The Webinar Gazette - January 2022 by thewebinarvet

JANUARY 2 0 2 2

The

Webinar Gazette

WHAT’S INSIDE: CPD’ers of the month

Speaker of the month

CEO Update

Simply Vets

David’s reviews

WEBINAR

Introduction from

Anthony Chadwick I’m writing this newsletter just before Christmas and uncertainty is still in the air! Omicron numbers continue to rise and I think we are all wondering where this will go in the next few weeks. In some ways, massive experiments are going on as different nations approach the pandemic in various ways. The UK has still not brought in strict lockdown regulations like some parts of Europe. At the end of the pandemic, it will be really interesting to study what has worked and what hasn’t to prepare us for the next pandemic which seems more likely if we do not sort out the climate crisis. Always wishing to be a part of the solution at Alpha Vet International, we have set up a green prize as part of VC 2022. The greenest practice in the veterinary world will receive £2000 whilst the individual who has done the most for the environment in the veterinary profession will receive £1,000. all entries and nominations need to be in by the 12th of January. Please email me at anthony@thewebinarvet.com. The sustainability Summit is something I’m looking forward to in January as well as the green Awards we will be having a keynote speaker to discuss biodiversity and the environment as well as sessions from our partners who are supporting The Summit including IVCEvidensia and Nationwide Labs. As a profession, we are all on the sustainability journey together.

Some of us are a little bit further down the road and I hope that the profession can work together collaboratively to make the biggest difference for our planet and to be an example for other professions and industries. As well as the sustainability Summit VC 2022 is packed with high-quality varied continuing education that we are making free to view live during the week 17th to 22nd January. This is to celebrate the tenth anniversary of the first virtual conference back in 2013. The world has changed so much in the last 2 years and who would have thought that virtual conferences would even be a thing in 2022. As I’ve said on several occasions we have been planning for the pandemic for the last twelve years we just didn’t realize. We have helped over 50 Veterinary events take place online since the pandemic began with highlights such as the World Veterinary Association Congress of 2020 and WCVD9 last year. I do hope you will join over 5000 colleagues at VC 2022 who have already registered. The event is free live and you will be able to purchase the recordings for a small fee. The end of the year is a great time to reflect on all that has happened over the last 12 months and I thank God that despite catching covid I am still here and in good health. It was also a very joyful time seeing my 2 children after almost 2 years apart. Covid has made me

appreciate family and the simple things in life much more. However, as we all know, there have been huge challenges for all of us. The pandemic has seen many people working from home and an increase in the number of pets because of home working. This has not been without its issues and for this reason, we have teamed up with bought by many and renowned behaviourist, Sarah Heath, to provide three webinars on the problems of pandemic pets. Sarah is one of our most-loved speakers and I am already looking forward to these 3 webinars to help us understand the challenges that we will see in 2022. These webinars will be free to view thanks to the kind partnership with Bought by Many. Finally, I want to wish you a new year full of good things and much happiness. Best wishes Anthony

CPDer’s of the Month • Joni Geils • Jenny Lithner • JOSÉ PEDRO AMARAL LEITÃO • Sara Sguanci • mikael gagnon With a combined total of 349 hours!

Meet the team

Samantha Madigan

Sam has international experience working for large corporates and start ups, helping them to transform the business, improve efficiency, reduce risk, optimise processes and reduce costs. She is passionate about gender balance and is a mentor and ambassador for women in STEM. What is your role at TWV? I’m Chief of Staff for TWV, which involves supporting our CEO Kathryn Bell and the wider leadership team. How long have you worked at TWV? 7 months Favourite thing about the company? The people! From the moment I arrived everyone has been so helpful and great to work with.

Speaker of the month

Douglas Thamm

Dr. Thamm is the Barbara Cox Anthony Professor of Oncology and Director of Clinical Research at the Colorado State University Flint Animal Cancer Center. He has authored over 150 peer-reviewed publications and 20 book chapters in veterinary and basic cancer research, is Co-Editor for the most recent edition of the textbook Withrow and MacEwen’s Small Animal Clinical Oncology, and is Co-Editor-InChief of the journal Veterinary and Comparative Oncology. His clinical and research interests include novel targeted therapies for animal and human cancer and ways to integrate these therapies with existing treatment. https://www.thewebinarvet.com/shop/sotm-jan Code: SOTMJAN – use for discount off all of Doug’s webinars.

Any goals for 2022? To continue to support the organization and help it to grow. If you weren’t in this role what else would you be doing? Travelling the world!

CEO update

Kathryn

WEDNESDAY 19TH JANUARY 2022

Sustainability Summit FREE to attend during Virtual Congress 2022

Happy New Year everybody, how is it 2022 already?! The Webinar Vet team are feeling well rested after the festive break and are back in our virtual offices, excited for a wonderful January! This year we’ve joined forces with VMG to support the development of practice leadership and management skills, an area I feel so passionately about being a Business and HR graduate myself. We’re delighted to be able to offer the programme which looks fantastic for free to Unlimited Webinar Vet members and all VMG members too! If you’d like to find out more, you’ll be able to find further information on our webinar schedule page: https://www.thewebinarvet.com/schedule Last year, along with introducing a discounted memberships to those on maternity and paternity leave, I launched our first podcast series aimed at supporting and empowering women in the veterinary profession. Episodes included topics such as endometriosis and adenomyosis, hormonal battles and PMDD, balancing being a vet nurse and vet student, dealing with failure and menopause. The feedback we’ve received has been so positive and powerful, and I’m looking forward to continuing this initiative into 2022. If there are any topics you’d like to see covered, just let me know! https://www.thewebinarvet.com/pages/vetchat-podcasts/ Of course, it wouldn’t be a January at The Webinar Vet if we didn’t mention the small matter of our annual Virtual Congress! VC2022 is back and this year to mark our tenth celebration, it’s taking place live online in THE Vet Exhibition from 17th – 22nd January, and we’re providing it to the profession totally free of charge! We want to kick start this gloomy January by bringing you some amazing CPD and lots of prizes and fun. Find out more below and I hope to see you there! https://www.thewebinarvet.com/pages/save-the-date-virtualcongress-2022

Expert speakers will be presenting live sessions on sustainability. Helping to combat climate change is incredibly important to us, and we want to showcase what industry leaders are doing to promote sustainability both personally and professionally. We will also be hosting an awards ceremony in the evening, where the Green Award for Most Green Practice and Most Green Individual will also be announced. We invited members of our community to enter to win, giving examples of what they are doing to be green, sustainable, and combat climate change! Prizes: – Most Green Practice – £2,000 prize – Most Green Individual – £1,000 prize We are looking forward to hosting this incredibly important event.

