The Webinar Gazette - December 2021 by thewebinarvet

D E CE MB E R 2 0 2 1

The

Webinar Gazette

WHAT’S INSIDE: CPD’ers of the month

Speaker of the month

Butterfly Q&A

Simply Vets

David’s reviews

WEBINAR

Introduction from

Anthony Chadwick It’s hard to believe that we are already into December. As I write this newsletter, we are already into the first few days of Advent. Advent is the Christian Festival that precedes Christmas and signifies a time of waiting. The last 2 years have been times of waiting: waiting until the vaccine comes; waiting until we can get out and see our friends again; waiting for normality to return. The omicron variant has just been reported on and who knows how that will affect us this Christmas and beyond. Advent and the end of the year allows us to reflect on where we’ve come from and plan where we want to go to. Each year I spend some time on my future vision. This is what I hope for in the next 12 months and not only covers business aims but also my personal life too. I hope that during this time of Advent you also have time within hectic and busy schedules to take time to reflect and look forward in hope to 2022. As you may recall, I caught Covid 19 in midOctober. Thank God I was not badly affected having been double vaccinated. It’s sad to see that over 75% of hospitalized cases and deaths are still seen in unvaccinated individuals. A friend of mine in the know told me that vaccination takes 20 years off your actual age. Therefore, as a 55-year-old man, the vaccine affected me as if I were only 35.

If only! At the end of October COP26 started and I was lucky enough to spend 5 days there visiting the green zone; chatting to climate activists; protesting on the Saturday afternoon and also taking part in a workshop on climate change given by a French NGO called Climate Fresk. I hope to organise a workshop for Webinar Vet members interested in the future of the planet. My feelings about COP26 are broadly positive. Whilst there was a dumbing down in the final document, to get 197 countries to sign an accord that began to talk about fossil fuel reduction along with other significant steps why was important. My belief however is that the other constituents involved in preventing climate change from getting out of control are businesses small and large and individuals like ourselves. Governments move very slowly and if we wait for them to act, we will wait a long time. Many individuals making small changes can have a massive effect. Whilst Innovative businesses like the webinar vet can help to massively reduce our carbon usage by encouraging people to think of alternative means of training instead of traveling. Bigger businesses can have a huge impact. I spent time talking 2 Scottish and Southern energy about their work in reducing carbon emissions. All of the energy is now produced by renewable sources, and they do not use nuclear power.

After cop 26 I made my way down to London for the London vet show via Leeds where we picked up an award for being 1 of the top hundred Tech firms in the north of England and Scotland. This is a testimony to the hard work that the team has been doing for the benefit of the veterinary profession over the last several years and I was very pleased to receive it. London Vet Show was a great event although sadly I have heard several people caught covid shortly afterwards. We still need to be very vigilant particularly with the new variant likely to become more prevalent. I do hope that in the busyness of life particularly practice life at the moment you will get some time for rest and recuperation during this special season. With love and best wishes, Anthony

CPDer’s of the Month • Julia Kudackova • Maren Hogna • Signe Bagge Jensen • Terezia Prikrylova • Klaudia Oleksik With a combined total of 236 hours!

Meet

the team

My names Dawn and I am the Sales and Operations Manager at The Webinar Vet. I have worked here for 5 and a half years, and that time has flown by! I started in the company in a Sales role helping with our Virtual Congress and progressed into an Office Manager role. During the pandemic the role of Sales and Operations Manager became available and it felt like such a natural fit as I am the Queen of organization! Outside of TWV I am the Beauty Editor of an online blog and love to talk all things skincare and makeup! I am also a freelance makeup artist, so my weekends keep me busy! I genuinely love working at TWV, it is such a supportive company to be a part of and I enjoy working with the team and our partners/

speakers. I have been lucky enough to progress within the company throughout my time here and I’m still just as excited to be a part of an ever-changing business! If I didn’t work for TWV I think I would be doing something related to Beauty and writing full time as it is such a passion of mine. For 2022 I would like to continue to gain new skills within my role, maybe gain some sort of qualification and grow the business as much as possible. Outside of work 2022 will be all about growing my blog and my brand and considering I haven’t been abroad for 3 years I would love to fit some travel in too!

Speaker of the month

Sarah heath

Sarah spent four years in mixed general practice before setting up Behavioural Referrals Veterinary Practice in 1992. Sarah is an RCVS and European Veterinary Specialist in Behavioural Medicine and was made a Fellow of the Royal College of Veterinary Surgeons in 2018. She is an External Lecturer in small animal behavioural medicine on the veterinary undergraduate course at Liverpool University. In 2019 she gained her Postgraduate Certificate in Veterinary Education and became a Fellow of the Higher Education Authority. She is a Certified Clinical Animal Behaviourist under the ASAB accreditation scheme and registered as a Veterinary Behaviourist with the Animal Behaviour and Training Council. She sees clinical cases across North West England. In 2002 Sarah became a Founding Diplomate of the European College of Animal Welfare and Behavioural Medicine. Sarah has a special interest in the interplay between emotional and physical illness in dogs and cats and particularly in the role of pain. She promotes the recognition of emotional health issues in companion animals and the role of the veterinary profession in safeguarding the welfare of animals in this context. Sarah lectures extensively, at home and abroad, on behavioural medicine and is an author, coauthor and editor of several books. https://www.thewebinarvet.com/speaker/ sarah-heath https://www.thewebinarvet.com/shop/ Use code: SOTMDEC

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At NationWide Laboratories we are committed to making a positive impact on animal health by offering innovative products, technology and laboratory services to your veterinary practice. We have been providing a comprehensive range of veterinary diagnostic services since 1983. Our expert teams assist you in making decisions on relevant testing for companion, exotic and farm animals. We offer full interpretation in a range of testing areas including biochemistry, haematology, cytology, histopathology, endocrinology, microbiology, etc. Our sample collection service is powered by National Veterinary Services. For more updates, follow NationWide Laboratories on LinkedIn and Twitter, visit our website or join us in our interactive online learning hub.

