The Webinar Gazette The Webinar vet
To provide: The highest quality vet-led content To be: The world’s largest online veterinary community
JUNE 2020
To have: The planet’s most confident vets
WHAT’S INSIDE Blog from Ben Guest Article News from our Community CPDer of the Month Jane’s Blog Pippa Talks Guest Article Speaker of the Month David’s Reviews
Thank god for the good weather!
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know how trying these last 2 months have been for many in the veterinary community and I’ve just come off a fabulous webinar with Lisa Quigley from Mind Matters who was discussing how to support the team in these trying times. It was fascinating helping with the Q&A session. We are all feeling frustrated and lost in this very unique situation that very few of us have experienced before. I’m very mindful of the challenges that everyone is facing so I’ve decided to make our mental health webinars free to view for the whole of June. This has been ongoing since lockdown and I know a lot of people have been getting benefit from that. Mental Health Awareness week might last a week but it’s something I like to support all year round! You can find out more here I always try to look on the bright side in situations and I’ve been loving the beautiful weather albeit it was a bit windy at the coast over the weekend. We’ve also had a pair of blue tits using
a nest box we put up a few years ago for the first time. I love to sit and watch their toing and froing along with other birds in the garden. We loved running WVAC2020 with our friends at WVA and NZVA and I have filled my boots with all sorts of amazing CPD. It was run for a third party, the WVA, but was charged very competitively at £147+VAT and is available to view until the end of October. Here are just some of the amazing testimonials: “Thanks again, I very much appreciate The Webinar Vet and all the amazing content you have put up for the WVAC conference. - Maddy Connolly When I was perusing the different small animal streams for the original planned congress, I had realised it was going to be tough to decide what to do and what to miss out on! Having it online meant I could see everything! Great to be able to hit pause when needed or go back to listen again to information for further clarity. Would definitely recommend as covers a broad range of topics and there is plenty of it! - Lisa McIntosh I would like to convert my sincere appreciation and great thanks to The
Webinar Vet for giving us this golden opportunity to attend these outstanding scientific lectures through WVAC 2020. Although I’m continuously participating in lots of veterinary conferences, this is my first time watching webinars. I never expected it would be so interesting, easily accessible and with many great benefits. All the lectures are recorded in an excellent way. Every day I get more interesting and get much efforts to continue till I complete all available lectures with full attendance Abdalla Fadlalla Azrug Ahmed” Please do look after yourself during this time and make sure you get time to do nice things. I’m off on a bike ride now.
Take care! Love,
Anthony
Ben Sweeney BVSc MSc (VIDC) Cert AVP MRCVS
Telehealth: The dawning of a new age or simply an asteroid into the midst of our existence?
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have spent the last few months having lots of chats with vets, nurses and business leaders about their approach to telehealth. I have taken some of my musings and put them into this blog post. I love the film Cool Runnings! I must have watched it hundreds of times as a kid. There has always been one line that has stuck out for me: ‘People are always afraid of what’s different’. For me, this can ring true of the current circumstances for many of us as we adopt whatever it is that is this ‘new normal’.
A New Vertical Telehealth is not a new concept, it has permeated multiple avenues of human healthcare in recent times with varying levels of success and multiple hiccups as well as successes, but all with a very clear objective: to make the process of providing and receiving healthcare smoother, more cost-efficient and accessible. So, it makes sense for companies to look to things that have helped the digital evolution and success of other healthcare professions and apply them to a
new vertical. Namely, veterinary medicine. With the rollercoaster journey of companies like Babylon GP at Hand, GP One and the now countless others offering this service to people all over the UK and beyond, it is wise to look to them and their experiences for guidance and their users for insight into the products that we utilize – what has worked? What hasn’t worked? What helped? What hindered? However, as you are all well aware, the fundamental difference between human medicine and veterinary medicine is that need for a physical examination on some level of an animal as they can’t tell us what is going on. There is only so much we can do with telehealth consults – but is that ‘so much’ able to benefit our clients, our profession and, most importantly, our patients? Coronavirus and the COVID-19 outbreak have created a ‘global disaster state’ where many businesses have had to adopt a lean startup mentality: what can we do quickly and cheaply to stay alive.
Vets Get Lean Lean startup businesses work on a simple mentality: find a problem, have an idea to fix the problem, evidence that idea, then test that evidence in the form of a solution and pivot or change the bits that don’t work. They function on the premise that nothing is perfect to begin with, but we launch it and adapt it based on user insight. This is almost contrary to our viewpoint that many of us as clinicians suffer from perfectionism. The irony here is that our modern-day perfectionism to our current standards is based on the fact that at some point in the past someone has dared to challenge the status quo of how we did things at that point in time and tried things differently with the aim of improving outcomes. With this in mind, I don’t think that we as a profession are averse to adopting new things. However, I do think that we hold their success up to high standards. Our problem appears simple at first: reduced footfall means reduced turnover, practices in very real trouble financially with revenues dropping up to 75%, we can increase our digital footfall in order to maintain some cash flow. No brainer, we can see LOADS of digital consults every day… or can we? We have had to adopt a lean workforce owing to the lockdown, with only limited staff members in the physical practice but this opens our eyes to how our client flow works. Can we manage them digitally using part of the team working from home to streamline the flow of cases into the practices? Perfection doesn’t just happen Yes, there have been challenges to uptake, having to educate ourselves and our clients, stressful moments and hard times. The biggest hurdle at the moment is that a lack of any system with decent PMS integrations means that we are either creating two customer journeys, or worse, we are filling someone else’s database with all of our client’s data. And we all know that data is king. Even if we don’t really know what that actually means (if something is free to you, it means that the data or insights someone else is harvesting on the other end are probably worth a fortune to them). Consults have taken triple the time that we would normally take in person, owners can’t actually get
the animal to stay still long enough to show you the problem, Wi-Fi speeds aren’t fast enough, not everyone has the appropriate browsers or smart tech. The list of possible challenges is endless, but in that list of problems lies a list of solutions and those solutions will not be improved by our good experiences but by the challenges that we face and present to those companies offering telehealth products. By engaging with them and providing insight from our own experiences we will improve what is on offer.
