The Webinar Gazette The Webinar vet
To provide: The highest quality vet-led content To be: The world’s largest online veterinary community
MARCH 2021
To have: The planet’s most confident vets
WHAT’S INSIDE CPDer of the Month Jane’s Blog Speaker of the Month Pippa Talks David’s Reviews From the Literature
I
'm writing this in the middle of VC2021 and I must say that I've been having a great time. This is our 9th annual virtual congress! When I first had the idea in 2012, I walked into The Webinar Vet office above my old practice in West Derby, Liverpool and told Wendy and Kathryn that I had had an idea! They always hated that! It was early November beforeLondon Vet Show and within a few weeks we had the first ever virtual veterinary congress with just over 300 delegates. It's grown to over 10,000 last year and we helped many companies and associations hold their events in the last 12 months of the pandemic. This year we also have built our own www.thevetexhibition.com to house the conference in. It is Claire Wolfenden's idea and it's been amazing. It will be open all year
and is available for associations and companies to use this year and beyond. As well as VC2021 at the end of February, we also ran a very successful event for Royal Canin and built them a conference centre too. By a large dose of serendipity, we have become world experts in virtual conferencing and I've been so pleased that our foresight in this area has helped others. I have begun to tell people that I've spent 11 years preparing for the pandemic, I just didn't realise. I am also being asked by organisations outside of the veterinary profession to talk about our expertise. 4th March I am holding a UMI spotlight event around video https://www.weareumi.co.uk/news/ sectors/creative-media/spotlightsession-how-to-bring-video-intoyour-marketing-mix It really is a massive area that all
businesses should be concentrating on and I would encourage you to sign up for the session. If you are a paid up member of The Webinar Vet, you get a free ticket and will have been registered for the over 100 hours of diverse CPD which this year is also RACE accredited! The Associations Day was 6 hours of CE which you can watch if you belong to any of the associations listed on the front page: https://vc2021. thewebinarvet.com/associations/ Plus there were also 2 hours of our annual Mind Matters Initiative Symposium which this year covers the benefits of education for strong mental health. This is available free to anyone involved in the veterinary family: https://vc2021. thewebinarvet.com/rcvs-mindmatters-initiative/
The pandemic is still shaping our lives all over the world. Here in the UK, it has been poorly managed. However, the vaccine rollout is working well and this is probably the long term solution. I do hope wherever you are living that things will improve for you. I hope that in years to come we will see this time of sacrifice as also a time when lessons were learnt and a reset applied. We've all had more time to concentrate on relationships and simplify our lives and also listen to the birds singing. The Theme for our next year of discovery at The Webinar Vet is "Building a Regenerative World." We already have a strong
relationship with Vet Sustain and we will be building on our recent Silver accreditation as an Investor in the Environment to also help veterinary practices and businesses who also want to build a better planet for our children and grandchildren. Finally, I was sad to see Ben Sweeney leave the business last month. Ben is going off to look at the possibilities of telemedicine in the future. Everyone at The Webinar Vet wishes him well. Simply Vet will continue to develop to help vets meet the challenges of recruitment and IR35. Do feel free to contact me at anthony@ thewebinarvet.com if you'd like to know more about our plans.
To your continued good health and CPD success
Anthony
VIRTUAL CONGRESS 2021 Wow! What an exciting week we had here at The Webinar Vet from 22nd - 28th February. Not only did we had the pleasure of bringing to you Virtual Congress 2021 but also delivering it to you from the www.thevetexhibition.com – our new, live, virtual exhibition suite that allows 24/7 access to sponsors, networking opportunities and more! For those of you who joined us, firstly thank you, and secondly, we would love to hear your feedback and thoughts, not just on how the event was delivered to you but also on the topics that were covered. We had a brilliant lineup of speakers this year including keynote speakers Claire Lomas, Dr Julian Norton and Dr Sheridan Lathe. Topics covered this year by our specialists included: Recognising the link between animal abuse and domestic abuse – would you know the difference? There is no excuse for non-accidental injuries to occur but if you were to be presented by these in consult would you know what to do? The pandemic has left some people in a very dark place, and as we see the rise in domestic abuse we are also unfortunately seeing the rise in our pets suffering too. Interestingly, have our equine vets noticed a rise in abuse or abandonment cases? Let us know here. Mindfulness techniques for the workplace. We all know too well what the effects of stress can bring, and unfortunately the veterinary community is one of the highest industries at risk. To reduce the impact, we must firstly educate ourselves as to what stress can look like and how it can present itself in different ways. Secondly, we need to look at ways to manage our response to stress. Whilst the stress itself might be out of our control, how we respond to that stress isn’t. All of the content that our speakers covered is now available for our paid members over in the membership area. Not yet a member? Then why not sign up – we have tonnes of content to offer you covering specialist topics for small animal, large animal, equine and exotics. This content is delivered live on a weekly basis and also on demand. You will have access to the content 24/7 for 365 days. Finally, we would like to thank all our sponsors for their support of this year's event.
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CPD’er of the month
This month’s CPDer of the month is
DAVID MAYHEW
1. Which webinar did you enjoy the most this month?
Cardiomyopathy in cats: diagnosis and management . I particularly enjoyed the video loops showing the echocardiographic changes present with the various types of cardiomyopathy. 2. Did you attend any large events this month? If so, which?
