The Webinar Gazette The Webinar vet
To provide: The highest quality vet-led content To be: The world’s largest online veterinary community
SEPTEMBER 2020
To have: The planet’s most confident vets
WHAT’S INSIDE Blog from Ben Guest Article Jane’s Blog Speaker of the Month Pippa Talks From the Literature David’s Reviews
W
ho else has the recurring dream of being unprepared for exams? In the dream, I haven’t attended lectures and I feel sure I will flunk the exam. As a disclaimer, I was a very good attendee of lectures- I wasn’t clever enough to miss them. I still have this one 30 years after leaving vet school- crazy. I also think of September as the beginning of the new academic year. I’m very excited to let you know that we have acquired WikiVet which is one of the top student sites. I am sure it will become even more important during these strange times for vet students not attending lectures in person at their vet school. We are tidying it up at the moment but do look out for its launch this month and feel free to pass on its url to vet students and vet nurse students.
September is also the season for autumn conferences like BEVA and the various specialty associations. Of course, physical events are very much off because of the Coronavirus and we have been inundated by companies and associations approaching us to help them take their events online. We’ve been running virtual congresses for 7 years and they’ve suddenly become interesting to a lot of people. I’ve been honoured to help such august bodies as WVA, NZVA, ESVS, BVDSG and companies like Royal Canin and Virbac. Speaking of Virbac, they have released an amazing new product called Stelfonta for the treatment of MCTs. I was fortunate to join several hundred top oncologists earlier this summer to hear about this new pharmaceutical and we are hosting two webinars for Virbac as they launch it to the
general veterinary audience.
“Mass Cell Tumors - An Update” and “Stelfonta: Seeing is Believing”
You will really enjoy these webinars! Since many conferences have had to cancel their physical congresses, we have stepped in to help them go online. Cats Protection are running a behavioural conference in September which is also open to non- vets and nurses as well. This might be one to share with keen clients too.
We will be listing the other congresses that we are hosting in the Webinar Gazette so look out for the links if you want to buy tickets. However, I am so proud to be helping to take the World Congress of Vet Derm online in October. As you may know, I spent many years doing derm referrals in the North of England and Wales and have lectured internationally
on this subject. The congress is now online so instead of travelling all the way to Sydney, Australia you will be able to watch from the comfort of your own home. There are lecture packages particularly for GPs starting at as low as £110 plus VAT and if you follow this congress it will transform your derm skills. I do hope you can attend!
“Register for the Feline Behaviour Conference from Cats Protection!” I hope you are well. I am keeping you in my thoughts and prayers during these trying times.
Find Out More! Event Dates 21-24th October 2020. Access to the full event for 6-months post-event until April All the Best! Anthony
Ben Sweeney BVSc MSc (VIDC) Cert AVP MRCVS
Accessibility to the Profession
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think it is safe to say that if you ask anyone of the general public what their preconceived idea of a vet would be then you would most commonly get the answer ‘white middle class bloke in a check shirt and a long plastic glove’. As, I dare say, most of the profession are aware, this is not too far from the reality other than the gender part. Did you know that 24% of the veterinary profession went to private school, and a whopping 97% are white? The big variance is that we are a predominantly female profession, although until recently I was unaware that the ratio of applicants to vet school has actually always been very similar to how it is now, but in years gone by, there was a selection bias to males.
I can’t really say too much about having a tough journey through life: I went to a private school (I was fortunate enough to get a sports scholarship), and had parents who literally spent the best part of 18 years ferrying me and my siblings from event to event as they never wanted us to miss a thing-they invested in us. But how fortunate am I that they were willing to do that: for many of today’s youngsters there are parents who don’t make the sacrifices that mine did. Does that make them any less bright? Any less capable? I am sure that many of you are from similar backgrounds-and that is nothing to be ashamed of or afraid to talk about, and not what this thought piece is about. We should not be apologetic for our privilege, but we need to accept that we did have a privileged upbringing. There are certain struggles, that (and I thank God for this), I simply do not understand and cannot fathom to this point in my life.
I wonder why that was? Is it because of a preconceived idea of what the job entailed? Or perhaps about who ‘the right’ people for the job are? The profession itself has certainly changed to being almost unrecognizable to 30 years ago. For those of you who are parents, I am sure that, For transparency, I don’t know the answer…these like me, you want the best for your childrenare all just my musings. although what your interpretation of best is may vary.
Would you encourage your kids to be vets? This fascinates me as a topic, and for the most part many fellow vets and nurses that I speak to say no-a sad indictment of the low levels of morale in many sectors of the profession. There are, however, still plenty who say yes, they would.
where the consumer can get veterinary insights from anywhere, we as veterinary professionals need to be able to engage with and educate our clients to achieve maximum success of case management-does AAA guarantee that? I think not.
How many people do you know who are vets and have been to inner city comprehensive schools and are from single parent families? Or who grew up in areas where they are encouraged to chase their dreams, or even to have dreams? This isn’t a prescriptive definition of those without the same levels of privilege, access and exposure to the profession, but I know of so many kids who would make fantastic vets and nurses but have just never had the window of opportunity, or even the possibility of it as an option, opened to them. The harsh reality is that from a very young age the prospect of a career like ours has never been made accessible to them. Now, that isn’t down to us and our responsibility to help on every level, but it would help the profession an endless amount if we were better at making it more accessible in my opinion.
