Account and Accountability How Do We Quantify Welfare As Veterinary Professionals?

ONLINE EDITION VOLUME FOUR I ISSUE THREE I MAY/JUNE 2016

Account and accountability How do we quantify welfare as veterinary professionals?

10 hours PPD

Geriatric patients Wildlife Helping them to live life to the full The role of first-opinion practice

Rare breeds Interventional radiology The veterinary surgeon’s role in progressive Case reports in veterinary practice health management

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WWW.VETCOMMUNITY.COM | ONLINE EDITION @VPTODAY | WWW.VETERINARYPRACTICETODAY.COM 3 Contents Comment 18 Large animal COVER STORY 36 Management of the 6 Account and accountability periparturient goat How do we quantify welfare as Essential care during pregnancy and veterinary professionals? between kidding and peak lactation. 43 Physiotherapy for the ‘downer’ cow The benefits of physiotherapy in 6 secondary bovine recumbency. 46 Adverse events in livestock The second article of a three-part series on adverse events (AEs) in cattle, sheep, pigs and poultry.

COVER STORY COVER STORY 52 On being a vet for rare breeds 18 Living life to the full Understanding the genetic and Caring for the geriatric cat and dog. phenotypic value of rare breeds helps progressive flock/ 24 Dangers of dietary supplements herd planning. The exposure effects on companion animals.

27 Insight: pets continue to gain Small animal the pounds 36 A One Health approach to countering the pet obesity explosion. COVER STORY 8 Interventional radiology in veterinary practice Equine Case reports on some of the more commonly performed IR techniques. 29 Ins and outs of equine housing 14 Housing sick and immature Horses have specific stabling newborn puppies for hand rearing requirements in order to maintain Key issues for care and housing. the health of the patients and the biosecurity of the practice or yard. 8 29 52

4 VETERINARY PRACTICE TODAY | VOLUME FOUR | ISSUE THREE | 2016 WWW.VETCOMMUNITY.COM | ONLINE EDITION

Featured contributors

Kieran Borgeat CertVC DipACVIM DipECVIM- CA (Cardiology) MRCVS

Kieran is a RCVS Recognised Specialist in Veterinary Cardiology 72 Have demographics had their day? and a Diplomate of the Exotics and wildlife The cases for and the case against. American and European Colleges of Veterinary Internal Medicine in the sub-specialty of 76 Performance appraisals – why cardiology. Alongside a referral cardiology 57 About a bee – part 2 they matter service, he runs the interventional radiology How a colony supports itself and service at Highcroft Veterinary Referrals in Central to good management and how it divides with swarming. Bristol. His particular interest is in minimally practice success. invasive interventional procedures and he is COVER STORY involved in collaborate research projects on 78 Insight: pet insurance – necessity feline hypertrophic cardiomyopathy. 60 Wildlife in first-opinion practice rather than luxury? Giving the wildlife casualty the best As veterinary costs rise should pet treatment and outcome. insurance take presidence over some Declan O’Rourke MVB MBA FRCVS of the unnecessary pet luxuries? Declan graduated from University College Dublin 60 in 1979. After working in practice he spent over 66 20 years in the animal health industry. In 2006, he set up Ortec Consulting, specialising in pharmacovigilance marketing, technical support and clinical trial management. He is a Fellow of the Royal College of Veterinary Surgeons, an honorary associate professor at Nottingham veterinary school, past president of the British Cattle Veterinary Association and a member of the Veterinary Products Committee (VPC).

John G. Matthews BVMS BSc MRCVS

John qualified from the University of Glasgow in Management 1975. He spent three years at the Central Veterinary Laboratory, Weybridge, 63 Staying positive before entering general practice – and Avoid being hijacked by Industry becoming a partner in mixed practice in negative information. Essex, until retiring in 2013. He is honorary veterinary surgeon for the British Goat 66 Practice financial reviews 81 Profile Society and a past president as well as a visiting lecturer at the University of A useful, non-clinical tool for Jane Howorth MBE founder of the British Hen Welfare Trust. Cambridge. With his wife, he has a pedigree supporting cost-effective service and herd of British and British Saanen goats. staying ahead of the game. Sonya Nightingale MCSP Cat A ACPAT

63 81 Sonya is a chartered animal physiotherapist who qualified in the human field but upgraded to treat animals in 1988. She worked at London 2012 Summer Olympics as a headquarters veterinary physiotherapist and chaired the Association of Chartered Physiotherapists in Animal Therapy (ACPAT) for four years during that period. Although her main caseload is human and equine, Sonya has always included a healthy number of farm animals and their owners.

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Account and accountability As veterinary surgeons, we are accountable – morally James Yeates or legally – in many ways. Being accountable involves BVSc CertWEL DWEL MRCVS being required to explain or justify our actions. We

Dr James Yeates is chief veterinary officer of the are accountable to owners for how we care for their RSPCA, RCVS Registered Specialist in Animal Welfare animals. We are accountable to our professional bodies Science, Ethics and Law, editor of the Journal for our conduct, which should place animal welfare as of Animal Welfare Science, Ethics and Law and its first priority. And we are accountable to ourselves in previously chair of the BVA Ethics and Welfare Group and honorary secretary of the SPVS. the guilt and stress that we shoulder.

Nowadays we may feel more ‘accountable’ than in the past; our conduct is less a matter of personal morality and more one of societal demands. Google statistics suggest the word is being used more now than at any time since 1800; whereas ‘responsible’ has been declining in usage.

Society may not have the unquestioning trust in experts or professionals that it had in some earlier periods. The public does trust veterinary surgeons; but that trust is earned – and can easily be lost – by each practitioner and the profession, rather than assumed.

Stress factor This accountability can add to the levels of stress and dissatisfaction in the profession. It can make us constantly fearful of being challenged in the consulting room, courts or a disciplinary hearing. Ours is a difficult enough job without having the fear of being held to account. Even if those fears are exaggerated or ungrounded, this does not necessarily make them easier to deal with. Indeed, I would hypothesise that this stress is highest in those who are, in fact, least likely to do anything that would lead to such sanctions.

Increased accountability also risks our forgetting that we are helping animals and clients for their own sake – not simply to avoid complaints, litigation or disciplinary action. It risks our making clinical decisions to ‘cover our backsides’ rather than in the best interests of the animal.

A key example of this would be the increase in concern over ‘informed consent’, rather than thinking of owners as collaborators in helping the animals. And it makes us focus on the negative rather than the positive aspects of our work – worried about the risks rather than enjoying the successes.

Welfare accounts Each of us has an ‘animal welfare account’ as the sum total of all our effects on animal welfare (Yeates, 2013). Harms to animals are debited from this account; helping animals is to our credit.

I think we are accountable – at least to ourselves – for all the good and harm we do, particularly to animals. Perhaps in our clinical setting, we should consider this as a ‘clinical account’– the impact of our clinical veterinary work. We may also have other, non-clinical impacts on our welfare account, such as the food we eat and our charity fund-raising.

Every person has such an account, but veterinary professionals’ CLINICAL ACCOUNTING accounts have the chance of being particularly profitable – or indebted, if we cause harm. We are the animal welfare ‘Masters

of the Universe’ (in the Tom Wolfe sense, although the He-Man/ representation of the subjective value people place on real She-Ra sense works well too!) with the potential to change the things! We can use such methods, with empathy, to quantify world, yet also to cause major damage to both ourselves and value to animals. others. Our actions can cause significant harm, but they can also add enormous value. This should include both quantifiable clinical data (median survival times that vary from one to three months if untreated; The good news is that we do a great deal of good to go ‘in the around six months with amputation alone; around one year black’ on our welfare account. Veterinary work helps animals to for surgery and chemotherapy); incidences of postoperative avoid pain, malaise, pruritus, hunger, thirst, fear and distress, implant failure (11–60%); infections (40–70%) Corr and Yeates, and to continue enjoyable lives. In some cases, this good requires 2014); and aspects that are harder to quantify, such as lack of an ‘investment’ of short-term harms – postoperative pain or stimulation through exercise. The latter can draw on current hospitalisation for later recovery, for example. research about how to quantify quality-of-life (Belshaw et al, 2015) or on economic approaches (assessing owner willingness Sometimes our investments have risks of poor clinical outcomes to pay, or trade-offs). – drug reactions or particular sequelae, for instance – but in each case, we should be aiming to have a positive effect. The harms In our case management, we can draw analogies with some risked should be outweighed by the expected benefits in terms of financial management principles: improved quality of life. we should employ ‘risk mitigations’ to reduce the harms – analgesia, for example This idea of an animal welfare account also allows us to ‘credit’ we should employ a risk-averse investment strategy to minimise ourselves even when we are doing work that is less financially the risk of catastrophic welfare outcomes, and rewarded – pro bono work, for example. Our animal welfare we should avoid major short-term harms, such as severely accounts are personal accounts: so giving should be credited. painful or distressing surgery, in the hope of distant benefits in As well as seeing how healthy we and our practices are in longevity – for animals as for businesses, the short-term ‘cash- financial terms, we can also assess how well we and they are flow’ may be more important than ‘profit-and-loss’. doing in terms of our impact on the world. Just as companies should balance short-term commercial Mind the GAAP interests with long-run value for stakeholders, this approach can Generally accepted accounting principles (GAAP) allow us help veterinary surgeons maintain public and personal trust in to use accounting practices to evaluate what we have done the profession. and quantify its effects. Others can evaluate the health of our practice by means of year-end financial accounts and, more We might also assess whether changes in our hospitalisation importantly, we can use them as management accounts to plan practices improve overall welfare. Changing our waiting room the development of our practice in line with our strategy. and ward design can reduce animals’ stress or fear during hospitalisation. For example, separating dogs and cats (and cats The suggestion here is that we can use accounting principles and cats!) can help make our practices more ‘cat-friendly’ (ICC, in our clinical governance. As well as managing the financial 2015). Such changes will need financial investment – and may not accounts (using financial and management accounting), we can always lead to financial profit – but they can lead to profit in our also manage our welfare accounts. Currently, we often approach welfare accounts. clinical audit using scientific methods – testing hypotheses about specific procedures or protocols – to assess the actual incidence We can use the welfare accounting approach to evidence the of specific post-op complications, for example. We could also value that such changes add – even celebrating the fact that use management accounting practices within clinical audit to they cost us money to do so. We can use these methods to ask bigger questions of whether particular treatment regimens demonstrate the value we add and to enhance our transparency, are beneficial or harmful. and to help show us as the force for good that we are, should be, and are expected to be. And that our ‘bottom line’ is not all Such clinical management accounting should, in turn, facilitate about money. communication (such as clinical case discussions), the provision of relevant information, analysis of impacts, and should build trust (CIMA/AICPA, 2014).

How it might work References This accountancy approach can be adopted at the individual Belshaw et al (2015). Quality of life assessment in domestic dogs: an evidence- patient level. Imagine assessing no amputation and limb- based rapid review. The Veterinary Journal 206(2): 203-212. sparing procedures to treat osteosarcoma, in order to develop a Standard Operating Procedure. For each, we can quantify the Chartered Institute of Management Accountants (CIMA) and American Institute of short-term effects on each patient’s welfare: pain and nausea CPAs (AICPA) (2014).Global Management Accounting Principles. (the ‘initial outlay’); the longer value of the intervention (the ‘return on investment’); and the probabilities of side-effects International Cat Care (2015) http://icatcare.org/cat-campaigns/cat-friendly-clinic (the ‘risks’). Yeates J (2013). Animal Welfare in Veterinary Practice. UFAW/Wiley Blackwell. An immediate concern is that such derived values are ‘subjective’ which seems a major issue when we are using ‘scientific’ Yeates J and Corr S (2014). Use of a Quantitative Methodology to Evaluate methods. However, this is less of an issue for accounting Treatment Options: Methods and Proof of Principle Example. Journal of Animal methods – money is also not a real thing, it is only a quantitative Welfare Science 18(1): 9-14.

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Interventional radiology in veterinary practice Interventional radiology (IR) is a term used to describe minimally invasive, image- guided procedures, often performed using natural body orifices or percutaneous access. They are associated with less postoperative pain, a more rapid recovery time and a shorter hospitalisation period than routine surgical methods. In the following Kieran Borgeat CertVC DipACVIM DipECVIM-CA article, we aim to introduce readers to a series of the more commonly performed IR (Cardiology) MRCVS techniques in our clinic using a series of short case reports to illustrate their value. Kieran is a Diplomate of the Interest in this field began its own ‘specialty’ within some decades. In fact, the American and European in humans in the 1920s and the medical profession. In world’s first carotid access Colleges of Veterinary Internal has developed to provide veterinary patients, vascular documented in a companion Medicine in the sub-specialty a range of treatments for and cardiac catheterisation animal was performed in of cardiology, as well as an diseases affecting most has been performed for England by Stephen Hales on RCVS Recognised Specialist body systems, generating experimental purposes for a horse in the 18th century, in Veterinary Cardiology. Alongside a referral cardiology service, he runs the Table 1. Indications for interventional radiology and procedures available, performed using interventional radiology service fluoroscopic or endoscopic guidance at Highcroft Veterinary Referrals in Bristol. Body system Indication Procedure

He has an honorary post as Cardiovascular Patent ductus arteriosus device occlusion visiting lecturer at the Royal coil embolization Veterinary College and is Pulmonic stenosis balloon valvuloplasty module leader for the Certificate transvalvular stent in Advanced Veterinary Practice Subaortic stenosis cutting balloon dilation (Veterinary Cardiology) at Atrioventricular valve stenosis balloon valvuloplasty the RVC, he has lectured Cortriatriatum ballon/cutting balloon dilation internationally on cardiology Septal defects device occlusion and acts as a reviewer for Neoplastic obstruction (trans-)caval stent a number of peer-reviewed Heartworm obstruction image-guided extraction scientific journals. Supraventricular tachycardia radiofrequency ablation Bradyarrhythmia pacemaker implantation Kieran has a particular Arteriovenous fistula coil embolization interest in minimally invasive Respiratory Tracheal collapse tracheal stent interventional procedures and is Nasopharyngeal stenosis nasopharyngeal stent involved in several collaborate Foreign body image-guided extraction research projects on feline Epistaxis embolization hypertrophic cardiomyopathy. Nasal tumours chemoembolization

Urinary Ureteric obstruction ureteric stent subcutaneous ureteral bypass (SUB) device Urethral obstruction nephrostomy tube urethral stent anterograde urethral catheterisation 1.0 Ectopic ureters cystostomy tube hours* AUSMI laser ablation endoscopic injectable bulking agents Gastrointestinal Foreign body image-guided extraction Oesophageal stricture balloon bougienage *Suggested Personal & Professional oesophageal stent (if persistent) Development (PPD) Oesophageal neoplasia oesophageal stent Anorexia image-assisted feeding tube placement Hepatobiliary Portosystemic shunt coil embolization device occlusion Hepatic neoplasia chemoembolization RADIOLOGY Biliary obstruction retrograde endoscopic stent placement

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ONLINE EDITION RADIOLOGY | SMALL ANIMAL

to demonstrate the power of stabilised medically for four Thromobogenic embolization Ruby recovered well, and systolic blood pressure, and weeks pre-operatively. Under coils (Figure 1c) were then was monitored for the the first documented cardiac anaesthesia, percutaneous deployed in the shunt vessel development of seizure catheterisation (again, on jugular access was obtained – after flowing up against the activity (reported in 5% a horse) was performed in for her shunt occlusion. stent, thrombosis leads to of dogs after PSS surgery/ 1844 by Claude Bernard and attenuation of the PSS. embolization) and discharged François Magendie. A catheter was passed into 48 hours postoperatively the PSS and portal pressure Pressure within the shunt on medical management as By the 1980s and 1990s, was measured. Because portal was measured continuously, before. Lifelong omeprazole various pioneering veterinary hypertension was not present, and coil deployment was – initiated one week pre- clinicians were performing occlusion was appropriate. A ceased after a pressure operatively – was prescribed cardiac catheterisation for second catheter was advanced increase to 14mmHg (the (1mg/kg once or twice daily), diagnostic and therapeutic into the caudal vena cava, and maximum desired increase to prevent the development reasons, including the simultaneous portal and caval is up to 16mmHg). Vascular of gastrointestinal bleeding. transvascular balloon injections of contrast were catheters were removed and This complication occurs dilation of stenotic valves used to locate and size the a jugular catheter placed for (via an unknown mechanism) and occlusion of patent PSS on fluoroscopy. A laser 24 hours postoperatively. A in 20 per cent of dogs if no ductus arteriosus (PDA). cut caval stent was deployed post-procedure radiograph gastroprotectant treatment is Although ultrasonography in the caudal vena cava, to was taken as a baseline provided. In our experience, has superseded diagnostic cover the mouth of the PSS to monitor stent and coil it is uncommon with catheterisation for diagnostic (Figure 1b). position (Figure 2). omeprazole use. purposes in the vast majority of clinical cases, image- guided interventions in Figure 1. (a) Non-selective computed tomographic (CT) angiography, illustrating the position of veterinary patients are Ruby’s large, intrahepatic portosystemic shunt (PSS), which was of a left divisional anatomy. becoming more refined (b) Intra-operative fluoroscopy image, showing the caval stent in position immediately after deployment over the mouth of the PSS. (c) Photograph of a thrombogenic coil to illustrate their and experience has grown, Dacron fibres, which stimulate thrombogenesis. such that using IR is a viable treatment option for many conditions in dogs and cats.

The range of IR procedures available to veterinary clinicians (Table 1) ranges from aberrant vessel occlusion (for example, PDA or portosystemic shunt) to palliative treatment of neoplasia (using vascular stents or chemoembolization).

CASE STUDIES

Intrahepatic portosystemic shunt embolization Although we have used IR for the attenuation of Figure 2. Post-procedure radiographs showing the position of the caval stent (arrowheads) and extrahepatic portosystemic embolization coils situated within the intrahepatic shunt (circle). shunts in a minimally invasive manner, IR techniques have revolutionised the treatment of intrahepatic shunts, which are very difficult to close via an open surgical approach because of their position.

Ruby, a one-year-old female entire Cocker spaniel, was diagnosed with an intrahepatic portosystemic shunt (PSS) on computed tomographic (CT) imaging (Figure 1a). She was

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Cutting balloon dilation for subaortic stenosis Subaortic stenosis (SAS) is a common congenital heart disease in dogs. In the most severe cases, interventional treatment may help reduce clinical signs that have failed to respond adequately to medical therapy with beta-blockers.

Milly, a one-year-old female Figure 3. (a) Left ventriculogram showing a tunnel-like lesion of tissue below the aortic valve annulus entire Pug, presented with (arrowheads) as well as post-stenotic dilation of the aortic arch. (b) Initial inflation of the cutting a very severe SAS (trans- balloon. (c) Final inflation of a high pressure balloon to dilate the stenotic lesion. d( ) Photograph of the valvular pressure gradient over cutting balloon, showing the microsurgical blades which are designed to create precise incisions in the 200mmHg: severe stenosis fibromuscular tissue of the stenosis. classified as >80mmHg, and normal <30mmHg). The SAS was caused by a tunnel of fibromuscular tissue below the aortic valve annulus.

A recently described technique, a cutting balloon procedure, was performed to help alleviate Milly’s current clinical signs and attempt to reduce myocardial workload, potentially improving her Figure 4. (a) Retrograde cystourethrogram illustrating the site of neoplastic compression. (b) Urethral longer-term outcome (this stent deployed over the compressive lesion (arrowheads). (c) Post-stent retrograde contrast study technique is novel and long- illustrating reduced urethral compression. term outcome data has not yet been published).

Vascular access was achieved via the carotid artery under general anaesthesia. A pigtail catheter was advanced into the left ventricle and a left ventriculogram highlighted the severe SAS lesion (Figure 3a).

First, a peripheral cutting angioplasty balloon was advanced over the lesion and dilated three times, to score the fibromuscular lesion (Figure 3b and 3d). Next, a larger, high-pressure balloon was advanced over the lesion Figure 5. Selective angiography of the tumour’s arterial supply, arising from the left hepatic artery. Compared to before embolization, images post-embolization show blunting and dilation of the regional and dilated to increase the arterial supply. diameter of the left ventricular outflow tract in a controlled manner (Figure 3c). Invasive her demeanour and exercise dysuria when they occur presented with a six-month measurement of central tolerance, and a reduction in in the urethra or at the history of progressive dysuria. pressures showed a reduction clinical signs of breathlessness. urethrovesicular junction. Ultrasound and CT imaging in the pressure gradient over She remained on long-term In many cases, euthanasia is confirmed a soft tissue mass the lesion of 42 per cent treatment with atenolol. the result of a poor quality of infiltrating the bladder neck. (procedural success is defined life associated with dysuria. Cystoscopic biopsies were as 30-50%). Urethral stent for Clinical signs of stranguria diagnostic of a transitional urinary obstruction may be alleviated by cell carcinoma. Milly was discharged the Transitional cell carcinomas placement of a urethral stent. following day, and within 48 are malignant tumours of Stella was anaesthetised and a hours her owners noticed a the urothelium, which are Stella, a 14-year-old neutered retrograde cystourethrogram significant improvement in associated with obstructive female Bull terrier crossbreed, performed under fluoroscopic

guidance to localise the or abdomen. Fine-needle cranial and caudal margins of aspirate cytology suggested a the tumour. Over a guide wire, hepatocellular carcinoma. a urethral stent was advanced to bridge the site of A femoral arterial approach neoplastic obstruction. was made, and selective catheterisation of the arterial A follow-up retrograde supply to the tumour was contrast study showed performed using progressively reduced compression after smaller catheters and guide stenting (Figure 4) and Stella wires. A dose of doxorubicin recovered well and her clinical was administered intra- signs of dysuria resolved arterially, combined with Figure 6. Computed tomographic imaging of the tumour four weeks postoperatively. Although 25 micro-embolization beads. after chemoembolization showed an approximate 25 per cent per cent of female dogs have reduction in the volume of the mass (outlined), a more organised severe incontinence post-stent, Compared to before appearance to the parenchyma and resolution of the previous free Stella remained continent and embolization, angiography peritoneal fluid (labelled F). Areas of necrosis were present within received long-term treatment post-embolization showed the mass (arrow) but the patient was clinically much improved. with non-steroidal anti- blunting and dilation of inflammatory agents on the the regional arterial supply basis of their potential anti- (Figure 5). Within three tumour effects. days, ascites had resolved, Lucy was brighter, more Chemoembolization for interactive and her appetite palliative treatment returned with resolution of neoplasia of the gastrointestinal Chemoembolization signs. CT imaging of the is the delivery of a tumour four weeks after chemotherapeutic chemoembolization showed agent combined with an an approximate 25 per cent embolization technique to reduction in the volume of Figure 7. Images of a plastic foreign body extracted from the cause local tissue ischaemia, the mass (Figure 6), which stomach in a dog with intermittent vomiting. Endcoscopic (a and into the arterial supply of a had a more organised and b) and post-extraction (c) images clearly show the message ‘do tumour. Most operators use less vascular appearance, not remove’. This item transpired to be a part of an ear-tag used in small ruminants, presumably eaten whilst out walking in fields. intra-arterial doxorubicin or with evidence of necrosis epirubicin, combined with within the mass. small-diameter polyethylene Monty, an eight-year-old Trans-atrial stent embolization beads. Surgery was performed neutered male Border terrier, for palliation of subsequently to remove all was presented with a history large cardiac tumour The technique is best of the macroscopic tumour, of vomiting intermittently As in the urethra, a described in dogs with large and Lucy recovered well. She for two weeks. His owners metallic stent may be hepatocellular carcinomas, but remains free of clinical signs, reported a lifelong history of used to relieve neoplastic treatment of nasal tumours and has regained a normal scavenging, and abdominal obstruction or compression and other types of neoplasia body condition score. ultrasonography showed of blood vessels. Stent use has been described. It is a evidence of a foreign body in may be performed in any palliative treatment to consider Endoscopic gastric foreign the pylorus. large blood vessel, but has where no good medical or body extraction been most widely reported surgical alternative exists, Endoscopic extraction of A flexible video endoscope in the vena cava, hepatic where access to radiotherapy foreign objects from the was advanced into the veins, pulmonary artery is limited, or as a pre-surgical oesophagus, stomach and stomach and a brown, and trans-atrial sites. treatment to attempt tumour larger airways (and, rarely, circular foreign body was size reduction. the proximal duodenum) has identified. After some Although not a cure for been performed by many manipulation, a message was the neoplasia, palliative Lucy, a 12-year-old neutered centres for some years, clearly seen written on the improvement or resolution female golden retriever and does not represent a object (Figure 7). Disobeying of clinical signs relating presented with ascites, novel technique. However, the message, the foreign to vascular congestion cachexia and a history of an access to a suitable range body was extracted per os may significantly improve abdominal mass detected of flexible endoscope sizes using a set of endoscopic quality of life, especially in on ultrasound imaging. She in one clinic is not common basket forceps. In contrast to slow-growing tumours. had progressive inappetence in first-opinion practice. most patients undergoing a A post-stent survival time and intermittent vomiting Despite this being a well- gastrotomy, Monty recovered of six to 24 months has and diarrhoea. Abdominal described technique, we rapidly, with little or no been reported for CT showed a large, isolated wanted to share with post-procedure pain, and dogs with large venous hepatic mass with no evidence readers a memorable case was discharged that evening. obstruction causing of metastasis within the thorax from our hospital. Clinical signs did not recur. clinical signs.

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Figure 8. Sequential images from fluoroscopy, showing the procedure to place a trans-atrial stent. a( ) Caudal vena caval selective angiography shows the margins of the tumour, obstructing venous return from the caudal body (red arrowheads). (b) Next, a through-and- through wire is placed from caudal cava (CVC) to cranial cava (CrVC). (c) Balloon dilation to pre-dilate the compressed cava and right atrium prior to stent deployment. (d) The trans-atrial stent mid-deployment (yellow arrowheads). (e) Post-stent selective angiography, showing contrast enhancement of the caudal cava, right heart (RA and RV), and main pulmonary artery (PA). This confirmed relief of the neoplastic obstruction by the stent.

Finley, a 10-year-old neutered following day. Within five transvascular approach has illustrated the varied use male English Springer spaniel days, his ascites resolved and a higher rate of complete of interventional radiology was presented to his primary his appetite and demeanour occlusion and a significantly to provide both curative vets with sudden-onset improved significantly. lower risk of haemorrhage than and palliative treatments lethargy and ascites. Thoracic a surgical thoracotomy. for a range of clinical small ultrasound detected a cardiac One month later, he had animal presentations. The mass. At the time of referral, gained muscle mass and Dudley, a 12-week-old entire lower level of procedural Finley had a poor body at nine months post- male Border collie, presented risk and postoperative condition score, and was procedure he remained free for murmur evaluation. pain may favour the use of severely ascitic and lethargic. of clinical signs and was no A PDA was diagnosed on certain IR procedures over longer under-weight (body echocardiography and device more traditional surgical Echocardiography and CT condition score 6/9). occlusion pursued. Under approaches (PDA occlusion, imaging showed a large anaesthesia, a vascular for example). homogenous mass at the Thoracic radiography at this approach was made via the heart base, compressing time (Figure 9) showed no right femoral artery. After In other cases, IR techniques the caudal vena cava at its change in stent position and angiography in the ascending may offer a novel treatment, junction with the right atrium echocardiography confirmed aorta to confirm the location where no good alternative has (Figure 8a). good venous return cranially and size of the ductus, a previously existed – chemo- and caudally. delivery sheath was placed embolization of inoperable Non-selective angiography, across the PDA and into masses, occlusion of intra- performed via the lateral Occlusion of a patent the main pulmonary artery. hepatic shunts, or tracheal saphenous vein, showed that ductus arteriosus Through this, an Amplatz stents to alleviate collapse, blood flow from the caudal Patent ductus arteriosus (PDA) Canine Duct Occluder (ACDO) for instance. body returned to the heart via a is one of the most common device was situated in the dilated azygous vein and several congenital heart diseases of ostium of the PDA (Figure 10). Although open surgery dilated vertebral veins. No dogs. The ductus – a normal remains the primary evidence of metastasis foetal structure that allows After deployment, selective treatment for many structural was present. blood to bypass the non- angiography showed almost diseases in pets, the future expanded foetal lungs – should immediate occlusion of is bright for image-guided Approaching the heart from constrict in response to flow, and the heart murmur procedures and we are cranial (left jugular vein) prostaglandins and increased disappeared. Discharged standing on the threshold of and caudal (right femoral oxygenation within 72 hours the following day, Dudley realising their potential. vein), a through-and-through of birth. returned four weeks later for approach was made to the re-evaluation and had grown right atrium (Figure 8c). After A congenital lack of normal well. His owners reported an serial balloon dilations of the smooth muscle tissue leads to improvement in exercise ability, compressed region of vena patency of the ductus, which despite not having previously cava, a metallic stent was typically presents as a continuous reported clinical signs. deployed from the caudal murmur in a young dog, with vena cava, trans-atrially, to the abnormal flow ultimately Dogs such as Dudley tend to the cranial vena cava. overloading the left heart and have a very good prognosis causing left-sided congestive heart for a normal lifespan, and do Post-stent angiography failure. Survival to one year old is not routinely require follow-up showed good venous return reported at a level of 50 per cent. once their PDA is occluded. to the right heart through the caudal vena cava (Figure Surgical ligation is widely Summary 8d). Finley recovered rapidly performed, but interventional Through these seven and was discharged the device occlusion using a cases, we hope to have

Further reading Beal M (2013). Tracheal stent placement for the emergency management of tracheal collapse in dogs. Topics in Companion Animal Medicine 28 : 106 -111.