SIGN ME UP! NationWide Laboratories Our Green Partner

November 29 2021

Dip your toe into the world of locuming this January Did you know you don’t have to choose between being a locum OR a permanent employee? You can be both! Why not dip your toe into the world of locuming by doing a few days this January? Keep reading to find out why we feel it’s something to think about. Now, we know Christmas can be a pricey time. Not only is it all the presents, but we all like to indulge a bit too much with bottles of wine and the notorious selection box or two! This can stack up pretty quickly, leaving January a bit tight. With gross pay ranging from £300-£400 per day, the odd locum shift in January can go a long way to paying back those Xmas pennies. Locuming alongside a perm role doesn’t only mean higher financial rewards per month, it also aids personal development and growth. Working at a different practice means a new set of clients to see. Maybe there is a certain furry fellow with an ailment you haven’t come across before, and

wouldn’t have done if not for the odd locum shift. You can discuss cases/treatment plans with a different cohort of vets, who may have a different perspective. The wider depth of experience you gain by locuming can improve the level of care you provide to your regular clients at the practice where you hold down a permanent role. These benefits don’t have to be solely clinical either. The likelihood is that the practice you locum at will operate differently from what you are used to. Yes, this can be a downside of locuming (something we cover in-depth in our ‘Challenges of locuming’ blog post you can find on our website), but it is also a great benefit. Maybe they do something more efficiently than your current practice, are more streamlined, or more cost-effective! You can take this back with you and feedback to your Practice Manager. It could make your life easier in the long run. Contacts – something which is often overlooked about locuming. You make so many contacts and that’s NEVER a bad thing. I know it’s pretty easy to find a job right now, but how about in 10 years? That

practice owner you gave fantastic locum cover to in the past might be the one you call when you are looking for a new role. Never underestimate the value of a ‘checking in’ text. We have also seen vets and nurses use locuming to ‘break the cycle’ in the past. They have been in a rut in their permanent role and have used a couple of days at a new practice to refresh. This absolutely doesn’t work for everyone but can be useful if you are sick of seeing the same colour walls every day. We know how busy you are, and we know 2021 was an incredibly tough year. Being a boutique, vet-run payroll and recruitment company, we feel pretty close to the industry. Hopefully you’ve had a relaxing mini-break and are ready to kick 2022 off with a bang! If you want to enquire about some locum shifts in January, please email us at info@ simplyvets.com or submit a contact us form on our website, www.simplyvets.com. The Simply Vets Team

WSAVA Survey Highlights Urgent Need for Global Veterinary Oncology Education Veterinary healthcare team members rate their knowledge at just five out ten Veterinary professionals globally rate their knowledge of oncology at just five out ten, according to survey from the newly formed World Small Animal Veterinary Association (WSAVA) Oncology Working Group (WOW). The average score varied by language, with Chinesespeaking respondents rating their knowledge at the highest level (6.6) and Ukrainian-speaking respondents the lowest at 4.2. In contrast, respondents ranked the actual importance of oncology cases for their practice at seven out of ten, with minimal variation (6.3-7.7) between languages. Almost 2,000 veterinary professionals from around the world, 95% of them veterinarians, completed the survey in ten languages, during September and October 2021. The results will help the WOW Group prioritize its efforts to educate and support WSAVA members globally in raising standards of care for veterinary oncology patients. Respondents were also asked to rank the most common tumor types seen in their practice. The most common answer was mammary tumor (81%); followed by skin tumor 75%; abdominal tumor 40%, malignant lymphoma 39%, and other tumors 5%.* As limited numbers of North American, African, and Oceanic veterinary professionals participated in the survey, this result may not fully reflect regional differences. For instance, in parts of the world, mammary tumor incidence is lower because of a culture of early neutering. Surgery was the most common therapy used in private practice at 55%; followed by surgery and adjuvant therapy in 30% of cases; chemotherapy in 7% and palliative care in 4%. Immediate euthanasia was recommended in 1% of cases. While chemotherapy is only currently used by 7% of respondents, when asked which educational resources would be most valuable to them, chemotherapy protocols were requested by 82%. In addition, 53% asked for information on tumor staging, support with cytology was requested by 51%, information on treatment side-effects by 38%; advice on surgical margins by 36%, on radiation therapy by 24% and on palliative care by 6%. “Cancer is increasingly common in companion animals, with almost 50% of dogs over 10 years of age developing this devastating disease. To support WSAVA members effectively in treating oncology patients, we wanted to know where they needed help most urgently,” explained

Dr Jolle Kirpensteijn, former WSAVA President and Member of the WOW Group. “Our survey is the largest the WSAVA has ever conducted and shows the reach of this well-respected association, which works to share best practice in companion animal veterinary care around the world.” He added: “It is salutary to see the huge demand for veterinary oncology education all over the world. We have much to do but are excited at the opportunity to support WSAVA members and to offer new hope to oncology patients and their owners globally.” WOW Group Secretary Dr Ann Hohenhaus, who practices oncology at the Animal Medical Center in New York City, added: “We will use social media, webinars and a range of other channels to ensure maximum reach for the educational tools and resources we are developing. Based on the results of the survey, we have already adapted the focus of our stream during the 2022 WSAVA World Congress in Lima, Peru, to focus on mammary tumors – but there is much more to come before then so stay tuned!” * Multiple answers were possible in this section

Note to editors: Of 1,825 participants surveyed, 95% were veterinarians and 5% other veterinary professionals. Approximately, two-thirds of the respondents were female, one third male, with 0.2% indicating that they were nonbinary. All age groups were represented, with 39% between 30-40 years; 28% between 40-50 years; 18% between 20-30 years and 17% older than 50 years. Survey responses were skewed towards Western Europe (48%), followed by Eastern Europe and Russia (22%), Asia (15%), the Americas (11%). Fewer than 1% of respondents were from Africa and Oceania. The WSAVA Oncology Working Group (WOW) was established during 2021 under chairmanship of Dr Martin Soberano, a veterinary oncologist working in Mexico City. 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

The Webinar Vet

Baileys are delighted to continue their partnership with The Webinar Vet and sponsoring the Equine Webinar Series. As a company, we’re passionate about educating the horse owner so that they can make informed choices when feeding their equine partner. Vets are integral to helping us achieve this aim and, while we already work closely with vets around the country to this end, partnering with The Webinar Vet means we can reach many more and give them an insight into the depth of nutritional knowledge and support we have to offer.