The lockdown in England has sadly made attending any large events impossible over the last few months. 3. What was the biggest take-home message you learned this month from our webinars?
U
ntil early 2020 I had always attended CPD courses in person. However the rapid growth of our young practice (opening in 2017) had made finding time for attendance courses logistically difficult and with the pandemic looming I decided to try The Webinar Vet. The experience has been overwhelmingly positive with vast numbers of webinars available at any time with no need for the hassle or cost of travel, much lower cost of the content and the ability to pause them to take notes and rewatch them just before a relevant case is coming into the practice. I can't see myself going back to attendance courses without a practical element, it now seems so inefficient.
That most cats with cardiomyopathy don't have progressive disease needing treatment and how to determine which ones do need treating. 4. Are you looking forward to any future webinars or events from The Webinar Vet?
Yes, I'm looking forward to the March webinar on the Esophageal feeding tube, tracheostomy tube, catheter technique for removing linear foreign bodies as well as ultrasound of the canine and feline pancreas in April.
Register FREE to watch: "Veterinary Telehealth: Remote consulting in 2020 and beyond" Wednesday 17th March 2021, 12:30 pm Presented by Elly Russell (VDS), Sarah Caney (Vet Professionals), David Prien (CEO FirstVet), Sarah James RVN (Bought By Many), Thom Jenkins (PetsApp), Julien Renard (Vetstoria), Susie Samuel (Vet Help Direct).
ABOUT THE WEBINAR: Veterinary telehealth for vets and pet owners has existed as a formal service for a number of years now, but until recently awareness of such services has been limited. During the coronavirus pandemic, veterinary practices needed to deliver individualised services and as such, pet parents and veterinary practitioners sought out new ways of connecting with one another, to ensure that animal wellbeing was not impacted by the lockdown. What has followed is a sizable shift in how both pet owners and veterinary practitioners are choosing to operate. During 2020, 93% of vets used remote consulting to deliver veterinary services. This has provided us all with a wealth of experience on which to build. For pets and their owners, telehealth has put a digital vet at their side for health and welfare needs as they arise. For vets, it offers flexibility and the opportunity to work remotely. It also allows the vet to see the animal – something that telephone consultations do not allow. For pet owners, teleconsultations cut out travel time, offer immediacy of experienced, qualified support. With veterinary care becoming more digitised, these two panels will discuss what we have learned so far and look at what the future of pet telehealth may hold. First, the opportunities that it presents to vets and pet owners. Second, what needs to be done to fully integrate pet telehealth solutions into the veterinary care chain. And finally, what reflection on the past six months can tell us about what the future of remote pet care might look like.
Register Here: /www.thewebinarvet.com/pages/firstvet-register-free-watch-veterinary-telehealth-remote-consulting-2020-beyond
WHAT IS ‘RARE’?
A
s we see the hospitality industry beginning to advertise again post lockdown my nagging question about the use of the word ‘rare’ is once again at the forefront of my mind. Yes, I’m aware there are bigger things to think about but my mind seems to enjoy going over this conundrum. My issue is with the many hog roast companies or restaurants or butchers that advertise their carnivorous offerings as ‘rare’. Rare breed hog roasts, sausages and more seem to be the new ‘organic’ or ‘home made’ of the menu. Yet these are animals and in the veterinary or natural world anything ‘rare’ would mean we cherish and protect them and definitely not eat them. The OED has the adjective ‘rare’ as meaning: ‘of a kind seldom found… uncommon, exceptional’ Yet we are praising this as a reason to eat them over and above ‘popular’ meat sources. This got me thinking about what words we use for other food stuffs. In fruit and vegetables it seems more common to use the term ‘heritage’ when describing less common varieties.
Heritage also lends itself to those older species of fruit and veg that became less common as mass produced food reduced the number of options for growers. Would heritage work well for similar items of meat produce? Removing the possibly unsuitable use of the word ‘rare’. However I am aware that to finance a farm to keep less common or ‘heritage’ breeds then you need a decent income. So perhaps the marketing of ‘rare’ breeds is a way to ensure the survival of these and keep a diverse gene pool in our animal stocks. But the word ‘rare’ still worries me. It feels slightly fatalistic compared to the feelings around the word ‘heritage’. Back to my initial conundrum. Is using the word ‘rare’ for animals we are eating a good marketing plan? Does it make consumers aware that these animals need as much support and protection as rare wildlife? That this protection is coming in part from their purchase? I feel that consumers understand this with fruit and vegetables but maybe less so with animals.
Jane’s Blog
With wilding parts of the UK with ‘rare’ breeds now a common conservation move, maybe a re-brand is needed to promote the positives of eating, and keeping, ‘rare breeds'.