Sure there are lots of AAA students who would be fantastic vets, but my money is on there being a hell of a lot more out there who would be just as good even if they got BBB? Are we guilty of being a bit arrogant of the requirements to get in? When it comes to experience before going to vet school, it was hard enough to get all the appropriate things back in the day, but in this modern age of health and safety and red tape littered around access to any bit of veterinary exposure, is expecting 16-18 years old’s to have done several month’s worth of experience in places that they may never come across realistic. I am an inner-city boy from Liverpool, so I had very little clue about farming pre vet school. Did that affect my ability to learn and understand my teachings at vet school? It appears not. Sure, I didn’t end up a farm vet, but not spending much time milking and shoveling slurry or chasing sheep around a fell before vet school didn’t impact on me being able to learn what I needed to be a safe vet in that environment.
I am privileged to go into local primary schools and talk about being a vet: it is brilliant to see their faces light up. For some of them it is the 14th job they have thought about doing when they are older that week, but for others a seed is planted, and these are the vets and nurses of the future. It is our responsibility and that of the wider community to encourage our youngsters to dream big, to push their boundaries and achieve whatever they want in life. Do you really need straight A’s to get into vet school? I am not convinced of this one to be honest. Afterall, I got AAB and I know other vets who have gone on to do great things in the profession but got nowhere near the preconceived standard. Sure, that shows an ability to perform academically, but are we selecting for the right things? You need to be a bright cookie to be a vet, but you need to be adaptable, communicable and engaging-not just book smart. In an age
Personally, I think working in a bar or in a supermarket gives equal if not greater life experience to equip potential vets and nurses to deal with the general pet and animal owning public than cleaning kennels, poo picking and mopping floors. The recent fiasco with A level results has highlighted the issues within our education and selection system-whatever your feelings on the matter, there is clear bias based on your geographic location and upbringing. Sadly these are parts of the divides in society that have become the norm. Occasionally someone pops up and breaks the norm for their area and are briefly heralded, but for the most part, your upbringing dictates your future success: that is a sad reality for me, to think that people who have so much
potential may miss out because they simply never had a bit of help where others did. As a profession we are in a bit of a pickle really aren’t we: drop out rates from experienced clinicians is at an all time high, many practices are understaffed, suicide rates are higher than any other profession, I could go on. So, maybe now in this new dawn post Gavin Williamson’s monumental cock up with the results system, to redress how we advertise our profession to a wider audience of young people who may well be our colleagues of the future. So, my challenge to you when someone comes into your practice or sees you on a yard or
farm moving forwards, is to engage with them. To encourage them to follow their ambitionswhatever that might be. Sure it is hard when we are spinning a million plates, but I promise you, in the same way that I hold those that helped me get to vet school, through vet school and every day since then, they will remember you and who knows, in 20 years it may just be them waxing lyrical about your influence on making this profession accessible to them that they write about and tell others! Now that is a legacy to be proud of: to have inspired someone and enabled them to find and follow a dream.
GUEST ARTICLE WORLD CONGRESS OF VETERINARY DERMATOLOGY 2020 David Grant
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he 2020 9th World Congress of Veterinary Dermatology was scheduled to take place in Sydney, Australia in October this year. Due to coronavirus the congress, like many other professional gatherings, was forced to cancel. But fortunately with recent significant advances in online technology the entire programme will be available to view from the comfort of your home for six months from the start of the congress until April 20th 2021 -but more of that later. The world congresses of veterinary dermatology have always been and continue to be an opportunity for any veterinary practitioner, whatever their interests, to quickly get up to speed in dermatology. It is most certainly a congress for all -not just those already committed to the specialty. I was able to attend 5 of the 8 congresses that have taken place. Each setting has been in a prestigious location, allowing for a very lively social programme as well as the scientific content. The first congress was held in Dijon, France in 1989. There were 600 delegates from 35 countries and it was a resounding success. On the social side the congress banquet stands out with the very best in French food and wine. Three years later in 1992 it was the turn of Montreal, Canada with slightly less delegates but again with a very good scientific programme.
The congress thereafter moved to every four years and in 1996 to Edinburgh. This is one of my favourite cities and the congress was blessed with wall-to-wall sunshine throughout-not always guaranteed to be fair, but when the weather is fine Edinburgh is one of the loveliest places to be and so it proved. The number of delegates had by now increased to more than 800 and the social programme was superb with the Scottish country dancing being immensely popular, especially with the delegates from north America, and being outdoors added to the spectacle. This was one of the best congresses I had been to. In 2004 it moved to Vienna, another world-class city and with by now 1,500 delegates from 56 countries. I missed this one but was able to go to Hong Kong four years later in 2008. It was the first time the congress was held in Asia and it attracted 1,150 delegates from 50 countries. It was incredibly well organised with the standard mix of general updates for practitioners and advanced information for experts, along with the latest in scientific research. Vancouver in 2012 proved to be very popular with a record attendance of 1,600 delegates and many took the advantage of organising vacations round the congress dates. Bordeaux in 2016 was yet another resounding success but tinged with sadness due to the
death two years previously of two of the world’s most knowledgeable dermatologists, Didier Carlotti and Peter Ihrke. Didier was very instrumental in getting the first congress off the ground and had always been at the forefront of veterinary education, and subsequent congresses, in addition to running a successful veterinary referral practice. Peter, as a professor of veterinary Dermatology at the veterinary school in Davis, California, had supervised many residents to achieve specialist status and would have been President of the WSAVA had it not been for his untimely death.
these have a truly Australian basis including, for example, the intriguing ‘Saving the Tasmanian Devil from Extinction’ As I have suggested I hope, this year’s congress is a rare opportunity to listen to the world’s experts on a range of topics that will be bound to inspire you, and vastly improve your knowledge. I dipped into the programme to update practitioners. The content is enticing! I am commenting on some of them here, but you can see for yourself by logging in to the congress website.