We offer our Equine Membership holders access to world class equine CPD delivered by experts in the field. We ensure our community are up to date with the latest insights into equine veterinary medicine and much more. Below, you can see our exceptional 2022 webinar programme. January Trigeminal-mediated headshaking in horses. Current knowledge, diagnosis and treatment options - Part 2 - Veronica Roberts MA (Oxon) MA(Cantab) VetMB PGCert(HE) DipECEIM FRCVS

February Practical considerations for reducing antimicrobial resistance in equine practice - Zoe Gratwick BVSc MSc MMedVet DipECEIM

March Sepsis in Neonatal Foals - Pamela Wilkins DVM, PhD, DACVIM-LA, DACVECC

May Corneal ulcers in horses. Only 0.8 mm separate you from disaster! - Ron Ofri DVM, PhD, DECVO

July Equine Infectious Disease and their diagnosis and treatment - James Prutton BSc (Hons) BVSc DipACVIM DipECEIM MRCVS

August Colic in our equine patients - a current perspective - Dr Matthew Sinovich

October The Equine Neurological Examination and Recent Outbreaks - James Prutton BSc (Hons) BVSc DipACVIM DipECEIM MRCVS

November Equine recurrent uveitis. The world’s leading cause of blindness in horses - Ron Ofri DVM, PhD, DECVO

December Surgery for bladder and umbilical problems in foals - Carolyn E. Arnold DVM, DACVS, PhD

Baileys Horse Feeds Vet of the Year 2021 Elizabeth Frew, of Kings Bounty Equine, at the Horse & Hound Awards ceremony, at Cheltenham Racecourse, on 1 December. Elizabeth was one of three nominees, shortlisted from those put forward by Horse & Hound’s magazine and online readership, who then also got the final vote. Over 300 guests gathered to celebrate the 13 award winners for whom over 100, 000 votes had been cast. Last year’s Award ceremony was an online affair so, in this second year of Baileys’ sponsorship of the vet category, they were delighted to welcome last year’s winner, Tim Randle, of Stable Equine Practice, to join the “inperson” celebrations. Baileys Marketing Manager, Jane Buchan, said, ”As a company, we often work closely with vets helping educate horse owners and advising on individual equines. We’re also horse owners ourselves

and understand full-well how important a good relationship with your vet is, to the ongoing health and welfare of the horses in our care so it was great to help see them honoured through this award.”

THE Vet Exhibition continues to grow as we welcome Royal Canin and Purina into the virtual venue this month!

Elizabeth was thrilled to have been voted this year’s winner and when asked for any career highlights, stated that, “When anything gets better, or you make a difference, that’s a highlight!” 2020 winner, Tim, was equally happy to celebrate his award, “It had been a long time since I’d had a trophy to collect and I can’t tell you how much it meant to me to win.”

Both spaces are available to visit and have some fantastic content for you to view and interact with! Be sure to check out the spaces and connect with the exhibitors using the live chat function for any questions or comments you may have.

2021 nominees also included Beth Bromley of Severn Edge Vets, Eamon Smyth of Equivet Ltd and Ricki Watson of Emerson & Watson, while previous winners of the award are Ken Anderson (2019), Alistair Field (2018) and Natalie McGoldrick (2017).

The NationWide Laboratories exhibition booth has undergone its regular monthly makeover with a new topic of focus: Exotics! The content will be available to access until the 22nd November where you can view their webinar of the month: “HELP! IT’S A FERRET” by Madonna Livingstone BVMS MRCVS as well as listen to Exotics Case Studies podcast! Be sure to also visit the stand and complete the survey to be in with a chance of winning a CPD bundle (up to 5 hours with certificates).

Visit the MSD Animal Health Showroom today to learn more about Vector Borne Diseases! Take a listen to the Canine Leishmaniosis Symposium brought to you by Prof. Guadalupe Miró where you can also download the supporting White Paper. You can also chat with MSD or ask a question by clicking on either of the representatives located on their stand!

You may have also noticed, Ceva have some exciting news to share…DOUXO S3 welcomes CALM pads to its innovative range of dermatopicals! DOUXO S3 Calm Pads are available in veterinary wholesalers from 1st October 2021. DOUXO S3 CALM pads provide targeted skincare solutions to hard-to-reach areas to soothe itchy, irritated skin while maintaining the skin barrier. They join the popular DOUXO S3 CALM range which also includes DOUXO S3 CALM shampoo and mousse formulations. Click on the banner abowve the auditoriums to download the brochure today! To book a demo or to enquire about advertising or exhibiting within THE Vet Exhibition, email me today! I look forward to ‘seeing’ you in THE Vet Exhibition soon! Stephanie, THE Vet Exhibition Show Manager

About the author Dr. Dave Tittle BVetMed CertVA GPCert(WVA&CPM) MRCVS is an RCVS Advanced Practitioner in Veterinary Anaesthesia and is in clinical practice in the South West. He sits on the International Advisory Panel for ElleVet Sciences in the US and

egislation surrounding the use of cannabinoids can be tricky to navigate in some circumstances. Following the licence approval of two cannabinoid medicines for specific human conditions, Doctors who are listed on the ‘Register of Specialist Medical Practitioners’ are able to prescribe cannabinoids (NICE, 2019). The Veterinary Medicines Directorate issued a guidance statement in 2018. An extract from this statement reads: “As there are currently no CBD products authorised in the UK for veterinary use, a veterinary surgeon may prescribe a legally obtained human CBD product under the provisions of the prescribing cascade. Administration of an unauthorised product containing CBD without a veterinary prescription is an offence”.

