The Webinar Gazette - November 2021 by thewebinarvet

NOVE MB E R 2 0 2 1

The

Webinar Gazette

WHAT’S INSIDE: CPD’ers of the month

Speaker of the month

BSVP article

Simply Vets

David’s reviews

TVE

Introduction from

Anthony Chadwick Lots to talk about as we come close to the end of 2021- another turbulent year particularly in the UK where dithering and poor leadership has led to many other problems on top of the pandemic. Late September and early October were times of respite for me. I’ve worked very hard the last 18 months trying to support the profession as best as I could particularly by supporting conferences going online. It was so lovely to get over to see my daughter in Belgium and son in Canada. The second entailed my first trip in an aeroplane for almost two years which Chris Copeman rightly called me out on. Our theme this year is regenerating the veterinary world and flights over to Canada don’t help. I also used the time to make some contacts with vets in Canada to encourage them to use our environmentally friendly way of training. We’ve been working with Chantelle Brandwood’s Eco Offset to measure our carbon in the business to work on ways of reducing it but also double offset our carbon to support a scheme in Madagascar protecting virgin forest from being logged; providing solar stoves to refugees in Chad which stops them cutting down trees for firewood and a re-afforestation project in Argentina. On top of this as a new member joins our paid service we plant two trees and also when a locum starts doing shifts for SimplyVet. We’ve planted nearly 1500 trees in the first half of the year. All of these things mean we are now a carbon negative country.

Returning to Plague Island in mid October from Canada, I was present at LDC’s dinner in Manchester to be named one of their one to watch group which had been published in The Times. That week I also tested positive for Covid 19. Luckily, I am double vaccinated and, Thank God, have not been too badly affected. I am trying my best to rest amongst all the busyness of work. I am so thrilled to announce our partnership with Vetoquinol in the Battling Burnout series, a 3 webinar series starting midNovember. I really understand that it is tough in practice at the moment and I hope you take time to register and give yourself some self-care time! https://www.thewebinarvet.com/pages/ battling-burnout-with-vetoquinolregister/?utm_source=anthony_ facebook&utm_medium=social&utm_ campaign=vetoquinol I’d like to thank Vetoquinol for the commitment they are showing to the profession at this time. With all the issues in the profession at the moment, it’s very easy to spend our time navel-gazing and missing what is happening in the world. I always try to help the profession with this aspect and I will be at COP26 in November to see how we as vets can make our contribution to making this world a better place. I will be feeding back with regular vlogs and social media posts. The climate emergency is our biggest

existential threat which is why we are so committed across the various business units to have a very robust environmental policy. I just heard that we have been named once again in the top 100 tech firms in Northern England and Scotland. This is a big thrill for us as we continue to build the best veterinary platform in the world to help make veterinary CE accessible and affordable across the globe. I’m hoping that LVS can go ahead in view of the rising Coronavirus numbers. I hope to see you there or on one of our webinars. Finally, Claire Wolfenden left us after over two years as CCO. Claire has been a massive help in developing the business and goes with our love and thanks. I want to wish Claire well in whatever she does next. Best wishes, Anthony

Top 5 Cpd’ers of the month, combined total of 180 hours Helena Lafuente-Nicolas Sivavatchr Panitarnangit Blanco Alejandro Peggy Lewis Nicky Shaw

Meet

the team

Luke Curtis, Finance Director. Hey community I’m Luke, CFO of Alpha Vet International which means I am involved with all thegreat brands we have from the world leading education platform The Webinar Vet to the dynamic recruitment platform Simply Vets. Having been with the business for a super speedy 5 ½ years I am privileged to have seen it grow and look forward to help guide it into the future. Outside work, my world revolves around two key things: 1st) My wife and 2 boys. 2nd) Running, lots of running, Chair of Penny Lane Striders Running Club in Liverpool and Run Director of The Mystery Junior Parkrun Ahh yes I also spend lots of time in the winter feeding the birds. You can’t beat a nut hatch, jay or greenfinch!

If I wasn’t doing this? I would probably be organising running events and generally be promoting active travel trying to get people out of the their cars wherever possible #sustrans #runsome As we move toward 2022 my goals are to keep up my CPD (I know, as the accountant I have to do it as well) to be the best I can be to support the company growth. And, you will not be surprised my second goal is running related, to complete my first Ultra Marathon from Old Trafford to Aintree (50 miles). Finally if what 3 words best describes me? focus.reliable.driven (what3words – makes me somewhere west of Kyiv in the Ukraine – where does your 3 words place you?)

