The Webinar Gazette - August 2020 by thewebinarvet

The Webinar Gazette The Webinar vet

To provide: The highest quality vet-led content To be: The world’s largest online veterinary community

AUGUST 2020

To have: The planet’s most confident vets

WHAT’S INSIDE Blog from Ben Jane’s Blog Speaker of the Month Pippa Talks Guest Article David’s Reviews From the Literature

Fabulous News about WCVD9 I’m so pleased to tell you some fabulous news about the World Congress of Veterinary Dermatology which was due to take place in Sydney in October. First, I’d like to tell you a story! After I qualified, I moved about a bit. I didn’t settle immediately into the profession. I’d always wanted to be a vet but I guess I didn’t spend as much time as I should have deciding what type of vet I would become. About two years into my professional life I signed up for a weekend course on dermatology given by Richard Harvey at Cater and Campbell’s practice in Llandudno. It ignited my interest in dermatology and I started to attend the RVC symposia organised by Professor David Lloyd. I decided to attempt the RCVS certificate in Veterinary Dermatology in 1995 and managed to persuade David Grant to be my mentor. He was splendid and I managed to pass first time, having

read Muller and Kirk’s Small Animal Dermatology from cover to cover. In 1996, I attended WCVD3 in the beautiful city of Edinburgh and had a lovely meal with the famous Danny Scott from Cornell University. In 1997, I won the Frank Beattie Travel Scholarship from the BSAVA and had 3 weeks in Cornell with Danny which was amazing. By this time I was running my own peripatetic dermatology clinics in the North of England and Wales. 2000 saw me travel to San Francisco to WCVD4 and give a short communication on the use of acitretin in the treatment of canine epitheliotropic lymphoma. I can’t believe it was 20 years since I was exploring the streets of San Francisco with veterinary dermatology colleagues who became friends like Stephen White David Shearer and Gordon Duncan. In 2004, WCVD5 was in Vienna and we got a private view of the Lippizaner stallions which was fantastic. The

conference was held at one of the Habsburg palaces-palatial! In 2008, it was held at the exhibition centre in Hong Kong. I went via Dubai to see an old school friend and also to try to acclimatise to the jetlag. However, I found it really tough and was often awake in the night and then sleeping in and missing lectures. On the Sunday, after the congress finished, I took a ferry to one of the islands to run a very hilly 10k and met a Chinese lady sporting a Penny Lane striders t-shirt from a run I had done also- small world. Hong Kong was so busy but I enjoyed sitting with a Japanese group one of the social evenings. 2012’s event took place in the summer holidays. I was able to take Rachael, my wife, to the beautiful city of Vancouver and also visit Vancouver Island. We watched orcas for an hour which was magnificent. The CE was, of course, amazing too! In 2016, I had decided to stop practicing because The Webinar Vet was getting busier. My first European derm

conference was also in Bordeaux so it was great to bookmark my dermatology career with two conferences in Bordeaux. Both conferences were as famous for their splendid wine as they were for their amazing CE. I was looking forward to Sydney in October to keep my hand in with dermatology and also to see old friends but unfortunately the Coronavirus popped up. I’m honoured that the committee of WCVD9 have asked me

to help bring their fabulous conference online. If you are interested in knowing more about WCVD9 click here.

Take care and God bless,

Anthony

Ben Sweaeney BVSc MSc (VIDC) Cert AVP MRCVS

Evolution time for the profession?

don’t know about you, but something I had never really considered as a younger person was whether or not we would ever be out of a job as vets and nurses-after all, people will always have pets and therefore there will always be jobs, right? Covid-19 has thrown a few curve balls out there for all of us, but one thing that is starting to come to everyone’s knowledge is the very real prospect

of larger numbers of redundancies than we have seen in my professional career for sure. Pet sectors have always been considered to be ‘recession proof’, and by that I don’t mean that we don’t see the impact of recessions, but that we don’t feel their effects to the same level as other industries and professions and have never really been impacted by mass redundancies. It is why so many venture capitalists and private

equity investors put their money into it, it is considered ‘safe’. But how safe is your job nowadays? We are already hearing about redundancies being announced across the profession, and even the closures of some practices. No doubt we will all know people who are stressed with work at the moment: whether that is due to high workloads or fear of redundancies, or even those who have already been added to the ever increasing list of unemployed people in the UK and beyond.

the work day? There are no easy solutions, as there is already so much we have to cram into the veterinary work day, especially in such a competitive environment like we live in now.