CAN

TORS DIA ME

THE ENTOURAGE EFFECT

ElleVance

The ECS

RECEPTORS

Drugs such as gabapentin, tramadol, opiates, and phenobarbitone may require dose adjustment to minimise side effects, such as summative lethargy. Concurrent administration of cannabinoids with selective serotonin reuptake inhibitors, tricyclic antidepressants or benzodiazepines will most likely cause a more profound lethargy. Whilst not described to date, there is a theoretical risk of serotonin syndrome at higher long-term doses and individual patients may respond differently.

TER PE N

ENZYME S

ethargy is occasionally observed in patients, especially when initially commencing cannabinoid therapy. With continued use, this effect will most likely resolve quickly, or may require an initial dose decrease. Subsequently, the dose can be titrated to effect. In my experience, many routinely used chronic pain pharmaceuticals will work synergistically as part of a multi-modal approach to management. Coadministration with pharmaceuticals can mean that both doses of cannabinoid and of pharmaceuticals can be reduced, which in turn prevents or decreases side effects.

IDS NO I B

The ndocannabinoid system (ECS) is thought to be the largest receptor system in the mammalian body. It is a neuromodulatory and immunomodulatory system, which is vital to maintaining homeostasis and aiding stressrecovery. The ECS ‘tone’ is vital in the maintenance of health (Hughston, 2019). The ECS influences the release of neurotransmitters, causing excitation within the central and peripheral nervous system and influences pain responses, as well as modulating the inflammatory response within the body.

Through the Cannabinoid Minefield

‘The ntourage Effect’ is described as the synergism that comes from utilising combinations of cannabinoids and terpenes, with an action at different points within the ECS. This is akin to ‘multi-modal’ therapy, as it unites a variety of modulatory systems at more than one point and through more than one mechanism of action. Each unique blend of cannabinoids and terpenes will therefore interact with the ECS in a different manner. As such, CBD isolates cannot be compared with full-spectrum products, nor can one hemp extract be directly compared with the next.

provides a consultancy service to ElleVance Sciences in the UK.

with allergy. Although this paper is pre-publication, a press release has been issued (ElleVet Sciences, 2020) stating that there was a statistically significant reported decrease in itchiness, although histopathological skin lesions did not improve significantly.

a number of factors surrounding the product content, including a breakdown of the full cannabinoid content, a breakdown of the full terpene content, pesticide and fungicide levels, mycotoxin and bacterial contamination, heavy metal analysis and residual solvent analysis.

europathic pain and seizures are the only two conditions for which phytocannabinoids have been granted a Marketing Authorisation as a human medicine (Epidiolex, 2020; EMC, 2020). CB2 receptor agonists are currently being researched as treatments for both inflammatory and neuropathic pain. There are several ongoing studies exploring the potential use of phytocannabinoids in the treatment of several clinical conditions in humans and animals, as well as a large amount of anecdotal evidence suggesting efficacy in the management of neuropathic pain states (Abraham, et.al., 2020; Hossain, et.al., 2020).

pilepsy studies in both humans and animals, have demonstrated seizure reduction following administration of CBD alongside commonly prescribed anti-epileptic drugs (Gunning, et.al., 2020; McGrath, et.al., 2019). Highly purified CBD has now been licensed for the treatment of specific seizure related conditions in humans (Epidiolex, 2020).

A robust ertificate of Analysis is crucial when selecting a cannabinoid product to prescribe. A respectable company would have readily available to view on request, a Certificate of Analysis detailing the content of each batch of product. This independent testing should measure

SCRABBLE SCORE: 14 Fourteen is the percentage of Americans who personally use CBD products (Gallup, 2019)!

arious cannabinoid receptors are involved within the ECS and these are located throughout the body. This system is importantly involved in multiple physiological processes, including the regulation of pain, mood, appetite and memory. CB1, CB2, TRPV1, GPR55, and PPAR are some of the more common receptors involved with the ECS. These receptors interact with various other endogenous molecules and receptors, as well as other exogenous molecules. They will be found on the membranous surface, or the nuclear surface, of numerous cell types.

References:

topy and allergic skin disease has recently been investigated by numerous teams.

Devitt-Lee, A. (2018) A Primer on Cannabinoid-Drug Interactions. ProjectCBD.org https://www.projectcbd.org/sites/projectcbd/ files/downloads/cannabinoid-drug-interactions_2018-10-11.pdf [Accessed 08/12/2021]

Scheau et.al. (2020) published a detailed summary paper highlighting the many potentials of cannabinoids in human dermatology. A research team, led by Dr. Andrew Rosenberg of the Animal Dermatology and Animal Specialists in New York, completed a placebo blinded controlled clinical trial to evaluate CBD’s effectiveness in managing itch associated

Furthermore, McGrath et.al. (2019) found a statistically significant, thirty-three percent reduction in seizure frequency in dogs administered CBD, compared to placebo. More studies are in press, proving efficacy and improved quality of life in these disease states, following administration of cannabinoids.

Further information available on request from: www.ellevancesciences.com or by email: customersupport@ellevancesciences.co.uk Abraham, A.D., Leung, E.J.Y., Wong, B.A., Rivera, Z.M.G., Kruse, L.C., Clark, J.J. and Land, B.B. (2020) Orally consumed cannabinoids provide long-lasting relief of allodynia in a mouse model of chronic neuropathic pain. Neuropsychopharmacol. 45: 1105–1114

ElleVet Sciences (2020) ElleVet Sciences Announces Results of Atopic Dermatitis Study Using Its CBD+CBDA Oil On Dogs [Press Release] Retrieved from: https://www.prnewswire.com/news-releases/ellevet-sciences-announces-results-of-atopic-dermatitisstudy-using-its-cbdcbda-oil-on-dogs-301189648.html [Accessed 09/12/2021] Epidiolex, Full (2020) Prescribing Information. Greenwich Biosciences Inc., Carlsbad https://www.epidiolex.com/sites/ default/files/pdfs/VV-MED-03633_EPIDIOLEX_(Cannabidiol)_USPI.pdf [Accessed 08/12/2021] Brenan, M. (2019) 14% of Americans Say They Use CBD Products. Gallup https://news.gallup.com/poll/263147/americans-saycbd-products.aspx GMC (2018) Information for Doctors on Cannabis-based products for medicinal use (CBPMs). General Medical Council https:// www.gmc-uk.org/ethical-guidance/learning-materials/information-for-doctors-on-cannabis-based-products-for-medicinal-use Gunning, B., Mazurkiewicz-Beldzińska, M., Chin, R.F.M., Bhathal, H., Nortvedt, C., Dunayevich, E. and Checketts, D. (2020) Cannabidiol in conjunction with clobazam: analysis of four randomized controlled trials. Acta Neurol Scand. 143: 154-163