Butterfly Q&A Point-of-care ultrasound in the initial exam: Getting more insights, faster Adding clinical insights into the initial physical exam can expedite care timelines, improve outcomes, and give client’s more peace of mind. Handheld ultrasounds have helped many veterinarians achieve these goals. In this Q&A, we learn more about how point-of-care ultrasound (POCUS) is attainable for clinics of all sizes with Katie Moore, Veterinary Clinical Product Specialist at Butterfly Network. Q: How can the physical exam, as typically practiced, fail veterinarians? A: Palpation can be an inconsistent source of information. If an animal is tense, you’re not going to feel anything other than a rock-hard abdomen, meaning an animal could have a mass that goes completely undetected. Let’s say a tense dog comes in; you conduct your physical exam, and you’re not able to palpate a 10cm mass that’s on their spleen, because their abdomen’s too tense. That mass won’t show up on lab work either. So this dog will leave your practice, go home — and could collapse when that splenic mass ruptures. Suddenly, that dog is in a critical state, and it may be too late for surgical intervention. Q: What does incorporating ultrasound into a physical exam look like? A: You’re still using your eyes to conduct external evaluation. You’re still using your stethoscope to listen to the heart and the lungs. But you’re taking out the palpation procedure; instead of gripping at the animal, you put the animal into an appropriate recumbency, and scan through the abdomen’s four quadrants. The cranial: liver, spleen and stomach. Left lateral: kidney, left adrenal, retroperitoneal space (this quadrant is where we can detect possible renal disease). You then fan through the caudal abdomen, the urinary bladder and the reproductive tract, then circle back to the right kidney, where you’d also visualize an abnormal pancreas to detect potential pancreatitis. This can all be completed in 3-5 minutes. hen you’re imaging instead of palpating, you get more insights earlier, and more actionable ones. For example: is that an enlarged W kidney? Or just a filled colon? If you’re able to have more information upfront, then your client isn’t spending all their money on diagnostics — there’s something left to actually treat your patients. Q: What about POCUS makes it more well-suited for the physical exam than traditional ultrasound? A: I t’s all about accessibility. POCUS devices are easier to learn than traditional cart-based devices, and far more affordable. Most veterinary clinics can’t afford to spend $50,000 on a traditional ultrasound machine. But $3,000 is much more doable. With POCUS, you can afford to introduce new technology into your practice. Q: Should ultrasound examination be standard of care in veterinary practice? A: It should always be the standard of care when your patient is in decline, or critical. Image early, see if something acute like a hematoma has grown, which may resolve, or if this is something like a neoplasm, when you have to stage or refer to surgery. Q: What other benefits could the introduction of POCUS deliver for a veterinary practice? A: Improving the imaging capabilities within your practice can have a surprising impact on your relationship with neighboring clinics. By attaining more actionable insights earlier, you avoid unnecessary referrals. Without that confidence, you can fall into a habit of piling your most difficult cases onto neighboring clinics, which are already under duress.

Member Spotlight This month is George Raymond! George had the following to say about The Webinar Vet Membership: The webinar I found most informative from October was titled ‘Anal Sac Adenocarcinomas’ presented by Caroline Boothroyd. The lecture was clear, concise and practical in reviewing the current state of treatment of this problem and opened my eyes to an entirely new way of managing this dreadful disease.

The Simply Vets team is thrilled to unveil our new website, www.simplyvets.com. We specifically designed the new website for Vets, Nurses, and Practices to get the most out of the Simply Vets service. Here are some of the features of the website: • Search for locum and permanent roles via our jobs board. • Sign up to receive personalised jobs in your local area. • Visit the ‘About Us’ page to read about how we came to run Simply Vets and our vision for the future. • Read up on the Simply Vets payroll service and why it might be for you – more on this below. • Use our blog to find out more about locuming. What to charge, how to find work, pros and cons, etc. • Take a look at our Career Zone if you’re a student looking to learn more about the Veterinary industry. There are also lots of resources on how to get ahead in the recruitment process. • Our FAQs are there for all your umbrella/ locum questions to be answered. • Use our contact us form to submit your queries. Looking for even more? Well, here are a few things we have in the pipeline: • Rate Calculator. Plug in your daily/hourly rate to see a full breakdown and find out how much you would make with a typical umbrella company in comparison to the Simply Vets payroll service. • Calendly.com Diary. We want to make it even easier for you to book a meeting with us. You’ll be able to see our diary and book a meeting with one of us at the click of a few buttons!

