The Webinar Gazette The Webinar vet
To provide: The highest quality vet-led content To be: The world’s largest online veterinary community
JANUARY 2021
To have: The planet’s most confident vets
WHAT’S INSIDE CPD’er of the Month In our Office Jane’s Blog Speaker of the Month Pippa Talks David’s Review
HAPPY 2021!
L
et’s hope for a better year than last year which was unprecedented. The year started with the massive bush fires in Australia, developed into the Coronavirus pandemic crisis and is finishing in the UK at least with the Brexit ballsup. I’m writing this by my Christmas tree unsure how the Brexit deal and, indeed, Christmas will pan out. However, having voted to leave four years ago and still not having a deal does show how far our political process has fallen. I’m preparing for the worst and hoping for the best. 2020’s close does bring some good news with the roll out of the vaccine in the UK, closely followed by other countries and we at The Webinar Vet are continuing to offer help to congresses, companies, practices, nurses and vets to get their message out or receive high quality training. The Vet Trust Awards were also a shot in the arm for me personally as a show of positivity and everything that is good in the veterinary industry. We raised over £7000 for Vetlife and
celebrated some fantastic companies and individuals which we will showcase later in the Gazette. VC2021 is promising to be an amazing congress which I hope you will attend. Members get the congress for free. If you are a member of our community go to url to see the great programme and buy a ticket for our 9th annual virtual congress( we were doing these when nobody else thought they were cool!). You can get all your training for 2021 for as little as £47 plus VAT! My highlight for the year was helping to host WCVD9 as an online event. As you read this, tickets are no longer available. If you missed the congress, you missed a treat. The committee put an amazing programme together for GPs as well as dermatologists. My old friend, Danny Scott, who I studied under at Cornell when I won the Frank Beattie Scholarship in 1997, won the Schindelka prize and presented several amazing lectures- an amazing congress to rival many of the physical WCVDs that I have attended over the last 24 years! I’ve been reflecting on 2020 over the
last few days. I spoke about it being the year for vision, particularly 20:20 vision and in many ways, I think, we’ve done that. It’s changed our perception of what’s important. I hope that in five years we will look back and reflect that 2020 taught us a lot about ourselves; that amid the terrible sacrifice we, maybe, learnt more about ourselves and how we can prioritise others and the environment. We were so pleased to learn we had won silver accreditation at Investors in the Environment- a huge thrill for me as an embattled environmentalist.( can we include an article on this in the gazette) Finally, I want to wish you a joyous Christmas amongst all the difficulties and a peaceful and better 2021.
Anthony
We are pleased to announce our new Mental Wellbeing partner - It’s Mental.
Their drive and empathy for coaching and mentoring people to build a more robust mental and physical wellbeing comes from their own personal experiences. Their purpose and mission is to teach 1 million people to improve and manage their mental wellbeing going forward. They are passionate about making positive changes. Changing behaviour, changing habits – either breaking bad ones or creating good ones, the key foundation to Its’ Mental wellbeing coaching programmes are to teach and guide people to be able to improve and self-manage a good work life balance and most importantly living a happier life. When you join Its Mentals safe online community you are presented with a wide selection of on demand and live self-help sessions delivered by the best experts from around the world. They are all about action. mental action. physical action. If we can get just one stressed out person to look up and open their eyes to the wider possibilities, then we have started the process of positive change and good things will begin to present themselves. They are confident by using a 3-step approach based on the PERMA model and preventative learning they will begin to improve the wellbeing of your employees and increase their productivity. Please see below 2 programs that we will be launching with The Webinar Vet.
Work Life Balance – Mental Wellbeing Coaching Program - Veterinary Sector Improve Your Mental Wellbeing by learning how to create and manage a Better Work Life Balance. We have brought together 3 of the best experts in their field to create the best wellbeing team for a 12-week live webinar program that will give you the tools, techniques and advice to improve and self-manage your mental wellbeing going forward. We have spoken to numerous professional in the veterinary industry to understand the pressures and emotional strain you are under on a daily basis. We have tailored the program to help and prevent some of the negative thought processing and in return creating positive action. We provide you with a wealth of knowledge, supported through downloadable content. One of the main objectives of the program is to assess your wellbeing before and after the program has finished, to highlight the progression in the 9 key categories below. This is to help you achieve your mental wellbeing vision or goal. Our weekly sessions we be a different subject each week with reflection session on the 4th, 8th and 12th weeks, we will be providing a Q and A session. If you cannot attend each week due to commitments, each session will be recorded and available on demand.