Hossain, M.Z., Ando, H., Unno, S., and Kitagawa, J. (2020) Targeting Peripherally Restricted Cannabinoid Receptor 1, Cannabinoid Receptor 2, and Endocannabinoid-Degrading Enzymes for the Treatment of Neuropathic Pain Including Neuropathic Orofacial Pain. Int. J. Mol. Sci. 21; 1423 Hughston, L. (2019) Scoobies Doobies: Cannabis Use in Veterinary Medicine VetTechExpert/Fetch dvm360 https://www. dvm360.com/view/scooby-s-doobies-cannabis-use-veterinary-medicine-proceedings-pdf [Accessed 10/12/2021] McGrath, S., Bartner, L. R., Rao, S., Packer, R. A., & Gustafson, D. L. (2019). Randomized blinded controlled clinical trial to assess the effect of oral cannabidiol administration in addition to conventional anti-epileptic treatment on seizure frequency in dogs with intractable idiopathic epilepsy. Journal of the American Veterinary Medical Association. 254 (11) 1301–1308 NICE (2019) Cannabis Based Medicinal Products. National Institute for Health and Care Excellence https://www.nice.org.uk/ guidance/ng144/chapter/Recommendations#prescribing [Accessed 08/12/2021] EMC (2020) Sativex Oromucosal Spray. Electronic Medicines Compendium https://www.medicines.org.uk/emc/product/602/ smpc#gref [Accessed 10/12/2021] Scheau, C., Badarau, I.A., Mihai, L.G., Scheau, A.E., Costache, D.O., Constantin, C., Calina, D., Caruntu, C., Costache, R.S., Caruntu, A. (2020) Cannabinoids in the Pathophysiology of Skin Inflammation. Molecules. 25 (3) 652 VMD (2018) VMD Statement on Veterinary Medicinal Products Containing Cannabidiol. Veterinary Medicines Directorate https://www.gov.uk/government/news/vmd-statement-on-veterinary-medicinal-products-containing-cannabidiol [Accessed 08/12/2021]

There is general agreement that culturing bacteria and performing sensitivity testing is a waste of money. In both humans and in dogs the number of bacteria is so broad that meaningful sampling is impossible. In addition to the comprehensive account of the situation in dogs, the consequence of periodontal disease in humans is summarised with a long list of horrible diseases- from stroke, cognitive impairment, to cancer and ten others. Clearly regular visits to the dentist are very necessary, but I wonder what the compliance level in people is? Or animals?

David’s reviews

FROM THE LITERATURE January 2022 The January 2022 edition of Veterinary Clinics of North America: Small Animal Practice comprehensively deals with all aspects of dental disease. There is a huge amount of information on surgical procedures, but as a non-surgeon I took a look at a couple of articles about the oral microbiome and periodontal infection.

species is increased at the sites of inflammation.

Oral Microbiome in Dogs and Cats: Dysbiosis and the Utility of Antimicrobial Therapy in the Treatment of Periodontal Disease

To date most microbiome studies have focused on bacteria. Identification of microorganisms based on their unique RNA or DNA has enabled a more detailed analysis of the oral microbiome. Unlike in humans, in dogs and cats, Gram-negative species are most prevalent in health and Gram-positive species are most prevalent in periodontal disease.

Eric M Davis and J Scott Weese Veterinary Clinics of North America: Small Animal Practice Volume 52 Issue 1 Pages 107-119 The authors note that the oral microbiome of dogs and cats is composed of hundreds of different bacterial species, fungi, viruses and protozoa. Immune tolerance of the microbiome prevails in health with no immune response. This can change if the equilibrium between the microbiome and host immune surveillance is disturbed. Despite decades of research, specific bacteria have not been shown to initiate the transition from health to inflammation, although the proportion of more virulent

There is no evidence to date that adjunctive systemic antimicrobials given days before, or post operatively, or as a substitute for surgical treatment of periodontal disease, is medically beneficial in canine and feline patients.

Because periodontitis is associated with microbial communities rather than specific pathogenic species, as previously mentioned systemic antibacterial therapy for days before and days after dental treatment is of questionable value. The only indication for antimicrobial prophylaxis described by the authors is if the most likely bacteria are associated with infective endocarditis, rather than periodontal pathogens.

In the same edition Colin Harvey, a Bristol graduate, who has led a distinguished career at the University of Pennsylvania Veterinary School in Veterinary Dentistry, expands on the effects of periodontal disease and systemic and distant organ disease. The relationship between periodontal Infection and systemic and distant organ disease in dogs Colin Harvey Veterinary Clinics of North America: Small Animal Practice Volume 52 Issue 1 January 2022 Pages 121-137 Periodontal infection is common in dogs, as is bacteraemia. Distant organ pathology associated with periodontal infection is seen in the kidneys, heart and liver. There is a great deal of information on this in the article. Colin also draws attention to stress indicators (serum CRP, serum amyloid A, white cell count), which increase as the severity of the periodontal disease increases. Clearly prevention of dental plaque is an important contributor to good health. In the summary of the article recommendations are made to achieve this.