Blackburn AL et al (2013). Evaluation of outcome following urethral stent placement for the treatment of obstructive carcinoma of the urethra in dogs: 42 cases (2004-2008). Journal of the American Veterinary Medical Association 242: 59-68.

Durant AM et al (2012). Use of nitinol stents for end-stage tracheal collapse in dogs. Veterinary Surgery 41: 807- 817.

Lateral and dorsoventral radiographic projections of Finley, immediately post operatively Figure 9. Kleman ME et al (2012). How after placement of a trans-atrial stent to relieve caudal vena caval obstruction. The stent can be seen, to perform combined cutting compressed at its caudal aspect by the presence of the large heart base mass (arrowheads). Radiographs balloon and high pressure balloon nine months later showed no change in stent position and the dog was non-clinical because caudal caval inflow remained patent. valvuloplasty for dogs with subaortic stenosis. Journal of Veterinary Cardiology 14: 351-361.

Singh MK et al (2012). Occlusion devices and approaches in canine patent ductus arteriosus: comparison of outcomes. Journal of Veterinary Internal Medicine 26: 85-92.

Veterinary Image Guided Interventions, Weisse and Berent (Eds), Wiley Blackwell, 2015.

Figure 10. Situation of an Amplatz Canine Duct Occluder (ACDO) to occlude a patent ductus arteriosus Weisse CW (2011). Introduction via a trans-arterial approach. (a) The device was placed in the ductal ostium (arrowhead) via a femoral to interventional radiology for the artery approach, and the delivery sheath and wire can be seen in the descending aorta. (b) Post- criticalist. Journal of Veterinary deployment angiogram shows complete ductal occlusion within seconds of device release. (c) A post Emergency and Critical Care 21: operative radiograph demonstrates an appropriate ACDO location and conformation (circle). 79-85.

Weisse CW et al (2014). Endovascular evaluation and treatment of intrahepatic portosystemic shunts in dogs: 100 cases (2001-2011). Journal of the American Veterinary Medical Association 244: 78-94.

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Housing sick and immature newborn puppies for hand rearing Puppies may need to be hand reared because the bitch has died or is unwell, she may not have sufficient milk or because she has rejected a puppy. In case of rejection, unless there was a traumatic birth or Caesarean section, it is important to note that bitches will often reject an individual puppy that has a serious abnormality or Samantha Bloomfield health issue. A puppy may need to be hand reared if it cannot feed from the bitch BSc MA VetMB GPCert(SAS) MRCVS owing to an anatomical abnormality such as a cleft palate, an illness such as septicaemia, or through being immature. Samantha has a Degree in Nutrition from King’s College, Puppies can be born ‘to term’ similar sizes from the same a twice-daily basis as the London, and qualified as – at the correct gestational litter can be re-introduced to warmth and humidity is an a veterinary surgeon from date – but are, in fact, very each other. ideal environment for the Cambridge University in 2005. immature as a consequence multiplication of yeasts Since then she has worked of adverse factors inside the It is important to socialise and bacteria. Bedding can in mixed and small animal uterus, such as infection, puppies back with their litter comprise a piece of veterinary practice in the UK and abroad. during their development. mates as soon as possible. If bedding (woven-backed Although now working in This immaturity can cause this is not possible because synthetic fleece) cut to size or general practice, she has over problems feeding from the there are no siblings, then a folded cotton cloth. Once 30 years of experience of hand- bitch because of a lack of supervised, slow introduction soiled, this must be changed rearing sick and premature lung surfactant that makes it to a carefully considered, immediately and washed at a animals starting with her time difficult for the puppy to suck healthy, fully vaccinated temperature of 90°C. running a referral clinic and causes diarrhoea through adult dog is important for for puppies and kittens. a lack of gut maturation. social development. In doing Housing healthy and this, the author has never older puppies Samantha has a website Unless ‘top-up feeding’ is experienced the negative In the absence of an incubator offering help and being instigated to help a behaviours often cited as a and for moving on from advice to breeders and bitch with a large litter, sick result of hand rearing. using an incubator, a suitable to the veterinary profession, and immature puppies are environment can be set up www.puppyandkittenclinic.com best nursed completely away Incubators with the following equipment and her book, Bloomfield’s from the bitch and from the Ideally, healthy newborn and (Figures 2 and 3). Manual of Puppy Hand rest of the litter to enable immature puppies are nursed in Rearing, is available from accurate monitoring of their an incubator for the first 24 to Plastic box with a the website and from condition and progress. 48 hours after birth. Immature heat source www.amazon.co.uk Individual nursing prevents puppies often benefit from an Warmth can be supplied exhaustion as the puppy incubator for up to seven days. from either a covered electric spends less time – and, Some veterinary clinics may heat pad (not a pressure- therefore, energy – trying to have one, but it is probably not dependant one) or a covered compete with litter mates and practical for most to keep one microwaveable heat-retaining negotiating a large whelping on standby. gel heat pad. Many heat pads box. In the event of rejection are far too hot for newborn by the dam, removal of the Individual bench top puppies and can cause burns. puppy prevents potential laboratory incubators are attack by the bitch. ideal for single newborn Figure 1. Individual ‘bench-top’ puppies with space for a laboratory incubator. 0.5 If hand rearing more than small soft toy to cuddle hours* one puppy, it is best to house up to (Figure 1). Healthy it separately until weaning newborn puppies can be for similar reasons to those nursed at 29.5°-32°C with stated above. Also, hand- immature puppies nearer reared puppies tend to suck 31°-32°C gradually reducing each other in the first few to 30°C after a few days. The *Suggested Personal & Professional Development (PPD) weeks of life leading to skin, incubator temperature must be gastrointestinal and urinary monitored constantly because tract infections. Once weaning overheating can be a problem commences – which can be and easily kill a puppy. as early as 18 days if needed PUPPIES – then the sucking problems The incubator must be tend to abate and puppies of thoroughly disinfected on

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Figure 3. Place a cuddly toy in with the puppy to nestle up to and provide a background rhythmic noise such as a ticking clock or Figure 2. Equipment needed for housing a newborn puppy. If using watch close to the box. During the day, a low-volume radio provides a microwaveable heat pad, purchase two as they need to cool useful background noise and stimulation. The blanket should be completely before re-heating. pulled fully over the box at night for additional warmth.

Check the surface temperature reduced to 21°C – the exact Once a puppy is more mobile, by placing a thermometer on temperature depends on the it may try to climb out of Summary of key the proposed bed with the maturity, body fat and hair the box. An effective way to housing points heat pad underneath for an coat of the puppy. Puppies prevent this is to place a fine Provide a stable hour. If it is too hot, wrap the that are too cold will curl up net (such as a net curtain) over environment: pad in another layer of cotton and huddle. Puppies that are the box secured with elastic. immature puppies towel and test again. A hot too warm will try to lay out Clothes pegs or bulldog clips 30°-32°C for the first water bottle can be used in an flat and have an increased help secure the net in place. few days, then emergency, but is not ideal for respiratory rate or pant. treated as mature safety reasons and loses heat Humidity should be around Hygiene newborn puppies too quickly. Infrared lamps 60 per cent. The box should be thoroughly newborn mature tend to dehydrate puppies and disinfected on a daily basis puppies 29.5°-32°C for they cannot move away from Appropriate bedding with a standard veterinary the first week of life, the heat source easily. This may simply be a towel disinfectant. The bed may need then reducing to 26.5°C or blanket that can be changing two or three times a by three weeks of age The heat source must provide pulled across the top of day if the puppy has diarrhoea; keep the environment clean warmth at a constant rate, the box – half way during otherwise, once a day is keep the puppy clean because puppies that are the day and fully at night in sufficient, with the bed being nurse puppies separately too cold tend to nestle up order to create the correct washed at 90°C. The absorbent if sucking each other under the bedding, while temperature in the box. paper toilet area should be (put back together those that are too hot move Clothes pegs or bulldog clips replaced as soon as soiled. at weaning). off the bed to a cooler part of are useful to keep this the box. If the environmental in place. If the puppy becomes dirty temperature keeps fluctuating from faeces and food, then it the puppy will waste valuable Bedding may include: can be cleaned with fragrance- energy trying to stabilise its a towel or cotton sheet to free newborn baby wipes. It internal body temperature. place on the bottom of the is usually necessary to wipe box for insulation around the mouth after each A thermometer veterinary bedding cut to feed if feeding from a teat to This should be attached to size for the bed area remove milk from the coat, the inside of the box, with the absorbable paper or puppy which will harbour bacteria bulb of the thermometer at training pad/ and cause infection. If the the same level as the puppy. incontinence pad. puppy develops skin ‘scalding’ Immature puppies should be from diarrhoea, then zinc kept at 30°-32°C for the first An area of the box should be oxide cream applied after few days then treated as mature free of the heat pad and bed every clean is recommended. newborns. Newborn mature for use as a toileting area. The puppies should be kept at an puppy will start to use this environmental temperature of area by 10-14 days of age. 29.5°-32°C for the first week of life, then 26.5°C up to three It is a good idea to provide weeks of age. a soft toy for the puppy to nestle up to and a ticking After three weeks, the clock to simulate the mother’s temperature can be gradually heart beat for comfort.

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National Veterinary Data service

The new microchipping legislation has Once registered on the system, pet owners need only keep increased the demands on pet owners their veterinary practice informed of any changes of address and breeders and highlighted the or contact numbers. importance of secure and reliable data NVD® goes a long way to address the problem of incorrect storage, registration and updating of data held about a large percentage of microchipped pets. pet owner details. Indeed, in 2015, startling research conducted by the charity, Dogs Trust, revealed that 46% of British dog owners did not he National Veterinary Data service (NVD®) is a keep their microchip contact details updated. This figure new facility that offers seamless registration on its was particularly alarming, as 22% of owners admitted their Tnational database via registered veterinary pratices, dog had gone missing within 48 hours of moving house. for newly microchipped pets. Registration also includes an With a brief reunification period of seven days before a lost on going automatic renewal of contact information via the pet is rehomed or put to sleep, it is essential for all contact client’s registered vet. information to be kept up-to-date.

The introduction of a synchronised system that coordinates modern practice management systems with the National Veterinary Data service, means pet owners need only keep their details up-to-date with their veterinary practice.

“NVD® – the database that actively promotes microchipping by veterinary practices”

NVD® reinforces the relationship clients have with their vets and helps to ensure that as well as being microchipped, every pet is registered with a veterinary practice that can help with successful reunification.

In addition to being a database that is continually updated through regular contact, there are further advantages of focusing the service around veterinary practices. The

16 VETERINARY PRACTICE TODAY | VOLUME FOUR | ISSUE THREE | 2016 benefit of a vet’s local knowledge (pet owner’s local friends “The introduction of a and relatives for example) and detailed understanding of the pet’s medical history, allows them an advantage when synchronised system that working to reunify a lost or found pet. coordinates modern practice management systems with NVD® has initially been implemented with AT Veterinary the National Veterinary Systems a long established and leading provider of management systems to the veterinary profession. Data service, means pet The service is also being made available through other owners need only keep their management systems upon request. details up-to-date with their veterinary practice”

Any practice looking to implement this service should contact: Central Veterinary Services Ltd on 0330 123 9924 or email [email protected] www.nvds.co.uk

For further information: The Microchipping of Dogs (England) Regulations 2015. www.legislation.gov.uk/uksi/2015/108/contents/made The Microchipping of Dogs (Scotland) Regulations 2016. www.legislation.gov.uk/ssi/2016/58/contents/made The Microchipping of Dogs (Wales) Regulations 2016. www.legislation.gov.uk/wsi/2015/1990/contents/made The RCVS Guidance ‘Microchips, microchipping and animals without microchips’. www.rcvs.org.uk/microchipping The BSAVA Information on best practice for microchipping. http://www.bsava.com/Resources/Microchipping.aspx

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Living life to the full Ageing is an inevitable part of life. With an increased array of medication and services to support the ageing pet, practices are seeing substantial benefits from engaging in proactive support of the older companion animal – with some estimating that care of the geriatric pet accounts for 60 per cent of their practice income. However, with an overall intention of ‘do none harm’, we must ask whether such health support is truly enhancing the lives of our geriatric patients? Claire Hargrave MSc BSc(Hons) PGCE CSci CChem MRSC CCAB This article considers some extra support that should be part of every dog and cat’s geriatric support package if life is to continue to be lived to ‘the full’. Claire is an ASAB-accredited clinical animal behaviourist and Increased affluence, improved recognised that during ageing inflammation; and that occur lecturer in companion animal nutrition, better general health ‘the inevitable changes in exogenously in our environment behaviour. She has a referral care and increased owner biological processes within the as air pollution and ionising practice taking cases from expectations mean that our body result in a progressive radiation, for example. throughout Wales. pets now live longer (Watson, reduction in the animal’s 1996). Consequently we are ability to cope with internal The rate at which these ‘oxygen seeing more animals showing physiological and external species’ affect an animal’s body age-related changes in their environmental stressors’ will be dependent upon how behaviour that can make the (Heath, 2002). efficiently the body’s internal and companion animal’s geriatric external defence mechanisms years problematic for both One well-accepted theory are functioning. The efficiency of pet and owner (Gunn-Moore, related to ageing is that such systems inevitably decreases 2011; Landsberg et al, 2012). associated with free radicals – with age, so the susceptibility the unstable, reactive ‘oxygen of the ageing pet to free radical When is a dog or cat old? species’ that are produced damage increases. Studies of longevity in different naturally, endogenously, in our breeds have replaced the cells from energy production As free radicals react with previously accepted adage that and as a result of infection and protein, fat and DNA – one ‘dog year’ is equivalent to seven ‘human years’. With more meaningful data, it is now reasonable to assume that dogs will show signs of old age by eight and cats by 11 (Overall, 2013). Ageing, however, will also be dependent upon genetics, size, breed, hybrid vigour, family characteristics, individuality, lifestyle, nutrition and the environment (Landsberg et al, 2013).

Human twin studies have shown that heritable influences result in 25 per cent 1.0 of the variation in life span hours* and that the environment and lifestyle of an individual result in 75 per cent of the variation (Herskind et al, 1996). “Too many owners still assume that many

*Suggested Personal & Professional of the cognitive and physical changes Development (PPD) The ageing process Despite its universal associated with their pet’s old age are application, the ageing process remains little simply part of ‘getting old’, that they are understood; but we know inevitable and that nothing can be done GERIATRICS that it affects the cells of all body systems. However, it is about them”

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and older animals have a particularly in those individuals Old age doesn’t behaviour is likely to be caused decreased capacity to produce exposed to a lifetime of come alone by internal stressors associated antioxidant enzymes – the negative environmental A behavioural change in any with illness or old age. results in affected pets will be factors (Overall, 2013). With elderly pet should be a source cell damage, cell dysfunction, its concentration of protein, of concern and should be Typical of the physical neoplasia and cell death. fat and DNA, the brain is mentioned to the veterinary deterioration observed in This, in turn, leads to physical particularly targeted by free team – if there is no obvious older animals are lower energy deterioration and a greater radical activity in the external stimulus to initiate levels, sensory deficits (sight, susceptibility to infection, ageing animal. the change, the alteration in hearing, taste and smell),

Table 1. Behavioural signs of neurological and sensory changes associated with ageing

Sign Result

Confusion loss of recognition of social and environmental stimuli

Attitude or personality change decreased/loss of interest in people and/or other pets out-of-character ‘neediness’ social hierarchy changes inter-dog aggression provoked by individual’s bizarre behaviour

Decreased activity – apathy/depression decreased exercise tolerance decreased interest in play reduced interest as a social companion to family increased weight chronic stress increasing ‘negativity’ increased daytime sleep

Increased activity – pacing, repetitive activity reduced night-time sleep wakefulness agitation vocalisation demands for attention destructive behaviour increased irritation of family, leading to punishment and increased anxiety

Increased frequency of normal behaviours – agitation in owner barking, whining, drinking, licking frustration if behaviour interrupted anxiety if behaviour punished

Loss of learned associations disorientation house training breakdown social breakdown

Increased anxiety or irritability increased likelihood of: anxiety related conditions (e.g. separation problems social anxieties (especially cats) noise fears and phobias aggression if disturbed/need to move to avoid stimulus

Appetite change increased decreased bizarre – pica

Memory loss social confusion environmental confusion and possible toileting issues aggression to family and other pets

Inability to cope with change anxiety irritability aggression

Loss of house training loss of learned appropriate associations loss of ability to communicate needs loss of inhibition

Disorientation getting lost in familiar places failure to recognise familiar people failure to recognise familiar objects (e.g. barking at furniture) inappropriate reactions to familiar objects/situations (e.g. waiting at wrong side of exit door)

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Table 2. Essential advice to convey to the owners of elderly pets during clinic visits

Resource Dogs Cats

Food and water help dogs with joint and spinal problems to eat raise bowls off ground by a few centimetres to and drink more comfortably by raising bowls ease joint and spinal discomfort and separate the prevent slipping with non-slip matting, extend drinking and eating locations to regular walkways on lino or parquet many cats feel more secure eating on raised surfaces (windowsills/worktops) – provide a ramp or steps (Gunn-Moore, 2014)

Activity feeding relieve behavioural frustration and lack of cats benefit from many small meals mental stimulation with purchased and gentle puzzle feeding games encourage movement, home-made puzzle feeding enhance investigation and encourage cognitive many small meals, in quiet places, will enhance activity (Ellis, 2009) digestibility and can be timed to coincide with times when the dog might otherwise be anxious or uncomfortable activity can replace lost exercise (Landsberg et al, 2012)

Home environment once the dog’s sensory system begins to decline the cat’s capacity to cope will benefit from a it is important that the layout of the home consistent map of the physical environment, but its environment remains as consistent as possible olfactory map will also be very important (Warnes, 2015) using products such as Feliway (Ceva) can assist, as can ensuring that sleeping and resting places smell of the cat pheromones can be harvested from the cat’s facial area with cotton gloves and rubbed over novel items brought into the home

Toileting sensitivity and tolerance may be required – e.g. need an area separate to eating and drinking areas an outside latrine close to the door or puppy (unless the cat is very incontinent) pads in a large tray inside the home use larger trays with lower sides to improve access owners will need to be extra observant of subtle for cats with mobility problems signs of requiring help to leave a room as dogs if cats have previously toileted outside, they may may forget which side of the door opens no longer be able to manage a cat flap, so a tray owners may need to take their dog to their with fine-grained, sand-like litter may be preferred latrine regularly, particularly after food or sleep (Warnes, 2015)

Resting areas the dog will require comfort and support although beds should be easy for the cat to access, (memor y foam) the cat will feel exposed if sides are too low, so bed size may need to increase to prevent the dog select an easy entrance facing away from activity being forced to curl a painful spine with higher sides in other areas sides should be low for ease of entry and exit bed should be large enough for them to lie out flat areas should be draught-free and warm because if they wish the dog may not be able to move to keep warm cats prefer to rest in raised places, so older cats will bedding would benefit from smelling of the benefit from ramps or steps in order to access both owner, but care must be taken that the dog beds and observation areas doesn’t become ‘tangled’ in items help elderly cats to keep warm using fleece and Adaptil diffuser and collar (Ceva) may help the consider electrically heated beds. Don’t wash dog to settle overnight bedding too often and replace bedding with pre- used items – cats rely on items that smell familiar and hence a pheromone diffuser can reduce anxiety when plugged close to the bed (Gunn- Moore, 2014)

Social interaction owners may assume the dog needs to rest, when owners often think that elderly cats become “lazy” and play it is actually withdrawn through discomfort rather than appreciating that they are reticent to once pain is controlled, owners should encourage move owing to discomfort gentle social interaction and simple games – once this is resolved, simple puzzle-feeding exercises particularly those encouraging movement to and short periods of interaction with toys (e.g. ‘puzzle-solve’ for small portions of food fishing rod toys) or a slowly moving laser beam from use remaining olfactory capacity in food searching a pen can provide entertainment and exercise keep other family pets busy in other areas of the end games on very small portions of tasty food to home during these activities complete the behavioural sequence and reinforce for future use >>>

Resource Dogs Cats

Moving around (inside in addition to non-slip matting, consider cats can also benefit from non-slip matting and outside home) non-slip ramps to aid access to the home, car and ramps – particularly to feeding, resting and and sofa observation platforms (Gunn-Moore, 2014)

Exercise dogs with reduced exercise tolerance can receive cats will also benefit from puzzle feeding to substantial gentle exercise from numerous, compensate for a reduced inclination for small, puzzle-solving feeding exercises in the extensive exercise house and garden to replace set meals in addition, as cats may become confused whilst short walks that give the dog time to sniff outside the home, owners should consider around can replace longer walks, as can sniffing withdrawing access to the cat flap and if cats are games to find food in the garden to go into a garden they should be accompanied by the owner (Warnes, 2015) musculo-skeletal degeneration members and other family With so many older pets In addition to these and a compromised immune pets (Cory, 2013; Landsberg et experiencing ageing changes suggestions, owners should system. Consequently, al, 2013). associated with neurological be encouraged to consider many geriatric pets present and sensory changes, dietary supplementation. with reduced mobility, The urino-genital and behavioural signs are often Supplementation with reduced exercise tolerance, digestive systems are often the first indication of geriatric enzymatic and non-enzymatic disorientation, increased affected by infection in the changes (Table 1). antioxidants may benefit risk of infection across organ geriatric pet too. Whether geriatric cats and dogs; systems and a decreased these systems are infected, Use it or lose it and older dogs receiving rate of recovery. As a result whether the animal is If elderly pets are to continue a combination of dietary – but less often considered – confused regarding learning to live a full life – despite antioxidants showed better many geriatric cats and dogs associated with toileting physical and sometimes retention of learned behaviour experience chronic pain; and behaviour, environmental cognitive challenges – and if compared to age-matched the combination of this and a cues, or whether the animal families are to continue to controls (Milgram et al, 2002). decreased capacity to escape is simply too uncomfortable perceive their elderly pets as from the pain or anxiety to be able to move in fulfilling companions, it is Studies have shown that such inducing stimulus (internal or sufficient time, old age is essential that both pet and supplemented diets can both external) will lead to anxiety often associated with a loss family play as full a role as reverse and prevent some or fear (Blackwell et al, 2013), of toilet training in the elderly possible in each other’s lives. of the behavioural changes irritability – and often – cat and dog (Bowen and To ensure this, families need associated with old age (Heath aggression towards family Heath, 2005). to make provision to maintain et al, 2007). Caution should their pet’s cognitive and be used, however, when physical function. supplementing the diet of the “The veterinary profession has a cat because some antioxidants Too many owners, however, found to be safe in dogs may responsibility to encourage the owners still assume that many of the be toxic– or potentiate toxic cognitive and physical changes reactions – in cats. of geriatric pets to take advantage of the associated with their pet’s old life-enhancing opportunities provided by age are simply part of “getting Medium chain fatty acids old”, that they are inevitable have been found to have behavioural and environmental enrichment” and that nothing can be done beneficial effects on cognitive about them (Landsberg et function and may provide al, 2010). Particularly at risk an alternative energy source of exposure to this attitude for damaged brain cells with are the many elderly pets altered glucose metabolism whose owners have allowed (Landsberg et al, 2012); but, their annual vaccinations and although likely to benefit cats, regular preventive parasite such diets have been found control to lapse. to be unpalatable. Elderly animals are often loath to It is the owners of these pets accept dietary changes and who will need significant the use of supplements that inducement to re-engage with can be added to an existing preventive strategies for their diet, may be better accepted. ageing pet. Consequently, it is the concept of the ‘free’ nurse Supporting cognitive clinic for the elderly pet that decline with medication will often entice such owners In addition to the medication to re-engage with medical care required to control medical for their pet (Table 2). conditions and associated

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discomfort, the behaviour of if elderly dogs and cats are References some elderly pets may be such to ‘live life to the full’ the Blackwell EJ et al (2013). Fear responses to noises in domestic dogs: Prevalence, that they will benefit from veterinary profession has a risk factors and co-occurrence with other fear-related behaviour. Applied Animal support from psychotropic responsibility to encourage Behaviour Science 145: 15-25. medication (Landsberg et the owners of geriatric pets al, 2013). Such medication to take advantage of the Bowen J and Heath S (2005). Behaviour problems in Small Animals – Practical should be selected with the life-enhancing opportunities Advice for the Veterinary Team. Elsevier/Saunders. aim of improving cognitive provided by behavioural and function, reducing anxiety and environmental enrichment Ellis S (2009). Environmental Enrichment: practical strategies for improving feline encouraging the pet to sleep at that can turn a life prolonged welfare. Journal of Feline Medicine and Surgery 11: 901-912. night (Landsberg et al, 2011). into a long life well lived. The medication of choice Gunn-Moore DA (2011). Cognitive Dysfunction in Cats: Clinical Assessment and will depend on compatibility Management. Topics in Companion Animal Medicine. 26: 17-24. with existing pharmaceutical regimens (Warnes, 2015). Gunn-Moore D (2014). Dementia in ageing cats. Veterinary Times April 21 2014: 14-16 Conclusion There is increasing evidence Heath S (2002). Behaviour problems in the geriatric pet. In: BSAVA Manual of to suggest that timely Canine and Feline Behavioural Medicine. BSAVA Publishing. pre-emptive nutritional support can delay the ageing Heath SE et al (2007). Nutritional supplementation in cases of canine cognitive process and there can be dysfunction – a clinical trial. Applied Animal Behaviour Science 105(4): 284-296. no doubt that early medical intervention in age-related Herskind A M et al (1996). The Heritability of human longevity: a population- disease processes is crucial to based study of 2,872 Danish twin pairs born 1870-1900. Hum Genet. 97: 319-323. maximising health. However, Landsberg G et al (2010). Cognitive dysfunction in cats. A syndrome we used to dismiss as old age. Journal of Feline Medicine and Surgery 12: 837-848.

Landsberg GM et al (2011). Clinical Signs and Management of Anxiety, PPD Questions Sleeplessness and Cognitive Dysfunction in the Senior Pet. Veterinary Clinics of North America: Small Animals 41: 565-590.

1. When should owners alert the veterinary team to a Landsberg GM et al (2012). Cognitive Dysfunction Syndrome: A Disease of behaviour change in their elderly cat or dog? Canine and Feline Brain Aging. Veterinary Clinics of North America: Small Animals 42: 749-768. 2. When should veterinary staff enquire about old-age changes? Landsberg GM et al (2013). Behavior Problems of the Dog and Cat. 3rd edn. Saunders.