Having practiced for over 40 years, I am impressed by the young minds in our profession. The knowledge and sophistication of current medical and surgical practice is awe-inspiring. We have come a long way, and these dedicated clinicians are outstanding. We love hearing from our community, and constantly strive to improve, so if you have any thoughts about the website, please get in touch! Why might the Simply Vets payroll service be for you? Here at Simply Vets, we like to be a little different. We don’t like timesheet fees, or the locum losing out with Employer’s National Insurance. So, we have decided to shake things up. With our Simply Vets payroll service, you don’t have any timesheet fees, Employer’s National Insurance, OR any membership fees. All of your daily rate ends up in your pocket… and that’s before you add on your holiday and sick pay. Basically, you pay the same taxes as you would if you were employed. On top of this you are enrolled in our company pensions too. That’s not where the benefits stop either, if you use our payroll service for 10 or more shifts per month, you get FREE access to over 2000 of The Webinar Vet’s webinars! Visit our new website to read about more of the benefits of using the Simply Vets payroll service.

I am looking forward to all of the 2022 World Congress but especially on the subjects of Internal Medicine, Dermatology and the Imaging Series. The ability to stay current with today’s medical advancements is at times an insurmountable task. Webinar Vet has provided a means to make such a task both manageable and enjoyable. Since discovering Webinar Vet a year ago, I continue to be impressed with the audio visual webinars. I particularly find the imaging series to be of exquisite quality both in terms of presentation and degree of expertise exemplified by the academic community. The eclectic nature of the presentations as well as the diversity of educations makes Webinar Vet the most phenomenal media available today for the busy veterinary clinician. I look forward to a long lasting commitment to Webinar Vet and its unsurpassed excellence in delivering quality education to the members of our profession.

23 November 2021

Indian Veterinarian Awarded 2021 WSAVA One Health Award in Recognition of Pioneering Work to Combat Rabies Dr. Thinlay N. Bhutia, a veterinarian who has spent his career working towards the creation of a rabies-controlled state in his Himalayan home state of Sikkim, is the recipient of this year’s World Small Animal Veterinary Association (WSAVA) One Health Award. A prestigious global Award, it is presented by the WSAVA’s One Health Committee (OHC) to an individual or organization which has promoted an aspect of One Health relevant to companion animals. Beginning his career as a state veterinary officer in India, Dr. Bhutia began working in rabies control as program coordinator of the first government-sanctioned, state-wide program– the Sikkim Anti-Rabies and Animal Health (SARAH) Division- a dedicated Division under the Department of Animal Husbandry & Veterinary Services, Government of Sikkim. This program advocates for the humane treatment of animals, while focusing on sterilization, rabies vaccination and community education as control measures. In this role, Dr. Bhutia helped to end the mass shooting of stray dogs, a common, ineffective practice employed for rabies control. Instead, he collaborated with Vets Beyond Borders, an Australian animal welfare charity, and Fondation Brigitte Bardot, a French animal welfare organization, to introduce sterilization as a more humane approach to managing dog populations. He has also set up community education programs to help local people understand how to behave around dogs in order to reduce the risk of biting. In partnership with Vets Beyond Borders, Fondation Brigitte Bardot and the SARAH program, Dr. Bhutia runs an annual state-wide vaccination program, which is having a lasting impact on difficultto reach, stray dog populations. As a result of his work, the state of Sikkim has been almost free of human rabies deaths since 2006 with only four unconfirmed human cases arising in 2016-2018. Commenting on the award to Dr. Bhutia, Dr. Michael Lappin, Chair of the WSAVA One Health Committee, said: “Dr. Bhutia and the SARAH team have worked tirelessly to achieve their goals and his body of work in the region aligns perfectly with the spirit of the WSAVA One Health Award as it serves as an excellent example for others to follow in rabies endemic areas, worldwide.” Dr. Bhutia said: “’When one door closes, another opens.’ At the time of the announcement of this award, I was feeling despondent with postCovid illness complications. Suddenly, when I heard the news, my symptoms subsided. Thank you WSAVA for bestowing this award in the nick of time. “The Award means a lot to us. The recognition of our work gives us a source of motivation to work more conscientiously and develop further. The One Health approach which was initiated as a concept should now be a movement across all sectors and the world. It is clear that the veterinary workforce acts as a ‘first line of defence’ in the effective prevention, containment and eradication of invisible enemies, such as zoonotic diseases. In doing so, we play a fundamental role in the One Health model.” Dr Bhutia received his award during this year’s global community congress, WSAVA2021, which took place online from November 13-15. He presented an Award Winner’s lecture on his work with the SARAH Program during Congress on Monday November 13. The title of his lecture was: “Interdisciplinary Approach - An Effective Tool for Rabies Control in Sikkim, India.” Note to editors: The WSAVA represents more than 200,000 veterinarians worldwide through its 115 member associations and works to enhance standards of clinical care for companion animals. Its core activities include the development of WSAVA Global Guidelines in key areas of veterinary practice, including pain management, nutrition and vaccination, together with lobbying on important issues affecting companion animal care worldwide. For further information, please contact: Rebecca George, George PR, Tel: 01449 737281 / 07974 161108 email: rebecca@georgepr.com

David’s reviews

FROM THE LITERATURE DECEMBER 2021 In the latest Feline Medicine and Surgery Journal is a well designed trial looking at the effects of a nutritional supplement to alleviate pain associated with degenerative joint disease in cats. I think the results and conclusion might surprise you. The authors are all colleagues from the North Carolina State University Veterinary School in Raleigh, USA.