Control Your Anxiety This anxiety coaching program, presented by Anna Ashworth, a BABCP accredited CBT Therapist, will be accessible via live weekly webinars. The three sessions will increase your understanding of CBT, what anxiety is, what maintains it, and equip you with key Cognitive Behavioural Therapy skills and techniques to manage your worry and anxiety. There will be time for questions and answers during each session and downloadable materials will be included to accompany each session
Remember, Your Health is not just Physical Its Mental!
Contact: stephen@itsmental.co.uk Call: 01257 423800 www.itsmental.co.uk
NationWide Laboratories proudly presents a FREE CPD webinar
HYPERCALCAEMIA IN DOGS AND CATS: AN OVERVIEW By Dr Stacey A Newton BVSc Cert EM (Int Med) PhD FRCPath MRCVS
Hypercalcaemia is a common finding in both dogs and cats. In the dog common presentation is PUPD and hypercalcaemia is a differential that must be excluded when PUPD is the presenting clinical sign. In the cat clinical signs are often vague with anorexia as the most common clinical sign. The webinar will focus on pathogenesis and discuss parathyroid dependent as well as parathyroid independent hypercalcaemia. The difference between total calcium and ionised calcium will be discussed and its use in diagnosis along with the parathyroid hormone as well as the use of parathyroid related hormone, vitamin D and calcitriol. Sample management and submission will also be covered. Treatment will be mentioned at the end but will not be extensively discussed. Stacey graduated from Bristol in 1993. After building up experience in general practice, she became a resident in equine medicine at Leahurst, Liverpool University. Stacey then went on to complete her PhD in equine neuroanatomy and neurology in 2002. She obtained her Diplomat of the Royal College of pathologists in 2008 and was awarded her FRCPath in 2010. She is currently working at Nationwide Laboratories as a senior veterinary clinical pathologist. NationWide Laboratories is committed to making a positive impact on animal health by offering innovative products, technology and laboratory services to your veterinary practice. We have been providing a comprehensive range of veterinary diagnostic services since 1983 for companion, farm and exotic animals. For more information contact us at info@nwlabs.co.uk and follow us on LinkedIn and Twitter. This webinar will take place at 12:30pm on WEdnesday 10th February 2021, you can register to attend live here: https://www.thewebinarvet.com/webinar/hypercalcaemia-in-dogsand-cats-an-overview
CPD’er of the month
2. What was the biggest take-home message you learned this month from our webinars? There is always time to arrange for webinars that keep you up to date in your field with the webinar vet (I completed one webinar between ooh calls/consults) 3. Are you looking forward to any future webinars or events from The Webinar Vet? Very interested in neurology so looking forward to “neurology made easy - interactive cases” on the 10th of december.
Israel Crespin
W
hat a nice surprise to have been the CPDer of the month for January!
1. Which webinar did you enjoy the most this month? Difficult to decide since there have been a few, but I am going with “Early detection of Chronic kidney disease in cats” by Jonathan Elliot, very indepth and relevant for me at this moment since having more and more cases in consult.
Thanks to the webinar vet team for the CPDer of the month mention, I have just recently changed career path (about a year ago), from government vet to small animals practitioner, and access to the extensive library in the webinar vet has really made the transition smooth and stress free, able to organize my available free time around useful topics, and helping me to accumulate extensive up to date knowledge for my day to day field work. You can check me out in my practice webpage http://www.dacrehouse.co.uk/ and in facebook as Israel Crespin.