Speaker of the month

James Prutton

bachelors in Veterinary Pathology

Jamie undertook a bachelors in Veterinary Pathology at the Royal Veterinary College as an intercalated degree during his veterinary degree at The University of Liverpool. Upon graduation he started working at a mixed large animal clinic in Yorkshire. Following a year and a half in this role he started an internship at Rossdales Equine Hospital in Suffolk. While there he became interested in Equine Internal Medicine and after the internship moved to California to start an Internal Medicine Residency at The Veterinary Medical Teaching Hospital, University of California, Davis. He gained Diplomat status from the American College of Veterinary Internal Medicine in July 2015 and has been practicing at Liphook Equine Hospital since then. https://www.thewebinarvet.com/speaker/ james-prutton https://www.thewebinarvet.com/shop/sotmnov2021, coupon code: SOTMNOV coupon code: SOTMNOV

IDEXX Laboratories UK were proud sponsors of the BSVP Autumn Meeting Conference “Reversing the Brain Drain: Neuropathology Goes Global”. IDEXX supports education of young vets and pathologists. An initiative developed during the COVID lockdown to provide additional training for residents in the IUK and beyond has continued, and we are proud to have delivered a number of seminars for vet students and pathology residents, to support their training and development as other opportunities may have been limited with lockdown restrictions. Although the majority of the team were used to working remotely, as we have been fully digital for pathology for a number of years, the lockdown periods of 2020 and ongoing restrictions have posed some challenges. With a diverse and global team, we have been able to support our colleagues through some more challenging times, including allowing flexible working when schools were shut. It is important to us that we are able to continue to provide the service that our clients are used to, particularly at a time when practice staff are under increased pressure.

ELBOW TRAUMA COURSE Application of Fusion LEAP & HIRS Online Classroom and Remote Guided Dry Lab Upcoming Course Dates:

Tuesday 30th November 2021 Tuesday 18th January 2022 Tuesday 15th February 2022 COURSE AGENDA 09.30 10.15 11.45 12.00

13.00 13.30

14.30 15.30

HIF and Humeral Condylar Fractures In Dogs: Aetiology and Pathogenesis, a Review HIF – Clinical Management; Including The Humeral Intracondylar Repair System Coffee Break Practical: Placing a Transcondylar Implant. Placing a HIRS Implant, Including Custom Drilling Guides Lunch Humeral Unicondylar Fracture Management: Including The Lateral Epicondylar Anatomic Plate Practical: Placing LEAP Case Discussion and Close

Workshop speaker: Ben Walton BVSc DSAS(Orth) MRCVS RCVS Specialist in Small Animal Surgery (Orthopaedics)

Course Price

£420.00

For more information please contact

+44 (0) 151 794 4912 info@fusionimplants.com www.fusionimplants.com

Many people ask us, ‘What should I be charging?’. Now, if you are here to find out what you should be charging as an individual, then you may be disappointed. We will talk about some of the pay scales and the factors that should be considered when deciding what to charge, but for a conversation about individual figures, drop us an email at info@simplyvets.com for some personalised advice. It’s a pretty good time to be a Locum right now. With the current state of veterinary recruitment and the national shortage of veterinary staff, locums are in incredibly high demand. This allows you to charge more for your services as practices become more desperate for cover – of course, you don’t want to take advantage and practices can only pay so much, but it’s a locum’s market right now. The pay range for our locums starts at £300 per day and goes all the way up to £1000 for specialist emergency OOHs work. Finding the figure between valuing your time and not overcharging can be a difficult balancing act so here are some of the factors that come into play: 1. Skillset/Experience 2. Location 3. Accommodation and travel 4. The nature of the work… are there antisocial hours? 5. General costs

Skillset/Experience Experience isn’t everything, just because you are 30 years qualified, it doesn’t mean that you know everything. You also shouldn’t undervalue yourself just because you are recently qualified. Yes – typically there is a correlation between how long you have been practicing and the breadth and depth of your skillset, but that’s not the be-all and end-all. If you are a very clinically capable vet or nurse, then you should command a higher price than one operating at a lower level.

Location

Travel

DEMAND DEMAND DEMAND! You may think that a locum in London can charge twice what one in Newcastle charges right? Probably not. Locums are in SUCH high demand across the whole country, however, there are certainly some areas worse affected than others. The north of England and rural Scotland are especially desperate and this incredible demand for a locum dictates a good deal of what you can charge. Of course, you can’t charge £2000 a day just because you are the only vet or nurse for 100 miles, but it does have a massive impact.

If you’re just commuting to and from the practice every day, then charging for travel really isn’t necessary. If you will be making house calls or farm visits with your vehicle, then you should think about charging mileage or at least baking that cost into your day rate. If you do charge, you NEED to record your mileage. In terms of what to charge, 45p per mile is considered standard.

Accommodation and travel Accommodation Now, if you’re working at a local practice then skip along, however, if you are in a different part of the country, you need to think about your living arrangements. These things are always up for discussion with the practice and you’ll typne of 4 responses: • There is accommodation on-site (some are better than others so always ask to see pictures first!). • There is accommodation down the road/nearest town etc. Typically these are B&Bs or Airbnbs that a practice has a relationship with. Used mostly for shorter-term contracts, normally a week or two. • The practice provides you with an allowance to find a place yourself. These allowances can cover anything from 10% to the total cost of your accommodation. Make sure you do your research before agreeing to anything with the practice – find a place first! • Some practices don’t offer accommodation or any allowances. In this case, we would recommend a slightly higher day rate to help cover the costs you will incur working away from home.

It’s so important that accommodation and travel are discussed well in advance. You don’t want to turn up and find that the arrangements aren’t fit for purpose. Make the practice aware that you need some form of accommodation and ask what they can offer. Most practices will cover accommodation costs but may ask you to lower your daily fee slightly. Enquire about any house calls or farm visits and what the procedure is. Communication is key.