Conclusion Telehealth is not the alternative solution to challenge existing veterinary life, but simply a new element and part of the journey for us all to achieve our aims of customer support, attraction and retention but built on the bedrock of providing excellent animal health and welfare. It isn’t perfect now, it may never be, but as our client base becomes more digitally dependent and techsavvy, it will inevitably form an intrinsic part of their veterinary journey: the more we help them to utilise it, the more we help ourselves perhaps? Much like the journey of the Jamaican bobsled team into and through the Winter Olympics, our initiation into the world of telehealth has been bumpy, with fallouts, crashes and failures. Neither us or our clients have had all of the necessary tools, the time to train or familiarise ourselves with the multiple pieces that comprise the customer journey and our own professional journey to maximise the experience. Despite the various bumps in the road, it is my view that the process will become more efficient, more user friendly and more wholesome based on user insights and evolution of the products and integrations into practice management systems to make everybody’s lives easier. The Webinar Vet have spent the last 9 months working closely with Smart.Vet on their end to end fully integrated solution, we really like it and think you will too. Why not have a look and have a demo to show you how it compares to what you are currently using? Find out more information about Smart.Vet here
Guest Article Keeping Sane in Lockdown Elle - The Positive Vet Nurse
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s for many of us, the lockdown has been challenging, especially for those who are on furlough leave like myself and miss doing their job. It is a worrying time for everyone and at the beginning of lockdown, I felt extremely anxious and worried every day that it started to affect my mental health.
What has helped me keep sane? Games I know that not everyone enjoys games and I wouldn’t say that I am a regular gamer, however I have recently bought a Nintendo Switch with the game Animal Crossing. Since playing the game, I have felt relaxed and a lot of my worries have been pushed aside as I have been focusing on this instead. Animal Crossing was a game I had growing up as a child on other gaming consoles and it brought back nostalgic moments for me and made me feel comfortable. I really recommend losing yourself in a game and taking your mind off worrying matters.
Activity books
During lockdown I decided to purchase an activity book which was actually in the sale. I honestly wasn’t expecting for the book to help me as much as it has (It’s called Mrs Hinch Activity Book)!. The book contains cleaning lists (I am a list person, so this ticked the In this article, I wanted to talk about ways that boxes for me, literally!), puzzles, crosswords, I have overcome some anxiety and how I have colouring pages, dot-to-dot and spaces to kept sane during lockdown. write positive things and practice gratitude.
Where is your energy going? At times like these, there isn’t an awful lot that we can control and most of our energy is consumed worrying when we should be focusing on what we can change. I made a sheet to help me on days where I feel overwhelmed. I write down my worries and then put them in the correct place on the circle. It then gives me a clearer picture of what I can and cannot control. Surprisingly, this really helps me to see things from a different perspective and allows me to focus more on ‘the circle of influence’ meaning things that I can change and have control over.
Colouring has also been a helper for me as I don’t realise how long I have been doing it for, so the time passes, and I almost forget what I was worried about in the first place!
Baking Before lockdown, baking for me was a form of punishment. I am not the best baker in the world and never really enjoyed doing it, I make a mess and often burn everything. With that being said, I have had chance to practice and enhance my skills and I have surprised myself! I have made shortbread, gingerbread, cupcakes and my absolute favourite is a white chocolate and raspberry loaf cake! It’s also been really fun to eat everything too!
Making a comfy area When feeling anxious, I have made a little area in the house where I can feel really comfortable. For me this comfortable area includes; cushions, blankets, candle wax melter on, a podcast or my favourite music playing and dimmed lighting. It is amazing how making a little area for yourself can make you feel so much better. I like to sit and read or journal in this area and it makes me feel less anxious.
I really hope you liked some of my “ways to keep sane” activities, maybe you can have a go at finding the things that relax you and incorporating them into your daily schedule. Stay safe! You can access the whole of The Webinar Vet’s mental wellbeing content for free during May – unlock your access here You can find the rest of Elle’s blogs here
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The Bought By Many CPD course aims to help nurses fulfill their CPD requirement efficiently and cost-free. And because Sarah James, Bought By Many’s Vet Relationship Manager, is a former vet nurse, she understands they’re the heart of every practice. She knows it can be difficult to find the time and money to travel for the best CPD, so Bought By Many’s course is a way to bring the experts to you. It’s a digital business so it knows the importance of connecting people online, especially in a post-Covid-19 world as this form of learning becomes more common. Bought By Many is helping vet nurses because its team loves pets and wants to see them get the best possible care, just as vet nurses do. Sarah James says: “At Bought By Many we’re making pet insurance like it should be and want to do the right thing for pets, owners and vets. Vet nurses have a vital role in ensuring practices operate smoothly. We want to show nurses our support and thank them for the difficult and important work they do.” Bought By Many is fast becoming the choice of pet lovers across the UK. It already covers more than 200,000 pets and was voted the most trusted pet insurance provider in the UK at the 2019 Moneywise awards. Bought By Many is also making things easier for vet practices. When it comes to claims, it was ahead of the curve on removing paper forms and simplifying the process by reducing broad exclusions. And its excess is paid only once per year, rather than for each treatment. Vet nurses who sign up for the Bought By Many CPD course will also benefit from free access to the Many Nurses Club – an online community that plans to offer unique content and offers for vet nurses. The club will also be your opportunity to help improve pet insurance further by giving your thoughts on changes Bought By Many is planning.
To find out more about the Many Nurses Club and the unique offers we plan to bring you, visit us online at http://bbm.link/manynurses
With thanks to our WVAC 2020 sponsors We hope you enjoyed the WVAC 2020!
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NEWS FROM OUR COMMUNITY
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ne of The Webinar Vet’s top speakers, Professor Ian Ramsey BVSc, PhD, DSAM, DipECVIM-CA FHEA, FRCVS has been appointed President of the BSAVA for 2020/2021. The Presidential handover usually takes place at BSAVA Congress but was delayed this year given the cancellation of the April event due to COVID-19. During his Presidency Professor Ramsey intends to promote and enhance the digital offering of the Association to BSAVA members coping with the pandemic. He will also oversee changes to BSAVA congress with a more interactive approach to training; shortened, more focussed lectures and greater integration between the exhibition, the scientific content, and the social events. You can find Professor Ian Ramsey’s webinars here and read more on the story here.
CPD’er of the month
Rodyan Crangaci
The Webinar Vet, e-library’s, and other e-learning sources, has made a significant difference in my professional development, because we are experiencing so many changes e.g. Fluid therapy, Assessment and Management of diseases due COVID-19, veterinary standards, or something becomes less common for the UK etc. Memorizing a massive amount of information was daunting, so reflective notes, and reviewing the information helped me not only to know “how” to, but “what” and “why” also become much clearer.