The congress can be counted as one of the most http://www.wcvd-9.com successful to date with 1,750 delegates from an astonishing 72 countries. Of these 20% were from Asia, demonstrating the drive and enthusiasm for dermatology by our colleagues from that part of I liked the look of every single one of these general the world. practitioner updates From the beginning each congress has opted for a similar format of themes, including a significant one for the general practitioner. This is important because you might not think of registering if you thought it was a congress just for the dermatologists. We all know that skin cases are very common in practice, but it might seem very difficult to keep up to date with these seemingly complicated time -consuming cases. This year’s congress has 24 general update lectures designed for the general practitioner on a wide-ranging area of small animal dermatology. Just for access to these, (as mentioned until April 20th 2021), will only cost £100 (for the full range of costs see below). The full registration will allow access to more than 100 hours of CPD. There are various themes including the one for practitioners that I have already mentioned. The others are: • Advanced dermatology for the practitioner • A feline dermatology theme • An Equine dermatology theme • Exotics • Scientific Advances in dermatology (for specialists, those in training and anyone else with a curious mind that wants to know what’s currently happening!) • A session on exotics and wildlife-some of
• Diagnostic approach to the pruritic dog. • Update on staph pyoderma • An interesting up date on parasitic skin diseases in the age of isoxazolines. Will they exist I wonder? • Four separate lectures bringing you up to date on everything to do with atopic dermatitis-five if you include food allergy • Has anything changed in eosinophilic granuloma complex? Danny Scott- asks the question based on his extraordinarily long experience at the forefront of veterinary dermatology. He is generally acknowledged to be the most knowledgeable and charismatic speaker anywhere. It is great to see that he hasn’t retired, as many like me had thought. Very good thinking of the organisers to give him some extensive cover in the programme. If you haven’t heard Danny speak-now is your chance! • A lecture on cytology-what does it actually tell us? • Skin diseases of the nuzzle and paw • Four lectures devoted to otitis externa • Top practice tips from a range of speakers • General diagnostic approach to alopecia • Demodicosis –is it still a problem? This from Ralf Mueller-I am intrigued to know what he will say in answer to the question!
• Dermatophytosis update • Hypothyroidism-what should we be doing? • Ditto hyperadrenocortism • Diagnostic approach to nodular skin disease-is it infectious, sterile or neoplastic?
that the coronavirus will eventually be tamed in time for the next world congress in 4 years time in Boston. The only sad part is that Sydney would have been fun, for those able to get there, with the renewal of friendships. The online conference does enable potentially many more colleagues, however, to learn from world-renowned specialists.
• Update on flea-borne zoonoses In the time available you would only need to watch one per week to cover a huge chunk of dermatological diseases likely to be seen in practice. I would suggest going for the advanced section too, as many of the lectures are complementary to the update theme. The costs represent extraordinary value for money and you can be educated at any time wherever you choose in comfort. I doubt we will ever have an opportunity like this to access all the talks and much more in a world congress of veterinary dermatology. We must hope
Find Out More! Event Dates 21-24th October 2020 Access to the full event for 6-months post-event until April 2021.
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onlin
Feline Behaviour
Conference
Friday 11 September 2020 • 9.30am – 4.30pm Cost: £50 + VAT
Sign up to join us for the first online Feline Behaviour Conference by Cats Protection The Feline Behaviour Conference by Cats Protection is one of the first conferences dedicated to cat behaviour and is ideal for veterinary professionals and everyone working in the animal welfare sector, caring for cats as well as budding cat behaviourists. Speakers include a range of cat behaviour experts, including welfare advocate Sarah Ellis, a Research Fellow at the University of Lincoln and leading expert in feline behaviour and animal welfare and co-author of ‘The Trainable cat’. Register now at www.thewebinarvet.com/pages/feline-behaviour-conference-cats-protection-tickets/
Come and join us! Reg Charity 203644 (England and Wales) and SC037711 (Scotland)
VET_5798
IN PRAISE OF THE EVERYDAY VET
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started this blog 2 years ago and have re-visited it a couple of times, but recent events have finally got me to work out what I feel I need to say. A vet friend is looking for a new job in a first opinion clinic and the lack of respect and financial reward for being a brilliant all-rounder is worrying me.
through ever advanced job titles and roles? It sometimes feels like this. Undertaking further certificates, adding management responsibilities alongside clinical duties. But is this the only way to measure a career? A discussion that has been going on for a long time, so back to the present and my friends situation.