59 cats with DJD were randomly enrolled in the study with 30 receiving a placebo and 29 the nutritional supplement for 6 weeks. All 59 cats received the placebo for an initial two weeks. The outcome measures were: -

Evaluation of a nutritional supplement for the alleviation of pain associated with feline degenerative joint disease: a prospective, randomised, stratified, double-blind, placebo-controlled clinical trial Rachel Cunningham, Margaret E Gruen and others Journal of Feline Medicine and Surgery First published November 1st. 2021

• Quality of life (QoL)

The abstract defines the purpose of the study, namely to evaluate the painalleviating and actively enhancing effects of glucosamine/chondroitin sulphate in cats that had degenerative joint disease (DJD) and impairment of mobility/activity as measured by their owners. The hypothesis was that the nutritional supplement would improve mobility and reduce pain.

• At home accelerometry and client specific outcome measures (CSOMf) • Feline Musculoskeletal Pain Index (FMPI) • Veterinary Examination These parameters were collected at days 14, 28, 42 and 56. 27 cats in the treatment group and all 30 in the placebo group completed the study. During the initial time period (all cats receiving placebo) 78% improved in CSOMf scores. Both groups showed significant improvement at most time points in all the parameters, but the placebo group outperformed the supplement group (this was significant for CSOMf, P=0.01.) There was no difference in activity between the groups but cumulative distribution function analysis indicated that for most levels of activity the placebo cats were more active. However, a group of cats designated the least active were more active on the supplement.

The conclusions, based on the above, are surprising, although quite clear when the results are carefully appraised. The study showed a strong placebo effect. The glucosamine/chondroitin sulphate supplement did not show pain-relieving effects when compared with placebo. I’m not sure what to make of the strong placebo effect. In the same edition of the journal are two articles, which I am sure will delight the cardiologists. They are part of a series of three looking at the feline cardiomyopathies. The authors are specialist clinicians from the Davis, USA Veterinary School, and as to be expected is a very thorough and comprehensive account. I will briefly mention them here as a detailed reading is required and a summary is never going to be enough. The Feline Cardiomyopathies: 1 General concepts Mark D Kittleson, Etienne Côté Journal of Feline Medicine and Surgery First published October 25th 2021 The cardiomyopathies are the most prevalent heart diseases in cats. Several forms have been identified, (the three

articles in this collection deals with all of them in depth). Hypertrophic cardiomyopathy (HCM) is the most common. Clinically the cardiomyopathies are often indistinguishable. Cats with subclinical cardiomyopathy may or may not have characteristic clinical findings (heart murmur, dyspnoea, tachypnoea) or systemic thromboembolism (ATE, pain and paralysis), and sudden death is also possible. Treatment does not alter the progression from subclinical to clinical disease, and often the treatment approach, once clinical signs are apparent is the same whatever the type of cardiomyopathy. The authors suggest, however, that being able to differentiate the diseases from normal may be important prognostically. Heart failure and ATE are the most common clinical manifestation of severe disease and are the therapeutic targets regardless of the type. The long-term prognosis is often guarded or poor once overt clinical manifestations are present. There is a great deal of cardiac physiology discussed in the article, good in particular for certificate and diploma students. Knowledge of pathophysiologic mechanisms helps the practitioner identify the type of cardiomyopathy and understand how these diseases progress to heart failure or ATE. The second of these articles in the edition deals with hypertrophic cardiomyopathy HCM). The Feline Cardiomyopathies: 2 Hypertrophic cardiomyopathy Mark D Kittleson and Etienne Côté First published October 25th. 2021 This is a particularly relevant article because HCM is the most common form and may affect up to approximately 15% of the domestic cat population, primarily as a subclinical disease. The severe form leading to heart failure and ATE only occurs in a small portion of these cats. Both articles are quite extraordinary in the depth and attention to detail. I doubt whether a more comprehensive account exists anywhere. Particularly interesting is that you can listen to heart abnormalities, see them depicted radiographically and also in echocardiograms with and without Doppler. Post-mortem material is well illustrated too. Extensive information regarding treatment is given with prognostic indicators. Quite simply these are phenomenal articles. I expect the third in this series, dealing with the other cardiomyopathies, will be published in the next edition.

WEBINAR

LOCKDOWN FOR SMALL MAMMALS – HOW TO MAKE INDOOR LIVING WORK In an introduction to this veterinary webinar John outlines the challenges of indoor living for rabbits and guinea pigs. Of course many rabbits and guinea pigs are kept indoors rather than, as traditionally, outside. On the surface this would seem to be safer and more controllable, but indoor living can bring its own challenges for prey species. The webinar looks at some medical problems associated with indoor living as well as possible social issues. It discusses how to mitigate some of these issues and how living with predators can be made easier. A distinction is made between what owners of pets want and what rabbits and guinea pigs want. Prey species needs are quite different. This is well illustrated by answering the question ‘How do prey species behave?’ • They have enhanced senses for detecting predators • They stick together • They want to have an escape plan • They can be aggressive • They have a TI (tonic immobility) response ‘playing dead’ • They are anxious when they don’t have these, or when they are in unfamiliar surroundings • They breed lots There are lots of fundamental questions to be answered. For example ‘Does domestication over-ride basic biology of these species? And ’How does the basic biology tie in with our needs for keeping pets indoors with us? ‘How does this affect us as vets? ‘Do we have tools to help? John takes you back to the five freedoms to explore the issues raised. The result, as you will find out, is a very good revision and update on the basic needs of rabbits and guinea pigs and what can be done to maximise their wellbeing in an indoor environment. I have picked out some examples but this can only be a snapshot as the webinar merits careful viewing with a huge amount of information with many practical tips.

