrition common in females, whereas In these breeds, genetic testing polysaccharide and/or Clinical signs of muscle an abnormal hind limb action should be performed prior to amylase-sensitive glycogen dysfunction in most horses is more common in males. muscle biopsy. are characteristic findings can be controlled by dietary Onset of clinical signs of on muscle biopsies stained modification to reduce the muscle dysfunction caused by Genetic testing may also with periodic acid–Schiff number of calories from PSSM can occur at almost any be useful in younger (PAS) stain. However, digestible carbohydrates – age and has been identified animals where changes in histopathological findings sugar and starch – and to in horses aged less than one histopathology samples in muscle biopsies from increase the total number of year (De La Corte et al, 2002) are fewer, despite PSSM horses do not always calories from fat. and those over 20 years old clinicopathologic evidence (Valentine, 1999). of exercise-induced muscle injury. It is known that the PSSM1 has been found in severity of the polysaccharide “Equine polysaccharide storage myopathy over 20 different breeds. accumulations increases as an (PSSM) is progressive, and early detection It was first recognised in animal ages (De La Corte et horses with Quarter Horse al, 2002) and, therefore, false and institution of therapy are vital”

“If both diet and exercise are altered, then the duration of exercise is References restricted and that exercise 90 per cent of horses have no – or few – is performed consistently De La Corte FD et al (2002). Devel- episodes of exertional rhabdomyolysis” with few rest days (Valberg opmental Onset of Polysaccharide et al, 1992). As duration Storage Myopathy in 4 Quarter Horse and intensity of exercise Foals. Journal of Internal Medicine, The beneficial effect of the elevate plasma free fatty acids increases, an extended 16: 581-587. low digestible carbohydrate, and alleviate any restrictions warm up and adequate high fat diet is believed to in energy metabolism in stretching is advised. Stressful Ledwith A and McGowan CM (2004). be the result of less glucose muscle. If necessary, calorie environmental elements Muscle biopsy: a routine diagnostic uptake into muscle cells and intake should be reduced should also be minimised. procedure. Equine Veterinary Educa- provision of more plasma free by using a grazing muzzle tion, 16(2): 62-67. fatty acids for use in muscle during turn-out, feeding hay Conclusion fibres during aerobic exercise with a low NSC at one to PSSM is progressive, and early McCue ME et al (2008). Glycogen (Valentine et al, 2001). 1.5 per cent of body weight, detection and institution of synthase (GYS1) mutation in diverse Because insulin stimulates providing a low calorie therapy are vital. Diagnosis breeds with polysaccharide storage the already overactive enzyme balancer and gradually relies primarily on recognition myopathy. Journal of Veterinary GYS1 in PSSM1 horses, introducing daily exercise of characteristic clinical signs, Internal Medicine, 22: 1228-1233. feeding hay with a low non- (Valentine et al, 2001). especially in high-risk breeds, structural carbohydrate diagnostic work-up to rule Naylor RJ et al (2012). Allele copy content (NSC) of 12 per cent Management out other causes of the signs number and underlying pathology or less, is advisable. An important part of the observed and interpretation are associated with subclinical sever- management of PSSM1 horses of muscle biopsy findings and ity in equine type 1 polysaccharide Diets that contain at least 20 is daily exercise. This enhances genetic test results. storage myopathy (PSSM1). PLoS per cent of total daily calories glucose utilisation and One 7: e42317 from fat (which equates to improves energy metabolism Much less is known about approximately 0.45kg fat per in skeletal muscle. If only the Type 2 PSSM, because the Sierra E et al (2012). Complex poly- 450kg of horse per day) added diet is changed, it has been cause – or causes – have saccharide inclusions in the skeletal to feeds that are less than 33 found that approximately 50 yet to be determined and muscle of stranded cetaceans. Veteri- per cent starch and sugar by per cent of horses improve. clinical trials have not been nary Journal, 193: 152-156. volume, are recommended. If both diet and exercise performed to study diet and It takes about four months are altered, then 90 per exercise responses. Stanley RL et al (2009). A glycogen for full fat adaptation in cent of horses have no – or synthase 1 mutation associated affected horses (Valentine et few – episodes of exertional It is intriguing that similar with equine polysaccharide storage al, 2001), although transient rhabdomyolysis. muscle pathology has recently myopathy and exertional rhabdo- improvement may be seen been described in a large myolysis occurs in a variety of UK within the first few weeks of Following an acute episode number of marine mammals; breeds. Equine Veterinary Journal, diet change. of exertional rhabdomyolysis, although, unsurprisingly, the 41(6): 597-601. horses with PSSM1 should clinical histories for these Rather than provide dietary commence a gradual return species are unknown (Sierra et Valberg SJ et al (1992). Polysaccha- fat to an overweight horse, to exercise as soon as their al, 2012). ride storage myopathy associated fasting for six hours prior reluctance to move has with recurrent exertional rhabdo- to exercise can be used to abated. It is important that myolysis in horses. Neuromuscular Disease, 2: 351-359.

Valentine BA (1999). Polysaccharide PPD Questions storage myopathy in draft and draft- related horses and ponies. Equine Practice, 21: 16-19. 1. In which gene has the mutation been found that codes for Type 1 PSSM? Valentine BA et al (1998). Muscle biopsy diagnosis of equine motor 2. Are the clinical signs of PSSM usually more apparent in the forelimbs or hind limbs, and why? neuron disease and equine polysaccharide storage myopathy. Equine Veterinary Education, 10: 42-50. 3. Which diagnostic technique is more useful in the diagnosis of Type 2 PSSM? Valentine BA et al (2001). Role of dietary carbohydrate and fat in horses 4. How long can it take a horse with PSSM to adapt to a fat-based diet? with equine polysaccharide storage

myopathy. J Am Vet Med Assoc, 219:

4. up to four months. four to up

3. muscle biopsy muscle 1537-1544.

2. the hind limbs are usually more severely affected owing to a higher concentration of Type 2 muscle fibres muscle 2 Type of concentration higher a to owing affected severely more usually are limbs hind the

glycogen synthase 1 synthase glycogen 1. Answers

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Save our Suffolks When we think of endangered species, we usually conjure up mental images of the Amur leopard, the Sumatran tiger or orang-utans. We may not even consider the genuine threat to a creature closer to home. However, experts predict that we have less than 10 years to save the Suffolk Punch, and that the breed could become extinct by 2027.

The Suffolk Punch, also known as the The need for urgent action Another important aim in the fight to Suffolk horse, is Britain’s oldest heavy The Rare Breed Survival Trust has save the Suffolk Punch is to promote their horse breed. The modern form of this declared the breeds ‘critical’ on its equine versatility and to change the perception of striking breed descends from a single endangered watchlist, and is now rarer the breed. While still used for ploughing stallion simply named ‘Crisp’s horse’ than the Siberian tiger, the Sumatran and forestry – albeit far less frequently than – foaled in 1768 near Woodbridge in rhino and the giant panda. previous generations – they are excellent Suffolk to Thomas Crisp of Ufford. choices for carriage driving, ceremonies, A concern is the so-called ‘extinction shows and demonstrations, and make a A unique history vortex’; where inbreeding and a loss of surprisingly gentle riding horse. With the average Suffolk Punch standing genetic diversity can lead to a small, at an impressive 16.1hh – 17.2hh, this live population where its members are Where there’s life, there’s hope magnificent breed was used broadly in so closely related, and with increasingly In April this year, The Suffolk Punch Trust farming and forestry. Suffolk Punches are similar physical issues – such as smaller celebrated the successful foaling of a unique among heavy horses of Britain as testes and poor semen quality – that vital filly – named ‘Colony Fern’ – into their legs have little to no feathering, giving extinction can feel unavoidable. its stud in Suffolk. Announcing the birth them the advantage of not becoming on social media, the Suffolk Punch Trust weighed down with mud while working. Viewers of the BBC’s programme commented that they were “thrilled”. Countryfile may remember the plight of Their stocky and strong build made the the Suffolk Punch featured in an episode The Suffolk Horse Society has also Suffolk Punch an invaluable powerhouse in back in July. On the show, Andrew confirmed that 26 new foals have been the First World War; working the land and Thompson – one of the UK’s top breeders registered this year – up on 23 from 2018 helping to keep our ancestors fed, and also of Suffolk Punches – described his – and that at least 30 foals should be in pulling heavy artillery to the front lines devastation at recently losing a filly that delivered in 2019. where thousands of horses were killed. had been born prematurely. While we must celebrate these victories, Although listed numbers of the Suffolk “It’s very upsetting … the breed is sitting more must be done to protect this most Punch recovered somewhat after the on a knife-edge – if we don’t get more noble of breeds. It would be a sad day indeed First World War, the move to mechanised foals born, the breed could be extinct to lose not only such a wondrous part of our agriculture resulted in far less demand for within 10 years.” living heritage, but an animal that has been the breed. the backbone of British agriculture. In a world first, viewers witnessed a While the war years saw approximately pregnancy diagnosis examination on 6,000 registered Suffolk Punches, it is now a Suffolk Punch mare who had been References estimated that there are fewer than 300 artificially inseminated with sexed Suffolk Punches left in the UK; with this semen – a process common in cattle, but Countryfile (2019). The British Broadcasting Corpora- list including fewer than 73 viable breeding in its infancy with horses – yet felt the tion. Aired: 14 July 2019. females and 34 licensed stallions. disappointment as it was confirmed that she was not in foal. Horse and Hound (2019). Pioneering science helping save rare breed horses on BBC One [online]. Utilising science and technology www.horseandhound.co.uk/news/stallion-ai-services- Also featured was the use of genetic countryfile-2019-691193#IxBToadqOxsjU6b4.99 tissue banking. “There are 25,000 species that are going to go extinct in the next Ipswich Star (2018). Less than ten years to save the three years” explained Tullis Matson, AI critically endangered Suffolk Punch. services founder. “We can stop this from www.ipswichstar.co.uk/news/less-than-ten-years-to- happening using new technologies, and save-the-suffolk-punch-from-extinction-1-5480386 this can hopefully aid the rare breeds and Suffolk Punch as well.” Suffolk Horse Society (2019). The Suffolk Horse Maga- zine: Issue 100 (Spring 2019). ISSN 1476-959X. Asked on the controversy around ‘cloning’, Matson explained: “People The Telegraph (2016). Britain’s oldest horse breed in think it’s messing with nature … but I battle for survival. think it’s really important we use the www.telegraph.co.uk/news/2016/09/03/britains- tools of the industry – the science and oldest-horse-breed-in-battle-for-survival/ technology – to stop these breeds from going extinct”.

Practical approach to sudden death in cattle Sudden or unexpected death of cattle can be a challenging investigation for the large animal veterinary surgeon. Many cases will involve an insurance claim, so accurate record keeping is imperative. Lee-Anne Oliver BVM&S CertAVP (Cattle)(Sheep) Although the death appears MRCVS to be sudden, it is largely age of the animal – is the animal young and therefore dependent on the frequency more likely to have died from other causes? Lee-Anne graduated from the that the cattle are checked by University of Edinburgh Royal the stockman and the level has the animal been ill in the last few days, or has it (Dick) School of Veterinary of stockmanship. There may been losing condition and weight over a long period – Studies in 2007. Having worked have been clinical signs for suggesting an acute (but not peracute) or chronic illness? in predominantly farm animal several hours before death that has the animal been visibly bloated over the last few hours practice for five years, Lee- had gone unnoticed. Table 1 – suggestive of bloat? Anne joined SAC Consulting lists some of the common is there evidence of convulsions during a period of grazing Veterinary Services in 2013 as a causes of unexpected death; on lush pasture – suggestive of hypomagnesaemia? veterinary investigation officer. categorised into traumatic, infectious, toxic (including is there evidence that the animal has been in parturition, In mid-2014, Lee-Anne returned nutritional), metabolic, for example, is a dead foetus partly visible – suggestive to farm animal practice at and miscellaneous. of dystocia? Scott Mitchell Associates in is there evidence suggestive of poisoning as the likely Northumberland where she is Irrespective of the cause of cause, for example, ingestion of yew or water dropwort? now a partner. She achieved death, the same principles are there other animals recumbent with flaccid paralysis, advanced practitioner status of investigation can be others that may have died and a recent history of in cattle health and production followed. Any sudden or spreading of poultry litter – suggestive of botulism? in January 2016, as well as unaccountable death in farm a certificate in advanced stock should always raise was the body found directly under a tree that has signs veterinary practice in sheep in suspicion of anthrax unless of being struck by lightning, or beside a metal fence or August 2018. an alternative diagnosis is object, or are there scorch marks visible on the carcase – made (APHA, 2019). When suggestive of lightning strike? the farmer initially informs have milking cows died suddenly in a parlour – suggestive their veterinary surgeon of of electrocution? a bovine sudden death, the vet – official veterinarian (OV) or not – needs to establish if Figure 1. Questions suggested by APHA to conclude on the anthrax can be reasonably likelihood of anthrax as the cause of death (APHA, 2019). ruled out. The questions in Figure 1 can be used to help decide if anthrax remains the duty vet at their Animal Other findings that may a differential diagnosis. If and Plant Health Agency be suggestive of anthrax there is any doubt, there is (APHA) regional office under are: a history of anthrax an obligation for the private Article 4 of The Anthrax on the premises, recent veterinary surgeon to notify Order (1991). ditching or soil exposure, or

Table 1. Common causes of unexpected death in cattle 0.75 Category Examples hours* Traumatic dystocia, uterine prolapse, injury, lightening strike, stray electric current, traumatic reticulitis, haemorrhage, gut torsion Infectious clostridial disease, acute pneumonia, mastitis, metritis, acute fasciolosis *Suggested Personal & Professional Toxic/nutritional plant poisoning, lead poisoning, acidosis, ‘fog fever’, ‘white Development (PPD) muscle disease’ Metabolic hypomagnesaemia, hypocalcaemia SUDDEN DEATH Miscellaneous jejunal haemorrhage syndrome

