The Webinar Gazette - September 2021 by thewebinarvet

SEPT E MB E R 2 0 2 1

The

Webinar Gazette

WHAT’S INSIDE: Speaker of the Month

Supporting Women

Simply Vets

David’s Review

Webinar Articles

BVDA

Introduction from

Anthony Chadwick I’m wring this before I go on holiday down to Cornwall in Nicky Paul’s cottage in Cornwall. We bid for it at The Vet Trust Awards in November which we held online last year along with Vet Dynamics. Our auctioneer, Brian Faulkner, helped us raise over £7,000 for Vetlife which, I think, is pretty phenomenal. Thanks to everyone who donated prizes like Nicky and, of course, Brian! Who could resist those dulcet tones! I know everyone has worked so hard and I hope you manage to get some R&R time. Last week, I managed to fulfil an ambition of visiting Knepp Estate in Sussex which is a big rewilding project run by Sir Charles Burrell and Isabella Tree. Isabella’s book “Wilding” sparked my interest a couple of years ago but the lockdown prevented me visiting. The place and the book inspires me to hope that amidst all the worrying stories about climate emergencies there is still time. We have to move quickly and I suspect business has to lead the way. Since the beginning of April, we have planted 853 trees- 2 trees for every new paid member of The Webinar Vet and we have also calculated our carbon footprint with the help of Chantelle Brandwood at Eco Offset. With our contributions to reducing travel for CPD, we see ourselves as part of the solution but we all need to do a bit. We’ve also planted a wildflower meadow at the Liverpool Science Park and encouraged the Park to get all of its electricity from a green supplier. We are also running a weekly sustainability podcast until COP26 takes place in November in Glasgow. I’m hoping for real leadership from our government as the hosts of the event but I’m feeling doubtful and somewhat forlornwe shall see!

The weekly podcasts have been really interesting with all the speakers giving some concrete examples of how we can make a difference. https://anchor.fm/vetchat/episodes/CraigBennett---Nature--Sustainability--And-WhyIt-May-All-Be-On-The-Line-e14stvs https://anchor.fm/vetchat/episodes/SimonDoherty---The-Next-Steps-For-GlobalFood-Security-e157nph h t t p s : / / a n c h o r. f m / v e t c h a t / e p i s o d e s / H a n n a h - J a m e s - - -Ve t Pa r t n e r s Sustainability-Initiatives-e15hmn6 https://anchor.fm/vetchat/episodes/SeanWensley---The-Joys-Of-The-Natural-Worlde15p052 h t t p s : / / a n c h o r. f m / v e t c h a t / e p i s o d e s / Chantelle-Brandwood---Can-You-CarbonOffset-Your-Pet-e166n88 I’m also thrilled that in October we will be hosting MSD’s One Health congress- more details soon. The environment, social justice, animal welfare are all interconnected and we can’t afford to ignore any of these elements. It’s a circle of life kind of thing! As I’ve discussed before, I’m enjoying spending more time on Simply Vets and WikiVet. Simply Vets is quite a unique business on its own offering payroll help for IR35 compliant locums and recruitment assistance too. We are fast approaching 100 vets and nurses on our books and are offering free recruitment for all our paying Webinar Vet practices. Feel free to email me at anthony@thewebinarvet.com if you’d like to know more. We now have a team of four web developers to accelerate the changes we want to make having listened to all the responses we got in

our recent annual survey. I really appreciate your support in replying to the survey. We already have the practice management tool to allow practice managers to monitor use of the site by employees to make sure they are RCVS compliant and our new integration with the RCVS 1CPD app will save busy vets and nurses MANY, MANY hours. https://youtu.be/044jq5-EIhY I wanted to also have a big shout out to our five top CPDers of the month • Abigail Hayhurt • Marcel Subbotko • Mikael Gagnon • Patrick Day • Gustavo Canals Time pressure can make it difficult for some to keep up to date with their CPD which I absolutely get but we know that doing CPD is a positive stressor, it makes us feel good about ourselves, and makes us better, more confident vets. One hour a week means we do about 50 hours at the end of the year and doing them virtually means no time is wasted travelling. It’s been the only way during lockdowns too. Finally, I wanted to say a big thank you to the team at ADM Protexin for becoming our first partner in the WikiVet project. Alpha Vet is the new custodian of the site but we are hoping to build many collaborative partnerships across the industry to make this the encyclopaedia of the vet profession but particularly to assist vet and nurse students in their studies. To your CPD success, Anthony, Founder of The Webinar Vet

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SAVE THE DATE! Virtual Congress 2022 A

FREE CPD Event Taking Place from

17th - 22nd January 2022

The world's largest online veterinary congress is returning in 2022, and this time, it'll be

free to attend live. Taking place from 17th - 22nd January and streamed through THE Vet Exhibition, there will be daily evening webinar sessions during the week (7-9pm GMT) and a full day of CPD webinars on Saturday. We'll be joined by expert veterinary speakers delivering sessions on a variety of topics. Register your interest today and you'll be the first to hear more about this spectacular veterinary virtual event!

Want to find out more about VC2022? REGISTER

YOUR

INTEREST

Speaker of the month

Owen Davies

MA VetMB MVetMed MANZCVS(SAM) DACVIM(Oncology) MRCVS

Owen is an RCVS & American Specialist in veterinary oncology. He is a Cambridge graduate who spent 9 years in practice before his residency term at the Royal Veterinary College. Since 2017, Owen has worked for Highcroft Referrals in Bristol. He interested in all aspects of oncology but especially haematopoietic malignancies, immunotherapy for cancer and paraneoplastic disease. https://www.thewebinarvet.com/shop/ sotm-september2021 Code: SOTMSeptember

Gender balance in the veterinary profession has changed significantly over the last 40 years globally. According to the RCVS, women now account for almost 60% of registered practicing veterinarians and almost 80% of students enrolling in veterinary medicine are women. However, despite the number of women in the sector, females still encounter a gender pay gap and are underrepresented in certain key and senior roles within the profession, including Directors and Partners. Additionally, a BVA survey conducted in 2017 found that women experience more explicit gender discrimination and are recognised and appreciated less frequently than male colleagues. The continuity of male-led practices, combined with the nature of work, does not allow for a sustainable shift towards more flexible working practices. In addition to this, levels of stress and burnout are generally higher among women than men in the veterinary profession.