In our Office January marks nine years since I joined a little start up called The Webinar Vet. I cannot quite believe it has been nine whole years: it has gone by so so quickly! The Webinar Vet in 2012 looked very different to life right now; we were a team of three, running at most one webinar each week, and every time I told people where I worked, they would ask me what a webinar was! This year has seen our team grow to 30, we have over 2,500 webinars on our platform, and have delivered over 146k hours of CPD/CE to our global community! I absolutely love and feel very proud of everything we have achieved over the last nine years, and the team we have built is incredible. I’m very excited to continue my Web Vet journey and thankful for the opportunities I have had to date‌the exciting thing is, it feels like we are just getting started! -Kathryn Bell
I am currently busy pulling the VC2021 programme together and liaising with over 30 speakers from around the world to try and put together the best VC programme to date. I am also looking at how to link the live sessions we show at VC into our new virtual exhibition hall, which is another huge project that my colleagues Claire and Helen are leading and we are all really excited about. -Pam Atkins-Jones
I have been asked to lead on the Association of Charity Vets Conference which will take place on the 6th February 2021. Really excited to be working on this event with the ACV team. It is the first year that the conference will be held online so we really want it to be a great and valuable experience for everyone involved. This month its about getting to know the ACV team, mapping out the technical details and looking at how we add in all those wow moments for our client. -Steph Boyle
My main focus over the next few months is leading on Virtual Congress 2021 - pulling together all of the elements including the programme, marketing, tech and ops. This year is going to be the biggest and best online conference The Webinar Vet has delivered and we are so excited to share this event with you all in February! -Amy Young
S
o the January blog rolls round once more I sometimes feel the need to make these the most positive and uplifting blogs with what to look forward to for the New Year personally and professionally. I think we all know that that’s probably can be quite hard to do a number of levels for 2021. So I thought I would share with you something thats got me through the last few months. A little something that might also help you. I feel that in the veterinary field with very goal and product focused. Not really unusual in general life as a rule but sometimes we may be only see the wood and don’t see the trees. It’s something I know many have considered in terms of how to cope with stress in practice and cope with burnout. We are usually a group of high achieving individuals and yet sometimes we may rate our success on how long our patients live or how many of our patients live. Yet I think that is looking at a gigantic forest and not seeing the individual trees in various states of growth. This mindset that has helped me in the past few months. I’m doing my PhD, I sold my flat, I bought a new house. All in their own way forest of my horizon and so to manage that I had to start looking at the
trees in each forest. I think we can apply this to clinic work as well. Each consult where you’ve met the client and patient’s needs is a tree, and is a positive moment. Each staff interaction that has been a positive and growing experience is a tree and is something to be proud of. With the current working situations and so many clinics each day that you achieve being there and caring for your well-being is a tree in the overall forest of your life. I realise this probably makes me sound like a bit of an old hippy but the theory behind it is a well-known coping strategy of just breaking things down into tiny tasks and achieving them one by one. But again we often apply that to a product or a goal that is identifiable. Yet identifying what makes us happy and what keeps as calm and wellbalanced can sometimes be difficult. So identifying your ‘tree’ moments may take a little bit of skill. These skills are a tree in itself. Anything you do to consider how to improve your well-being is a tree and a step in the right direction. So for 2021 let’s consider the little saplings of happiness joy and well-being that we have growing around us but that we might not see let’s focus on those and we will truly grow forest of positivity.
Jane’s Blog Yet identifying what makes us happy and what keeps as calm and well-balanced can sometimes be difficult. So identifying your ‘tree’ moments may take a little bit of skill. These skills are a tree in itself. Anything you do to consider how to improve your well-being is a tree and a step in the right direction. .
Speaker of the Month
Myles McKenna Myles graduated from University College Dublin in 2013. After some time in general practice he completed an internship in small animal medicine and surgery at Cornell University, USA. He subsequently undertook a Masters of Veterinary Science at the University of Edinburgh, completing a thesis on dogs as sentinels of Lyme borreliosis in humans. In 2019 he completed a residency in small animal internal medicine and a Masters of Veterinary
Medicine at the Royal Veterinary College, becoming a Diplomate of the American and European colleges of veterinary internal medicine. Since completing his residency he works in private referral practice in the UK. Add any webinar by Myles and add code SOTMJAN on checkout for a 50% discount on any of Myles’ webinars!