General advice is twice yearly veterinary dental health checks from an early age. To prevent plaque accumulation it would be prudent to follow the following 3 steps: 1. Periodic, at least annual oral examinations (including ‘lifting the lip’ every time the animal is examined for whatever reason). Six monthly intervals are recommended for dogs that are recognised as heavy plaque formers. 2. Effective daily hygiene -starting from completion of eruption of the permanent teeth. A very useful website is recommended covering all aspects of veterinary oral health is recommended. This is the Veterinary Oral Health Council website (www.vohc.org). This includes detailed information on recommended products for tooth cleaning intended to help retard plaque and tartar on the teeth of animals 3. The teeth should be treated professionally when indicated, again starting from an early age. As always this journal produces very high quality, comprehensively researched articles, and this one is a must for anyone interested in dentistry, which really should be all of us given the poor state of companion animal teeth, I suspect. Keep an eye out for future editions of the journal. Forthcoming issues are: MARCH 2022. Soft Tissue Surgery MAY 2022. Hot topics in Small Animal Medicine JULY 2022 Small Animal Orthopaedic Medicine

WEBINAR

A team approach to canine osteoarthritis management

Russell has enjoyed a very varied career since qualifying from the Bristol school in 1987. This has included stints in mixed and small animal practice and four years in Hong Kong. He established the territory’s first orthopaedic referral service and passed the RCVS certificate examination in small animal orthopedics. On return to the UK he established Alphavet referrals in South Wales and somehow found time to obtain an interesting MSc from Cardiff University in Orthopaedic Engineering, usually a qualification for orthopedic specialists in human medicine. I was wondering what to expect from this webinar. When I was in practice both charity and private practice my approach to arthritic dogs (I rarely diagnosed it in cats, my ignorance at the time,) was generally to reach for the NSAIDs and advise weight loss, advice that frequently fell on deaf ears. What this veterinary webinar is about is, by involving everyone in the practice from frontend staff to referral surgeons plus other professionals and crucially the veterinary nurses, a huge amount can be achieved. The approach outlined here benefits the practice reputation, revenue, and team spirit (by bringing everyone together). Most importantly it gives the numerous animals with chronic osteoarthritis a much better management plan, which results in great animal welfare benefits. Canine OA is unrecognized, underdiagnosed and undertreated. It affects dogs in all veterinary practices. It causes pain and suffering and can progress to being a disease of the whole dog. The webinar is meant to be practical with some scientific components, especially about obesity, but the information gained is aimed for its use the next day in your practice. You might think the opening comments in the webinar are obvious and a matter of common sense. However you will find that each slide builds until a comprehensive management plan is delivered. A seemingly obvious but important comment is that ‘the patient must be at the centre of all that we do’. It’s not possible to disagree with that but of equal importance is that ‘the owner is also essential in co-producing an osteoarthritis management structure.’ But as Russell points out the owner might prefer the opinion of the breeder (sounds familiar?), dog walker, dog trainer, friends, family, social media, blogs and chatrooms. Even if that hurdle is overcome there are some interesting thoughts on reasons for not calling the vet as the first port of call. For example: • Don’t want to bother the ‘busy’ vet. Previous visits to a busy practice may have reinforced that prejudice • Don’t think the vet can help

• Don’t want to use potentially harmful medications • Think that it will be expensive • Wants to try what worked for my friend’s lame dog • Want something ‘natural’ as mistrust ‘science’ and ‘chemicals’ • There’s a wealth of experience in the above! Russell makes a case for the vet’s role to overcome these negative conceptions. He suggests that there may be a problem with some colleagues feeling that they don’t have enough time. Or that their knowledge of OA is scanty, (obviously this was mine until the WebinarVet put a stop to my ignorance!). Furthermore the OA field is ‘not exciting’ to some, or accelerating too fast to keep up for others. There is some controversy too. Taking everything together this could result in lack of confidence in discussing OA or educating clients. Of these time is really important-and how to allocate sufficient time is very well described in the webinar, including the statement that time is expensive and needs to be charged according to the practice’s hourly rate Correct pricing makes the OA service self-funding. Much of the work can be ‘outsourced’ from the vet to other parts of the team. The starting point is getting all colleagues involved and then scheduling time for clinics. This is essential. An important slide summarises how to achieve this-and the remainder of the webinar deals with each component separately. On getting colleagues involved: • No one person has all the knowledge or mastery of all the disciplines to manage OA • A multidisciplinary team is therefore crucial • Within existing veterinary teams there will be people who are more oriented towards OA care than others • Recruiting the people who are already interested is the best place to start • Include receptionists, veterinary nurses, animal care assistants, physiotherapists and veterinary surgeons The rest of this webinar shows how different skills and expertise need to be combined synergistically and how to establish an OA team. It is very detailed and covers all conceivable aspects. Russell points out that he is describing what works for his (referral) practice, but there are many ideas to be found here applicable to any veterinary practice. Timed at around 40 minutes I recommend the webinar as an ideal ‘lunch and learn’ webinar for the whole team. Otherwise senior partners will find many constructive ideas to improve the practice service and reputation, and more junior colleagues will be stimulated to join in.

I was struck by the time management aspect and how nurses, especially, but everyone in the practice have a part to play. It also struck me how a not too dissimilar approach could be constructed for the dermatological cases. Inadequate time is one of the main drivers for an inability to achieve a diagnosis, which leads to the all too common chronic skin case. One of the potential stumbling blocks identified by Russell in this excellent webinar is the expanding knowledge base and difficulty in keeping up. To help with this he cites four resources: • The textbook Multimodal Management of Canine Osteoarthritis (second edition) by Stephen M Cox • LOAD questionnaire (Liverpool Osteoarthritis in Dogs) • Veterinary Osteoarthritis Alliance (VOA) • Canine Arthritis Management (CAM) Finally when researching Russell’s website I came across the following statement, very appropriate in difficult times such as those we are all dealing with, and worth remembering I feel, if you happen to be a bit down at the moment.