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“Any sudden or unaccountable death in farm stock should always raise suspicion of anthrax unless an alternative diagnosis is made” multiple unexplained deaths. has the animal been Unopened anthrax-infected recently handled? carcasses are described as what recent treatment has swollen – with blood oozing been administered? from the nostrils or other has there been any natural openings of the body. dietary change? However, this is not always has there been any dumping the case, as these signs are of waste in the field? not specific to anthrax and has the pasture been grazed are not, therefore, necessarily by animals before? helpful in deciding if anthrax may be involved. The animal’s ear tag should be recorded in cases of litigation If an anthrax enquiry is or potential insurance claims. Figure 2. Carcass of a dairy heifer for external examination. initiated, the keeper of the Photographs of the carcass animal should be advised to and identification marks, keep other livestock away from as well as where the carcass the carcass; as well as any area was found, are also useful. A where the carcass has been, careful external examination or where discharges from the of the carcass can often carcass are present. Drainage provide further information ways in the vicinity of the (Figure 2): carcass should be blocked, haemorrhage, fractures and and the carcass must not be wounds may be clearly visible moved from its location or the – suggestive of trauma premises. Disinfection must the degree of autolysis take place on any surfaces should be noted – autolysis that the carcass has had can often be rapid in cases contact with. of clostridial disease scorch marks on the legs are Carcasses suspected of, or sometimes present in cases known to be infected, must of lightening strike not be opened. Doing so is aqueous or vitreous likely to result in an increase in humour can be easily the number of anthrax spores sampled to diagnose formed – resulting in greater hypomagnesaemia, environmental contamination. hypocalcaemia and More information is available nitrite poisoning Figure 3. Mesenteric torsion. from the APHA website. urea levels within ocular fluid can give an indication Once anthrax has been ruled of renal disease – a common Hazardous to Health mesenteric/intestinal torsion out, further investigation is finding in oak poisoning – (COSHH) legislation. There (Figure 3), organ rupture, required to identify the cause and Beta-hydroxybutyrate should be adequate light internal haemorrhage, of death. A thorough history (BOHB) concentrations drainage, as well as wash metritis, mastitis, plant is vital, and some of the correlate strongly with down and disinfection of poisonings, acute fasciolosis, questions in Figure 1 will have BOHB in serum (Edwards facilities. Alternatively, the dosing gun injuries, acidosis helped to establish possible and Foster, 2009). carcass may be referred to a (Figure 4), and pneumonia diagnosis. However, further local disease surveillance centre. can all be diagnosed from information may be required: A post-mortem examination gross pathology. when was the animal last (PME) may be required as It is beyond the scope of this seen alive? part of the investigation. article to describe a PME in Where a diagnosis cannot what is the animal’s This may be carried out full; alternative texts should be reached from gross vaccination history? by the practitioner in situ, therefore be consulted examination alone, is the animal purchased or with adherence to current (Otter and Davies, 2015). appropriate sample collection home-bred? Animal By-Product (ABP) and Gross examination alone may be required for further what is its reproductive Health and Safety at Work may provide a diagnosis. For laboratory analysis. Before status? and Control of Substances example: traumatic reticulitis, commencing a PME, it is

essential to have appropriate tongue, and are not always References sampling equipment present: easy to find sample pots (preferably ‘black disease’ caused by Animal and Plant Health Agency wide-top) Clostridium novyi presents (2019). Official Veterinarian An- formalin to fix tissues as a distinctive lesion in thrax Instructions [online]. for histopathology the liver. A pale yellowish http://apha.defra.gov.uk/External_ evacuated blood tubes circular area up to six OV_Instructions/Anthrax/index. 21-gauge vacuum tube centimetres in diameter htm. Accessed 27 January 2019. needles and mount surrounded by a zone of permanent marker to congested tissue. ‘Black Edwards, G and Foster, A (2009). identify samples. disease’ can be associated Use of ocular fluids to aid post mor- with fascioliasis tem diagnosis in cattle and sheep. In cases of suspected lead bacillary haemoglobinuria In Practice 31: 1 22-25. toxicity, biochemical analysis caused by Clostridium of the liver and kidney are haemolyticum has distinct Harwood, D (2006). Clostridial Figure 4. Large amount of grain required. Liver selenium and gross pathological findings: diseases in cattle: Part 1. UK Vet Vol in the rumen suggestive vitamin E levels can be useful, red urine, single or 11 November of acidosis. along with histopathology multiple necrotic infarcts of active muscles (heart, in the liver extending up Harwood, D (2007). Clostridial diaphragm, intercostal, to 20 centimetres and a Conclusion diseases in cattle: Part 2 UK Vet Vol skeletal) to confirm a diagnosis jaundiced carcass A logical approach can be 12 No 2 March of white muscle disease. abomasitis caused by applied to investigating Clostridium sordelli in calves sudden death, starting with Otter, A and Davies, I (2015). Making a diagnosis of presents as an oedematous a comprehensive history Disease features and diagnostic clostridial disease can be emphysematous hyperaemic and followed by an external sampling of cattle and sheep post- challenging on gross pathology abomasal lining. examination, PME and mortem examinations. In Practice, alone. Tetanus and botulism laboratory analysis. The 37(6):293-305 diagnosis are often made from A diagnosis of ‘blackleg’, process may take time and the clinical presentation. ‘black disease’, bacillary action may need to be taken haemoglobinuria, and C. during interim periods to Clostridium perfringens type sordelli abomasitis can all be prevent further losses. For D causes ‘pulpy kidney’ and confirmed by a combination of example, if the deaths are demonstrates a combination culture, fluorescent antibody suspected to be owing to of the following at PME: test, and histopathology of feeding mismanagement, such marked autolysis of the the lesions. as in cases of acidosis. kidney in comparison with the rest of the carcass fibrinous pericarditis glucose urea detectable on urine dipstick C. perfringens detected on anaerobic cultures of the small intestine PPD Questions epsilon and alpha toxins detected in the small intestinal contents or 1. Which toxins are detectable in the small intestinal peritoneal or pericardial fluid contents at PME in a case of pulpy kidney? brain may fluoresce under ultraviolet light 2. Which four tissues can be samples for histopathological focal symmetrical examination if white muscle disease is suspected? encephalomalacia: a large amount of perivascular leakage in the white 3. List three things that a stock keeper should be advised to matter cores, as well as do if anthrax is suspected in a carcass before an anthrax the meninges, detected enquiry is carried out? on histopathological

examination of the brain. 4. What bacteria causes 'blackleg'?

Other clostridial chauvoei. Clostridium conditions include: been has carcass

‘blackleg’ caused by the where disinfect and carcass; the move not do carcass; the of vicinity the in been, or where discharges from the carcass are present; block any drainage ways ways drainage any block present; are carcass the from discharges where or been,

keep other livestock away from the carcass and any areas where the carcass has has carcass the where areas any and carcass the from away livestock other keep Clostridium chauvoei 3.

intercostal, skeletal, heart and diaphragm and heart skeletal, intercostal,

– lesions can be found 2. epsilon and alpha toxins alpha and epsilon

associated with the 1.

diaphragm, heart, and Answers

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Telephone integration for a better connected future

We have all been there: the phone rings in a busy practice, the client has a query about their pet and, try as you might, you don’t seem to be able to retrieve the correct record from your management system. It’s embarrassing and inefficient, but help is now at hand from the Spectrum Integrated Telephony module which links client information between a telephone system and the Spectrum management platform.

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hide when calls are received and taken. If the system identifies the caller, their name will be displayed along with the first line of their address. The receptionist then has client information and patient records at their fingertips so that they are able to answer client queries without having to ask the caller to wait while they find their records. The calls can also be transferred internally and the same client details will appear on a new computer screen.

With direct integration to the client record, users can quickly see if the incoming caller has a pet being cared for by the practice, whether they have upcoming booked appointments, their outstanding balance, and any other relevant notes. As the management platform detects the incoming caller number, the reception team can retrieve the correct client record regardless of noisy reception areas and poor signal quality.

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Spectrum Integrated Telephony will record the information of all the incoming calls throughout the day: when they were received, whom they were by, how long the call lasted, and will also list calls that went unanswered. This is an excellent telephone monitoring tool for the practice manager, who can use this information to design the most hen a call is received in the practice telephone efficient telephone answering service. system, Spectrum is able to identify the client Wcalling via existing stored practice data, and Spectrum Integrated Telephony will improve your will automatically bring up the client’s record on the client’s telephone experience and the efficiency of your screen. A blue phone icon on the main client selection reception service with a telephone system integrated screen alerts users to incoming calls, and the colour of into your management platform. the icon will change as calls are received and their status is progressed.

Calls appear in the Phone Call Active Queue window which can be moved to anywhere on the screen. This window can be configured to automatically pop-up and

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• Scheduling tasks • Monitoring progress • Recording and ﬁling results

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Student experiences and choosing farm animal practice I first came to Northumberland as a fresh-faced 19-year-old in the Easter of my first year for a hastily organised lambing placement. Indeed, I only checked where the county was after signing up, with some vague idea that it was somewhere in ‘the North’. This corner of England is, much to the satisfaction of the residents, little Kaz Strycharczyk visited compared to similar areas to the South and West. I quickly realised that, not BA VetMB MRCVS only was I going to one of England’s most rural counties, but that I was heading deep Kaz qualified in 2017 from into its remote hills. St Catharine’s College, Cambridge. Since 2018, he Despite some initial has worked as an assistant apprehension – I might as veterinary surgeon at Black well have been entering the Sheep Farm Health in Rothbury, Arctic Circle – I had such a Northumberland – a member great time, that I returned practice of XLVets*. The each Easter until revision for practice predominantly services fifth-year exams stopped me sheep and beef farms in the UK from doing so. Nonetheless, and abroad. I saw practice at a branch of a large, local mixed practice *XLVets is a community with a good reputation for of independently-owned, progressive beef and sheep progressive veterinary practices work. Similarly, I had a that work together to achieve fantastic time with this team, the highest standards of and it opened my eyes to farm veterinary care. work beyond dairy cows. www.xlvets.co.uk By this point, I had decided that my future lay in farm animal medicine – either entirely, or with a heavy bias. As a native of North East London with only very distant until the autumn. I had a pregnancy diagnosis. I stayed connections to farming, this chance encounter just after there for about six months surprised some of my friends my finals with one of the before joining Black Sheep and family. There was no vets I’d seen practice with Farm Health a fortnight after crystallising moment but, in Northumberland, which its doors opened. The practice instead, a steady stream of resulted in a surprise job offer. is probably unique in the UK placements and clinicians that Two assistants were setting-up for being 100 per cent farm encouraged me; ranging from on their own and needed some animal – with a large majority the West Country to Ireland extra manpower for their of the caseload being beef and to the Midwest USA. On top start-up. sheep. I knew from seeing of this positive reinforcement, practice with these vets farm animal practice So, I was sorted for a job. But I that they were committed dovetailed nicely with other had six months to fill between to creating a practice that interests of mine – agriculture, a summer graduation and the was farmer-focussed and food and the natural world. new practice opening in the vet-owned. Despite being taught by – and following January. Thankfully, 0.75 working with – some excellent a mixed practice in Castle Working in farm practice: hours* vets in small animal practice, Douglas was looking for my experience I found that the ‘paediatrics some temporary help and it The most significant difference with fur’ approach did not provided a great introduction to companion animal appeal to me in the same to farm practice, especially in practice must surely be the way that the challenges of *Suggested Personal & Professional production animal practice did. Development (PPD) “The most significant difference to A natural slacker, I was in companion animal practice must surely be STARTING IN PRACTICE no rush to find a job, so my plan was to kick back the seasonality of workload”

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“Building rapport with farmers takes time ... but more often I find it great fun and professionally satisfying – especially when it translates into a practical change in husbandry that yields results”

practice with told me, “I like advice is given on a ‘do as I say, animals, that’s why I became not as I do’ basis. However, a vet, but it’s the people that the most important piece of make the difference”. That advice is that honesty, integrity has certainly held true for me and attention to detail are all so far. foundations upon which we can use the specifics: Building this rapport with get a mentor who cares, farmers and farm staff takes and ideally more than one. time. It can suffer setbacks, They do not have to be but more often I find it at the same practice, but great fun and professionally they should be at the end satisfying – especially when of a phone when you need it translates into a practical them without judgement. change in husbandry that Never hesitate to get a yields results. It is a different second opinion type of gratification compared look after yourself on and to ‘blue-ribbon’ calls, such off-farm. This includes not as delivering a live calf by putting yourself in harm’s caesarean section or replacing way but also exercising, a prolapse. I find the two meditating and taking time seasonality of workload. With was at first intimidating complement each other nicely; off to see friends a predominantly beef and – my classmates in mixed sometimes it takes a heroic support staff can make or sheep caseload, this is more practice were shunted into ‘firefighting’ session to be break you. Be polite and marked; suckler work is more small animal practice to taken seriously. build a rapport with them seasonal than dairy work, keep them busy. This quiet follow-up on cases, even with sheep work even more so. period is either a drawback I was never particularly if you fear the worse. Set I find this is a positive – you or an opportunity. You could concerned about being from reminders if it helps are able to prepare for busy use this time to contemplate a non-farming background. if in doubt, take more periods and then reflect on your imminent redundancy, Of the four vets at Black samples than you need. It is them afterwards. or you can use it to drum up Sheep, two of us grew up much easier to bin a few at business and develop new farming, and two of us didn’t. the practice than to explain The calving and lambing ideas – CPD for vets and I can certainly see there to a farmer that they need rush is great fun, but if it farmers, health planning, are advantages to working to run an animal through were indefinite, I suspect it marketing, benchmarking with livestock from an early the crush again would eventually grind us your own caseload, age, but I also believe that report laboratory results down. The autumn peak is personal projects and more. relative ‘outsiders’ bring novel promptly to clients, even if an important component Sometimes, necessity is the attitudes and outlooks that it’s bad news of our year, including plenty mother of invention. add value to the practice. decent equipment makes of ram fertility testing and Plenty of clients like to banter your life much easier. ‘PD’ing’ spring calvers. As I continue to enjoy several about the vet from London Persuade your employer to such, there are few ‘typical’ aspects of the job, such with the funny name; get the right kit, then look days, although at different as the seasonality and nonetheless most seem glad after it times of the year we have more the pragmatic approach. to see a young non-local take any opportunity to get routine work booked in than Other aspects are more come to the area and join on-farm, especially during emergencies, and vice versa. fundamental – I enjoy the community. quiet periods. It helps build working outside, for relationships and often you Often, we combine jobs – for example. Otherwise, Recommendations book in your next visit over a example, roughly 40 per cent developing relationships with for starting out in cup of tea of our suckler herds test for clients is what I find most farm practice in my opinion, a Caesarean Johne’s disease and this is rewarding. Our client list is I have learnt nearly as much section is not a ‘Day One made much more convenient tiny compared to a small as I have forgotten since Competency’. Call for for the farmer when we animal practice, but we’re graduating. Any suggestions assistance until you are combine it with ‘PD’ing’. in touch with most at least here come with several caveats; confident that you can The inevitable summer lull every month. One vet I saw not least that plenty of the handle it by yourself

keep your work vehicle Over the next few years, I “Take any opportunity to get on-farm, organised. Knowing that am going to explore certain you are well-stocked topics in-depth; nutrition is especially during quiet periods. It helps will help you to look one that I find daunting and professional and calm I should learn more about build relationships and often you book in in emergencies it. I currently spend about a your next visit over a cup of tea” don’t forget that you need month as a locum each year, to record medicine batch and I am keen to continue numbers so that your this as it allows me to see how clients can note it in their other practices do things and medicine books I get some dairy work under keep in touch with my belt. classmates and share your experiences with them – I am keen to do some work good, bad and ugly abroad, especially in New don’t stay in a job where Zealand, although for now you feel consistently I’m staying put as I am undervalued or where you still learning a lot with a aren’t supported. supportive team of vets.