Back to 2018... I’m writing this as I head home from BSAVA, I’ve paid for the more expensive Virgin train home and am luxuriating in the fact I have a seat and there isn’t a hen party surrounding me like last year… I have had an absolute ball this year, avoided hangovers, met even more of the amazing people in our online community. Oh and a few lectures and workshops and learning too! I’m sitting here reflecting on all the conversations and new info so thought a run down might be good for everyone. You can give dog blood to cats in an emergency ! – but please read up on this first! I can now do a Chinese finger trap suture We need to talk about what we all mean by telemedicine Then there were the wider discussions on diversity and social media and new grads and what does a veterinary ‘career’ mean. Is a career progressing
The friend I mentioned is an exemplary first option and ECC vet, the type of vet every clinic needs. They can turn their hand to medical and surgical cases and emergencies. They have experience across private and charity work and if their ‘specialism’ had been to focus on an area represented by a certificate they would be in a wellknown name in the referral world right now. Instead they are looking for a job as an ‘experienced’ vet with superb clinical and people skills, but as a first opinion vet without the ‘certificate’ available for other skills sets. Current certificate options are still focused on a clinical skills set or adding management roles. Yet good first option vets offer expertise across medical, surgical and imaging skills sets AND are usually amazing leaders for their team. Yet the certificate world is still trying to mould them into a specific clinical and management role. However the true genius of the successful everyday vet is their skill across all required clinical areas as well as being true leaders with no need
Jane’s Blog for specific titles. Yet this lack of identity makes defining how much these people give to a team and their patients very hard. As vet nurses we know this then makes it hard to have a financial value that can be demonstrated in a salary. I don’t have any specific answers for this issue but wanted to acknowledge that the brilliant everyday vet has been a valuable colleague to me in many teams and I know many vet nurses feel the same. There may not be a snazzy certificate or job title for you, but we do know your true worth, lets try and make sure everyone else does too.
The first pet focused eye health awareness week takes place at the end of September to coincide with Eye Health Awareness Week. As you will be aware, eye problems in pets can go from bad to worse quickly and are often painful did you know that the cornea has around 300-600 times and 20-40 times the density of nerve fibres than the skin and tooth pulp respectively? With this in mind, early identification and treatment of eye problems is essential to animal health and welfare. The Pet Eye Health Awareness Week campaign aims to inform and educate pet owners about the common symptoms of eye disease so that they can be recognised early and veterinary attention sought where necessary. TVM UK offers a range of corneal health products which are accompanied by free ophthalmology in-practice resources and now, to help veterinary practices engage and educate pet owners, is offering waiting room board display kits. These kits are intended to help veterinary practices create personalised, eye-catching displays which will inform owners about the common signs of eye problems. The kit comes in pieces so practices can create their own displays using symptom bubbles which are designed to visually engage pet owners to help them understand the symptoms to look out for including redness, irritation, discharge, dull or cloudy eyes, tear staining, asymmetry and declining vision The board kits allow pet owners to access further, more in-depth information by scanning the QR code with their smartphone camera which takes them directly to the webpage www.tvmuk.com/eyehealth where they can find out more about how to look after their pets’ eye health. There is also an optional ‘Who’s got their eye on you?’ mini quiz to help keep little ones entertained. Can they spot their pet in the animal eye line up? TVM UK will also be providing eye-health related social media content to help practices reach clients who are unable to visit the practice or enter the waiting room due to Covid-19 restrictions. This can either be downloaded from the resource page on www.tvm-uk.com or shared directly from the @TVMUK Facebook page.
Vet practices can request their FREE waiting room board kits via www.tvm-uk.com/eyehealth, or for more information, can contact their local territory manager, email help@tvm-uk.com or call 0800 0385868.
Speaker of the Month
Matt graduated from University of Liverpool in 2003 and spent several years enjoying mixed practice before returning to Liverpool to undertake a residency in anaesthesia and analgesia. From 2009 to 2018 he led the anaesthesia team at Northwest Veterinary Specialists in Cheshire and is now Head of Anaesthesia at Anderson Moores Vet Specialists in Hampshire. Matt is a cofounder of The Zero Pain Philosophy which provides educational resources to veterinary practitioners. Matt was awarded the fellowship of the RCVS this year.
BVSc CertVA PgCertVBM DipECVAA FRCVS 16 Webinars
View Matthew’s Webinars As Matthew is our Speaker of the Month, all of his webinars are now on offer for the month of September!
Check out Matthew’s webinars in our shop.
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.”
What’s the Evidence for Non-Prescription Anti-anxiety Products? The ability to sedate anxious or aggressive patients is a wonderful way to alleviate their stress, which in turn eases ours. On September 10th, Carl Bradbrook’s webinar is on the topic of Safe sedation for dogs and cats. Getting the low down on the optimum choices for that feisty cat with a grade IV heart murmur or the aggressive dog with renal disease certainly sounds a winner. But stress doesn’t just happen at the vet clinic. There are legions of pets out there that are afraid of thunder, fireworks, or
Pippa Elliott BVMS MRCVS
even being left alone. It’s natural that owners want to help their distressed pets, and as always there are products marketed to meet that need. Which set me wondering about how effective these products are. With that in mind I started sifting through the evidence to find out. In this short article I’ve cherry picked some products that are highly visible to pet owners and often found on clinic shelves. But should we recommend these products? Let’s find out.
Pheromone products A study by Danielle Gunn-Moore investigated synthetic facial pheromones as a management tool for feline idiopathic cystitis [%] This was a small scale study (12 cats started it), in which 56% of owners felt
their cats overall health improved with the pheromone, rather than the placebo. Owners noted fewer days with clinical signs and also a reduction in behaviours such as aggression or fear. So far so good, but this study did have faults, of which the small sample size is most glaring. Perhaps all we can fairly conclude is a definite ‘maybe’ and that further study is warranted.