3. If consistency is important in the environment, Milgram NW et al (2002). Landmark discrimination learning in the dog: effects should owners be advised to make no changes? of age, an antioxidant fortified food and cognitive strategy. Neuroscience Biobehaviour Review 26(6): 679-695. 4. There is no cure for old age – why should owners be encouraged to consider treatments? Overall K (2013). Manual of Clinical Behavioural Medicine for Dogs and Cats. Elsevier.

5. When should treatment strategies for cognitive Warnes C (2015). Changes in behaviour in elderly cats and dogs Part 1: causes

dysfunction be implemented? and diagnosis. The Veterinary Nurse 6(9).

the prognosis for improving the signs of cognitive dysfunction cognitive of signs the improving for prognosis the Warnes C (2015): Changes in behaviour in elderly cats and dogs Part 2: The earlier these treatment strategies are implemented, the better better the implemented, are strategies treatment these earlier The 5.

progression of cognitive dysfunction in elderly animals elderly in dysfunction cognitive of progression management, treatment and prevention. The Veterinary Nurse 6(10).

medication, can be effective in improving the signs and slowing slowing and signs the improving in effective be can medication,

encouraging gentle physical activity, dietary supplementation and and supplementation dietary activity, physical gentle encouraging Watson D (1996). Longevity and Diet Veterinary Record 3: 71.

Treatment strategies, such as increasing mental stimulation, stimulation, mental increasing as such strategies, Treatment 4.

mobility problems, sensory loss or cognitive dysfunction cognitive or loss sensory problems, mobility

significantly improve the quality of life of elderly cats and dogs with with dogs and cats elderly of life of quality the improve significantly

accessibility to the environment and important resources, can can resources, important and environment the to accessibility

Environmental management strategies, aimed at improving improving at aimed strategies, management Environmental 3.

dogs from eight years of age and cats from 10 years at the latest the at years 10 from cats and age of years eight from dogs

owners about any changes in their pets’ behaviour whenever they see see they whenever behaviour pets’ their in changes any about owners

changes during practice visits, so veterinary staff should be asking asking be should staff veterinary so visits, practice during changes

Owners of elderly animals will not always mention behaviour behaviour mention always not will animals elderly of Owners 2.

welfare

treated, improving both the prognosis for treatment and the animal’s animal’s the and treatment for prognosis the both improving treated,

the sooner the underlying medical or behavioural condition can be be can condition behavioural or medical underlying the sooner the

As early as possible. The earlier behaviour changes are recognised recognised are changes behaviour earlier The possible. as early As 1. Answers

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Dangers of dietary supplements The past few years have seen an exponential rise in the number and variety of dietary supplements, some of which are medically valid and some of which promise easy alternatives to weight loss or achieving a healthy lifestyle. As always, there is potential for companion animals to access or be exposed to these preparations, which, depending on the class of compound involved, will have varying consequences.

Jane Ellison There is a vast range of So, when dealing with vitamin polydipsia, profuse vomiting and BSc (Hons) dietary supplements – some D, you must be certain diarrhoea could all develop. of the most common groups whether you are dealing with Jane is an information scientist are multivitamins, vitamin ‘plain’ vitamin D (as above) or As the calcium concentration who has worked for the D preparations, weight-loss with the common analogues rises above 3mmol/L (12mg/ Veterinary Poisons Information preparations including bulking of vitamin D3 (colecalciferol dL – usually 24 to 36 hours) Service (VPIS) and the human agents, joint supplements, or cholecalciferol) or less there may be severe vomiting, poisons service at Guy’s omega-3 fatty acids and bee commonly D (calciferol anorexia, constipation, ataxia, Hospital, on and off since 1984, 2 products, such as pollen or or ergocalciferol). D3 dyspnoea, tachypnoea, arching and has also worked in the royal jelly. is frequently found in of the back, muscle spasms, pharmaceutical industry. Jane combination with calcium. twitching and convulsions. was a founder of the veterinary Multivitamins The dangerous dose of D or service in the 1980s and has 2 Multivitamins, even when D3 is >0.5mg/kg (or 21,000 IU/ In severe cases, recently returned to work for it taken acutely in large kg) – given that tablets often hypercalcaemia and as a member of the quantities, do not pose contain around 400IU or hyperphosphataemia may be 24-hour rota team. a significant risk to the less, it would be unlikely to be present from 12 to 72 hours, health of the animal, as the acutely dangerous. and deposition of calcium quantities of each component in tissues may cause initial vitamin are so small. Dogs Calciferol and colecalciferol tachycardia, then bradycardia ingesting large amounts are rapidly absorbed and and renal insufficiency of over-the counter (OTC) metabolised by the liver (polyuria, azotaemia and vitamins may experience and kidney. The parent hyposthenuria) or renal some mild self-limiting compounds and the failure. Haematemesis and gastrointestinal effects, but intermediate metabolites have haemorrhagic diarrhoea generally, no treatment will some limited pharmacological may occur as a result be required. action but the major toxic of calcification in the effects are a consequence gastrointestinal tract, and The vitamin D content of of the major metabolite, pulmonary haemorrhage has these OTC multivitamins calcitriol, which enhances also been reported. is commonly between 1μg resorption of calcium to 20μg per tablet, but the from bone, absorption Metabolic acidosis treatment dose of vitamin D of calcium from the gut, and leucocytosis and in these preparations is 500 intestinal calcium transport thrombocytopenia are tablets/kg bodyweight (for a and proximal renal tubule occasionally seen too, and the 1μg preparation), so even for reabsorption of calcium in commonest causes of fatality a higher strength (20μg), a the kidney. This gives rise to are shock and fulminant dog would need to ingest over hypercalcaemia and toxicity. pulmonary oedema. 25 tablets/kg for there to be cause for concern. Calcipotriol produces Cardiac abnormalities may similar effects by the also be seen on ECG and 0.75 Vitamin D analogues same mechanism. hours* hypercalcaemic cardiac On the other hand, vitamin failure can occur if the serum D analogues – which are If sufficient tablets were calcium concentration exceeds almost exclusively prescribed taken, the onset of clinical 3.5mmol/L (14mg/dL). medications rather than effects for calciferol and OTC dietary supplements – colecalciferol would usually These effects are all the *Suggested Personal & Professional Development (PPD) have a really bad reputation be within 12 to 36 hours. result of raised calcium levels in toxicology; with good Initially polydipsia might following vitamin D-mediated

reason. Some of the vitamin occur in the absence of any release from bone. D analogues are extremely other signs; subsequently, Treatment toxic – tacalcitol has a anorexia, depression, POISONS potentially lethal dose of weakness, lethargy, Initial treatment will include <4μg/kg in dogs. recumbency, polyuria, emesis – if the dog or cat was

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seen within a few hours – and activated charcoal probably has no real value. The main aim of therapy is to ensure adequate hydration and urine output and to control calcium concentrations and reduce phosphorus concentrations.

Drug therapy includes intravenous saline with furosemide, steroids, antiemetics, gastroprotectants, a phosphate binder and a bisphosphonate. Although lipid emulsion therapy should work (as vitamin D is lipophilic), the half life of vitamin D is too long for this to be practical.

Weight loss medications This group of preparations has, over recent years, increased and diversified, with each new addition giving the hope of effortless weight loss. Amongst the most commonly ingested formulations are those containing orlistat – they are available both on prescription and OTC.

Orlistat raspberry and other soft fruits and chemical precursor, Treatment, other than early Orlistat is a potent, specific, or – more likely and cheaper – as well as being a emesis and activated charcoal long-acting inhibitor of are synthesised. At very high metabolic intermediate – if safe to do this – is aimed at gastrointestinal lipase, doses in animal models, they in the biosynthesis of the controlling the hyperthermia which leads to unfortunate may reduce weight gain in neurotransmitters serotonin and convulsions. Ideally, leakage of fatty diarrhoea. animals eating high fat diets and melatonin from diazepam (or barbiturates) Most animals, however, (Morimoto et al, 2004). tryptophan. In addition can be used to calm agitation, remain asymptomatic to its role as an appetite tremors or convulsions, and following ingestion. Other The few cases the Veterinary suppressant, 5-HTP is used it should not be necessary to gastrointestinal effects Poisons Information Service as an OTC antidepressant scale up; although propofol reported in humans include (VPIS) has on file – and where (and indeed as a prescribed constant rate infusion could increased defecation, oily/ follow-up is available – suggest antidepressant elsewhere in be considered, if required. fatty evacuation, soft/liquid that there is no stimulant effect. the world). stools, faecal incontinence, This fits with studies that show Intravenous fluids may flatulence with discharge and they are safe, acutely, unless The risk is that some animals be needed to maintain abdominal pain. very large amounts are given – and we have several severe hydration and to assist, (Gaunt et al, 1970). cases in dogs – develop a when cool fluids are used, in Gastrointestinal serotonin syndrome after controlling hyperthermia. decontamination is not However, these compounds ingesting even small amounts. required, but it would be are often found mixed with: Cyproheptadine (Periactin, prudent to recommend a low caffeine – which will clearly It is available as 100mg Auden Mckenzie) is a non- fat diet for at least 24 hours. be a potential problem, tablets and a 30kg Labrador specific serotonin antagonist Rehydration is rarely needed. causing stimulation, retriever – that reportedly ate that has been used in dogs tachycardia, hyperthermia, 50 to 60 tablets – developed (Wismer, 2000). A suggested Raspberry ketones restlessness; and hyperthermia, tachycardia, dose of 1.1 mg/kg orally or Raspberry ketones are sold more worrying, 5-HTP. tremor and convulsions. This rectally every one to four hours as weight loss agents even is a not uncommon picture should be used until signs though there is little evidence 5-HTP and the onset of clinical signs resolve. The dose should be of their efficacy – they are 5-HTP (5-hydroxytryptophan may be rapid (<30mins), with given rectally if there is vomiting the aroma from raspberry or oxitriptan) is a naturally recovery taking in his case two or activated charcoal has been and are either extracted from occurring amino acid days, but sometimes longer. given recently.

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Bulking agents Joint supplements and liver toxicity has not been References ‘Bulking’ agents are also Joint supplements commonly reported in any VPIS cases Anon (2011). Fish oils. Lawrence claimed to aid weight loss. contain chondroitin – a with follow up. Review of Natural Products. Wolters Fibre complex of plant origin, glycosaminoglycan that is Kluwer Health. contains various forms of a structural component of Bee products cellulose – microcrystalline cartilage – and glucosamine, Bee products – such as pollen, Gaunt IF et al (1970). Acute cellulose, hydroxypropyl which is a naturally occurring propolis and royal jelly – are and short-term toxicity of methylcellulose (HPMC) and amino-sugar that is a claimed to do wonders for p-hydroxybenzyl acetone in rats. others, for example. The mode precursor for the biosynthesis our complexions, vitality Food and Cosmetics Toxicology, of action of these agents is of the glycosaminoglycans and overall health, and can 8(4): 349-358. http://doi. to make the gut ‘feel fuller’ – and proteoglycans of the be considered non-toxic, org/10.1016/S0015-6264(70)80388-1 which, in fact, it is! cartilage matrix. even when ingested in large quantities by overenthusiastic Khan SA et al (2010). Accidental As these products are of plant It is widely used for the relief pets. The VPIS has numerous overdose of joint supplements in origin, they work in part by of joint pain and stiffness, and cases where dozens of tablets dogs. J Am Vet Med Assoc 236(5): holding additional water to improve joint movement or capsules caused no clinical 509-510. in the colon. This is likely, and flexibility. There may be signs at all. when taken in quantity, to a variety of other ingredients Morimoto C et al (2005). Anti-obese produce diarrhoea. Treatment present, including green- Conclusion action of raspberry ketone. Life will only be supportive with lipped mussel extract – a rich Always ensure the correct Sciences, 77(2): 194-204. http:// additional fluids and control source of nutrients, including identification of any dietary doi.org/10.1016/j.lfs.2004.12.029 of diarrhoea. glycosaminoglycans, such as supplement, obtaining the chondroitin, vitamins, minerals packaging or manufacturer’s Wismer T (2000). Antidepressant Other supplements and omega-3 triglycerides. information if possible and drug overdoses in dogs. Vet Med Fish oils check that nothing has been 95: 520-525. Fish oils are used as There is insufficient consumed with it. nutritional supplements and information to determine have high concentrations the toxic dose of a joint of omega-3 fatty acids, supplement. Liver toxicity eicosapentaenoic acid (EPA) has been reported after 20 and docosahexaenoic acid to 240 tablets (Khan et al, (DHA). The most common 2010) and an emetic and/or oil is cod liver oil (derived activated charcoal should be from liver of cod fish) which considered, particularly after a also contains vitamin A large ingestion. and vitamin D. Halibut oil, salmon oil and shark oil are Gastrointestinal signs – usually also used. Krill oil is similar only diarrhoea (often watery), and made from a species of sometimes accompanied krill (Euphausia superba), a by vomiting and abdominal small crustacean. discomfort – can occur within one to three hours, with Typically, capsules containing recovery invariably occurring fish oil are available in within 12 to 48 hours. various strengths (500 mg, 1,000 mg, 1,200 mg) and Liver damage (Khan et al, there is little information on 2010) and multi-organ toxicity in animals (Anon, dysfunction has been reported 2011). They are, however, in dogs after ingestion of generally considered to be of joint supplements (Khan et low acute toxicity, because al, 2010; Nobles and Khan, their content of vitamins A 2015). The onset of elevated and D is low and insufficient liver enzymes has been to cause acute toxicity, even reported as 24 to 48 hours if a very large quantity of in most cases but occurred capsules has been ingested. within 10 to 12 hours in No treatment is likely to two cases. The cause of be required. hepatotoxicity is unknown

“The past few years have seen an exponential rise in the number and variety of dietary supplements…”

Pets continue to gain the pounds Pet weight clinics have been around for a long time, most having a varied degree of success and it’s more than likely that they mirror the success of human diet programmes.

Losing weight for most of us is a tedious and depressing activity yielding only a marginal degree of success and it would seem that this is reflected in our attempts to help our pets do the same.

It has been reported that one in five dog owners have been advised to put their dog on a diet because they are overweight (Dog Obesity Survey, 2015).

Although some owners simply feed their pets too much – and what dog or even cat will refuse more tasty morsels in their bowl – there is a growing tendency to feed pets treats or extra tidbits either on demand or just as commonly, because the owner takes pleasure in doing so. The proliferation of small, but expensive packets of treats has In the case of owners, obesity is linked to implications of obesity from human to done nothing to curb this trend. Type 2 diabetes as well as a myriad of other animals – and vice versa – in such a way weight-related illnesses and conditions. that both owner and pet are able to enjoy The PDSA Animal Wellbeing Report for In the case of pets, obesity can increase healthier lifestyles. 2015 reported that over 3.3 million dogs the risk of other health problems, such as receive a daily treat from their owners. orthopaedic and cardiorespiratory disease Nurses’ weight clinics can play an important In general, owners were most influenced and reproductive disorders. part in reducing pet obesity once owners to give their pet a treat because they have either been referred to them or sought wanted to make them happy and provide So what role do the medical and veterinary help themselves for their overweight pet. variety for them; but it was noteworthy professions have to play in the obesity One of the challenges such clinics have that about 20 per cent of owners gave epidemic? Perhaps the major role is in always had is that encouraging owners treats because it made they themselves more education about the hazards of being to restrict their pet’s diet is potentially feel happy. Alongside these treats, dogs overweight and, in the case of pets, showing taking away from them a great deal of the are also being fed toast, human biscuits, how what may be perceived as a kindness, pleasure of owning the pet. This is why it is takeaways, milk, chips, cake, human indulgence or treat, could in fact be another imperative that the nurse pulls no punches chocolate and alcohol – despite the fact nail in the coffin of a much-loved pet. For a when it comes to explaining the dangers of that some of these foods are toxic to pets. long time it has been said anecdotally that a pet being overweight. overweight pets tended to have overweight In an interesting feature article in the owners; and that these were the owners We are in danger of becoming a nation of Veterinary Record (Sandoe et al, 2014, Vet who had the most difficulty in helping their overweight, unhealthy individuals and it Rec 175: 610-616), the authors point out the pets to lose weight. Sandoe et al point would be cruel of us to force this upon our importance of studying the human-animal out that ‘It may be necessary for people pets as well. bond in relation to obesity and argue that to be able to recognise and tackle their it is, ‘probably the most important health own unhealthy lifestyles before they can Perhaps we should also consider the five issue of man and pets in Western countries, recognise and address the problems welfare needs set out in The Animal Welfare is a shared epidemic, often directly related to related to the overfeeding of their Act 2006 to which all our pets are entitled: aspects of this shared human/pet lifestyle’. animal companions’. the need for a suitable environment The One Health approach has until now the need for a suitable diet concentrated very much on the benefits From a medical point of view, it is only the need to be able to express companion animals may offer human health, when someone is able to accept that they normal behaviour but in the case of obesity, there can be two- are overweight and they understand the the need to live with or apart from way benefits. adverse effects on their health, that they other animals will begin to attempt to lose weight. If the need to be protected from pain, By adopting a two-way approach and an owner is unable to accept that they suffering, injury and disease. looking at the link between owner and themselves are overweight, what chance is pet obesity, both medical and veterinary there for their overweight pet? The owner of an obese pet is almost professions may begin to have more success certainly not complying with the second, in tackling what is now a serious health The One Health approach should enable third and fifth of these needs. problem for both humans and animals. both vets and doctors to transfer the health

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Ins and outs of equine housing Generally, horses are stabled for human convenience; however, stabling is also sometimes essential for medical management of sick or injured individuals. Whatever the reason for stabling, horses have specific requirements of which Registered Veterinary Nurses (RVNs) must be aware.

Along with normal stable requirements, accommodation in an equine hospital warrants Marie Rippingale specific fittings, fixtures and BSc(Hons) REVN clinical coach cleaning protocols in order G-SQP DipHE CVN DipAVN(Equine) to maintain the health of the patients and the biosecurity of Marie is head equine nurse the practice. and a clinical coach at XLVets practice Scarsdale Vets in Derby. Medical reasons for stabling She is also a lecturer on the Stabling is an essential factor veterinary nursing diploma in the management of sick or course at Bottle Green Training, injured horses, for example in Melbourne, Derbyshire. the following situations: orthopaedic problems requiring box rest monitoring of sick patients requiring the horses to Figure 1. Brick is the most desirable stable building material. be stabled as a preventive measure it has disadvantages. It is: the cheapest type of brick for certain conditions such prone to being chewed by available (Scorer, 2006). as laminitis, insect bite horses and rodents hypersensitivity or horses susceptible to damp Floors and drainage suffering from mud fever or invariably harder Floors are usually made of rain scald to disinfect concrete as it is hard-wearing in situations requiring a fire risk and relatively cheap. When isolation. (Linnenkohl and difficult to eradicate laying concrete it is important Knottenbelt, 2012) contagious pathogens – to roughen the surface to ringworm or infectious prevent the horse from slipping. General considerations causes of diarrhoea, Size such as Salmonella spp., Drainage must be considered Stabling can come in many from wooden structures. when laying a floor in a stable. forms and variations – from (Monsey & Devaney, 2012) It may consist of a slope leading one or two loose boxes to to a drainage hole at the large barns. There are some Brickwork is more expensive base of the wall or the use of minimum requirements but is easier to keep clean and ‘porcupipes’, which are holes regarding dimensions that are can be treated with antifungal embedded in the floor leading standardised by the British paint or rubber (Monsey & into a system of pipes that Horse Society (BHS) and these Devaney, 2012) (Figure 1). carry fluid away (Scorer, 2006). are displayed in Table 1. If the floor slopes into a A cheaper option is to drainage hole, it is important to Walls build up a brick base to position it in a place where the Walls can be made out of prevent vermin and damp horse cannot stand in it and 1.0 several materials. Wood may hours* and put wooden sections injure itself. Drains are essential be the cheapest material, but on top. Breeze blocks are within and outside a stable to facilitate effective cleaning. They must always have covers Table 1. Recommended stable dimensions (Monsey & Devaney, 2012) on and these should be cleaned *Suggested Personal & Professional out daily to reduce the build-up Development (PPD) Type/size of horse Minimum dimensions of waste products. Ponies (up to 14.2 hands) 3.05m x 3.05m Ventilation Horses (up to 16.2 hands) 3.65m x 3.65m Ventilation is important to Large horses (>16.2 hands) 3.65m x 4.25m avoid draughts at ground level – which can cause a chill HOUSING Foaling boxes 4.25m x 4.25m – yet maintain a through-flow

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of air to prevent a build-up windows should be hinged with RAO as a secondary of bacteria and reduce the at the bottom and open condition. It is very important transmission of airborne outwards. There should for RVNs to be able to infection (Scorer, 2006). be a wire mesh or iron recognise and manage horses There are two types of bars covering the glass to with RAO as part of a holistic ventilation – passive prevent the horse from nursing approach. and active. injuring itself on the glass (Figure 2) RAO is a chronic respiratory Passive ventilation: the glass itself should be condition where the horse can be achieved by keeping wired safety glass. develops a sensitivity to dust the top door of the stable (Scorer, 2006) antigens in the environment open to allow air to pass (Scorer, 2006). When horses through and up into the Active ventilation: with RAO are exposed apex of the roof pulls air mechanically into to allergens, a complex Figure 2. There should be air vents allow the air to and/or out of the stable, inflammatory cascade is a wire mesh or iron bars pass out and fresh air is usually by the use of an initiated which results in: covering glass in stables then drawn in through the extractor or air-conditioning airway inflammation to prevent horses from door, maintaining a cycle system (Scorer, 2006) increase in the volume and injuring themselves. the heat from the horse is expensive and, as a viscosity of airway discharge rises upwards and further consequence, rarely seen in increased numbers encourages this cycle – this equine accommodation. of inflammatory cells linked to moulds in hay and is called the ‘stack’ effect (neutrophils) in the airways straw. Horses at grass can windows should be Recurrent airway Bronchospasm. also develop sensitivity to located on the same side obstruction (RAO) (Slater & Knowles, 2012) pollen – known as summer as the door to prevent This condition is relevant pasture-associated obstructive through draughts but to RVNs as horses are often Typically RAO is seen in pulmonary disease (SPAOPD) provide light admitted to the hospital stabled horses and is often – with similar clinical signs to

Table 2. Types of bedding [Scorer, (2006) and Linnenkohl & Knottenbelt, (2012)]

Type of bedding Comments Advantages Disadvantages Straw Barley straw may be eaten so Good insulating properties. Dusty, therefore can increase wheat straw is more commonly Inexpensive to buy. Easily the risk of RAO. May harbour used as it is less palatable disposed of and recycled spores. Barley and oat straw can be eaten and may cause impactions Shavings Used as an alternative to straw Absorbent and can be bought More expensive than straw. Bought in bales dust-extracted so better for More difficult to dispose of horses with RAO. waste. Will compost down Provides warmth in time Sawdust Used as an alternative to straw Absorbent and More expensive than straw. Bought in bales provides warmth More dusty than shavings. More difficult to dispose of waste. Will compost down in time

Paper Can buy in bales or shred Absorbent and dust free. More expensive than straw. newspapers yourself Reasonably warm More difficult to dispose of waste. Will compost down in time Peat moss Used as an alternative to straw Inedible. Dust free. Easily More expensive than Bought in bales recycled. Reasonably warm straw. Can soften the feet. Environmental issues – becoming less readily available Hemp Used as an alternative to straw Dust and mould free. Warm Expensive and can be eaten Bought in bales Rubber matting Surface is anti-slip and lower Cheap to maintain after initial Initial cost is expensive. Surface has drainage channels purchase. Good drainage and Little warmth if used alone; Buy as mats supports horse’s feet. Can therefore, will need to provide warmth purchase additional bedding

horses suffering from RAO. soft Good stable ventilation is easily managed particularly important to non-toxic help reduce the risk of horses dust/damp free developing RAO. readily available easily disposed of and Symptoms recycled (Scorer, 2006). The horse will develop a cough and display poor performance Table 2 shows the types when ridden. Mucus is brought of bedding available up, but there should be no and the advantages and elevation in temperature. disadvantages associated Eventually the horse will begin with each. to have difficulty breathing and Figure 3. A bank of bedding should be built up around the edge of the stable to reduce draughts, provide comfort and to help prevent will wheeze as the airways in the Bedding for special cases the horse getting ‘cast’ (stuck against the wall). lungs narrow (Scorer, 2006). Patients often have specific bedding requirements Affected horses may also according to the condition Colic injured horses, however, and develop a ‘heave line’ from which they are suffering. It is vital that these patients neonatal foals may require (hypertrophy of abdominal It is important to understand do not have access to edible the use of supplementary muscles resulting from chronic the different requirements of bedding, as they may need to heating, examples of which and severe dyspnoea) these patients, in order to be be starved. Shavings, peat or are listed below: (Slater & Knowles, 2012). able to prepare appropriate paper can be used; and a deep rugs and bandages – accommodation quickly bed should be supplied, with indoor and outdoor Treatment and effectively. banks as the horse is likely rugs are available for all Treatment for RAO includes to want to get down and roll shapes and sizes of horse, environmental management RAO (Scorer, 2006). pony or foal. Bandages – keeping the horse turned The most important aspect should be applied securely out as much as possible, of treating RAO is to remove The patient should be put in and the use of ‘gamgee’ using dust-free bedding and the cause of the problem – the a part of the hospital where it underneath will reduce soaking hay or feeding haylage. dust, mould and/or pollen can be monitored easily. the risk of the patient Bronchodilators are used to usually found in hay and straw developing bandage sores reverse bronchoconstriction (Scorer, 2006). These horses Lighting duvets – commonly put and improve ciliary clearance should be fed haylage or Lighting may be natural or under a stable rug to add (Slater & Knowles, 2012). These soaked hay. However, the more artificial. Natural lighting is extra warmth. Ensure the agents can be given as an oral moisture that is contained in achieved by using windows, duvet is secured correctly medication in feed or used as an the bedding, the more likely it skylights and leaving the top to prevent slipping inhaled drug. is to become mouldy. half of the stable door open; central heating – effective but to ensure that owners but very expensive, so Corticosteroids are also used Straw should be substituted and staff can see adequately, rarely used. Heating units to block the inflammatory with hardwood dust-extracted some form of artificial should be kept out of the cascade; however, there is a shavings, paper, peat or lighting must also be available horse’s reach risk of laminitis associated with rubber matting. (Scorer, 2006). electric fans – can be noisy the use of these drugs (Slater and create dust. Ensure & Knowles, 2012). Overall Laminitis The most common form of that the unit is kept out of prevention is – as always – much This is inflammation of the artificial lighting is a fluorescent the horse’s reach. better than cure with RAO laminae of the foot. The feet strip light attached to the infrared heat lamps – can and this can be achieved if receive an inadequate supply eaves of the roof; and hanging be small, portable or close attention is paid to good of blood and this in turn light bulbs are not advised permanent fixed to the ventilation, and use of dust-free damages the blood vessels, as the horse may be able wall (Figure 4). Either bedding and dust-free forage. causing inflammation and to reach them with serious must be a safe distance pain (Scorer, 2006). consequences. Light switches away from the horse Bedding should be placed outside the (Scorer, 2006). Bedding is used to provide Horses with laminitis need to stable and protected from warmth and comfort to the be stabled and will require moisture with a waterproof Fittings horse. A bank of bedding should soft, supportive bedding cover; and all cables inside or Some fittings are required for be built up around the edge of such as shavings. As these outside the stable should have all stables. However, equine the stable (Figure 3) to reduce horses also like to lie down sufficient waterproof coverings hospitals will need some draughts, provide comfort and a lot, rubber matting should (Scorer, 2006). more specific fittings and to help prevent the horse getting be used with a deep bed equipment. Care should be cast (stuck against the wall). on top (Scorer, 2006). The Heating taken to ensure that all fittings bedding should be continued Healthy horses can tolerate are secure and placed in an The ideal bedding should be: all the way up to the door a wide range of temperatures area that is convenient for warm and food and water situated as long as the air remains staff but will not endanger absorbent close together. dry and draught free. Sick or the horse:

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The mucking out process the horse should be removed from the stable and either tied up outside or put in another box. This is safer for the person mucking out and for the horse as it can’t injure itself on any of the equipment water buckets should be removed and disinfected before being refilled and put back once the stable has been mucked out hay nets and discarded/uneaten hay should be removed starting at the front of the stable, any droppings should be removed and put on the wheelbarrow the remaining bedding should be forked up so that any further droppings can fall down. These should be removed Figure 4. Permanent heat lamps are a good source of any urine soaked bedding should then be removed. Clean supplementary heat for sick horses. bedding should be put to one side to be re-used the floor should be swept and left to dry before the clean bedding is spread back on to the floor. Fresh bedding hooks are required on the automatic water bowls should be applied on top, if required top and the bottom of the are not usually used in an banks can be built if needed and the front of the bed stable doors to hold them equine hospital. Whilst should be swept back into a straight line. The bed should open and prevent them they do save on labour, the be thick enough so that if a fork is stabbed in to it, the floor from slamming, which will main disadvantage is that it cannot be felt frighten horses is not possible to monitor the clean water bucket and fresh hay net can then be replaced bolts on both doors – one how much the horse is (Monsey & Devaney, 2012). on the top door and two on drinking (Scorer, 2006). This the lower door. A kick bolt is not ideal for RVNs when is advised for the lower bolt monitoring sick patients. foals and patients with eye lower the fluids when the to prevent clever horses who Usually a large water bucket ulcers. Feed troughs and bags need changing, and a undo their top bolts is supplied as horses will mangers must be placed spiral giving set allows the to escape! drink approximately 20-40 high enough for the horse horse to move freely around metal strips are required on litres of water per day under to feed comfortably but the stable (Scorer, 2006) the horizontal part of the normal circumstances not so high that they can’t door grills are used to lower door to prevent the (Scorer, 2006). Water reach the food and they prevent the horse from horse from chewing should be changed must be cleaned out and being able to get its head the wood frequently as it does absorb disinfected regularly to over the stable door tying rings should be placed ammonia from the bedding, reduce contamination (Figure 6). These are at the front of the stable at and the water bucket should (Scorer, 2006) used for patients with the horse’s eye level. Hay nets be emptied and disinfected fluid hangers are hooks indwelling IV catheters. can be tied straight on to the at least once daily for attached to the ceiling As the jugular vein is tie ring. When tying a horse every patient for suspending fluid most commonly used for up the horse must always be feed troughs and mangers bags for intravenous (IV) catheters in horses, the attached to bailing twine, may be concrete, wooden administration and other grill is used to prevent the not the tie ring. If the horse or plastic. These fittings medications (Figure 5). horse from rubbing the panics the bailing twine will are useful for patients that Ideally, an overhead pulley catheter on the door and/ snap and release the horse cannot have a hay net – system is used to raise and or pulling it out.