The future As for the practice, Black At the time of writing, it Sheep is currently going has been just under two from strength to strength, years since I graduated. As a and is now cemented in the practitioner, I’m happy that I local farming community. It make a competent veterinary remains to be seen how our surgeon and that I am able clients and, by extension, the to deal with routine and practice, will be affected by emergency complaints, as well future trade arrangements. as some of the more exotic. Some events are out of our I have no doubt that there is hands – we will continue to still plenty to learn and that offer the service we believe I am far from the ‘finished our clients want, need product’ – if that exists. and deserve.

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Farm animal welfare – a Catch-22 Speaking at the BVA Animal Welfare Forum on 5 June, Professor Jim Reynolds from Western University of Health Sciences, California, warned the UK not to dilute its high animal welfare standards in order to secure trade deals with the US.

Along with other speakers, he argued UK Ministers have been warned, however, flats and, occasionally, factory-farmed that vets play a key role as advocates for not to water down animal protection laws livestock. They generally fail to recognise animals, even if this requires speaking after Brexit, as a recent poll2 found eight that it is their insistence on cheap food uncomfortable truths about issues. in 10 people believed legislation should that is a major factor in precipitating the According to a report in the Veterinary be maintained or strengthened when welfare problems on farms. Record, he argued that US livestock vets Britain leaves the EU. And it is worth do not speak out enough about animal recalling that there was a public outcry in So where is the veterinary profession in welfare issues and, as a result, welfare is late 2017 when the Government dropped all of this? After all, Professor Reynolds less consistent than in the UK. recognition of animal sentience from the mentioned the importance of vets “raising EU Withdrawal Bill. their game”. To be fair, the BVA has Professor Reynolds added that taken a vociferous lead on the matter – maintaining the UK’s current standards Yawning gaps although words and achievements, such in any post-Brexit trade deals could help Yet now, even with all the much vaunted as having vets restored to the Shortage to pressure the US to change its own. welfare schemes – RSPCA Assured, Red Occupation List, are only of any use when “Our system has changed over the years Tractor and so on – there are still regular turned into practical solutions. And here from a supply management system to a reports of cruelty and neglect on farms. there is a mismatch. commodity-based system in which the Only a few weeks ago, two farms near profit margins are low … so America’s Eye in Suffolk were suspended from high A substantial part of food standards and looking desperately to export low-value welfare assurance schemes, following meat inspection, together with some products. That’s how we make money.” the release of undercover footage that farm animal welfare work, is carried out showed a range of animal welfare issues by OVSs, many of whom are EU citizens, He argued that while the UK has high and abuse.3 who will not necessarily stay in the UK welfare standards, the issue is one after Brexit. And despite their much of confidence – whether animals are The pressure group, Animal Justice heralded ‘special status’, the numbers of represented in all circumstances and Project, went undercover at Trees Farm EU vets applying to work in the UK are whether assurance schemes take into and Brome Grange Farm, between already declining. account the lives of the animals. February and May this year. As a result of its findings, Trees Farm was excluded Food hygiene and welfare work are not UK – a curate’s egg from the RSPCA Assured scheme, which ‘top of mind’ for most UK vets either, Certainly, the recent Animal Welfare promises higher animal welfare standards; including the projected influx of young (Sentencing) Bill1 means that animal Tesco suspended Brome Farm, which vets qualifying from the increasing abusers could one day face up to five supplied chicken to the retail giant; whilst number of veterinary schools. years in prison, which is a significant the Red Tractor scheme was suspended increase from the current maximum on both farms. So stiffer sentences and tighter sentence of six months. In fact, it will regulations, combined with high-minded make it one of the toughest sanctions in But it does raise questions about the political statements, may appear to be Europe, strengthening the UK’s position level and standards of routine policing. highly laudable; yet without appropriate as a global leader on animal welfare. Notice that in the case cited above, all the commitment by the veterinary profession accreditation stakeholders held up their and adequate numbers of Wellington hands in horror, and there was the sound boots being placed firmly on the ground, of slamming stable doors. But who was they are but hollow sounding rhetoric. actually checking? Anyone? And Professor Reynolds’ rallying call After Brexit, this situation is not likely simply turns out to be a feeble cry in to improve. Pressures will increase on the wilderness. consumers and producers alike as the economy enters recession, cheaper Sources imports begin to displace home-grown 1. www.gov.uk/government/news/gove-delivers-new- products, and expectations increase on bill-to-punish-animal-abusers farmers – exacerbated by supermarkets – 2. www.wcl.org.uk/warnings-of-public-dismay-as- to reduce costs of production. animals-become-victims-of-brexit.asp Who will step up to the plate? 3. http://mrcvs.co.uk/en/news/18512/Undercover- footage-reveals-animal-abuse-at-Suffolk-farms When it comes to the subject of animal welfare, members of the public generally conjure up images of puppy farms, dog fights, elderly people hoarding cats in

Livestock farmers are an essential part of the solution The original idea of this ‘Insight’ was to explore the consequences of Brexit on the UK sheep farming industry. Yet, however serious and economically damaging these things might be to local farming structures and community livelihoods, they reflect a bigger and wider debate on sustainability of livestock production as a whole, in the face of global climate change.

Underlying all these issues is the fact that initiation of any change of direction in “In the UK, where two-thirds of the farmland is only suitable for agriculture is similar to the manoeuvring grazing livestock, 56 per cent of the roughly 49 million tonnes of an oil tanker at sea – it involves anticipation and navigational certainty, of CO2 equivalent emitted annually comes from methane” unavoidable delayed responsiveness and a finite period of time in which to execute the change of course. 37,000 carcasses a week that are usually Decades of policy designed to create cheap sent to Europe could be stopped and this food have degraded the environment and So, contrary to the perception of most meat would flood the domestic market. spiralled ill-health [obesity and Type 2 consumers and politicians, a sheep diabetes] claims a recent report3, entitled farmer in Wales, running a flock of The report also warned that the impact ‘Our Future in Land’, compiled by the several hundred ewes producing even on farmers could be a 24 per cent RSA Food, Farming and Countryside more lambs, cannot change course at the decline in lamb prices at market and an Commission, and created rural poverty and behest of political whim or a contrived 87 per cent fall in beef exports, while stress on farmers. trade deal. Like the captain of the oil non-EU imports into Britain could rise tanker, he or she needs time. Time to substantially. And trade barriers will ‘Farm gate prices are low; and whilst food plan for change, months – even years – in plunge profitable farmers into loss. in the supermarkets is getting cheaper, the advance, to breed stock or diversify to true cost of that policy is simply passed meet market needs, all constrained by Mr Roberts said cattle, sheep and pork off elsewhere in society,’ states the report. the rigours of seasons and weather. farming contributed £688m to Welsh ‘The UK has the third cheapest food agricultural output and made a “huge amongst developed countries, but the As vets, we are all acutely aware of this. contribution to Welsh communities and highest food insecurity in Europe’. And the louder we shout about it, the way of life”. He concluded: “It is difficult better. If ever there was a time to support to think of any time where we have faced According to the report, many farmers our farming clients, it is now – through such uncertainty as to where the future are at a loss to know what to do for the action, not just words. markets for our products are.” best. Agro-ecology or high-tech solutions? More intensification, extensification or A stark warning was delivered by Kevin And therein lies the nub of the whole Brexit diversification? And how to disinvest Roberts, chairman of the Welsh Red debacle. Its uncertainty. A disconnect from investments made in good faith? Meat Levy Board at the Royal Welsh between ideology and the relentless ‘We found farmers open to change but Show in July, when he pointed out that realities of life faced by ordinary people, anxious, and locked into their current a 31 October Brexit deadline would such as farmers and the communities and business models by debt, skills or expose the Welsh sheep industry to a allied businesses they support. circumstance,’ it concludes. “Halloween horror story” if it brought a no-deal scenario and tariffs. Time to respect food and farmers And if this were not enough, livestock Immediately after WWII, farmers – who farmers find themselves increasingly According to a report1 in Farmers had literally fed the nation throughout caught between a rock and a hard Weekly, he said: “The impact would no the course of the war – were held in place when it comes to climate change longer be seismic, it would be off the high regard by the population; and the – especially from sustainability projects Richter scale and produce a fault line purchase of food represented almost half which appear to focus on methane fissure right through Welsh farming’s of household expenditure. emissions from ruminants alone. immediate future.” Nowadays, following years of highly polluting But yonder shines a light Mr Roberts referenced new research2 global transport expansion, a wide range Yet there is hope. Sometimes, life throws by sources, including the Agriculture of non-native products and out-of-season up strange bedfellows. and Horticulture Development fruit and vegetables are imported annually Board (AHDB), calculating that and cheap imports of meat are available Such a moment happened in July at a combined beef and sheep meat exports from countries in which production welfare conference organised by the Sustainable to the EU could decline by 92.5 per cent, standards leave much to be desired. And the Food Trust at which ‘Extinction Rebellion’ co- with lamb export trade most severely purchase of food represents only around 10 founder, Gail Bradbrook, shared a platform affected. In a no-deal scenario, the per cent of household expenditure. with NFU president, Minette Batters.

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greenhouse gas, but can also store carbon dioxide in soils, trees, and plants.

Farming practices such as minimal tilling of the soil, planting cover crops between main cash crops, and crop rotation can all help boost the organic matter in soil so it holds more carbon. Additional gains can come from planting trees, hedges, and other flora.

Even cows and sheep can be part of the solution. As they graze grasslands, they spur growth of vegetation, accelerating the carbon cycle, and holding more gas in the soil.

An FT article [23 July]4 described how Less emotion in tackling the issues Currently, there is no policy framework to Ms Bradbrook had a stark message for According to the FT report, agriculture count on-farm carbon storage, or to give farmers as she suggested that, given their produces three main gases that farmers credit for such initiatives. But this reliance on the land, farmers should ally contribute to global warming – nitrous must be rectified in a big way such that with the Extinction Rebellion movement oxide from fertiliser use, methane from farmers are encouraged to evolve the way ahead of protests planned for autumn in livestock, and carbon dioxide, that comes in which they approach their production London. “Join us and bring your tractors!” from electricity or fuel for machinery. criteria – even one day maybe getting paid for storing carbon. This moment captured the dilemma facing In the UK, where two-thirds of the British farmers. For, as with other sectors farmland is only suitable for grazing Ultimate responsibility of the economy, agriculture will have to livestock, 56 per cent of the roughly 49 But, despite the glimmers of hope contribute if the UK is to meet its pledge to million tonnes of CO2 equivalent emitted beginning to show by encouraging reach net zero carbon emissions by 2050. annually comes from methane. Nitrous farmers to be part of the solution, the But farming, which accounts for roughly oxide accounts for a further 33 per cent ultimate responsibility lies with us all as nine per cent of national emissions, is and carbon dioxide 11 per cent. consumers, because not everyone acts on already confronting a period of profound their ethical concerns when shopping. change as it contemplates the prospect of The largest source of greenhouse gases life outside the EU. is from dairy cows, which naturally emit A blog on the ‘Wicked Leeks’ website5 methane as they digest their food. Manure quotes a recent survey by global research Ms Bradbrook claimed that economic and straw collected from housed cattle, company, StreetBees, which claims its growth falls by one per cent with every stored outdoors and subsequently used as data prove that people ‘regularly say one degree of warming. She also noted fertiliser also contributes to the problem. one thing, but do another’. It collected consumerism as a cause of environmental information from 2,500 consumers degradation, saying: “The ultimate cause So, the biggest wins may come from relating to their ‘claimed’ and ‘actual’ is overpopulation and overconsumption measures that help raise livestock while sustainability buying decisions. Around by the rich. If people reduced their minimising methane emissions – through 80 per cent of respondents said they consumption to that of the average dietary management and better manure consider sustainable issues when making European, emissions would go down handling. Research is also under way to purchases – but only four per cent said by a third. There is an issue here about determine whether some sheep and cattle they act on this at the point of buying! individual action as well as policies.” breeds naturally emit less methane. Our hypocrisy must be exposed Minette Batters, joined Ms Bradbrook Reducing chemical fertiliser use is also and confronted. in highlighting the severity of the climate important – one way is to inject it into crisis. The NFU has called for net zero fields instead of applying it on top, and carbon emissions from agriculture by satellite imagery can be used to apply only 2040. But British farmers face other where needed. major challenges, including access to Sources seasonal Eastern European labour and More co-operation and 1. https://www.fwi.co.uk/news/eu-referendum/no- the lowering of quality and welfare encouragement in creating solutions deal-brexit-a-halloween-horror-story-for-sheep-industry standards to secure any proposed trade In addition to finding ways to cut 2. https://ahdb.org.uk/knowledge-library/red-meat- deal with the US. emissions, policy makers and government route-to-market-project-report scientists must come up with ways to 3. https://www.thersa.org/globalassets/projects/ And overshadowing both of those issues measure and audit how much carbon is psc/ffcc/reports-2/1.-our-future-in-the-land_executive- is the prospect of a no-deal Brexit. being stored on farmland. Such work is summary_ july19.pdf “No deal will set us back decades. It crucial because farming differs in one 4. https://www.ft.com/content/7d522ad8-abb4-11e9- is catastrophic. If we have no deal, we important way from other polluting 8030-530adfa879c2 won’t be able to negotiate for anything sectors such as power generation or 5. https://wickedleeks.riverford.co.uk/news/ on standards,” said the NFU president. transportation – it not only generates environment-ethics/most-shoppers-ignore-ethical-issues

A guide to common diseases affecting the reproductive tract of rabbits and rodents Convenience is underpinning the trend for rabbits and rodents to be kept as pets by Siuna A Reid adults or as the main pet in the family. They do not need regular commitment to BVMS Cert AVP (ZM) MRCVS exercise, take up less space and can be left unattended with a supply of food and

Siuna graduated from Glasgow water for longer periods of time. The concomitant provision of better health care for University Veterinary School in these species – including more regular visits to the veterinary practice – is putting 1990 and worked in Thornton- veterinary professionals under more pressure to be able to provide up-to-date, Cleveleys, Lancashire, before buying The Veterinary Health cutting edge advice and treatment. Centre, Lytham St Annes in 1995. In 2000, the practice The reproductive system of “… provision of better health care for these moved to Greenways, male and female mammals Lytham St Annes. is, fundamentally, the same. species – including more regular visits Siuna enjoys all aspects of Females have paired ovaries to the veterinary practice – is putting small animal medicine and that release eggs into uterine surgery with a particular horns where they are fertilised, veterinary professionals under more interest in exotic medicine and the foetuses implant and and surgery and in 2012, she grow. All have at least one pressure to be able to provide up-to-date, was awarded the Certificate in cervix and babies are born via cutting edge advice and treatment” Advanced Veterinary Practice the vaginal canal. Males possess (Zoological Medicine). She two testicles and a penis. has written a series of six therefore, more or less and the inguinal ring remains books under the Reptiles Are There are, however, species variations. always in oestrus and open allowing the testes to Cool banner – designed to copulate then ovulate. move freely in and out of provide simple and clear care Rabbits the abdomen. The penis is instructions for owners of these The male rabbit long, tubular and erectile but fascinating creatures. The female rabbit The female rabbit has two The reproductive system of contains no Os penis. Sexual ovaries, two uterine horns the male rabbit is similar maturity is similarly dependent that have two separate to that of other mammals. on age and breed. cervices. The ovaries lie under However, it consists of two the kidneys, hidden in the testicles that sit externally Rodents mesometrium. The cervices within two hairless scrotal Rodents commonly enter a large vagina where the sacs. The testicles descend seen in practice are the vulva enters mid-way. There into the scrotal sacs between suborder Myomorpha and is also a vestibule exiting two and three months of age, Hystricomorpha. Myomorpha through the urogenital orifice. Laterally lie the Bartholin and preputial glands.