With thanks to our WVAC 2020 sponsors
WE ARE COMMITTED
TO HELPING YOU CARE FOR ANIMALS We do this by providing you with highly effective products, exclusive to veterinarians worldwide and the very highest level of support and education.
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CONFERENCE COMMUNITIES
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’m going to manage two blogs without using the C-word this month, but I need to acknowledge that lockdown means I’m missing the usual buzz of conference season. Although I wasn’t planning to go to many this year because I’ve noticed that a PhD is really a full-time job (!) I’m still missing seeing you all share your conference fun. I now realise that attending conferences has very much been a pattern for my life for a few years.
and the only one with their toes out. It was like the end of winter for me, and those time markers are gone for this year. Oh and I did learn things too – promise!
Coping in lockdown has brought loads of ‘self help’ and online support – which is great. However the thing that has helped me most is acknowledging what I am missing most, and BSAVA to Vet Fest and everything in between is definitely up there. I’m missing seeing friends I’ve written lots about and putting the vet world to professional and learning rights as we chat. Missing communities and I now realise choosing which lectures to go that the people you see at to and the nuggets of exciting conferences who you don’t new info that will excite me. see elsewhere are their own Meeting new people and little community, who we connecting with those I’ve won’t get to see this year. It only met online. Truly fun also was part of my start to events and ones that I hope Spring as I aimed to be tanned don’t have to change too and in sandals at BSAVA in much in the future to fulfil our April! Even if I was freezing CPD and social needs.
Jane’s Blog One positive of lockdown is I am much more likely to join in online activities now. Travel, standing and walking at events really ruins my back and I had to balance conferences with rest time. Online events negate that and I can sit in my ‘special’ back chair. I’m also able to focus more easily with the reduced pain levels of ‘attending at home’. So I am missing you all, my conference community, and I know people are working hard to ensure events happen in the future. Yet, there may be exciting new avenues to create to establish that familiar conference season pattern – toes out,or toes in!
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
20th Century Rabbit
Rabbiting on about Rabbits Let’s peer down the rabbit hole at some social history relating to people and rabbits. For example, did you know that for the Victorian’s a rabbit’s ear length was everything; and that ‘cuniculture’ was a Roman term for farming rabbits for meat and fur?
Despite being popular pets, rabbits carry a world of misunderstanding on their furry little shoulders. This is evidenced by the need for Guen Bradbury’s webinar (16th June 2020) on Managing bodyweight in rabbits. Sadly, obesity in pet rabbits is a big thing. In part, those expanding rabbit waistlines are due to their heritage as food producing animals. Indeed, pelleted foods were actually a product of the rabbit meat industry. Originally high energy compounded diets were designed to encourage rapid growth so the animals could be culled for the maximum financial return. Unfortunately, whilst owners have a perception that commercial diets are what rabbits eat; many foods are inappropriate when fed ad lib to pets with no need for rapid growth.
If farming rabbits for meat makes you feel squeamish, know that mind-sets have changed a lot. During both World War I and II, the UK government encouraged people to ‘grow’ rabbits in their gardens for meat. In one year, a single breeding pair could produce an estimated 80 kg of meat, something not to be sniffed at in a survival situation. It’s arguable that these wartime backyard bunnies are responsible for their reputation as an ideal child’s pets. During the war it was often the children who cared for the rabbits and gathered weeds to feed them. You can imagine with the pressure of war removed, children rebelling against culling Flopsy and instead promised to care for her without the parents needing to get involved.
twenty inches long, to present a specimen to Prince Albert. This dream had a little way to go though, with ear length in the 1830s being 13-inches, and in the 1840s 14 – inches.
Rabbits in the Middle Ages Stepping further back in time to the Middle Ages, rabbits were mostly about meat (again raised by the children of peasants for this purpose)… and some rather crude euphemisms about genitalia.
But even in the previous century, keeping pet rabbits was not a new thing, as we will see.
The rabbit or ‘coney’ in common parlance referred to the female reproductive parts. Indeed, a ‘rabbit hunt’ meant something else altogether from the obvious, as evidenced by an ivory mirror from the period (currently in the V&A) which shows a hound leaping on a rabbit, which was widely understood as symbolic for a lover leaping on a lady.
Victorian Rabbits
Roman Rabbits
During the 19th century, there was a large migration of people from the countryside to towns. Previous to this, rabbits were mainly meat-producing animals, with the occasional odd-ball keeping them as pets. But the Victorians moved the latter to a whole new level. Many of the transplanted middle classes, somewhat sentimentally, kept pet rabbits as a reminder of the rural idol of their roots.
But it is the Romans who are credited as creating ‘cuniculture’ or the organized breeding of rabbits for meat. Of course, they also get credit for the rabbit’s Latin name, Oryctolagus Cuniculus. The ‘cuniculus’ part refers to an underground passage or tunnel, and ‘orycto’ meaning digging. Interesting.
An impression of these new attitudes to rabbits is gleaned from the founding, in 1827, of the Metropolitan Rabbit Club. Their aim was “to improve them [Rabbits] without pain.” And what did they mean by ‘improve’? A quote from the Club Show of 1847 puts us in the picture: “The ears have it with the fancy conies, and all thoughts of… puddings and roastings are set aside for ears and “carriage of ears”.’ In 1844 the Chairman was quoted as saying: It would be his greatest ambition when they could produce rabbits with ears
And Back to the Future Bringing us back to the present day, its perhaps no big surprise given their shift from meat production to pampered pets that owners think a ‘cuddly bunny’ is a happy bunny. Indeed, Guen Bradbury’s webinar (16th June 2020) on Managing bodyweight in rabbits is not to be missed, for those veterinarians tasked with encouraging good health for modern rabbits in their role as pets.