The Nature of The Work Some people shy away from talking about if you should charge more at weekends, but they really shouldn’t. Weekend shifts are part of the Veterinary profession and there are a lot of locum shifts floating about on Saturday and Sunday. Are these considered anti-social hours? Well, that’s down to you. Of course, your clinical skills are no different on a Saturday to a Wednesday. As a locum, you can choose to work weekends (or not!) and therefore the ball is in your court. It is up to you, some people will increase their rate on a weekend if they don’t ‘need’ the work, others may decide that they can do with the money and charge a normal rate. Practices don’t HAVE to use you and if they aren’t happy paying an increased rate over weekends, they will be able to find someone else at a lower rate.

General Costs/Things to Consider VAT There are 3 things you need to know about charging VAT: • It’s only pertinent for locums that are billing via a Limited Company • You NEED to be VAT registered to charge VAT • You HAVE to register if you have over £85,000 in taxable income per annum The practice can claim the VAT back, so don’t think of it as adding an extra cost onto them. VAT is charged at 20%, so if you charge £350 a day then your invoice would be for £420 (120%). If you’re not sure about all of the above, either get in contact with your accountant or send us a message via our contact us page. Insurance If you’re starting to locum from a full-time role, you will be used to having your Personal Indemnity Insurance and RCVS fees paid for. As a locum, this isn’t the case. Whilst the most common provider of insurance is VDS, there are also others available – it should be a couple of hundred pounds. You can find a list of RCVS charges here. You will need to factor in these costs when thinking about what to charge. Granted, if you are working 280 days per year, these costs don’t amount to much as an average per day, but something to consider. Payment Vehicle Depending on how you bill the practice, there will be changes to make in your thinking. If you bill via a Ltd. Company, then you need to factor into your costs an accountant, setup costs, companies house fees, etc. Again, these won’t break the bank but need to be factored in when working out what to charge. If you’re using an umbrella company, speak to them to see what you will be paid per day after deductions. Different umbrellas operate in different ways, so be sure to speak to yours about what to charge, what they would charge the practice, and what you will end up being paid, both as gross and net. Do I charge hourly or daily? Personal choice. It doesn’t matter at the end of the day if you end up charging the same overall rate when the pro-rata is calculated. If you are going to be doing varying shifts, hourly may be easier rather than having to work out what 9/10ths of your day rate is for a shorter day.

Conclusion If you charge fairly, you will always get work – if you have an extortionate day rate, you’ll struggle. The profession is a small one, and reputations spread. Be sure to be personable, punctual, and do your best for every animal you come across and you will fly through locuming. If you wanted to speak to one of our experts about what to charge, please get in touch here.

Cannabigerol (CBG) The New Kid on the Block!

Review

CBG - The Next Big Thing

Earlier articles have largely concentrated on the benefits of using broad spectrum products containing a blend of both CBD and CBDA, alongside terpenes. ‘The Entourage Effect’ has also been discussed previously and is the utilisation of several types of molecules that work synergistically towards the same goal. This is akin to ‘multi-modal analgesia’, whereby we will, for example, use NSAIDs, opiates and gabapentin together to aid pain control.

Cannabigerol (CBG) is the decarboxylated form of the parent cannabinoid, cannabigerolic acid, from which other cannabinoids are synthesised. It is found in hemp and during growth, most of the cannabigerol is converted into other cannabinoids. Recently however, plants have been cultivated to form only this non-toxic, non-psychotropic cannabinoid. It has been found to possess profound anti-inflammatory and potential antibiotic properties, particularly in models of gastrointestinal and neuro-inflammation. CBG has potential for multiple more specific effects and uses, due to its action on a variety receptors (Russo et. al., 2011). Behaving as a potent α2 adrenoreceptor agonist, CBG provides analgesic effects, alongside moderate 5-HT1A antagonism, suggesting antidepressant properties (Cascio et. al., 2010).

Furthermore, we know that each unique combination of cannabinoids and terpenes interacts with the endocannabinoid system in a different manner. Again, we have previously discussed that CBD isolates cannot be compared with full-spectrum products, nor can one hemp extract be directly compared with the next.

Figure 1: Pictorial of some aspects of ‘The Entourage Effect’ and its constituents, highlighting the various phytocannabinoids and terpenes, and their role in this effect. Terpenes

• Cannabidiol (CBD)

• β-Myrcene

• Cannabidiolic acid (CBDA)

• β-Caryophyllene

• Cannabigerol (CBG)

• α-Pinene

TER PE N

DIA ME

THE ENTOURAGE EFFECT

ElleVance

The ECS

ENZYME S

TORS

CAN

IDS NO I B

Phytocannabinoids

Borelli et. al. (2013) found that CBG lessened the signs of colitis in mice, decreasing inflammatory biomarker production (nitric oxide production in macrophages) and decreased reactive oxygen species’ formation in intestinal epithelium. They further state that CBG could be considered for clinical experimentation in IBD patients. De Petrocellis et. al. (2012) showed that CBG could decrease gastrointestinal inflammation by an action on an alternative transient receptor potential (TRP) channel. Several workers have demonstrated inhibition of progression of certain tissue neoplasia’s on animal models following administration of cannabinoids, including CBG (Borrelli et. al., 2014; De Petrocellis et. al., 2014; Ligresti et. al., 2006). Ligresti et. al. (2006) more specifically found that CBD, then CBG, followed by cannabichromene (CBC) acted as a more potent inhibitor of cancer growth than tetrahydrocannabinol (THC). Both pure CBD and CBD-rich extract were confirmed to have anti-tumour effects in vivo in mice with highly invasive breast cancer xenografts. Both of these CBD compounds inhibited formation of lung metastasis following inoculation with breast cancer cells. More recent work by Farha et. al. (2020) showed that cannabinoids demonstrate antibacterial activity against MRSA. Additionally, their work found that cannabinoids also inhibit the ability to form biofilms, but could also remove biofilm that was already present. More specifically, CBG targets the cytoplasmic membrane of Gram-positive bacteria, but can also have an effect on the inner membrane