The above facts suggest that relying on the female heavy pipeline will not be sufficient to address gender inequality, so what can we do to help? To start these hugely important conversations, I’ll be hosting a panel event on Monday 13th September with five wonderful ladies who’ll be sharing their thoughts and experiences on mentoring, career development strategies, communication, connections, communities and so much more! Life is very busy right now, but please join us and take part in what we hope will be the first of many webinars, covering a topic which is hugely important to me and all my team. Register here: https://www.thewebinarvet. com/pages/register-free-panel-eventsupporting-and-empowering-women-inthe-veterinary-profession/

I hope to see you there! Kathryn, CEO, The Webinar Vet

Co-organized by ESVD-ECVD-ISVD, the online congress dates will remain 16-18 September 2021 but will be virtual. Due to the ongoing epidemic situation with COVID-19, the organizing committee has made the difficult decision to cancel the traditional format of the 32nd European Veterinary Dermatology Congress, planned to take place in Porto, and organize the congress online.

REGISTRATIONS ARE OPEN! During the online congress, scientific invited lectures will be streamed, including live Q&A. All lectures will remain available on-demand until 31 December 2021. A virtual commercial exhibition area will be available with digital booths of each sponsor and exhibitor. The commercial exhibition will also remain accessible until 31 December 2021. https://www.eventure-online.com/eventure/participant/invitee.form?2183d11d-c6374795-ba93-66d385f4e651 https://www.esvd-ecvdcongress.com/programme

THE VET TRUST AWARDS 2021

We have partnered with

Preferred Pet Food Company

Vet Dynamics again to

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light on the people and

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companies who have made a positive contribution to the

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These shortlists have

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time for you to cast your vote! The result of this survey will determine

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Cat Behaviour Conference: In the Company of Cats Friday 24 September 2021 Get ready for a day of cat behaviour CPD, featuring expert speakers from around the world! After the success of Cats Protection’s first virtual behaviour conference in 2020, we’ve been excitedly planning for our 2021 conference. The day will be focused on feline behaviour, looking at the interactions cats have with each other and with other species. Registration will be open to all members of the veterinary profession, as well as anyone else working with cats, e.g. shelter staff or pet sitters.

The conference will take place virtually. Please keep an eye on the ‘For vets and nurses’ section on our website for further details. www.cats.org.uk/help-and-advice/information-for-vets

Reg Charity 203644 (England and Wales) and SC037711 (Scotland)

VET_6362

The British Society of Veterinary Pathology Reversing the Brain Drain: Neuropathology Goes Global 8th - 9th October 2021 The BSVP are delighted to announce this year’s two day autumn meeting:

Reversing the Brain Drain: Neuropathology Goes Global. This event is bringing together specialists in Veterinary Neuropathology from around the world, together with speakers from veterinary neurology, human medicine and research, to give you two days full of exciting talks across a variety of topics and species. We start in Australia with Prof. Brian Summers giving us his approach to neuropathology. We travel around the UK and Europe, and then on to the USA to hear the latest update on canine gliomas and meningiomas from Prof. Jey Koehler, with a stop-over in San Diego for a bonus lecture on the latest applications of brain model technology. Discover the full programme and find out more about the speakers here: BSVP Autumn Virtual Conference 2021 - The Webinar Vet Tickets are available to buy now - BSVP Autumn Virtual Conference 2021 - The Webinar Vet

About The British Society of Veterinary Pathology The objectives of the society are to advance veterinary pathology in all its aspects for the benefit of animals and man; to foster training, to advance education in all aspects of veterinary pathology and to foster communication between pathologists working in various fields. The society was formed in 2006 and is a ‘not for profit’ organisation.

What is locuming and could it be for you? A locum temporarily fills the position of a permanent member of staff. Locums can be all types of vets and nurses and sometimes non-clinical staff too. Paid daily or hourly, locums choose the days and times they work, along with their preferred practice(s). Some locums travel across the country, taking advantage of accommodation which can be offered along with employment at a veterinary practice, whereas others choose to stay closer to home, working with 1-3 local practices. Locuming works for different people in different ways. One often overlooked benefit of locuming is the chance to meet new people. Whether you are combining locuming with travelling around the country or just in your local area, you will be working with new teams regularly. It also allows you to meet new clients and of course, new animals. Working as a locum also help you to become more involved in both the local and wider veterinary community. With the distinct lack of locums currently available, when going into a new practice and joining a new team you will be appreciated which is incredibly rewarding. In smaller practices, it may allow the owner or lead vet to have

some time off for the first time in months! Locuming also allows for a flexibility in hours not seen with a permanent role. Don’t want to work Saturdays? Fine. Need to pick the kids up from school early every Tuesday? The practice will likely accommodate that. Whether it is life commitments, hobbies or just wanting to take things a little slower, locuming allows you to take back control of your diary. We aren’t saying you can just leave early whenever you want and if you have made a commitment to a practice, please honour it, but if you are open with your preferences and hours from the outset, there is incredible flexibility to work to YOUR schedule. Some people choose to work full time; some just the odd day and everything in between on locum contracts. What we are finding to be more and more popular is working for a few months followed by taking some time off. We think once travelling opens up once again, we will be seeing much more of that! When working full time as a locum it often has a financial edge on permanent work. Some choose to work less (normally for similar money), freeing up time for other projects, and that elusive work:life balance. Some of our locums have started to branch out into blogging or their own

online businesses whilst supplementing their income by locuming. Locuming is not for everyone, we get that, so please keep an eye out for our next piece, which will be discussing some of the problems with locuming, and why it might not be for you. In the meantime, if you do want to find out more about locuming and joining Simply Vets on a zero-hour contract, please get in touch: harry@thewebinarvet.com

JOB OF THE WEEK: Practice in Gosport in need of an ongoing locum vet. No requirements for weekends or out of hours with a lovely working day of 10am-5pm. You will need to be confident with sole charge. The workload is mainly neutering and minor diagnostics. Unfortunately, the practice is unable to accept limited companies or sole traders. If you are affected by this, please contact Simply Vets directly to learn more about their payroll service.