Guest Article Sun, snakes, serum and students John E Cooper and Margaret E Cooper
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e enjoyed reading your Guest Article “Snake handling gives me the shivers” (The Webinar Gazette May 2020) but must warn readers that we not only like snakes but have worked with them for decades – particularly in Kenya, East Africa. We first lived in Kenya fifty years ago. Since 2002 we have been returning 2-3 times a year to provide teaching and training on various subjects, but our focus has been reptiles. We have laid particular emphasis on working with local people, ranging from veterinary surgeons and students to reptile keepers and attendants. On our latest visit, in February, we visited a collection in Mombasa, where there are forty mature tortoises (mainly leopard, Stigmochelys pardalis) and approximately 20 babies – all of which hatched on the site (Figure 1). We organised a practical, interactive, training seminar. It was attended by staff who care for the collection’s tortoises, others involved with the project and Mr Shadrack Kombe, a senior and experienced Kenyan African herpetologist (Figure 2). It was clear that there is an urgent need to upgrade the accommodation for newly-hatched and young tortoises. They are protected from predators such as mongooses and Indian house crows (Corvus splendens) by being confined in a covered pen but this structure is deteriorating fast. Plans were drawn up to renovate and replace the pen, but the restrictions relating to Covid-19 mean that this is
unlikely to be completed in the near future. The second task was to examine the tortoises. Two adults were examined in some detail as they had lesions that needed veterinary investigation (Figure 3). Advice was given on diet, including the preparation of ground cuttlefish as a calcium source (Figure 4). The other reptile-related part of our visit took place at the Kenya Snakebite Research and Intervention Centre (KSRIC), near Nairobi. With Kenyan colleagues we organised a seminar entitled “Reptiles and Snakebite”. The morning started with a tour of the KSRIC Herpetarium, led by Mr Geofrey Kephah, an experienced snake-handler and herpetologist (Figure 5). The snakes are kept for venom production and research and are housed in temperature- and lightcontrolled rooms, with shelves of labelled plastic box cages. The formal part of the programme took place in the new Conference Hall, which was full to capacity with staff and visitors. Several short lectures were given, covering topics ranging from health, diseases and legal considerations when keeping reptiles in captivity to the use of snake venoms in the treatment of humans and animals. One presentation that attracted considerable interest was given by Dr Jessicah Murere, who graduated in veterinary medicine at the University of Nairobi last year. Jessicah is part of a small group (they call themselves “The Snake Charmers”) who provide veterinary services to the Nairobi Snake Park. Jessicah spoke about some of the cases she has treated. Participants then mingled and talked over Kenyan “bitings” (refreshments - nothing to do with reptiles!). More information about the seminar can be found on: https://thefrightenedfaceofnature.com/2020/03/25/ charming-snakes-by-dr-valerie-jeffries/ The seminar was a reminder of the advances that have made in Kenya in respect of herpetological medicine. Fifty years ago John served for four years as honorary veterinary surgeon to the Nairobi Snake Park. Based on that work and his research at Jonathan Leakey’s snake farm at Baringo, he co-edited with the late Dr Oliphant Jackson MRCVS one of the first textbooks on diseases of reptiles (Cooper and Jackson (1981) Diseases of the Reptilia. Academic Press). The arrival on the scene half a century later of “The Snake
Charmers” is an historic step forward and promises to give Kenya a strong start once again in this specialised field of veterinary science. We returned from Kenya seven weeks’ ago. Now we can hardly believe the time we had there – the heat and bright light, unlimited travel, interesting work, good friends and spectacular countryside. The people
of Kenya were apprehensive, not only about the coronavirus - it arrived just after we left – but also the menace from the north, swarms of locusts munching through the crops. We fear for the effects of these two pestilences on people in Kenya and their fragile health services and food supplies.
Figure 1: Some of the tortoises, marked with chalk for examination, feeding on cabbage from the local market.
Figure 2: The team prepares to examine tortoises and their accommodation.
Figure 3: Shadrack Kombe and John Cooper investigate tortoises with lesions.
Figure 4: Margaret Cooper and colleagues with cuttlefish.
Figure 5: Geofrey Kephah explains how the venomous snakes are kept and tended.
JEC/MEC 7thh May 2020
Speaker of the Month • Why did you choose this career path? Becoming an oncology nurse was an evolving situation for me. I was Head Medicine Nurse at the time and asked to help Dr Ana Lara in starting the service at the QMHA in 2008; I quickly found the subject fascinating and the nursing skills required both exciting and innovative so when given the opportunity in 2015 to concentrate my time there I jumped at it.
• Tell us a bit about yourself Hi I am Nicola, Head Oncology Nurse at the Royal Veterinary College. I took the apprentice route in qualifying 23 years ago and have been actively learning ever since, most recently graduating with a Masters in Veterinary Nursing (Harper Adams University) and Post Graduate Certificate in Veterinary Education (Royal Veterinary College). I love to learn new things and be as active as possible within the oncology community. • What’s your favourite holiday destination? I love going to the beach and being by the sea; my most favourite place I have visited so far is Mexico – I find the country so vibrant and beautiful, plus it ticks the beach and sea boxes very nicely. I was due to visit the west coast for the first time this April (2020) but we all know what happened there! • What’s your favourite thing to do of a weekend? My home is on the Isle of Wight so when I have finished my working week, as often as I can, I escape the bustle of London to walk, relax, eat yummy things and indulge in the Island’s Mermaid Gin. • What area do you specialise in? My chosen discipline of Oncology Nursing is a small field, yet it has opened up a number of interesting and rewarding opportunities for me, including lecturing, mentoring, teaching and research – which for me luckily, has also involved some travel! I have a particular interest in mechanisms and treatment of nausea (which I did my research project on) and want to work with like minded colleagues to investigate and look for the best methods to treat our patients.
• What do you enjoy most about your job? There is no isolated part to my role that I enjoy the most, the satisfaction I get when looking after the patients, for me equate to the rewards in caring for the client; it sounds nostalgic but I have always felt a real calling towards this role. There are good days and they are sad days, but I work with a fantastic group of people who collaborate as a team to do our very best, in the kindest way using the most current and emerging evidence based medicine. • What are some everyday challenges you face in your profession? The hardest part of my role is definitely the saying goodbye. I learned a bit about grief in my studies, which led me to appreciate more the impact of loss and therefore the reasons why our clients make the choices they do. I have learnt to respect the uniqueness of each family circumstance and work with other professionals to help clients make really difficult decisions and prepare them for the loss of their companion. • If you weren’t doing this career, what do you think you would be doing instead? If I wasn’t doing this job (and after winning the lottery of course) I would open up a pasty shop by the beach at home. As the former sounds highly unlikely and I am very happy doing what I do, I haven’t had a reason to explore anything else however I do wonder if my skillset could be transferred to look after people…. • Are you on social media and happy for people to connect with you? If so, what are your contact details? Yeah why not – best way is nread@rvc.ac.uk I am on FB too
WEBINAR DOES THIS CAT HAVE ASTHMA OR BRONCHITIS? LYNELLE JOHNSON
David’s Review
Lynelle is a diplomate of the American College of Veterinary Internal Medicine, and professor at UC Davis, California and is very well qualified on this subject.