RECEPTORS

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

References:

of Gram-negative bacteria once the outer membrane is permeated. Cannabinoids were also demonstrated to work synergistically with polymyxin B, where multidrug resistant Gram-negative bacteria were an issue. This exciting work showed that CBG had the more potent anti-biofilm activity and that these molecules may be useful as combination therapy, alongside an antibiotic with a high minimum inhibitory concentration (MIC). Figure 2: Electron micrograph demonstrating Staphylococcus aureus biofilm in an indwellng catheter.

Borrelli, F., Fasolino, I., Romano, B., Capasso, R., Maiello, F., Coppola, D., et al. (2013) Beneficial effect of the non-psychotropic plant cannabinoid cannabigerol on experimental inflammatory bowel disease. Biochem Pharmacol [Online]. 85 (9) 1306–16 Borrelli, F., Pagano, E., Romano, B., Panzera, S., Maiello, F., Coppola, D., De Petrocellis, L., Buono, L., Orlando, P., and A. Izzo, A. (2014) Colon carcinogenesis is inhibited by the TRPM8 antagonist cannabigerol, a Cannabis-derived non-psychotropic cannabinoid. Carcinogenesis. 35 (12) 2787–2797, https://doi.org/10.1093/carcin/bgu205 Cascio, M.G., Gauson, L.A., Stevenson, L.A., Ross, R.A., & Pertwee, R.G. (2010) Evidence that the plant cannabinoid cannabigerol is a highly potent alpha2adrenoceptor agonist and moderately potent 5HT1A receptor antagonist. British Journal of Pharmacology. 159 (1) 129–141. https://doi.org/10.1111/j.14765381.2009.00515.x De Petrocellis, L., Orlando, P., Moriello, A.S., Aviello, G., Stott, C., Izzo, A.A. and Di Marzo, V. (2012) Cannabinoid actions at TRPV channels: effects on TRPV3 and TRPV4 and their potential relevance to gastrointestinal inflammation. Acta Physiologica. 204: 255266. https://doi.org/10.1111/j.1748- 1716.2011.02338.x

Image credit: CDC/ Rodney M. Donlan, Ph.D.; Janice Carr (PHIL #7488), 2005 https://commons.wikimedia.org/w/index.php?curid=2740748

Summary There is a significant amount of emerging pre-clinical evidence to suggest that CBG will provide alternative specific therapies in the future to treat a number of conditions. More work, however, must still be done to fully understand and harness the potential properties of this compound, to ensure it is utilised in an appropriate and effective manner. This is an exciting area of ongoing development in cannabinoid therapy.

De Petrocellis, L., Ligresti, A., Schiano Moriello, A., Lappelli, M., Verde, R., Stott, C.G., Cristino, L., Orlando, P. and Di Marzo, V. (2013) Non-THC cannabinoids inhibit prostate carcinoma growth in vitro and in vivo: pro-apoptotic effects and underlying mechanisms. British Journal of Pharmacology. 168: 79-102. https://doi. org/10.1111/j.1476-5381.2012.02027.x Farha, M., El-Halfawy, O.M., Gale, R.T., MacNair, C.R., Carfrae, L.A., Zhang, X., Jentsch, N.G., Magolan, J. and Brown, E. D. (2020) Uncovering the Hidden Antibiotic Potential of Cannabis. ACS Infect. Dis. 6 (3) 338–346. https://doi.org/10.1021/ acsinfecdis.9b00419 Ligresti, A., Moriello, A. S. K., Starowicz, I., Matias, S. P., De Petrocellis, L., Laezza, C., Portella, G., Bifulco, M., & Di Marzo, V. (2006) Antitumor activity of plant cannabinoids with emphasis of the effect of cannabidiol on human breast carcinoma. The Journal of Pharmacology and Experimental Therapeutics. 318 1375 – 1387. https:// doi:10.1124/jpet.106.105247 Russo, E. (2011) Taming THC: potential cannabis synergy and phytocannabinoidterpenoid entourage effects. British Journal of Pharmacology 163: 1344-1364

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

THE Vet Exhibition continues to grow as we welcome Royal Canin and Purina into the virtual venue this month! Both spaces are available to visit and have some fantastic content for you to view and interact with! Be sure to check out the spaces and connect with the exhibitors using the live chat function for any questions or comments you may have. The NationWide Laboratories exhibition booth has undergone its regular monthly makeover with a new topic of focus: Exotics! The content will be available to access until the 22nd November where you can view their webinar of the month: “HELP! IT’S A FERRET” by Madonna Livingstone BVMS MRCVS as well as listen to Exotics Case Studies podcast! Be sure to also visit the stand and complete the survey to be in with a chance of winning a CPD bundle (up to 5 hours with certificates).