Figure 5. Fluid hangers are hooks attached to the ceiling used for Figure 6. Door grills are used to prevent the horse from being suspending intravenous fluid bags. able to get its head over the stable door and damage indwelling intravenous catheters.

Cleaning stables A broad knowledge of equine hospital accommodation. References It is very important that stables veterinary conditions is These protocols will help Linnenkohl W and Knottenbelt DC are ‘mucked out’ regularly also required so that the ensure that the health of the (2012). ‘Basic equine management’ and correctly to preserve the correct accommodation in-patients and the biosecurity in: Coumbe K (ed) Equine health of the in-patients and to can be prepared for each of the equine hospital are both Veterinary Nursing Manual 2nd prevent the spread of disease. patient to suit their individual maintained effectively. Edition, Oxford: Blackwell Science. As a general rule, stables are requirements. mucked out properly once Monsey L and Devaney J daily in the morning and then RVNs are also required to (2012). ‘Maintaining animal ‘skipped out’ (all the faeces are produce protocols for the accommodation’ in: Cooper B et al removed but none of the urine) cleaning, disinfection and (eds) BSAVA Textbook of Veterinary in the afternoon. maintenance of equine Nursing 5th Edition, Gloucester: BSAVA. Each yard should have designated equipment such Scorer T (2006). ‘Stable design as a wheelbarrow, fork, yard and management’ in: Aspinall brush and ‘skip’ and these PPD questions V (ed) The Complete Textbook can be colour coded for easy of Veterinary Nursing London: identification. This equipment Elsevier. 1. How large should a foaling box be? should be disinfected on a daily basis. Slater JD and Knowles EJ (2012) 2. What does RAO stand for? ‘Medical nursing’ in: Coumbe K (ed) Disinfecting stables Equine Veterinary Nursing Manual After each horse is discharged, 2nd Edition, Oxford: Blackwell 3. Which type of bedding is not suitable for a colic its stable should be emptied Science. patient? of all bedding and then disinfected with an appropriate solution. In the case of horses 4. Why are automatic water bowls not generally used in with an infection, the stable equine hospitals? should then be swabbed for culture, and cleaning repeated as necessary. (Monsey & 5. How often should a stable be cleaned out every day?

Devaney, 2012)

the afternoon the At least twice – they should be mucked out in the morning and skipped out in in out skipped and morning the in out mucked be should they – twice least At

All rugs, brushes, head-collars 5. Water intake cannot be accurately monitored with automatic water bowls bowls water automatic with monitored accurately be cannot intake Water 4.

Straw Straw and lead-ropes, hay nets and 3.

Recurrent airway obstruction obstruction airway Recurrent water buckets used by the 2.

4.25m x 4.25m 4.25m x 4.25m horse should be thoroughly 1.

washed and disinfected. It is Answers very important that protocols are in place for the mucking out, maintenance and disinfection of stables and equipment in the hospital. Creation and implementation of these protocols would normally fall under the responsibility of an RVN.

Conclusion Horses require specialised housing in general, and requirements are even more specific for equine hospital accommodation. Therefore, an RVN should have a good working knowledge of the requirements for accommodation in an equine hospital, including the size of the stable, bedding type and ventilation together with more specific requirements, such as access to a fluid hangers and heat lamps.

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Creating the next generation of veterinary nurses Veterinary nurse training has evolved to become By employing a range of different strategies when addressing a multidimensional learning experience, preparing nurse training, such as problem-based learning, discussion, prospective veterinary nurses for successful careers in workshops and seminars, the college can best meet the needs of all the individuals within the group. The added bonus is that by practice. Whilst practical training is a key component adapting and varying course delivery methods on a small group when preparing individuals for their career in veterinary basis, every member of the teaching group will develop a variety nursing, their personal and professional development of skill sets to match those of their peers. while training is paramount in generating a well- Varying teaching methods to incorporate both practical and rounded and successful nurse. theoretical methods addresses the issue of maintaining levels of engagement in course material by assigning so much of the he responsibilities of the modern veterinary nursing team discussion and practical work to the group as a unit. Preparing are extremely varied and creating resilient, competent the trainees for their subsequent life in the workplace in this Tand caring professionals that thrive in practice is the goal way also instills teamwork values and a strong work ethic. of the national college for veterinary nurse training, Central College of Animal Studies. Being able to react, adapt and interact appropriately are key skills imperative for the successful career as a veterinary nurse Direct and ongoing close contact and communication in practice. between the college and practices facilitate tailored and flexible training programmes designed to produce graduates who contribute effectively at all levels within “Small group based the practice. learning provided by

The college is an advocate for small group training where Central College proves dialogue and collaborative processes become the foundation of invaluable in promoting the learning experience. With careful planning and structured sessions, small group learning turns teacher into facilitator, and interactivity and reflexivity redirects the emphasis on teaching to the group as a whole. in the workplace”

Having training centres located close to or within practices creates both an easy and convenient access to current case loads but also helps to instill professional values in the learning process. Offering student nurses the opportunity to train on site with access to state of the art equipment and facilities encourages responsibility and creates a natural progression from student to professional employed nurse and valued team member.

Central College tutors are experienced and regularly work in practice enabling them to pass on current techniques while recent and current case loads help generate discussions, contextualise learning and ensure deeply embedded skills that can be used in the future.

34 VETERINARY PRACTICE TODAY | VOLUME FOUR | ISSUE THREE | 2016 Teaching staff who work in practice offer a realistic view of what life With its centres based close to – or within – practices and with in practice can offer, and advise accordingly when certain topics or access to high-calibre facilities, teaching spaces, the latest situations arise. With the veterinary industry forever developing and technologies and a varied caseload, students of Central College progressing, the teaching and learning experience becomes a shared are promised a great learning experience and introduction to one, with staff developing their teaching methods and skills as an on the veterinary nursing profession. going process.

With kinaesthetic learning at the heart of nurse training, student Practices looking to develop their nurses can develop the skills and techniques in a controlled and veterinary nursing teams or experienced monitored setting that they can then apply their theory based learning to. When delivering course material assessors can best nurses looking for careers as tutors should assess when students are ready to make the transition with contact Central College of Animal Studies their learned skills and theory into a practical environment. by phone on 01359 243405. For further

Generating confidence in students and their practical skills is information or for online enquiries visit vital in ensuring that they are assertive, decisive and competent www.ccoas.org.uk when they enter the work place. The unrivalled benefit of working on a small-group basis means that the process of mentoring extends beyond the assigned individual in practice to the training provider.

This pioneering approach to veterinary nurse training by Central College of Animal Studies extends the teaching and assessment experience into an opportunity for students to grow into a well- rounded, adaptable and versatile individual by instilling core values and cultivating creativity, passion and enthusiasm.

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Management of the periparturient goat Management of the doe during pregnancy and between kidding and peak lactation is essential for the health of the animal and the economic success of the goat farmer. This is the critical period in the goat reproductive cycle and the period during which most problems occur.

Goats should remain fit but where singles or twins are of prolactin and reducing not fat – a body condition the norm. In addition, many milk secretion. Pressure of score of 3 is ideal. Body animals will still be growing milk causes an inflammatory John G Matthews condition at kidding plays a and/or lactating. Their response, so leucocytes collect BVMS BSc MRCVS pivotal role in determining requirement for calcium in the udder helping to prevent subsequent health, and phosphorus is similarly infection. Udders should never John qualified from the production and reproductive increased. At this time of be partially milked out as this University of Glasgow in 1975. performance. Both increasing nutritional demand, increases the susceptibility to He then spent three years in overfeeding and underfeeding dry matter consumption is infection. Teat dipping for a the biochemistry department in late pregnancy increase the depressed because the growing week after stopping milking of the Central Veterinary risk of metabolic disorders. In kids restrict abdominal space will help prevent infection Laboratory, Weybridge, before the United Kingdom over-fat and rumen fill. during drying off. entering general practice – and does and multiple foetuses becoming a partner in – rather than underfeeding Abdominal volume is further Routine use of dry goat mixed practice in Essex, – cause most periparturient reduced in goats carrying therapy is not recommended, until retiring in 2013. problems (Table 1). large amounts of abdominal unless there is a history of fat. A similar – or even greater mastitis during the previous John is honorary veterinary The gestation period for the – increase in nutritional lactation. There are no surgeon for the British Goat goat is approximately 150 requirement occurs during the intramammary preparations Society and a past president of days, but 80 per cent of foetal transition from late gestation licensed for goats, so dry cow the Goat Veterinary Society. He growth occurs during the into lactation. A goat at peak products must be used in is also a visiting lecturer at the last six weeks of pregnancy, lactation can produce its own accordance with the cascade. University of Cambridge; and, so additional nutrients are weight of milk in 10 days. Drug withholding times for with his wife, he has a pedigree not required until this time. intramammary preparations herd of high-yielding British and During the third trimester of The dry period may be much longer than in British Saanen goats, having pregnancy, the nutritional As with cows, a six- to eight- the cow and drug residues also kept Angora and Cheviot requirements of the doe for week dry period is generally may persist for some time into goats in the past. crude protein and energy recommended before the next lactation. increase above those required parturition; although some by a non-productive adult by research work indicates that Table 2 shows the routine about one and a half times for this is not necessary. However, husbandry tasks that need does carrying a single kid and short dry periods may have a undertaking in the dry period. two times for those carrying negative impact on the quantity twins (Figure 1). and quality of colostrum Feeding during produced, as well as affecting late gestation Breeds such as the Anglo- the subsequent lactation. Both underfeeding and Nubian, that often produce overfeeding in late pregnancy three or more kids, face a Milking should be stopped increase the risk of metabolic greater challenge than breeds abruptly – stopping production and other problems (Table 3).

Table 1. Problems with over- and underfeeding

1.0 Obese goats Thin goats hours* depressed appetite pregnancy toxaemia pregnancy toxaemia abortion vaginal prolapse? rectal prolapse *Suggested Personal & Professional ruptured uterine artery Development (PPD) maternal dystocia from reduced pelvic size kids with reduced birth weight foetal dystocia from oversized kids inappetence/anorexia lower milk yield postparturient toxaemia (fatty liver ketosis/acetonaemia GOATS syndrome/ketosis) kids with reduced weight gains

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Figure 1. ‘Dog-sitting’ is normal in late pregnancy. Figure 2. Good forage is an important part of the (Photo: Peter Jackson) periparturient diet.

It is essential to supply good If foetal numbers have been overfeeding concentrates in not mirrored by changes in quality roughage ad libitum determined by ultrasound late pregnancy confers little condition score as goats carry during this time to maximise scanning, the goats can be benefit and may even be little subcutaneous fat. dry matter intake, whilst at grouped and fed according to detrimental to future the same time increasing the the litter size. Angora goats milk yield. High yielding does require amount of concentrates fed have higher protein and energy roughage and concentrates to about 0.5 to 1.0kg/day requirements than dairy Feeding in early lactation of good quality because the by parturition. goats at the same stage of On a bodyweight-for-weight demand for energy and protein pregnancy and lactation, so basis, goats are much is high. Despite the increased The lactation ration should the dry and transition periods heavier producers than demand for nutrients, the be introduced before kidding can be critical. cows. All heavily lactating dry matter intake is likely to (Table 3). A gradual increase goats – particularly young be limited and similar to late in the amount of concentrates Offering goats a choice of first kidders – will lose weight pregnancy, particularly during fed allows time for the forage at this time, coupled despite the availability of an the first two to three weeks. rumen micro-organisms with clearing and refreshing adequate diet. Peak milk yield Ideally long roughage should still to acclimatise, minimises racks and troughs regularly, (about four to six weeks after comprise 50 per cent of the total the move towards negative will promote an increase in parturition) occurs before dry matter intake (Table 4). energy and protein balances, roughage intake (Figure 2). peak appetite (about 10 weeks reduces the potential for High forage intake during after kidding). A positive Periparturient toxaemia rumen acidosis and avoids late pregnancy appears to energy balance is not reached Pregnancy toxaemia occurs food refusal associated with a stimulate high forage intake until six to eight weeks after in the last four to six weeks of sudden diet change. during lactation, whereas kidding. These changes are pregnancy when energy intake

Table 2. Routine husbandry tasks before kidding

Action Benefit

Maintain fixed groupings avoids undue stress on less dominant goats

Move to the kidding area at least 2 weeks before the maternity areas should be clean, well ventilated, well bedded, kidding date quiet and provide secure footing

Kidding area should be cleaned and rested between kiddings reduces the incidence of mastitis, metritis and kid septicaemia

Clostridial vaccination: tetanus + enterotoxaemia 4 to 6 weeks before kidding to ensure maximum transfer of immunity to kids

Hoof trim promotes increased mobility less stressful than after kidding

Anthelmintic treatment avoids need to throw milk away reduces burden on dam reduces exposure for kids

Check for external parasites: lice + chorioptic mange lice are a common problem in winter and can cause anaemia in kids chorioptic mange is common in housed goats in winter

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is insufficient to meet the Does with pregnancy toxaemia the dam; but is slower. A parturient toxaemia is increasing demand (Table 5). and post-parturient toxaemia compromise is to give the the same. The goat needs show similar clinical signs – corticosteroid injection, encouragement to continue In early lactation, most does initially inappetence, eating followed by a prostaglandin eating (anything!). Goats that suffer a mild ketonaemia as the browsings and hay but injection 24 hours later. continue to eat may survive; energy demands of lactation refusing concentrates, and but totally anorexic animals are not met adequately by then complete anorexia and The owner and veterinary will die. Appetite stimulants the diet. In most animals, an rapid weight loss. Terminally surgeon are often faced include B vitamins, rumen equilibrium is established and nervous signs are evident with a dilemma – terminate stimulants and proprietary the ketosis remains subclinical, – tremor around the head pregnancy early to save the ‘twin-lamb disease’ remedies. although a more severe energy and ears, reduced vision or dam or wait until the kids Glucogenic agents include deficit may lead to an acute blindness, head pressing, are nearer to full-term to try 20 per cent glucose solution, clinical ketosis or acetonaemia. ‘stargazing’, and eventually to rescue live kids. Delay, of glycerine (glycerol), propylene the goat becomes recumbent, course, carries the risk of glycol and proprietory About two to four weeks comatose and dies. Ketones losing both dam and kids. products based on these; after kidding, goats that have can be detected in urine or If there is doubt concerning and gluconeogenesis can be large fat deposits at kidding milk by using reagent, and the viability of foetuses, stimulated by administering may develop a postparturient ß-hydroxybutyrate will be foetal movement can be dexamethasone. toxaemia similar to pregnancy present in the blood. demonstrated during the toxaemia or fatty liver disease last month of gestation by In severe cases, aggressive fluid of cows. In the absence of abortion ultrasonography although, therapy – including dextrose and or parturition, treatment for near to term, foetal bicarbonate for ketoacidosis Although goats can use pregnancy toxaemia is generally heartbeats can be more – is necessary. Hypocalcaemia products from rumen unsatisfactory, particularly difficult to detect. can occur concomitantly with fermentation (such as volatile when fat animals are involved. pregnancy toxaemia, so calcium fatty acids) for most of their Pregnancy can be terminated There is evidence that borogluconate should be energy requirements, the by inducing parturition or hypoglycaemia might indicate given routinely. Other possible nervous system, kidneys, removing the kids by Caesarean that the foetuses are alive supportive treatment includes mammary gland and foetus section or by rapid removal and hyperglycaemia that multivitamins, particularly A have a direct requirement for of the kids by non-sterile the foetuses are dead. It is and D, and vitamin E/selenium glucose. Glucose requirement Caesarean section under postulated that foetal death preparations, which may help peaks during late pregnancy local anaesthesia, followed by removes the suppressing hepatic metabolism. Giving and early lactation. If a glucose euthanasia of the doe. effect of the foetus on hepatic natural yoghurt or probiotics deficiency occurs, excessive gluconeogenesis. Marked or drenching with the rumen fat breakdown begins in an Using dexamethasone rather hyperglycaemia occurs contents from a healthy animal attempt to maintain blood than prostaglandins to induce terminally in goats with can help restore normal glucose levels, resulting in parturition may be beneficial pregnancy toxaemia. rumen microflora. abnormally high levels of to improve the survival rate ketones and fatty degeneration of the kids, as well as having The general treatment for Adding flunixin to the standard of the liver. a gluconeogenic effect in pregnancy toxaemia and post- protocol for the treatment

Table 3. Feeding in late pregnancy

Actions and rationale of pregnancy toxaemia Aim to avoid over-fat or over-thin does may improve the success to maintain body condition score 3 rate for the delivery of live kids and the survival of the Forage feed high quality forage ad libitum dam. Acetonaemia generally hay intake will be approximately 1.5 to 2.5 kg/100kg bodyweight responds well to treatment offer fresh forage several times daily with corticosteroids and allow for 20+ per cent wastage to encourage maximum intake supportive measures as for dry matter intake can be increased by offering green forage postparturient toxaemia. woody browse will help maintain rumen function

Concentrate increase concentrate part of ration gradually over the 8 weeks before kiddingDrug doses are given in Table introduce the lactation ration before kidding to avoid feed refusal and to6 .allow Those rumen licensed bacteria for use in to adapt farm animals in the United high energy diets enable requirements to be met with a lower dry matterKingdom intake should be used in accordance with the cascade. Minerals and vitamins ensure the concentrate ration is correctly supplemented with minerals andVaginal vitamins prolapses home-mixed rations may need a suitable supplement These are relatively common check calcium/phosphorus balance if large amounts of brassicas or sugarand beet likely pulp to arerecur being during fed 70kg doe requires 6g calcium and 4.2g phosphorus/day subsequent pregnancies with excess calcium intake increases the risk of milk fever probable increasing severity; offer suitable mineral lick

Figure 3. Prolapsed vulva. (Photo: Peter Jackson) Figure 4. Goat eating its placenta. although some goats prolapse retainers often cause vaginitis purse-string suture. Very large need distinguishing from only once (Figure 3). and further straining and are rectal prolapses may need incomplete dilation of the difficult to attach to short- amputating under caudal cervix. Attempted correction Most goats generally kid coated dairy breeds. epidural anaesthesia. by rolling is invariably normally without subsequent unsuccessful and correction is prolapse of the uterus. The Where retaining sutures Rupture of the usually made after removal of presence of multiple foetuses, are inserted, these must be prepubic tendon the kids by Caesarean section. the conformation of the dam released to allow kidding to This is rare, but can occur (musculature, pelvic anatomy) take place, so the doe needs in older multiparous goats Prolonged gestation and a possible hereditary regular checks once the pelvic during the last few weeks of This can be caused by: component appear to be more ligaments relax. Induction of pregnancy or occasionally non-pregnancy(!) significant than over-fatness. parturition with prostaglandin following trauma. The false pregnancy allows the retaining suture rupture occurs on the left (hydrometra) No treatment is necessary for to be removed at the side and presents as a a single large kid minor prolapses if the vagina optimum time. swelling immediately cranial dead kids, and is clean, untraumatised and to the pubis. Affected does hypocalcaemia. returns to its normal position Rectal prolapse are unlikely to kid naturally when the doe stands up. Rectal prolapse is rare, but and will need manual The average gestation period Larger prolapses will need may occur on its own or assistance at kidding or a of the doe is 150 (145-156) replacing after thorough follow vaginal prolapse if Caesarean section. The doe days. Single kids are often cleaning. NSAIDs and caudal straining continues. Effective should be euthanised if it carried longer than multiples. epidural anaesthesia to caudal analgesia often allows survives kidding. If parturition has not occurred provide analgesia and control the rectal tissue to return to by 155 days, parturition should straining are essential before its normal position. Larger Uterine torsion be induced with prostaglandins replacement of the prolapse prolapses may need manual Uterine torsion – which is very and will result in kidding within is attempted. Intravaginal reduction and a retention uncommon in the doe – may about 36 hours.

Table 4. Feeding in early lactation

Actions and rationale

Aim to obtain a high nutrient intake to minimise loss of bodyweight and promote a high milk yield to formulate the ration to supply adequate nutrients to enable the genetic potential of the goat to be expressed to avoid metabolic problems such as laminitis and ruminal acidosis

Forage feed high quality forage ad libitum offer fresh forage several times daily allow for 20+ per cent wastage to encourage maximum intake maintain 50 per cent forage in total diet dry matter

Concentrate increase level gradually by about 0.1kg/day during the first weeks of lactation 0.5kg concentrate (16-18% CP) for each litre of milk produced high energy, high protein (18-22% CP) in heavy milkers split concentrate feed into 3 or 4 feeds a day if possible avoid giving >0.5kg at a single feed to prevent rumen acidosis and maintain a stable population of rumen micro-organisms

Minerals and vitamins as for late pregnancy

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A light, odourless, reddish Retained kids Rupture of the uterus hours after kidding – often vaginal discharge (lochia) Retained kids after parturition This usually occurs dorsally subsequent to a retained is normal for about 14 days are more common and in the body of the uterus just placenta or as a result of or more after kidding and potentially more serious than cranial to the cervix. Repair continued straining because should not be confused with a retained placenta. The kid of a dorsal tear is extremely of pain and inflammation in metritis. The discharge sticks may be delivered normally difficult either by a left-flank the reproductive tract. If the to the tail and many owners after a few days, but most abdominal incision or vaginally. placenta is still attached, it clip and wash the tail to make affected does will become However, in many cases, should be removed gently the doe more comfortable. lethargic and anorexic, with contraction of the uterus will before thorough cleaning and Metritis – which is most likely a dramatic drop in milk yield, seal the defect and the doe replacement of the uterus to follow manual kiddings, and eventually die if the may not only survive, but also under epidural anaesthesia. dystocia, retained foetal condition is not recognised. breed and kid satisfactorily in membranes, retained kids Vaginal examination of a sick subsequent years. The horns of the uterus and abortions – is indicated doe post-kidding should be must be fully extended when by a dark, sticky, usually carried out routinely. The main dangers are shock replaced. Retention sutures smelly, discharge that may and peritonitis – the foetal are not generally necessary if contain pus. membranes should be the replacement is complete, Top tips removed as completely as but a purse-string suture is Retained placenta adequate analgesia and possible and high levels of sometimes used. A doe that Retained placentae are much control of straining intravenous antibiotics and prolapses her uterus is unlikely less common than in the cow. should be primary pain relief given. Intravenous to do so the following year. Many reportedly ‘retained considerations when fluid therapy will increase the placentae’ have, in fact, been dealing with problems goat’s chance of survival. Mineral disorders eaten by the goat! (Figure 4). around kidding Frank hypocalcaemia (milk vaginal examination of A ruptured uterine artery fever) is relatively uncommon Foetal membranes should a sick doe post-kidding is rare but may accompany in goats compared to sheep normally be passed within should be carried out as a ventral tear of the uterus and cattle and is more likely to four hours of kidding and a routine measure or occur during a difficult be seen in primiparous, high- veterinary attention should prostaglandins will kidding. It may also occur yielding animals a few weeks be sought if they are not terminate pregnancy at spontaneously during late into the lactation. Subclinical passed within 12 hours. In any stage of gestation pregnancy, particularly hypocalcaemia may be more many cases, membranes that consider early induced in overweight does. Fatal widespread and many goats are hanging from the vulva, parturition with intraperitoneal haemorrhage will benefit from calcium are easily removed by slow, prostaglandins if a goat can occur without obvious therapy when presented with gentle traction; but forced is distressed vaginal haemorrhage. other periparturient diseases manual removal should not a ‘retained’ placenta such as mastitis and metritis. be attempted. Oxytocin or may have been eaten by Uterine prolapse prostaglandin injections may the doe! Uterine prolapse is also Hypomagnesaemia is aid removal. rare, but may occur a few uncommon in goats, but

Table 5. Peripaturient toxicosis

Pregnancy toxaemia Pregnancy toxaemia Postparturient toxaemia fatty liver syndrome When Last 4 to 6 weeks of pregnancy Last 4 to 6 weeks of pregnancy 2 to 4 weeks postpartum Which animals Fat goat Thin goat Fat goat

Predisposing factors pet goats in small pens Angora, Cashmere high milk production over-conditioned extensively grazed over-conditioned show goats show goats multiple foetuses goats on maize silage goats on maize silage stress – fear, weather, pets multiple foetuses housing, shearing lack of exercise

Aetiology decrease in voluntary food starvation decrease in voluntary food intake intake rapid mobilisation of fat reserves rapid mobilisation of fat and subsequent hepatic lipidosis reserves and subsequent hepatic lipidosis

Biochemical findings metabolic acidosis metabolic acidosis metabolic acidosis hypoglycaemia hypoglycaemia hypoglycaemia ketonaemia ketonaemia ketonaemia hyperglycaemia terminally with dead foetuses

occasionally occurs early in Suggested reading lactation in goats grazing rich Anderson DE and Miesner MD pasture. Pregnant goats on (2008). Rectal Prolapse. Vet Clin poor pasture may also develop North Am: Food Animal Practice the disease. Transit tetany, a (July 2008) 24(2): 403-408. combination of hypocalcaemia and hypomagnesaemia, can Brozos C et al (2011). Treatment occur in stressed animals in and Control of Peri-Parturient late pregnancy. Metabolic Diseases: Pregnancy Toxaemia, Hypocalcemia, Laminitis Hypomagnesemia. Vet Clin North Acute laminitis may occur Am: Food Animal Practice (March after any toxic condition, 2011) 27(1): 105-113. such as mastitis, metritis and retained foetal membranes, Chamberlain AT (2010). Dry Goat but also a few days after Nutrition. Goat Vet Soc J 26: 31-35. kidding without one of these conditions (Figure 5). East NE (1983). Pregnancy Figure 5. Goat with laminitis. toxaemia, abortions and It presents as a sudden onset periparturient diseases. Vet Clin tenderness of a foot or feet – feet, teeth grinding and other energy diet – hay with a very North Am: Large Animal Practice generally both front feet but signs of pain, pyrexia and a fall reduced or no concentrate (November 1983) 5(3): 601-618. occasionally all four – with in milk yield. The coronet of ration – and a deep bed a disinclination to walk, the affected foot feels hot, but provided. Antibiotic cover Groenevelt M (2012). Periparturient prolonged recumbency or the toe cold. should be given to combat any problems in the goat. Goat Vet Soc walking on knees, a shifting infectious or toxic cause of the J 28: 80-85. of weight distribution when Acute cases should be condition. Pain relief with an standing to spare the affected placed on a reduced protein/ NSAID is essential. Matthews JG (2009). Diseases of the Goat, 3rd edn, Wiley-Blackwell, Oxford.