The British Society of Veterinary Pathology held their Autumn meeting in conjunction with the Webinar Vet on the 9th and 10th of October. This was the first time the society had attempted a virtual meeting and thankfully the meeting went without a hitch – huge thanks to our partners at the Webinar Vet for their valuable expertise! A huge amount of gratitude must also go to our generous event sponsors, IDEXX Laboratories UK and NationWide Laboratories. The two day conference covered “A holistic approach to the diagnosis of lymphoma” and we heard from several key opinion leaders in the field of diagnostics. Dr Butty Villiers from Dick White Referrals gave two very detailed lectures on cytology and flow cytometry, and Professor Amy Durham from the University of Pennsylvania covered the World Health Organisation system for lymphoma diagnosis, as well as splenic masses in dogs, some specific lymphomas we see in cats, and a fantastic mystery slide session with much discussion of some interesting common and more unusual cases. These lectures were complemented by an overview of human lymphoma diagnostics from Dr Bridget Wilkins, a consultant histopathologist with a wealth of experience in the field, and there was much discussion on comparative aspects throughout the whole meeting. We also heard an update on treatment of canine lymphoma from Dr Ana Lara Garcia of IDEXX Laboratories, to help put everything into context. Dr Mark Stidworthy from IZVG Pathology discussed lymphoma and lymphoproliferative disease in exotic and wildlife species, and Dr Suzanne Turner gave a fascinating talk on some of her basic science research into anaplastic large cell lymphoma in children including in some mouse models. Many of the attendees at the meeting were working in the field of diagnostic pathology but we also welcomed anatomic and clinical pathology residents and some oncologists too. The meeting is still available for registration and recordings of the sessions available to view – anyone with a professional interest in oncology and lymphoma would find the lectures and associated discussions very interesting and useful for day-to-day diagnosis and work-up of these cases. The BSVP is a not-for-profit society that aims to advance veterinary pathology in all its aspects for the benefit of animals and man; to foster training, to advance education in all aspects of veterinary pathology and to foster communication between pathologists working in various fields. Keep an eye on our website www.bsvp.org for information about upcoming meetings. -DR LOU DAWSON, SCIENTIFIC ORGANISER AND HONORARY SECRETARY OF THE BSVP
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
Reptile 101 for the Busy, General Practice Vet
Reptiles are Ectothermic: True or False?
Imagine how the GSD owner would react you couldn’t recognize their dog’s breed? Not to do so immediately undermines confidence in your advice. The same goes for reptiles
Firstly, a reptile that travels in a cold box looks really sick…because they’re cold. So when a client wants to bring in a sick reptile, have the latter travel in a box with a heat source to better assess their demeanour on arrival.
True…reptiles are ectothermic and derive the majority of their body heat from Do you know a Border Collie from a German external sources. Of course you knew this, Shepherd? Of course you do. but what about the practical implications?
With reptiles becoming popular pets (spoiler alert: I own a Bearded Dragon) if the general practice vet wants to save face with that reptile owner, it helps to know some basics.
Secondly, temperature husbandry at home is crucial to the reptile’s well-being. Just as you might ask if a cat is indoor or outdoor, so you need to ask intelligent questions
about a reptile’s living quarters. Know that the vivarium should be maintained at the species ‘preferred optimum temperature range’ or POTR – a quick online search of the species is a great help. Also, most species need a thermal gradient (a cooler end) with a warmer basking spot – usually a heat lamp (not a hot rock as these cause nasty burns.) But temperature is just about body heat. Many lizard species (especially the popular ones such as Bearded Dragons and Chameleons) need a UV source to maintain healthy bones. And these UV lights need replacing every six months (it’s important to know when the tube was last changed.)
Reptiles have a Four-chambered Heart: True or False? False: Reptiles have a three-chambered heart, with two atria and a single ventricle. Hopefully you won’t have to scan a reptile heart, but it’s an interesting fact to know. Also, the heart sits way far forward in the chest, practically at the thoracic inlet between the shoulders. So don’t be surprised if you can’t find a heartbeat – the chilly reptile isn’t dead – you’re just listening in the wrong place and they need warming up Other interesting anatomical quirk is that the kidneys sit relatively far back in the abdomen, almost within the pelvic canal.
This is important because drugs injected into the hind legs are circulated directly to the kidneys, which may risk nephrotoxicity or result in unexpectedly low serum levels of the drug. Also, know that reptiles have a large ventral abdominal vein that runs on the inner surface of the abdomen. This is bad news for the unwary because it’s exactly where, in a cat or dog, you enter the abdomen for an ex-lap. Long story short, make the incision slightly lateral to midline…or live with regret.
Holding a Reptile by the Tail is a Good Idea: True or False? False. Most lizards are capable of shedding their tail as a defence mechanism to evade predators. Indeed, tails are often brightly coloured to catch the predator’s eye, and may wriggle for several minutes after detaching (let’s hope you don’t get to see this.) Long story short, don’t restrain a reptile by the tail.
Reptiles as an Emergency Reptiles are engaging pets and responsible owners go to great lengths to take proper care of them. But if your heart sinks at the thought of triaging a reptile, then Louise Abuzet’s webinar (14th Jan 2021) on the subject of reptile emergencies is not to be missed.