1. Freedom from Hunger and Thirst Animals should have access to fresh water all the time and the right type and amount of food to keep them fit. There is a discussion on grass, and how it can be provided, and the need for better quality hay and how to feed it. Advice on the correct amount of nuggets comes with a warning that it is easy to overfeed these with the danger of obesity. Requirements for vitamin C (guinea pigs), vitamin D and calcium are described with the aim of achieving optimum amounts in the indoor setting. 2. Freedom from Discomfort Animals should have the right type of home, including shelter and somewhere comfortable to rest. Arguably this ought to be easier indoorsbut there are worries about security and hiding. They need escape places, and guinea pigs in particular prefer deep litter providing burrowing opportunity. Temperature and relative humidity are important and there needs to be assessment of risks from foreign bodies and electric wires, for example. Look at the whole environment from the pet’s perspective. Does dietary boredom play a part in chewing dangerous objects? There are tips on this and also solutions in the additional information from Burgess in the second part of this webinar. 3. Freedom from Pain Injury and Disease Animals should always be fit and well and should be treated by a vet if they are sick or injured. This should be better indoors but is the normal understood and are some common diseases more likely, and are some so common they become ’normal’? Discussed here are urinary, dental, and respiratory diseases. With the latter there are some potential underlying factors suggested, such as a hot dry atmosphere, possible irritants, stress, and poor ventilation. There may be additional latent issues that are exacerbated-pneumonia, middle ear disease and rhinitis/sinusitis, for example. Preventative healthcare and monitoring are essential.

This is followed by a useful list of the signs of pain: • Reduced activity • Lame/gait changes • Weight/muscle loss • Altered mood • Altered appetite • Faecal/urinary changes These can be subtle and vets need to educate owners on what to look out for. 4. Freedom to Express Normal Behaviour Animals should have enough space, proper facilities and the company of other animals of their own kind. John notes that this can be tricky! Not surprisingly this section is particularly detailed. Rabbits and guinea pigs need to be kept in groups, never singly, and in this context the owner doesn’t count. A description of the normal group situation of rabbits and guinea pigs poses the question how do pairs fit into this? What is the effect of neutering and what should be done when one dies? The pros and cons of neutering within the context of indoor living is discussed and alternatives to neutering are suggested. Sufficient space is very important and the more there is the better. John is not in favour of quoting minimum data. It is poorly worked out and in any case ‘why should we work to a minimum’? Deep litter and hiding places are especially important for guinea pigs, with well ventilated, secure boxes for sleeping. Guinea pigs must be able to get away from owners and other animals. Suitable substrates are important as if this is not adequate foot problems will emerge. Part of normal behaviour is finding food and if this is too easy what is done with spare time? This is such an important, easily overlooked point. Hiding food in the form of treats, such as those described in the second part of the webinar is helpful. Another important slide summaries behaviour. ‘In order to provide capacity to perform normal behaviours, the owner and their advisors must understand what normal behaviours are.’

WEBINAR

5. Freedom from Fear or Distress These are prey species and the question is posed ‘are more potential predators inside compered to outside?’ To help mitigate fear and distress early socialisation is important-as soon as weaned. Early handling, especially by breeders, is essential because if a rabbit is not used to being handled by the time it is sold at 8 weeks it is too late. The consequences of poor handling are illustrated with a radiograph of a healed spinal deformity following damage due to being dropped. Training with positive reinforcement is important from an early age. John’s summary slide advises that it is perfectly possible to keep rabbits and guinea pigs indoors-but it is not easy. Requirements are:• The need to work on husbandry, diet and the pet to make it work

Excel Treats ensures feeding is optimal. Recommended is the Rabbit Code of Practice see www.rabbitawarenessactiongroup.co.uk. Burgess has also taken over a company that provides a safe outside extension from the home into the garden. It looks very interesting. For more information www.runaround.co.uk

In an introduction to this veterinary webinar John outlines the challenges of indoor living for rabbits and guinea pigs.

This is a great webinar that takes us back to basics on the needs of rabbits and guinea pigs kept indoors. There is a huge amount of information delivered by a real expert with a lot of hands -on practical experience and a passion for his subject. The webinar is highly recommended for everyone who has an interest in rabbits and guinea pigs-students, vets, vet nurses, who between them can inform owners, breeders and sellers.

