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LivestockMATTERS
VOLUME 3 EDITION 2WORKING TOGETHER FOR A HEALTHIER FUTURE
www.xlvets.ie
Inside this issue:
We explain the key to profitability in suckler farming and how good management andrecording can help maximise conceptionrates on farm.
Suckler cow fertility
€3.25
EXCELLENCE IN PRACTICE
The members of XLVets have worked hard to create what they see as amodel of how practices can work together, sharing the latest ideas andpassing on savings and joint expertise to clients.
The group comprises of a number of the foremost farm practices in Ireland. With many years of combined experience, it is able to give expert advice on all areas of farm livestock, health and production.
XLVets -WeExcelInvest in Health Don’t pay for Disease
Killenaule VetsThurles, Co.TipperaryTelephone: 052 9156065
Mulcair Veterinary ClinicsCappamore, Co.LimerickTelephone: 061 381209
O’Connor Julian VetsCashel, Co.TipperaryTelephone: 062 61196
Old Church Veterinary HospitalBallyshannon, Co.DonegalTelephone: 071 9851559
Ormonde VeterinaryKilkenny, Co.KilkennyTelephone: 056 7763630
Riverview Veterinary GroupBandon, Co.CorkTelephone: 023 8841503
Sliabh Luachra Veterinary CentreRathmore, Co.KerryTelephone: 064 7758009
Southview Veterinary HospitalClonmel, Co.TipperaryTelephone: 052 6121429
The Veterinary HospitalGorey, Co.WexfordTelephone: 053 9421151
Adare Veterinary SurgeryAdare, Co.LimerickTelephone: 061 396390
All Creatures Veterinary ClinicRoscommon Town, Co.RoscommonTelephone: 0906 626898
Avondale Veterinary ClinicsArklow, Co.WicklowTelephone: 0402 33744
Clerkin VetsCootehill, Co.CavanTelephone: 049 5552777
Comeragh VeterinaryKilmacthomas, Co.WaterfordTelephone: 051 294143
Donal Lynch VeterinaryTullamore, Co.OffalyTelephone: 057 9354505
Glen Veterinary ClinicsTipperary Town, Co.TipperaryTelephone: 062 52992
Glenbower Veterinary GroupKilleagh, Co.CorkTelephone: 024 95189
Glenina Veterinary ClinicGalway, Co.GalwayTelephone: 091 752 014
Gortlandroe Veterinary ClinicNenagh, Co.TipperaryTelephone: 067 31016
XLVets member practices are dedicated to providing ahigh quality, cost effective service to their clients, tosupport long-term growth and future prosperity withinthe Irish livestock industry.
XLVets is committed to being a part of a healthy future.
www.xlvets.ie
XLVets IrelandMember Practices
Adare Veterinary SurgeryStation Road, Adare, Co.Limerick
All Creatures Veterinary ClinicLanesboro Street, Roscommon Town,Co.Roscommon
Avondale Veterinary ClinicsFerrybank, Arklow, Co.Wicklow
Clerkin Vets90 Bridge Street, Cootehill, Co.Cavan
Comeragh VeterinaryMain Street, Kilmacthomas, Co.Waterford
Donal Lynch VeterinaryKillurin Cross, Killeagh, Tullamore Co.Offaly
Glen Veterinary ClinicsBlind Street, Tipperary Town, Co.Tipperary
Glenbower Veterinary GroupClashdermot East, Killeagh, Co.Cork
Glenina Veterinary Clinic1 Glenina Heights, Galway, Co.Galway
Gortlandroe Veterinary Clinic6 Church Street, Nenagh, Co.Tipperary
Killenaule VetsKillenaule, Thurles, Co.Tipperary
Mulcair Veterinary ClinicsDromsally, Cappamore, Co.Limerick
O’Connor Julian Vets67 Main Street, Cashel, Co.Tipperary
Old Church Veterinary HospitalThe Mall, Ballyshannon, Co.Donegal
Ormonde Veterinary14 Barrack Street, Kilkenny, Co.Kilkenny
Riverview Veterinary GroupDistillery Road, Bandon, Co.Cork
Sliabh Luachra Veterinary CentreWest End, Rathmore, Co.Kerry
Southview Veterinary HospitalIrishtown, Clonmel, Co.Tipperary
The Veterinary HospitalArklow Road, Gorey, Co.Wexford
XLVets is a novel and exciting initiative conceived from within the veterinary profession.We are all independently owned, progressiveveterinary practices located throughout Irelandcommitted to working together for the benefit of our clients.