Stressed Out! The potential role of cannabinoids to help manage various forms of stress and anxiety The mention of the words ‘cannabinoids’ and ‘stress’ perhaps conjures up a stereotypical image a long way from the reality of where now are, regarding the use of these molecules. We have previously discussed how cannabidiol (CBD) has gained support for its use as a medical treatment, as research has shown it may treat pain and inflammation without the intoxicating effects. As more research is undertaken, more preclinical and clinical evidence documenting value for CBD in some neuropsychiatric disorders, including epilepsy, anxiety and schizophrenia. Evidence points toward a calming effect for CBD in the central nervous system (Shannon, et. al., 2019). A review article published by Blessing et. al. (2015) reported that there was preclinical evidence to strongly support the use of CBD in the management of generalised anxiety disorder, panic disorder, social anxiety disorder, obsessive compulsive disorder and post-traumatic stress disorder in an acute administration setting. They clearly state that there are few studies evaluating use in a chronic management setting, especially for generalised anxiety. The majority of experimental models assessing chronic dosing effects have to date been limited to rat or mouse models, although these experiments show anxiolytic effects, and a reduction in anxiety behaviours that may be linked to the disorders listed above. It is believed that chronic dosing of CBD would have similar effects in relevant clinical populations. Bakas et. al. (2017) discuss how the mechanism of action of cannabidiol in producing it’s “anti-epileptic, anxiolytic and anti-hyperalgesic” properties was unclear. Whilst it is known that endogenous and synthetic cannabinoids interact with GABAA receptors, no studies until theirs had confirmed an action on “specifically configured GABAA receptors that may be relevant to the anticonvulsant and anxiolytic effects” of CBD. Those of us who have a pathological dread of public speaking will appreciate the findings of Bergamaschi et. al. (2011). This team’s work found that those candidates who suffered from social anxiety disorder (SAD) who were given a single dose of CBD one and a half hours before giving a public speaking test, showed a significant decrease in anxiety, cognitive impairment,

discomfort in speech performance and significantly decreased alert in anticipating their speech compared to a placebo group. No significant difference was found between a Healthy Control (HC) group who had no anxiety related to public speaking and the cohort administered CBD prior to performance.

“It is becoming ever more apparent that there is a plethora of potential medical uses of cannabinoids in various forms. Research into these molecules and their actions is in its infancy and more work is ongoing to increase the knowledge of their benefits. It is evident that there is a potential value and need for further study of CBD for the management of anxiety disorders.”

In a neuropathic pain model, a series of rather involved experiments were performed by De Gregorio et. al. (2019). Their summary is that low dose CBD induces analgesia via TRPV1 activation and reduces anxiety via 5-HT1A receptor activation, also rescuing 5-HT neurotransmission if impaired, in neuropathic pain conditions. This supports the suggestion that allodynic pain and the anxiety-like behaviours associated with this, is decreased by CBD.

A recent review by Christie et. al. (2021) suggested some promise utilising CBR1 and CBR2 receptors within the bladder, without the CNS psychotropic actions and therefore side effect of current treatment options. There may be a role in such molecules for the treatment of anxiety induced cystitis, overactive and painful bladder syndromes. As well as for humans, there are currently some exciting studies being undertaken in the United States exploring the use of certain blends of cannabinoid products in the management of anxiety, separation, noise aversion and associated behaviours in animals, including dogs, birds, and cats. It is anticipated that results of these studies will be available soon. Recently, a white paper was released in the US, detailing the effects of acute administration of a CBD/CBDA product for anxiety inducing events in dogs (ElleVet Sciences, 2020). Whilst this Pilot Study acknowledges that there is a lack of scientific data in this area, researchers found that 83% (20/24) of dogs responded positively and had decreased stress or anxiety-related behaviours following administration of a single dose.

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 Devon. He sits on the International Advisory Panel for ElleVet Sciences in the US and provides a consultancy service to ElleVance Sciences in the UK.

Figure 1: Proposed analgesic and anti-inflammatory effect of CBD. Figure taken from Maayah et. al. (2020).

References: Bakas, T., van Nieuwenhuijzen, P.S., Devenish, S.O., McGregor, I.S., Arnold, J.C., Chebib, M. (2017) The direct actions of cannabidiol and 2-arachidonoyl glycerol at GABAA receptors. Pharmacol Res. 119: 358-370 Bergamaschi, M.M., Queiroz, R.H., Chagas, M.H., de Oliveira, D.C., De Martinis, B.S., Kapczinski, F., Quevedo, J., Roesler, R., Schröder, N., Nardi, A.E., Martín-Santos, R., Hallak, J.E., Zuardi, A.W., & Crippa, J.A. (2011) Cannabidiol reduces the anxiety induced by simulated public speaking in treatment-naïve social phobia patients. Neuropsychopharmacology. 36(6) 1219–1226

De Gregorio, D., McLaughlin, R.J., Posa, L., Ochoa-Sanchez, R., Enns, J., Lopez-Canul, M., Aboud, M., Maione, S., Comai, S., & Gobbi, G. (2019). Cannabidiol modulates serotonergic transmission and reverses both allodynia and anxiety-like behavior in a model of neuropathic pain. Pain. 160(1)136–150 ElleVet Sciences (2020) The Use of ElleVet Sciences Calm and Comfort Acute Strength CBD+CBDA Chews for Anxiety Inducing Events in Dogs. [Online]. ElleVet Sciences. Available from: https://info.ellevetsciences.com/ hubfs/CC_White_Paper.pdf [Accessed 16th August 2021]