Morand-Fehr P (2005). Recent developments in goat nutrition and application: a review. Small PPD Questions Ruminant Research 60: 25-43.

1. What are the main problems likely to be encountered in an obese doe? Ospina PA et al (2013). Using Nonesterified Fatty Acids and -Hydroxybutyrate Concentrations 2. What routine management tasks are necessary before kidding? During the Transition Period for Herd-Level Monitoring of Increased 3. What are the predisposing causes for pregnancy toxaemia in the doe? Risk of Disease and Decreased Reproductive and Milking Performance. Vet Clin North Am: 4. What are the aims of feeding does in the last third of pregnancy and how can this Large Animal Practice (July 2013) be achieved? 29(2): 387-412.

5. What are the aims of feeding the doe in early lactation and can this be achieved? Scott P and Gessert M (1998). Management of ovine vaginal

prolapse. In Practice 20(1): 28-34.

single feed to prevent rumen acidosis and maintain a stable population of rumen microorganisms. rumen of population stable a maintain and acidosis rumen prevent to feed single

(16-18% CP) for each litre of milk produced, high energy, high protein (18-22% CP) in heavy milkers, avoid giving >0.5kg at a a at >0.5kg giving avoid milkers, heavy in CP) (18-22% protein high energy, high produced, milk of litre each for CP) (16-18%

in total diet dry matter; to increase level gradually by about 0.1kg/day during the first weeks of lactation, 0.5kg concentrate concentrate 0.5kg lactation, of weeks first the during 0.1kg/day about by gradually level increase to matter; dry diet total in

laminitis and ruminal acidosis; feed high quality forage forage quality high feed acidosis; ruminal and laminitis – offer fresh forage several times daily, maintain 50% forage forage 50% maintain daily, times several forage fresh offer – libitum ad

supply adequate nutrients to enable the genetic potential of the goat to be expressed; to avoid metabolic problems, such as as such problems, metabolic avoid to expressed; be to goat the of potential genetic the enable to nutrients adequate supply

To obtain a high nutrient intake to minimise loss of bodyweight and promote a high milk yield; to formulate the ration to to ration the formulate to yield; milk high a promote and bodyweight of loss minimise to intake nutrient high a obtain To 5.

with a lower dry matter intake. matter dry lower a with

kidding to avoid feed refusal and to allow rumen bacteria to adapt; feed high energy diets to enable requirements to be met met be to requirements enable to diets energy high feed adapt; to bacteria rumen allow to and refusal feed avoid to kidding

increase concentrate part of ration gradually over the eight weeks before kidding – introduce the lactation ration before before ration lactation the introduce – kidding before weeks eight the over gradually ration of part concentrate increase

does; feed high quality forage forage quality high feed does; – fresh forage several times daily, woody browse will help maintain rumen function; function; rumen maintain help will browse woody daily, times several forage fresh – libitum ad

To provide enough protein and energy to meet the requirements of the rapidly growing kid; to avoid overfat or over-thin over-thin or overfat avoid to kid; growing rapidly the of requirements the meet to energy and protein enough provide To 4.

lack of exercise; decrease in voluntary food intake. food voluntary in decrease exercise; of lack

Obese does – pet goats in small pens, over-conditioned show goats, goats on maize silage; starvation; multiple foetuses; foetuses; multiple starvation; silage; maize on goats goats, show over-conditioned pens, small in goats pet – does Obese 3.

weeks before the kidding date. kidding the before weeks

four to six weeks before parturition; treat with an anthelmintic during the dry period; move to the kidding area at least 2 2 least at area kidding the to move period; dry the during anthelmintic an with treat parturition; before weeks six to four

Check for external parasites, especially lice and chorioptic mange; trim hooves to improve mobility; give clostridial vaccine vaccine clostridial give mobility; improve to hooves trim mange; chorioptic and lice especially parasites, external for Check 2.

dystocia; fatty liver syndrome/ketosis. liver fatty dystocia;

Depressed appetite; pregnancy toxaemia; vaginal prolapse(?); rectal prolapse; ruptured uterine artery; maternal and foetal foetal and maternal artery; uterine ruptured prolapse; rectal prolapse(?); vaginal toxaemia; pregnancy appetite; Depressed 1. Answers

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Physiotherapy for the ‘downer’ cow Secondary bovine recumbency is a poorly understood and all too common occurrence in modern farming. Once the obvious pathologies have been addressed – and failed to resolve the situation – the animal is often just given nursing support and time to see what happens. Many are ultimately destroyed on humane grounds. Does physiotherapy have anything to add in these situations? Although there is little controlled research to support this intervention, there is a growing body of anecdotal evidence accruing as to its benefits. Sonya Nightingale MCSP Cat A ACPAT Bovine recumbency is and delivery. The exercise the recumbency. Recumbency a relatively common of clinical judgement and duration of over seven days Sonya is a chartered animal consequence of parturition informed interpretation is at has a much poorer prognosis physiotherapist who qualified and a prompt differential its core’ (CSP, 2015). owing to the degree of soft in 1985 in the human field but diagnosis is essential. A cow tissue ischaemia and high upgraded to treat animals in that has been down for over In short, physiotherapy is levels of joint stiffness. 1988. Her career highlights six hours will start to develop aimed at restoring normal Objectively this is followed included working at London secondary pressure ischaemia function and movement by an attempt to rouse the 2012 Summer Olympics as to muscle and nerve tissue, whilst not necessarily animal to assess how much a headquarters veterinary especially in the pelvic limbs. treating the pathology. For active movement she is physiotherapist and chairing This may prevent – or severely example, in human medicine prepared to attempt. Those the Association of Chartered restrict – optimum results physiotherapy is used to patients that attempt to Physiotherapists in Animal from treatment of the primary help restore function and rise but fail have a better Therapy (ACPAT) for four years cause (Giudice et al, 2010; movement in victims of prognosis than those who will during that period. Although (Lambert et al). stroke, while not actually not make any effort. her main caseload is human treating the brain injury and equine, Sonya has always Metabolic and toxaemic directly. In instances of spinal Objective examination included a healthy number of causes of recumbency are well pain, it is well documented consists of a full body farm animals and their owners! outside the physiotherapist’s that mobilisations and other palpatory examination as far She lives and works in remit and are the issues physiotherapeutic techniques as is possible. It is occasionally Highworth, Wiltshire. normally addressed by relieve pain and restore not practical or possible to veterinary surgeons in this mobility while not altering the move the animal from side to time frame, alongside the underlying pathology (Cyriax, side to expose all the limbs. major differential diagnoses Maitland). Physiotherapy However, the cows that of pelvic or limb fracture may, therefore, be utilised respond most successfully are among others. However, for to help the animal regain those with palpable spinal those cattle with no obvious movement, thereby enabling signs. These signs may include: pathology, or for those recovery without treating the fasciculation paraspinally who fail to rise in spite of source of pathology. on palpation of the treatment, a physiotherapy spinous processes and or assessment may well be of For this approach to work, paravertebral musculature value. I include a definition of a sound understanding of grunting/verbalisation physiotherapy here to explain normal movement patterns is as a response to pressure this conclusion. paramount – at both global over affected vertebrae and segmental levels. The change in coat texture ‘Physiotherapy is a profession following is a system that and/or skin moisture from concerned with ensuring has resulted from personal cranial to caudal higher standards of animal experience, combined with palpable loss of smooth 0.5 welfare through promotion sound clinical reasoning. continuity of alignment of hours* of animal function and spinous processes movement and maximising Case assessment trigger points potential. It uses physical Initial assessment involves paravertebrally approaches to promote, the taking of a full history localised areas of maintain and restore physical, including, perhaps most increased muscle tone *Suggested Personal & Professional psychological and social importantly, the duration of or spasm. Development (PPD) well-being, taking account of variations in health status. It is science based, committed “Physiotherapy provides a cost-effective to extending, applying, evaluating and reviewing method of easing the problem, and PHYSIOTHERAPY the evidence that underpins and informs its practice improving animal welfare”

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Figure 1. Sonya Nightingale using Maitland mobilisation techniques.

In addition, those individuals physiotherapy – ‘know when, These movements include The type of mobilisation and that maintain sternal how and which techniques roll, spin and glide which the depth/pressure that is used recumbency, whose hind to perform, and adapt these accompany physiological is chosen as a result of the limbs are flexed and who are to the individual patient’. It movements of a joint. The palpatory examination and is on a surface of deep straw or can be applied to peripheral two are inextricably linked too large a subject to be covered outside on grass fare better. or spinal joints, but in the and both impact joint here, and I would recommend case of downer cows, it is the function. Restoring normal the various textbooks written Formulating a plan spinal mobilisations that are range to physiological and by Geoffrey Maitland to anyone A physiotherapy treatment of interest. accessory movements is, who is interested. plan is devised using clinical therefore, essential for success reasoning from the objective Mobilisations or (Maitland, 2005). Broadly, mobilisations are findings. This will usually manipulation are passive graded into five levels or follow broadly the Maitland techniques where the Mobilisation principles depths and named after concept of rehabilitation therapist applies a force In the downer cow, this involves the direction of movement planning. Geoffrey Maitland to a joint taking it through mobilisations of the spinal (Figure 2). The direction was seen as a pioneer in its normal physiological joints with pressure directed at is clinically reasoned and musculoskeletal physiotherapy range of movement. In either the spinous or transverse appropriate for the specific joint and developed his model, these cases, there is often processes (Figure 1). dysfunction; the grade used is alongside colleagues in a loss/restriction to normal influenced by the effect required Australia, to modulate pain range which accompanies These are mainly accessory – for pain relief or to stretch a and restore function. and results in some of the movements of the vertebrae. restricted range, for instance. objective signs listed above. The Maitland Concept of In addition, mobilisations Manipulative Physiotherapy utilise accessory movements Figure 2. The five levels of movement. emphasises a specific way of the joints, defined as of thinking, continuous those joint movements that Grade I – small amplitude movement at the beginning evaluation and assessment cannot be performed by of the available range of movement and the art of manipulative the individual. Grade II – large amplitude movement at within the available range of movement Grade III – large amplitude movement that reaches the “Although there is little controlled research end range of movement Grade IV – small amplitude movement at the very end to support this intervention, there is range of movement a growing body of anecdotal evidence Grade V – small amplitude high velocity thrust at and of range of movement. accruing as to its benefits”

The start position chosen is References influenced by accessibility and CSP (2015). Chartered Society of patient comfort, and also by Physiotherapy – Consultation Group how forces applied can have the PPD Questions on Animal Physiotherapy, 2015. most effective localised reaction. Giudice E and Giansella M (2010). 1. List four objective palpable signs that would indicate Other considerations include the Hydro-physiotherapy in ‘downer a good outcome from physiotherapy treatment. rhythm, range and amplitude of cow’ rehabilitation. Large Animal the technique, plus its duration, Review 16(3): 125-131. frequency and expected 2. Why would a physiotherapist be considered an option treatment soreness. in the treatment of downer cows? Lambert et al. http://farmnw. co.uk/factsheets/nursing_and_ As a rough guideline most management_of_the_down_cow 3. Name and define the two main types of movement treatments are concluded available within normal joints. within approximately 45 Nowroozi A et al (2010). Successful minutes. On re-examination management of a case of downer there should be a marked 4. How are mobilisations/manipulation graded? syndrome in a crossbred cow improvement in the palpable after 45 days of recumbency. signs listed above; but, Comparative Clinical Pathology 5. What other techniques may be utilised by the farmer in addition, continuous 19(3): 241-242. First online 26 to help with a good prognosis? reassessment takes place May 2009

during the treatment process warmth and grip good with surface a on down bedding with care

Turning, sling standing, passive movements, massage but overall good nursing nursing good overall but massage movements, passive standing, sling Turning,

with the techniques used being 5. Further reading

modified as the treatment movement. of range of and at thrust velocity high amplitude small – V Grade Cyriax’s Illustrated Manual of

Grade IV – small amplitude movement at the very end range of movement of range end very the at movement amplitude small – IV Grade Orthopaedic Medicine (24 Jun session progresses. movement of range end the reaches that movement amplitude large – III Grade

Grade II – large amplitude movement at within the available range of movement movement of range available the within at movement amplitude large – II Grade 1996) Cyriax JD and Cyriax PJ.

Extensive follow-up advice is movement of Butterworth-Heinemann.

then given to the owner/farmer. range available the of beginning the at movement amplitude small – I Grade Graded 1 to 5 (I - V). - (I 5 to 1 Graded

4. 4. Maitland’s Vertebral Manipulation

This may include turning, sling movement. voluntary

standing, passive movements, of result a as independently performed be cannot that ranges those (9 Sep 2005) Eds Maitland G,

massage and overall good are movements Accessory volition. own its under itself for perform can animal Hengeveld E, Banks K and English K. Physiological and accessory. Physiological is the range of movement that the the that movement of range the is Physiological accessory. and Physiological 3.

nursing care, with bedding input. valuable

down on a surface with good have may restoration its and movement in expert an factors, causative as

grip and warmth. excluded been have pathologies other When pathology. the treating necessarily

Physiotherapy is aimed at restoring normal function and movement whilst not not whilst movement and function normal restoring at aimed is Physiotherapy 2.

or spasm. or

Giudice and Gianesella tone muscle increased of areas Localised paravertebrally. points Trigger

(2010) also note success with processes. spinous of alignment of continuity smooth of loss Palpable caudal.

hydrotherapy using deep to cranial from moisture skin and/or texture coat in Change vertebrae. affected vertebral musculature. Grunting/ verbalisation as a response to pressure over over pressure to response a as verbalisation Grunting/ musculature. vertebral

Fasciculation paraspinally on palpation of the spinous processes and or para para or and processes spinous the of palpation on paraspinally Fasciculation water to support the cow’s 1. weight in standing enabling Answers easier movement and fewer complications of recumbency. However, this is not a practical option in most cases owing to the lack of suitable immersion tanks/pools.

Summary Most downer cows, with no other pathological diagnosis, respond very well to physiotherapy input and, anecdotally, farmers who use it believe that their survival rates and lactation volumes are far better since they have been using physiotherapists to help care for these animals. Downer cow syndrome is a common event in modern farming with large financial implications. Physiotherapy provides a cost-effective method of easing the problem, and improving animal welfare.

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Adverse events in livestock In the second article of this three-part series, adverse events (AEs) in livestock (cattle, sheep, pigs and poultry) are reviewed.

Pharmaceuticals Vulvar swelling in cattle and Blindness can occur in Swelling and inflammation at oedema of the rectal mucosa, sheep following the use the site of injection can occur partial anal protrusion of closantel. This usually both with antimicrobials and (‘rosebudding’), erythema occurs following overdosing Declan O’Rourke products for the treatment and pruritus in pigs have been with the drug which, can be MVB MBA FRCVS and prevention of parasites. observed following injection commonplace as farmers On very rare occasions, of tylosin. tend to give the same Declan graduated from anaphylactic shock and death dose to all sheep treated. University College, Dublin in can occur in cattle and sheep Neurological signs, such Closantel is known to 1979. Following a couple of treated with antimicrobials. as blindness, ataxia, and have relatively low toxicity years in practice in England and In these cases it may be the recumbency, may occur in sheep. Canada, he worked for over result of: following topical application 20 years in the animal health sensitisation to the excipient of a closantel plus ivermectin Vaccines industry. In 2006, he set up in the formulation formulation in cattle – anorexia The most common adverse Ortec Consultancy specialising the needle penetrating a and diarrhoea may also be events with vaccines are in pharmacovigilance, vein on injection, resulting in seen in these cases. injection site reactions – marketing and technical intravenous administration with swelling and pain, for support and clinical rather than via the Drowsiness, depression, example – and anaphylaxis trial management. recommended subcutaneous lethargy, apathy and or anaphylactic type or intramuscular route weakness may occur following reactions that can on He holds a Diploma in the fact that the animal is in injection of moxidectin in occasions lead to death Marketing, a Master of very poor health. cattle (Table 1). (Table 2). Business Administration and a Fellowship of the Royal Table 1. Adverse events involving pharmaceutical products in cattle (Source: IMB* Annual College of Veterinary Surgeons; Report 2014) and is an honorary associate professor at Nottingham Active Number Number Number Speed of veterinary school, past Route Clinical signs president of the British Cattle substance treated reacted died onset Veterinary Association and cloprostenol sodium IM 1 1 1 sudden death <= 2 mins a member of the Veterinary Products Committee (VPC). closantel and topical 28 3 0 anorexia, <= 7 days ivermectin dullness, depression, disorientation, impaired vision closantel and SC 40 6 0 anorexia, <= 24 hours ivermectin dullness, depression, recumbency, impaired vision closantel and topical 7 7 0 allergic reaction, 5 mins ivermectin hyperexcitation, 0.5 trembling, ataxia hours* moxidectin SC 38 1 1 ataxia, death by <= 48 euthanasia hours moxidectin SC 29 1 1 collapse, death < =12 hours moxidectin SC 50 1 1 death <= 24 hours *Suggested Personal & Professional moxidectin SC 150 1 1 injection site > 30 days Development (PPD) abscess, death

oxyclozanide oral 1 1 0 recumbency <= 24 hours procaine IM 1 1 1 involuntary <= 2 mins benzylpenicillin and movement, PHARMACOVIGILANCE dihydrostreptomycin collapse, death

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Time between treatment and adverse event The most common signs seen Sow in suspected adverse events Vaccinated with with pharmaceuticals and Vaccine A immunological products vary across species and the speed of onset can range from minutes to weeks (Tables 1 Vaccinated with Anaphylaxis and 2). Sow farrows Passive Mycoplasma Antibodies in Piglets hyopneumoniae In the majority of cases, colostrum Transfer vaccine Death a reaction occurs within hours of treatment; thereby leading to the suspicion of a Figure 1. Flow chart of the sequence of serious adverse events in piglets following the administration of link between treatment and a Mycoplasma hyopneumoniae vaccine [Source: Irish Medicines Board (IMB)*]. the clinical signs (AEs) seen. However, one should keep in mind the possibility of a investigation, it was found of adjuvant which was similar Vaccine-vaccine reaction drug-drug interaction that that the vaccine contained to an excipient in some The IMB received reports can lead to an adverse event saponin, apparently antibiotic formulations. of serious adverse events some period after the initial contaminated with povidone, in piglets following the treatment with the product. which had sensitised The Veterinary Medicines administration of a the cattle. Directorate (VMD and the Mycoplasma hyopneumoniae Vaccine-pharmaceutical Irish Medicines Board (IMB)*) vaccine. The clinical signs reaction A hypersensitivity reaction identified that sheep which had reported ranged from The Dutch Authority received to an inactivated bovine at any time previously been drowsiness to convulsions and 11 reports (170 cattle) of RSV vaccine occurred in vaccinated with any brand of death (Table 3). anaphylactic reaction to the UK when parenteral foot rot vaccine should not injection of tetracyclines and antibiotics were given to be injected with moxidectin. Subsequent investigation penicillins. The cattle had calves. On investigation, it In animals that reacted, one, indicated that the vaccine had been inoculated previously was found that the cause of or a number, of the following a component in the excipient with an inactivated bovine the reaction was sensitisation effects were noted: difficulty in that was also present in other respiratory syncytial virus to a compound erroneously breathing, poor co-ordination, types of vaccines with which (RSV) vaccine. Following present in identified batches depression, abortions or death. sows had been immunised.

Table 2. Adverse events involving vaccine products in cattle (Source: IMB* Annual Reports 2012 & 2014)

Active substance (antigen) Route Number treated Number reacted Number died Clinical signs Speed of onset bovine rotavirus, bovine IM 25 17 0 Injection site abscess, <= 30 days coronavirus and E.coli injection site swelling C. chauvoei whole culture, SC 3 1 1 Collapse, minutes C. haemolyticum, C. novyi anaphylaxis, death type B toxoid, C. septicum toxoid, C. tetani toxoid Inactivated bovine RSV, SC 15 1 0 Hyperaesthesia, <= 1 min inactivated Parainfluenza- collapse NOS, 3-virus inactivated anaphylactic type Mannheimia (Pasteurella) reaction haemolytica A1

Table 3. Details of adverse events with a Mycoplasma hyopneumoniae vaccine (Source: IMB*)

Active substance (antigen) Number treated Number reacted Number died Clinical signs Speed of onset Mycoplasma 284 unknown 9 drowsiness, convulsions, minutes hyopneumoniae death vaccine Mycoplasma 600 unknown 6 drowsiness, convulsions, minutes hyopneumoniae death vaccine

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As a result, the piglets If adverse events caused by received by the IMB during with only one report in 2008. had become sensitised via either maladministration or the period 2012 to 2014 A similar finding occurred ingestion of colostrum from poor teat preparation do concerned SLEE (23% related in Ireland. the dam (Figure 1). occur, it is important that to pharmaceuticals and 77% veterinary surgeons act to to vaccines). In 2009, the IMB received Off-label use educate their farmers and eight reports where it was Maladministration milking personnel in the It is vital that these suspected that triclabendazole Maladministration of bolus correct technique in order reports are investigated was ineffective for the products can lead to tracheal to avoid such occurrences in because they can lead to treatment of fascioliasis or oesophageal obstruction or the future. identification of key issues in sheep. Resistance to perforation resulting in death in relation to the benefit-risk triclabendazole was suspected or euthanasia. Lack of efficacy assessment of a product. in four reports and, for two The majority of adverse event of these reports, this was Poor teat preparation reports in livestock relate to Pharmaceuticals confirmed by a positive faecal Incomplete or poor teat suspected lack of expected In 2007, the VMD received egg count reduction trial. preparation prior to efficacy (SLEE). In 2014, just 67 reports (out of a total In 2010, the IMB received infusion of a dry cow tube under 55 per cent of the reports 166 SLEE reports) that six reports where it was or a teat seal can lead to for livestock, received by the involved ectoparasiticides suspected that triclabendazole post infusion mastitis. VMD concerned SLEE (45% indicated for the control of was ineffective for the Coliform bacteria present related to pharmaceuticals and blowfly in sheep. A heavy treatment of fascioliasis in on the skin of the teat are 55% to vaccines). blowfly challenge in 2007 sheep and, for a further two forced into the teat canal and product misapplication reports, it was suspected during the infusion of Sixty-one per cent of adverse appeared to have been that the same substance was the product. event reports for livestock factors involved in treatment ineffective for the treatment of failure. Climatic conditions liver fluke in cattle. that prevailed in 2007 may Table 4. Livestock adverse event reports as a percentage of total also have had an influence. Vaccines AE reports (2008-2014) In 2007, the VMD received The number of reports 11 SLEE reports relating to VMD IMB received by the VMD involving Marek’s disease vaccines. Cattle 11.5 48.1 suspected lack of efficacy No reports involving Marek’s to products containing disease vaccines were received Sheep 6.6 13.2 triclabendazole increased in 2006. Pigs 0.4 2.1 from 15 in 2008 to 48 in 2009. Of these 48 reports, 16 were Investigations suggested Poultry 0.3 0.3 confirmed as a lack of efficacy that early or heavy challenge, by the use of faecal egg count together with husbandry TOTAL 18.8 63.7 reduction tests, compared factors, led to incomplete

protection against Marek’s bacteria that were not in the References disease in vaccinated birds. vaccine(s) used. Crawshaw WM and Caldow GL The VMD noted that there In a field study of outbreaks (2015). Field study of pneumonia in was an increase in the number of bovine respiratory disease vaccinated cattle. Veterinary Record of reports of suspected lack in vaccinated (mainly beef) 176: 434. of efficacy involving a vaccine cattle, bacterial pathogens for ovine enzootic abortion in were commonly detected – Suspected Adverse Event Reports 2010. In 2009, only 14 reports the most common pathogen to Veterinary Medicinal Products, – involving 270 animals – were being Pasteurella multocida 2012, 2013 & 2014, IMB (Health received; whereas 36 reports (Crawshaw and Caldow, 2015). Products Regulatory Authority) – involving 618 animals – were received in 2010. Twelve of Reporting of livestock AEs Veterinary Pharmacovigilance in these reports had already During the period 2008 to the United Kingdom Annual Review been reported to the VMD 2014, livestock adverse event 2014 (www.gov.uk/government/ during 2010 by the company reports accounted for only publications/veterinary-medicines- responsible for the product. 18.8 per cent of all the AE pharmacovigilance-annual- However, even if these cases reports received by the VMD. review-2014) were excluded, there was still Cattle and sheep accounted an increase in the number of for the majority of these Wheelhouse N et al (2010). reports between 2009 reports with 11.5 per cent Evidence of Chlamydophila abortus and 2010. and 6.6 per cent respectively vaccine strain 1B as a possible (Table 4). cause of ovine enzootic abortion. A study carried out in Vaccine 28:5657-5663. Scotland (Wheelhouse et al, Whilst the total number of 2010) found the vaccine strain adverse event reports received of Chlamydophila abortus in by the IMB during the same the placentas of some aborted period was only five per cent foetuses from cases of ovine of that received by the VMD, enzootic abortion. In these it is interesting to note that cases, no other cause for the livestock AE reports accounted abortions could be identified. for 63.7 per cent of all AE Based on these findings, it was reports received by the IMB. considered that ‘in very rare Cattle and sheep accounted for cases abortions may occur the majority of these reports where the vaccine strain can with 48.1 per cent and 13.2 per be identified’. The overall cent respectively. incidence of reports involving cases of abortion following This is a concern and the use of Enzovax (MSD suggests/indicates that there Animal Health) was very low. is under-reporting of livestock adverse events in the UK. There are often reports that Of equal concern is the very point to apparent failure to low number of reports relating establish immunity following to pigs and poultry. Veterinary vaccination, resulting in the surgeons should report all development of the disease. AEs of which they become In some cases, the vaccines aware as it is only then that may have not been used the benefit-risk profile for a in accordance with label product can be fully assessed recommendations; while and determined. in other cases, vaccinated animals may have been exposed to infection * The IMB changed to HPRA (Health before immunity had Products Regulatory) in 2014. properly developed. However, for the sake of continuity, IMB is used throughout this article. Reports are also received of vaccine breakdown or failure to protect – for example, calves vaccinated for respiratory disease. Investigations often reveal that the cause of the respiratory disease is a virus or

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Connect – Contribute – Converse My Personal and Professional Development

VetCommunity.com is the online portal for the whole veterinary profession and has considerable resources for professional and personal development. Membership is free owing to the support VetCommunity.com receives from its sponsors and advertisers.

Making it count With many vets and veterinary nurses completing substantially more hours of PPD than the statutory minimum, VetCommunity.com has created a quick and simple way of planning and accounting for these.