VOLUME 3 EDITION 2
C O N T E N T S
XLVet Ireland Ltd Registered Office at:
DromsallyCappamoreCounty LimerickTel: 061 381505
© XLVet IrelandNo part of this publication may be reproducedwithout prior permission of the publisher.Disclaimer:XLVets does not necessarily share the views of contributors. No responsibility can be acceptedfor opinions expressed by contributors, or claimsmade by advertisers within this publication.
SUMMER FEATURE 05Suckler cow fertility:
Contact XLVets:
061 381505 and
o!ce@xlvets.ie
Practical, farm based training, delivered by vets to
improve your livestock and businessperformance...
XLVets Skillnet is funded by member companies and the Training Networks Programme, an initiative of Skillnets Ltd. funded from the National Training Fund through the Department of Education and Skills.
XLVets FarmSkills courses are designed toput the farmer first; finding out what youknow now and what you’d like to know toimprove your business.
Courses are available across Ireland and areopen to everyone. Topics catered for includecattle lameness, mastitis and cell count, calfrearing and fertility management.
Training is a vital part of the jigsaw that makes up modern farm business success. But finding the training that’s right for you needn’t be a puzzle.
CONTENTSHERD HEALTH
03 Infectious respiratory disease in calves:Tommy Heffernan, Avondale VeterinaryClinics provides information on how toidentify the causes and clinical signs of respiratory disease in calves and theimportance of timing when treating theinfected calves.
07 Johne’s disease:Padraic Kilmartin, Glen Veterinary Clinic focuses on the clinical problems associated with Johne’s disease and outlines basic principles of control.
09 Five ways that animals look at theworld differently to humans:Willie Buckley, Riverview VeterinaryClinic reflects on the book ‘Animals inTranslation’ from Temple Grandin’s providing some interesting facts andthoughts explaining how animals lookand think differently, to humans.
Karl Darcy, Glenina Veterinary Clinic explains thekey to profitability in suckler farming.
It is important to remember when vaccinating young calves that maternal antibodies are present. So this is why the timing of vaccination programmes and the use of intranasal vaccinations is so important.
TO M M Y H E F F E R N A N M V B
RESPIRATORY DISEASE
Veterinary Surgeon Tommy Heffernan
XLVets Practice Avondale VeterinaryClinics, Co.Wicklow
3 LIVESTOCK MATTERS WORKING TOGETHER FOR A HEALTHIER FUTURE...
1. Causes
The main causes of respiratory diseases in calves are viruses and bacteria.Another very important cause of respiratory disease in calves is parasitichowever I will mainly deal with the infectious causes in this article.
The main viruses are:
l PI3
l RSV
l IBR
l Coronavirus
l BVD
The main bacterial causes are:
l Pasteurella multocida
l Histophilus somni
l Mycoplasma bovis
2. Risk factors
These can reduce calf immunity orincrease the infectious pressure, meaning a respiratory infection can bemuch worse under these conditions.
l Poor colostrum management
l Malnutrition
l Poor weaning management
l Contact/shared airspace with older animals
l High humidity
l High stocking density
l Poor air quality
l Wet bedding
l Large groups/overcrowding
l Power washing in presence of calves
Belgian Blues can be even more susceptible to pneumonia as they have smaller lungs due to double muscling
Healthy calf
Infectious respiratorydisease in calves
RESPIRATORY DISEASE
VOLUME 3 EDITION 2 LIVESTOCK MATTERS 4
3. Recognition - whatare the clinical signsto watch for?
1. Elevated respiratory rate (panting)
2. Fever
3. Nasal discharge
4. Depression and inappetance
It has been suggested that any animalwith a temperature of over 39.7 degreesCelsius is deemed to be febrile.
If any of these symptoms are apparent,then the key to a successful outcome isBEGIN TREATMENT EARLY.
4. Making a diagnosis
This is important to isolate the viral cause so you can implement an effectivecontrol programme through vaccination.Isolating mycoplasma could also beimportant as treatment options can belimited and some follow up herd screening may also be important.Samples should be taken early andbefore treatment begins. Usually this isdone by nasal swabbing. Any calvesfound dead should also have postmortems undertaken to rule out acute pneumonia as a cause.