Blessing, E. M., Steenkamp, M. M., Manzanares, J., & Marmar, C. R. (2015) Cannabidiol as a Potential Treatment for Anxiety Disorders. Neurotherapeutics: The Journal of the American Society for Experimental Neurotherapeutics. 12(4)825–836 https://doi.org/10.1007/s13311-015-0387-1

Maayah, Z.H., Takahara, S., Ferdaoussi, M., Dyck, J.R.B. (2020) The molecular mechanisms that underpin the biological benefits of full-spectrum cannabis extract in the treatment of neuropathic pain and inflammation. Biochimica et Biophysica Acta (BBA) - Molecular Basis of Disease. 1866 (7)

Christie, S., Brookes, S., & Zagorodnyuk, V. (2021) Endocannabinoids in Bladder Sensory Mechanisms in Health and Diseases. Frontiers in pharmacology. 12: 708989 https://doi.org/10.3389/fphar.2021.708989

Shannon, S., Lewis, N., Lee, H., Hughes, S. (2019) Cannabidiol in anxiety and sleep: A large case series. Perm J. 23: 18-41

Further information available on request from: www.ellevancesciences.com or by email: customersupport@ellevancesciences.co.uk

David’s reviews

FROM THE LITERATURE SEPTEMBER 2021 The Journal of Feline Medicine and Surgery is consistently of a high standard and this month I have looked at several interesting articles. Two of these are directly relevant to Benoît Cuq’s webinar on the treatment of feline ureteral obstruction using a SUB, which I reviewed in this edition of the WebinarVet Newsletter. The first of these was cited in the webinar mentioned. Subcutaneous ureteral bypass device placement with intraoperative ultrasound guidance, with or without microsurgical ureterotomy in 24 cats Emmanuelle Marie Butty and Mary Anna Labato Journal of Feline Medicine and Surgery First published March 23rd. 2021 Both authors work in the Tufts Cummings School of Veterinary Medicine in Boston, USA and are diplomats of the ACVIM (SAIM). What they were aiming to achieve with this study was to describe a method of subcutaneous ureteral bypass (SUB) device placement with intraoperative ultrasound guidance for the treatment of benign ureteral obstruction in cats, and to compare cases with microsurgical ureterotomy or without. In addition a secondary aim was to describe the complications and outcomes in those two groups of cats. 24 cats treated with a SUB device between April 2013 and June 2018 were reviewed. All cats had a SUB device placed with intraoperative ultrasound guidance (26 operations). Of these 14 also had a microsurgical ureterotomy. 11 of the cats had a previous history of chronic kidney disease

(CKD). Following successful operations in all cats the median survival rate was 1555 days (4.25 years) and there was no statistical difference between the two groups. However, as might be expected, the ureterotomy significantly prolonged the operative procedure time (180 minutes in comparison to 125 minutes), but this did not impact on the short or long-term complications or the survival time. Stone analysis and culture, where available for review, revealed calcium oxalate in 12/12 and a negative culture in 6/7. The authors conclude that placement of a SUB device under intraoperative ultrasound guidance is an alternative where the surgeon does not have access to fluoroscopy. Microsurgical ureterotomy did not demonstrate any advantage and prolonged the anaesthetic time. The median survival time emphasises a good outcome of SUB device placement even in cats with a previous history of CKD. However another article published a few months earlier in the same journal paints a less upbeat picture of the procedure. It is a comprehensive analysis of what can go wrong with the procedure. Complications and survival after subcutaneous bypass device placement in 24 cats: a retrospective study (2016-2019). Emily Vrijsen, Nausikaa Femke Mortier and others

Devriendt,

Journal of Feline Medicine and Surgery First published November 24th. 2020 The authors are from the small animal department of the University of Ghent Veterinary College, Belgium.

The aim of their study was to document survival complications and risk factors for the development of complications and mortality prior to discharge after placement of a SUB device in cats. Information was gathered from the clinical records of cats that had SUB placements between January 2016 and August 2019. The development of complications (overall, intraoperative, perioperative short and long term complications) and risk factors for mortality prior to discharge were assessed statistically. 24 cats were included: 12 (50%) received a unilateral SUB, 11(45.8%) a bilateral nephrostomy tube with single cystotomy catheter and the remaining cat (4.2%) two unilateral SUBs. Nearly 80% developed complications, ranging from mild to fatal, including partial SUB obstruction (33.3% of complications), lower urinary tract infections (20.8%), pyelonephritis (20.8%) and sterile cystitis (12.5%). Five cats (20.8%) died before discharge and 6 cats (25%) required revision surgery. The overall median survival time (MST) was 274 days (range 1-311 days) Complications were most common in the long-term period (14/16 cats), followed by the short term (9/18 cats), perioperative (10/23 cats) and intraoperative (4/24 cats). Older cats had an increased risk for developing post-operative complications and were less likely to survive to discharge The authors conclude that although complications similar to those previously described in other studies were observed, the complication rate was higher and the MST shorter in this study. Despite good short term survival the development of