The age at which sexual maturity is reached very much depends on the breed of the rabbit and also body size (Figure 1). A 1.25 rough rule of thumb is that most hours* rabbits reach sexual maturity when 75 per cent of their adult weight and size has been achieved – normally between four to six months. *Suggested Personal & Professional Development (PPD) Rabbits do not have a true oestrous cycle and are Figure 1. The age at which sexual maturity is reached very much REPRODUCTION considered reflex ovulators. depends on the breed of the rabbit and also body size. Adult female rabbits are,

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Figure 4. There is no true Figure 3. Female chinchillas scrotum in male chinchillas and have a urinary cone that can be the scrotum and testes are Figure 2. Remove males to prevent unwanted pregnancies. mistaken for a penis. freely mobile. are all rats, mice, hamsters bicornuate uterus. They have Male chinchillas she is caring for the young and gerbils. Hystricomorphs one cervix and vagina. There is no true scrotum in during the first two weeks are all chinchillas, guinea pigs chinchillas and the scrotum post partum. and degus. Female guinea pigs and the testes are freely Female and male guinea pigs mobile (Figure 4). Chinchillas Dystocia The female rodent have a soft fibrocartilaginous do not have an Os penis. Dystocia can occur in any Only female rodents have pubic symphysis that fuses species; but is particularly nipples and the mammary after one year of age. Dystocia Reproductive diseases common in guinea pigs, tissue in both female rats, is common in females if From a reproductive where pregnancy is attempted mice, hamsters and gerbils breeding is attempted after anatomy perspective, after the pelvis has fused at is extensive. Rodents differ one year of age, owing to the rodents and rabbits are six to nine months. Under from lagomorphs – such as ossification and narrowing of similar. Hence, many of these circumstances, the rabbits, hares, picas and the pelvic canal. the conditions that affect pelvic canal is invariably too other mammals – in that the reproductive tract of narrow – necessitating an they have a separate vaginal Female chinchillas and both male and the female emergency Caesarean section. opening. This is normally female degus rabbits and rodents overlap. For the remaining rodent and not patent and covered by The female of these species However, there are some lagomorph species, obesity, a vaginal membrane until have a urinary cone that can conditions – such as uterine uterine inertia, small litters oestrus or parturition. be mistaken for a penis (Figure neoplasia – that are more can all result in dystocia. 3). As with other rodents, the common in rabbits than in Rodents are also vaginal membrane is closed rodents. Therefore, listing Clinical signs include sudden polyoestrous and ovulate except during oestrus and the conditions is an attempt death, finding the body in spontaneously. All female parturition. Chinchillas have to simplify the conditions. the cage overnight, straining, rodents ovulate immediately two uterine horns and All of the conditions discharge, depression and postpartum – perpetuating two cervices. mentioned are possible collapse. If the state of the the species and necessitating across all the species. patient is sufficiently robust, the removal of the male Male rodents then treatment by Caesarean to prevent unwanted The reproductive anatomy of Reproductive diseases section should be considered. pregnancies (Figure 2). the male rodent consists of of rodents two testicles, an erectile penis Cannibalism of young Mammary tumours Most myomorphs with an Os penis. The inguinal Cannibalism is common In rats, mammary tumours are are polyoestrous and canals remain open and they amongst certain breeds most often fibroadenomas. spontaneous ovulators; have accessory sex glands. of hamsters, such as Mammary tissue is extensive whereas hystricomorphs are the Chinese hamster. and found ventrally and slightly different. Guinea Male guinea pigs Primiparous females who are dorsally over the shoulder pigs are polyoestrous and The male guinea pig has an stressed – most commonly blades and around the pelvis. spontaneous ovulators, Os penis and the inguinal by the owner handling them Most of these tumours chinchillas are seasonally canals are open. However, inappropriately – indulge in respond well to surgical polyoestrous and degus are they also have large vesicular this unwanted behaviour. removal. Ovariohysterectomy induced ovulators. glands that extend into the reduces oestrogen and abdominal cavity. Care must It is important to educate pituitary development, Female rodents have two be taken during surgery of owners that if they have which subsequently reduces ovaries, uterine horns that this area, because they can be a pregnant hamster, they oestrogen and come together to form a mistaken for uterine horns. should not handle her whilst growth hormone.

Treatment and prevention Ovarian cystic disease involve surgical removal and This condition is remarkably ovariohysterectomy (Figures common in both guinea 5, 6a & 6b and 7). pigs and gerbils. It is most common in the older female Mastitis and often affects both ovaries. There are several bacteria that The ovaries form cysts that are responsible for causing are referred to as cystic retes mastitis in hamsters – such ovarii. Clinically, the sows are as Pasteurella, β-haemolytic often very well in themselves, Streptococcus and but have a hugely distended Pseudomonas aeruginosa. As abdomen (Figures 8 & 9). is the case in other species, Non-pruritic, truncal alopecia predisposing causes for is also commonly seen. mastitis in guinea pigs include trauma and dirty bedding. Treatment of choice is Figure 5. A small mammary mass prior to surgery. ovariohysterectomy. Often Clinical signs for all species these sows are elderly on include hot, painful, red, presentation and have other swollen mammary tissue with concurrent conditions. pyrexia, anorexia, depression The cysts can be drained and rejection of the young. percutaneously with a needle Culture and sensitivity can and syringe, however this only be obtained from the milk in gives temporary relief (Figures order to devise an accurate 10, 11 & 12). antibiotic treatment protocol, accompanied with pain relief Various medications can and surgical resection, where be tried to manipulate the necessary. The young may ovarian cysts – such as need to be removed and hand- leuprolide acetate injections fed or surrogate-fed. (100μg/kg SC once weekly 6a. for three weeks) and human Mycoplasmal endometritis chorionic gonadotrophin Infection with Mycoplasma (1,000 usp once weekly for pulmonis is the most three weeks). However, there common and most serious are risks of allergic reactions respiratory pathogen and also the cysts can of rats. It affects the continue to grow and return respiratory epithelium, but over time. also the middle ear and the endometrium. Treatment to Pregnancy toxaemia be considered may include Pregnancy toxaemia describes 6b. enrofloxacin (10mg/kg an imbalance in energy where orally q12h for 14 days), the pregnant uterus and Figures 6a & 6b. During surgery to remove a large mammary mass doxycycline (75mg/kg SC lactation use more energy and (b) after the operation. depot 7+ days), nebulisation than the body consumes. In and meloxicam. order to make up the energy

Figure 8. Large cyst palpable Figure 9. Radiograph (D/V) Figure 7. Ovariohysterectomy in a rat. through abdominal wall. showing mass.

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Figure 10. Ultrasound picture showing multiple cysts. Figure 11. Ultrasound-guided drainage of the largest cysts. Figure 12. Clear cystic fluid. deficit, the body starts Male rodent disease pain relief. Separation and linked to uterine disease, and to break down body fat, Testicular tumours prevention of future fights is treatment and prevention which results in metabolic These are not commonly seen also important. involve surgical removal acidosis and ketosis. If this in male rodents. and ovariohysterectomy. situation is not reversed Diseases of female rabbits immediately, then the female Cryptorchidism Mastitis Pregnancy toxaemia and the foetuses are in fatal The testes are normally There are several bacteria As described above for danger. It is important not descended by 12 weeks of that are responsible for female rodents, pregnancy to change the diet during age. Most rodent inguinal this condition in rabbits, toxaemia is an imbalance in pregnancy in order to prevent canals are huge and patent. which is usually seen in energy where the pregnant gastrointestinal upset or any Any testicle that has not either lactating or pseudo- uterus and lactation demand risk of metabolic acidosis. appeared by this age is pregnant does. The more energy than the body considered cryptorchid. pathogens involved include consumes. Approaches to its Clinical signs include Treatment is castration. Pasteurella, β-haemolytic management and treatment sudden onset lethargy, Streptococcus and are the same. anorexia, depression, inco- Fur rings and paraphimosis Pseudomonas aeruginosa; ordination and recumbency. This is a condition while predisposing causes Pseudopregnancy Treatment requires occasionally seen in chinchillas for mastitis include trauma This is a relatively common immediate intravenous fluid possibly owing to the flaccid and dirty bedding. condition seen in female therapy with glucose and nature of the penis and the rabbits when mating has replacement of calcium absence of an Os penis. Fur Clinical signs include been unsuccessful. It can gluconate and magnesium collects around the head of hot, painful, red, swollen also occur in the absence sulphate. It is important to the penis and, if not removed, mammary tissue with of any mating and results in prevent this condition. can cause a stricture leading pyrexia, anorexia, the rabbit showing ‘nesting’ to paraphimosis, permanent depression and rejection behaviour – nest building Pyometra damage or amputation of of the young. Culture Note that it is common the penis. and sensitivity can be to mistake the normal obtained from the milk vaginal discharge seen Trauma for an accurate treatment in hamsters during Fights – particularly between protocol, with pain relief oestrus as a pathological males of any of the above and surgical resection, discharge. If there is doubt, species – can result in where necessary. The young cytology should be used in serious damage to the penis, may need to be removed and differentiation. Treatment testicles and scrotum. The hand fed or surrogate fed. is ovariohysterectomy wounds may need surgical (Figure 13). debridement, antibiotics and Mammary tumours In rabbits, these often start as cystic masses which then develop into mammary “… many of the conditions that affect the adenocarcinomas. Certain reproductive tract of both male and the breeds are more prone than Figure 13. Pyometra in a others – such as New Zealand guinea pig. female rabbits and rodents overlap” White and Belgian. Most are

PPD Questions

1. The reproductive system of rabbits and rodents has many species variations. Mark the following statements as true or false. A. rabbits do not have a true oestrous cycle and are considered reflex ovulators B. in the male rabbit, the penis is long, tubular and erectile and contains an Os penis C. rodents commonly seen in practice are the suborder Myomorpha and Hystricomorpha D. rodents differ from lagomorphs, such as rabbits, hares, picas and other mammals reproductively, as rodents have a separate vaginal opening Figure 14. Orchitis and epididymitis are uncommon conditions but E. female and male guinea pigs have a soft may be seen after infections. fibrocartilaginous pubic symphysis that fuses after one year of age – dystocia is not common in females if and pulling out hair. Without syphilis (Figure 14). Treatment bred after six months of age. treatment, this can progress involves the use of antibiotics to hydrometra or pyometra. and pain relief. Medical manipulation with 2. Dystocia in rodents and lagomorphs is commonly progestins, androgens and Myxomatosis can be prevented caused – or complicated – by certain conditions. Which cabergoline has not been by the use of an appropriate is the most common cause of dystocia for guinea pigs? proven to be successful. vaccination programme. A. where pregnancy is attempted after the pelvis has fused at six to nine months Uterine neoplasia Trauma B. obesity This is the most common Fights – particularly between C. uterine inertia form of neoplasia seen in males – can result in serious D. small litters female rabbits, with a very damage to the penis, testicles E. infection. high incidence in individuals and scrotum. The wounds may over three years of age. As need surgical debridement, 3. In rats, mammary tumours are most often many as 50 to 80 per cent of antibiotics and pain relief. fibroadenomas. Which of the following statements are entire females are affected, Separation and prevention of true about mammary tumours in rats? with clinical signs varying future fights is important. A. most of these tumours respond well to from depression, anorexia, surgical removal haematuria and mammary Conclusion B. mammary tissue is extensive and found ventrally and development. Metastases to Many of the conditions in dorsally over the shoulder blades and around the chest region are common, rabbits and rodents, with the pelvis although the tumours are which we are presented in C. ovariohysterectomy reduces oestrogen and pituitary usually slow growing. small animal practice, may development, which subsequently reduces seem impossible to manage oestrogen and growth hormone Prevention by ovario- owing to the small body size D. the use of implants such deslorelin may also help to hysterectomy is key. When of the patient. However, all control mammary growth uterine neoplasia is suspected, of the general skills used in E. the tumours grow back very quickly. serial radiographs of the mainstream canine and feline thorax and abdomen are medicine and surgery can be 4. Ovarian cystic disease is common in gerbils and guinea recommended to rule out utilised to treat these patients. pigs. Which is the treatment of choice? metastases prior to surgical A. leuprolide acetate injections 100μg/kg SC once weekly ovariohysterectomy. So, for instance, with extra for three weeks care, ovariohysterectomy B. hCG (human chorionic gonadotrophin) 1,000usp Diseases of male rabbits of rats and smaller species once weekly for three weeks Orchitis and epididymitis can be perfected, thereby C. to do nothing These are uncommon offering the client prevention D. ovariohysterectomy conditions but may be of mammary tumour E. the cysts can be drained percutaneously with a needle seen after infections with development in their pet.

and syringe.

Pasteurella, myxomatosis and

D. 4.

A-E [all true] [all A-E 3.

“… all of the general skills used in mainstream 2.

A True, B False, C True, D True, E False E True, D True, C False, B True, A 1. canine and feline medicine and surgery can be Answers utilised to treat these patients”

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CM 1989 2019

MY CY AT S CMY VET STEM K ERINARY SY

CELEBRATING 30 YEARS supporting the veterinary profession

www.vetsystems.com 01359 243 400 | [email protected] ONLINE EDITION BIRD MIGRATION | WILDLIFEONLINE and EXOTICSEDITION

Tracking birds for research and conservation Many birds undertake remarkable journeys – moving between habitats and sites, crossing continents or even vast expanses of ocean. Such journeys can make understanding their ecology a challenge for researchers and those involved in species conservation. Mike Toms

Mike Toms is head of Take the case of the cuckoos “UK cuckoo populations have declined by communication at the British that breed here in the UK Trust for Ornithology, www. as an example. UK cuckoo three-quarters since 1967…” bto.org – a charity whose staff populations have declined by and volunteers monitor change three-quarters since 1967 and the bird carrying it. This is not collect and store information in the environment, delivering British Trust for Ornithology as accurate as GPS – typically on the bird’s location, which is the information used to plan (BTO) researchers have been the best locations are accurate then downloaded at a future and assess conservation working to understand why to within 500 metres, whereas date when the bird is either action, and informing decision- (Figure 1). GPS has an accuracy of just recaptured or is in the vicinity making processes for the a few metres. It is, however, of a base station. One such benefits of society, wildlife and The drivers of cuckoo decline very accurate on a global and device is the geolocator – no the natural world. might be located here in the UK, on their breeding regional scale and provides a bigger than a shirt button, far more reliable and detailed this device has an in-built Formerly the lead for work on grounds; but they might track than smaller tracking electronic calendar, a clock garden birds, Mike has been equally be operating in the devices, such as geolocators. and a light sensor that heavily involved in research wintering areas within Africa monitors daylight against the into the effects of feeding or somewhere along the Return to sender clock and calendar, storing garden birds and the BTO’s migratory ‘flyways’ used by The devices used on smaller this information within the work on disease. the species. Understanding the journeys made by our cuckoos birds – usually those weighing device’s memory. Once the – and what happens to them less than 100g – typically device is recovered, scientists along the way – can reveal the factors driving decline. Tracking methods GPS, PTT and Geolocator tagging On the wing systems all use different systems of calculating A range of devices are available their position. to researchers following the journeys of birds – both at the scale of movements within a home range and those covering an entire migratory cycle. Manx Shearwater The latest platform terminal GPS: Uses several transmitters (PTT) tags, linked satellites to the Argos satellite-based system, enable birds weighing Cuckoo Doppler PTT: as little as 100g to be tagged Emits signals to satellite with devices that can reveal the location of the bird without its needing to be recaptured.