It goes without saying that continuing Each member of VetCommunity has their own individual record of PPD that acts as a compendium of learning material that professional development is crucial to ensure that work-related knowledge and skills are up to date and all Helping to plan and record your personal & professional development professionals are fully competent and Date Subject area Type of activity Description/Source Hours current in their areas of work. To achieve 22 Mar 2016 About a bee Vet Community article 0.50 23 Mar 2016 Adverse events Vet Community article 0.75 success, happiness, resilience and career 29 Mar 2016 Home visting service for cats Vet Community article 0.25 29 Mar 2016 Rabbits in practice Vet Community article 0.50 2 April 2016 Setting up a dermatology clinic Vet Community article 1.00 development requires a considerable 5 April 2016 Staying motivated Vet Community article 0.50 7 April 2016 Treating the older rabbit Vet Community article 0.75 degree of ongoing personal development.

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With the vast array of subject matter, specialisms and methods of participation available online, creating a portfolio of personal and professional development is just a few clicks away.

Planning Having a plan is one of the best ways of ensuring things get done, Personal & Professional so MyPPD log has the facility for members to enter and amend their own plans for PPD. Development Record

Discussing your PPD plans with your employers and scheduling training events, reading, and the myriad of other methods of PPD Name: Susan Roberts can be motivational and ensure you attain your desired goals. PPD items logged: 7

Convenience Date from: 22 March 2016 Tracking and planning your study needs to be as simple and convenient as possible. Often discovering interesting reading To: 7 April 2016 material on websites or in journals can get lost in the midst of Total hours: 4 hours 25 minutes a busy day. Being able to add articles or events to a calendar to later revisit, read and record is a great way to ensure that relevant articles do not get forgotten about. Particularly when undertaking MY PPD LOG SPONSORED BY: work-based observation, or ‘seeing practice’, having access to your record log immediately after or during the event will enable a quick, but accurate recollection of events or information that can subsequently be revisited at a later date.

At your fingertips Certification and audits With smart devices featuring increasingly in our daily routine, Veterinary and other professionals self certify their PPD and from factoring your PPD recording into a tablet or phone will not only time to time colleges, regulators, examination boards, employers increase the likelihood that you will update it when you have a and other bodies perform audits to ensure statutory minimum spare moment, but also mean that any information or responses hours are being achieved. to your course material can be immediate. Later editing can convert a response and a thought into a more detailed reflection With the click of a button, MyPPD log can produce a portfolio file or note, if necessary. Having access to MyPPD log in any location in a choice of formats suitable for emailing, attaching to records at any time also enables you to note down relevant reading or printing as a certificate. material or course information to later revisit. The versatility of how and when MyPPD can be accessed, viewed Once you’ve joined VetCommunity.com, MyPPD log is available and digitally cross-referenced can make for an eclectic and engaging all the time, on desktop, laptop, tablet or smart phone and you record of study, personal and professional development. can stay logged in permanently for one click options or for more detailed note taking.

The personal touch Creating a PPD log that is as individual as your own needs and To become a member of career progression will mean your study records are of optimum relevance to your areas of interest. VetCommunity and get MyPPD log, visit www.vetcommunity.com The My Profile facility on VetCommunity.com allows members to select primary and secondary areas of interest and thereby

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On being a vet for rare breeds Veterinary surgeons in mixed and farm animal practice come into contact with rare breed varieties of farm animal species. The Rare Breeds Survival Trust (RBST) was founded in 1973 and since its inception has seen the resurgence of many native British breeds.

As a veterinary surgeon, future with potential global endangered bloodlines of cattle, Emily Gascoigne having an understanding of significance. For example, sheep, goats, pigs and horses. MA VetMB MRCVS the genetic and phenotypic there is evidence that some Emily qualified from the value of these breeds will of the primitive rare breeds Crucially, the movement Cambridge veterinary school lead to greater appreciation of sheep have increased aims to optimise the health and is currently a farm and understanding of endoparasite tolerance, and diversity within the animal vet with Synergy Farm the production goals for so maintaining the gene recognised breed catalogues, Health in Dorset. She is also many flocks and herds frequency may be crucial limiting inbreeding and loss of a small ruminant alternative and can lead to positive in the future as genomics is diversity and managing these resident with the Royal working relationships and explored and the sector looks small populations. The Trust Veterinary College, London, opportunities for progressive for animals with these genes also provides marketing advice and a member of the Rare flock/herd planning. (Golding and Small, 2009). and a selling forum for rare Breeds Survival Trust and the breed owners with national Hebridean Sheep Society, and The RBST monitors the shows and sales, where buyers has her own flock The RBST and the Rare number of breeding animals of can source pedigree animals of Hebrideans. Breeds Movement each species and breed on its on the register. In addition, The Rare Breeds Survival register and additional threats it also co-ordinate national Trust is a charity founded to the long-term survival shows for rare breed animals. in 1973 with the ambition of each population. Whilst of conserving British native breeds may be added to the Why do people keep rare breeds of livestock species. register based on breeding breeds and what do they Intensification of the global females, geographical do with them? farming industry and modern vulnerability is also identified, Rare and native breeds are farming methods following together with relative risk found on smallholdings, World War II accelerated the analyses for each breed – in commercial herds and extinction of many British as was the case with the flocks, in registered premises breeds, with heavy horses Herdwick in the 2001 foot- – herds/flocks under the outcompeted by automation. and-mouth outbreak with the management of the RBST, Peter Siviter majority of the breeding flock for instance – in open farms BVetMed MRCVS Relative inability to compete within the Cumbrian National and in conservation grazing Pete qualified from the London on a commercial scale and Parks heavily affected. schemes (Figure 1). veterinary school and is a to meet commercial targets production animal vet at had lead to this reduction, In addition, the Trust manages Some stewardship schemes Synergy Farm Health, spending but the rare breeds movement the ‘Gene Bank’ – a frozen encourage the usage of native much of his time with rare recognises the alternative semen bank of embryos and British breeds in grazing breeds, especially pigs. importance of retaining semen straws of critically management schemes, so national breed diversity. It acknowledges the social Figure 1. Many of the rare breeds are used in conservation grazing importance of these diverse systems often requiring low input but high health strategies. and historic breeds as part of the British farming legacy, their 0.5 ability to utilise and perform hours* in non-favourable conditions – North Ronaldsay sheep on their native island, for example – and their importance for preventing genetic constriction *Suggested Personal & Professional of their species. Development (PPD) Maintaining this bank of non-improved animals, where little selection pressure has been applied, protects the RARE BREEDS genetic library available to the commercial sector in the

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ONLINE EDITION RARE BREEDS | LARGE ANIMAL

vets should expect to see these breeds outside of the smallholding. This is typically a consequence of their different grazing behaviours (Newborn et al, 2000) and often as a public attraction. Furthermore, the traditional characteristics of their carcasses make them popular with premium meat outlets – even some UK supermarkets are marketing meat from rare breeds, including Gloucestershire Old Spot pork and Dorset lamb.

Studies have looked at the comparative production of rare breeds with no conclusive Figure 2. A Red Poll calf in Canterbury, New Zealand. The rare breeds community is large with global disadvantage emerging with resource pooling and knowledge transfer for vets and farmers. regards to meat sales in terms of yield and retail value in comparison with other breeds (Hall and Henderson, 2000).

The variety of breeds within the rare breed catalogue is appealing to smaller flocks, as is the perceived importance of conservation whilst breeding animals. There is also a large showing movement, with classes across the UK for rare breed animals.

What is a rare breed? Having an understanding of the definition of a rare breed is helpful in appreciating the relative importance of each individual animal. The RBST Figure 3. Working with rare breeds can facilitate the development of novel services. defines threshold targets as part of its conservation policy and aims to identify those breeds at most risk to enable targeting of resources. The RBST maintains the registrations for the majority of breeds on the Watchlist through the Combined Flock Book (their annual registration).

Breeds are defined in risk categories on a progressive scale: Critical (e.g. the Suffolk horse) Endangered (e.g. the original population of Aberdeen Angus cattle, prior to Figure 4. Establishing high health strategies can be crucial for flocks. Here is a four-horned Hebridean Canadian/USA ram being bled as part of an infectious disease screen. genetic introduction)

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Vulnerable (e.g. the Middle White pig) At risk (e.g. Irish Moiled cattle) Minority (e.g. Dorset Horn sheep) ‘Native’, no longer on the register (e.g. Red Poll cattle) (Figure 2)

The relative number of breeding females necessary per category varies between species – 3,000 breeding ewes are necessary for a breed to move to category 6, but just 1,000 breeding sows are necessary for a pig breed to move to ‘native’ recognition. A critically endangered breed of cattle – such as the Northern Dairy Shorthorn, a former commercial cow capable of yielding >6,000 litres per lactation – has fewer Figure 5. Working with rare breeds can be very rewarding for both vet and keeper. than 150 breeding females left on the register. animals across the county to have included the export of the gene and presentation of Although the ‘native’ breeds list maintain genetic diversity and breeding males away from the the disease. The Jacob sheep is is extensive and they are popular limit inbreeding, biosecurity highest densities of stock to now used as an animal model animals, commonly seen on strategies are essential. With reduce the risk from epidemic for human disease. farms – Shetland sheep, Belted evidence of increasing key diseases in a geographically Galloway cattle and the Jacob production-limiting diseases dense population and to The RBST regularly analyses sheep, for instance – they are not in sheep – Maedi visna maintain diversity outside inbreeding coefficients with considered at significant threat. (Ritchie and Hosie, 2014) the main epicentre of the their ‘Geneped’ analysis, and contagious ovine digital breed. The North Ronaldsay based on relatedness of Key opportunities for dermatitis (CODD) (Duncan Sheep Fellowship has piloted individuals within the veterinary intervention et al, 2014), the emergence of a project removing rams from population; but clinicians Because of the relative new diseases such as porcine the island for this purpose. should be aware of the importance of individuals endemic diarrhoea virus in pigs, risks associated with small within a flock or herd of and the perpetual challenge of Alternative applications populations and aware of rare breed animals, there bovine tuberculosis – a robust There are key examples of novel presentations is increased opportunity prevention strategy is essential. application of rare breeds of diseases. for progressive veterinary in advancing human and intervention (Figure 3). Diseases considered endemic veterinary medicine. Common pitfalls in the respective species – involving legislation Optimising reproductive such as enzootic abortion GM2 gangliosidosis was Whilst most pedigree breeds performance and youngstock in sheep, infectious bovine diagnosed in Jacob sheep in are interested chiefly in selling survival rates are key drivers of rhinotracheitis in cattle 2010 and has subsequently replacement livestock, the conservation success and are and enzootic pneumonia in been identified in the UK main objective for many is to opportunities for veterinary pigs – may have disastrous sheep population. This target the food chain directly input and health planning. consequences at both a condition is homologous with with a niche product that Management of infectious commercial and conservation the neurodegenerative disease commands a premium. Many diseases affecting these two level for these businesses. This of children, Tay-Sachs disease. of these breeders are not key sectors are critical for should be considered. Genomic work in the USA has commercial farmers, so it is the success of a rare breeds identified the genetic mutation important that their veterinary programme and, where Additional conservation in Jacob sheep associated surgeon understands the possible, disease eradication strategies include the use with the expression of the legislation surrounding such should be an aspiration of artificial insemination condition (G444R mutation). an enterprise. (Figure 4). and embryo transfer in maintaining a genetic resource Work on the American genetic Using an approved Given the high level of and maximising its spread pool suggests that the genetic slaughterhouse movements to shows and nationally – both of which bottleneck created from a Remember that a ‘home kill’ sales within this sector, and necessitate veterinary input. high co-efficient of inbreeding – an animal not slaughtered the movement of breeding Complementary strategies has lead to a high frequency of at an approved abattoir by

trained slaughtermen – can opportunities for progressive References only be used for private health management. Health Duncan JS et al (2014). Contagious ovine digital dermatitis: an emerging disease. consumption and may not and welfare strategies are The Veterinary Journal, 201(3): 265-268. be sold to the general public. essential for optimising both If pigs or ruminant species production of replacements Golding N and Small RW (2009). The relative resistance to gastrointestinal are intended for sale, then and production of premium nematode infection of three British sheep breeds. Research in Veterinary Science, the approved slaughterhouse meat products, often with an 87(2): 263-264. route must be used. emphasis on sustainability. Hall SJG and Henderson R (1999). Rare and minority British sheep for meat The producer should contact Whilst individual animals production: the Shropshire and Ryeland as sires, and the Cotswold and primitive the Food Standards Agency often have a high value for a breeds as dams. Small Ruminant Research, 35(1): 55-63. (FSA) for advice and further population – and although certification if they wish to their economic value may Newborn D et al (2000). The value of Hebridean sheep in controlling invasive perform any meat processing not apparently reflect this purple moor grass. Aspects of Applied Biology, 58: 191-196. at home or on the farm. – owners frequently engage with veterinary practitioners. Ritchie C and Hosie B (2014). Concern over maedi visna breakdowns. Veterinary Choosing places to sell These premises provide Record, 175(2): 50-51. Many smallholders feel a unique opportunity for that the best way to gain a veterinary surgeons to engage Torres PA et al (2010). Tay-Sachs disease in Jacob sheep. Molecular genetics and premium for their product in individual, flock and metabolism, 101(4), pp.357-363. is to sell through farmers national health and breeding markets, local butchers or strategies and can be highly Useful links farm shops. In order to do rewarding (Figure 5). Rare Breeds Survival Trust, www.rbst.org.uk this, the animals must be slaughtered as described Foods Standard Agency, www.food.gov.uk above, and the place of sale must be known to the local council and comply with guidelines set down by the Food Standards Agency and Trading Standards Institute.

Product labelling Product labels must not only be accurate, but also conform with the requirements dictated by the Trading Standards Institute (details on its website), which prevents the misuse of specific product descriptions such as ‘pedigree’ or ‘free range.’

Producers should also be aware that certain foodstuffs, such as Parma ham and Wensleydale cheese, have an EU-recognised ‘protected designation of origin’ (PDO) and as such can only be sold by those names if produced within a specific geographical area. A list of the product names included in these schemes can be found on the Database of Origin and Registration (DOOR) online.

Conclusion Rare breed flocks and herds often have different targets to typical commercial herds and engagement with these clients can mean there are

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Designed & [email protected] | 01359 243400 | produced by ONLINE EDITION BEES | WILDLIFE and EXOTICS About a bee The second article in a two-part series on the natural history and management of bees.

In the first article, we covered the principles of eusociality, the three castes of honeybee, queen, worker and drone and the divisions of labour John Hill within the colony. Now we MVB MRCVS shall consider how a colony supports itself and how it John qualified from Trinity divides with swarming. College, Dublin, in 1975, and recently retired as senior A honeybee colony is an partner in a six-vet, mixed ‘organism’ that requires four practice in County Antrim, main materials to be brought Northern Ireland. He is into the hive – namely, nectar, currently a trustee of the Pet pollen, water and propolis. Blood Bank and is the founder president of the recently Nectar formed British Bee Veterinary Nectar is a sweet, watery Association set up to raise liquid produced by flowering knowledge of bees within the plants in nectaries deep in profession. He also sits on the the flower. The forager bees Bee Health Advisory Forum, are attracted to the flower which advises ministers and by smell and electrostatic politicians on bee policy, charge and can be directed and is an enthusiastic into the flower by colour lines Figure 1. The bee may visit many flowers in one trip – on any beekeeper himself. only visible in the ultraviolet foraging trip, the bee will be faithful to one type of pollen from one flower species. range. Using its extendable proboscis, the bee sucks up the nectar into the honey crop she returns to the hive, she Once the honey reaches 18 – a sac which is an extension transfers the nectar to a per cent moisture, it is stored of the oesophagus, just ‘store’ bee who takes it to a in a cell that is then sealed before its true stomach, storage cell in the nest. Nectar with a wax capping. A colony the ventriculus. has a high water content of will produce up to 200kg of between 40 to 70 per cent. honey in one year, most of The honey crop contains The water content must be which is consumed as fuel. A nectar from many flowers reduced to about 18 per cent productive hive may be able to and the enzyme invertase and this is honey, one of the allow the beekeeper up to 25 is secreted to begin the two main food stores the to 30kg of honey as a harvest. conversion of sucrose colony produces. Honey with to fructose and glucose. a higher water content – of say Pollen Flowers have a negative 25 per cent – runs the risk of Pollen is the main protein electromagnetic charge and spoilage by fermentation. source for the hive. It is the bees are slightly positively male gamete of flowers and charged. When a bee visits a The nurse bees have the is produced in quantity. 0.75 flower, the electromagnetic task of reducing the nectar During nectar gathering, the hours* charge is neutralised, so the water content by two main bee comes into contact with next bee will ignore this flower means. Firstly by fanning their the anthers and becomes because it will be empty of wings to create air currents covered in pollen which sticks nectar. The flower needs and increasing evaporation. to the many plumose hairs time to replenish its nectar Secondly, they draw nectar on its body. This pollen is *Suggested Personal & Professional and electrostatic charge into their honey crop and then transferred to the style of Development (PPD) before becoming attractive to regurgitate a droplet on to the next flower and cross another bee. their outspread mouth parts pollination is achieved. to increase surface area and The bee may visit many enhance evaporation. This A high proportion of the flowers in one trip, depending swallowing and regurgitation pollen is gathered off its hairy BEES on the volume of nectar in process continues until the body by grooming with its each flower (Figure 1). When water content is reduced. legs. The pollen is transferred

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WILDLIFE and EXOTICS | BEES ONLINE EDITION

Site 1 Sun Horizon

Forage site 2 Forage site 3 Site 2 80º 80º

Beehive Site 3

Round dance Waggle dance Forage site 1 (inaccurate) (accurate) food nearby food further away Figure 2b. The waggle dance. Site 1: Bee waggles down the comb as forage source is due south in relation to sun; site 2: bee waggles 80 Figure 2a. The two types of bee dance. degrees to west of sun; site 3: bee waggles up the comb towards the sun. to the tibial tarsal joints on its are present. Evaporation of find it but just alight where the she started her waggle and hind legs which have a ‘pollen water by fanning is used for hive was previously sited. repeats it. At the end she turns press’ that compresses the temperature regulation. back to the starting point in pollen into a pellet. This is If you close up a hive in the the opposite direction. pushed into a structure of stiff Propolis evening and move it less than hairs called the corbicula that Propolis is ‘bee glue’ and it three miles, you run the risk of The direction of the waggle is stores the pollen to be taken is gathered from the sap of bees following their old flight in the direction of a source of back to the hive. A bee can trees. The bees use it to seal lines back to the hive’s old forage in relation to the position carry up to 40mg of pollen. any small gaps inside the hive position. So it must be moved of the sun at that time. and wild colonies will coat the more than three miles, such On any foraging trip, the bee whole of the inside of a tree that they are outside their The length of time waggling will be faithful to one type hollow. Propolis inhibits the flight lines and will orientate indicates the distance the of pollen from one flower growth of fungi or bacteria themselves to the new forage is away – the longer species. The beekeeper can within the hive and creates a position. The area potentially the waggle, the further the identify the foraging source more healthy environment for foraged by one colony is nearly distance. The dance is a by the pollen colour on the occupants. 30 square miles, though most communication to recruit the hind legs of returning will forage closer to the hive. other forager bees to where bees. The forager places the In winter bees do not there is a good source of food. pollen directly into a cell hibernate but cluster into How bees navigate was The forager bees could be with a droplet of nectar or a ball with the queen in the worked out by Karl von Frisch flying up to three miles away honey, where it ferments middle. During this time and won him a Nobel Prize. and visiting many hundreds of and produces a reduced pH the temperature may drop It had long been observed flowers over a period of time environment – effectively a few degrees and heat that some returning foragers and are able to adjust for the ensiling the pollen for storage. is generated by muscular performed one of two dances change in position of the sun Pollen provides the protein activity. An individual bee on the surface of the comb to navigate back to the hive. source required to make the is a poikilothermic or cold- – known respectively as the brood food fed to the bee blooded creature, yet the ‘round’ dance and the ‘waggle’ Bees are able to utilise larvae. It also contains the colony acts as a warm- dance – in almost complete polarised light so as they can minerals and trace elements blooded organism. Water is darkness (Figures 2a and 2b). still ‘see’ the sun on cloudy required. A colony needs needed to dilute honey when days. The concern about use about 25 to 30kg of pollen required for consumption. A round dance is performed of neonicotinoid pesticides on per year. if the nectar or pollen food flowering crops, such as oil Navigation source is closer than 100 seed rape, is that it interferes Water One of the first facts that metres. It involves a repeating with the bee’s navigation ability. As is the case with all living beekeepers learn is that figure of eight movement organisms, bees require forager bees are very good at exaggerated into a circle. Swarming water for metabolism and for finding their way home. They Swarming is the means by thermoregulation, because are also told that bees forage The waggle dance has a which a colony reproduces a developing brood needs on average up to three miles section in which the bee itself to form two colonies a constant temperature of from the hive, in any direction. moves rapidly in a straight or more. The main event 35°C. The temperature inside If you wish to move a hive in line, vigorously waggling her involves the queen leaving a hive is maintained at this an apiary, you can only move abdomen rapidly from side to the hive with about half the constant temperature during it three feet at most – more side. She then turns and walks worker bees and some drones any time when eggs and brood than this and the bees will not in a semi-circle back to where in one sudden, gigantic

Several sites could be flights and then fly out to be acquiring scout bees and the mated by 10 to 15 drones. site that recruits the most will One colony becomes two. be the site to which the swarm will depart. A site that was There is a system called popular with recruits at the supersedure where an old start may be superseded by queen may be replaced in another site that more recruits a colony by her daughter found more suitable later. This without swarming occurring. is a remarkable and democratic The two may co-exist for a method of new home selection short period before the old and could take a few hours or a queen is eliminated. This few days to achieve. means that a colony will keep a younger more vigorous queen. Once the decision has been made, the swarm takes flight Summary again and the scouts control A honeybee colony is a the mass and direct it to the remarkable entity ruled by new nest site at speeds of over a highly complex system of 20 miles per hour. How the communication in the form scouts make the swarm slow of chemical smells, food down is still a mystery. In their transference, vibrations, new abode, the workers set sounds and temperature. This about the task of constructing complexity is so elaborate comb for the old queen to that we are only just beginning begin laying in and forming a to understand a little of how new colony. it works and its potential benefits for mankind. Figure 3. A swarm of bees in a hedgerow. Meanwhile, back in the original hive, the new virgin exodus. The main swarming When the first queen cell is queens are metamorphosing season is mid-May to mid- sealed at eight days, this acts into adults. The first to July and tends to occur when as a signal for the old queen emerge will seek out the other the hive population is at a to leave with between 10,000 queens and either kill them in maximum. There is variation to 20,000 other bees. She will their cells by stinging through with the swarming period have been ‘slimmed down’ the cell wall or fight to death and swarming behaviour by workers so she is able to on comb until only one virgin depending on climate, the fly. Just before flight, all the queen is left. The triumphant local region, the honeybee bees take in plenty of honey virgin will do orientation subspecies and local strain. – stored in their honey crops – for the journey to their new The principal reason for the home. They sometimes fly only preparation for swarming is a short distance and cluster thought to be a reduction in together in a ball, perhaps in PPD Questions the transmission of ‘queen a hedge or branch (Figure 3). substance’. This can occur if They cling to each other in this the hive box is very crowded cluster protecting the queen in 1. What is the ideal water content of honey? and/or the queen produces the centre. less of the pheromone as she 2. What is propolis? gets older. ‘Scout’ bees travel from the cluster in search of a suitable Swarm preparations are new nest. Tree hollows, roofs, 3. When is the queen most likely to swarm? initiated by the workers, not chimneys, old fridges are the queen. They begin by all candidates. The scout 4. What is the constant temperature inside a hive in producing queen cells – a few bee measures the internal spring, summer and autumn? or many – that hang vertically dimensions by repeated flights from the comb. These are backwards and forwards much bigger cells and they through the space – thereby 5. Why do bees collect pollen?

look like monkey nuts. An mapping it. The ideal volume is

Pollen is the main protein source protein main the is Pollen

egg is laid in each cell and it 20 to 30 litres. When she returns 5.

C ° 35

receives a much higher level to the cluster she does a waggle 4. When the new queen cell(s) are sealed at Day 8 Day at sealed are cell(s) queen new the When 3.

of nutrition which, in turn, dance to recruit more scouts to properties anti-microbial

Propolis is resins from trees used to seal small gaps in hives and has and hives in gaps small seal to used trees from resins is Propolis affects the larval hormones to her site, and these new recruits 2.

18% produce a queen rather than visit her site and return and may 1.

a worker. dance in its favour. Answers

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Wildlife in first-opinion practice All first-opinion practices will see some wildlife cases, usually brought in by a client with little understanding of what to do and – on some occasions – what species is involved. Where do we stand in first-opinion practice and what can we do to give this animal the best chance of survival?

Initial triage should be carried instinctively huddle down in to keep captive any uninjured out before the person bringing an attempt to hide, so it can species protected by the Act. Emma Purnell the animal leaves the practice. be hard to distinguish this BSc MSc RVN CertNut Much of the wildlife seen from lethargy and depression Keeping any wild animal in a in spring comprises young if you are inexperienced. manner preventing its return to Emma qualified as a Registered animals, such as fledgling the wild – restricting birds from Veterinary Nurse in 2008 and birds, that would actually If the animal is to be admitted practice flights or imprinting works full time as head nurse stand a far better chance of to the hospital, a consent young animals, for example – is and clinical coach at The survival if returned to where form should be completed. an offence. While free-living Stocks Veterinary Centre in they were found, especially This form should include wild animals do not usually Worcestershire. She also has if adult birds have been seen the following questions and fall into the category of being a BSc in Zoology with Animal feeding them. provide all the information ‘owned’, if they are picked up Ecology and an MSc in Ecology, needed both within the and taken into captivity (in helping to fuel her interest in Exclusions to this rule practice and if the animal is legal jargon, being ‘reduced into more exotic species. include the youngster that to be transferred to a possession’) they becomes the is in severe danger on a busy specialist centre: property of the person taking it Emma has a particular love road, for example, or if they client name, address and from the wild. Signing over this of ‘small furries’ and nursing have been seen to be caught contact information ownership allows treatment or clinics and has just gained a by a predator. If the animal date and time the animal euthanasia to be carried out Certificate in Canine is identified as a youngster was found without permission from the and Feline Nutrition. with no injuries, the person where the animal was found ‘owner’ of the wild animal. bringing the animal in can be (as detailed as possible) advised to return the individual in what circumstances the While this is, thankfully, immediately to where it was animal was found not a problem commonly found, thereby increasing its species and approximate experienced, it is good chance of survival. age (e.g. neonate, young, practice. Failing to provide adult, elderly) appropriate treatment to a Fawns and leverets are visited what has been done since sick or injured wild animal very rarely by their parents the animal was picked which has been ‘reduced into and, if returned, will usually up (e.g. first aid or food possession’ can be classed as continue to be nursed. Despite offered/eaten) cruelty and may be an offence the myths, handling most wild statement transferring under the Wild Animals animals for a short period of ‘ownership’ (Protection) Act 1996; while time will not cause the parent client signature and date the Protection of Animals Act to abandon them. of admission. 1911 states that it is an offence to treat any species cruelly or If there are cat-attack injuries Legal considerations cause it unnecessary suffering. that are very mild – maybe a The statement transferring few small scratches or even ‘ownership’ is advised as the This can involve failure to just knowledge that it may be legalities can be complicated. provide necessary food, water, a cat attack with no visible According to the Wildlife and care and veterinary attention 0.5 injuries – antibiotics should Countryside Act 1981, an to wild animals. The Animal hours* be given to help prevent animal may be taken from the Welfare Act 2006 relates to septicaemia, before returning wild if sick or injured only for both domestic animals and the creature to the wild. the purpose of tending it until wild animals under veterinary it is fit for release. Once it is or rehabilitation care and Initial triage should take considered fit and well, it must means that an offence may have

*Suggested Personal & Professional place by viewing the animal be released – it is an offence been committed if a released Development (PPD) in the container or box in which it was brought into the practice – checking things such as general demeanour, “Initial triage should be carried out movement and the level of before the person bringing the animal CASE ASSESSMENT shock. Be aware that fledgling birds and many young animals leaves the practice”

60 VETERINARY PRACTICE TODAY | VOLUME FOUR | ISSUE THREE | 2016 WWW.VETCOMMUNITY.COM | ONLINE EDITION

ONLINE EDITION CASE ASSESSMENT | WILDLIFE and EXOTICS

This kingfisher had the It is important to keep unfortunate experience of flying monitoring the bodyweight A swift. A young house martin. into a window. of hedgehogs.