• We all have to work on the breeders and sellers to ensure the rabbits are socialised • If we do this well we should have a pet that fulfills what is expected as a pet, while allowing it to fulfill its natural wishes. This benefits all with reduced stress levels. The sponsors of the webinar, Burgess, add an excellent contribution in two sections. A new product is Indoor Guinea pig Nuggets, and along with Excel Feeding Hay and

John Chitty B.Vet.Med. Cert ZooMed. MRCVS. Anton Vets Andover Hants SP10 2NJ exotics@antonvets.co.uk

WEBINAR

Trigeminal-mediated headshaking in horses-current knowledge, diagnosis and treatment options (what, who, why and what to do about it) This is an eye- catching title for a veterinary webinar and it certainly provoked my interest, always present when my knowledge base of the subject is low to non-existent. So I wasn’t sure what to expect. A look at Veronica’s extraordinary CV, which I recommend, must surely make her a world expert in head shaking in horses. Added to her love of teaching, this presentation had all the potential of one not to be missed, whatever your interests. I was not disappointed. The title of the webinar outlines much of its content. But in the first slide Veronica states that ‘there is a lot we don’t know yet’ and that the webinar will cover the main points. Viewers are welcome to ask for further information. We begin with an idea of the problem. Whereas it is perfectly normal for a horse to shake its head, and there are many reasons why it might do so, trigeminalmediated head shaking accounts for 4.6% of the UK horse population, based on a survey of 44,000 horses. In referred hospital cases about 90% of head shakers are due to trigeminal neuropathy. This is probably biased and there will be fewer in the population, emphasising the need to consider all possible differentials. The clinical signs of TGM headshaking are usually classic: • Predominantly vertical head shaking (often with some sharp vertical twitches/flicks) • Often accompanied by signs of nasal irritation • Snorting, twitching lips. Rubbing nose, striking at the nose • Worse at exercise (crucially wany exercise) • But may be seen at rest • A variable number (from 25-64%) are seasonally affected

• Anecdotally some horses are affected only outdoors

• Are all horses sensitised? Why just that nerve?

• Some are worse out hacking/near trees

• There is a complex environmental interaction –but not an allergy (a favourite theory in the past)

• It is a worldwide phenomenon • Acquired as a young adult with a median age of onset (but there is a wide range) • Any breed • Any use • No evidence to date of direct heritability (but no specific studies) The first of many videos, throughout the webinar, demonstrate the abnormality. One in particular illustrates that affected horses can be dangerous to ride. The signs should be classic, as shown in the videos, otherwise think again. These videos are perfect examples of a picture being worth a thousand words and videos even more so. They made the condition very clear and made everything that followed easy to follow, interesting, and also intriguing. Summary slides outline what we know about TGM headshaking. • The nerve has become sensitised-firing threshold is 10 x lower than normal • Causing neuropathic pain, described in people as pins and needles in mild cases to the extreme of a burning sensation with electric shock like pain. • There does not appear to be any physical damage to the nerve, which asks a question ‘could it be reversible?’ • The question is supported by seasonality in some cases and spontaneous remission in others (5%). After some revision of the anatomy of the trigeminal nerve there a number of things listed that we don’t know: • Why how and who? • The identity of the switch, how it is flicked and how do we flick it back?

Taking all this together there is so much more work to be done. Diagnosis is currently one of exclusion. This carries a risk of over diagnosis. In 1987 equine specialists diagnosed 98% of horses as TGM mediated. Access to better diagnostics to date has brought that percentage down to 90%. Nevertheless it is still a diagnosis of exclusion, begging the question ‘Is it worth making a diagnosis?’ and if a client thinks a horse is TG mediated is it better to spend money are treatment rather than diagnostics? This is a rhetorical question when talking to a world expert. Even if 90% can be diagnosed on historical and physical grounds Veronica maintains that almost any diagnosis is better so take the 10% chance. This is very well demonstrated in a clinical case later on. ** History and observation, as we have already seen in the videos, are important in raising suspicion of the condition, and you are advised to think hard if these signs are not classic. Important considerations in the history are the signalment, timing of headshaking, its character, response to a ‘bute trial’ or corticosteroids and finally response to a nose net. There has been an attempt to issue guidelines (notably BVA). These are very straightforward • 0/3 No headshaking • 1/3 Headshaking at exercise but not sufficient to interfere with ridden exercise • 2/3 Headshaking at exercise making the horse impossible or dangerous to ride • 3/3 Headshaking at rest

WEBINAR And possibly refer, obviously. Veronica’s on-going research in this area actively encourages horse owners to visit and participate in clinical research, with suggestions for what can be done. Her contact details are: B&W Equine Vets, Breadstone, Berkeley, Gloucestershire GL13 9HG Tel. 01453811867 (option 2 Hospital)

The next part of the webinar asks whether the headshaking is due to facial pain, and whether to perform nerve blocks. The question is answered, with technical information on when and how to do the nerve block. There is a caveat, however, in that recent work by Veronica and colleagues showed that ‘where you are confident in your diagnosis of TGM mediated headshaking, response to nerve block did not predict treatment outcome’, More of the excellent videos demonstrate classic signs resolving following the nerve block. Further diagnostics are now explored emphasising the advantages of working in a very large referral hospital or academic equine environment. These typically involve” – • Repeat clinical examinations-perhaps pointing to further tests • Upper respiratory tract and guttural pouch endoscopy • Ophthalmic examination • Oral examination • CT scan • Blood and urine advised (as not extensively reported in these cases.) An interesting case** where this approach was very useful is presented. The diagnosis, not TGM mediated, was confirmed by CT scan, which also showed that the horse was sold as a ten year old, but was likely six years older! Fortunately treatment made an improvement Veronica now looks at treatments with some proven efficacy, noting that any proven headshaking treatment seems to work by reducing sensory input from the trigeminal nerve, even before sensitisation was known to occur. Treatments fully described with before and after videos include: -