PTTs transmit basic data Swift about their functioning Geolocator: 0.5 Uses light levels * to estimate hours that is picked up by the location Argos satellites as they pass overhead. Owing to the Doppler effect, a shift in wavelength of these radio *Suggested Personal & Professional transmissions occurs as the Development (PPD) satellite passes overhead and this allows the ground-based Figure 1. A range of devices are available to researchers following BIRD MIGRATION part of the system to calculate the journeys of birds (Photo: Nigel Hawtin, BTO). the position of the PTT and

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are able to work out where on the planet the geolocator was at any given date and time.

BTO researchers have used geolocators on a range of species, including nightingale, spotted flycatcher and nightjar – using the information gathered to identify wintering areas and the routes used to get there. The downsides of geolocators are that they are far less accurate than larger GPS devices, and they are of very limited use for at least 10 days either side of the spring and autumn equinoxes (when day and night are of equal length).

More recently, BTO researchers have been using high-resolution GPS tracking Figure 2. The downside of GPS tags is that the birds have to be recaptured in order for the data to be downloaded (Photo: Mike Toms, BTO). devices with nightjars – the devices now small enough to be deployed on these birds. of nightjars have been tracked route, through Italy, was region (Hewson et al, 2016). The downside of these GPS as they make their way south predicted from ringing data, The cuckoos tagged in the UK tags is that the birds have to through Europe, across the which showed that some spend the winter in central be recaptured in order for Mediterranean and the Sahara birds breeding in England Africa. For the first time the data to be downloaded to wintering grounds in leave the UK in a south- this project has allowed us (Figure 2). The tags have been central Africa. Initial findings easterly direction. to follow cuckoos to their used by BTO and Natural from this ongoing project wintering grounds, which England staff to examine reveal that autumn migration The second route, down are mainly in and around the the movements of nightjars starts during September and is through Spain and then Congo rainforest (in DRC, breeding in Thetford Forest quite direct – the birds taking entering Africa at the western Congo or Gabon) and in and at Dersingham Bog around six to eight weeks to end of the continent, was similar habitat as far south National Nature Reserve. reach their wintering sites, previously unknown. as Angola. These habitats which are occupied from have not yet been extensively The GPS tags record November through to March. The choice of route appears cleared and, as the cuckoos hundreds of precise locations to have an influence on prefer forest edges rather than at five-minute intervals over The wintering locations an individual’s chances of vast tracks of unbroken forest, many nights, providing the obtained from the GPS survival – the tracking devices a moderate degree of opening most detailed information tags confirm that the main revealing that those cuckoos up may actually benefit them. on foraging movements and wintering area is located in the migrating via Spain were Without knowing which habitat use ever obtained scrub-dominated grasslands much more likely to die before habitats they occupied in the for the species, and derived to the south of the equatorial they reached sub-Saharan past, however, it is difficult to from the tracking of over rainforests, primarily within Africa than those migrating be certain. 50 different individuals. the Democratic Republic of via Italy. Interestingly, the The information generated Congo (Evens et al, 2017). birds using the Spanish route In spring, all of our cuckoos demonstrates the importance Previously, it was thought came from those parts of cross the Sahara from of specific foraging habitats that nightjars only wintered the UK where the species is previously unknown stop-over and their proximity to nest in Eastern and sub-Saharan declining, and the proportion sites in West Africa. Previously, sites. These results will greatly West Africa. of Spanish-route birds in it had been supposed that improve our understanding of local populations correlated cuckoos crossed the Sahara nightjar habitat requirements Growing our knowledge with the degree of recent in a single flight direct from and inform management The work on UK cuckoos, population decline seen in a their wintering locations all and conservation efforts tracked with PTTs and now in heathlands and in its ninth year, has already plantation forests. revealed new and important “As with any tool, it is essential to ensure data (Figure 3). Information BTO researchers have used collected so far has revealed that it is appropriate for the task in hand, the same tags to examine that UK cuckoos use two and that its use does not compromise the nightjar migration. Since different routes to reach the summer 2015, small numbers same wintering grounds. One welfare of the bird being studied”

used to examine how gulls References interact with wind farms and how, more generally, their Evens R et al (2017). Migratory behaviour might put them at pathways, stopover zones and risk of colliding with turbine wintering destinations of Western blades (Thaxter et al, 2018). European Nightjars (Caprimulgus The results support previous europaeus). Ibis View at journal BTO research suggesting website ( DOI : 10.1111/ibi.12469) that lesser black-backed gulls are safer when turbines are Hewson CM et al (2016). Population designed such that the lower decline is linked to migration edge of the blades is 30 metres route in the Common Cuckoo, a above sea level (as opposed to long-distance nocturnally-migrating some current turbine designs, bird. Nature Communications View where the blade tips reach 22 at journal website (DOI: 10.1038/ metres above sea level). ncomms12296) Figure 3. A UK cuckoo (Photo: Edmund Fellowes, BTO). These findings provide Ross-Smith VH et al (2016). the way to North Africa or BTO researchers first tagged evidence that can then be Modelling flight heights of Lesser southern Europe; so this birds breeding at Orford Ness used to shape wind farm and Black-backed Gulls and Great Skuas stop-over – and the dog-leg National Nature Reserve on turbine design, together with from GPS: a Bayesian approach. migration into West Africa the Suffolk Coast, before identifying potential effects Journal of Applied Ecology 53 (part that its use entails – were expanding the project to where a wind farm has been 6) View at journal website (DOI: highly unexpected findings include birds breeding on proposed for development in 10.1111/1365 -2664.12760) from the current work. Skokholm Island off the an area used by foraging gulls Understanding more about coast of Pembrokeshire, and (Ross-Smith et al, 2016). Thaxter CB et al (2018). Dodging the location of important South Walney in Cumbria. the blades: new insights into three- stop-over sites could be The lesser black-backed gull Conclusion dimensional space use of offshore another crucial part of the is protected at all three sites, Tracking devices are an wind farms by lesser black-backed conservation of this species. and offshore wind farms are important tool for those groups gulls (Larus fuscus). Marine either proposed or are already and individuals studying birds. Ecology Progress Series 587: 247- Informing policy and land in operation close to each of As with any tool, it is essential 253 View at journal website (DOI: management decisions the three colonies. to ensure that it is appropriate 10.3354/meps12415) In addition to the valuable for the task in hand, and that its contribution that the tracking The project, which is funded use does not compromise the studies mentioned have made by the Department of Energy welfare of the bird being studied. to conservation action, such and Climate Change, is using tracking data can be used to state-of-the-art GPS tags The use of tracking technology inform land management and manufactured by scientists at is regulated by the Special policy decisions. The BTO has the University of Amsterdam Methods Technical Panel been tracking breeding lesser to explore how this species – an independent panel of black-backed gulls since 2010. might interact with wind experts convened by the This species was classed as farms. These tags are solar British Trust for Ornithology, ‘Amber’ in the most recent powered and download data who assess proposals for Birds of Conservation Concern automatically when birds move all projects involving the Review, and large declines to within a few kilometres of a fitting of devices other than have been reported at several mast located at their breeding standard metal or colour important breeding colonies colony. In addition to the gulls’ rings to birds. We are likely where it is protected. It is, position, the tags transmit to see more studies carried therefore, important to assess data about their altitude out as tracking technologies how these gulls might respond and acceleration. continue to develop, providing to changes to their environment, valuable evidence to support such as those brought about by One of the most important conservation action and the construction and operation components of the data management decisions. of offshore wind farms. collected is that being

“A range of devices are available to researchers following the journeys of birds – both at the scale of movements within a home range and those covering an entire migratory cycle”

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Does your management platform support EBVM? Practising evidence-based veterinary medicine (EBVM) and quality improvement (QI) in veterinary care are becoming increasingly important, and having systems in place to record, retrieve and reflect on clinical cases and outcomes is central to this.

vidence-based decisions combine clinical expertise, the most relevant and best available scientific evidence, patient Ecircumstances and owners’ values. The principles of EBVM provide practitioners with a method of dealing with the large amount of different types of evidence available and applying it to clinical decision-making.

However, in the environment of a busy veterinary practice, having the time to store, assimilate and correlate the large amount of clinical information generated by cases is difficult and can form a barrier to efficient EBVM. For example, the information available is often spread over many different sources (notes, x-rays and laboratory reports) and practitioners have limited time to seek them out and analyse all the information.

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The benefits of EBVM are undeniable, with growth in this Clinical coding area expected to impact on all aspects of veterinary practice. VIPER uses its own multi-species coding system which maps Increasing clinical standards, an expanding range of clinical across to VeNOM codes to avoid replication and allows the interventions, and the need for a sound evidence base user to suggest new entries to the database. If the presenting to underpin practice has led AT Veterinary Systems – in signs, protocols, diagnosis or outcomes are not in the available conjunction with its clinical and education partners – to develop database when inputting information, clinicians can simply VIPER, an acronym for their Veterinary Information Protocols suggest their own and they will be reviewed by the VIPER and Evidence Recording module. VIPER fits seamlessly into their administration team. Spectrum management software and opens the gateway to EBVM with effective case recording, coding and management. Grading schemes The VIPER database contains grading scheme information for Recording information for EBVM both condition and patient severity at initial, active and final To enable the effective practice of EBVM, a careful, clear and stages of a case. These grading schemes create useful graphs for concise way of recording clinical cases is needed – and VIPER tracking patient treatment. Custom grading schemes can also be provides exactly this for the clinician. The VIPER software created which allow experienced clinicians to design their own creates cases and attaches all relevant information such as custom scales for each condition. Practices wishing to record laboratory reports, clinical notes, appointments, inpatient care additional graded data can add custom fields, while cases can and diagrams to the case study. Each case receives a unique also be linked together as secondary conditions. case number, with a linked item icon displayed in clinical notes. Presenting signs, protocols, presumptive diagnoses, final EBVM can help practitioners in a number of areas including diagnoses and review dates can be set for each case – with an optimising clinical outcomes for patients, developing reliable active grading displaying condition severity, along with useful evidence-based practice protocols, and evaluating the efficacy information such as which vet graded the case and on what date. of interventions used within practice. The problem is, as always, having the time to research conditions and collect information. Case management VIPER places at your fingertips all the clinical details of cases The VIPER Administration Window enables veterinary surgeons seen within the practice – providing an invaluable source of to manage the information input from clinical work. A pop- information on which to base diagnoses as well as surgical up box prompts the user to search for recent cases, with the medical and other interventions. surgeon’s own cases displayed automatically. It is easy to sort and filter cases according to the primary clinician, secondary clinician, surgery, species and review date. Cases also have a priority level set, allowing sorting and examination of high profile cases first.

VETERINARY INFORMATICS PROTOCOLS & EVIDENCE RECORDING

To find out more about EBVM and QI contact AT Veterinary Systems today. Call: 01359 243 400 or email: [email protected]

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It’s all there ready to be discovered Those readers of more mature years will recall the launch, in 1976, of two intramammary products – Cepoxillin and Ceporin – by pharmaceutical firm Glaxo, under the marketing strap line, ‘Antibiotics from the Sea’.

This subtext was more than a cursory of the bacterium are becoming increasingly antimicrobial properties. nod to the fact that the first chemical common, opening up a need for new drugs. Through much trial and error, the team – compounds of the cephalosporin group Working with colleagues at Kings which comprised researchers from Stanford were isolated from Cephalosporium College London, Dr Pitt separated sterile and Mexico – managed to synthesise acremonium, a cephalosporin-producing solutions of protein fractions in a novel the compounds. The red benzoquinone fungus first discovered by Giuseppe way, so that smaller portions could be was particularly effective at killing Brotzu in 1948 from a sewage outfall off sent for antimicrobial testing. The team staphylococcus bacteria, while the blue one the Sardinian coast. An unprepossessing were surprised to find that fractions was lethal to both normal and multi-drug- source of several generations of life-saving containing some smaller proteins also resistant strains of TB-causing bacteria. human and veterinary antibiotics. worked against the bacteria. Researchers, publishing in the Proceedings Now fast forward to 2019 to a “Matching them with the international of the National Academy of Sciences2, news story on MRCVSonline in July, database of proteins, we found that no said being able to synthesise the venom is headlined ‘Garden snails offer hope one had reported them before, so they highly important, as the amount of venom for new antibiotic’. It may well be that are newly identified. If we can make the components that can be obtained from our focus for new compounds for proteins artificially in the lab, we can try animals is extremely low. the treatment of bacterial infections and work out what they are doing to the should be more outward looking, bacterium,” she added. “We think that Nature, balance and humility rather than simply relying on the it might be possible to incorporate the This all highlights three important points. potentially myopic constraints of purified protein into a cream to treat deep a laboratory. Mother Nature may burn wounds and possibly an aerosol to First, it adds another compelling well already have the answers – our treat lung infections.” dimension to the global drive to conserve challenge is to discover them. as many species of plant and animal as Healing sting possible and to reverse the decline in Snail pace solution Other similar stories have followed. Scientists biodiversity on our planet. Many potential Dr Sarah Pitt from the University have discovered two healing compounds in solutions to current medical problems of Brighton began collecting the scorpion venom that can kill staphylococci have already been created through frothy mucus from brown garden and drug-resistant TB bacteria. natural evolution. Our challenge is to snails and testing it for antibacterial discover them. activity against a panel of bacteria. The scorpion, Diplocentrus melici is Her research, published in the British native to eastern Mexico and can only Second, there are tensions that must Journal of Biomedical Science1, suggests be found in the rainy season – it is buried be addressed. For instance, in the case that proteins isolated from the mucus during the winter and dry seasons. When of the scorpion venom, there is only a could lead to a new antibiotic cream researchers milked its venom, they noticed finite source; and destroying a species to for deep burn wounds, and an aerosol that it changed from clear to brownish in harvest the antibacterial compounds it for lung infections seen in patients with colour when exposed to the air. contains is neither practical nor a bright cystic fibrosis. idea in the wider conservation sense. So, Two chemical compounds were found to acceleration of efforts to copy potential In previous work she had found the mucus be responsible for the colour change, one antibiotics on a molecular basis in the inhibited the growth of Pseudomonas of which turned red when exposed to air, laboratory are paramount. aeruginosa, which is a very important the other blue. The compounds are two cause of lung infections in patients with previously unknown benzoquinones – a Finally, in searching for solutions to global cystic fibrosis. Antibiotic-resistant strains class of ring-like molecules known to have medical problems, a hefty dose of humility would seem to go a long way. The eminent biologist, Louis Pasteur, said, “In the fields of observation, chance favours only the prepared mind.” And he knew a thing or two about medical discoveries. But perhaps even more telling are the words of Alexander Fleming, “Nature makes penicillin; I just found it.”