Dr. Dave Tittle BVetMed CertVA GPCert(WVA&CPM) MRCVS RCVS Advanced Practitioner in Veterinary Anaesthesia*
EXPLORING OUR UNDERSTANDING OF THE SAFETY DATA SURROUNDING
THE USE OF CANNABINOIDS IN SMALL ANIMALS
A
s the use of cannabinoid (CBD) based products increases, both in the veterinary sector and by the general public, it is essential to understand published safety data associated with their use. Deabold et al. (2019) showed that healthy animals tolerated a 2mg/kg dose over twelve weeks, of one particular CBD and terpene-based product. There were no clinically significant alterations in serum haematology or biochemistry in the trial animals, except for one cat, who demonstrated a persistent rise in serum alanine aminotransferase (ALT) for the duration of the study. This study suggested that CBD-rich hemp nutraceuticals appear to be safe in healthy adult dogs, while more work in cats is needed to fully understand utilisation and absorption. Whilst this trial proved safety and absorption at this dose, a good starting point clinically for most animals is 1mg/kg PO BID. The work undertaken by Gamble et al. (2018) demonstrated safety at both 2mg/kg and up to 8mg/kg. They found that dogs with osteoarthritis receiving an industrial hemp extract high in CBD at 2mg/kg twice daily were perceived to be more comfortable and active. There appeared to be no observed side effects of the treatment in either cohort in the pharmacokinetic study, at both 2 and 8 mg/kg. In larger dogs, the higher dose’s cost-prohibitive nature tends to make this a less practical option but does demonstrate the scope to titrate dose to clinical response.
Not All Products are Equal! Under the UK Veterinary Medicine Regulations, only Veterinary Surgeons can prescribe cannabinoid containing products to animals; we should also closely follow the VMD ’Prescribing Cascade’ when choosing to use an unlicensed product. Administration of such products without a veterinary prescription is an offence. Vets are in the unique position of largely controlling the recommendation, prescription, supply and monitoring of the use and administration of cannabinoid products in animals. Owners should also be educated about the risks involved in sourcing and administering untested products, potentially at incorrect doses, which will likely result in lack of efficacy, or even potential health risks. When prescribing a CBD product under the cascade, we should ensure that the product we use has a robust Certificate of Analysis, which the manufacturer is happy to share upon request. Worryingly, Bonn-Miller et al. (2017) analysed several cannabinoid products intended for human use, obtained via the internet in the United States (US). They found that more than 42% of products contained more CBD than indicated, whilst 26% of products had less concentration of CBD than stated, meaning nearly 70% of products sold online in the US were mislabelled.
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anti-inflammatory effect. High heat extraction techniques during the processing of the hemp plant decarboxylate CBDA to form CBD; a superior blend would contain CBDA and CBD in an approximately 1:1 ratio. Some manufacturers appear to have a robust aromatic terpene profile; this gives the impression of increased potency but masks the fact that little CBD is present in the product. A future article will explore the benefits of terpenes in more detail.
Similar findings were made by Wakshlag et al. (2020) during their analysis of pet-specific products marketed in the US. Of the 29 products ultimately analysed, two samples contained no detectable CBD, and four were found with levels of heavy metals (lead, arsenic and cadmium). All products analysed were below the US Federal limits of 0.3% THC content. It is known that the presence of CBDA provides a superior
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Figure: Analysed Constituents of Hemp-Derived Products from the US Pet Market (Adapted from Wakshlag et al., 2020).
CBD products’ use appears to be safe within suggested dose ranges, with minimal side effects. It is prudent to educate and encourage the use of high-end products, backed by research and strict production and quality control measures.
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References: Deabold, K.A., Schwark, W.S., Wolf, L., Wakshlag, J.J. Single-Dose Pharmacokinetics and Preliminary Safety Assessment with Use of CBDRich Hemp Nutraceutical in Healthy Dogs and Cats. Animals (Basel) 2019 9 (10) 832 Gamble, L.J., Boesch, J.M., Frye, C.W., Schwark, W.S., Mann, S., Wolfe, L., Brown, H., Berthelsen, E.S., Wakshlag, J.J. Pharmacokinetics, Safety, and Clinical Efficacy of Cannabidiol Treatment in Osteoarthritic Dogs. Front. Vet. Sci. 2018 5, 165–172 Bonn-Miller, M.O., Loflin, M.J.E., Thomas, B.F., Marcu, J.P., Hyke, T., Vandrey, R. Labeling Accuracy of Cannabidiol Extracts Sold Online. JAMA. 2017 318 (17) 1708–1709 Wakshlag, J.J., Cital, S., Eaton, S.J., Prussin, R., Hudalla, C. Cannabinoid, Terpene, and Heavy Metal Analysis of 29 Over-the-Counter Commercial Veterinary Hemp Supplements. Vet Med (Auckl) 2020 Apr 15 (11) 45-55
(*) The author sits on the Advisory Panel for ElleVet Sciences in the US and provides a consultancy service to ElleVance Sciences in the UK.
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.
Feedback on Dr Thamm’s webinars: “Look forward to more lectures on other aspects of oncology from him.” “Brilliant delivery. Kept me attentive for the duration.”