A Dog’s Life is to be Sniffed at Strong evidence in favour of canine synthetic pheromone therapy is also lacking. A study by Tod et al [&] looked at the behaviour of shelter dogs when exposed to synthetic canine pheromones. This found a reduction in dog barking, along with improved interactions between the dogs and friendly strangers. Again, the study has flaws, with the results best described as ‘encouraging’. Conclusion: Pheromone therapy is a definite ‘maybe’ when it comes to stress relief, just don’t expect too much.
Fighting Like Cat and Dog? Oh, but before we leave the topic of pheromones, consider this work by Prior and Mills [#]. The results indicate the use of both feline and canine synthetic pheromones in multi-species households improves inter-species harmony and reduces conflict. As the authors conclude there is a “reasonable chance of success at reducing inter-species tension”. Anything that stops the fur from-flying has to be good!
Pet Remedy Personally speaking, I love the smell of Pet Remedy and find it calming…but that’s not evidence for its use in pets. In search
of the later let’s look at Binks et al study. [@]. They monitored the effect of various smells on the behaviour of good ol’ shelter dogs (sadly, the poster dogs for stress). Long story short, they found exposure to the scent of valerian (the main ingredient in Pet Remedy) increased the time spent in relaxed positions, and decreased restlessness and barking. However, once again the study did have flaws and some might argue the evidence is as strong as wet kitchen-paper. Conclusion: Pet Remedy is unlikely to do harm and may be helpful at relieving low level stress, but the effect is subtle.
Alpha-casozepine This nutraceutical is probably on a shelf in your clinic, but how effective is it at relieving stress? A study [£] shows promise with an increase in friendly behaviours in some cats, such as interacting with people and higher scores for positive behaviours at the end of the trial period. But once again, it’s not clear how reliable the results are, with some assessments made subjectively by owners. Again, this seems to be a case of alphacasozepine being unlikely to do harm, other than to the owner’s pocket.
Owner Placebo? A thought to finish on. If a pet picks up their owner’s stress, which then stresses the pet in return… even an iffy product might indirectly help the pet. If the owner believes in the product, they may relax, helps the pet to chill. Now there’s a study right there, but for human medics rather than vets!
References [%]A pilot study using synthetic feline facial pheromone for the management of feline idiopathic cystitis [&] Efficacy of dog appeasing pheromone in reducing stress and fear related behaviour in shelter dogs [@]The behavioural effects of olfactory stimulation on dogs at a rescue centre [#]Cats vs. Dogs: The Efficacy of Feliway FriendsTM and AdaptilTM Products in Multispecies Homes [ÂŁ]Effect of alpha-casozepine (Zylkene) on anxiety in cats
From the Literature – September’20 The virtual world congress of veterinary dermatology is fast approaching-October 21st-24th 2020. You are sure to hear a lot more about this congress, the fabulous programme and the equally fabulous value for money that it represents. Of course it is not the same as being able to go to Sydney, for those able to afford it, but being able to access the entire programme on line with availability for 6 months makes up for the disappointment. I have looked at a couple of recent articles with a dermatological connection. The first, appropriately, comes from Australia and is published in the Australian Veterinary Journal-always good value.
Incidence of presenting complaints and diagnoses in insured Australian dogs Wolf S and others Australian Veterinary Journal 14 July 2020
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he authors make an interesting point in that studies such as this one will help veterinary educators prepare veterinary students to manage the most frequently observed clinical conditions in first opinion practice. Data over a year long period was taken from a very high number of dogs-488, 472. The top two presenting complaints were vomiting followed by pruritus. The diagnoses with the highest incidence were otitis externa and dermatitis. In fact in both years of the study 2016 and 2017 diagnoses involving the skin were the most common. I presume this will translate into more resources for veterinary dermatology in Australia. This information will come as no surprise to UK vets interested in dermatology. It was statistics like these that persuaded me to do post graduate education at the Dick vet in the 70’s. I reasoned then that as these diseases were so common, (thought then as now to represent a third
of consulting time in the clinic), I might as well try to learn more about them. I hope many colleagues will take the opportunity of registering for the on line WCVD9 congress to rapidly update their expertise. Another good resource is the European Society of Veterinary Dermatology (ESVD). Membership of the ESVD comes with many advantages not least receiving Veterinary Dermatology. This monthly journal is full of research articles, case studies, guidelines for diagnosis and treatment and much more. The most recent volume contains some information on a subject, which not so long ago was causing a media furore and just like now advice to wash your hands, failure to do being a major part of the problem. I am referring to meticillin resistant staphylococcus aureus (MRSA).
Recovery of meticillin-resistant Staphylococcus aureus species from pet grooming salons Veterinary Dermatology 31 pages 262-266 2020 Gould and others
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here have been many articles documenting the possibility of culturing MRSA from veterinary hospitals and instruments. The purpose of this study was to see if pet salon environments and grooming tools pose a risk of contamination with MRSA. 19 grooming salons were sampled. Samples sites included clipper blades and handles, leashes, rims of
bathtubs, drains, insides of shampoo caps, bath spray hoses and tap handles. The salons were asked to complete surveys of cleaning practices. MRSA was isolated from 12 of the 19 premises and 25 of 112 samples. Meticillin –resistant S.pseudintermedius, S. aureus and S. schleiferi were isolated from multiple salons, most commonly from electric clipper blades, clipper handles and grooming leashes. An obvious conclusion drawn is that the tools mentioned need increased disinfection practices. Surprisingly no statistically significant correlation was identified between cleaning practices and the isolation of meticillin resistant bacteria. However the authors note that a prospective, controlled, large-scale study is warranted to examine the effect of grooming salon hygiene on the isolation of MR staphylococci in salons.