5. Treatments
Antibiotics play a key role in the treatments of pneumonia. There is nogeneral rule that one antibiotic is best fortreatment. There are many options whichyour vet can advise you on. There aresome golden rules for using antibioticssuccessfully when treating pneumonia.These are that treatment is started earlygenerally within the first 48hrs of any ofthe aforementioned clinical signs. Also it is very important that antibiotics aregiven for the correct duration. This meansthat every case of calf pneumonia has to be treated for at least three days. Anti-inflammatories also play a key role in treatment and can be given inconjunction with antibiotic at the start of treatment.
6. Control vaccination
The main control is by reducing risk factorsand implementing vaccination strategies.
It is also important to remember when vaccinating young calves that maternalantibodies are present. So this is why timing of vaccination programmes and the use of intranasal vaccinations is soimportant. All vaccination programmes
should include the main viruses which are IBR, RSV, PI3, BVD and there is also a vaccination available against Pasteurellapneumonia. A pneumonia vaccination programme should be included as part ofyour overall herd health plan. Also goodmanagement plays an essential role inreducing pneumonia outbreaks.
Passiveimmunity
(Colostrum)
Active immunity(Calf’s own
immune system)
Period of highsusceptibilityto pneumonia
DiseaseResistance
0 1 2 3 4 5 6 7 8 9 10
Age of the calf (weeks)
Vaccination timing essential to cover risk period
Suckler cow fertilitySUCKLER COW FERTILITY
Veterinary Surgeon Karl Darcy
XLVets Practice Glenina Veterinary Clinic, Co.Galway
5 LIVESTOCK MATTERS WORKING TOGETHER FOR A HEALTHIER FUTURE...
CowsCows kept for breeding must be fit, healthyand have sound feet. For maximum fertilitycorrect body condition score (BCS) of cowsboth at mating and calving is essential. Theideal is a BCS of between 2-3 i.e. ‘fit notfat’. Overly thin cows at calving will be slower to cycle and conceive; overly fatcows are more prone to calving difficultieswhich in turn frequently lead on to delayed conceptions.
Trace element deficiencies can have a major impact on conception rates. Copper,selenium, vitamin E and iodine should be supplemented where necessary. Blood testingalong with silage/soil analysis can pinpointlikely deficiencies. Supplementation with traceelement boluses, lick or feed additives shouldstart two months before calving, up to at leastearly pregnancy.
Likely problem cows should be recognisedand managed on an individual basis. Themost obvious candidates to require specialcare are those cows that had difficulty at oraround calving as a cow's womb has only afew weeks to change from holding a full termcalf to being ready for conception.
BullThe bull is ‘half the herd’. Semen productiontakes two months so ideally the bull should be in good health and ready to operate twomonths ahead of the breeding season. Asemen quality test should be considered at thistime. Even a sub-fertile (rather than completelysterile) bull can wreck a well-planned breeding schedule. Physical soundness is vital, particularly of the reproductive organsand of the feet and legs. A bull should bewatched at work to ensure he is serving cows properly, particularly young bulls. Early pregnancy diagnosis is the ultimateguarantee that a bull is fertile.
The key to profitability in suckler farming is to produce the maximum number of calves per cow. Thegreatest loss of potential earnings arises in most Irish farms from a failure to get cows and heifers in calf in the first place. Farmers should aim to produce one calf per cow per 365 day interval. In mostsuckler herds a shorter calving and breeding season brings further advantages in terms of reducedlabour, production costs, simpler animal management, more calves and fewer and fewer calf healthproblems. Good management and recording along with suitable veterinary intervention when neededcan help maximise conception rates.
Any cow that:
had a dead calf/miscarriage
retained foetal membranes
had a difficult calving
had twins
should be considered a likely case ofendometritis and treated appropriately.
The most obvious candidates to require special care are those cows that had difficulty at or around calving as a cow's womb has only a few weeks to change from holding a full term calf to being ready for conception.
K A R L DA R C Y M V B
SUCKLER COW FERTILITY
VOLUME 3 EDITION 2 LIVESTOCK MATTERS 6
Disease controlA number of common diseases impact on sucklercow conception rates. These include BVD(Bovine Viral Diarrhoea), IBR (Infectious BovineRhinotracheitis), leptospirosis, salmonella andneosporosis. Where repeat services are higherthan expected,blood testing should be initiated.Where a disease problem is diagnosed,a herdhealth plan that encompasses a vaccinationprogramme, replacement policy and quarantine procedures for new stock should bedrawn up in consultation with the farm vet.