A fledgling jay that had found its A rather hungry young blackbird. Baby pheasants, a few days old. A young grey squirrel. way into someone’s house. rehabilitated wild animal does and the animal, using padded has catastrophic wing injuries, are damaged and growing new not have a chance of survival gloves and towels to help. this will not be compatible with tail feathers can take months, equivalent to that of other wild The animal being handled release and euthanasia should so providing a good size perch animals. This includes releasing will be scared, and is likely to be considered. can be important to their animals at unsuitable sites, in make sudden fight or flight rehabilitation and release. wrong territories, not able to responses – so be prepared. Wild animals will usually not Treatment or referral should be hunt (learned or physically), demonstrate signs of pain – this arranged as soon as possible unable to behave normally, Keep birds’ wings tucked is a survival response and does because time in a veterinary imprinted, in the wrong season in close to their bodies as not mean they do not feel pain practice will be stressful. and more. they can cause damage to and do not need analgesia. If themselves or others by they have an injury that you or Remember, certain species – As with any ‘normal’ pet, the flapping when frightened. one of your pet patients would including mink, grey squirrels basic needs of the animal must Teeth, beaks and claws can find painful – they are likely to and rabbits – cannot be kept be met: also leave lasting marks on be in pain. or released without a licence a suitable environment handlers! Cover the head of the under the Destructive Imported a suitable diet animal being examined, as the Checking the inside of the Animals Act 1932. Also, if the ability to exhibit dark will help to calm them, container in which the animal any animal under your care is normal behaviour keep the room quiet and calm arrived can also provide suspected of having a disease the need to be housed with, – and secure in case of escape – valuable clues – with blood and that is notifiable under an or apart from, other animals and avoid eye contact. excretions sometimes giving Order made under the Animal protection from pain, invaluable information. Making Health Act 1974 (including suffering, injury and disease. Assess body condition, comprehensive clinical notes tuberculosis, Newcastle disease, hydration and weight, as well as of these findings can help a foot-and-mouth disease, Clinical examination any signs of illness and injury. diagnosis and aid with referral. anthrax or rabies), the animal Once the animal has been Record all findings. must be isolated and reports admitted, a thorough clinical Once initial triage and first made to the police and Defra. examination can be carried The first thought when aid is complete – and before out by handling and assessing assessing any wild animal further treatment or referral – And finally… it. Care should always be for injuries must be ‘Will this house the animal in a suitable Establishing a good relationship taken to ensure that handling animal be able to be released box or cage in a quiet place with your local wildlife centre is is safe for both the handler back into the wild?’. If a bird away from other individuals, invaluable. Having the expertise ensuring no route for escape. of its staff to call upon and Some animals have specialist aid you with treatment plans “Establishing a good relationship with your needs – birds of prey, for and rehabilitation will give example, struggle to behave wild animals the best possible local wildlife centre is invaluable” normally if their tail feathers chance of survival and release.

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ONLINE EDITION MIND-SET | MANAGEMENT

Staying positive

We have all been there. We get out of bed, the sun is shining and it is looking to be a lovely day. Then we turn on the radio and listen to the news, we get stuck in traffic and by the time we arrive at work, the world is somehow less lovely. In short – we have been hijacked by ‘noise’.

Noise is information that is In his book Before Happiness, on television, newspapers, Anne-Marie negative, false or unnecessary psychologist Shawn Achor online news and radio. Svendsen-Aylott or that prevents you from describes the following CandMedVet, MRCVS perceiving a world where four criteria that can help 2. It is the wrong time success is possible. Noise can you decide whether or not You are not going to use the Anne-Marie is an inspirational be internal or it can something is noise. information immediately and leadership coach and trainer. be external. it may have changed by the Her focus is on helping 1. It is not usable time you do decide to use it businesses create a culture Internally it is how you speak information (Figure 1). of change where employee to yourself – “I’m stupid!” Your behaviour will not motivation and happiness “Idiot” and so on; while change as a consequence of So you may be waiting to hear is in focus. All her training externally it can be a flood this information. If it is not if you can have the vacation is grounded in research and of negative news from the going to inspire you or drive days that you have requested psychology and provides in- media, it can be people telling you to change something, – and in the meantime you are depth skills in communication. you that you are not capable then it is not valuable. constantly checking the price of something or it can be of air fares and worrying about Anne-Marie qualified as a cultural beliefs around you – This criterion is one that travel and accommodation the veterinary surgeon, has worked “In this family we work for a will quickly make you closer you get to the dates. for many years in sales, living – studying is not work” realise that most of the marketing and training and and “Boys are better at maths information that you come 3. It is hypothetical now runs the company, and science than girls”, across belongs in this Hypothetical information PurpleCat Coaching. for example. category. One of the most is based on what someone significant places from believes ‘could be’ rather than Noise is usually dominant which you gather unusable ‘what it actually is’. when we don’t understand information is the news how to create appropriate media; so a quick way Classical examples in this filters to choose what to reduce this noise is to category include house prices, information is allowed strictly limit your time spent the long-term weather forecast through. Remember that with 11 million pieces of sensory information hitting our brain Figure 1. Sometimes information is noise, simply because the every second (Zimmermann, timing is wrong. (Image: Hartwig Kopp-Delaney) 1986), filters are what create our reality.

In order to carry on in the pursuit of a realistic, positive world, there is a series of steps that can be useful: differentiate between noise 0.5 and meaning hours* choose to reduce noise change your inner voice. Differentiate between noise and meaning *Suggested Personal & Professional Just because information is Development (PPD) negative, it does not mean that it is noise. Negative information can be useful and important. So how do you differentiate between an unnecessarily

MIND-SET negative world view – and a realistic and positive one?

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or whether the dog in the kennel is going to make it through the night.

4. It is distracting This information distracts you from your goals.

So if your goal is to gain promotion, then listening to someone complaining about another team member is just noise – it isn’t going to advance you further towards your goal and may, indeed, sap your energy.

Choose to reduce noise We can become addicted Figure 2. Media, computers and smartphones are some of the worst offenders when it comes to to the noise. Just think of generating noise. (Image: Bernard Goldbach) computer games, television series or having to check the news all the time – and our Some of the ways of reducing avoid reading articles or Again, if it is unusable, smartphones and emails the information are to: listening to conversations untimely, hypothetical or are other examples of areas turn off the ‘notifications’ about tragedies that you distracting, then it probably that drive our addiction to on your phone or on your cannot, or will not, affect falls into either one of those information (Figure 2). computer. Choose when to with your behaviour two categories (Figure 3). look at what is there and avoid listening to songs with The problem is, that in order swiftly delete anything that negative lyrics, especially if Some of the ways of to increase the amount that is either unusable, untimely, you are working. reprogramming your inner we can do, we need more hypothetical or distracting voice are to: than 2.9 positive experiences force yourself to disengage Active noise cancellation notice what you are per negative experience to from conversations that Think of noise-cancelling thinking about. Are maintain high performance meet the above criteria. head phones. They do not you ruminating or (Losada and Heaphy, 2004) Purposefully move away from just block out the sound the catastrophising? If you and most of the noise to which negative, energy draining way ear plugs do, they actively are, develop the discipline we are exposed falls solidly situations whenever possible. replace the noise around you to stop yourself. You into the negative category. Think about your friends with silence. For humans, this may hold up a ‘virtual’ and family – are there people translates into quietening stop sign in your head; There are two strategies for who inadvertently drag you down your internal noise by or maybe say to yourself: cancelling noise – passive down that negative pathway? replacing it proactively with “You are ruminating/ and active. Choose to spend less time something more meaningful catastrophising”; or you with them and purposefully and positive. may devise another method Passive noise cancellation direct conversations into that works for you In 2008, an American study more positive areas Negative thinking, in the if you are worrying – what determined that, on a per turn off your car radio or form of fear, anxiety, self- is the likelihood that what capita basis, the daily time choose to listen to music that doubt, pessimism or worry, you are worrying about is spent consuming information puts a smile on your face is the most dangerous form going to happen? If it is at home (not including work!) keep your car journeys sacred of noise around because 10 per cent, limit yourself was 11.8 hours (Bohn and – purposefully focus on the it not only impairs our to thinking about it no Short, 2010). And this is just good things on the way to ability to hear the positive more than 10 per cent of the external noise. and from work; noticing the signals around us but it also the time leaves on the trees, funny undermines our other efforts purposefully choose to So an easy way to cut down details in shop windows and to create positive change and focus on the positive – on the noise, is simply to the courtesies of car drivers an increased happiness. keep redirecting yourself reduce on your overall around you by focusing on what your information assimilation. mute TV and There is a difference between senses tell you. Think of it Even a mere five per cent internet commercials appropriate learning from as a form of instantaneous reduction in overall intake remove news links from your the past and planning for mindfulness. By focusing can help refocus you away bookmark tool bar the future, and the constant on what you see, hear, from a state of being limit watching the news or stop churn of going over and touch, smell or taste, you overwhelmed into a place watching it all together. If the over past events (known as are moving your head where you can focus on stories are big and important ‘ruminating’) and worrying away from thinking and perceiving a realistically enough, people will talk about constantly about the future analysing and into being positive world. them and you will find out! (known as ‘catastrophising’). present in ‘the now’

References Bohn RE and Short JE (2010). How much information? 2009 report on American consumers. Consumer Reports, Dec 9, 2009, last updated January 2010, http://hmi.ucsd.edu/ pdf/HMI_2009_ConsumerReport_ Dec9_2009.pdf

Losada M and Heaphy E (2004). The role of positivity and connectivity in the performance of business teams: a non-linear dynamics model. American Behavioral Scientist 47(6): 740-765.

Zimmermann M(1986). Neurophysiology of Sensory Systems. In Fundamentals of Sensory Physiology, 3rd edn (revised), ed Robert F Schmidt, New York: Springer, p116.

Further reading Figure 3. Catastrophising and ruminating can cause our minds to spiral down into negative noise and Shawn Achor (2013) Before depression. (Image: Yogendra Joshi) Happiness – 5 Actionable Strategies to Create a Positive Path to Success. make sure that you with the best of intentions, The most damaging noise Virgin Books. understand the difference operating on the information of all is the ‘self talk’ that between being loving and they have to hand and the goes along the lines of: “I am caring – and worrying. resources – practical, emotional bright, so this should be easy; Worrying is a form of active and mental – that they have and if it isn’t then I won’t go destructive communication. available at that time. there” or “I am too stupid to This is when someone shares do this” or “People are born a goal or a desire and you As long as we learn from different – some get it and respond with “Yes; but have any outcome in our lives; some don’t”. you thought about” and you and realise that (even if we then proceed to list all the could have made a different We can all learn. Learning things that can go wrong. decision) at the time we made happens when we take it we thought that we were responsibility for what we think Active destructive making the right one (even and say and choose to change, communication is common when subsequently things acknowledging that we can in teams when you have one went wrong). Rather than constantly improve – no matter person constantly ‘pooh- beating ourselves up about who or where we are. poohing’ other peoples’ what has happened (thus suggestions and coming up creating more noise), it is with reasons for why they crucial that we focus on what won’t work. Make sure that we would do differently next you avoid doing it to yourself. time and on what we have When you truly care about learned from the situation. yourself, you give yourself positive feedback and support Creating a lasting, realistic – just as you would with any state of positiveness that other person. translates into success in our personal and work One of the most debilitating lives requires that we fears that a person can have, constantly focus on gradual is the fear of being wrong. improvement. The brain is In some cases this leads a flexible organ that grows directly to ‘decision paralysis’; and changes all the time. So while in other cases it simply no matter what attributes drives underlying anxiety and and attitudes we were born passivity. It is important to with, we can change things realise that nobody is right and move forward in a all the time. Most people act positive manner.

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Practice financial reviews You own or manage a successful practice. You know how much money is in the bank at any one time. Surely there is no need to carry out a financial review?

Whatever the size and nature It is worthwhile at the outset (Table 1). Each practice has of your practice, a financial to consider what you are 5.5 full-time equivalent (FTE) review process will help you trying to achieve. Clinical veterinary surgeons. spot trends and act on them excellence first and foremost, Mark Harwood quickly. It is a useful, non- no doubt. Somewhere high EBITDA BSc ACA CTA clinical tool for supporting up the list is also likely to be a EBITDA stands for Earnings cost-effective service and practice with happy staff, yet (i.e. profit) Before Interest, Tax, Mark has been with staying ahead of the game. one that is profitable at the Depreciation & Amortisation. Hazlewoods since 2003 and same time. It provides an indication works solely with veterinary And further good news? It of the underlying financial practices and their owners. need not be complex or overly Let’s run with striving to performance of a practice, He enjoys advising on a time consuming. achieve a profitable practice irrespective of its structure wide range of business and being important to you. (sole trader, partnership, LLP, accounting matters, helping Financial review should not How can you tell a poorly Limited Company), debt levels, veterinary practices make the mean a one-off exercise after performing practice from one policies on writing off the most of their opportunities to the year’s end. Reviewing the that is flying? values of assets (depreciation/ be successful. ‘financials’ of your practice amortisation) and exposure should be a continual process. There are, of course, no hard to tax. In his spare time, Mark is Management accounts are and fast rules. So, by way a keen runner, cyclist, tennis often cited as being similar of example, let’s consider a Where necessary, EBITDA can player and is also a fan to year-end accounts but small animal practice that has be further adjusted to exclude of motorsport. produced on a more regular ‘below average’ profitability private costs/income and basis. In reality, however, against another small animal exceptional items – one-off management accounts can practice that has ‘above repairs, legal and professional help you to monitor key data average’ profitability, based fees, and so on. It also gives from many other areas of your on our benchmarking data an indication of the amount practice business. Table 1. A comparison of the financial performance of two small These key data are animal practices commonly referred to as key performance indicators ‘Below average’ ‘Above average’ or KPIs. practice (£’000) practice (£’000) Tools at your disposal Turnover 1,150 1,500 What does your practice have at its disposal to help with a financial review? Some key Gross profit 800 1,180 areas include: Gross profit % 69.6% 78.7% you and your team

clients Staffing costs (535) (575) accounts and budgeting (including market 46.5% 38.3% practice management system rate equivalent for external advisers, e.g. owners) your accountant. 0.5 Overheads (320) (310) hours* All of these factors are interlinked and complement (Loss)/Profit (55) 295 each other as part of the before tax financial review process. *Suggested Personal & Professional Interest 5 5 Development (PPD) Profitable or not? You need to decide what Depreciation 25 15 information will be most Amortisation 35 25 helpful to you as part of your practice’s ongoing EBITDA 10 340

FINANCE financial review. How do you decide that? EBITDA % sales 0.9% 22.7%

staff to share their ideas about how to make the most of what your practice has to offer. It is human nature that someone is likely to be keener to take ownership of an idea and follow it through if they have come up with it themselves.

In setting your action plan, try to keep it manageable. It is worthwhile brainstorming yourself and with your staff – although trying to put in place too many new initiatives at once is likely to mean that none, or few of them, will receive the focus and energy that they really need to succeed. Instead, you can focus your action plan on those areas that are likely to make the most difference, set against the resources needed to achieve them. The old of cash a practice generates finances, it just needs a it sells a high volume of pet 80:20 rule. before capital expenditure and moment to stand back and food that has a lower gross drawings/dividends. consider what factors will profit margin than solely Having come up with an make the most difference. fee-based work. This is not action plan, monitoring actual On a wider front, EBITDA is bad per se, but demonstrates financial performance against the key figure for assessing To really understand how that understanding the your targets as part of a small animal practices when your practice stacks up, drivers behind your practice’s monthly (ideally) or quarterly valuing their ‘goodwill’ benchmarking is needed. performance relative to the review will help you fine tune or, increasingly, the Gross Comparing your practice benchmarks is crucial to avoid your action plan in those areas Enterprise Value – goodwill, data to pooled data from setting targets that that would most benefit. equipment and practice other practices (external are unrealistic. vehicles. Historically, turnover benchmarking), as well as What sort of information has been the key driver of comparing your own internal Targets, budgets should be considered? the goodwill value for large practice data over time and projections There is no right or wrong animal and equine practices; (internal benchmarking) will Targets, budgets and answer to this question. The but market activity in the past help you establish where projections – are they all list is, in reality, endless and few years has seen a move the land lies. There may be the same? They are often you need to try and narrow towards EBITDA becoming very good reasons why your talked about as being it down. So, looking at a more important for assessing practice is above, at or below interchangeable. practice’s profit and some large animal and equine average against benchmarks. loss account, key practices too. However, without reviewing Ultimately, if you prepare components include: these, how would you know? financial projections that set turnover If ownership change is on out expectations for your gross profit the horizon and/or you are Whilst helpful, benchmarking practice’s profit and loss staffing costs considering retiring, working in isolation only provides account, cash flow position overheads closely with a specialist value to a certain degree. So, and balance sheet for the overall ‘profit’. veterinary business valuer will having established where the future, you will also be setting help ensure the best outcome land lies, setting targets as targets. If you choose to Space dictates we do for you. the next stage will provide a try and adhere to those not explore the different focus for you. Working with projections in terms of the definitions of profit here in any Of course, an owner may be veterinary specific advisers in projected expenditure, then detail; but it is worth pointing happy with the performance the target-setting process will you will be budgeting. out that – when comparing of his or her practice, even if it help ensure that the targets ‘profit’ – it is crucial to ensure does have supposedly ‘below set are realistic. Targets set, now you need an that ‘like-for-like’ are being average’ profitability. For action plan to try and achieve compared because differences most owners, maintaining a By way of example, there those targets. Involving your in practice financial structure good work/life balance is very may be a very good reason staff in setting the action plan and how profit is defined important. However, often no why a practice’s gross profit process can be invaluable – will impact on what is being extra work is required to boost margin is slightly below both in setting it and following scrutinised. Many of the the health of a practice’s average – perhaps because it through. Encourage your concepts discussed here

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apply equally to farm and an average of 90 procedures your looking at the information important to the well-being of equine practices. per vet. If we said that the is any less valuable. the individual animals under actual average charged price their care. Turnover per dental procedure was Having identified trends in It may sound obvious, but £100 plus VAT, then these turnover and procedure/ An example of this would be without a comparatively procedures are contributing service numbers, some following up with personalised decent level of turnover for £49,500 (excluding VAT) to practices use these data contact to clients whose any given level of costs, profit turnover. If, however, the to help them target their pet had scored an amber or and cash flow will suffer. average ‘cat dental’ price marketing campaigns. One red on the rating scale for should be £130 (excluding example of this is through teeth, perhaps linking in with, Your veterinary practice VAT), that would instead give the use of visual healthcare say, a dental promotion. management system contains a potential turnover handouts given to clients. Such contact could be a wealth of information about of £64,350. These leaflets offer ratings automated using the practice turnover. Ensuring that it is – using a green, amber and management system with text set up to provide you with It might be then, that of the red traffic light type system and emails, or through phone clear reports incorporating 5.5 veterinary surgeons, one – that can be applied to calls or using the post. accurate information is of them performs a much key clinical health areas, critical. If there is information lower number of ‘cat dentals’ such as dental health, renal A key part of this – indeed in that you wish that your than their colleagues – at function, coat condition communicating with clients system could provide – and say 30 procedures in that and mobility. generally – is considering you are unsure how to report year. In this example, there offering all clients the choice it – speak with your system is also scope to support that The use of the word as to how they wish to be provider as it will probably particular individual, with a ‘recommend’ is often contacted when they are not be possible to accommodate consequent knock-on benefit suggested to be powerful at the practice. The easier your request. to turnover. However, without when talking with clients and more tailored to their actively monitoring the whole too. Backing this up with preferences each client finds Monitoring, say, the top 10 or picture, it would be very something visual for their interaction with your 20 turnover categories – not difficult to pick up on this. them to take away helps practice, the more likely they only by value (£) but also by to consolidate your are to remain bonded to you the number of procedures/ Some practices choose to healthcare recommendations. over the long term. items sold – will help you share a wealth of financial identify trends. Looking at information with their staff It is possible to take this Lost income through this for the practice as a – others less so. There is no concept a step further by having undercharging is often cited whole and also by veterinary one-size-fits-all policy and a corresponding numbered as one the toughest areas to surgeon is worthwhile. you should do what works rating system for recording crack. Some management It is accepted that work best for you and your staff. the healthcare ratings on systems allow you to run sometimes gets booked under Your accountant should be the practice management ‘exception reports’ – based a staff name other than the able to help guide you here. system. This enables practices on certain user-defined person who carried out the Even if you prefer not to share to then actively target their charging parameters – to help work – although over time this certain information with your promotional efforts to the identify where items should exercise should still help you employees, that does not mean areas that are arguably most have been charged but have identify trends.

Of course, more in-depth analysis can be carried out and the above should perhaps be a minimum starting point. Monitoring turnover in this way can help to identify staff who may be uncomfortable in certain clinical areas – hence their lower numbers – and who may benefit from training and mentoring. It will also help you to understand how small changes in pricing and charging behaviour can have a significant impact.

Let’s consider a similar practice to the examples in Table 1, with 5.5 full-time equivalent veterinary surgeons who carry out 495 cat dental procedures during the year –

for example, when looking at Value (£’000) external benchmarks or your Turnover (sales) X own data over time. Cost of sales Final word drugs and consumables (a) Financial reviews are not laboratory fees (b) just about historic accounts. clinical/carcass waste disposal (c) Some practices manage their referral fees (d) finances by their bank balance and find that the practice Gross profit Y performs ‘okay’. However, taking a more proactive look Table 2. Calculating gross profit at your practice’s ‘financials’, through benchmarking, not been. For example, say exceptions outside this range. target setting, devising action a client books their dog in A percentage outside the plans and monitoring targets for a follow-up consultation, range might well not be the against actual performance, you would expect a follow-up consequence of staffing pay ideally on a monthly basis, consult to be charged. issues either, but could instead opens up many more be linked to ‘turnover per vet’ opportunities to maximise Using the management system levels. A useful exercise can be your potential and stay ahead to ‘package up’ common to compare individual turnover of the competition. procedures can also be per vet to an individual vet’s help, as can regular invoice ‘package’ – namely, their reviews. Another idea is for gross salary plus the value of all the veterinary surgeons any benefits provided by the to ‘diagnose and manage’ a practice. A typical range is 16 sample case, to see how their to 25 per cent based on our charges might differ. data, with around 19 per cent being average. Gross profit A practice’s gross profit is Where turnover is booked driven by the mix of fee-based to ‘non-vets’, this can be work compared with the sale overcome to some degree by of drugs/consumables, its allocating this turnover to the buying terms with suppliers, veterinary surgeons based on pricing strategy and charging, their own ‘turnover per vet’. as well as speed of work. It is Monitoring this can be very calculated as shown in Table 2. enlightening and the relative figures between vets are often Small gains in any of these areas not always what you might can, when combined with the expect to see. overall financial picture, have a significant impact. Overheads An annual review of The average first opinion small overheads is always animal gross profit margin worthwhile. This is not based on our data is 73.1 per to say they cannot be cent. Practices in the south- monitored more regularly; east of the UK tend to have a it is just that rather greater slightly higher margin because opportunities for boosting they tend to command slightly practice performance tend higher prices. to be available from more regular review of turnover and Staffing costs staffing costs. We generally consider that an efficient proportion of Overall profit small animal staffing costs We referred to EBITDA earlier. (including employer’s National This is a key figure providing Insurance and ensuring any a guide to underlying the figures are adjusted to profitability. Whatever profit include equivalent market rate is being considered, it is salaries for the owners) to important to understand how sales is between 38 and 45 per it is defined and ensure that cent – although there can be like-with-like is compared –

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When writing staffing rotas, the modern veterinary dd to the mix regional shortages of veterinary and practice has to factor in a variety of considerations; veterinary nursing staff, maternity and paternity including out-of-hours working schedules, varied Aconsiderations, holidays and CPD days coupled with staffing requirements and allocations, and the the Working Time Directive and it can become a struggle for increasing need for flexible working hours. Practice the management team in a veterinary practice to produce managers, vets and veterinary nurses who have effective working rotas. been given the responsibility for organising staff rotas are often faced with the juggling act of Know your staff keeping everybody happy while ensuring that staff Being responsible for rota writing carries the fundamental with the required expertise are in the right places requirement of knowing every staff member’s capabilities at the right times. and preferences as well as the varying workloads that naturally exist within the practice. In addition there are several guidelines and regulations that need to be adhered to. Creating a working environment where staff can thrive and be happy often starts with designing and implementing suitable staffing patterns. Healthy and happy staff will also reflect how your practice runs and projects itself to your client base.

Generating effective rota templates that work for clients, their animals, the practice and staff is an essential planning requirement of the modern practice. The ‘7Ps’ military adage is commonly used to emphasise the importance of good planning.

Work in progress Rota requests can often be last-minute and maintaining a ‘working draft’ of your next rota is a good way to accommodate requests as they come in. This strategy should ensure that reasonable demands can be met prior to distributing the rota to staff. The politics involved with subsequent rota alterations and reviews once a rota is published can generate discontent among staff who may question why certain requests were accommodated, so waiting until a designated request deadline can reduce the amount of visible revisions that may have to occur.