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

You may have also noticed, Ceva have some exciting news to share…DOUXO S3 welcomes CALM pads to its innovative range of dermatopicals! DOUXO S3 Calm Pads are available in veterinary wholesalers from 1st October 2021. DOUXO S3 CALM pads provide targeted skincare solutions to hard-to-reach areas to soothe itchy, irritated skin while maintaining the skin barrier. They join the popular DOUXO S3 CALM range which also includes DOUXO S3 CALM shampoo and mousse formulations. Click on the banner above the auditoriums to download the brochure today!

To book a demo or to enquire about advertising or exhibiting within THE Vet Exhibition, email me today! I look forward to ‘seeing’ you in THE Vet Exhibition soon! Stephanie, THE Vet Exhibition Show Manager

David’s reviews

FROM THE LITERATURE NOVEMBER 2021 Reliability of detecting fundus abnormalities associated with systemic hypertension in cats assessed by veterinarians with and without ophthalmology specialty training Laura Moretto, Arnold Lavaud and others Journal of feline Medicine and Surgery First published January 13th. 2021 This Swiss study (from the Zurich veterinary school) is an interesting idea and something that will certainly have occurred to all who watched Ron Ofri’s excellent webinars on eye diseases over the last year. The main take home message for me was to make an ophthalmological examination part of the routine clinical examination-something I hadn’t always done regularly. As the authors state, systemic hypertension in cats causes severe organ damage, emphasising the need to continuously bear it in mind. Fundoscopy can be used to corroborate blood pressure measurements, and decide on immediate therapy. In the study cats with a suspicion of hypertension or belonging to an at risk group and with a first blood pressure measurement greater than 160 mmHg were examined first be a recent graduate followed by a veterinary ophthalmologist. Two subsequent measurements of blood pressure subsequently confirmed systemic hypertension. Systemic hypertension was confirmed in 27 cats with a variety of clinical problems.

The reliability of detecting fundus abnormalities by non-trained veterinarians, compared to specialists was 72% for cats with vision. For the six cats presented with blindness the reliability was 100% between the two groups. The authors encourage fundus examination by first opinion practitioners since, as this study shows, it has a reasonable high reliability to detect abnormalities in systemic hypertension cases. And by watching Ron Ofri’s webinars, plus some reading, that would surely push the figure of 72% higher. From the same journal, and from the veterinary school in Barcelona: Efficacy of oclatinib for the control of feline atopic skin syndrome: correlating plasma concentration with clinical response Isaac Carrasco, Puigdemont

Luis

Ferrer,

Anna

Journal of Feline Medicine and Surgery First published October 6th. 2021 The objective of the study was to assess the efficacy of a new therapeutic regimen of oclatinib for the control of feline atopic skin syndrome (FASS) and to correlate plasma levels with clinical effects. 28 cats with a clinical diagnosis of FASS were recruited for the study. Oclatinib was administered at 1mg/kg every 12 hours for 2 weeks and then 1mg/kg every 24 hours for a further 2 weeks. Clinical lesions were

assessed at the beginning and end of the study using a validated scoring system, (SCORFAD). Additionally, pruritus, using an adapted visual analogue scale, was recorded (PVAS). At the same time plasma oclatinib levels and haematological measurements were made. It was concluded that oclatinib emerged as a safe and effective means of controlling clinical signs of FASS, and a mean dose of 1mg/kg could be considered to be a suitable therapeutic regime. Measurement of plasma drug levels did not add to the usefulness of predicting clinical responses during treatment. It’s easy to overlook the sister journal to the above, Journal of feline Medicine and Surgery open reports. The journal is open access and always contains interesting case reports and small case studies. These are often very complicated emanating from referral centres allowing residents to cut their teeth in the publication process. A couple caught my attention recently. A case of behavioral changes in a castrated male cat due to a functional adrenocortical adenoma producing testosterone and androstenedione Archivaldo Reche Junior, Daniela Ramos and others Journal of Feline Medicine and Surgery Open Reports First published January 12th. 2021

The report, from academic and practitioner colleagues in São Paulo, Brazil, describes a 9-year –old neutered male cat with a functional adrenal tumour. This was manifested by aggression to other cats in the household, excessive meowing and urine spraying. Apart from these clinical signs, an enlarged right adrenal gland noted on ultrasound imaging, penile spines and elevated sex hormones flowing an ACTH stimulation test confirmed the diagnosis of adrenocortical tumour. A CT scan indicated no invasion of the caudal vena cava, suggesting a more favourable prognosis for surgical treatment. The tumour was removed surgically and submitted for histopathological examination, which confirmed adrenocortical adenoma. There excellent images of the ultrasound examination and most strikingly a close up of the penile spines. Another image taken three months later demonstrates the demise of the spines, and excessive meowing and urine spraying had stopped by this time. The aggressive behaviour took much longer to resolve and required behavioural advice. Also interesting was that the behavioral changes pre-dated the adrenal signs and the penile spines by 5 months, indicating the importance of considering medical causes for behavioral problems. The cat was alive and well three years following surgical removal of the tumour.