As a profession where people are increasingly crying out for new ways of working, in many cases desperately seeking a way to find to make veterinary careers work for them rather than the other way round, multiple companies have popped up who can deliver flexible opportunities to vets and nurses. Unlike many practices who are desperate for people to join them to work, these guys are almost beating people away such One of the positives to really emphasize to the is the competition for jobs with them : sadly the entire veterinary community is that where one knock on effect of high competition for these door closes, others open. There are a multitude roles is that it can lead to them being devalued so of new types of work opportunities that are being people get paid less for them than they would for opened up to veterinary professionals nowadays. physical services. As evidenced by a recent poll that I published in a large Facebook group, 54% of veterinary professionals are now looking for flexibility in their work life. So, is this the opportunity that the profession has been waiting on for some time now to evolve how we deliver our services?

There are no right answers for the profession as a whole I don’t think, but there are definitely right answers for you as an individual. What do you want from life? What do you want from work? What is important to you? What are you going to do to make it happen?

I am not suggesting that we replace physical with digital, in fact the requirement for physical veterinary services has never been highlighted more, but is the purely physical service based business model a hindrance to our practice and personal success? Does it stand in the way of you growing your practice? Of engaging with your clients? Does your practice offer flexibility to it’s staff? How could you create flexibility in

I hope you all manage to find the right formula to achieve you own career success. We have recently launched www.simplyvets.com which is a careers networking platform where as part of our community you will be able to network opportunities for yourself and your friends and colleagues and would love for you to join us and find your #vethappy

MAKING NURSE CONSULTING WORK FOR YOU AND YOUR PRACTICE

Colourful CPD’s ‘Making Nurse Consulting Work for you and your Practice’ is an ideal multipresentation webinar event for all veterinary nurses who are keen to develop or progress nurse-led clinics in their practices. Brian Faulkner and Steph Writer-Davies from Colourful CPD are joined by Clare Hemmings from Royal Canin as well as Samantha Payne and Kristi Paul, two veterinary nurses whose days are spent in full-time consulting roles in their respective practices. Steph’s and Brian’s presentations lay the groundwork for nurse consulting, covering the Legislation it is important that veterinary nurses understand and considering how it applies to consulting roles. Also providing a template for consulting that will allow nurses to approach any consultation with confidence and ensure it proceeds effectively, as well as thinking about the common challenges faced by veterinary nurses when setting up clinics and ways these can be overcome. Clare’s talks look at the possibilities of remote consulting for veterinary nurses as well as tips to make your weight clinics successful. Samantha and Kristi share their stories of what they love about a majority consulting role, explaining the way nurse consulting works within their practices and how they succeeded in getting the support of management and their colleagues to expand their clinics into the successful and valued services that they offer. The day that provided 6 hours of excellent CPD aired live on July 15th with some interesting questions and debate. Any veterinary nurses who missed this great event can now purchase the recording for £49+VAT.

OFFER

https://www.thewebinarvet.com/pages/buytickets-colourful-cpd-nurse-consulting-roadshow/

CONTACT DETAILS: Sophie Lo Curto (Operations Manager) contact@colourfulcpd.com 07907 306911

A TRULY BLENDED APPROACH?

or many years the delivery of face to face and online learning has been termed a ‘blended approach’. Yet many learners struggled with combining classroom and online learning and educators faced issues too. Is the online learning trying to replicate the classroom experience or not? A question still being debated today. Perhaps the enforcing of online activities during Covid19 is going to bring in a new and better era of blended learning. I hope it will begin to facilitate the need to re-visit information 3-4 times to

aid recall and understanding. It could make us value face to face interaction more highly and use shorter sessions more wisely. As an educator in my ideal world (bear with me on this) I’d ideally like students to have accessed the information they need to learn 3-4 times before they consider setting aside those notes to return to them for revision or further learning. Before you start panicking about time and how little of it you have consider the following time allocations for traditional learning:

OPTION 1 ACTIVITY

TIME TAKEN

Pre-read lecture notes 10-15 mins

LEARNING OPPORTUNITIES • Look up words you don’t understand • Align info to learning outcomes • Note any questions you feel you need answered

1 hour face to face lecture

60 minutes

Note take

Post-read and information seek

15-20 minutes

• Review notes and your questions • Research the questions you have • Consider lecture in context of module course

4 TOTAL TIME

Collate with other relevant notes

10 minutes

90-105 MINUTES

Note relationships to overall learning outcomes

Jane’s Blog As an educator in my ideal world (bear with me on this) I’d ideally like students to have accessed the information they need to learn 3-4 times before they consider setting aside those notes to return to them for revision or further learning.