WEBINAR AMR ON FARMS- WHAT DO WE KNOW SO FAR? ANDREA TURNER PROFESSOR OPTHALMOLOGY UNIVERSITY OF CALIFORNIA DAVIS
David’s Review
David Maggs is a graduate of the University of Melbourne (1988) and has had extensive experience in practice followed by research training at the University of Missouri. Since 2000 he has been at Davis as professor of veterinary ophthalmology and is one of 7 ophthalmologists in the university ophthalmology service. He is, along with Ron Ofri and Paul Miller, author of the standard textbook ‘Slatter’s Fundamentals of Veterinary Ophthalmology’ now in its 6th edition.
Andrea is a first opinion practice vet at the University of Bristol Veterinary School. She is a Cambridge graduate, and after graduation she undertook a residency at the Bristol veterinary school from 2014-2016. She is a diplomate of the European College of Bovine Health Management Her research project was on the reduction of high priority critically important antibiotics on dairy farms.
A
thought provoking slide begins this important veterinary webinar. It is a chart summarising the O’Neill commission into the reduction of antimicrobials in agriculture and their dissemination into the environment. It is estimated that as things stand Anti Microbial Resistance (AMR) by 2050 will have a greater impact than infectious disease, road traffic accidents and cancer-10 million cases with cancer in second place on 8.2 million. There is an important link between livestock AMR and human health. ‘If you work/live
closely with animals you share their bacteria.’ Much of this webinar uses extensive citation of research articles to demonstrate the evidence for any statement made. Evidence based medicine is key to Andrea’s research. The literature search has been meticulous and will be of great value for students particularly post graduates working in AMR. Vets have a critical role: • The most recent UK five –year National Action Plan includes a target to reduce Antibiotic Use of food producing animals by 25% • In 2018 industry led policies were enforced in the UK that aimed to almost eliminate the use of Highest Priority Critically Important Antimicrobials (HPCIAs) in dairy farms. Specifically• Third and fourth generation cephalosporins • Fluoroquinolones A graph follows demonstrating encouraging reduction of veterinary antibiotic sales
using data from 2014-2018. Articles indicate that reduction of antimicrobial use leads to a reduction in AMR. Many of the studies looking at risk factors for AMR measure Extended Spectrum beta Lactamase E. coli (ESBL E coli). These bacteria produce an enzyme that can hydrolyse penicillins and cephalosporins. E coli that produce the extended Spectrum Beta Lactamase cefotaximase are classified as CTX-M. They are resistant to most third and fourth generation cephalosporins, which are important antibiotics in human medicine. Similar enzymes called AMP C beta lactamase have ben found in some isolates of E. coli, Klebsiella and Salmonella. There is considerable detail in the webinar on this subject and it is very relevant to the many studies that are mentioned later.
Andrea goes through all of these by researching articles where the evidence is strong with conclusions for each area. For example the first batch of articles gives very good evidence for AMR associated with HPCIA use, biosecurity and cleanliness.
We move onto practical matters asking the question: -
Thus calf areas, hygiene and feeding (waste milk) are added to the risk factors, and highly significantly so.
What are the risk factors for AMR on individual farms?
The rest of this impeccably researched webinar looks at mastitis treatments, dry cow management and even ambient temperature, (an increase in ambient temperature leads to increased AMR.)
Clearly antibiotic use is an important factor but there are many other possibilities, which I list here: In addition to antibiotic use a subdivision can be made into the class of antibiotic, whether it is used prophylactically or metaphyllactically, and topical/parenteral • Dry cow management • Farm husbandry • Buying in • Slurry • Wildlife • Waterways • Footpaths
I was very interested in the role of calves that were fed waste milk containing antibiotic residues on the prevalence of ESBL -producing E. coli in calves. Several articles conclusively demonstrate a link leading to a statement from RUMA (Responsible Use of Medicines in Agriculture Alliance) Waste milk (excluding colostrum) from cows under the statutory withdrawal period for antibiotics should not be fed to youngstock’
Andrea states at the beginning that she would not be able to give all the solutions but would indicate areas where research is on-going. There is an amazing amount of detail in the presentation but it gives an excellent insight to the problem and what vets should be considering when trying to implement strategies on farms. This research is incredibly important when you consider the rather worrying forecast of what might be the situation by 2050 if action is not taken now. I very much enjoyed this webinarit’s obviously one for the LA practitioner and students-but ultimately AMR impacts on all our lives, and it’s really good to see that the profession is tackling the problem.