Existing vaccination programmes should betailored to fit around the critical and delicatebreeding stage. A shorter breeding seasonwill facilitate this.
Artificial inseminationand heat detectionWhere AI is used either in part or in full goodheat detection is critical. Twenty minutes of alertobservation at least three times daily is a goodrule of thumb. Artificial heat detection aids suchas tail paint or scratch cards can be helpful.Most accurate of all is an active vasectomisedbull with a chin ball.
Synchronisation
Pregnancy detection
l It can help dramatically tighten the calving period.
l It can be used in cows that are not coming into heat (more common in suckler cows because of the maternalbond).
l It reduces time spent observing for heat.
l It allows for fixed time AI, removing alot of guesswork.
l Done correctly in suitable cows/heifers,conception rates can be as high as 75 per cent.
Synchronisation of heat in suckler cowsis useful for a variety of reasons:
Cows should be at least 40 days calvedand heifers at least 15 months old beforesynchronisation is attempted. A number of different protocols exist. All drugs used are prescription only medicine (POM). In general, a combination of a progesteronereleasing device with GnRH andprostaglandin injections works well for cowsnot yet seen in heat, while prostaglandininjections alone can be used successfully in heifers.
Ideally pregnancy detection should occurearly on in pregnancy with a view both toensuring both bull and cow fertility and todiagnose animals failing to conceive thatthis may be rectified. Ultrasound scanningcan be performed from as early as four
weeks. Early detection of a poor or low conception rate allows for earlier intervention and investigation and a better chance of avoiding having to feed a herd of empty cows!
Diagnosis of cattle showing clinical signs is not difficult but finding the subclinically affected animals is more challenging.
PA D R A I C K I L M A RT I N M V B
Johne’s disease
JOHNE ’ S D I S EASE
Infection is acquired as calves via the faeco-oral route. MAP can survive in the environment for up to one year and only multiplies in a host animal. Not all animalsinfected become clinical cases some areaffected subclinically but these animals shed MAP intermittently in their faeces. Risk factors for contracting clinical Johne's disease include age and infectious dose. The younger the calf at the time of exposureand the greater the infectious load increasesthe risk of developing clinical Johne's
disease. Clinical cases of Johne's disease are rarely seen in animals less than two years of age.Johne's disease causes granulomatous enteritis. Early in the disease process no clinical signs are evident, these animals aretermed subclinically infected animals. As the disease advances subclinical animalsprogress to clinical cases, these animals have intractable diarrhoea and an inability to absorb plasma proteins causing weight loss and eventual emaciation.
Johne's disease is caused by Mycobacterium avium subspecies paratuberculosis (MAP). It manifests clinically as chronic diarrhoea without loss of appetite and results in progressive emaciation. Once clinical signs occur animals rarely survive more than a year. There is no cure for this disease.
Veterinary Surgeon Padraic Kilmartin
XLVets Practice Glen Veterinary Clinic,Co.Tipperary
Bottle jaw may be as a result of Johne's Disease
7 LIVESTOCK MATTERS WORKING TOGETHER FOR A HEALTHIER FUTURE...
Low
Low
Low
J0
J1
J2
J3
J4
J5
Minimum two negative tests
Negative but only one test performed
Negative but one positive in more than three tests
Positive/Negative interchanging
Positive but all other tests negative
Two positive tests
High
High
High
Green
Green
Green
Yellow
Yellow
Red
Risk Level Classification Johne'sinfection group
Definition
JOHNE ’ S D I S EASE
Diagnosis
Diagnosis of cattle showing clinical signs is not difficult but finding the subclinicallyaffected animals is more challenging.There are two types of tests available.
Taking a faecal sample and culturing itand/or looking for antibodies in the milkand/or blood.
Type of Test Advantages Disadvantages
Faecal sampling l Accurate l Min 16 weeks to culture MAP
l Labour intensive
l Expensive
Serology
A. Milk (Dairy)
B. Blood (Dairy andBeef)
l Faster results
l Easily performed
l Poor sensitivity. (High % of infected animals missed)
l Repeat testing required
Control
Basic principles of control are:
1 New infections prevented
2 Infected animals identified andremoved from herd
3 Disinfection/Hygiene and Husbandry
A classification system in Holland was usedto reduce the level of Johne's on affectedfarms. Due to the poor sensitivity of theblood and milk sampling, repeat sampling(every 3 months) is needed.