OPTION 2 ACTIVITY

TIME TAKEN

Pre-read lecture notes 10 mins

LEARNING OPPORTUNITIES • Look up words you don’t understand • Align info to learning outcomes

Submit and review questions on a forum

10-15 minutes

Note any questions you feel you need answered

Face to face lecture

30 minutes

Supplement existing notes and answer questions raised

Post-read notes and questions

10-15 minutes

• Review notes and your questions • Research the questions you have • Consider lecture in context of module course

5 TOTAL TIME

Collate with other relevant notes

5 minutes

75 MINUTES

Note relationships to overall learning outcomes

For recall and understanding we need to visit information 3-4 times with an active learning approach. Sitting and taking notes in a lecture or simply re-reading notes is a passive and slow way to learn. Your mind drifts, the stuff you don’t understand doesn’t get any clearer, and you congratulate yourself for time taken rather than goals achieved. Perhaps Option 2 is scary – it should be, you have to become an active learner and that means hard work! But it saves time, reduces face to face contact and improves your recall and understanding of the information shared. It requires you to start analyzing and processing information and not be reliant on a staid 1 hour lecture to hand the info to you. We are all learning during Covid19 but perhaps it will bring in a better use of online learning of benefit to us all.

Speaker of the Month Sonya Miles

Sonya Miles BVSc CertAVP (ZooMed) MRCVS, qualified from Bristol University in 2013. In early 2015 she started work as an exotic species veterinary surgeon at Highcroft Veterinary Referrals, completing her zoological medicine certificate in early 2018. She has a special interest in reptile medicine and surgery, but enjoys all aspects of being an exotic species veterinary surgeon.

https://www.thewebinarvet.com/ webinar/reproductive-diseases-inchelonia-1 https://www.thewebinarvet.com/ webinar/common-conditions-inleopard-geckos https://www.thewebinarvet.com/ webinar/bearded-dragons

Get 50% off Sonya's fantastic webinars here.

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.”

The Eye-opening Story of the Ophthalmoscope… and other Trivia TRon Ofri’s webinar on 6th August is titled, ‘Making sense of what I see in the ophthalmoscope’, which sounds a practical and useful webinar. However, I’m a sucker for trivia and the first thought that popped into my head was “How long has the ophthalmoscope been around?” With this in mind, let’s throw some light on early theories about how feline eyes could see in the dark (emitting light rays rather than receiving them) and the origin of the first ophthalmoscopes.

Pippa Elliott BVMS MRCVS

The First Ophthalmoscope The credit for the first ophthalmoscope goes to the German, Hermann von Helmholtz. In 1851(the same year The Great Exhibition took place in Victorian England) Helmholtz developed an instrument he called the ‘augenspiegel’ or ‘eye mirror’. This hand held device used mirrors to focus ambient light onto the retina. Of course, mirrors were necessary because at this time the incandescent light bulb had still be invented (patented in 1879 by Thomas Edison- although electric arc lighting had been around since 1837, twoyears before Queen Victoria came to the throne.)

New Instrument, Old Name Helmholtz came up with an original instrument, but the word ‘augenspiegel’ was nothing new. This had been used since the Middle Ages for an early form of spectacles or eyeglasses. However, the term ‘ophthalmoscope’ was first applied to his device in 1852 by a Greek, Andreas Anagnostakis, being derived from ophthalmos (meaning eye) and skopos (observer.)

Eye Opening Investigations Prior to having a suitable instrument to study the back of the eye, early experiments were somewhat bizarre. For example, how do cats could see so well in the dark? In an attempt to explain the latter, in 1703 Jean Mery observed luminosity at the back of a cat’s eye… when the animal was held under water. Six years later this marvel was explained by the theory that water abolished corneal refraction, which allowed the observer to see divergent light rays emerging from the eye. This was in keeping with the then current theory that light originated from the retina to facilitate that awesome night vision. A breakthrough came when Professor Prevost repeated some of these experiments and discovered that when performed in the dark (presumably submerging the poor creature in water once again) the cat’s eyes became invisible. ‘It is not the light which proceeds from the eye to an object that enables the eye to perceive that object, but the light which arrives in the eye from it.’ Prof Prevost

This discovery brought the fledgling science of ophthalmology out of darkness and into the light.