1. British Journal of Biomedical Science, 76(3): 129-136. 2. Proceedings of the National Academy of Sciences, 116(26): 12642-12647.

Reception sets the tone for client experience

Penelope Fox BA (Hons) CCMI

Penny joined Blacks Vets in January 2016 as head of client experience and technology after 15 years working in a variety of management positions within British Telecom and in education. Her experience in the corporate world spanned sales, customer service, business development and project management. This was followed by a career change into the world of secondary education; teaching business studies and IT, while While a veterinary practice’s principle focus is, without doubt, the provision of also co-ordinating support excellent pet health care, we are also businesses that compete for market share just for students with special educational needs. Penny was like any other company. When presented with choice, consumers vote with their feet appointed as head of client and and give their custom to the providers that go above and beyond standard levels of team experience the following service. As a client’s first interaction with a practice will likely be at reception, it’s year and appointed to group vital that we don’t underestimate the importance of training and developing our practice manager from 1 September 2018. front-of-house teams to levels that match our high standards of clinical expertise.

Although it takes many years clients and patients alike. candidates. Occasionally, to become a veterinary surgeon Provide a calm and friendly this means losing a promising or nurse, once qualified, it is experience here and you set contender who realises that the possible to quickly become the foundations for a smooth role may not be for them. But, active within the practice. and productive consultation. it does ensure that people start However, for someone joining with realistic expectations. as a receptionist – particularly From the outset, it is It is also a great way for the from outside the veterinary important to ensure that any reception team to feel part of industry – it can take months final interview candidates the recruitment process, with to become fully skilled. It is have at least a half-day trial. their views and feedback being important to embrace this and This is a great way to ensure taken on board as part of the make the training of a first- that the role meets their selection process. class reception team expectations and allows you to one of the core tenets of further assess the candidate’s On trial day, make sure that, business philosophy. suitability. It can also be a other than welcoming the useful way to differentiate candidate on arrival, you 00..755 Invest in the between two strong leave them to spend time hours* development process Reception can be defined as ‘the act of welcoming “From the outset, concentrate on someone or something’ and it is this aspect that training new staff in activities that *Suggested Personal & Professional we need to truly embrace Development (PPD) in our training. Reception they can grasp quickly. Feeling useful is the relatable face of the and adding value really helps new team RECEPTION veterinary practice; providing warmth and reassurance for members to settle in”

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with the team. They will new starters to staff events “Insist that all new entrants – irrespective usually ask more questions in and CPD before they join, this environment and show as well as ensuring that of role – spend time with each functional elements of their character they have their uniform in that would not normally be advance. This way, they feel area of the business. It’s imperative that seen in an interview. You may part of the team from day team members understand the impact of experience a very nervous one and have the opportunity candidate who becomes to wash the uniform so it their actions on others” confident when welcoming feels more comfortable; much clients, and equally the better than scratchy necks and ‘perfect’ applicant who may be folded shirt lines. It is useful Have a dedicated is, they will identify the areas more interested in when lunch to send out selected standard induction plan they want to improve. This breaks are, what the staff operating protocols in advance Each new receptionist should achieves much greater buy-in discount is, and how often they to the new team member so have their own bespoke than if a line manager points have to stay over. Either way, that they can read these and six-to-eight-week induction out areas to improve. it’s a really helpful process, prepare any questions. plan. Each week the plan both for the employer and the should have a set of suggested In the first few days of the candidate alike. From the outset, concentrate activities and objectives. induction, try to let the new on training new staff in The activities drive learning team member listen to some Inclusivity is key activities that they can grasp and the objectives set a clear great examples of telephone An inclusive approach quickly. Feeling useful and expectation of what the team calls. This sets the expectation is essential to building a adding value really helps new member should be able to high and demonstrates in successful reception team. team members to settle in complete by the end of each practice the golden rules to It is considerate to circulate and it builds their confidence. week; often aligning to the abide by, such as: a short biography and a Activities like check-in on previous week’s activities. including their name in photograph of all new joiners arrival, booking routine However, the plan isn’t set in the greeting in advance of their start date appointments, registering stone and often the objectives asking for and using the so that common ground microchips and promoting are met ahead of time, or are pet’s name is built among colleagues ‘four weeks’ free insurance’ slightly out of the set order. introducing preventive care before their first day. It is offers can all be covered as This is fine – it provides a plans where appropriate also a good idea to invite soon as possible. framework to work from and, avoiding putting the client again, aids confidence as the on hold new team member can chart avoiding long silences their own progress. using warm and friendly language The induction plan should being focused on the client cover expected elements such – not on the task. as taking payments, insurance paperwork, call handling It can also be of benefit along with knowledge to use a national mystery development, care plans, shopping programme. protocols and expected Having independent feedback behaviour. Utilise the strength benchmarked against other within the team to support practices is a great way to the new team member measure improvements in call through their induction handling and in identifying plan. This has many benefits, next steps. The team also get including making people great satisfaction from seeing feel valued and providing a how they have improved, measure of progress for them and how they compare to reflect on. against competitors.

Concentrate on Insist that all new entrants – fundamentals irrespective of role – spend Telephone technique is a key time with each functional part of the training for new area of the business. It’s and existing team members. imperative that team members If possible, record all of the understand the impact of client telephone calls so that their actions on others, you are able to listen back and that they understand to them with your teams. where to go for support and Receptionists are generally advice. For example, if a their own worst critics and, receptionist understands why if they listen to their own it’s important that the clinic calls – as uncomfortable as it staff know the exclusions on

situations, so arrange for your training allows them to really “Remember that we are all human – it is teams to undertake an online feel involved and valued. vital to not let new team members feel training programme in pet Ensure that all new entrants bereavement. This will help spend time with the various out of their depth” them to offer compassion and teams or functions in your practical support to clients practice. Make sure they during highly emotional times. understand other roles so a pet’s insurance policy, they what happens, and how the The training is tailored to that they can appreciate why are more likely to remember to clinic looks after their pet, their role and includes online their responsibilities are so capture that information. than if it has been experienced videos, advice and thought- important, as well as the first-hand? This is particularly provoking ideas that cater for impact of not doing them. Likewise, ask all new veterinary important for those team the new entrant and highly surgeons to spend a few hours members who are new to the experienced employee alike. Finally, remember that we working on reception. If they industry; this is an example are all human – it is vital to understand how difficult it can of how that individual’s plan In summary not let new team members be to present an invoice to a would be different to another. It is key to demonstrate feel out of their depth. A client they haven’t seen, they excellence from the start, lack of confidence can lead a are more likely to ensure that Embrace the sensitive and ensuring standards are set high. new receptionist to unfairly the client knows what they challenging aspects of the Always support the individual question their abilities are being billed for on that role. Dealing with clients to make the necessary steps to during the hectic early days visit. The reception team also who are facing, or have faced, deliver against those standards – of a new role, and their appreciate the chance to coach the difficult decision to put be that call handling, putting up well-being is central to the the vets on what they need their pet to sleep can be very prescriptions, dealing with stray heart of what we do. Foster from them, too. uncomfortable, especially for pets, or end-of-life guidance. a culture of inclusion with inexperienced receptionists. clear lines of communication Ensure that new receptionists Supporting new staff Using the whole team to so that problems are solved observe hospital admissions members with comprehensive support the new joiner adds collectively before they are and discharges so that they can training in this area can real value. Your team already allowed to fester. see how their role integrates make a real difference to do the role day-to-day and with these processes. In everyone concerned. know better than anyone the Invest in your reception addition, new receptionists tips and techniques required team as the first point of should observe a range of It is human nature to busy to make that activity easier. client contact and they procedures. What better way yourself with tasks or to Getting the team involved in can become your greatest to be able to explain to clients distance yourself from difficult both the selection and the brand ambassadors.

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Keeping your team engaged at work

Traditionally, an engagement is the relationship between two people intending to get married. It is a time when the couple can develop and define their relationship – or in other words – their culture and climate. This process is also an important Deborah Croyle consideration in leadership and the veterinary practice. This article will explore ways of improving staff engagement. Following successful careers in customer service and people In leadership, the terms ‘culture’ management, Deborah joined “Researchers have reached the same and ‘climate’ have been used the veterinary business sector for so long that employees conclusion about employee engagement: in 2002, and has held roles in can be confused and cynical it as diverse as receptionist, that it is the result of relationships about what they mean and how administrator, practice important they are to the health manager and business director. between employees and their managers” and wealth of your practice. She has a miniature dachshund that was born blind, another So, let’s define the differences: appear to be telling you what is there an increase in older dachshund, a tailless cat, Culture is ‘how we do things they don’t like and what is sickness and/or absence? Is a very old rabbit and a tortoise. around here’, or, what the wrong more than what is good. this particularly noticeable practice believes in – and on Mondays, Fridays, and perception is reality to the So, what happened? weekends? Is the team beholder. Many businesses will Have you sunk into a rut of frustrated with a particular have a set of values proudly complacency? When the culture team member’s absences displayed on a board informing no longer matches the climate, and, possibly, your lack of their team that these are the there is a drop in morale in the addressing this? desired behaviours within practice – but have you taken a is there a lack of respect the business. If you have such good look as to why this is? within the workplace? a display, it might be worth Are some team members asking yourself whether these There will be many contributing spoken to differently than values are actually lived, or factors. When you look at these others? Is this related merely laminated. some may appear unimportant, to their experience and/ but when left unaddressed, or seniority? Is there an Climate is ‘how we feel about their impact is reinforced. unwritten, unspoken things around here’ – again, And in the same way that status culture? perception is reality – individual our happy couple row about is there an attitude of ‘do as I employees will see and feel squeezing the toothpaste in say, not as I do’? things very differently from each the middle of the tube, it is are there gripes about other. What do they feel about often the smallest things that processes and procedures the values you’re so proud of? have the biggest impact. that were never previously Are they engaged with these? an issue? Are they still being Ask yourself: carried out properly or are Is this your practice? are there issues between corners being cut? You can’t quite put a finger some employees and their is the cleaning still carried on it, but there is definitely a managers? Is there a out to your normal high different feel in the practice clash between certain standards, or are corners than there used to be; not the team members? cut there, too? Are you same happy buzz, and more are there particular getting the results you 0.75 gossiping. Maybe it’s been a bit managers who struggle expect, or just results from hours* stressful recently, a few team to engage with their what you inspect? members have moved on, all employees? Do they have for very genuine reasons you’ve trouble relating to the team These are just a few examples told yourself, and of course it and use reprimands more that may make you question takes time for new employees frequently than praise whether things are still good, *Suggested Personal & Professional to get to grips with the job, the and recognition? or whether your culture Development (PPD) team, and the practice. You is the general is no longer aligned with felt a bit disappointed when communication style that of your climate. Are your team STAFF ENGAGEMENT no one fancied the team night commands rather still engaged, or has their out you suggested, and they than requests? engagement been broken off?

‘Ostrich’ syndrome Remember, life is about choices and consequences. No matter what you may think, you always have a choice. You make it and the results are the consequence. In this instance, should you do something or not?

You could choose not to deal with this now, there simply isn’t enough time, and if people really think the grass is greener elsewhere, let them go and find out. Really, they just need to get on with it. So you keep your head in the sand; you believe that the core of the team is still perfectly fine, it’s just a blip, it’ll blow over. However, the trickle becomes a flood: there is talk of poor benefits and not enough holiday amongst the team your reliable employee who is never ill takes sick leave with stress equipment gets broken and researchers have reached Starting out of the rut and receive responses no one tells you or owns up the same conclusion about Once you’ve recognised from over 20 per cent of you find mistakes made employee engagement: that or admitted that there’s your employees. by people not following it is the result of relationships a problem, start by procedures which they between employees and their carrying out an employee Some unhappy employees know about managers. In short, people engagement survey. There may not feel comfortable people don’t tidy up don’t leave a job, people leave is a wealth of information giving honest feedback after themselves people. So let’s go back to on the internet and through for fear of retribution, so you receive client complaints choices and consequences. various associations that your surveys should always about poor service, If you really want to stop can help you put together a be anonymous. If you can rudeness or being ignored this trend of employee questionnaire. If you want reassure them that no there is an increase in disengagement, find out what employees to engage with answers can be attributed to clients moving to a is really happening. you and the practice, make individuals, your responses competitor practice. sure they will engage with the will increase. Consider Engagement and survey. Keep it brief and to setting this up online through What’s happening? You kept motivation the top line. You can always an independent external your head in the sand. It now Most managers focus on run another survey to explore body or a website such as appears that whatever you what they believe motivates particular areas of interest or ‘SurveyMonkey’ or similar. do or say has no effect. These a person – a team event, new concern at a later date. occurrences are becoming equipment, staff discount, Be honest with your team more frequent. The team you or other benefits. But here it The survey should contain and explain why you are had that genuinely enjoyed is worth thinking differently. ten to twenty questions doing this and what has their work and the practice, Rather than focusing on and cover four or five areas, brought it about. Let them now appear to be going what might motivate an such as team, benefits and know that this is a direct through the motions. Their already engaged employee, relationships with managers result of your observation perception – the climate think about what causes – with three to five questions and the feedback that you – is that they don’t matter these employees to become on each. Your goal is to get have been listening to, and anymore and they don’t disengaged. Rather than answers to all the questions that you want to know feel respected. They’ll ask looking for ways to make themselves: “What’s the point, people happy, look for because whatever I say, it will ways to prevent them from “Some unhappy employees may not feel either be ignored or just not becoming unhappy. As listened to?” successful managers realise, comfortable giving honest feedback for the biggest single motivator fear of retribution, so your staff surveys While we’re looking at you can apply is to remove the negatives, numerous any demotivating factors. should always be anonymous”

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“If you want to implement change, be are the role model for how you place to be, and that the want your team to behave. grass is not greener elsewhere. prepared to change yourself so that you Remember, if you always do When that happens, give what you have always done, yourself a pat on the back, are the role model for how you want your you will always get what you and communicate the results team to behave” have always got. Not only will to the team. Tell your team you need to address some how proud you are of them for potentially uncomfortable making the changes they have the cause so that you can reviewing the current issues, but you will also need gone through, and recognise address their concerns. structure within the to adopt and adapt to a new the hard work they have put in Most importantly, inform practice – look at and way of working. to get there. your team what will happen understand what functions following their feedback people actually carry out, A word of caution: watch Remember, if you want to and what improvements will rather than the traditional for the ‘change curve’ to kick reward your team for their result from them. reporting line in. Your team may well be hard work, engage with setting-up a working group suspicious at first and the them. Find out how they Next steps to gather further ideas and morale may seem to dip even would like to be rewarded Whatever the results of to listen to their feedback further. This is all part of the and what they would really the survey, and however rooting out bad behaviour normal change curve – not appreciate. For a happy disappointed you may feel, and tackling it directly. a sign that you have got it relationship, engagement has you must act upon the results. wrong. It is the stage where to work both ways. If you don’t, you are just Whatever your actions, be you must remain consistent reinforcing everything that the realistic with time frames – you and keep trying, and to team already feel is not good. and your team still have the recognise that it will take Present a summary back to day job to do – and ensure that perseverance and time. your team and inform them every step is communicated what the next steps will be. with your whole team. This will If you have asked for feedback include what you are doing and and have not received any, Depending on what the issues why, and the benefits that this don’t stop asking or trying, are, you may want to consider: will bring. but do keep going. Eventually taking the top two or three that change curve will shift points and addressing Be the change you and rise up – resulting in your them directly want to see team taking notice, changing booking any necessary If you want to implement themselves and becoming management CPD for those change, be prepared to convinced, once again, that who manage teams change yourself so that you the practice really is a great PPD questions

1. Do you have a set of values for your practice?

2. Have your team bought into these values? Can you tell by their behaviour?

3. What decisions have you made recently that will improve employee engagement? (And how many times have you decided not to address a lack of engagement? Which is the greater?)