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he begins her veterinary webinar with a differential diagnosis list of respiratory causes of coughs in cats: -
• Bronchial Disease • Pneumonia (mycoplasma, bacteria, protozoa, fungi) • Neoplasia
requires a re-assessment of the diagnosis to include heart failure. Corticosteroids come with known side effects and Lynelle describes a study in 29 cats tat developed congestive heart failure as a direct consequence of corticosteroid use.
Clinically these cats may present with a dry hacking cough, and there may be audible breath sounds or wheezing. Cats with respiratory distress present with cyanosis and open mouth breathing. Excellent videos with sound supplement these opening observations.
Once animals are stabilised radiography is an essential part of the diagnostic pathway and some radiographs are shown to demonstrate some of the features that might be seen in chronic respiratory disease. These are of a very high standard. Further diagnostic procedures include transoral tracheal wash and bronchoscopy. These are described in detail step by step. Examples of information that might result from these procedures include laryngeal oedema, saccular eversion and tracheal hyperaemia. There are some very good examples of the thick airway mucus that is often seen in the bronchi in chronic cases. Another diagnostic procedure that is very well described is the airway wash. Some eosinophils prominently featured in one slide suggest asthma, whereas a neutrophil exudate in another suggests bronchitis.
Management of an acute case is presented. This cat was given oxygen in a non-stressful way (it would not be advisable to perform blood sampling or radiography initially.) Additionally sympathetic beta agonists can be prescribed, such as terbutaline. Follow up treatment could include short acting corticosteroids, e.g. dexamethasone in this case. Failure to respond to initial therapy
Prednisolone is the favoured management for feline bronchitis systemically, with dosages described. Longer-term therapy once remission is obtained can be with aerosol therapy. There is a comprehensive description of the equipment necessary with the dose and cost in US dollars. Expense (at least with US clients) is one drawback with aerosol treatment. For me
• Foreign body • Lungworm Feline bronchial disease tends to occur in middle-aged females with Siamese predisposed. Signs include intermittent cough or wheeze, panting with exercise or acute respiratory distress. Certain trigger events are known. These are: • Upper respiratory infection, stresses • Dust, smoke, aerosol sprays
the best picture I have seen so far in this excellent congress follows. It shows a 2-year-old girl administering aerosol treatment to her cat. The girl has trained the cat to accept the mask and she rushes to administer it whenever that cat starts coughing. A budding vet surely!
suitable for adoption, so as Lynelle observes, a veterinarian steps forward to home the cat. You get the feeling, as if you were in any doubt, from Lynelle’s little asides that she has had plenty of experience with cats and their owners. Her comment on getting a cat to slim down amused me too.
Another case takes us through the history and subsequent diagnosis in a cat with a four-year history of coughing. In this case we are introduced to the use of bronchodilators and the value if nebulisation.
Going back to Ted’s case, it was feline heartworm and the pathway that led to this diagnosis is clearly outlined, along with suggestive treatment.
We are asked - is it asthma or something else? ‘Tache’ a 9-year-old DSH is presented with a history of episodic cough for one year. The diagnosis was asthma but the cat did not respond to prednisolone. What follows is a brilliant detective story with a team effort involving pathologists proficient in cytological analysis. Large amounts of plant fibres were found via bronchoalveolar lavage. The successful diagnosis and treatment is extraordinary and I challenge you to work it out yourselves! Ted’s case follows a cat that is FIV positive-not considered
The final case in the differential diagnosis is a cat with lungworm-more common in Europe but some cases are seen in the USA too. I recommend this webinar for its clarity, quality of the images and description of the diagnostic procedures and the stories that the cats tell. Thoroughly entertaining and educational. This webinar was part of WVAC 2020 and was kindly sponsored by Zoetis. You can find out more about WVAC 2020 here
SPVS and VMG launch ‘Focus on our Digital Future’ digital summit We have all been required to adapt our working practices to overcome the challenges brought to us by Covid-19. This includes SPVS and VMG who have been working with The Webinar Vet to offer their ever popular ‘Focus Day’ as an online event and with the subject this year being ‘Our Digital Future’ the timing couldn’t be more appropriate. The live ‘Focus on our Digital Future’ online CPD day will take place on Tuesday 23rd of June. Ticket prices are just £50 for SPVS and VMG members, and £75 for nonmembers. For more information and to book, visit www.spvs-vmg-events.co.uk With two streams of live and interactive sessions from speakers at the forefront of digital development, the event will be concentrating on how any and every practice can embrace a digital future to enable them to improve their service to existing clients and attract new ones. The day will have a particular emphasis on telemedicine, focusing on ‘how to do’ and incorporating experience and lessons learnt from practices who have been catapulted into teleconsults as a result of the Covid-19 social distancing rules. Key speakers include: • Susie Samuel, Vet Help Direct, discussing the challenges of teleconsultation and how to sell to clients. Including case studies of how practices have used telemedicine before and during the Covid-19 epidemic. • Nuala Summerfield, Cardiology Specialist and founder of VVS, explaining how to create a virtual referral service in your practice. • Ruth Serlin, Lecturer in Veterinary Professionalism, Royal Vet College on how to adapt your consultation styles to the small screen. • Thom Jenkins, PetsApp discussing Client Communications in a Post Covid 19 World, including how everyone’s digital experience has changed in the past few months. The day will include a digital exhibition with a chance to connect with select suppliers, and concludes with what is sure to be a lively digital debate on what we have learnt from Covid-19; what will remain, what will be lost or put back on the shelf? SPVS is a not-for-profit organisation for professionals within the veterinary industry. It promotes responsible leadership by providing tools and resources that enable members to develop and expand their business and leadership skills The VMG represents and supports veterinary professionals in leadership or management roles. Offering a range of resources for professional and personal development, it is a collaborative community within which veterinary leaders can share experience, build relationships and work together to advance their practices and the wider profession.