complications may necessitate regular and intensive control visits. Owners that consider SUB placement should be informed that follow up can be strenuous and expensive. Continuing with the latest from this journal, I liked the article on phenobarbital administration in cats. Evaluation of the effect of phenobarbital administration on the biochemistry panel with a focus on serum liver values in epileptic cats Michelle Hermans, Marios Charalamous and others Journal of Feline Medicine and Surgery First published August 13th 2021 The authors note in their abstract that phenobarbital (PB) is the most common anti-seizure drug for the management of feline epilepsy. In dogs, PB is known to cause serum liver enzyme induction and hepatotoxicity, especially after long-term administration or in high concentrations. In cats insufficient information is available to draw similar conclusions. The aim of this study therefore was to evaluate the effect of PB administration on the serum biochemistry profile of epileptic cats. Additionally there would be an opportunity to record other adverse effects. This was a four-centre, multi-author project with researchers from the Ghent, Vienna, and Hannover veterinary colleges, and from the Anicura Animal Clinic in Kalmar, Sweden. Medical records of cats being treated for epilepsy were retrospectively reviewed. These cats had no concurrent disease and were not receiving any other medication apart from PB. Baseline and at least one follow up biochemistry profile measurements were made. These included liver enzymes,(AP, ALT, aspartate transaminase , gamma glutamyl transferase), total bilirubin, bile acids, glucose, albumin, total protein and creatinine. 33 cats with a median age of 3 years (range 3 months to 12 years) met the inclusion criteria of a diagnosis of idiopathic or structural epilepsy. The follow up period ranged from 9-62 months. The study found an increase in ALT in three cats, possibly related to PB serum concentration greater than 30 mcg/ml. No statistically significant increase in serum liver enzymes or other evaluated biochemistry parameters were found by comparing pre and post-treatment parameters. The authors note that PB administration did not result in hepatic enzyme induction or other biochemical abnormalities in these cats. The conclusion is that the study strengthens the safety profile of PB when used as an anti-seizure drug in cats.

WEBINAR

FARM ANIMAL TOXICOLOGY

WEBINAR Paul is a graduate from the RVC (2005) and since then has had an extremely interesting career, as you will see on the WebinarVet biography introducing this webinar. He has worked extensively in general practice, obtained an MSc in Wild Animal Health from the Zoological Society of London, in addition to farm animal clinical roles in the RVC and Cambridge University, and a brief role in industry for Pfizer. Since 2016 he has been at the Dick Vet -but has not stopped studying. He is currently working towards his ECBHM diploma and has started a part time PhD in veterinary education. I found the subject of farm animal toxicology difficult at university mainly I suppose because we had the lectures shortly before taking final examinations. It is also quite difficult to review this webinar because it has a phenomenal amount of facts compressed into the hour. The result is a very comprehensive and fully researched account. I suspect that it’s greatest value will be that whenever a suspect toxicology case presents itself the webinar will act as a good aide-memoire and reference. What you will find in this webinar is summarised in the first slide, which I reproduce here: • Approach to investigation (of possible toxicity cases) • Clinical signs and common causesplants, chemicals, metals, mycotoxins and miscellaneous • Common’ toxins including treatment • ‘Common’ poisons including treatment • Prevention In the introduction Paul advises that presenting signs will be variable depending on route of entry and that diagnosis is often based, particularly, on the history and clinical signs supported by diagnostic investigations with a variable prognosis. Poisonings occur for a variety of reasons including lack of access to food/water, access to poisonous plants, incorrect storage/mixing, incorrect disposal of hazardous substances and a lack of feed discrimination by animals. There is a useful introduction to important aspects of the history, common details of which include: • Unexplained illness or deaths • Loss of condition • Sudden death • Unusual clinical signs • Abortion • Change of feed/pasture • Historical experience

The clinical signs can involve any of the body systems and vary according to the toxic agent. Each of the systems is described with signs and common causes. For example the first one is cardiovascular, and moderate and severe intoxication signs are listed with the following causes: • Cardiac glycosides such as Oleander, Foxglove • Taxine –Yew • Selenium toxicity • Ergots from Claviceps spp. The section on ‘common’ toxins is more detailed. Where plant poisoning is described pictures borrowed from the internet are included. If I were studying this subject again I would build up a picture library and download them. Without exam pressure this would make a good hobby to enliven country walks. My youngest daughter has developed a keen interest in foraging and this is mentioned later when discussing hemlock and its similarity to parsley! Here we learn about alkaloids, glycosides, cyanogenic glycosides, goitrogenic glycosides, cardiac glycosides, saponins, nitrates/nitrites, oxalates, urea/ammonia, photosensitising agents, proteins, peptides and amino acids, tannins, aflatoxin, zearalenone, fumonisin, and finally ergots. For each of these there is a detailed summary of clinical signs and where appropriate plant pictures, and for the photosensitising agents clinical pictures of affected animals. The section on ‘common’ poisons follows the same detailed format. Considered here are bracken, rhododendron, ragwort, yew, laburnum, rape, umbilliferae (the carrot family), copper poisoning-acute and chronic, and lead. There is considerable clinical information on each of the poisons described with illustrations, (some clinical) and treatment recommendations. But for some poisons there is very little to go on. Yew poisoning may cause sudden death or collapse. There are no specific post mortem findings and the diagnosis often rests on the finding of yew twigs and leaves in the rumen. There are lots of clinical gems like this in the webinar. Finally one slide summarises prevention and is reproduced here: • Avoid sources of known contaminants • Investigate any suspicious signs • Provide adequate feed • Dilution of feedstuffs with noncontaminated feed (where finance is an important consideration, but not without risk)

• Remove contaminated feed or change pastures • Good pasture management • Control livestock access •C heck field for dumped materials-e.g. Car batteries The amount of work and research that has gone into this webinar is quite incredible. It’s a valuable resource for anyone involved in farm practice. The webinar could be a springboard to learning more about the common poisons, and toxic plants in particular. It would make a walk around a farmer’s fields great fun and impressive. As I suggested previously it could also be a useful source of information to be referred to whenever suspicious cases are seen.