4. How would you describe your working relationship with your team and how might they describe their working relationship with you?

5. What de-motivating factors exist in your practice? What quick wins could you achieve by removing these?

6. How committed are you to making changes that will improve your business? What will you need to change in yourself to achieve these? How hard will it be and what help will

you need to do it?

The real PPD will come when you get feedback from your team. your from feedback get you when come will PPD real The

There are no definitive answers to these questions as the intention is to get you thinking about your own practice. practice. own your about thinking you get to is intention the as questions these to answers definitive no are There Answers: Answers:

How can LinkedIn benefit your practice? When thinking about connecting with pet owners online, LinkedIn might not be the first social network that comes to mind. The platform is used by professionals to network, showcase their skills and find work. But pet owners are professionals too and, with around half of UK adults owning a pet (PDSA, 2018), there’s a good chance Clara Ashcroft that many of your clients will also be using the website. BA (Hons) With more than 500 million this, click the ‘work’ icon in lots of relevant keywords in Clara writes for Vision Media members, LinkedIn is the the top right-hand corner your company description – a media agency specialising largest online professional of your homepage, then to draw in and build your in marketing, communications network in the world. It was ‘create a company page’ and target audience. Give a clear and design services for the launched in 2003 to help follow the instructions. You’ll description of who you are veterinary industry, and users build and maintain then be able to add a logo, and what you do, and keep a publisher of veterinary their professional network description, information it consistent with any other websites, news websites and and to help people find and about your location and more. social media platforms you consumer magazines. reconnect with classmates. might have. The site also aims to help To start growing your follower users learn about other base, add the people you work Another good SEO practice companies and gain insights with who are already LinkedIn is to share the link to your into different industries. members – these are your company page as much as biggest advocates. This will possible. Place it on your LinkedIn has long been an allow them to like, comment company website, blog or important tool for people and share information on your other social media feeds, and to expand their professional company page and will help encourage your employees contacts, promote services to widen your overall reach. to include it in their personal and secure more companies Ensure these people are listed LinkedIn profiles. The more and clients. It is also as current employees so that times a link is shared, the increasingly being used by their profiles link back to your higher it will appear in search recruiters to find new staff company page. engine results. and for users to find new roles. But beyond the realms Enhance your It’s also important to post of LinkedIn for personal use, visibility online and share content on a regular what makes LinkedIn an With a busy practice to basis to keep your audience important business tool and manage, your online presence interested. Encourage your why should your veterinary may be low on your list of followers to ‘like’ and ‘share’ practice be using it? priorities. This is why it is your posts as much as possible so important to be selective as this will help to expand the LinkedIn Company Page about the social networks overall reach of your post. A A LinkedIn Company Page you use. LinkedIn is a brilliant good phrase to use is ‘please provides a fantastic, free choice for veterinary surgeries share if you find this content opportunity for veterinary because its company pages helpful/valuable/useful.’ practices to promote their rank well in search engine services, advertise job results – meaning pet owners Build a personal brand openings and share important are more likely to come across People tend to only think news. If you don’t yet have you before your competitors. about updating their personal a LinkedIn Company Page, LinkedIn profile when they are then you could be missing By optimising your company looking for a new position. 0.5 out on potential new clients page with good Search Engine But the platform can do much hours* and exciting networking Optimisation (SEO) practice, more than attracting potential opportunities. your page will be easy to employers. It’s also a fantastic find. This includes using way to bolster credibility A LinkedIn Company Page is an official LinkedIn profile for *Suggested Personal & Professional your practice. If you’re new Development (PPD) to LinkedIn, however, you “LinkedIn is a brilliant choice for veterinary will need to create a personal surgeries because its company pages rank LINKEDIN profile before setting up this page. Once you have done well in search engine results”

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and helps pet owners form awards you may have received share tips and keep tabs on vacancies. The platform can an opinion of you and the or any published articles. important topics. LinkedIn offer more than posting on practice in which you work. can also help you to connect a recruitment board – it lets Once your profile with specialists who you may you interact with potential To ensure your personal is established, ask consider sending patients to new recruits and allows you profile stands out from your connections for for specific procedures. to utilise the networks that the crowd, make sure that recommendations and you and your colleagues have it is accompanied by a endorsements. This is LinkedIn also has a variety of already established. professional photograph and common practice and is groups in which you can share an interesting headline. For something that you would content, post and view jobs and There are multiple ways for SEO purposes this headline usually return the favour make industry connections. posting jobs on LinkedIn – should include both your job for. Recommendations will Click the ‘work’ tab in the top some are paid for, others are title and things that interest appear at the bottom of your right corner of your homepage free. Paid-for job methods you that relate to your profile and endorsements and select ‘groups’. You can use an algorithm to target profession. For example, a confirm the skills that you view suggested groups by the most relevant candidates. veterinary surgeon’s headline have already listed. clicking ‘discover’ and then They work by analysing might read: ‘Experienced request membership by clicking member platforms to find veterinary surgeon with Networking ‘Ask to join’. Participating in a match and then place the a special interest in feline Another benefit of having a group discussions provides jobs on their LinkedIn feed so medicine’. Try to make your LinkedIn account is that it an opportunity to learn that they don’t need to search LinkedIn profile different from provides an opportunity to more about your industry. for them. your CV and include details network with other like-minded For example, there may be that make you stand out from professionals and to stay topics on running a practice, For a small business, the crowd. Your byline should informed about industry news online marketing, or the LinkedIn’s ‘30-day Job include details about any and events. As your network latest treatments. It can Postings’ feature is the most lectures you might have given, grows, you can discuss, also improve your practice’s cost-effective option. The online reputation. cost of posting a job varies depending on your location, Recruitment but this will only be revealed “With millions of potential recruits at your With millions of potential once the location has been recruits at your fingertips, it entered. If you know that fingertips, it makes perfect sense to use makes perfect sense to use you’ll be hiring several LinkedIn to advertise job vacancies” LinkedIn to advertise job candidates over the next 12

References

5 ways LinkedIn can benefit your practice. Accessed 15 April 2019 https://www.lifelearn. com/2017/07/24/linkedin-benefit- veterinary-practice.

Carrozza, A (2018). Better you Brand, Better your Business with LinkedIn. Accessed 15 April 2019 from https://www.vmdtoday.com/ journals/vmd/2018/january2018/ better-your-brand-better-your- business-with-linkedin

How to optimise your LinkedIn company page for SEO. Accessed 15 April 2019 from https:// theundercoverrecruiter.com/ optimise-linkedin-page/ months, you can save time Laboon, P (2018). The Pros and and money by purchasing “Once you have established a good Cons of LinkedIn Marketing in ‘Job Credits’. These are follower base, use the platform to grow 2018. Accessed 15 April 2019 from available individually, in https://www.inc.com/young- packs of five and in packs of your practice and establish yourself as a entrepreneur-council/the-pros-cons- 10 at a discounted rate. They of-linkedin-marketing-in-2018.html remain valid for up to 365 leading authority on pet care” days after purchase. Lewis, G (2017). How Small Businesses Can Use LinkedIn to If you want to post job 18-29 are Instagram and Grow your practice Recruit. Accessed 15 April 2019 adverts for free, then you Snapchat, so these are better While it might not be the from https://business.linkedin. can simply share them via if you want to appeal to a most on-trend social network, com/talent-solutions/blog/ your company news feed. younger audience. LinkedIn is a worthwhile small-business/2017/how-small- Some of the best candidates platform on which to invest businesse-can-use-linkedin-to- may already follow you and, Another disadvantage is your time and energy. Post recruit when you post an update, that LinkedIn advertising content and share information it will appear in the news can be expensive to buy with your audience on a Long, R (ND). How to post jobs on feed of anyone who has liked when compared with other regular basis and keep in mind LinkedIn. Accessed 15 April 2019 your company page. Readers social media platforms. For that both your Company from https://resources.workable. can add comments and tag example, Facebook adverts Page and personal profile com/tutorial/how-to-post-jobs- anyone they think might average at around $1.86 per can attract new clients and linkedin be interested in the role – click, while LinkedIn adverts provide exciting networking therefore further extending start at around $2 per click opportunities. Once you have PDSA Animal Wellbeing Report the reach of the job post. You and can run up to $5 per established a good follower 2018. Accessed 15 April 2019 can also post jobs for free click. You are more likely to be base, use the platform to grow https://www.pdsa.org.uk/ in LinkedIn groups, many of charged the higher rate if the your practice and establish media/4371/paw-2018-full-web- which have a specific ‘job’ advert doesn’t receive many yourself as a leading authority ready.pdf section, and you can share click-throughs. on pet care. jobs on your personal profile so they can be seen by your There are also a few own connections. disadvantages to having a LinkedIn Company Page. Disadvantages One of the most frustrating Like any social network, is that it doesn’t allow you to LinkedIn does have its send personal messages to share of disadvantages. For your connections. Company example, you will be unlikely Pages are simply a platform to reach young people that to share content and post the haven’t yet started their odd promotion or job advert. career or are not looking If you’re looking to network to network professionally. and build up professional The social media platforms relationships then it’s better to most used among those aged use your personal profile.

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CMY

The easy and eﬃcient way to manage rotas

To ﬁnd out more about our Rota Management System tel: 01359 243 400 or email: [email protected] www.vetsystems.com/rota-manager ONLINE EDITION LEADERSHIP | MANAGEMENT

Lonely at the top In the second part of our new series, two practice managers share further wisdom on the challenges leaders face – but may not talk about. Here, they explore line managing a team who may be more clinically adept than you are, and how a little fallibility can go a long way in improving work relationships with your team.

Leading a team who may know more than you do If you are a non-clinical practice manager, or if your team are more clinically adept, it can be daunting to take on a line management position to those who know ‘more’ than you do, and who could well be on a higher salary. But don’t lose perspective – your role is unique and essential to the practice.

Tradition may tell us that the person appointed as leader should be the one with the most clinical knowledge, the longest tenure, or even the one who is the eldest. It can therefore initially feel strange to be leading employees who score higher on this list than you do. It is impossible for you to do every single task, to be expected. However, this common also, sadly, not uncommon to experience and this is why you have a team. ‘teething’ problem may be exacerbated if disrespect from those in your team who it is perceived that you are somehow lower also believe – whether consciously or A huge part of your role is to organise, on the pecking order of clinical expertise. subconsciously – that you somehow don’t create structure and to motivate. Think of ‘qualify’ to be in charge. yourself as the conductor of an orchestra; Unfortunately, it is possible for that initial you won’t know how to play every uncertainty from your team to escalate What is important here are two points: instrument, but you will lead – keeping into disrespect – and even into upward that you don’t fall prey to any attempts of everyone together and in time. bullying – if the situation is not managed upward bullying, and that you thoroughly promptly. This can sometimes present understand how you are the best- You will need to have a clear, overall itself as a failure of staff to comply with appointed person for the role. picture of what you want the practice rules and deadlines, increased episodes to look like, even down to the finest of gossip, and ignoring communication Defining your role of details. In order to manage this such as emails. It is important that you It is worth reminding yourself what you process effectively, you will first need establish clear protocols and to build a are responsible for, and what you are to understand what each team member united front with other managers and not. It is easy to feel as if you need to does on a daily basis. The best way to team leaders within the practice. It is also know how to do every single task that achieve this is by spending time with each important that you take the time to get to goes on within the walls of the practice, person; carefully observing in a non- know your team and to understand their but, while you need to understand and judgemental way, and listening to their individual roles – as previously described appreciate how each role comes together, individual challenges. The intricacies – as it is often a fear of change that can the important part is the understanding of the role may often be overlooked. subconsciously drive negative behaviour. – not the doing. It would be physically If possible, spend some time in or Once your team feel listened to and alongside the role itself. It is often only supported, you will most likely find that through personal experience that we fully any hostile behaviour reduces rapidly. appreciate what someone may be up against. Not only will this understanding It is also important that you do not help with your overall vision for the subconsciously enable any upward 0.75 practice, but your team will feel valued bullying through a lack of self-belief. hours* and listened to. ‘Imposter syndrome’ is more common than we may think, and it is essential Resistance from the team that you realise your own worth, and Starting a new practice management the influence that your role has on position will always come with initial the rest of the team. Similarly, do *Suggested Personal & Professional challenges. Whether someone else in the not be tempted to compensate for a Development (PPD) practice wanted the role over you, or if lack of clinical expertise or leadership you have a team particularly resistant experience with imperious behaviour. LEADERSHIP to change, a period of settling in and This will win you no favours, and will managing your new team’s concerns are only serve to isolate you further from

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your team. Care and integrity are far more effective means of gaining your employees’ respect.

Ultimately, as if you are the conductor of that orchestra, your role is not to play all the instruments. Therefore, there is no reason to compare yourself to those within your team. A veterinary specialist will, quite rightly, know more than you do in their area of specialism, but don’t confuse the issue. You are not there to match them on their level of knowledge; you are there to help the orchestra sound as good as it possibly can.