The authors note that the condition appears to be quite rare with only six similar cases reported. They suggest retained gonadal testes, administration of exogenous testosterone or hyperthyroidism as the main differentials. The following case report is along similar lines, and is from academic colleagues, from the University of Sydney veterinary School and a feline practitioner Gynaecomastia in a male neutered cat with an adrenal tumour and associated hyperprogesteronism, hypercortisolism and hyperaldosteronism Jane Yu, Jason Lenord and others Journal of Feline Surgery and Medicine Open Reports First published September 29th. 2021 The signs in this 7 year-old male neutered domestic longhaired cat were substantially different to the previous cat with an identical tumour. This cat presented with chronic progressive polydipsia, polyphagia, weight loss and poor fur regrowth. Sexualised behaviour or other virilisation signs were not present on physical examination. The only pertinent haematological finding on routine analysis was a mild hypokalaemia. Left adrenomegaly and mild prostatomegaly were identified on a CT scan. Evaluation

of adrenal sex hormones with a low dose dexamethasone suppression test, serum progesterone, testosterone, oestradiol, plasma aldosterone, renin, plasma metanephrine and normetanephrine measurement supported a diagnosis of hyperprogesteronism, hypercortisolism and hyperaldosteronism. Adrenalectomy was performed and histopathological examination was consistent with adrenocortical tumour, (based on low mitotic indices and an absence of definitive criteria for malignancy adenoma.) Clinical signs and hormonal elevations resolved post-operatively with a remarkable improvement at 8 and 11 months follow up. As is so often the case with this excellent journal the clinical pictures and a series of CT scans in this case report are superb. The authors believe this is only the second report of gynaecomastia secondary to an adrenal tumour and the first associated with hyperprogesteronism.

WEBINAR

WHY DO OUR PATIENTS GO BLIND? INHERITED REINAL DISEASES

WEBINAR This is the last of six lectures by Ron Ofri on blindness in dogs and cats. All, including this one, are superb with fantastic illustrations of the various conditions. If you have missed any of these lectures, and want to get up to speed in the best possible way, here is a list of the five previous blindness lectures. All are available on the WebinarVet website August 8th. 2020 Applied anatomy of the fundus: making sense of what I see in the ophthalmoscope October 20th. 2020 Ophthalmic exam made easy January 7th. 2021 Acute blindness in dogs April 15th 2021 central blindness

Optic

nerve

and

June 17th Blindness in cats Ron begins by referring to two useful primary sources, also referenced at the end. The subject matter in this webinar is: • Retinal Dysplasia • Collie Eye Anomaly • PRA/PRCD • What can we do about it? Retinal Dysplasia is described as a congenital developmental abnormality, with abnormal retinal differentiation. This is beautifully shown histologically with folding of the sensory retina (rosettes). It may be acquired due to maternal infection (FeLv, BVD, Blue Tongue) or toxicity. Significantly, in dogs, it is inherited either as an autosomal recessive or dominant. Throughout this webinar there is a huge amount of information describing which breeds of dogs are susceptible to the various disorders. This is not possible to detail in this summary, but suffice it to say it is comprehensive and would benefit from downloading for future reference. Four forms of retinal dysplasia are described in detail. These are: 1. Focal/Multifocal 2. Geographical 3. Complete 4. Oculoskeletal syndrome Breeds and ophthalmic features are illustrated for each of these forms. Forms 1 and 2 are discovered only during screening. For prevention discourage breeding for any dog, even though milder forms have minimal effect on vision, severe forms with blindness can be transmitted to pups. Collie Eye Anomaly has a worldwide distribution affecting 30-45% of smooth and rough collies.

Shetland sheepdogs, Lancashire heelers and Australian shepherds are also affected with a sporadic incidence in other breeds The anomaly is defined, and after revising the ocular anatomy examples are illustrated demonstrating the diagnostic features. In 10-30% of cases there is an optic nerve coloboma. Another histological illustration demonstrates this very well and makes the findings on opthalmoscopic examination much clearer. The ‘diving’ vessels into the coloboma are very striking. Coloboma may cause significant visual deficits. Other features including intraocular haemorrhage or retinal detachment may occur (2-10% of cases), with tortuous vessels and small litters in affected dogs. There is further discussion of inheritance and problems associated with attempts at eradication. Progressive retinal atrophy (PRA) is a general term, which includes PRCD, (Progressive rod cone dysplasia). Most forms begin as rod degeneration, which spreads to cones (prcd, rcd). Some breeds are prone to cone-rod degeneration and others to cone degeneration. Most forms of ‘PRA’ are inherited as an autosomal recessive defect, which may be X –linked, dominant, incompletely dominant, or sometimes two forms in the same breed. To explain the variability in the genetic basis there is a brief and detailed description that will delight the geneticists. We then go back to the clinic with information on how to diagnose ‘PRA’. This involves: 1. Behavioural signs and/or history 2. Clinical signs-ophthalmic examination 3. ERG-electroretinography to detect electrical activity in the retina

examinations and genetic testing. The final part of this webinar describes what we can do about inherited retinal diseases. European and American programmes for inherited eye diseases are detailed with examples of the various forms in use, including the use of ‘Mate Select’ a web based selection tool for pedigree dogs in promoting sustainable breeding. There is a summary of publications demonstrating some impressive results in driving down the percentage of various inherited ocular inherited diseases in a number of breeds of dog. But what of the future? This seems to be very exciting, offering hitherto impossible opportunities of restoring sight in both people and dogs. We are invited to take a look at http://www.2-sight.com . Other therapies include stem-cell therapy and gene therapy. It seems like science fiction but Ron and his team have been restoring photopic retinal function and visual behaviour with gene therapy in recent years. A reference is provided. This is a very uplifting finale to an exceptional series of not to be missed webinars on the topic of blindness