I found the subject of farm animal toxicology difficult at university mainly I suppose because we had the lectures shortly before taking final examinations

PAUL WOOD B.VET.MED. MSc PGDipVetED FHEA MRCVS PRINCIPAL CLINICIAN FARM ANIMAL PRACTICE AND HOSPITAL SENIOR LECTURER IN FARM ANIMAL PRACTICE ROYAL (DICK) SCHOOL OF VETERINARY STUDIES EDINBURGH UNIVERSITY

WEBINAR

HAEMANGIOSARCOMA-IS THERE ANY MORE WE CAN DO FOR THEM? Owen has an interesting CV. After qualifying in 2005 from Cambridge he spent 9 years in general practice, including a stint in charity practice and some time in India. As a result of a threeyear residency at the RVC, and after sitting relevant examinations, he has specialist qualifications from the USA, and Europe as well as from the RCVS. This veterinary webinar has five headings: • Introduction to haemangiosarcoma • Approach to splenic tumours and differential diagnoses • Biology of haemangiosarcoma • Treatment of haemangiosarcoma • Prognosis Most of us if asked about haemangiosarcoma (HSA) will probably think of the spleen. However in addition there are other possible sites, and the next part of the webinar is entirely pictorial with examples of Atrial HSA, Intramuscular HSA, Subcutaneous HSA, Dermal HSA, Intra-osseous HSA, Retroperitoneal HSA and Lingual HSA. The behaviour of HSA depends on its location and we are given metastatic rates for all those mentioned, the first of a lot of useful statistics throughout the webinar. HSA is a cancer of blood vessels and differs therefore in the classical metastatic process from other malignant neoplasms. The typical metastatic process of HSA is described from survival in the circulation, arrest in a target organ, extravasation, initiation and maintenance of growth to angiogenesis. An excellent feature of this webinar is that at regular times during its delivery Owen pauses to summarise key points

Key point 1

Key point 2

• HSA can occur anywhere

Without pathology the diagnosis of a splenic mass is uncertain. Consider using the following clinical features to refine the double two-thirds rule

• Anatomic location has an important effect on behaviour • Most cases are rapidly growing • Most cases are highly metastatic due to intravascular localisation

• Haemoabdomen?

There is a review of the literature looking at the anatomic site of haemorrhage in spontaneous hemoperitoneum before listing a differential diagnosis for canine splenic masses. The importance of this is emphasised, for example, by reference to a study into the outcome of canine splenic lymphoma. It was quite surprising to see that in canine splenic lymphoma cases presenting with haemabdomen there was a one-year survival rate of 58.8%, after which no animals died of their disease. Additionally in these dogs adjuvant chemotherapy did not provide a survival benefit.

• Large size with no metastatic spread

To help in predicting the diagnosis we are reminded of two useful aids Double two-thirds rule • 2/3 splenic masses are malignant • 2/3 of these are Haemangiosarcoma (HSA) (This means that 44% of splenic tumours are HSA) Triple two-thirds rule (after Owen Davies) • 63-70% of splenic masses associated with haemoabdomen are HSA Additional discussion in predicting the diagnosis refers to the presence of metastatic disease, size and possibly breed. Possibility rather than certainty is due to the evidence of breed association with malignancy or HSA is decidedly ‘loose’. With over 300 breeds, meaningful statistical comparison is difficult. Dogs with HSA were in fact 75% GSD, but spaniels, poodles, dachshunds, beagles and many others were significantly represented

• Association with distant metastatic disease?

• Breed? Feline splenic masses are briefly mentioned noting that according to one retrospective analysis involving 65 cats, 28% of haemoabdomen cases were due to HSA. Of these cases only 12% survived to discharge. Some examples of dogs with pulmonary metastasis are illustrated asking whether chest x-rays are advisable, and the significance of finding metastatic neoplasms. There is a series of cases, which show some quite startling improvement after chemotherapy, very well illustrated clinically and with CT scans. Owen notes that the textbooks say: ‘When advanced metastatic disease is present the prognosis is unsurprisingly poor to grave although occasional responses to therapy have been observed’ By reference to the literature and his own cases, some of which were previously described in the webinar, Owen states that even with metastasis dogs do just as well as those without. This leads to: -

You will never consider a haemangiosarcoma case in the same way again.

WEBINAR

Key point 3

The chemotherapy agents described are: -

Key Point 6

• Haemangiosarcoma is a medical disease

• Doxorubicin only

• Surgery is first aid (or for diagnosis) only

• Doxorubicin/cyclophosphamide (AC)

This is followed by some theoretical concepts in cancer biology demonstrating that HSA needs to be considered as a systemic disease with some similarities with T-cell multicentric lymphoma. Examples given to support this statement are multiple foci, 80% response rate to chemotherapy and a comparable survival rate of 5-6 months (a little longer with T-cell lymphoma).

• Vincristine/doxorubicin/ cyclophosphamide (VAC) and possibly in some cases

• Surgery and chemotherapy will be indicated in the vast majority of HSA cases that we see

Next there is another theoretical section, of particular interest I am sure, to those colleagues in oncology training. It deals with paraneoplastic anaemia, among others. Owen delves into the history books with a description of Virchow’s Triangle. This is fascinating stuff that inspired me to check out Rudolf Virchow (1821-1902)-a quite remarkable clinician from Germany. He had six children all of whom lived to advanced ages (one of them, Adele, reached 100 years) unusual for those times.

Key point 4 Where haemangiosarcoma remains in situ paraneoplastic disease of some form or other is likely -for example: • Microangiopathic anaemia • Consumptive thrombocytopaenia/DIC • Vasculitis • Immune mediated disease • Systemic inflammation and fever All the above will have implications for anesthesia, surgical treatment and chemotherapy. Treatment is divided into surgical removal of a tumour and chemotherapy. A few statements and some statistical information : • Surgical treatment is to stabilise and obtain a diagnosis only. • Bleeding cases are described as ticking time bombs. • Surgical removal alone for a splenic/ visceral case has just 50-60 days survival • Chemotherapy is the mainstay of treatment

• Metronomic chemotherapy

• Location may affect the prognosis to a degree but doesn’t change the treatment • Exceptions may be seen in some lingual, dermal or primary nasal HSA

There is a comprehensive description of all these drugs including adverse side effects. Included here also is the use of thalidomide.