WEBINAR CHRONIC RESPIRATORY DISEASE IN RATS BOB DONELEY BVSc FANZCVS (AVIAN MEDICINE) ASSOCIATE PROFESSOR AVIAN AND EXOTIC PET MEDICINE SCHOOL OF VETERINARY SCIENCE QUEENSLAND
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his veterinary webinar is quite short-just under 20 minutes but tells you all you need to know about respiratory diseases in rats. Bob starts by detailing a few things about the brown rat, (Rattus norvegicus), the one you will be used to dealing with in the clinic. These rats are social and gregarious, friendly, but short lived -3-5 years. Nevertheless they are quite commonly kept as a popular pet. It’s worth remembering their limited life span in the context of this webinar. This is because chronic respiratory disease is one of the commonest seen in pet rats and also a common cause of death. There is some revision of the anatomy of the upper respiratory tract, trachea and lungs. A surprising statistic is that extension of the head can result in lengthening of the trachea by 50% with no decrease in tracheal diameter. Serous cells in the respiratory epithelium secrete the low viscosity peri-ciliary liquid layer found at all levels of the rat’s respiratory tract. Predisposing factors to chronic respiratory disease are listed: • Irritation of the airways. Poor ventilation, dusty substrates, aromatic oils, ammonia from urine • Immunosuppression. Overcrowding, stress, genetic background, malnutrition, lack of biosecurity e.g. introducing an infected rat
Mycoplasma pulmonis is considered to be a major component in the aetiology. It is ubiquitous in rats and therefore there are many persistent or subclinical infections. The organism is transmitted by aerosol or intrauterine and a very long incubation period may be seen (up to 6 months). Various secondary pathogens –both bacterial and viral are possible and Bob lists these. A neat line diagram in the form of an arrow takes us through a typical pathogenic pathway from establishment of Mycoplasma in the lungs, acute tracheobronchitis and pneumonia, damage to airway epithelium leading to long-term effects. These are airway oedema, increased mucus production and fibrosis. There is a dramatic postmortem specimen of the lungs demonstrating how severe the disease can be. Clinical signs such as dyspnoea, coughing and sneezing are listed along with frequently observed systemic signs such as weight loss, a harsh coat due to lack of grooming (we are reminded that these are very clean animals) and inappetance. Other clinical signs that may be seen include red tears, and a head tilt. This is a disappointing disease to treat in the long term, because it is a progressive disease and nearly always terminal. It is important to emphasise this to owners and aim for prolonging the rat’s life with good quality. In
order to achieve this treatment is directed towards: • Reducing the bacterial load • Reducing the viscosity and quantity of respiratory mucus • Improving airflow through the airways There are suggestions of suitable antimicrobial agents, their dose and length of treatment. Nebulisation with hypertonic saline hydrates the respiratory tract, increases the water content of airway mucus and therefore acts as an expectorant. Finally the use of bronchodilators is described, both inhaled and systemically. As a last resort steroids and/or NSAIDS may have some benefit. Unfortunately euthanasia is necessary in some cases. Bob’s delivery of this very informative webinar is just right. He manages to get over a great deal of relevant information without ever seeming to be hurried. This webinar was part of WVAC 2020 - you can find out more about WVAC 2020 here
WEBINAR VETERINARY STUDENT SELECTION-THE MOST IMPORTANT ASSESSMENT IN THE VETERINARY DEGREE? ELOISE JILLINGS ASSOCIATE DEANADMISSION AND STUDENTS MASSEY UNIVERSITY VETERINARY COLLEGE NEW ZEALAND
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was drawn to this webinar as it’s a topic that regularly crops up in the veterinary press (often, I think, as a criticism of the status quo) but also because I have been for several years part of the interviewing panel for vet students at one of the UK veterinary colleges. Eloisa begins by completely surprising us with a couple of slides in the Maori language. This is soon explained as a way of demonstrating how Maori people introduce themselveswhere they are from who they are married to and how many children they have etc. It is quite relevant in Eloise’s case as she is herself half Maori. Later we see how well (or not) indigenous people are represented in the veterinary community. Assessment, of course, is very important during the veterinary course and is a fairly comprehensive process designed to help, not least, those that are struggling
to meet the various core requirements of the course. Selection before entry to the vet school should be equally important. Massey, we are told, typically has 330 applicants for 100 places. Encouragingly, and presumably due to comprehensive assessment during the course, 95% or more of a typical cohort do succeed in graduating. I am also reviewing the lecture by Stuart Gordon on student assessment at Massey, which is highly recommended together with this one. Eloise states that the goal of veterinary education should aim to; • Select students likely to be successful in veterinary education and career • Plus other specific goals (for example widening access to certain segments of society, selecting for those from a rural background and perhaps more likely to enter rural practice.) Until recently, Massey, as with many colleges around the world, had focused on academic ability. The inevitable question is -are academically gifted students best suited for a veterinary training career? Academically selected students are in general: • Highly motivated • Intelligent • Competitive-but….