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BEHAVIOUR – A MULTIDISCIPLINARY APPROACH The British Veterinary Behaviour Association are affiliated to BSAVA and our mission is to promote, disseminate and facilitate exchange of up to date and evidence- based information in the field of companion animal behaviour and welfare. BVBA members include veterinary surgeons, veterinary nurses, academics, students, charity workers and behaviourist paraprofessionals. We encourage open dialogue between these groups to promote a greater understanding of behaviour problems, diagnosis, treatment, and prevention thereof. This is for the benefit of companion animal owners, patients, veterinary and charity teams, and the wider community. We invite members and non-members to join us at this year’s study day, which will be held on Wednesday 24th March 2021, and due to COVID-19 restrictions it will be a virtual event hosted by The Webinar Vet. The theme is ‘Behaviour-a multidisciplinary approach’, and the event will explore behavioural and physical aspects of treating the painful patient. Sarah Heath, RCVS Veterinary Specialist in Behavioural Medicine, is no stranger to the study day platform. Sarah begins the day with a session on the relationship between pain and behaviour, using case examples to illustrate her points. Sagi Denenberg DVM MRCVS, a
popular and entertaining speaker, joins us again and will also use case studies to illustrate the topic of psychopharmacology for the painful patient. BVBA are delighted to welcome, for the first time, Danielle Pountain, an advanced veterinary nurse who manages Mobility Matters small animal rehabilitation centre in Staffordshire. Danni will cover rehab for the painful patient, including physiotherapy. We are also proud to welcome Lynn Hewison, CCAB, senior lecturer at University of Lincoln and long standing BVBA committee member, who is well qualified to discuss practice organization for behaviour referrals. All presenters will be available for questions at the end of their presentations, and we hope the audience will be as inquisitive as usual. During the refreshment breaks there will be an opportunity to engage with our behavioural poster sessions, and our sponsors’ representatives will also be available to interact with delegates in a number of ways. Although we would obviously prefer to get together face to face, we are still looking forward to a stimulating and informative day and are grateful to our sponsors and Webinar Vet, who are making this possible.
Pippa Talks
Pippa Elliott graduated from the University of Glasgow back in 1987 and appreciates the vital role of CPD, as a compliment to practical skills developed over the years. Pippa works in companion animal practice in Hertfordshire, along with pursuing OV export inspection work and freelance veterinary copywriting. Pippa’s motto is “If you want something done, ask a busy person.”
Pippa Elliott BVMS MRCVS
“Only Elephants have Floppy Ears”
Hear This! What Links Charles Darwin and Otitis Externa? What is one of the most common reasons for a dog to visit the vet? The answer (of course) is ear disease. For information about treating Otitis Externa then Edward Davies webinar on March 4th is an invaluable learning tool. But my aim here is altogether more trivial, after I unearthed some tantalizing titbits which link the venerated Victorian scientist, Charles Darwin, to ear infections in dogs.
Strange but true: the above quote is from Charles Darwin – yes, he of the theory of evolution. The august Mr Darwin noticed that in the natural world, only elephants had floppy ears. But it didn’t escape his observation that dog breeds, engineered by man, had droopy ears. This fact obviously played on Darwin’s mind, because in 1868 he wrote a weighty tome titled “The Variations in Animals and Plants under Domestication”. Here Darwin compared physical differences between wild animals and those nurtured by man. At this point, bear in mind the science of genetic inheritance was not yet established (Gregor Mendel first published his pea-
plant studies in 1866, which was largely ignored and only taken seriously at the turn of the 20th century.) Darwin particularly notes changes in domestic dogs that weren’t present in their forebears – such as white patches of fur, shorter muzzles, and floppy ears. To describe these he coined the phrase “domestication syndrome”… which seems to have fallen out of common usage. Amongst Darwin’s postulations was the droopy ears were a disadvantage to a wild animal, because the heavy earflap blocked sound from entering the ear canal. This muffled their hearing and could make the difference between early detection of a threat or being predated on. But that’s ignoring the cute-factor as a survival tool. When it comes to a pet dog, to have a sweet, face-framing floppy ears is an advantage because it makes them even more endearing to their owner. They are more likely to be given treats and lavished with affection, and more likely to be bred from to perpetuate the look. But, of course, we know that heavy ears obscuring the ear canal can give otitis externa a helping hand. All of which brings us back to otitis externa. Amongst the other risk factors for a dog developing ear infections, having a heavy ear flap that seals the auditory canal that creates a warm moist environment is right up there. Then add in a migrating
grass awn or two and the scene is set for otitis externa. So does this mean that Mother Nature is wiser than man, and if so, what does it say about the elephant? Now, there are a couple of thoughts to ponder. PS On a slightly different note, I have a soft spot for dog-lover, Charles Darwin. He carefully weighed up the pros and cons of marriage, and his wife-to-be came out slightly ahead of the companionship of a four-legged friend as in this quote. [Darwin’s arguments in favour of marriage] “Constant companion [a wife] and friend in old age who will feel interested in one, an object to be beloved and played with.— better than a dog anyhow.”
WEBINAR GALLBLADDER MUCOCELES AND SALIVARY MUCOCELES PROFESSOR JOHN BERG DVM MS DACVS VETERINARY SURGEON & CLINICAL DIRECTOR
TUFTS UNIVERSITY CUMMINGS SCHOOL OF VETERINARY MEDICINE
David’s Review
John Berg begins this thoroughly recommended veterinary webinar with Gallbladder Mucoceles, first recognised in the early 90’s. Hyperplasia of mucus-secreting glands occurs in the gallbladder mucosa. Although of unknown cause it may be associated with hyperadrenocorticism or hypothyroidism in some cases. Mucus in the biliary tree may lead to extra hepatic biliary obstruction with an increase in bilirubin and a risk of gallbladder rupture. In a publication in 2004 60% of rupture cases were documented. Over time and improved recognition of the condition this figure has dramatically reduced.