• Consultation with an oncologist will be beneficial for these cases

Key point 5

• Cutaneous/subcutaneous forms are invasive but may have a low metastatic rate

• Surgery for first aid and to confirm diagnosis • Look for other lesions during the operative period that might rupture and cause further bleeding • Doxorubicin based protocol is the mainstay of treatment for systemic HSA • In non-metastatic cases metronomic chemotherapy or thalidomide may be of value • Coriolis versicolor (turkey tail fungus) extract may be useful in a supportive role? This is my question mark because when

And a final note on feline HSA suggests the following: -

• 60-80% recurrence • Visceral as for canine visceral HAS As with previous contributions from Owen Davies, this veterinary oncology webinar is highly recommended for all colleagues in clinical practice or research. It is extraordinary how much information is imparted in an hour. It bears watching several times. A promotional material from WebinarVet states that if you view this webinar ‘You will never consider a haemangiosarcoma case in the same way again.’ I have to agree.

I looked into its use in human medicine there seems to be a fair bit of controversy. Further discussion of supportive treatments includes tranexamine acid, pentoxifylline, analgesia and gastroprotection. The final part of this comprehensive webinar lists prognoses for the various types of HSA cases described at the beginning. For example most cases of splenic HSA live 5-7 months, but survival remains very variable. An interesting observation is that most owners would pursue the treatment again with another dog. The survival statistics cited for other HAS cases, such as retroperitoneal, subcutaneous, intramuscular, cardiac dermal, lingual and nasal would be very useful when discussing options with owners. The final key point summarises surgery and chemotherapy

OWEN DAVIES MA VETMB MANZCVS (SAM) DACVIM (ONCOLOGY) DECVIM (ONCOLOGY) RCVS, AMERICAN AND EUPOPEAN SPECIALIST IN VETERINARY ONCOLOGY

WEBINAR

FELINE URETERAL OBSTRUCTION-PART 2 MANAGEMENT AND LONG TERM FOLLOW UP This veterinary webinar is, as the title notes, a follow up to a previous webinar that deals with the diagnosis of feline ureteral obstruction. Although that webinar is summarised here I would nevertheless recommend watching part 1 before part 2. We are reminded of the challenge in diagnosing feline ureteral obstruction, although a combination of radiography and ultrasound is around 90% sensitive. Otherwise a clinical diagnosis can be made on presentation and clinicopathological data, alongside the imaging findings. We are also reminded that time is nephrons, (or rather loss of them, since 40% function is lost after just 24 hours). Medical management is extremely limited after 24 hours. Subcutaneous ureteral bypass (SUB) is stated to be the new gold standard treatment for the condition. One of Benoît’s patients that we saw in part 1 (Yukiko) is reintroduced with relatively mild signs. However the routine biochemistry panel painted a different picture with severe kidney disease and a very high creatinine level. The diagnosis of feline ureteral obstruction was made with radiography and ultrasound imaging. The ureteroliths are clearly visible with both imaging techniques. There is a comprehensive list of the possible causes of feline ureteral obstruction, ten in all, but 81.6% are either ureterolithiasis or strictures. In some cases, 16.7%, both occur in the one cat. For management the options are medical, or surgical. The latter comprise stents, SUB or others. Medical management, we hear later, has less than 10% success. It is however instigated following the diagnosis in order to stabilise the cat prior to surgery. The goal of medical therapy is prevent progression from sub -lethal to lethal injury, and to protect from additional renal injury by preventing ischaemia, hypertension and at the same time avoiding overhydration. To achieve this requires the judicious use of fluid therapy. The following section goes into some detail on assessing hydration and calculating the fluid needs of an individual patient. Weight

is a good surrogate for monitoring hydration and can be measured every 4-6 hours while the cat is hospitalised. There are some useful definitions of what constitutes normal and abnormal in a patient’s urinary output in mls/kg/hour. Further recommendations for assessing ongoing losses cover GI causes such as vomiting and diarrhoea. Following on from this there is advice on calculating fluid rates specifically to avoid overhydration. There is a list of the problems that overhydration may cause: • 10% weight gain • Increased respiratory rate or effort, harsh lung sounds or crackles on auscultation • Development of chemosis, serous nasal discharge • Decreased skin turgor and a ‘gelatinous’ feel to the skin and subcutaneous tissue • Monitoring fluid balance every 4-6 hours is important as overload is associated with negative outcomes There is a very detailed table, adapted from a recent article, which lists seven drugs that are of use for the management of ureteral obstruction. Included are mode of action, dose and possible side effects. Pain, often described as the worst imaginable in people with kidney stones, is an important feature in cats too, and suitable analgesics are described. We return to Yukiko for a description of her initial management, which ties the previous material together before moving on to surgical options, as the obstruction needs to be relieved. Ureterotomy is described as an historical technique but is briefly reviewed here. Of note is a complication rate, presumably in the best hands, of 31% and a perioperative mortality of 21%. Stents appear to be a better option, but also with some serious complications, apart from the difficulty of working with feline ureters that only have 1mm diameter. Some published studies have recorded survival times of 515742 days.

WEBINAR The remainder of the webinar outlines the use of subcutaneous ureteral bypass (SUB). The SUB catheter is shown and its placement requires either fluoroscopy or ultrasound guidance. Experience has shown that ultrasound guidance is equally good. The surgical procedure is via a ventral midline laparotomy and does seem a lot easier than placing stents. Another advantage is that if the tubing blocks it is a simple procedure to replace it. This complication occurs in 25%. Others include leakage, bleeding and infection. There are currently no guidelines, but Benoît states his preference for this technique. As you might imagine a detailed discussion with the owner is necessary about risks and possible complications. These are clearly summarised for SUB, ureterotomy and stents with SUB being described as ideal. However it is noted that long-term management of SUB will be required, 1 month post operatively, and then every 3-4 months continuously. 25-35.7% of cats will have chronic urinary tract infection. E. coli is the most common bacterium, and infection is more likely if devices are placed in the presence of infection. Other aspects of long-term management includes the use of tris EDTA, SUB flushing (the device makes this relatively straightforward). Flushing is very useful to prevent biofilm formation and/or incrustations. To emphasise why Benoît prefers to SUB is seen in the statistics given for long-term management of SUBs: -

The two webinars on this subject are a very good grounding for a comprehensive understanding of the problem.