70 VETERINARY PRACTICE TODAY | VOLUME FOUR | ISSUE THREE | 2016 The family objective Engage with your staff With a large proportion of the veterinary workforce being Involving staff in changes to their rota patterns will not female and the need to accommodate paternity leave, only enable you to gain their perspective on how the rota staffing a veterinary surgery can often require a degree currently works for them, but also create a sense of inclusion of flexibility when accommodating part-time or family and teamwork. Where individual rota changes may only compatible working hours. Generating a stress-free return need addressing on an individual level, larger changes to to work for staff after having children, or factoring in shift patterns allocation and timing should ideally be done maternity and paternity leave and medical appointments as a team and will often bring out some innovative solutions. can be complicated and time consuming. As managers are often privy to personal information about individual team members they may be able to make A useful feature of the Rota Manager program is its ability to rota amendments and allowances to ensure that as far as cater for part-time working hours, block time periods when possible a fair and balanced rota is produced. employees have specified that they are unavailable and set up working patterns that meet the needs of all concerned. Own it Implementing Rota Manager is about making the Cost effective commitment to effective and efficient management of the Efficient rota management should significantly reduce or most valuable resource of the practice – its staff. remove the requirement to use ad hoc s t aff and locums. O f ten expensive and without engrained knowledge and training Rota Manager has been designed specifically to take of your practice’s values and procedures, unnecessary into consideration the numerous factors that exist in this employment of agency staff can be best avoided by ensuring complex process and has the flexibility to address the very current staff are suitably distributed where they are needed. varied needs of different veterinary practices. Appropriate work patterns and jobs will also make for a happier and healthier work force. Whilst many elements of the day in veterinary practice cannot be predicted, Rota Manager can best prepare your Work spaces teams for success. Specifying locations and workspaces within your rota is a great way to ensure that on arrival your staff know their duties and area of work. Thinking ahead about how your practice uses spaces and specialist equipment, such as scanners or theatres, will enable the rota writer to ensure that when a certain room is needed there are sufficient staff levels within that space to make it best operational.

esigne rouce by

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Have demographics had their day? Humans are, in the main, programmed to conform. Follow the crowd. Don’t stand out. As consumers, pet owners are no different – that’s why we’ve always been able to say that the ‘average’ pet owner is female, middle-aged, lives within five miles of their practice and uses only one Emily Eudall practice; whilst the ‘average’ horse owner is older (a third Having originally trained in are aged 45 and over) and equine management and female (90%). equitation, Emily has over 20 years of experience working Conversely, when it comes in a variety of equine-based to decision-making in the roles. She spent eight years agricultural and mixed in equine practice, working in sectors, we know that men both nursing and customer- fundamentally drive this. facing roles. Emily now combines motherhood with her And yet ‘average’ by its work as marketing manager very definition masks for Onswitch and has recently a whole multitude of gained a distinction factors – smoothing out for the CIM Certificate in the extremes to provide Common sense tells us that of – whilst also exceeding the Professional Marketing. generalisations. Marketers, people are more likely to own expectations of – your clients politicians and business horses in rural rather than in is always a given, wherever owners have used these urban areas; just as it tells us you are. population classifications that in rural areas pet owners and generalisations (or are more likely to have to drive And if you’re staying in ‘demographics’) for for more than 10 minutes to Bath and looking to buy decades; providing a useful reach their nearest veterinary another practice in the area, yardstick against which to practice. Fundamentally, that then understanding the target communications and is all demographics is – putting demographic make-up of local allocate budgets. statistics into perspective with owners will confirm whether common sense. Because nature the right course of action is to You’ve probably used them follows rules. leave the practice’s established yourself – if your practice is in brand positioning alone, or a southern urban catchment, If you own a successful bring it under the umbrella of you may well target cat practice in Bath and personal your existing premium brand. owners with added-value reasons cause you to relocate Whilst if you’re looking to services and health plans; to Margate, it is very likely that open a brand new site, then whereas, if your clients are your business model no longer identifying social trends and works. An ageing population consumer behaviours amongst elderly, you probably sell more accessories and treats with low incomes has the people who live within 10 than prescription diets. replaced your wealthy, young, minutes of the building will progressive clientele. Changing determine how your practice But are such generalisations the focus of your offering to should be branded, as well useful? Or are they patronising promote value-for-money as which services you should 0.5 health plans ahead of keyhole offer. An understanding of hours* and pointless? In short, have demographics had their day? surgery is, perhaps, more in local demographics will tell keeping with the needs of your you, for example, that opening Demographics are still a new clients. a new veterinary practice in valuable business tool central Leicester or Bradford One thing, however, is not in faces a fundamental hurdle – a Few would argue that there *Suggested Personal & Professional question. Meeting the needs high proportion of residents Development (PPD) are some parts of the country where the local economy is struggling – in ex-mining areas, for example; just as there “…today’s consumers want their brands are others where industry is to be more ethical, fair, responsible DEMOGRAPHICS flourishing such as in the ‘M4 motorway corridor’. and inclusive”

with Asian heritage, means detailed demographic analysis few pets. of your catchment area and in the UK, women now account for the majority of target consumer will. video game players, and there are more gamers aged Know your consumer over 44 than under 18 (Internet Advertising Bureau, Demographics help you do Demographics are dated September 2014) just that. So let’s look at and useless 31 per cent of UK Aldi and Lidl shoppers are from the another example. According to the AB demographics (The Grocer, March 2015) international think 32 per cent of The Sun readers are from the ABC1 Your new client registrations tank, Trend Watching, demographics (www.newsukadvertising.co.uk) are stagnating. Close ‘Demographics are dead. every generation and every income band uses social by, a large new housing Adapt your strategy or media regularly (Pew Research Center, September 2014) development is being built, perish’. Its November 2014 “If you look at the list of the 1,000 favourite artists for full of family homes. And report, Post-demographic 60-year-olds and the 1,000 favourite artists for 13-year- where there are families, there Consumerism declares: olds, there is a 40 per cent overlap.” (Head of Music, are pets. Targeting mailings ‘People – of all ages and in all BBC Radio 1, May 2014) and door drops to these markets – are constructing post codes allows you to put their own identities more Figure 1. Some pertinent facts. a £5 welcome voucher into freely than ever. As a result, the hands of hundreds of consumption patterns potential clients. You can tell are no longer defined by them about your late-night ‘traditional’ demographic Who uses social networking sites opening for working owners, segments such as age, Percentage of internet users within each group who use introduce your weekly puppy gender, location, income, social networking sites. class and encourage them family status and more’. to ‘like’ you on Facebook. All internet uses 74% Targeted, effective advertising They cite examples from made possible because you global brands, such as Netflix, A. Men 72% understand the type of person that are finding demographic B. Women 76% moving on to your patch. profiling of customers increasingly pointless – the A. 18-29 89% CD National ‘vox pop’ data find films we like are determined by B. 30-49 82% CD that 75 per cent of pet owners so much more than how old C. 50-64 65% D live within five miles of their we are and which part of town D. 65+ 49% chosen practice. Ongoing we live in. research consistently confirms A. High school graduate or less 72% that ‘local’ and ‘convenient’ Let us consider the facts in B. Some college 78% are the key drivers when Figure 1. C. College+ 73% choosing a small animal practice. Most of your clients We can all recognise that in A. Less than $30,000/year 79% come from your town; so our modern society, barriers, B. $30,000-$49,000 73% don’t waste time and money conventions and stereotypes C. $50,000-$74,000 70% advertising too far afield. are crumbling. It is no longer D. $750,000+ 78% enough to ask, “Are you A quick look at your client married or single; straight or Pew Research Centre’s Internet Project January Omnibus Survey, database tells you that gay?” when there are infinite January 23-26, 2014. Note: Percentages marked with a superscript letter (eg.,CD) indicate a statisically significant difference between that within your town there shades in between. Indeed, row and the row designated by that superscript letter, among categories are undoubtedly some when it comes to defining the of each demographic characteristic (e.g.,age). suburbs with an increased very essence of a person – such concentration of clients as the ethnicity or gender with Figure 2. Who uses social media? – so targeting your Friend- which they identify – is it even Get-Friend communication OK to ask? And does it really there makes sense. Likewise, matter anyway? YouTube and mobile phones of the country you live in, vaccination offers will be more haven’t always existed, the or what colour your skin is, effective in some postcodes, We have all heard of younger generation (who all Millennials have similar just as gold standard annual generations X and Y. Most will increasingly make up a expectations about how care plans will be much more commentators agree that larger proportion of your the world works, about popular in others. we’re now living through the client base) live differently. what they need from the birth of generation Z – the To them, searching for businesses they use and the In short, demographics can ‘Millennials’. Coming of information online – brands to which they aspire. certainly be a valuable tool in age at the start of the 21st instantaneously and on informing top-level business century, Millennials live in a the move – is simply the Because the wheel is turning strategy. All the common brave new world. norm. But crucially, this new full circle, today’s consumers sense in the world won’t cut classification transcends want their brands to be more it in the business plan you Whilst those of us born demographic constraints – it ethical, fair, responsible and submit to the bank, whereas a before 1980 appreciate that doesn’t matter which part inclusive – using models of

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all shapes and sizes in their happens). There’s no need to consult prices, it seems there in the funding and utilisation advertising, making honest dismiss social media because is no real north-south divide, of demographic profiling. We claims, demonstrating a sense lots of your clients are old even though the principles of know that you are sensible of humour and an insight into – those silver surfers are on demographics would have us enough to understand your normal life. This is not driven Facebook just as much as their believe differently. clients’ needs and we think the by demographics. grandchildren (Figure 2). time has come to acknowledge We could just as easily that they don’t depend on Uniqlo’s mission statement Just communicate clearly and apply the ‘looking out of the whether those clients fit into a embodies perfectly how a consistently. One message, window’ test here. If your box marked AB1 or C2DE. business can successfully for everyone. practice in on a ‘Waitrose abandon demographics: street’, it doesn’t matter It might seem controversial, ‘We consistently provide We talked earlier about the whether that street is in but it shouldn’t be. Far fashionable, high quality, role of common sense in Newcastle or Newhaven, your greater minds than ours have basic casual clothes that business decisions. Why not clients will expect to pay a fair been saying for years that anyone can wear anytime undertake your own (free) price for excellent care. demographics are no longer anywhere – and always at demographic analysis by relevant, and some of the the lowest possible market looking out of your window? And the verdict is... world’s biggest brands and prices.’ And it is working. Ten If there’s a Waitrose, a My colleagues and I at the UK’s most successful years ago, Uniqlo had just Fairtrade coffee house and Onswitch believe that companies are embracing that 100 stores, all in Japan. By a nail bar, you can probably demographics have had their fact wholeheartedly. Perhaps the end of 2015, it had 840 ditch the £10 microchip day. We think that veterinary it’s time veterinary practices in Japan plus another 1,170 offer; whereas a Poundland, practices have enough to did too? around the world, with many a launderette and a corner worry about without adding more planned. shop might suggest adding in a vaccination offer too. Which is all very interesting, but what relevance does it Then there’s equine practice. have for the veterinary sector? With catchment areas PPD Questions often covering hundreds of Well, for a start, the miles, it’s hard to imagine a 1. What percentage of pet owners live within five miles implications for your client demographic grouping that of their practice? communications are huge. would be valid for such a large There is no longer such a thing area. In the equine world, as an ‘average’ owner – your owners do their research; 2. How can you undertake your own (free) clients can be young, old, they talk to fellow owners demographic analysis? male, female, black or white and equine businesses, they but they’ll still have the same go online and find out who is 3. What was the average consult price difference needs. There’s no requirement the expert on the particular between both the lower and upper quartile in the to pay large sums of money condition from which their north of England and the south east? for a report telling you what horse is suffering. Then they sort of people live around your travel as far as they have to. practice. Save yourself the And if their chosen vet moves 4. Are men or women the highest percentage of internet money and know this – as long to another practice, most users who use social networking sites?

as you focus your business owners will follow. Once

Women (76%) Women on delivering a truly excellent more, reality doesn’t fit the 4.

£3

customer experience, shaped demographic model. 3.

by an understanding of what expect. owners horse and pet what delivering a truly excellent customer experience, shaped by an understanding of of understanding an by shaped experience, customer excellent truly a delivering

on business your focus then test; window’ the of out ‘looking the Apply pet and horse owners expect, And if you need more proof 2.

75 per cent per 75

your business will grow. that demographics has had 1. its day, let’s take a look at Answers Your practice mission the thorny issue of consulting statement (you have one, prices. A 2015 Society of right?!) and your branding are Practising Veterinary Surgeons universal truths, declaring that (SPVS) survey plotted average you provide superior care for consult prices across the UK both companion animals and and found only a £3 difference their owners. There’s no need between the lower and upper to print things in pink for your quartile average prices in the Sources predominantly female clients north of England and the Onswitch National Vox Pop data (honestly, we’ve heard this south east. When it comes to Mintel data

“There is no longer such a thing as an SPVS survey data ‘average’ owner” British Horse Society research

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Performance appraisals – why they matter Look in any good management book and you will find the ‘hows, whys and wherefores’, of staff appraisals and how to carry them out. This article concentrates on why the appraisal is so important to the success of a veterinary practice and on some of the things that can affect its success. Maggie Shilcock The performance appraisal Maggie is a zoology graduate – also referred to as from Imperial College, London performance review, employee University. She has worked appraisal, performance in the management field of evaluation, development veterinary practice for the last discussion, employee 20 years both as a practice appraisal, to name but a few manager and as a veterinary terms – is the way in which management and training the job performance and consultant and course provider. development of an employee is Maggie has contributed documented and evaluated. management articles to many of the major veterinary Appraisal systems are journals and has spoken at UK central both to human and international veterinary resource management and management conferences and performance management. meetings. She has written three They improve organisational veterinary management books efficiency by ensuring that and contributed chapters to individuals perform to the three BSAVA Manuals and was best of their ability and aspect of their work as it could perhaps be improved president of the Veterinary develop their potential. The provides a good opportunity and the best way the practice Practice Management performance appraisal is an to formally discuss what can help this happen. They Association in 2003. She is now effective means of ensuring help and support they can also provide an opportunity one of the editors of Veterinary that managers and team seek from the practice. to talk in depth about an Practice Today. leaders meet with their staff The appraisal can also be employee’s job and their on a regular basis to discuss very motivating as well as future with the practice. performance issues, training reassuring. Everyone needs and development needs; and to feel motivated and valued Why appraisals matter to to make sure that all is done if they are going to work well the practice to make the best of the human and really enjoy their job. The practice needs happy, resources the practice has at motivated employees if it is its disposal. Why appraisals matter to going to operate effectively the team leader/manager and efficiently. Motivating Why appraisals matter Appraisals provide a ‘window’ and developing employee to employees for team leaders and skills and potential will have a Appraisals are important managers into the success, positive impact on the service because all employees need development and needs of the practice provides to its reassurance about how well their staff and enable them pet and human clients. Well- 0.5 they are doing their work, to plan – not just the training trained, motivated staff will hours* what is expected of them and they need to provide, but also provide the very best service. whether they are meeting how they will be able to use the required standards. this person to the best of their On a less positive – but Most employees want to abilities in the team. very practical – note, the improve and develop their lack of formal recorded *Suggested Personal & Professional performance, skills and Appraisals help managers find appraisals for staff is very Development (PPD) knowledge and to progress – out how well the employee much frowned upon if a a good appraisal system will is doing, if there are any staff member should take help them to do this. problems, and whether or the practice to any kind of not they are encouraging the industrial tribunal or dispute. The appraisal is equally good best from their staff. They The provision of appraisals APPRAISALS for a member of staff who enable the manager to assess for all staff is now widely may be struggling with some how a member of staff’s work accepted as ‘good practice’.

Some points to remember

soon as they arise – never Appraisal follow up “Everyone should be appraised if the at an appraisal interview. The whole appraisal will fail if the follow-up scheme is to be seen to be fair” Don’t criticise process is poor – this There may well be includes good feedback deficiencies in an to ensure that promises ‘Appraise all’ where new members of employee’s work, but the are kept and targets are It can be a big mistake staff have one-, three- point of the appraisal is to met and any support to appraise only a and six-month ‘mini’ see how the employee can needed during the year is section of your staff. It’s appraisals before they slot be helped to overcome provided. Follow up the tempting when starting into annual appraisals. these. It is not the time action plan by agreeing an appraisal system to If staff think that their for direct criticism. This a time by which you “just try it out on the appraisal is going to should be addressed at a will deliver what was receptionists or the influence any salary separate interview. promised. Make sure nurses”. Equally, vets review, they are unlikely to this happens. quite often get left out give totally frank answers Don’t promise what of appraisals because “it to questions, or be you cannot deliver Appraisals should be a doesn’t apply to them” or particularly relaxed at the It is very easy to make continuous process “it’s different for vets”, or interview. off-the-cuff promises at Once begun, appraisals other such excuses. the appraisal interview should take place on a Avoid a – maybe to provide regular basis – ideally Everyone should be moaning session more training, give more every six months. If it is appraised if the scheme Most managers have been responsibility, or allow a possible to hold short is to be seen to be fair. here. It is when a member staff member to develop informal one-to-one of staff has strong feelings a particular interest. quarterly meetings, all the Don’t tie appraisals about an issue and uses This is fine so long as better. Twelve months is in with pay their appraisal to voice you are able to make it a long time if things are It is probably inevitable them. This is OK up to a happen. The commonest not going well, so regular that a good appraisal point; but appraisals are criticism of appraisals contact is important. is likely to have some not a time for moaning, by staff is that they influence on financial so it’s vital to halt this were promised things reward if staff are flow of conversation that never actually measured and rewarded early on and point out happen; so, at the end in this way. However, that the appraisal is for of the appraisal, have an appraisals should not be positive discussion and action plan listing what tied in directly with pay for looking forward. If you and the employee and it is important to there is a problem, then it have agreed. keep them separate from should be discussed at a salary review time. different time.

The easiest way to do this Appraisals are not for is to spread appraisals disciplinary issues “At the end of the appraisal, have an throughout the year – easy Disciplinary issues should to do if you have a system always be dealt with as a action plan listing what you have agreed” of induction appraisals separate matter and as

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Pet insurance – necessity rather than luxury? The Spring Budget increased the insurance premium tax (IPT) from 9.5 per cent to 10 per cent – a small increase, but one which will noticeably increase the cost of all insurance policies, including pet insurance. However, alongside this tax increase came a personal tax allowance increase of £500, starting from 2017/2018. So it would seem very much a case of taking with one hand and giving with the other.

The increase in IPT will indeed raise the two years, spending on pet presents has reasons why people do not take out cost of insuring a pet, but it really is grown by £3 million, which says a great insurance inluding: important to keep a sense of proportion. deal about our willingness to spend on It won’t happen to my pet – yes it For the average pet owner who is our family friends. could and if it does it could be insured, the annual payment pales into very expensive insignificance compared with all the other Sadly, these facts do not translate into I’ll have my own savings account costs of pet ownership. a significant increase of spending on pet for any extra veterinary costs – but insurance. In some ways this should not what if the big bill comes only a few As the cost of veterinary care increases to come as any great surprise as spending months into the start of the a very large extent owing to the new and £30 for a present for your pet is something savings account? developing medical procedures that can tangible that gives you pleasure, while I’ll still have to pay the excess – yes now be performed – it becomes ever more spending £30 on pet insurance feels – as but that is a lot cheaper than the important that pets are insured. Sadly, with any other insurance – like money lost £1,000 bill this message does not yet seem to have hit with no return. It’s only when the pet is ill My pet is now too old/too ill to be home with the general pet-owning public, or injured that spending on pet insurance insured – this is a fair point because it as it is estimated that over half of the becomes a more attractive proposition and can be very difficult to find insurance nation’s dogs and over two thirds of its of course, by that time it is usually too late. for such pets cats are still uninsured. I’ll take my chance – be it on your head, There is probably no easy way to but sadly it will be your pet that may be Choosing pet insurance is no easy task encourage the insuring of more pets. the one who suffers and depends not only on an owner’s Emphasising the growing cost of I can’t afford pet insurance – this is finances, but also on the type of policy veterinary bills only serves to fuel the a very fair point in some cases and, they want or need. Choosing from criticism of veterinary charges rather hopefully, if faced with a big bill, the ‘lifetime’, ‘maximum benefit’, ‘time- than encouraging or highlighting the owner will be able to receive some limited’ or ‘accident-only’ and other need for pets to be insured. Veterinary form of animal charity help. However, similar policies is complicated enough practices can certainly do more to perhaps a slight tweaking of the budget before even beginning the process of encourage pet insurance, but the and priorities – such that less is spent comparing the policies of the many cynical owner may simply see this as on treats and presents and more on different insurance companies and, of a way for the practice to make sure insurance – might put affordability in a course, reading the small print. that their bills are paid. Insurance different light. companies can-and-do cite the possible Clearly the cost of insurance is a costs of unexpected vets bills and how There is no easy answer. All we as significant financial factor in pet keeping, being insured will cover such costs; and veterinary professionals can really do but when we realise that in 2015 UK pet dog and cat magazines can encourage is to advocate insurance as impartially owners spent £4.6bn on their pets, it and advocate the advantages of as possible in the hope that more pet brings into perspective the £25-£30 per insuring a pet. However, at the end of owners become willing to spend money month that the average pet owner might the day, choosing to insure one’s pet is on future possibilities rather than spend on pet insurance. £4.6bn is an a personal decision and there are many present pleasures. awful lot of money and it is important to understand that a significant proportion of this is not spent on food, insurance or vets bills, but on pet accessories, gifts and treats.

Research results show that in Britain almost 90 per cent of pet-owners spend up to £50 on extravagant gifts for their pets – with one of the more extreme gifts cited being a £1,400 doggy treadmill. Birthday gifts are given to 27 per cent of the pet population and pet fashion is also on the rise, with hundreds of pounds sometimes being spent on fur coats for dogs and cats, not to mention the jewellery and the rhinestone- (or even diamond-) encrusted collars. Over the last

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There are also industry-related communications, such as the joint leaflet covering avian influenza that I am currently working on with the NFU and British Free Range Egg Industry Profile Producers Association.

The Trust produces a magazine three times a year. It has a Your name: Jane Howorth MBE circulation of nearly 60,000 households and includes a mix of new stories, information, special features, major retailer and Position: Founder celebrity interviews. Our readership profile includes those people Company: British Hen Welfare Trust who enjoy keeping hens – whilst appealing to a broader audience (www.bhwt.org.uk) of ‘foodies’, encouraging consumers to think about welfare and food, and to promote British free-range eggs.

Similarly I want to see progression in veterinary support for backyard flocks – keeping hens as a hobby is here to stay and What inspired you to start rescuing battery hens? currently there is a lack of knowledge, experience and licensed I watched BBC Panorama’s Down on the Factory Farm as a treatments available for poultry as a whole. Being awarded teenager in 1979; and finding out that commercial laying hens Charity of the Year status by the BVNA has given me a wonderful never had an opportunity to experience the outdoors at any point opportunity to highlight these areas, and work towards in their lives had a big impact on me. I started writing to my local improving support for the increasing number of households that MP as well as various institutions, such as the Meat & Livestock keep hens as pets. Commission, to try to improve awareness of how laying hens were kept and increase consumer choice through better food labelling. The last few months have been an exciting time for you, how do you feel about being awarded an MBE? How did the British Hen Welfare Trust evolve from a It certainly has been an exciting time! News of the MBE was one-woman enterprise to what it is today? a huge surprise, and apart from giving me a lovely sense of My parents died within a year of each other – too young – and achievement, it is enabling the charity to open more doors there is nothing that brings the value of life into focus more and explore more ways in which keeping hens as pets can sharply. That fact, together with my growing passion for the pet benefit society. hens I had begun saving from slaughter, led me to advertise for homes for ‘spent’ hens – much as the RSPCA seeks homes for Being awarded the BVNA Charity of the Year status was just cats and dogs. My first advertisement read: perfect timing for us, and I’m deeply grateful to Sam Morgan ‘We’ve never seen the sunshine and never tasted grass. Is there for putting us forward; the possibilities for improving veterinary anyone out there who can offer us a second chance to enjoy support for poultry are exciting! And, of course, our half a a better life? We’re spent battery hens due to go to slaughter. millionth hen, Dee, was re-homed in January of this year too. Please help us if you can. Call etc.’ When I started helping hens, my target was a lorry load (around My telephone didn’t stop ringing; so following some regional 4,000) and sometimes I have to pinch myself that we have now and then national media coverage I was able to build a network saved over 500,000 from slaughter. I could not have achieved of like-minded volunteers, all of whom understood the ethos of what I have without the support of the wonderful volunteers the charity. It was very important to me from the outset that all though, and the goodwill of the farmers with whom we work. stakeholders within the egg industry were treated with respect That is certain. and not berated for how they kept laying hens in cages – systems which, ultimately, were designed to meet consumer demand for How do you work to raise public awareness of battery cheap eggs. hen keeping? As well as achieving lots of media coverage – and promotion The Trust now has 500 volunteers – how do you through our own publication Chicken & Egg – the Trust also organise them? attends events such as The Edible Garden Show, county shows I have a small and very capable team here at ‘Hen Central’ in and, for the first time this year,Gardener’s World Live and Devon. Gaynor Davies, RVN, heads up the operational side of Countryfile. the charity, which includes the recruitment and management of volunteers in over 30 regional teams nationwide. The volunteers We have a small number of volunteers who give talks to are given training on farm visits, bird handling and care. Each schools, the WI and other groups, and we want to develop team has a structure covering transportation, equipment this side of our educational campaign. We are also very active disinfection, bird handling, ‘poorly’ care, administration and, of on social media, where people from all walks of life can enjoy course, re-homer liaison. communicating about a common passion, and learn about the charity and its aims. All our educational work has a positive What does your role within the Trust now involve? stance and we avoid shock tactic style campaigning. I’m still very ‘hands on’ in that I am involved in hen ‘collection’ days; but I also do more in terms of building a bridge between welfare and commerce, which I believe is key to high welfare. My work involves writing articles for backyard hen keeper “It was very important to me from the publications, wider consumer-based coverage through regional outset that all stakeholders within the egg and national PR highlighting how consumers can influence hen welfare through their shopping basket. industry were treated with respect…”

The Trust celebrated its 10th birthday during 2015, how do you see it developing over the next 10 years? Hopefully, the next 10 years will see: improvements in veterinary support the charity reaching a much wider audience, such that we appeal to those who eat eggs rather than simply those who enjoy keeping hens development of an educational programme targeting schools and other groups widening our educational reach to include vets and vet nurses, research work – working more closely with the industry to bridge the gap between welfare and commerce so that consumers have a clear knowledge of laying hen welfare.

We are also currently planning our first flagship re-homing and educational centre at our Devon base, which is very exciting! How do you make sure hens are re-homed to suitable owners? How do you educate owners, who keep just a small Every single person who adopts our hens must speak directly number of hens, on chicken welfare? to a member of our staff so we can assess their knowledge We educate through our publications, and social media activity. and the facilities they offer to birds. We also offer bespoke We cover serious subjects – such as what to do in the event of an advice on merging flocks, common health issues and nutrition outbreak of avian flu, the value of registering with APHA (part requirements. We do not re-home hens where there is a high of Defra), the implications of a ban on beak trimming and much expectation of continued egg production. more – but in an entertaining and engaging way.

Do you see a day when there will be no battery farms? As more hens are kept as family pets, how do you think I hope so, but that will depend on consumer demand. We this might effect the need for veterinary care? encourage support for British free-range farmers, especially There is no doubt that the need for wider veterinary support is those who keep their birds in small flocks of up to 4,000. The growing. The kind people who adopt hens from us are primarily free-range sector has grown considerably since the charity began driven by compassion and, therefore, they treat their hens as (32% free-range in 2008 to 52% in 2014), but free-range eggs family pets and require veterinary advice provided in a similar are potentially in danger of becoming a commodity product; so way to that available for companion animals. we need to be mindful of what we are asking farmers to do, and what consumers are willing to pay for. We see a gap in the market here and would like the knowledge and experience of the current handful of forward-thinking avian Huge flocks of 32,000 free-range hens arguably would not offer vets to spread and become the national norm. birds the lifestyle that consumers expect from a free-range, egg-producing chicken, so attention to range enrichment and What relationship does the Trust have with the adequate protective cover is vital to ensure the quality of a free- veterinary industry? range system that meets consumer expectation. I would say the relationship is growing nicely. When I started there was no substantial veterinary support – in fact, I recall Do you think that the general public’s attitude to animal several hens that had been written off by local vets that welfare is changing? subsequently enjoyed a good quality life as a result of my I think there is more awareness of food provenance generally. We homespun remedies! appeared with Hugh Fearnley-Whittingstall and Jamie Oliver in a high profile Channel 4 programme in 2008, called Jamie’s Fowl When the charity was established, it became the norm for vets Dinners and that brought the entire poultry industry to the fore. to call us, asking our advice on hen treatment; that still happens Certainly it is our experience that when someone adopts our and is welcomed today. Obviously, we cannot offer technical hens, it changes their shopping habits in that they become more support, but we are knowledgeable through experience and have discerning and supportive of the free-range movement. access to innovative and highly respected avian vets. We are delighted to partner with Chicken Vet (www.chickenvet.co.uk) – How do the RSPCA’s Five Freedoms relate to battery part of the St David’s Poultry Team based in Devon – who have hen farming? developed CPD courses for vets and vet nurses. Caged hens have access to food and water. A good stockman will also ensure birds are free from discomfort, pain, injury How do you think the veterinary industry can help and disease as none of these are conducive to a productive improve the welfare of hens? flock. I would agree that birds can also behave ‘normally’ I think there is much that can be done to improve the welfare within a caged environment, but I don’t consider that they can of backyard flocks and would encourage vets and vet nurses to behave ‘naturally’. learn about these increasingly popular pets – voted sixth in the ‘Top Ten’ by the Pet Food Manufacturers’ Association. There It is normal to perch, preen and scratch – all of which can be are a handful of common health problems that recur and broad done within a caged environment; but birds are unable to behave knowledge of these will ensure a happy client and a happy hen. naturally in that they cannot dust bathe or enjoy the stimulation that an outdoor environment offers. I would argue that their well-being is compromised by limiting their natural behaviours.

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