Being a vet is the best job in the world. Like any job you only get out what you put in. If you continue to study and develop your skills throughout your career then you will always be professionally stimulated, but more importantly the pets under your care will benefit from continuing efforts

Russell Chandler BVSc Cert SAO MSc (OrthoEng) MRCVS RCVS Advanced Practitioner in Small Animal Orthopaedics Member of Advisory Board for Veterinary Osteoarthritis Alliance Veterinary orthopaedic Surgeon at Alphavet Referrals

WEBINAR

The new Butterfly iQ +Vet Ultrasound:

Bringing Vision to Veterinary Care This is a promotional veterinary webinar bringing to the attention of the veterinary profession a new point of care ultrasound unit with very wide practical use whether in equine or small animal practice and everything in between. Looking back at my career ultrasonography was something I missed out on. If I were starting out now in clinical practice it would be one of the first disciplines I would want to get as much experience of as possible. As we are reminded in this webinar there are many uses for ultrasonography and the new equipment described here is astounding. Very high quality images can be obtained with a small probe attached to an iPad or iPhone. Anthony Chadwick introduces the presenters before a promotional video showcases some of the new Butterfly iQ features. We are shown an image of a feline kidney using the on- device preset: Abdomen Small Animal. Further images using Doppler demonstrate urine entering the bladder from a ureter, before switching to another preset: MSK Equine showing ultrasound of an equine limb. Ultrasound guidance of needle placement for diagnostic or therapeutic use is also demonstrated. We hear from the equine and small animal specialists listed in the webinar title, who are very enthusiastic proponents. The next part of the opening video is quite striking. John Dascanio, professor of Theriogenology at the Texas Tech University School of Veterinary Medicine is the speaker for this section. John is also Senior Associate Dean for Academic and Student Affairs. He reminisces about performing ultrasound on horses using the familiar large, potentially vulnerable to being kicked to bits, and expensive machine. Before detailing how there has been a transition to the new equipment he makes some interesting comments about student education in general and the need to change the educational model. Students at Texas start practical training in their first semester, including in ultrasonography. A point made several times by the other speakers is that the new equipment can follow on from a physical examination including the use of a stethoscope, and of

course without the need to move the patient to another room. The aim of the Texas college is to equip the students with various skills at competent levels before they move on to clinical training. So, as John says ‘they took the logical step’ to empower students with the tools and technology that are standard of practice. All veterinary students now have a requirement to enter the programme with an iPad and they are allocated an ultrasound probe shared between two students. They take the probe home with them and can practice at home with their own animals if they wish. The objective is that ultrasound will become an integral part of the physical examination as mentioned above. As students spend some time in private clinical practice in their final year it is expected that in some cases they will be educating practitioners in the use of this new technology.

This is a promotional veterinary webinar bringing to the attention of the veterinary profession a new point of care ultrasound unit

The video, following Anthony’s introduction, is around 40 minutes in duration and finishes with a short communication from the company giving details on how to get further information, including purchasing the equipment. Joanna Aitken and Katie Moore take us finally through some striking clinical cases. Both have years of experience in small animal ultrasonography, outlined by Anthony in his introduction. We see more examples of feline kidney ultrasound and impressive views of heart chambers and an example of pericardial effusion. I was amazed by the clarity in diagnosing the presence of a grass awn in an abscess, inevitably bringing into question the need for poking around a dog’s foot with crocodile forceps. It’s even possible to use ultrasound guided methylene blue injection at the site of a grass awn making it much easier to find in many cases. There were colleagues listening into this webinar from all over the world and it resulted in half an hour of questions. The depth of knowledge and experience of Joanna and Katie in fielding some quite technical questions was impressive. I am sure there will be many more questions and, as mentioned, full contact details are available in the webinar.

Katie Moore

Dr Richard Markell

Dr Robert Fulton

Dr Joanna Aitken

WEBINAR

TUMOURS OF THE RESPIRATORY TRACT This highly recommended veterinary webinar will provide you with the latest clinical information on nasal, mediastinal and lung tumours in dogs and cats. It is brilliantly delivered ensuring that your interest will not waver

Nasal Tumours In general more common in older animals, in dogs compared to cats, and in dolichocephalic animals compared to brachycephalics. Other predisposing factors are an urban environment and possible passive smoke. Nasal cavity tumours tend to be locally aggressive and destructive, but with metastasis late in the course of the disease, and not usually the cause of death in dogs. An important clinical sign is epistaxis, but a substantial list of differentials is briefly discussed. Apart from epistaxis there are other possible clinical signs such as sneezing, respiratory stridor, facial deformity, exophthalmia and CNS signs. Following a history and physical examination staging is introduced. This could include FNA of regional lymph nodes (although only usually diagnostic in 10% of cases at diagnosis), thoracic radiographs, blood tests pre GA, coagulation studies and blood pressure. Open mouth radiographs obtain the best views and we are shown how best to achieve these,(critical), followed by excellent radiographs with a full description of characteristic abnormalities. The phenomenal value of CT scans, however, is shown by two normal scans compared to two demonstrating quite clearly the presence of a nasal tumour. Alternative imaging techniques discussed are rhinoscopy and this is followed by biopsy techniques. Perhaps you may be surprised that the good old fashioned nasal flush is excellent and frequently gives good diagnostic results as well as being therapeutic. We are reminded how to do it by a series of slides. Finally a pinch biopsy is described with advice on how to avoid sampling grey matter!

Four treatment modalities are discussed. Palliative treatment only has a median survival of 95 days (based on a study involving 139 carcinoma patients). I was surprised that surgical re oval (or more accurately attempted surgical removal) was similar to no treatment. The most recent (2019) study suggests a median survival time of 8 months but this is far less than that achieved by radiation therapy, which is now considered the treatment of choice. A practical tip is that when referring patients for radiotherapy ensure that the necessary CT scan is performed in the one facility to avoid duplication of costs. The median survival time in dogs with radiation therapy is 12-18 months, and with cats even better, and long-term survival in excess of 2 years is common. Alternative radiation protocols are described. These are ‘palliative’ radiation therapy (less intensive and therefore less expensive and with a median survival of 5-10 months). Multiple protocols gave been described, and more recently Stereotactic Body Radiation therapy has been introduced, designed to deliver large doses in a strictly targeted manner to avoid non neoplastic tissue damage. This technique has an 80% clinical improvement and a median ST of 12-18 months.

Mediastinal Tumours Clinical signs are listed and these can be varied from respiratory signs, to polyuria/ polydipsia associated with elevated calcium to a non-compressible thorax in cats (verified by Doug in his residency days by compressing the thorax of every cat encountered). Four main tumour types discussed are lymphoma, thymoma, ectopic thyroid, and chemodectomas, with others being rare. Diagnosis could involve ultrasound-guided FNA, flow cytometry and a pre-operative CT scan, (for thyroid, thymoma and chemodectomas). The importance of establishing an accurate diagnosis is emphasised when treating these cases. The two main differentials lymphoma and thymoma have quite distinct treatments, with chemotherapy for lymphoma, and surgical removal for thymoma. For chemodectomas the optimal treatment is less clear although with the treatments described there are favourable results. These are summarised with reference to the literature.