Two Trivia Titbits So let’s test out your knowledge of firsts. When was the idea of the otoscope first thought up? a) 1363 b) 1864 c) 1963 The answer is an astounding (a) 1363, but with (b) 1864 a close second. The first recorded description of an otoscope like-device occurred in 1363 when the French surgeon, Guy de Chauliac literally dreamt (much like James Watson had a dream about the structure of DNA) about a device that would allow him to better diagnose conditions affecting the ear and nose. However, it took until the 17th century for a German medical salesman to translate that vision into a speculum-like device for examining ears. And it was around 1864 (so an honourable mention for those choosing this option) for an otoscope to be developed that we might recognize today. Which of the following, in the past has NOT been used to suture wounds? 1) The giant ant, Eciton burchelli 2) Kangaroo tendons 3) Gold thread 4) Cat gut

OK, did you spot the trick answer as (d) cat gut? This is because this traditional suture material is not made from feline gut at all but from the ruminant mucosa or submucosa. It’s thought the term ‘cat gut’ originates from its use as violin or fiddle strings as ‘kitgut’ or ‘kitstrings’ (Kit meaning ‘fiddle’)

The ants were then decapitated in such a way as to leave the jaws supporting the wound edges.

Watch the Webinar

So there we are. That’s enough musing on the past for now, which leaves you And yes, the ancient world used giant ants plenty of time to catch Ron Ofri’s webinar on Making sense of what I see in the as suturing devices, much like an early surgical staple-gun. These large ants were ophthalmoscope. placed so their mouthparts pinched either side of the wound, drawing it together.

What can you compost in practice?

Guest Article Merryn Wymes RVN, Founder of Zero Waste Veterinary

• Human food waste • Shredded paper • Pieces of paper or cardboard that are too small to recycle • ‘’Clean’’ paper towels (I.e. from drying hands) • Soiled cardboard packaging (E.g. greasy pizza box) • Compostable packaging • Grass clippings Leaves and garden waste

id you know that a third of the food produced across the world is wasted? A THIRD! What’s more, food waste that is sent to landfill won’t actually break down or decompose as many people believe it will. Buried under layers of rubbish, with little access to oxygen or light, food waste in landfill can not decompose properly. This also goes for anything that is marketed as ‘compostable’. These items will only actually ‘compost’ in the right environment, which is definitely not found in landfills. As well as taking steps to reduce your food waste, composting is the most environmentally friendly way of dealing with food waste. Although councils offer green waste collections, the Royal Horticultural Society encourages home composting because it does not involve heavy transport, with its associated environmental costs. There are many ways to compost in practice, you will just need to collectively research and decide which one will best suit your needs. For example; if you have a keen gardener in your team, it may be easier to send your waste home with them to compost in their own garden. If you are lucky enough to have an outdoor green space with your practice, you may find it suits your practice to have your own compost bin outside (you may need to ask permission from your landlord). Or why not try a worm bin? Whatever you decide, it will all go a long way to reducing the waste your practice sends to landfill.

What NOT to compost in practice • All used patient bedding* • Faeces • Used cat litter • Soiled paper towels • Anything else that is classed as ‘offensive’ or ‘hazardous’ waste *When I asked the B.V.A whether it would be acceptable to compost unsoiled patient bedding (E.g. hay), the reply was; ‘’It wouldn’t be appropriate for staff to remove quantities of used bedding from the practice and it would be contingent on you to demonstrate that a risk assessment had been carried out for each item if the Environment Agency ever asked. It would be difficult to prove that used bedding was completely unsoiled.’’

Composting at home Home composting is a little different as you generally have more freedom to add what you want without the limits of ‘offensive’ and ‘hazardous’ waste. I personally love to compost and find it no trouble at all. There is a small food waste bin kept in my kitchen for ease and a large compost bin in my garden. I love the idea that all this ‘waste’ is given back to the Earth and turned into something useful. Isn’t nature amazing?!

What’s in my home compost bin?

• Biodegradable ear buds

• All food waste and scraps

• Vacuum bag contents

• Leaves, grass clippings and garden waste

• Human and pet hair

• Cut flowers

• Biodegradable cleaning products (E.g. Luffa sponge)

• Biodegradable cat litter (not faeces)

• Anything else which is classed as ‘biodegradable’

• Soiled (biodegradable) bedding, paper and cardboard from my hamster • Pieces of paper and cardboard that are too small to recycle • Soiled paper and cardboard packaging • Compostable packaging • Biodegradable dental floss

If you are interested in introducing composting to your workplace or your home, I say go for it! Do some research and get stuck in, the planet will thank you and you will be one step closer to zero (landfill) waste! PLEASE remember to keep all compost bins secure and away from pets to avoid compost ingestion/ intoxication.