WEBINAR APPLIED FUNDUS ANATOMY MAKING SENSE OF OPHTHALMOSCOPY RON OFRI DVM PhD DECVD KORET SCHOOL OF VETERINARY MEDICINE HEBREW UNIVERSITY OF JERUSALEM
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his is an absolutely superb veterinary webinar and it makes for essential watching prior to Ron’s next webinar in October, which will deal with acute blindness. He begins with a simple definition of the fundus-it consists of the structures we see through the ophthalmoscope. A colour line diagram of the structures of the eye, the sclera, choroid and retina and the chambers follows. More detail is given on the normal fundic structures –sclera, choroid, tapetum, retinal-pigmented epithelium (RPE), sensory retina, the retinal vasculature and the optic nerve head. There is now a very clever, educational series of colour diagrams building the fundus from outside in and a description of the structure of the normal retina. At this point in a university lecture Ron would invite his students to pull out a hair and examine it. The retina is about 250 microns thick –equivalent to three human hairs. Normally the retina is transparent and we only see it in disease. The retinal vessels are the only visible part normally. The structure of the retina is considered histologically and the dual blood supply is outlined. A very important and useful distinction is made enabling you to distinguish between retinal arteries and veins. The arteries, as we see many times in this presentation, are 15-20 narrower vessels, brighter, more tortuous
and are easy to spot as they start at the disc rim. The arteries are important in disease recognition. If you have watched one of Ron’s webinars previously you will know that there are bound to be large numbers of highresolution images. This webinar is no exception and there is now a section on some changes seen on retinal vasculature. Included are images of vascular attenuation demonstrating retinal atrophy, changes in colour and tortuosity enabling hyperlipidemia, polycythemia, and hypertension to be diagnosed-the latter being particularly striking, and retinal haemorrhage. The optic disc gets the same treatment before moving onto the tapetum-with a wonderful picture of the eyes of hordes of alligators introducing this section. The tapetum lucidum is located in the choroid and reflects light back to the photoreceptors increasing the probability of absorption. Examples of a hyper-reflective and a hypo reflective tapetum are shown. There are many normal tapetal variations possible -colour, pigment content, size, border with non-tapetum and variations due to ageing. 13 illustrations follow, taking us through the normal possibilities of tapetum and non-tapetum findings on ophthalmological examination. We move on to some comparative images of the fundus starting
with the cat. Of note is that all the retinal vessels stop at the optic rim. There are few variations in cats compared to dogs-just 4 are illustrated. The optic disc in cows, sheep and goats are demonstrated, one on horses and some examples in laboratory animals, an alligator (yes you read that correctly). You may wonder, as I did, as to how he got that close to take a fine image of the alligator fundus! Finally an example of a human fundus is shown. We don’t have a tapetum but do possess a macula and fovea. The final part of this webinar looks at the various types of ophthalmoscope techniques available. This includes indirect and direct ophthalmoscopy, and panoptic indirect monocular ophthalmoscopy. The last clinical slide of a canine fundus shows the results obtained by the various techniques. The final comment – arguably the most important ‘take home message’ is that ‘You should conduct ophthalmoscopy of EVERY patient you examine’. The webinar is inspirational and certainly just examining every patient with apparently normal sight should enable the development of a reasonable level of expertise- for what is normal-it’s there for the offering. And as Ron suggests this webinar is intended to be a primer for the next webinar in October, where blindness will be the theme.
WEBINAR A CLINICAL PERSPECTIVE OF FOOT AND MOUTH DISEASE PROFESSOR NEIL SARGISON UNIVERSITY OF EDINBURGH ROYAL (DICK) SCHOOL OF VETERINARY STUDIES
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was keen to watch this veterinary webinar. Foot and Mouth disease was the first one I encountered as a newly qualified vet, (48 hours after my last viva, emergency registration the next day and in Oswestry 24 hours later)! The afternoon of my first day of work I was on an IP (Infected Premise) with 400 infected sheep. The following Monday I was sent to another farm with the disease in cattle, sheep and pigs. It has been many years since I worked in farm practice but my curiosity about foot and mouth has never wavered. The promise of a clinical account was another attraction. The learning objectives of the webinar are as follows: • Understand the impact of FMD around the world • Recognise clinical signs as part of diseases surveillance • Understand ancillary diagnostic tests • Understand risk of transmission of FMD
control in endemically infected countries • Understand the principles of prevention or eradication in FMD free countries The essential features of the disease are outlined. It is a highly contagious acute viral disease affecting cloven hooved animals, pigs, cattle, buffalo, sheep, goats and amazingly (to me) more than 70 other species. The sites of lesions are listed and we are reminded that the disease has a low mortality in adults but deaths can occur in piglets, calves, kids and lambs. Throughout the webinar there are liberal illustrations of lesions based on Neil’s visits to the endemic areas of India, Pakistan and Africa. The disease matters because it reduces milk and meat production, is costly to treat and is a direct animal welfare concern. Presence of the disease results in denial in access to international markets, affects tourism, increased biosecurity coats, increased costs involved in eradication, and more animal welfare concerns, particularly involving pigs if they cannot be transported out. A summary of the costs involved in the 2001 UK outbreak points out that 6.5 million animals were slaughtered with £3.1 billion direct costs and £3.6 billion in indirect costs.