This is a very uplifting finale to an exceptional series of not to be missed webinars on the topic of blindness

4. Genetic testing These are comprehensively explained with excellent fundus pictures, and advice such as counting the bifurcations of the vessels. This section greatly increased my confidence in being able to spot the abnormalities in PRA. When we move on to electroretinography, however, we are immediately in the province of veterinary ophthalmology specialists. A huge amount of specialised information is summarised in a table with information on when retinal dystrophies and degeneration is first detectable by opthalmoscopic examination, behavioural signs and with ERG- in more than 20 breeds of dog. Similarly from the specialists there is an almost bewildering amount of information on genetic testing for inherited eye diseases. Ron summarises this information by comparing the advantages and disadvantages of opthalmoscopic

Ron Ofri DVM PhD DECVO Koret School of Veterinary medicine Hebrew University of Jerusalem, Israel

WEBINAR

LAMENESS IN (SPORTS) HORSES FOR THE NEW GRADUATE AND GENERAL PRACTITIONER Matthew graduated in South Africa in 2005. He embarked upon an equine career immediately after graduation gaining experience in a SA equine referral practice. During this time he obtained honours degrees in equine surgery and a diploma in equine surgery from the University of Sydney and Onderstepoort veterinary college respectively. Further training (rotating equine internship and residency) was at the Liverpool Veterinary College from 2015, where he obtained a masters degree. He stayed on at Liverpool as a lecturer before joining Liphook Equine Hospital in 2020. Matthew is clearly committed to constant personal development as he is working towards becoming a diplomate of the ECVS (Equine). He therefore brings a wealth of experience both in clinical work and in teaching for this veterinary webinar. He makes it clear from the outset that the webinar is aimed at new graduates and general practitioners rather than established colleagues/specialists. The learning objectives are: • Defining lameness • The clinical exam • Ancillary tests • Advanced imaging • Advice for practice He begins by asking ‘What is lameness?’ and after considering various aspects defines it, before considering lameness manifestations into several categories –supporting leg, swinging leg, mixed, complementary and mechanical. Two systems used for grading lameness are briefly described-one from the USA and the other more commonly used in the UK and parts of Europe. Their various merits are discussed, before moving on to the nuts and bolts of this webinar –the lameness examination. Matthew goes into some detail describing the systematic steps that he finds useful when evaluating lame horses under the following headings: -

• History -Process of evaluation -Visual, passive and dynamic -Palpation -Manipulation -Regional anaesthesia • Anatomic compared to physiologic imaging There is a lot of information here on history taking with emphasis on its importance and a reminder that horse people speak a specific and foreign language and that it varies geographically! He goes through some of the most important parts of the history, particularly suggesting open-ended questions, letting the owner talk freely and listening without jumping to conclusions. He introduces a word here that I was unaware of-ideolepsis. If like me you didn’t know the word, it is defined as a ‘state of being so convinced of one diagnosis or conclusion that all other rational alternatives are discarded’. Equally detailed information is given on the visual examination, emphasising that it should above all be systematic and performed in the exact established way every time. Look for effusion/swelling, posture, muscular symmetry/wasting and checking the horse at a walk, trot, canter and on multiple surfaces if possible. Some excellent clinical photos show changes in muscular symmetry and very good videos illustrate some aspects of fore limb and hind limb lameness, aiming to grade the lameness at front or back, left or right. There is a great deal of practical information on how to approach hind limb and forelimb lameness looking for typical head nod in forelimb lameness and not forgetting to listen to the louder sound on the opposite leg (on hard surfaces). Typically, hip hike occurs in hind limb lameness. The next part of the examination concentrates on palpation, again emphasising that it needs to be systematic. Advice is given on the use of hoof testers to assess pain and another basic but important adjunct to lameness examination is manipulation. Examples are passive flexion and wedge tests (for navicular disease), and clinical illustrations show these. The horse is also viewed while under saddle and on the lunge line.

The previous part of this webinar provides an excellent summary of the approach to the lame horse that should build confidence in a relatively inexperienced colleague to arrive at a sound provisional diagnosis without having given in to ideolepsis. Further progress will often require regional analgesia and the following digital nerve blocks are described: • Palmar digital • Abaxial sesamoid • Low four point For each of these its location is shown and what areas are blocked. These are very well summarised for future reference, before turning to the subject of imaging. Examples are: • Radiography • Ultrasonography • Computed tomography • MRI • Nuclear scintigraphy • Pet scan Perhaps much of this is likely to be somewhat specialised but necessary for completion of this webinar, particularly as the last part describes two cases where specialised diagnostics were use. Of interest for the general practitioner and new graduate is use of the Equinosis-lameness Locatorr. We end up in the equine hospital where two cases are described. They both follow the suggested described investigation leading to two different specialised techniques to clinch the diagnosis. In case one there are superb examples of a combination of nuclear scintigraphy and radiography and in the other ultrasonography was the most useful diagnostic technique. The advice for practice is succinct: • Be systematic • Learn what is normal • Treat owner expectations • Feel/look/look again/feel again • Don’t block what you can’t see • Back yourself

WEBINAR

After a list of key references the webinar ends with five multiple choice questions to see if you have been paying attention. I did, even though I have no experience with horses, and I found the webinar thoroughly educational and entertaining. I am sure it will benefit anyone in equine practice but especially the target audience mentioned at the beginning.