T
he problem is mainly seen in older dogs with a mean age of 10 years (3 years and up) and is a disease of medium sized dogs such as Cocker spaniels and Shetland sheep dogs. The principal signs are vomiting, anorexia, lethargy and jaundice. Vacuolar hepatopathy of Scotties and hepatic carcinoma are differentials, which are briefly described. A series of ultrasound images of gallbladder mucoceles follows, from mobile debris in the gallbladder, through stellate debris, an intriguingly named Kiwi fruit pattern (well -illustrated) to impending rupture and rupture. In spite of the very clear images shown, there are some limitations of ultrasound in diagnosis, which are explained by reference to two recent articles. A table outlines surgical decision making from just ultrasound monitoring, elective surgery, urgent surgery (within a day or so,) to emergency surgery. Two surgical procedures are suggested –cholecystectomy (when bilirubin levels are normal) and cholecystectomy + lavage
of biliary tree (when bilirubin is elevated). Prior to the surgical procedure we are advised to be prepared for transfusion, check platelet parameters and have haemostatic products available. A video illustrates the operative procedures, but before this there is a line diagram of the anatomy of the liver, showing the location of the gallbladder. The video is superb and takes us first through cholecystectomy and then lavage of the biliary tree. Initial case reports documented perioperative mortality at 22% and 32% but with time and early recognition this has come down to 7% in the latest article published in 2013. Of note is that in all three studies cited once the perioperative period had passed the prognosis for all operated dogs was good to excellent. Salivary mucoceles are next, described as an accumulation of saliva in the tissues surrounding the salivary glands. They are not cysts, and are fairly common in dogs but rare in cats (you could go through a veterinary career and not see one of these).
The cause is an idiopathic disruption of the sublingual salivary duct. An excellent colour line diagram demonstrates the relevant anatomy showing the mandibular and sublingual salivary glands sitting in the triangle made by the linguofacial and maxillary veins. The sites of the mucoceles are shown in case examples. These are cervical, sublingual (also known as ranula) and the much rarer pharyngeal, which may be a cause of dyspnoea or dysphagia. Some ruleouts for these are tabulated for easy reference. Cytology can be very useful in helping identify rule outs and there are examples shown of findings with mucoceles, abscesses and soft tissue sarcoma.
done bilaterally if doubt exists as to the affected side. John gives a tip that helps decide this, and in rare cases ultrasound can be useful. The procedure of salivary gland resection is demonstrated with a video. This is, like the first video, of a very high standard. As Bruce Stevenson, the chair for the live broadcast commented, specialists make it look easy! That’s true and adding to that statement I very much doubt you will find a better account of these two conditions anywhere. It really is teaching at its very best, and it is no surprise that John has received a number of distinguished teaching awards.
Treatment consists of removal of the sublingual and mandibular salivary glands, which can be
WEBINAR TRANSITION HEALTH MONITORING AND MANAGEMENT PHIL ELKINS BVM&S Cert AVP (Cattle) MRCVS INDEPENDENT DAIRY CONSULTANT
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aving started my career in mainly large animal practice, admittedly in the last century, I tried (unsuccessfully) to remember what exactly the transition period is. Fortunately Phil Elkins anticipated this possible gap in knowledge and defined the term in his first slide with an outline of what to expect in this veterinary webinar. The transition period refers to the process of a late gestation cow becoming an early lactation cow. It is suggested that this is from 60 days pre -calving to 30 days post- calving and involves a number of physiological changes: • Lactogenesis • Diet changes • Doubling of energy requirements
• Massive alterations in mineral metabolism • Socio-physiological effects • Local and systemic immunological changes A sobering statistic is that 75% of dairy cow disease is related to transition health, and a list of important diseases is given. These are: • Mastitis • Ketosis • Displaced abomasum • Ovarian Dysfunction • Metritis • Retained Placenta • Milk Fever An incidence range is applied to each of these, followed by a very
complicated diagram of relevant biochemistry that is, (fortunately), simplified in the next slide showing adaptations by adipose tissue, the rumen, liver, muscle and mammary gland to parturition and the onset of lactation. Two line diagrams summarise the interrelationship between immune suppression and a negative energy balance, with a detailed analysis of the effects of just one disease -milk fever. A graph analyses the costs of four transition diseases (early mastitis, metritis, retained placenta and displaced abomasum) comparing heifers at first lactation and cows in subsequent lactations. As seen, these costs can be considerable, which brings in the suggested role of the vet in minimising these losses. This is: -
• To treat LDA/MF and advise if there are too many. But importantly also
some time to set up but makes the monitoring easy.
• Monitor disease incidences (why wait until it is a problem?)
We are asked what percentage of cows should transition successfully –four possible answers to think about are 50%, 70%, 80%, and 90%. The suggested answer may surprise you.
• Advise on measures to optimize health, welfare, production and economics The suggestion made is that all transition diseases are interrelated so individual disease rates become less useful barometers for success. Vets should therefore be monitoring transition success rates. What does that imply? Transition success. A cow is deemed to have successfully transitioned if she has: • Calved without dystocia • Lasted 60 days in lactation in the absence of disease. These include metritis, purulent vaginal discharge, mastitis, high somatic cell count, displaced abomasum, retained placenta, milk fever, ketosis, and any cause for culling • Returned to normal cyclicity defined as oestrus and absence of abnormal ovarian structures • Suitable milk production Graphs follow showing the potential effects on milk production with suggestions of how we might monitor transition success. For smaller herds a simple system recording cow ID, calving date, disease and date if they fail, tick if they succeed, and tally over time is adequate. For larger herds set up reporting functions on a herd management system. It takes
Advised transition period goals are suggested: • Minimal risk dystocia • Minimal risk of stillborn calves • Minimal risk of metabolic diseases • High milk production in early lactation • Minimal loss of body condition • Enhanced return to cyclicity and improved fertility Factors influencing transitional goals are genetics, infectious diseases, dry matter intake and nutritional competency. Of these dry matter intake is key and there are a selection of highly technical slides looking at this and nutritional competency. These need very careful scrutiny and there are some quite complicated graphs that I won't attempt to summarise. Phil recommends one very useful resource. It is called ‘Healthy Start Checklist’ This is an Elanco publication, which will supplement the information in the webinar. In summary: Monitoring transition success rate has some key things to keep an
eye on. These are pre-calving dry matter intake, stocking density and nutritional competency. There are some supplementary methods of monitoring as described in detail in the webinar, including urine Ph., blood calcium, and blood betahydroxybutyrate (BHB). Phil suggests that there are lots more but makes the single most important point, which is that: ‘The transition period is a key opportunity for veterinary involvement’.