Animals were classified as low risk or high risk.
l Yellow and red animals should be calved in an isolation penaway from green animals and calves should be removedimmediately after birth.
l Calves should only be fed colostrum from green cows.
l Colostrum should never be pooled.
l Red cows should be culled at the end of their lactation.
l Pens should be disinfected between calving to reduce the level of exposure.
Poor condition may be as a result of Johne's Disease
Persistent scour may be as a result of Johne's Disease
VOLUME 3 EDITION 2 LIVESTOCK MATTERS 8
9 LIVESTOCK MATTERS WORKING TOGETHER FOR A HEALTHIER FUTURE...
Five ways that animals look at the world differently to humansFrom Temple Grandin’s “Animals in Translation”
ANIMAL BEHAVIOUR
Temple Grandin is an associate professor at Colorado State University.She lectures worldwide on both animal science and autism. She servesas a role model for animal lovers and people with autism. She is bestknown for being a passionate and effective animal advocate, and forexplaining how animals think, to humans. There are many interestingthoughts in this book and here are just a few.
Veterinary Surgeon Willie Buckley
XLVets Practice Riverview VeterinaryClinic, Co.Cork
1. Ability to see colour
The ability to see colours variesbetween animals.
Birds see four basic colours, ultra-violet, blue, green and red.
People and some primates seeblue, green and red.
Most other mammals just see blueand green.
‘Red rag to a bull’. Not Possible.
In nature any novel high pitched sound willcause a cow to baulk. It activates the part ofthe animal's brain that responds to distress.Reflex makes it think that maybe its calf is indistress or a herd mate in trouble.
An animal is more upset by a high pitchedsound that is intermittent and random. It can'trelax because nature has programmed the animal to always look towards the direction ofa distressed sound and it is instinctively waitingfor the next sound so it can't relax. The animalhas to make a conscious decision about whatto do with the sound. If she is a predator, doesshe need to chase something? If she is a preyanimal, should she run?
With our animals the less noise the better. Air hissing in a parlour can mimic the highpitched distress sound. Crush gates that rattletoo much or metal chains clanging, all causecows to move slower or unpredictably.
2. Sound
ARTICLE BY: WILLIE BUCKLEY MVBRiverview Veterinar y Clinic, Co.Cork
VOLUME 3 EDITION 2 LIVESTOCK MATTERS 10
ANIMAL BEHAVIOUR
Most of our commercial animals wereprey in the wild before they were domesticated; they depended on noticingany unusual flick of a shrub, as it couldhave made the difference between lifeand death by predator.Animals perceive more detail thanhumans (who are predators) in order tostay alive. Also animals' night vision ismuch better than ours, so again they seemore intense contrasts of light and dark.Cattle grids work because cattle perceivethe contrast between the bright at the topand the dark at the bottom of the pit sosharply, that they think it is a bottomlesspit and will not cross. In some countriesthey just paint a series of very bright lines on entrances to prevent cattle fromentering roads.During the war the Allies recruited totallycolour blind people to interpret satellitespy photos. They could see camouflagenetting draped over a tank much clearerthan people with normal sight. Contrast isbetter seen without colour. Shadows aremuch clearer in black and white. In factTemple Grandin always takes black andwhite photographs, to try to see what theanimals see.Strong changes in light are also very distracting for cattle. Cows will baulk at ashadow on the ground. Getting cattle togo from either a brightly lit area to a darkarea or vice versa always causes troubleto farmers.
I see some farmers leave cowsout the side gate of the crushwhen testing. The cows emptyeasier and the next cows loadbetter because there is less noise.
3. Ability to see contrast
We need to prevent strongreflections or shadows along acow's path. Moving shadows orreflections are even scarier to a cow. We need to have moreconsistent levels of brightnesswhen moving animals from different areas. Changes of texture from one floor to thenext also upset cows.