WEBINAR MANAGEMENT OF EQUINE SARCOIDS ANNA HOLLIS B.Vet Med MSc (Clin Onc) DipACVIM Dip ECEIM MRCVS DIRECTOR EQUINE SERVICES CAMBRIDGE EQUINE HOSPITAL University of Cambridge Veterinary School
I
came to this webinar armed with no experience and limited theoretical knowledge of equine sarcoids. In the past webinars like that have always turned out to be the most interesting because I was learning something quite new. This very educational and entertaining webinar by Anna Hollis is no exception. Her qualifications speak for themselves -in addition to two board –certification diplomas she is the only equine vet to have a masters in clinical oncology.
a collection this webinar has! Apparently benign neglect has (and still is?) advocated by some. This is not recommended as seen in the first case. It is as bad as anything I have seen in small animal dermatology. Treatment must be an option and the earlier the better. The treatment options are listed: -
She begins with a great quotation:
• Topical creams
‘Sarcoids are skin cancer. Rubbing a herbal cream into skin cancer is like treating a forest fire with a watering can’
• Intra-lesional injections
With no knowledge of the equine industry I wonder who that was aimed at? Later we see many examples of failures in various sarcoid treatments – pictures are worth a thousand words! The first slide emphasises that there are many hundreds of different opinions and that no one treatment is universally appropriate. Also critically, some are evidence based and some are not. Anna is well on the way, together with her substantial team in Cambridge in ensuring that all treatments are examined for their evidence basis. We are soon into clinical illustrations of sarcoids-and what
• Radiotherapy • Electrochemotherapy • Laser surgical excision
• Strontium plesiotherapy • HDR brachytherapy • Teletherapy Of these HDR brachytherapy appears to be very promising. It has been considerably researched in the Cambridge equine hospital and aims to be available soon generally. Some quite complicated radiation physics is summarised before clinical slides of patients wired up (literally). It looks like space age technology. These are quite unbelievable pictures! The results are very encouraging.
The treatment of sarcoids using HDRB has been on-going for nearly • Photodynamic therapy 5 years from the first cohort of • Sharp surgical excisions patients. 142 have had suitable follow-up time, and these cases • Cryosurgery have been mostly periocular, and also aural and lower facial In the notes attached to this lesions. 90% have achieved webinar there is a very good complete resolution- 129/142. summary table reporting the 7% were considered failures due success rate for each of these progression at treatment site. and whether the treatment is recommended. A recurring theme 3% had stable disease and of the remaining three cases two had a is that careful case selection is always merited and that with many successful second treatment. treatments there is limited data -going back to the comment about For me the next case was the most remarkable in a series of evidence-based treatments. remarkable successes. We are shown a photograph of a large Anna begins the account of sarcoid on the eyelids of a horse, treatments with radiotherapywhich had only three days before noting a published success of raced in the Grand National. 75-100%. The various treatment Whatever the rights and wrongs modalities are listed: of that just six months later there • LDR iridium wires/seeds was a complete resolution of
the problem, the horse was back in training and a month later in the winner’s enclosure after its first race back. The prize money surpassed the cost of treatment-a win-win for everyone! A series of five cases before and after treatment, including some previous treatment failures, all say the same thingHRDB is very effective, with careful case selection and expertise. It was very impressive to see long term follow up pictures of these cases-years in some. So what could possibly go wrong? In answer Anna reports on no serious side effects, either in the short term of long term, nearly 5 years in total. In the shortterm mild swelling, desquamation, depigmentation and leukotrichia have been seen in most cases. In a handful of cases there has been skin sloughing prior to healing, associated with higher doses of radiation. 4 horses developed fibrin in the anterior chamber, which resolved with treatment. Longer-term effects are theoretically possible such as cataract formation. This is deemed unlikely although owners have been informed of the possibility. Other treatment modalities are reviewed. These include strontium plesiotherapy, noted to be very effective on carefully selected lesions, electronic brachytherapy, and mitomycin C. In a small number of cases this was stated to be 100% successful (abstract only), but Anna points out that her team have treated multiple cases that has failed with this treatment using HDRB. Laser surgical excision is useful in early well-circumscribed lesions, with success rates reported to be 62-83%. We then come onto AW-5, a cream that is only available online from a specialist’s referral service. It is known to contain fluorouracil, thiouracil heavy metal salts and steroids. Intriguingly its exact composition is a closely guarded secret! AW3, AW4 and now AW5 have very sparse data on any formulation, although many thousands of cases have been treated. AW4 data suggests success rate of around 70% except in periocular cases where 35% success is reported. It can go wrong however and a severely inflamed lesion is shown where that was the case. The remainder of this excellent webinar summarises the use of 5-flourouracil, Tazarotene, Imiquimod, Acyclovir, Bloodroot ointment, Bleomycin,