Dr. Benoît Cuq Dr Vét Dip ACVIM-SAIM MRCVS University College, Dublin, School of Veterinary Medicine

• Median survival time in the most recent retrospective study was 1555 days (4.25 years) • This is very good compared to 260 days post ureterotomy. • In that study no fluoroscopic placement was necessary as ultrasound guiding was used Yukiko was an ideal case and is currently doing very well more than a year postoperatively. The two webinars on this subject are a very good grounding for a comprehensive understanding of the problem. I suspect for many first opinion practitioners recognition and early referral will be the best option. The webinar will certainly be of great interests to specialist surgeons and those in training also. Two articles have recently been published on this disease, one of which was referred to in the webinar. Both articles are in the Journal of Feline Medicine and Surgery and I have summarised their findings in this edition of the WebinarVet newsletter

The British Veterinary Dental Association

Virtual Conference 2021 The British Veterinary Dental Association would like to invite you to attend the BVDA Virtual Conference 2021, taking place online on 6th October. Each year the BVDA holds a conference where there are papers presented on veterinary dentistry, interactive sessions and state of the art lectures. After last year’s very successful event, we will again be running our conference online. This year’s conference consists of 2 live streams of webinars, running simultaneously throughout the day. Both webinar streams will be available for you to watch on demand after the live event! You’ll be able to watch the webinars as many times as you like for 6 months, on any connected device, at your leisure. Buy your tickets now: British Veterinary Dental Association Virtual Conference 2021 - The Webinar Vet

WEBINAR

THE GUTS OF COBALAMIN Amy begins her veterinary webinar by asking ‘Who routinely measures B12 in dogs/cats with chronic gastrointestinal issues?’ The result in the live transmission was that 74% did not. To change that figure was one of the core aims of the webinar. It begins with a summary of the benefits of vitamin B12. These are in DNA synthesis (cell formation, blood formation, and mucous membranes), Energy metabolism, (energy production, physical performance, vitality), Lipid metabolism, (cell membrane, protection of the nerves, brain), Messenger substances (hormones, neurotransmitters, mind cognition,) Detoxification (cyanide, homocysteine, nitric oxide, peroxynitrite). Thus cobalamin has an essential role in health, and dogs and cats cannot synthesise vitamin B12. The next part of the webinar takes you back to the days of biochemistry. It begins with a description of the B12 pathway from ingestion to metabolism. This section involves a series of very complicated diagrams that would benefit from downloading and careful scrutiny by the serious student of biochemistry. Included are descriptions of the role of B12 in all cells, the intracellular function of B12 and the production of homocysteine (HCY) and methylmalonic acid, (MMA). Along with serum cobalamin concentration, levels of HCY and MMA have been used in the evaluation of cobalamin status in dogs. This is demonstrated by citing an article by Kather et al in The Journal of Veterinary Internal Medicine. In a cobalamin deficient state 63% of dogs have undetectable B12 and increased MMA equating to cellular deficiency. This statement is supported by an abstract from another article demonstrating an association between serum cobalamin and methylmalonic acid concentration in dogs. We return to the clinic for a detailed discussion of the presentation of hypocobalaminaemia. This comprises a failure to thrive, no less than seven gastrointestinal signs, blood dyscrasias, for example non-regenerative anaemia and neutropenia, (included is a beautiful picture of a characteristic hypersegmented neutrophil), organic acidaemias leading to encephalopathy, and/or seizures. Biochemical abnormalities that may occur include hypoglycaemia, ketoacidosis, and hyperammonaemia. Two clinical cases, a dog and a cat are presented demonstrating the beneficial effect of B12 supplementation.

More clinical information follows with a detailed discussion of problems associated with B12 metabolism. This comprises intake, (with descriptions of required amounts in pet food), digestion problems, (in particular exocrine pancreatic insufficiency (EPI)), and malabsorption problems. There are good summary descriptions of all diseases that are likely to be seen. It was quite surprising (to me at least) that 82% of dogs with EPI have hypocobalaminaemia, which is a negative prognostic factor. Some inherited cobalamin malabsorption syndromes in selected breeds,(Giant Schnauzer, Border collie, Beagle , Komondor dog, Australian shepherd and Chinese Sharpei) are described by reference to the relevant literature. In Amy’s practice chronic inflammatory enteropathy (CIE) is the most common cause of hypocobalaminaemia, with a prevalence of between 19-38%. If you you haven’t changed your mind following the opening poll in the webinar about routine measurement of B12 in chronic enteropathies the advice that these patients may not respond to treatment for IBD without B12 supplementation will certainly suffice. I can reveal that the numbers saying they would now measure B12 in dogs and cats with chronic gastrointestinal issues increased to 99% at the end of the webinar. Amy, who clearly has a passion for this subject, would have loved to know who was responsible for the unconvinced 1%!

This very comprehensive and detailed webinar was generously sponsored by ADM-Australia (Protexin Veterinary in the UK) and a small contribution well worth watching summarises the company’s products of particular relevance to the subject matter. This includes Cobalazorb, Pro-Kolin Enterogenic, the gastrointestinal range and urinary range. The worldwide audience on the night provided some stimulating questions too.

There is a brief mention of the situation with cats. In lymphoma cases up to 78% will have a low B12, and in those cats with a chronic inflammatory enteropathy 28-42% will have low levels of B12. The webinar ends with advice on treatment. Two products are highlighted –injectable vitamin B12 and Cobalazorbr a preparation for oral use. Full details are given on dosing and monitoring. In summary Amy states: 1. Hypocobalaminaemia is a negative prognostic indicator

DR AMY LAM

2. The prognosis largely depends on the underlying disease

BVSc (Hons1) Grad Cert Vet Stud MRCVS MANCVS FANCVS

3. Treating hypocobalaminaemia improves clinical condition and quality of life 4. In diseases with the potential for remission the outcome is favourable (For further research four key references are added.)

Registered Specialist in Small Animal Medicine Small Animal Specialist Hospital Sydney

SE P TEM BER 2021