Dr Matthew Sinovich BVSc (Hons) CertAVP (ESST) MSc MRCVS Liphook Equine Hospital

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ORAL SURGERY IN THE CAT AND DOG-COMPARATIVE ASPECTS Jackie has an extremely impressive CV. Having spent one year in mixed practice after qualifying from the RVC in 1996, she undertook specialist training at the Dick Vet school in Edinburgh enabling her to pass the certificate surgery exam of the RCVS in 2000 with the ECVS diploma 2 years later. She subsequently worked in a referral practice for a year, then a lectureship at the Cambridge veterinary school and since 2012 a specialist surgeon at DWR. She has published widely and continues to train, most recently in interventional radiology (IR) and laparoscopy. It would be difficult to find a colleague so well qualified to present this veterinary webinar, and Jackie doesn’t disappoint. The amount of work and detail that has gone into this webinar is quite extraordinary. The webinar deals with common oral tumours in dogs and cats, their evaluation, surgical management, prognosis and complications. Oral tumours are common with a wide variety of malignant and benign types, the most common of the latter being epulis in the dog. The most common malignant tumours in dogs are melanoma, squamous cell carcinoma and fibrosarcoma. In cats the most common oral tumour is squamous cell carcinoma. Bone is often involved and surgical removal is often the treatment of choice. In general the clinical signs are: • Halitosis • Difficulty in mastication • Oral haemorrhage • Ptyalism • Swelling • Pain, weight loss In spite of the above signs the mass is often not noticed. In all cases the aim of treatment is to determine the type, its location, whether there is local invasion and/or metastatic spread. In order for this to be done imaging will be required. Conventional radiographs

are not very sensitive and CT and MRI are the modalities of choice. This is very strikingly illustrated with a maxillary tumour in a dog extending widely into the turbinate bones. For staging and diagnosis thoracic radiographs or CT are beneficial with cytological evaluation of regional lymph nodes. There is a reference in the literature of lymph node evaluation in 28 dogs and 3 cats with oral tumours. For tumours, cytological examination may be unrewarding as there is often necrosis and inflammation. This means that cytological examination is usually not very helpful. Various methods of obtaining a biopsy are discussed. The next part of the webinar gives clinical information on tumour types, their typical appearance with some indications of treatment. Surgical treatment is dealt with in some detail later. Tumour types that are discussed are: • Epulides • Acanthomatous epulis • Squamous cell carcinoma (SCC)-with a comparison of survival times in both dogs and cats. In cats SCC represents 70% of oral tumours, and is a very infiltrative disease often presenting a ‘too little too late’ scenario. Most commonly the tongue is affected and surgical treatment is impossible (other than total glossectomy, which is not compatible with normal function). Consequently palliative care is the most common treatment. There is some information on gingival (caudal maxilla or mandible) types of SCC. Generally most present too late for surgical treatment, although if attempted it is best performed as part of a multimodal approach. This could involve surgery, radiotherapy, and chemotherapy (most commonly with carboplatin, toceranib). Various combinations are listed with their respective mean survival times.

WEBINAR • SCC of the gingiva of dogs has better survival times and with surgical removal is frequently curative • Malignant melanoma is responsible for 31-42% of oral tumours in dogs, whereas in cats they are rarely found in the oral cavity • Fibrosarcoma is very aggressive locally and at 54% has the highest recurrence rate of all tumours. Surgical removal is still the best option as the tumour is relatively radioresistant.

This is a very well presented thoroughly recommended webinar.

Surgical treatment in some detail follows. Apart from a few cases of benign epulis this will involve radical excision and wide 2cm) margins, and in particular mandibulectomy and maxillectomy. These two surgical options are dealt with comprehensively with a description of the anatomy, surgical principles and many excellent intra-operative clinical pictures, (I counted at least 25). As with all surgical specialists Jackie made the procedures look straightforward, although my assessment is that these operations are not for the faint hearted. In the hands of specialists the results shown here were very good and importantly resulted in a very acceptable cosmetic appearance in all the patients. Getting the patient to eat following surgery is important. Dogs generally eat well but cats are more unreliable so feeding tubes must be considered. The main complications are wound breakdown, and reasons why this might occur are suggested with the required remedial action. Ulceration from canine teeth may be self-limiting. Excessive salivation or the formation of a sialocele (after rostral mandibulectomy) may also occur.

JACKIE DEMETRIOU B.Vet.Med Cert SAS Dip ECVS MRCVS DICK WHITE REFERRALS

The summarising points are: • Oral surgery is more common in dogs than cats • There is a better prognosis generally in dogs (with the exception of tonsillar SCC) • Cats may have more problems in eating initially, although a recent survey of 8 cats following radical mandibulectomy demonstrated that 6 were eating independently. This is a very well presented thoroughly recommended webinar.

NOV EM BER 2021