Lung tumours Almost all lung tumours are malignant carcinomas and metastatic tumours are more common than primary. There is some debate as to whether there is a higher incidence in urban environments and the effect of passive smoke. The presenting complaints are listed: • Cough/hemoptysis • Dyspnoea • Lethargy • Weight loss • Lameness reason for this unclear • 5% are detected as an incidental finding • In cats a primary lung tumour may metastasise to the digits ‘Lung-Digit Syndrome’

This highly recommended veterinary webinar will provide you with the latest clinical information on nasal, mediastinal and lung tumours in dogs and cats. It is brilliantly delivered ensuring that your interest will not waver

Thoracic radiographs in two views are very useful in detecting lung masses, demonstrated here with three highresolution radiographs, but there is a need to rule out other causes of lung masses-six are listed. Unsurprisingly CT scans allow much more sensitive evaluation, including identifying lymphadenopathy and other lung lesions. We are shown a CT scan that demonstrates this perfectly. Alternatively a fine needle aspirate or tru-cut biopsy done under ultrasound guidance may be performed. This procedure has a low risk of complications but may not be needed if a lesion is solitary and ‘classic’ and not in a fungal epidemic area. Lung lobectomy is the treatment of choice providing that all lung fields are evaluated for metastasis, and in particular an evaluation of hilar lymph nodes is made. This is dramatically emphasised by some data on survival times following surgical treatment. In particular with an absence of lymph node involvement the median survival time is 452 days. But when lymph nodes are infiltrated with neoplastic cells the MST is only 26 days. The webinar ends with unanswered questions on the role of adjuvant chemotherapy for high-risk disease.

Douglas H Thamm VMD DACVIM (Oncology) Barbara Cox Anthony Professor of Oncology Animal Cancer Center Colorado State University Veterinary Teaching Hospital Fort Collins, Colorado USA dthamm@colostate.edu

WEBINAR

AVIAN RADIOLOGY

WEBINAR This is an absolutely superb veterinary webinar, amazingly only just over half an hour long. I guarantee, whatever your professional interests might be, that you will find a great deal to keep you interested. Of course, those who regularly treat birds will be especially catered for, but it is also an excellent revision of bird anatomy too, and therefore very useful for pre-clinical students. Andrew qualified from Liverpool University in 2007 and has always worked in exotic practice in one way or another both in the UK and in the USA. Having achieved diplomate status from the American College of Zoological Medicine after completing a residency in Cornell, he briefly returned to the UK before being unable to resist the temptation of an academic post in the prestigious Veterinary College of the University of Tennessee, where he is an associate professor in zoological medicine.

First, however, correct positioning is vital and this is emphasised as getting it wrong is likely to make subsequent images non-diagnostic. If you thought the basic anatomy images were superb, wait to you see the coloured images overlaying the radiographs. For example in a VD normal you are shown how to identify • Tibiotarsus • Humerus

This webinar has lots of radiographs so I will restrict myself to just an outline of what awaits you. In fact Andrew does this in brief in his opening slide

• Clavicle

Objectives

• Scapula

•B e able to determine the most suitable method of restraint for the study and aims • How how to effectively position a bird for radiographs • Be able to identify normal anatomical structures, and thus, abnormal • Identify positional problems • Relate radiological changes to a specific clinical problem, or a differential list • Be aware of some potential pitfalls with diagnosing pathology on radiographs alone For methodology ‘bird in a box’, either perching or sedated, is the first to be discussed. Before these there are two horrendous examples of how not to do it-I just hope the hands seen in the radiographs didn’t lead to problems later for the person involved. Sedation is best for diagnostic images. Almost always take a VD rather than a DV and the lateral is usually done second as it requires a greater depth of anaesthesia to prevent wing movement. The next slides are a revision of anatomy with the opening question ‘If you don’t know what is normal, how do you know what is not? I don’t believe you will find better anatomical and radiographic images than what you have here. For example we begin

with the normal skeletal anatomy with labels for the sternum, coracoid, clavicles/furcula and scapula. The last tine I saw images of this quality was in the bone room at college! This is followed by respiratory anatomy with each component coloured for ease of identification. Similarly the gastrointestinal, reproductive and renal anatomy is demonstrated. The images are superb, and of course make the radiographs that follow much easier to interpret.

The final part of the webinar looks at some clinical cases. We see an egg- bound penguin, a Red Tailed Hawk (the ‘buzzard’ of north America, which Andrew also calls the pigeon of the raptors!). This patient was presented ‘down’-i.e. unable to fly. Other cases are a ‘quiet great Blue Heron, a sick Martial Eagle, a Cedar waxwing found down after hitting a window (complete with before and after radiographs of an orthopaedic repair,) a sick Grey Parrot, Toucan and Cockatiel. These cases are magnificent and end a thoroughly entertaining and educational webinar. An amazing amount of material was covered in the time at a relaxed pace. It’s not surprising our American friends tempted Andrew back state side and also not surprising that Andrew jumped at the chance to see such interesting clinical cases in a department dedicated exclusively to exotics.

• Coracoid • Pygostyle • Femur • Fibula And in the VD sternal• Intestine • Liver • Thoracic, abdominal air sacs

This is an absolutely superb veterinary webinar, amazingly only just over half an hour long

• Heart • Diverticula, clavicular air sacs • Cloaca • Lung • Ventriculus. The same format is used to identify structures that can be seen in lateral views, as well as a couple of examples of unusual ‘normals’. Moving on to the last two sections of the webinar we are introduced to some classic signs-loss of cardiohepatic waist, bone consistency and regularity, and symmetry (or lack of). These are all illustrated with possible reasons. For example the loss of a cardiohepatic waist (clearly identified) could suggest one of hepatomegaly, cardiomegaly, splenomegaly or enlargement of the ventriculus/proventriculus/reproductive tract. Summarised as ‘basically some kind of mass effect.’ Using various views we are shown how to further define the diagnosis from the possibilities listed.

Andrew Cushing BVSc Cert AVP (ZM) Dip ACZM Associate Professor in Zoological Medicine at the University of Tennessee Veterinary College USA

JAN UA R Y 2022