Phil Elkins graduated from Edinburgh in 2005 and quickly moved to the far south-Cornwall, where he has spent the majority of his time in clinical practice. He gained his Certificate in Advanced Veterinary Practice in 2015, and has been a BCVA board member for the last 4 years. There is a huge amount of information in this webinar, which I am sure will be of value food for many cattle practitioners and students.
WEBINAR UPDATE ON CANINE OSTEOSARCOMA -THE CSU EXPERIENCE DOUGLAS H THAMM VMD DIPLOMATE ACVIM (ONCOLOGY) BARBARA COX ANTHONY PROFESSOR OF ONCOLOGY ANIMAL CANCER CENTER COLORADO STATE UNIVERSITY VETERINARY TEACHING HOSPITAL
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ruce Stevenson in his capacity as chair for this excellent veterinary webinar summarised Douglas Thamm’s CV in the live recording, and commented that we were in for a treat. What followed was definitely a master class with a comprehensive update on canine osteosarcoma.
Of note is that regional lymph nodes are positive in only 5%, but when they are it indicates a worse prognosis. Staging continues with radiography, with some very good images shown, and a discussion of differential diagnoses. Included here are other primary bone tumours, metastatic tumours, bony involvement from systemic disease and It begins with some infectious causes. 7% of background information about dogs have radiographically the long bones most commonly detectable metastasis at first affected, and that it is large presentation emphasising the breed dogs predominantly that importance of radiography are prone to cancer. A few rare of the thorax. 3 views are causes are noted-particularly suggested –two laterals and implant and radiation one DV. However 90% of associated, before discussing these cases have microscopic the presenting complaints. metastasis not detectable Pain is important and may be by imaging. The final part of acute and raise suspicion of a staging is via biopsy and/or pathological fracture. In spite fine needle aspirates. These of what you may think the are well described including presence of a fracture does not a risk benefit analysis of the seem to affect the outcome most favoured Jamshidi biopsy negatively, and these fractures technique. It gives a diagnostic can sometimes be repaired if biopsy chance of approximately the owners refuse amputation. 90%, with the risk of failure in Lameness may also be chronic 7-10%. The procedure may be and progressive with an initial more painful for 24-48 hours response to NSAIDS and with a small risk of inducing a rest. Owners often suggest pathologic fracture. a perceived trauma that precipitated the lameness-but Treatment is outlined next, this is a red herring. beginning with symptomatic pain relief, before the stark Staging begins with the statistic that amputation physical examination, which alone is associated with only aims to localise pain, swelling 4 months median survival and the site of the lameness. time. Survival is improved by
the addition of chemotherapy protocols. There is extensive reference to the literature of protocols involving carboplatin. This drug has many advantages in that it is not toxic, has a low incidence of GI effects, no need for diuresis and is now off patent and relatively inexpensive. Myelosuppression is the most common side effect. Comparisons are made with cisplatin and doxorubicin. Prognostic factors to be taken into consideration are serum alkaline phosphatase, with a high level being unfavourable, humeral location and the presence of monocytes. Some contraindications to amputation are discussed. Although these are relatively few, one is that some owners will not consent to the procedure, and with these owners it is important to dispel myths surrounding amputation. Nevertheless there are some local treatment alternatives aiming to salvage the limb. The aim is to remove diseased bone and replace with either an allograft, or a metal implant. This is most effective in distal radius osteosarcoma. The disadvantage is increased expense (7-9 thousand dollars), limited availability and a high rate of complications-around 70%. There is some intriguing data from human research data
indicating that infection can improve outcome, and there is work ongoing to see whether this is applicable to dogs, particularly with Mepact. Osteosarcoma is being extensively researched in Colorado. Some of the procedures described, with some impressive results, include stereotactic body radiation, surgical excision of metastasis and various novel chemotherapeutic agents. There is also an interesting section, outlining new directions for the treatment of osteosarcoma, describing the use of bisphosphonate drugs. These inhibit bone resorption and are primarily prescribed in humans for the prevention of osteoporosis. They can significantly reduce the
pain associated with metastatic bone disease in humans. They have shown promise in dogs with a 30% subjective improvement in pain. Some of the most recent research at Colorado in this area is summarised bringing us right up to date. As is so often the case our American colleagues are masters at communication. Douglas Thamm is an excellent example on how to transmit knowledge in a thoughtful, interesting way that never loses you. John Berg in this review is in the same league. Everybody from student to specialist will find a lot of stimulating information in these webinars.