Accepting your own limitations and dealing with situations where you may not have the answer As practice managers, we often have the unrealistic belief that we need to be to the practice. There may be staff success as a leader and as someone who the font of all knowledge. Apart from members who have been with the people aspire to work for. this being an impossible accolade to practice for many years, and whom achieve, it is not necessarily the best way you can call on for knowledge and Honesty leads to respect of being viewed by our practice team. It is experience of the practice that you Having the respect of your team is one surprising how a little fallibility can go a cannot possibly have knowledge of of the most important requirements for long way in improving work relationships. yourself. The answer is to accept that a leader, and honesty in what you can or you do not have all the answers or cannot do will always pay dividends. If It is true that your team see you as the solutions to every problem, and to use you don’t know the answer –say so – but person to go to if there are problems or the abundance of knowledge already in make sure that you qualify this with "but I questions that they are unable to deal the practice. There will also be times will find out." with. They undoubtedly think that you where, unless you are a clinician, you should be able to answer most queries will need to seek advice from vets It is always worth asking your colleagues and deal with most issues. This puts and nurses with regard to clinical for their input, or, where relevant, their significant pressure and extra stress on issues which may impact upon your advice. Who does not like to give advice? the manager if they feel that they must management plans or decisions. Learn from your team – do not fear their have the solution to every concern. To Some managers worry that by showing knowledge. Use it, and thank them for it. avoid becoming your own worst enemy a lack of knowledge they are showing a through creating stress and unrealistic weakness, and that they will be criticised If you are new to the role, take some demands upon yourself, it is important or less well regarded. There is no shame time to sit with each of your employees; to accept your own limitations, and to in not knowing the answer to every watch their daily routines and ask lots of acknowledge that sometimes you need to question, and admitting that there are questions about what they’re doing and ask others for the answer to a problem. things that you do not know actually talking about. Just be careful that you do It is in this way that you will become makes you seem more ‘human’. It will not become dependent. As you grow with stronger, calmer and more in control. certainly win you brownie points and the role, so will your knowledge, and there make you more approachable. will be fewer and fewer occasions when It’s impossible to know everything you don’t know the answers. Some of those reading will remember If someone knows better or has more the old 1980s Automobile Association experience than you – delegate. Your The management consultant and author, (AA) advert. It goes like this: the family practice team is made up of individuals Peter Drucker, said: “The leader of the car has broken down and a child asks, who have different outlooks and abilities, past was a person who knew how to tell. “Dad, can you fix it?”. The reply comes, and who are at different stages in their The leader of the future will be a person “No, but I know a man who can”. In careers. Some may be ‘old hands’ at what who knows how to ask.” This approach some respects, this is how we should be they are doing, others may be looking – honest leaders who are not afraid to as leaders and as practice managers. for opportunities to stretch their skills. admit that they don’t know it all – can be You have the ability to develop people at a powerful strategy. Using the experience It is impossible to know everything, either end of this scale, and your skills in and knowledge of your team is essential especially if you are relatively new this area will help to define your long-term to any business’ success, while acting as though you need to know everything implies that you do not trust your team to “Think of yourself as the conductor of an orchestra; you do things themselves. won’t know how to play every instrument, but you will Next issue: we share how to effectively deal with conflict as well as the correct lead – keeping everyone together and in time” response to gossip.

Letting go A recent article in a veterinary journal looked at the dilemma pet owners face when having to make the choice to continue or stop treatment for their pet. This may be for a number of different reasons.

Owners may feel that their pet has simply had enough and that further “Although it is vets and nurses who are very closely investigations and treatment will be too stressful or harmful to their pet’s quality involved in the actual euthanasia process, receptionists of life. They may consider that their pet and administration staff also need to have a good has had a long and happy life, and that now is the kindest time to let them go. understanding of how pet euthanasia affects clients” The owner may also, sadly, simply not have the funds to continue treatment. Whatever the reason – and for most pet sense of guilt. The veterinary surgeon However much the vet may think that owners, such decisions are made after can play an important part in helping running exploratory tests may help to much soul-searching – there is likely to be an owner to come to terms with this ‘save’ or prolong a pet’s life, they must at a feeling of guilt. difficult decision by ensuring that, all times respect the owner’s decision and whatever the decision, they provide avoid making them feel guilty Choosing to end the life of a living support for the owner. about the choice that they have made. creature – great or small – is not something to enter into lightly. However It is really a simple matter of not Although it is vets and nurses who necessary ending that life may be, it is appearing to judge; to accept the are very closely involved in the actual inevitable that it leaves an owner feeling client’s decision and to help them to euthanasia process, receptionists and not only sad, but also guilty that they have come to terms with the loss of their pet. administration staff also need to have ended their pet’s life. Even though the final decision is to be a good understanding of how pet made by the owner, most owners would euthanasia affects clients. It therefore It is the pet owner alone who has to make welcome a little empathy from their vet behoves the manager to ensure that that final decision and, while they may at a time when they are making one of all their team – not just the vets and seek advice from their vet, the choice the most difficult pet-owning decisions. nurses – have the correct training in of action must be their own. When the understanding the emotions involved in current thinking for most vets is to work- It is a difficult decision for any owner making this big decision, as well as the up all cases as far as possible, an owner’s to make, and we should not forget bereavement process that follows. decision to stop treatment may seem to that for many vets who have emerged become harder. from a culture where investigation, Clients will react in many different tests and work-ups are seen as the ways to the death of their pet; some An owner can easily become natural progression of a pet’s illlness, will be in tears, some will appear to overwhelmed by a culture of work- having an owner refuse this and ask for show no emotion, some may behave in ups and investigation, and find it very euthanasia for their pet can be difficult unexpected ways, and many will want to difficult to say “stop” without a great for them, too. leave the practice as quickly as they can. Veterinary personnel should be prepared for all these different kinds of emotions and never judge a client by their intial reactions – everyone has their own way of dealing with loss.

So often, it is the veterinary practice staff where a pet has been put to sleep who have the closest contact with the owner at this traumatic time. In many cases, this can become a bond that can help the client through the days and weeks after they have lost their pet, although there are some clients who feel unable to re-enter the practice where their pet has died. If they do get another pet, they may take their custom elsewhere.

It is easy to become so used to euthanasia as a daily procedure that the appreciation of the emotions involved is lost. To veterinary employees, euthanasia

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is a daily occurrence, yet, to the owners, euthanasia is a dreadful and traumatic event. Somewhere ‘in the middle’ is the approach that staff must take when interacting with the client.

As managers, we must be fully aware of this and make sure that our administration and reception teams are well-trained in pet bereavement, and that they know how to help or assist any grieving clients whom they may come into contact with. They also need to be able to offer advice on the still ‘tricky to talk about’ subject of pet cremation. It is also a great advantage if the manager, and at least a proportion of their staff, have actually visited the pet crematorium that they recommend to clients. It is this kind of reassurance that the client needs at this time, and it certainly shows that the practice cares enough about their pet – both in life and in death – to make sure that the process from youngster to old age is as dignified and as smooth as possible.

There is now a wealth of information available on pet bereavement – both for possible effects on the staff concerned. the bereaved owner and for those wanting The veterinary team’s aim is to preserve to support them. Gone are the days when and enhance life and, as a last resort, the pet bereavement and euthanasia end a life that has reached its inevitable leaflets were kept under the reception conclusion. This act of ‘putting so many counter and only handed out to clients animals to sleep’ on a regular basis is when thought appropriate. stressful and vets and nurses need to have a means of releasing that stress. It is good for every member of the Managers should be aware of this and practice to have had some training, or to ensure that there are measures in place have read in some depth about this topic to help any staff who may be affected so that they are better placed to give help by the loss. and understanding to their clients. There are now many practices that have pet Dealing with the impact of pet loss and bereavement sections on their website the euthanasia of a much-loved friend and information, not only of their services on both clients and staff can be one to the client, but also links to other of the most challenging experiences in organisations that can help. modern veterinary practice, and the manager can play a large and important It is worth remembering that a high part in this making process as seamless proportion of ‘thank you’ cards are sent as possible. by owners who have lost their pet; this simply shows how important it is to ensure that this part of the veterinary service you provide is as well-managed as all the rest.

We tend to concentrate on the emotions of the client when euthanasia is the outcome of a visit, however, for the veterinary team, euthanasia can be highly upsetting – particularly if the patient has been known to the practice for a long time.

This being the case, the practice manager needs to be aware of any

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Industry Profile “I think there is probably an example of an ex-racehorse in every discipline ... Your name: Sue Molloy BHSII Position: Yard Manager they can go into any area of Organisation: Retraining of Racehorses equestrianism from ‘happy hacks’ (RoR) through to Badminton three-day eventers and top dressage horses”

Please could you provide a little background to RoR and explain the work that the charity does? Launched in April 2000, Retraining of Racehorses (RoR) is What careers can retired racehorses go on to have and British horseracing’s official charity for the welfare of horses do you think there is a myth that thoroughbreds are who have retired from racing. The charity raises funds from not versatile? within the racing industry for the retraining and rehoming of I don’t really think there is a myth that thoroughbreds are not former racehorses. It promotes the adaptability and versatility versatile; just a lack of knowledge and understanding. People of ex-racehorses to other equestrian activities, runs and funds see them at the races with their blood up and at the peak of competitions and educational events across the country, and fitness ready to gallop and win the race. Take out the high provides a safety net for vulnerable former racehorses. energy feed and the stressful lifestyle and the majority will settle into being a much more relaxed horse. What is your background and what inspired you to work with RoR? They can go into any area of equestrianism from ‘happy hacks’ I am a qualified BHS Intermediate instructor and spent many through to Badminton three-day eventers and top dressage years teaching, riding and competing various breeds of horses horses. They can also have successful careers in polo and – including thoroughbreds. Although I grew up in Newmarket, I horseball. I think there is probably an example of an ex- never really worked in the racing industry, having always preferred racehorse in every discipline. dressage, show jumping and eventing. I also spent six years working at Newmarket Equine Hospital. I think the combination of my What is the process for a retired horse coming into your teaching, riding and horse management skills landed me this role. care and how is it funded? Here at Palace House, the RoR flagship yard is a unique setup. You currently offer tours of the RoR flagship yard at The owners and trainers can send a horse to us at any stage of Palace House in Newmarket, do you think there is a its retraining for a few months for the public to meet and greet, general lack of awareness regarding life after racing and to be used for the daily demonstrations where they can see for racehorses? how we go about the retraining. The yard is funded in the most The ‘behind the scenes’ tours at Palace House are very popular part by the charity. and definitely help to increase awareness and educate the public on the life of a racehorse after racing. It is meant to be If the horse has just retired from racing, it is important that fairly light-hearted and enjoyable, while still getting across an it has a few months off to chill out and relax. We will then important message and dispelling a few myths! take them after that time when they are ready to start their new training.

We begin with ground work (long reining and/or lunging), introduce the new tack and establish the basics from the ground. Once we mount up, the riding style is obviously very different in establishing a contact, a ‘rounder’ shape, and leg contact. We gradually build on this work while still using the ground work as well. Patience is the key!

We also ensure the horses have daily turnout to keep their minds more relaxed.

What are the initial challenges that a newly retired racehorse may face when they enter retraining? The major challenges as far as the ridden work goes, are for the horse to start to carry itself in a rounder and more collected outline, and to build muscles over the back and neck – the topline – in order to carry the rider. Lateral bend for circles All horses staying at Palace House celebrate their birthday on and turns, standing at the mounting block and picking up 1 January. the correct canter lead are all foreign to the newly retired racehorse. Some learn and adapt quicker than others!

Please could you tell us a little about the RoR rehoming scheme and the support available to owners of former racehorses? Here at Palace House, we are a showcase yard, rather than a rehoming yard. The responsibility stays with the owner to have the horse back or to rehome them after their stay with us. However, as a charity, RoR have a website – ‘Source a horse’ – with ex-racehorses looking for new homes (https://sourceahorse. ror.org.uk). They also have a list of recommended commercial retraining yards which people can contact if they are looking to take on an ex-racehorse.

Having said that, we have rehomed a few horses directly from Palace House, and I do always try to keep in touch with all of our horses when they leave here to either go back to their old yard or to a new home.

RoR have a team of volunteer regional co-ordinators who organise training and educational clinics. Please could you tell our readers more about what these events offer? Sue spent many years teaching, riding and competing before taking A member of RoR with a registered horse is entitled to take up her role at RoR. part in any events and training that the charity organises. Split into regions around the country, volunteer co-ordinators will endeavour to arrange a variety of trainers from different What is the most rewarding part of your role? disciplines to cater for everyone’s tastes and interests. Seeing the horses change shape and learning to listen and work with me as the trainer is very rewarding. They are all very Dressage, show jumping, eventing and showing are the obvious individual, working at different levels, learning at different choices and members can get a much subsidised rate with some speeds; no two are the same. I have managed to get some horses top instructors. Our area also holds club nights where people as far as going out to their first dressage competitions. Others, can bring their RoR horse for a very informal session in a safe I have been pleased if they can manage to work in the arena in a arena away from home. A trainer is on hand to give help rather balanced, relaxed manner! than formal lessons. It is a chance to socialise, get your horse working around other horses, and to get some help and advice What would a typical day look like for you and your team? from both the trainer and other RoR owners. A typical day on the yard at Palace House would see half the horses out in the paddocks first thing with their breakfast. The Your role must be incredibly demanding. Do you others go on the horse walker first while we muck out the stables. manage to pursue any of your own equestrian hobbies We have two public tours a day – at 11:30am and 2:30pm – when in your spare time? visitors can come to meet the horses and go behind the scenes to The role as yard manager is quite demanding with some long see the walker, paddocks and the arena. If the arena isn’t hired days, especially as I live on-site. I do a late night check and I am out, one of our horses will be working for the tours. on hand if anything is needed out-of-hours. But, I love the job and will choose to work and ride horses outside of my work In between the tours, we work any of the other horses. When hours. I have a couple of friends whose ponies I ride outside of they are new, and at each new part of their training – for work, too. This is great, as we go to the forest and do stuff that example, the first time we get on – we obviously don’t choose to we don’t do with the work horses. I used to compete with my do this in front of an audience! last horse but I now enjoy the benefit of riding plenty of horses without the bills! I spend a lot of time walking my dog as well. The usual yard duties continue during the day as well. Some days there will be a particular group or a school visiting which may Do you think more could be done to help racehorses after require specific or extra time. We also have quite a bit of filming, their racing careers have come to an end? photo shoots and promotional work, too. It can be very varied There is always more that can be done to help ex-racehorses, day-to-day. but, I do think that over the past 20 years or so, that awareness and education has improved. As more ex-racehorses get to the ‘Big Orange’ has recently stayed at the RoR yard. top of their discipline, more riders will look to take on these Which other famous racehorses have entered your horses and lower-level riders will be inspired to follow suit. A retraining programme? showcase yard like Palace House has been great for getting the We love to have famous ex-racehorses staying here. They word out, so maybe there could be other showcase yards across bring in a surprising number of true fans who want to visit the country in the future, too. that particular horse. Not all of the famous faces have been here to be retrained or ridden. ‘Big Orange’ is one example www.ror.org.uk – he suffered an injury which ended his racing career and is www.palacehousenewmarket.co.uk here in the latter stages of his recovery. Other famous faces who have stayed here are ‘Our Vic’, ‘Purple Moon’ and ‘Sire De Grugy’.

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