• Nose net • Face mask • Contact lenses • Drugs –cyproheptadine/and or carbamazepine. (Gabapentin is published in the horse, although not for headshaking) • Diet-supplementation with oral magnesium citrate and boron. Work is on going to formulate a supplement, although boron is not allowed as a foodstuff in the UK or EU. There is research on diet but few outcomes yet. • A surgical approach-bilateral infraorbital neurectomy, and/or caudal ablation of the infraorbital nerve, (approximately 50% success rate in 57 horses but 26% relapse.) In the successful cases there was a median response of 9 months (2 months to 5 Years)

This webinar, generously supported by Bailey’s Horse Feeds, is extraordinarily good and brilliantly delivered. This is a webinar for everyone with an interest in horses, whether student, vet, equine nurse, or owner. There is undoubtedly much more to come from Veronica. In a congress setting there would be thunderous applause for this presentation.

This is an eye- catching title for a veterinary webinar and it certainly provoked my interest

The final part of this webinar deals with PENS neuromodulation. This is a minimally invasive technique, which can be used under NICE guidelines for the management of neuropathic pain in people. We are shown this procedure in horses and the results to date are promising. Currently EquiPENStm is the safest procedure with the best results for horses where a nose net doesn’t work. The final two slides advise equine colleagues what to do if a client’s horse starts headshaking, and following a clinical diagnosis it is suggested try: • Supplement magnesium • Try 3 types of nose net • Try a face mask

Veronica Roberts

• Try ‘bute’ trial

MA(Oxon) MA(VetMB) PhD PGCert (HE) DipACVIM FRCVS B&W Equine Vets

• Try Inhaled steroid • EquiPENS • Possible drug trials

WEBINAR

How I evaluate the coughing dog Simon Tappin is a 2002 Cambridge University graduate. After two years in practice he undertook a residency in small animal medicine and intensive care at the University of Bristol, which led to obtaining DipECVIM-CA. He now heads the internal medicine department at Dick White Referrals. He is very well qualified to deliver this veterinary webinar He begins by asking ‘What is Coughing?’ and makes the distinction between the cough reflex, which has a deep inspiration, powerful expiratory effort and an abdominal push with glottis closed and subsequently its opening. An expiratory reflex is as above, but without inspiration first and is typically associated with laryngeal irritation. A feature of this excellent webinar is the liberal use of videos, and two dogs are seen and heard with characteristic coughs. This is followed by a description of the pathophysiology of the cough reflex. We are advised to get owners on board and emphasise that cough is just a symptom of abnormality and it may be actually quite necessary. Nevertheless it can really affect the quality of life. The causes of coughing are divided into Upper Airway, Lower Airway and Parenchymal Interstitial with the next slide listing the six diseases for each cause. Another key point, perhaps surprising, is that it is all too easy to blame the heart-so keep an open mind and remember: • Heart murmurs are very common and much more common than heart failure • Most dogs with MMVD will not develop heart failure in their lifetime • Murmurs are common in dogs that cough, but most coughs are not caused by heart failure • Cats with heart failure don’t tend to cough

WEBINAR There is a discussion on whether coughing is a sign of heart failure, with a key reference, before returning to the clinic and outlining the approach to the coughing dog. This entails: -

• Obstructive inspiratory dyspnoea (narrowing of large airways)

• Defining the problem • Defining the location

With these respiration is slow and forceful

• Then considering the differential diagnosis

• Restrictive (choppy) (fibrosis, interstitial, pain, pleural space

Defining the problem entails looking at the previous medicine, in-contact health, vaccination and worming history, diet, environment and travel.

• Paradoxical (prolonged dyspnoea and reposition of central tendon)

Also define the current problem. Here the advent of universal mobile phone cameras is immensely helpful. Duration, progression, dynamics and response to treatment are considered. More useful tips are that coughing is noticed more at night, regardless of cause, and most causes of cough are worse when the dog wakes up. Added here are nine essential questions conveniently laid out in table form. For example the first question is ‘Is your dog coughing and well, or coughing and sick?’ By sticking to the format in the table nothing of relevance should be missed out. A single slide lists the essential features of kennel cough, and another details the important tracheobronchial parasites (Oslerus osleri, Capillaria aerophila, Crenosoma vulpis and Angiostrongylus vasorum). As Simon goes through the nine questions in the table we obtain concise information on, for example, bronchial foreign bodies accompanied by some quite exceptional endoscopic and radiographic images. Each question has a typical possible clinical case with illustrations. The history, therefore as in all diagnostic endeavors, is crucial and there is a lot of information in the previous slides. Also important is the physical examination and an equal amount of detail is attached to it. The key elements described are the colour of the mucous membranes, the respiratory pattern, auscultation and percussion of the lungs, and auscultation of the heart. In discussing the respiratory pattern Simon first describes what is normal. The abnormal respiratory patterns are particularly well described with superb accompanying videos emphasising, if it were needed, the benefits of modern mobile technology. These are: -

• Obstructive expiratory dyspnoea (small airway disease and air trapping)

With these respiration is rapid and shallow There is a brief revision of sinus arrhythmia with advice to listen for a while, and a reminder of the six cardiac murmur grades. From the previous information it should be possible to define the location of the problem (i.e. Upper Respiratory or Lower,) but what happens if the problem does not improve or the dog is sick? A table lists the key differentials in this situation.