WEBINAR FELINE INJECTION SITE SARCOMAS (Why should I know about them?) OWEN DAVIES. RCVS AND AMERICAN SPECIALIST IN VETERINARY ONCOLOGY
HIGHCROFT VETERINARY REFERRALS
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wen begins this highly practical veterinary webinar by presenting a feline sarcoma case seen some years ago illustrating the extreme difficulty these cases typically cause. He made reference to the guidelines suggested at the time, particularly to remove a 2 cm margin of tissue on all sides of the mass. As described later these guidelines have subsequently been updated. Of note in the case described are pictures of the original tumour (a challenge I think you would agree), some remarkable and horrific CT scans demonstrating how extensive these tumours often are, and in spite of heroic efforts euthanasia 11 months after diagnosis.
was found to be associated with multiple foci of granulomatous inflammation and was often seen histologically to be more aggressive than previous feline sarcomas. A year later the association with vaccination was described and the term ‘Vaccine Associated Sarcoma’ began to be used. Initially the most likely culprits were rabies vaccine and FeLV vaccine. However sarcomas arise in many parts of the body that are not associated with vaccines and Owen sets out a convincing argument in the next session that these cancers are a consequence of inflammation and it is not specific to vaccines, and the term ‘Feline Injection Site Sarcoma’ is now used. A surprising list of apparent causes is: -
Obviously then Feline Injection Site Sarcomas (FISS) • Vaccination need to be taken very seriously and in order to • NSAIDS update us the webinar unfolds as follows: • Antibiotics (especially long acting) • Steroids (especially long acting) 1. Review of soft tissue sarcomas • Insulin 2. What’s different about FISS? • Microchips 3. Diagnosis and investigation • Lufenuron implant 4. Management • Penrose drains 5. Is cure of FISS possible? • Spay wounds/surgical wounds 6. Is prevention possible? • Cat bite abscesses Sarcomas are cancers of mesenchymal cells and some very good pictures are included followed by a list of ten different mesenchymal cancers. There is a description of these in dogs, which gives some useful background comparative information, such as grades, metastatic rate, surgical guidelines for intention to cure surgery and survival statistics. FISS (a new type of sarcoma for the time) was first brought to the attention of vets in 1991 as a result of a letter to the JAVMA. The tumour
FISS can occur between 1 month and ten years after injection and the most common sarcoma is a fibrosarcoma. This tumour is highly locally invasive, travels along fascial planes, and has a reported 10-28% metastatic rate. If a reaction to a vaccine occurs it is estimated that 1/35-40 develop into FISS. Advice as to when to biopsy includes a very important point- never to do an excisional biopsy.
The diagnosis can also be made with good cytological specimens, and if sending these to a cytologist, always check the slide in -house. This is to avoid sending slides with no representative cells. Some general information lists differences between FISS cells and non-ISS cells. The section on treatment begins with general remarks and statistics. Local disease is the principal cause of death, either due to recurrence, or the tumour cannot be resected. With marginal resection expect recurrence in 79 days. With wide resection recurrence may not occur at all, or if it does between 325 and 419 days. There is a huge difference in tumour recurrence rates when comparing non-specialist surgeons and those that are board- certified. There is advice on how to submit specimens to the histopathologist and how to assess the report. There is an interesting discussion on why a second surgery is less successful ending with a highlighted comment ‘ An inadequate first surgery usually means that the disease will never be cured and the cat’s prognosis will be undermined.’ According to the literature, survival after surgery with 2 cm+ margins is 13-30 months and we are shown some statistics indicating that radiation therapy can improve survival times. However the latest excision recommendations are as flows: • 3 cm lateral margins • 1 facial plane deep (Based on CT)
Owen summarises his approach to treatment in the next slide using the 5 cm lateral plane, 2 fascial plane guideline, with suggestions when adjuvant radiotherapy and chemotherapy are justified. This leads us to important prognostic factors – • Size at diagnosis • Anatomic location • Previous surgeries • Biopsy technique • Surgical technique and expertise (specialist surgeon) • Use of appropriate adjunctive therapies where needed • Grade-metastasis more likely with high-grade tumours. Guidelines are summarised for preventing FISS. These include: • Avoid injection of irritating substances • Inject at room temperature • Avoid using the same site repeatedly • Vaccinate as often as necessary-but as infrequently as possible • Choose modified live recombinant vaccines if equally effective to rejuvenate products • Monitor injection sites (practice policy recommended) • Choose vaccine sites that can be easily amputated. A huge amount of work went into the presentation of this comprehensive webinar and only a summary was possible here. There are a lot of references to the literature and some statistics, which will be useful for clients as well as vet education. The webinar is thoroughly recommended.
But with 4-5 cm lateral surgical margins and 2 fascial planes median survival times in one study were from 2-5 years to ‘not reached’ and encouragingly 86% of cats treated in this way were disease free at 3 year post operatively. A series of dramatic operation pictures makes the very Owen has made a convincing case for referring to obvious point that this type of radical surgery is not these very unpleasant tumours rather than having for the faint-hearted/inexperienced. Emphasis is a go yourself if intention to cure is the aim. placed on the need for a multimodality treatment. There is a lot of detail on specialist procedures following surgery including chemotherapy, and adjunctive electrochemotherapy.