Some biological information updates us on the structure of the virus, which is a small • Appreciate difficulties of FMD non-enveloped RNA virus. A • Understand the concept of effective biosecurity
global map shows the current distribution of the virus and this is followed by a description of its pathogenesis. Ruminants are usually infected by the respiratory route. Interesting facts regarding pigs are that they require 80 x more viruses for respiratory infection, but are relatively susceptible to oral infection (hence bans on swill feeding). Pigs release large quantities of virus in exhaled air and are considered important amplifiers of the disease (the equivalent I imagine of coronavirus ‘super spreaders’). Large numbers of pigs can give rise to ‘plumes’ causing long distance virus spread. There is a great deal of information on immunological aspects of foot and mouth disease noting that cattle can become carriers for up to 3.5 years, with goats and sheep up to 9 months. The main transmission risks are direct contact, long distance airborne spread (I remember this being a factor in the Oswestry outbreak), fomites and animal products –high risk in swill fed pigs and veal calves fed contaminated milk. There follows a detailed account of the clinical signs in cattle with a very informative series of slides showing typical lesions on day one through to day 10 (of importance in trying to trace back infections). These are very clear and ought to enable the diagnose of F&M clinically. The clinical signs in pigs can be severe with recumbency
and reluctance to walk and there is a series of illustrations of vesicular lesions. Clinical signs in small ruminants may go unnoticed with silent spreading and lameness predominating. This was the situation on my first IP. The shepherd had been treating sheep for foot rot. There were lesions, as illustrated in the next group of slides, but the most noticeable thing I remember is that sheep were too sick to run away when approached. There is a comprehensive list of differential diagnoses in sheep, which shows that the diagnosis of F&M in this species is not always straightforward. Turning to diagnostic tests for F&M there are several methods discussed. These are live virus isolation, antigen ELISA, and reverse transcriptase PCR, and sequencing of whole virus genome. Antibodies can be tested for structural proteins in the viral capsid, and nonstructural proteins involved in virus replication. Comparing the two enables differentiation between natural infection and vaccination. The key features of vaccination and vaccination strategy are dealt with in considerable detail, including waiting times before a country can apply to the OIE for official freedom from the disease. Biosecurity measures do not eliminate risk but can reduce the transmission probability by considerable orders of magnitude. There are some examples of these and there is a very comprehensive section devoted to a F&M epidemiological investigations in two
enterprises in Uganda. This illustrates some of the problems that can be encountered and frustratingly in these examples there had been no vaccination since 2017 with doubts about subsequent vaccine availability. In summary: • F&M is highly contagious with virus produced in large quantities in infected animals, and only a low dose is sufficient • Virus is present in all secretions and excretions • There is a high morbidity add low mortality (infected animals remain alive to infect others) • Virus can persist in the environment • In endemic regions there is a social, economic and animal welfare impact • The impact can be devastating in a previously disease -free country • Importance therefore of effective biosecurity, surveillance at national farm levels in the UK with immediate response on suspicion of disease. This is a very interesting, very well presented and important webinar of great value to those colleagues that treat farm animals. I also think that final year students planning on spending some time in large animal practice, either here in the UK or overseas will find this highly recommended webinar invaluable.
WEBINAR HOW I TREAT APOCRINE ANAL SAC ADENOCARCINOMA JULIUS LIPTAK
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his comprehensive veterinary webinar is best viewed after the more general one on cancer treatment in dogs and cats. It is a quite remarkable update including information not only from the speaker’s extensive practical experience, but also because he frequently references the world literature. It makes an excellent summary for surgeons in training, and as in his more general webinar he is not afraid to point out controversies or disagree with earlier recommendations. He is clearly at the top of his game. In the introduction he notes that anal sac adenocarcinoma represents 2% of canine tumours, and is often an incidental finding, although polyuria-polydipsia secondary to hypercalcaemia is estimated to occur in between 25-40% of dogs. The diagnosis is outlined in 4 steps: 1. Rectal examination 2. Blood tests 3. Abdominal ultrasound or CT scan 4. Thoracic radiographs or CT scan As shown later CT scans are superior and can be used alone in those practices that have access to the scanner. Julius makes a convincing argument for not including any form of biopsy initially since it makes no difference to the treatment, and may make the outcome worse. Very good images of CT scanning emphasise the earlier point, leading on to a table (download this) showing the clinical staging of 4 stages of the tumour according to TNM criteria. There is disagreement on the significance
of tumour size and prognostic significance along with other criteria including a very complicated flow chart, which ultimately turns out to be not particularly useful! The reasons for this are dissected out and are of interest to demonstrate how in recent years more stringent peer review and statistical analysis has altered concepts that were previously considered standard.
Prognosis statistics are given for nonmetastasis, lymph node metastasis and distant metastasis. These are very interesting but for me an amazing slide follows. Julius has managed to distill all the information from the literature around prognostic factors onto the one slide. The prognostic factors considered, along with relevant survival values are: -
A more up to date and more manageable flow chart defines management for anal ac carcinoma according to four scenarios. These are non-metastatic, nodal metastasis, splenic metastasis and distant metastasis.