• Have unknown personal attributes Massey has moved to 50% academic assessment + 50% non-academic assessment for entry to vet school. There have been drivers for introducing non-academic assessment. These are from the international literature, accreditation standards, internal observations and finally professional feedback. Two references from literature are quoted-one from the medical profession and one from ours. They both have the same conclusion –that those with high academic ability alone cannot be turned into competent physicians via medical training, as other specific qualities need to be present from the start. Whilst accreditation standards can be uniform, Standard 7 for example in the New Zealand setting, other factors must be considered for admission criteria. An interesting survey of New Zealand vets was commissioned asking them if they thought non-academic criteria should be included in student selection. An overwhelming percentage was in agreement that it should be. The follow up question asked what non-academic attributes are important. In order of priority these were: • Communication • Problem solving
• Works well with others • Integrity and professionalism • Resilience • Empathy and Compassion We are asked how will we assess performance in the two groups-academic and non-academic? The former is straightforward based on grade point average, and that previous academic performance is the best predictor of future academic performance. The non-academic assessment is less straightforward. At Massey there is a combination of multiple mini interviews (much the same as most colleges in the UK), situational judgment tests, for example showing candidates a video and then asking searching questions, and a representative equity pathway. This is the one that really caught my eye. A diagram is shown of the proportion of people in New Zealand society. This includes those who consider themselves of European descent, those from Asia, Pacific peoples and finally Maori. Side by side we see the actual NZ veterinary profession figures. Needless to say they are very unequal (as a comparable analysis almost certainly is in the UK). Eloise suggests
ways and means of leveling up and ensuring equality and equity. There are many questions about this and we are left with the thought ‘that we should be thinking about what we should select for, think critically about it while investing the time to do it well’ This webinar is just 23 minutes long, but time is very well spent. It is thought-provoking and suggests a lot more time should be invested in thinking of the beneficial consequences to the profession of getting student selection right. I am really enjoying these webinars from the World Veterinary Association Congress. What a shame it could not have been in Auckland, but the webinars are the next best thing and a tremendous tribute not only to New Zealand, but also to those that collaborated in the setting up of the programme. It seems more than ever an overwhelmingly positive country and there must be many, like me, determined to visit once the world rids itself of Covid-19. Make sure you listen to Stuart Gordon’s contribution on a follow-up theme to Eloise’s. This webinar was part of WVAC 2020 - you can find out more about WVAC 2020 here
WEBINAR EDUCATING VETERINARY STUDENTS FOR THE WORKPLACE
STUART GORDON PGDIPED, M.PHIL., BVSC, BSC (HONS) SCHOOL OF VETERINARY SCIENCES, MASSEY UNIVERSITY PALMERSTON NORTH, NEW ZEALAND
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tuart has managed to pack a lot into his professional life just 23 years after graduating. Although born in Kowloon, Hong Kong, he was educated in South Africa and after graduation found himself living an ‘idyllic’ life in Zimbabwe, combing a lectureship in equine medicine at the University of Zimbabwe with private practice, and consultancy. In his own words ‘my country slowly turned into a social tragedy’ and he decided to relocate to New Zealand and become a senior lecturer in equine medicine at Massey University. He is also now responsible for teaching veterinary professionalism (while undertaking a PhD in that area), as well as teaching undergraduates clinical skills. In his biography he also mentions his, obviously, very happy home life. The optimism and enthusiasm that comes from that is noticably evident in his contribution. New Zealand was a good move! He begins by citing a recent publication that states ‘tailoring training to account for the current needs of both clients and employers would better prepare new graduates for the profession.’ There have been criticisms of too much emphasis on academic knowledge and technical skills to the detriment of generic skills. He quotes the UK Vet Futures Survey of 2015 in which only 23% of students and graduates felt adequately prepared for the work they hoped to do. Some of the problems of getting
the curriculum right are highlighted. The veterinary field is so broad, graduates being in non-clinical roles or in post graduate training, and others that wish to work internationally. Increasing the curriculum tends to encourage a superficial learning style in order to be able to regurgitate facts during examinations (that sounds familiar!). It is not considered realistic to increase the length of the programme. Following extensive consultation with stakeholders some themes became evident. Accrediting bodies are now placing increased focus on: • Effective communication • Cultural awareness • Personal and business finances • Practice management • Self-care Stuart continues with observations on self-care and professionalism. High levels of stress/poor mental health outcomes are well –documented within the veterinary profession and it is therefore essential that mental well-being issues are addressed in the curriculum. Professionalism is defined as the attitudes, values and behaviours that are expected of a veterinarian by the profession and society. Stuart goes on to list key attributes: • Communicating effectively with clients
• Putting the interests of the clients/ patients above one’s own • Maintaining high ethical and moral standards • Adhering to core humanistic values of honesty, integrity and empathy Professionalism training places additional burdens on students, faculty staff and external contributors such as actors as simulated clients, and all this needs assessment, which of course is time consuming. Increasing class size has driven academics to utilize easier to mark assessments such as multi-choice questions and short answer questions. An interesting triangular diagram is of Blooms Taxonomy, which at the lower level is ‘remember’ moving up through ‘understand’, ‘apply’ ‘analyze’ ‘evaluate’ and at the highest level ‘create’. Assessment often occurs at the lower levels and should be higher -but is then harder to assess. Other assessment issues discussed in detail include professionalism assessment. This is more difficult than assessing academic knowledge or technical skills, because there is a need to assess integrity and honesty requiring the use of: • Reflective practice • Case based scenario • Role playing exercises Other scenarios explored include a code of conduct, the failing to fail
phenomenon, and a greater need for day one clinical skills. Some possible solutions are aired, including allowing some degree of specialisation during final year (possible at Massey to an extent in final year and during external placements). However it needs to be remembered that veterinary registration in Australia and New Zealand requires general ‘Day One’ competence to be demonstrated across a wide range of species and subjects. Some of the interesting simulation models for teaching are illustrated from a realistic looking life -sized horse, to simple suture aids using a couple of tea towels, a kiwi fruit (what else?!) which doubles up as a very realistic way of performing a Schirmer tear test and an equally ingenious way of teaching skin scraping. Objective ways of assessing clinical skills are touched on before the important message, (I would say crucial), that employers and new graduates need to remember that learning does not conclude after graduation. And furthermore graduates and employers must also assume