From the Literature – March’21 The February edition of Veterinary Dermatology (volume 32 Number 1 February 2021) is essential reading for colleagues interested in Feline Medicine and in particular Feline Dermatology. The bulk of the edition consists of four review articles that will bring readers up to date with the most recent research and introduce new guidelines on nomenclature, immunopathogenesis of feline atopic syndrome, its correct diagnosis and finally a systematic review of treatment of feline atopic syndrome. Now might be a good time to consider joining the European Society of Veterinary Dermatology as membership has many benefits including the journal and reduced fees for conferences and courses. The review articles are as follows:
Feline allergic diseases: Introduction and proposed nomenclature Richard Halliwell and others Vet Dermatol 2021 32 8-12
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fter a very careful assessment of the human and feline veterinary literature the ten authors in this study proposed the term Feline Atopic Syndrome (FAS) to encompass allergic diseases of the skin, gastrointestinal and respiratory tract that may be associated with IgE antibodies. A caveat is that flea allergy can both mimic/and or contribute to the syndrome. The term Feline Atopic Skin Syndrome (FASS) is proposed to describe allergic skin disease associated with environmental allergies, a subset of FAS. Again there is a caveat that food allergy
and flea allergy can both mimic/ and or contribute to FASS. The authors are not aware of adverse reactions to cats that are attributable to causes other than immunological reactions against the food itself. The proposed term for these cases is therefore Food Allergy (FA). Feline asthma is likely a part of FAS and work will be on going to establish this as fact.
Immunopathogenesis of the feline atopic syndrome Richard Halliwell, Frane Banovic, Ralf S Mueller and Thierry Olivry Vet Dermatol 2021 32 13-25
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his is another very carefully researched article. The main conclusion, as stated in the abstract, is that the evidence is supportive of a role for IgE in the pathogenesis of both FASS and FA, albeit not strongly so. The inflammation in both these clinical entities is
accompanied by eosinophils and lymphocytes. Taken together with the cytokine expression the suggestion is that some (not all) cats have T-helper type 2 immune dysregulation. In the editorial for this edition Karen Moriello and Richard Halliwell state that ‘it is important to note that much of the work done on feline asthma was in experimental models. The challenge is to study the disease in spontaneous cases.’
Clinical signs and diagnosis of feline atopic syndrome: detailed guidelines for a correct diagnosis. Domenico Santoro, Cherie M Pucheu-Haston, Christine Prost, Ralf S Mueller and Hilary Jackson Vet Dermatol 2021 32 26-42
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his very detailed paper demonstrates that relatively little original research has been done on the clinical aspects of feline allergic diseases, with a tendency for recycling what is known. Just as with the article on nomenclature the authors have simplified the cutaneous reaction patterns in cats
into four major patterns: • Miliary dermatitis (MD) • Self-inflicted alopecia/hypotrichosis (SIAH) • Head and neck pruritus (HNP) • Eosinophilic granuloma complex (EGC) -Indolent ulcer -Eosinophilic (linear) granuloma. Typically seen on the caudal aspect of the thigh and also on the tongue and hard palate. -Eosinophilic plaque. Most often seen on the ventral abdomen and medial thighs. Either alone or in combination, and after excluding other causes, these patterns are consistent with a diagnosis of FASS. A comprehensive table lists the major differential diagnoses for FASS. Another feature of this article, demonstrating further its clarity, is the algorithm showing the clinical signs associated with FAS, under the headings of cutaneous, gastrointestinal and respiratory. There is a very good summary of feline food allergy and asthma in the article including some high quality chest radiographs of asthmatic cats. As is the case in dogs the authors emphasise that the diagnosis of FAS is by clinical signs with a compatible history and by exclusion of diseases with similar clinical signs. If perennial signs are present food allergy must be excluded and where fleas are known to be present in the environment strict flea control is a requisite prior to diagnosing FAS. The recommendation is that very strict flea control should be extended to 12 weeks.
Treatment of the feline atopic syndrome-a systematic review Ralf S Mueller, Tim Nuttall, Christine Prost, Bianka Schulz and Petra Bizikova Vet Dermatol 2021 32 43-60 This is the final review article in the series. It has 107 references and a truly comprehensive account of treatment options. Treatments evaluated included: •
Allergen avoidance
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Allergen specific immunotherapy
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Systemic glucocorticoids
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Topical and inhaled glucocorticoids
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Ciclosporin
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Oclacitinib
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Bronchodilators
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H-1 receptor blocking antihistamines
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Essential fatty acids and palmitoylethanolamide
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Maropitant
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Antibiotics
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Inhaled lidocaine
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Mesenchymal stem cell therapy
If this sounds daunting there is no need to worry. An excellent table summarises each, with a recommendation that categorises the quality of evidence and its strength. Perhaps not surprisingly glucocorticoids and cyclosporin are still the most effective and recommended treatments but all the others get a fair hearing. Also in this edition of Veterinary Dermatology is an article on staphylococcal communities in healthy and allergic feline skin showing variability and a starting point for future research into the importance of Staphylococcus spp. in feline skin. From Spain the first report of sublingual immunotherapy in 22 cats concluded that it should be considered a rapid effective safe and well-tolerated treatment in cats with atopic dermatitis. From Switzerland a report on a new congenital hair shaft abnormality resembling hair shaft changes previously only seen in several mutant mouse strains contains superb clinical and scanning electron microscopy images. Finally a couple of case reports and an article demonstrating regional anaesthesia of the paw ensure the journal is off to a truly excellent and international start for the New Year.