intra-lesional Cisplatin and intra-lesional BCG. The reported success rates for all of these are noted The remaining treatment options considered here are photodynamic therapy, and cryosurgery, (both these have widely disparate success rates) and both need careful selection. Even the elastrator band gets a mention. This is only suitable for clearly defined lesions that you can get underneath. It can be extremely effective, cheap and easy to apply. But you are warned to select your cases carefully –get it right and you will be a hero, choose the wrong case and you will cause a disaster! With so many options what to choose? The factors suggested are: • Location • Budget • Convenience • Temperament • Owner’s expectations A useful summary follows with advice of treatment according to location and it is summarised by always choose according to evidence: • Lesions around the eye HDR (once available). Having seen the Grand National horse I hope that will be soon • First line in any other location laser resection-but the others are mentioned. Anna is very happy to give free advice on any aspect of this webinar. She can be contacted at arh207@cam.ac.uk This is a brilliant webinar for equine vets, students both undergraduate and post-graduate and anybody interested in cancer therapy. It is thoroughly recommended.
WEBINAR NEUROLOGY MADE EASY-INTERACTIVE CASES LUISA DE RISIO DVM (HONS) PhD DECVN FRCVS Luisa is as well qualified in neurology as it is possible to be. She has a PhD from her alma mater (Parma, Italy), then an internship also in Parma followed by one in Paris. A residency in North Carolina completed her training culminating in passing the examinations for diplomate status of the ECVN. For many years she was lead neurologist at the AHT until recently becoming Clinical Research and Excellence Director for Linnaeus Veterinary limited.
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eurology made easy? Is that possible? There is only one way to find out and that is to watch this veterinary webinar. Luisa begins by emphasising the systematic approach using pieces of a jigsaw puzzle-a nice graphic touch. A lot can be achieved by a careful medical history and physical examination, much the same as in dermatological cases. Specifically here we see the benefits of a neurological examination enabling a differential diagnosis list and the selection of various diagnostic interventions. The next slide is of the brain simplified, (thank goodness), which clearly shows the forebrain, the cerebellum and the brain stem. For each of these divisions there is a list of historical, physical and neurological abnormalities typically seen. It is very useful to study this slide because in the subsequent cases that we see the first question asks which part of the brain is likely to be the site of the problem. Right away we are into the first case, a ten-year-old feline neutered DSH, ‘Boopy’, with a history of progressive neurological dysfunction, which has resulted in recumbency and decreased awareness. A video then demonstrates the problem and the neurological examination. These videos work really well and are followed by a summary of the neurological examination that you have just seen. At this point you are asked to define the neuroanatomical location. Luisa invites you to watch the video again if necessary and then construct your differential diagnosis to compare with Luisa’s. The next question is ‘What would you do next?’ This leads us to the diagnosis in Boopy’s case and subsequent treatment, and we see another video three days after treatment. To say I was astounded is a massive understatement! Another case is a 6-year-old female neutered cocker spaniel. ‘Bluebell’. In contrast to the previous case, which ultimately could only be solved by referral to a specialist, Bluebell’s problem was solved by the systematic approach and diagnostic tests quite suitable for first opinion practice. Again, videos before and after treatment are very impressive in just a few days. Most if not all the diagnostic investigations are straightforward. This case brings up a whole range of questions regarding treatment, answered by guidelines that are well summarised. The third case is ‘Buddy’ with a peracute onset of inability to stand up and walk, with several episodes of vomiting also. We see Buddy walking with great difficulty supported by a harness and falling to one side. Neurological examination findings are summarised, the neuroanatomical location is questioned as with the previous cases followed by your differential diagnosis. I liked the Sign-Time graph that is very useful in deciding the ranking of the differential diagnosis. Buddy’s diagnosis is perhaps more obvious than the previous cases (at least to non-experts such as myself). But just as in the first case I was astounded by the accuracy of the diagnosis made possible by specialist investigations. This is followed by up to date information on the syndrome, further investigations that might be necessary and the prognosis. I wouldn’t be surprised in substantial numbers of colleagues will be wanting more webinars from Luisa-this one was just perfect and so well explained that it did seem easy. But making things look easy is the hallmark of the true expert!