some responsibility for widening their knowledge and developing their employees’ skills. The webinar continues by outlining further training and mentoring and with a summary of the Professional Development Phase of the RCVS-familiar to UK vets. With pressure on students and academic staff for higher levels of knowledge, high levels of expectation from stakeholders, but at the same time high levels of stress in the profession there is obviously a need to look for solutions. Too many recent graduates are anecdotally leaving the profession. This excellent webinar looks at veterinary education and assessment holistically and forms a good basis for solving some of the reasons why vets might get disenchanted, and what Massey is doing about it. The only thing I need further information on is Stuart’s huntaway’ dog called ‘Chilli.’ This pom would like to know what a huntaway dog looks like! This webinar was part of WVAC 2020 - you can find out more about WVAC 2020 here
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Use Medicines Responsibly. Neptra contains 16.7 mg florfenicol, 16.7 mg terbinafine hydrochloride, equivalent to terbinafine base: 14.9 mg, and 2.2 mg mometasone furoate POM-V UK, POM ROI. Advice should be sought from the medicine prescriber. Further information from the datasheet at www.noahcompendium.co.uk or at www.apha.ie or on request. ÂŽRegistered Trade Mark of Bayer AG. Bayer plc, 400 South Oak Way, Green Park, Reading, RG2 6AD. Tel: 0118 206 3000. Bayer Ltd., Animal Health Division, The Atrium, Blackthorn Road, Dublin 18. Tel: (01) 299 9313. L.GB.MKT.11.2019.20842
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Otitis externa (OE) is a common, debilitating condition affecting up to 1 in 5 dogs in their lifetime and is seen on a daily basis in first opinion practice.1,2 Otitis is always painful and usually pruritic and has been shown to affect both the quality of life of owners and their dogs who develop it.3 Whilst the development of otitis externa is not an emergency, it is a potentially urgent problem that could lead to significant welfare compromise if left untreated. Otitis has been shown to have an impact on dogs’ sleep and playing behaviours, and cause their owners physical or emotional disturbances.3 Where otitis is not addressed adequately, a dramatic deterioration of the dog-owner relationship has been shown to occur, leading to low treatment compliance and the development of ear phobias in affected dogs.4 The key to therapy should be early intervention and based on recent quality of life studies, this should be with a veterinary directed treatment rather than an owner directed treatment.5 Selection of an appropriate treatment is essential to relieve pain and resolve infection effectively. This helps to prevent the development of chronic change within the ear canal, sometimes associated with the development of resistant infections and can help to prevent dogs from becoming ear phobic (if they’re subjected to recurrent treatment regimes). The use of long-acting otic products, prescribed on the basis of an aural examination and cytology (when Staphylococcus pseudintermedius and Malassezia pachydermatis are found), resolve infection effectively with the added benefit of being vet administered, negating any compliance issues. Neptra is a one dose solution licensed for the treatment of the most common pathogens seen in 70-80% of OE cases (Staphylococcus pseudintermedius and Malassezia pachydermatis). It contains a first-line antibiotic (florfenicol) which is not on the WHO list of critically important antibiotics, improving antibiotic stewardship, as well as an antifungal (terbinafine hydrochloride) and a potent corticosteroid (mometasone furoate). This highly potent, but “soft” corticosteroid acts rapidly and effectively at a local level to reduce inflammation within the ear canal, with minimal systemic absorption. Neptra improves comfort and there is no need for owners to treat their dog at home – reducing stress for everyone and improving compliance. Join Dr Sue Paterson MA VetMB DVD DipECVD FRCVS, RCVS and European Specialist in Veterinary Dermatology on 30th June at 8pm, to learn how to perform otic cytology and select the most appropriate antimicrobial for the most common OE cases.
ONE SIZE FITS ALL: A single 1ml dose, efficacy is independent of dog and ear size
NO REFRIGERATION NEEDED: For easy storage References: 1. Angus J. C. Vet Clinics of North America: Small Animal Practice. 2004 Mar;34(2):411-24. 2. Hill PB, Lo A, Eden CA, Huntley S, Morey V, Ramsey S, et al. Survey of the prevalence, diagnosis and treatment of dermatological conditions in small animals in general practice. Vet Rec. 2006;158(16):533-9. 3. Jamet J-F, Marignac G, Petit JY. Prospective study of the effect of otitis externa before and after treatment on 20 owners’ assessment of their and their dog’s quality of life Vet Dermatol. 2016;27:45 (abstract). 4. Boda C, Liege P, Reme CA. Evaluation of owner compliance with topical treatment of acute otitis externa in dogs: a comparative study of two auricular formulations. Int J Appl Res Vet Med. 2011;9:157-65. 5. Noli C, Sartori R, Cena T. Impact of a terbinafine-florfenicol-betamethasone acetate otic gel on the quality of life of dogs with acute otitis externa and their owners. Vet Dermatol. 2017;28(4):386-e90.
WEBINAR LOWER RESPIRATORY DISEASE IN HORSES-DIAGNOSIS ASSOCIATE PROFESSOR CRISTY SECOMBE BSc BVMS MVsc (HONS) MANZCVS Dip ACVIM UNIVERSITY OF MURDOCH PERTH AUSTRALIA
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risty Secombe brings a wealth of experience to this veterinary webinar having completed two equine residencies, the first in equine surgery and subsequently the second one in equine medicine as she found this to be her true vocation. Since 2019 she has been Interim Principal of the School of Veterinary Medicine in the University of Murdoch. Her principal areas of research are equine asthma, endocrine disease and clinical veterinary education. This shows in her well-constructed veterinary webinar delivered at just the right pace and occupying 30minutes. I particularly like these shortened webinars as they are uniformly easy to follow but are unfailingly able to deliver a large amount of information. Cristy divides her webinar into four sections. These are the history, physical examination, ‘looking inside’ and sampling lower respiratory tract secretions. Common history and clinical findings are listed: • Poor performance • Cough +/- nasal discharge • Horse unwell/abnormal auscultation • Obvious tachypnea and dyspnea Guidelines on auscultation including sites and the use of a rebreathing bag are well illustrated with line diagrams and videos. This is followed up by a description of adventitious lung sounds, wheezes, crackles and
absence of lung sounds. For each of these we are told where to hear them and what makes the sound. A table then divides lower respiratory diseases into infectious disease and non infectious. The non-infectious diseases include mild equine asthma (MEA), severe equine asthma (SEA) and exercise induced pulmonary haemorrhage, (EIPH). For each of these the expected history and clinical history are described. In the infectious disease section typical history, physical examination and clinical examination findings for bacterial pneumonia are listed. From this we proceed to the third part of the webinar-looking inside. This involves using diagnostic tests to determine how severely affected the lower respiratory tract is. Common diagnostic procedures are endoscopy and ultrasound with radiography being employed occasionally. There are some excellent illustrations of mucus and haemorrhage visualised by endoscopy and the amount of mucus seen is graded to aid in the diagnosis, with typical results we might find in MEA, SEA and EIPH. Further high quality ultrasound images follow and there is a superb thoracic radiograph enabling a specific diagnosis to be reached, although specific equipment will be needed to attain radiographs of this quality. The final part of this very informative webinar deals with airway sampling taking us through the techniques
of trans tracheal wash and bronchoalveolar lavage, which leads on to a summary of the usefulness of cytological examination in diagnosis. A table summarises the most common cytological findings in the various diseases encountered with a comparison of likely results with either of the techniques. As an example in cases of severe asthma a trans tracheal wash may only yield variable results whereas with bronchoalveolar lavage there will be marked inflammation. In summary: • The clinical examination can provide useful information around severity of the disease • Each diagnostic test can provide useful information. However, all have limitations and these need to be taken into consideration when choosing the tests and interpreting them. For experienced equine vets I imagine much of this will be familiar territory, but all colleagues experienced or not will find lots of information in this webinar delivered in a well thought out way. This webinar was part of WVAC 2020 - you can find out more about WVAC 2020 here