After two years in practice he undertook a residency in small animal medicine and intensive care at the University of Bristol, which led to obtaining DipECVIM-CA.

• Foreign bodies • Chronic bronchitis • Bronchopneumonia • Eosinophilic bronchopneumonia (EBP) • Parasites • Tracheobronchial collapse • Infectious tracheobronchiti Two possible ways forward are suggested -Symptomatic Treatment or Diagnostic Evaluation. If the latter is decided there will be a need to choose appropriate diagnostic tests. We are taken through the use of radiography, echocardiography, (not always needing the expertise of a board certified cardiologist), cardiac biomarkers (NT-proBNP), computed tomography (CTT) and bronchoscopy. All these are comprehensively illustrated. The webinar ends with a more detailed account of the aetiology, clinical signs and treatment of canine chronic bronchitis and bronchopneumonia, including advice on the judicial use of antibacterials. This webinar is recommended for all colleagues that treat dogs, students and will also be very useful for colleagues in training for certificates and diplomas. It is delivered fluently, with copious illustrations and videos with sound, and contains lots of clinical nuggets and tips, along with the general clinical information.

Simon Tappin MA Vet MB CertSAM Dip ECVIM-CA FRCVS

WEBINAR

RABBITS-NEUTERING

Sophie begins this veterinary webinar, generously sponsored by Rabbit Welfare Association and Fund (RWAF), with some general comments about rabbits. They are sociable and need rabbit companionship, part of the five freedoms. And of course they need neutering. Some astonishing statistics are given about the consequences of not neutering and the numbers involved in the wild. Females are reproductively active from 16 weeks, have a litter and then be pregnant again within 24 hours. Sexing can be undertaken from six weeks of age, and if this has ever worried you a series of very good photos make the procedure very straightforward. Sophie has even added a mini exam, consisting of a male and a female for you to test yourselves. There is a list of reasons why neutering is essential, apart from the inevitable population explosion if not done. This is very useful background information for rabbit owners. I was not aware of Rabbit Spring Fever. It is a phenomenon that can occur in any rabbit entire or not, stimulated by day length, temperature and young fresh grass. Rabbits become ‘frisky’ and may chase each other, mount, and occasionally nip their companion. Fortunately this isn't for long-it will pass. We now enter the clinic for neutering day. There is a lot of general advice, ensuring the companion rabbit is also admitted, for example. A full physical examination is undertaken and there are suggestions on the clinic environment to make the procedure as stress free as possible. We begin with castration. Everything is covered, from the use of EMLA cream prior to placing a cannula and intubation. Male neutering is generally done from 12-14 weeks, later in giant breeds. Local anaesthetic is injected into the scrotum after clipping and before the general anaesthetic. The various techniques, closed and pseudo- closed via scrotal, pre-scrotal and an abdominal approach, are fully described by means of photos taken during surgical procedures. I was struck by the use of post-operative K laser to aid healing, and even more so on the observation that it takes 6-8 weeks for sperm to be expelled from the glands, (CARE if the female companion is entire!) Females are neutered from 16 weeks and it is noted that they have a double cervix. More information follows on the need for neutering females, apart from the obvious one of preventing litters. Neutering females can be performed from 16 weeks and for owner information: -

• Prevents adenocarcinoma (incidence 50% female rabbis, 80% in New Zealand Whites) • Prevents mammary tumours, (reduces risk by 80% if performed before 6 months) • Prevents ovarian and uterine diseases-photos of these are shown later with normal for comparison • Reduces behavioural problems After suggestions on premedication and anaesthesia, the operative procedures are clearly explained with the aid of more than 20 clinical photos and some excellent line diagrams. There is a warning about the use of catgut. This should not be used in rabbits as, following absorption by proteolytic enzymes, an inflammatory response occurs causing adhesions.

With this webinar we have around 20 questions, and we could have had more, a testament to the quality of the presentation.

The webinar ends with a list of postoperative care requirements. These include pain relief, syringe feeding in hospital before discharge (and at home if not eating on its own). Owners must ensure that urine and faeces are being passed within 12 hours. There is no need for antibiotic cover, and in general metoclopramide is not needed. The summary slide lists the most important points: • Companionship is a must for rabbits • Neuter all rabbits in the group • Avoid catgut • Neutering prevents unwanted litters • Neutering prevents multiple diseases • Neutering prevents unwanted behaviours This is a superb webinar, an absolute must for anyone who treats rabbits and wants to update their surgical techniques. Sophie speaks with the authority of someone who is clearly very clinically involved, with great experience. No doubt this is due to her decision to set up an exclusively exotic practice some years ago. A feature that sets aside webinars from conventional conference lectures is the much longer time given to questions. With this webinar we have around 20 questions, and we could have had more, a testament to the quality of the presentation. Sophie showed how much she is on top of her subject dealing with some quite technical questions without hesitation. All in all, the webinar is a very good interesting and educational way to spend an hour, and I would recommend another hour with John Chitty’s webinar on rabbits and guinea pigs that I have also reviewed.

Dr. Sophie Jenkins B.Vet.Med. PGCEAS GPEXAP MRCVS Advanced Practitioner in Zoological Medicine Owner and Director Origin Vets Clinic Ltd sophie@originvetsclinic.co.uk www.originvetsclinic.co.uk

DE C EM BER 2021