• Clinical signs-associated with tumour size and metastatic disease
Surgical treatment is extensively described and will delight budding surgeons, surgeons that are already quite proficient or others who like me simply want an update on what is involved prior perhaps to referral. Anal sacculectomy is comprehensively described. There is a 10-12% complication rate, including infection, rectal perforation, faecal incontinence, tenesmus and perianal fistula. Sub -lumbar lymph node removal is also extensively covered and the whole section is brought to life with a very good video. There are adjuvant treatment options-again not without controversy for their true value. There is an extensive review of the veterinary literature outlining the results of various studies into the use of chemotherapy and radiation with surgical treatment
• Treatment with surgery-includes data on comparisons between surgery alone, no surgery or chemotherapy alone • Lymph node metastasis – comparison of survival between no metastasis or metastasis • Tumour size -controversy • Hypercalcaemia –more controversy detailed here. Some authorities claiming that median survival is 584 days if normocalcaemic compared to 256 days if hypercalcaemic. Others state that hypercalcaemia has no prognostic significance. This webinar is a real tour de force and thoroughly recommended.
WEBINAR HOW I TREAT CANCER IN CATS AND DOGS DR JULIUS M LIPTAK BVSC MVETCLINSTUD FACVSC DACVS-SA DECVS
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his veterinary webinar by Dr Julius Liptak is one of the many excellent contributions from the recent NZ world congress and I keep finding them! It serves as a general introduction to more specific cancer therapies discussed in other webinars delivered by the same author at the congress and are available to watch on WebinarVet. He begins by asking ‘Why treat cancer?’ His answers are that cancer is a common cause of death in cats and dogs, yet it is the only curable chronic disease and age should not be considered a disease. Important questions to ask are: • What am I treating? • What is the biological behaviour of the tumour? • What is the proper surgical approach? • What are the alternative treatment options? • What are the owner’s expectations and are these reasonable? The answers to these questions define the webinar content, but first he asks another question. ‘When should you do a biopsy?’ Not shy of controversy he states that there are two campsthose that insist on biopsy of every mass, and those (including himself), that will do a biopsy if the knowledge of the tumour type will change the treatment options, or change the owner’s willingness to treat -in other
words not on every mass. He follows this by some clinical examples where biopsy was done or not.
in the process, and surprisingly the sentinel lymph node is not necessarily the regional lymph node.
There is a comprehensive description of four biopsy techniques-fine needle aspiration, needle core biopsy, incisional biopsy and excisional biopsy. The pros and cons of each are outlined with good clinical pictures. Interesting statistics are that fine needle aspirates are non-diagnostic in 13-35%, but lead to a correct diagnosis in 70-100% for round cell tumours, 67-89% for epithelial tumours and 50-61% of mesenchymal tumours. Similarly the other techniques get ratings according to tumour type.
Distant metastasis has important implications on treatment and knowledge of the biological behaviour of the tumour will dictate where to assess for metastasis. Three-view chest radiographs (both lateral sides and VD) are essential and the reasons for this are explained. Also included here is CT scanning and nuclear medicine for bone metastasis.
There is emphasis on the advisability of surgical biopsy planning, which should have a minimal impact on the definitive surgical resection. Poorly planned biopsies can extend surgical margins, change treatment plans, increase morbidity and mortality and hence worsen the prognosis. Reference to the human literature emphasise these points, with two papers evaluating the hazards of biopsy. We move on to clinical staging, which provides information on the extent of malignant tumours and is specific for each type of tumour. In order to stage a tumour local characteristics of the tumour are assessed, with regional lymph nodes and metastasis. There is a lot of detail on sentinel lymph node mapping and techniques involved
Surgical management is discussed under the following headings: • Pre-operative steps. Following staging including CT scanning, complete blood count, serum biochemistry, urinalysis, coagulation profile, blood typing or cross matching and tumour specific tests • Perioperative considerations –being prepared for potential anaesthetic complications, with advice on essential anaesthetic monitoring equipment. Intraoperative blood loss is common and a useful technique for evaluating this is shown • Pain management is essential • Surgical preparation includes general advice on margins and dissection technique • Advice on wide surgical excision for adequate margins. There is a very good line diagram that shows the correct dissection below fascia in comparison with an inadequate
dissection. • A section on wound closure. This comprises information on primary closure, tension relieving sutures, releasing incisions, random and axial pattern flaps, and free-meshed skin grafts • Reconstructive surgery • All the above is extensively illustrated from live cases Histopathology is essential to case management for a definitive diagnosis, grade (where applicable), and margin advice. I very much liked and agreed with the next two points; 1. Histopathology costs are included in the surgical fee 2. Histopathology is NOT an optional fee for the client
It helps the histopathologist to have surgical margins marked with inks and three possible inks are mentioned. The importance of having a good relationship with the histopathologist is emphasised. Send as much clinical information as possible (I would add these days clinical pictures too, as these are very easy to send with smart phones). The good relationship and communication will make the reviewing of slides painless if the report does not match the clinical diagnosis and a second opinion will resolve matters to the benefit of all. What a huge amount of information there is in 58 minutes! It’s a very good summary of how to investigate and treat cancers in a very practical way. It is best watched prior to the webinars, from the same speaker, dealing with particular tumour types., one of which I have reviewed here.