WEBINAR SEIZURES IN CATS LAURENT GAROSI DVM ECVN FRCVS RCVS AND EVS & EUROPEAN SPECIALIST IN VETERINARY NEUROLOGY
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his veterinary webinar goes a long way to demystify a complicated subject. It is liberally supplied with client-supplied videos of their affected cats, an almost unequalled library of clinical manifestations. It’s quite refreshing too to be advised not to get lost in details (so easy to do in complex neurological cases), but instead concentrate on defining the problem via the presenting complaint and clinical findings, and then adapt the examination to the particular problem. A diagrammatic cross section of a brain illustrates the concept of events occurring pre-ictal and ictal, comparing generalised seizures with partial ones. Manifestations of these are often atypical in cats and may be focal, psychomotor or high frequency. Some examples of auditory reflex seizures, (FRAS), are given including extraordinary videos. Who would have thought that a seizure could be provoked by the noise of a crisp packet being opened? Here you see (and hear) it for yourselves.
The good news is that it is one of the seizures that responds well to levetiracetam. Laurent divides epileptic seizure causes into intracranial-idiopathic, (functional) secondary (structural) and extracranial – reactive (metabolic, toxic.) For each of these there is a list of possible causes with brief descriptions. For example for metabolic causes: • Porto-systemic shunt • End-stage of liver and kidney disease • Hypoglycaemia • Electrolyte imbalance • Polycythemia • Thiamine deficiency The following section of the webinar lists and describes the other causes of epileptiform seizures. Included here are some MRI images, some of which astonished meparticularly the before and after surgery images of a meningioma, and typical MRI findings in thiamine deficiency. We move on to a discussion of idiopathic epilepsy, which has a prevalence of between 3060%. These cases have equally focal or generalised seizures. There is a median age of 3.8 years (0.4-14.4) and seizure remission is attained frequently with a median of 1.4 years. A neurological examination aims to assess gait and mental status, followed by postural reactions and an examination of the cranial nerves.
Importantly a distinction is made between cats that are normal between seizures and those that are abnormal. A distinction also needs to be made between asymmetrical and symmetrical signs as this will help determine a differential diagnosis and associated investigations. There is a suggested list of blood analysis-haematology, biochemistry, urinalysis etc. Intracranial cases may need CSF analysis, serology, PCR and imaging of the brain. Treatment aims to identify and treat, if possible, an underlying cause. Allied to this is antiepileptic treatment. Currently available drugs are listed: • Phenobarbitone • Pregabalin • Levetiracetam • Zonisamide • Topiramate The aims of anti-epileptic treatment are to ‘control’ the epileptic seizures and minimise side effects. The question of when to start treatment is addressed: • If there is an identifiable structural aetiology • If status epilepticus has occurred • If there have been 2 or more seizures within 6 weeks • If the first seizure occurred within a week of trauma However each case is best considered on an individual basis with the owner, bearing
in mind that an owner will have to give treatment twice daily for life and we all know how difficult that can be with some cats.
epileptic drugs mentioned are also summarised, with levetiracetam the most commonly used alternative, and for cats it is affordable
The initial drug of choice is phenobarbitone and there is considerable time given to its pharmacology, formulations and dose recommendations. Phenobarbitone leads to good control (less than 6 seizures per year) in 50-80%. In a recent survey nearly 50% remained seizurefree for years. However, in 75% of cats cessation of treatment led to recurrence of seizures. One side effect of phenobarbitone that I had not come across is a marked lymphadenopathy, reversible with cessation of treatment and switching to another drug. The other anti-
This is an excellent, interesting lecture and it is thoroughly recommended. The summary main points that you will acquire after watching it are: • Partial seizures are frequent • Look for asymmetrical neurological sigs • Remember to check for systemic hypertension • Phenobarbitone can cause pseudolymphoma • No need to monitor phenobarbitone serum level regularly, unlike dogs