4. Ability to deal with the new
Humans are blind to anything they are notpaying attention to. Humans have evolvedto see what they are expecting to see.Cows are at the other end of the spectrumand notice everything.There have been studies done where peoplehave been interviewed by people holding abanana rather than a microphone and mostpeople don't even see the banana. Humansfocus on the end-point or goal i.e. getting tothe other side of the field. If there is somethingnovel in our path, our more advanced brainscan process the new item out of our minds.The human brain tries to recognise it, compare it to other ‘like’ things that we haveseen in the past, analyses the threat it maypossess and it makes the decision that it will not affect us achieving our goal. All this
happens without us consciously being awareof these decisions.
If a cow was to see the same novel objectin its path its brain does things differently. Ifsomething is novel or has changed in anyway, they notice and they need to think aboutit before proceeding. The cow does not havethe processing ability of the human and theywill fear it more. It may be a new predatorand may not take the chance of passing theobject as they don't know what it will do.
Any object or image in a cow's visual field will get her notice, but if they are used to seeing it every day, it does notcause fear. If it is the first time seeing it i.e. it is a novelty, you can't be sure howshe will respond.
5. Pain and suffering
Prey animals hide their pain. In the wild, an animal that shows pain is liable to be finished off by a predator, so they have to act as if nothing has happened. A predator might howl like a big babywhen in pain. They don't need to worryabout being heard. Prey animals in severe pain can still function. An animal in a state of panic cannot function at all. A prey animal has to start running before the lion starts runningin order to survive. That means it has to behyper-alert all the time keeping an eye outfor danger.
All animals feel pain. But the fear of pain toa cow is worse than actual pain. The singleworst thing you can do to a prey animal isto make it feel afraid. If you gave a choiceto a human to choose between pain andintense fear, most people would pick fear.Humans have a lot more power to controlfear than animals do. Animals are more punished by fear than pain and it is theopposite for humans.Animals also have a very long memory forfear. Animals may never unlearn a bad fear.Nature has made fear learning permanent.Our brain remembers better where we wereon 9/11 than our leaving cert poems.
I believe when a lame animal shows pain, we need to also considerthe level of un-expressed pain. Maybe we should use a lot morepain relief medication and not just antibiotics to help our cowsheal themselves.
There are many other aspects ofanimal behaviour that TempleGrandin has strong views on. It isvery hard to do a book like thisjustice, in a short piece like this.It is hard to think like a cow but it would be a great help to us and them if we did.
Temple Grandin's book ‘Animalsin Translation’ is available inEasons and many other bookretailers nationwide.
To enter, simply answer the three questions below and complete your details on the entry form. All theanswers can be found in the articles in this issue of themagazine. Details of where to send your entry can be found below.
ENTERTODAYGOOD LUCK...
A winner will be chosen from all the correct entries received before the closing date, Friday 23rd August 2013. The winner will be revealed in the next issue of XLVets Ireland Livestock Matters.
Name
Address
Daytime Telephone Number
XLVets Practice Name
Fleece size (please circle) S M L XL
My details
I do not wish to receive further information from XLVets I would like to receive further information from XLVets by e-mail
one... List three viral causes of pneumonia in calves
two...
three...
What is the main clinical sign of Johne’s disease?
List three diseases that affect suckler cow fertility
YOUR CHANCE TO WIN...We have an XLVets fleece to give away to thefirst correct entry drawn at random after thecompetition closes.
Send your completed entry to: Farm Competition No.11 XLVets Ireland, Dromsally, Cappamore, Co.Limerick
The editor’s decision is final and no correspondence will be entered into. The actual fleece supplied may differ slightly from the one pictured.
Welcometo the XLVets readers’competition...
NUMBER 11
Spring 2013 Livestock Matterscompetition winner:
Mary B Tierney, Lanespark,Killenaule, Thurles, Co. Tipperary.(client of Killenaule Veterinary)
XLVets Ireland Our primary aims are 4 fold:1. To be a primary source of on-farm advice and the
central co-ordinating consultant for other farm servicesfor our clients.
2. To be committed to the sharing of current best practice advice to our clients through direct XLVetsnewsletters and client training, associated with our own high levels of Continuing Professional Development (CPD).
3. To be highly competitive in the health and medicinesmarket with not just prescription only medicines butalso re-establishing the vet as a primary source forother on-farm medicinal and consumable products supported by impartial professional advice.
4. To improve our own efficiencies and reduce our costsby economies of scale over a wide range of practiceneeds and requirements.
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