WEBINAR RATIONAL APPROACH TO THE RED EYE DAVID MAGGS BVSc (HONS) DACVO PROFESSOR OPTHALMOLOGY UNIVERSITY OF CALIFORNIA DAVIS

David’s Review

T 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.

his veterinary webinar, as the title suggest, is all about getting an accurate diagnosis. It is case based and challenges you with ‘what would you do?’ for each case. As always with these webinars on eye disease, it is extensively pictorial, and all the illustrations are exceptional. We are reminded that red eye is common and in this seminar, which was part of the uniformly excellent World Veterinary Association Congress 2020, the approach and diagnosis of the following diseases is discussed: • Conjunctivitis • Keratitis • Uveitis • Glaucoma • Orbital diseases Red eye is seen with a wide diversity of diseases-and even more causes, which becomes apparent as we progress through the webinar. The first illustration is a red eye with extensive scleral congestion with the question

‘What would you do?’ Well he guessed correctly what my answer would be-but you must do this test for yourself! You will probably be correct to a point with your initial approach, but this leads on to six other assessments that every red eye should have, and yours? (mine) might not be necessarily the first. Blood vessels are a diagnostician’s best friend and we are taught how to differentiate between superficial vessels and deep vessels. The distinction is important. Superficial vessels are seen in conjunctivitis and superficial keratitis, whereas deep vessels are associated with deep keratitis, uveitis, glaucoma and orbital disease. Close ups make the distinctions perfectly clear just from your examination and they are listed. The next illustration shows a cloudy cornea with mucus at the lateral canthus, which leads on to the second assessment-the Schirmer Tear Test (STT). This is advised in all cases before any eye drops and without topical anaesthetic. We are shown the correct way of performing this (did you know that

oil from your fingers can influence the result?) - me neither. Normal values are given for dogs and cats.

as demonstrated in a cat, (which had the very high reading of 73 mg/Hg.)

The next abnormal eye, in a cat, demonstrates another essential assessment in most cases, (with the exception of deep ulcers with corneal fragility.) It is retropulsion, which just on its own may be strongly suggestive of the underlying disease as demonstrated in this particular case.

A summary slide lists some important features of pupil size in reddened eyes: -

The last two diseases in this webinar address glaucoma and uveitis with suggestions of how to differentiate between them. A very useful technique is an assessment of aqueous flare. This is pathognomonic for uveitis and a simple technique for demonstrating aqueous flare is beautifully illustrated using just an ordinary ophthalmoscope, and a magnifying lens in a darkened room. Glaucoma is conveniently assessed using a tonometer and normal and abnormal values are given for dogs and cat. A final assessment, also useful for suggesting glaucoma if a tonometer isn’t available, is the retroillumination technique. Excellent illustrations show that by using the ophthalmoscope at arms length it is quite possible to pick up abnormalities associated with glaucoma,

• Uveitis –sometimes small • Glaucoma-sometimes large • Conjunctivitis (and others) –always normal The last revision slide lists the seven tests for every red eye: • Assessment of blood vessel depth • STT • Retropulsion • Assessment of flare • Retroillumination • Tonometry (Oh-and fluorescein!) This webinar is thoroughly recommended-it is teaching at its very best

WEBINAR NEPTRA-THE FUTURE IS LONG ACTING SUE PATERSON MA VetMB DVD DipECVD FRCVS

he learning objectives of this veterinary webinar are:

1. How to approach an otitis case and optimise the experience for the dog and owner, 2. How to approach a case and how to make informed decisions on the most appropriate drugs to treat a case. 3. It also introduces colleagues to the new product Neptra, which promises to significantly improve the management of acute otitis externa cases in first opinion practice. The webinar begins by considering a typical client and his dog ‘Hercules’. This section examines the client and vet expectations in the approach to the case. Sue refers to a paper in Veterinary Dermatology that looked at the effect of otitis externa cases on the pet and owner quality of life. The main conclusions from this study were that 80% of owners found the ear disease time consuming, 70% found the odour or discharge unpleasant and 85% were stressed by the problem and worried that they might be hurting the dog when administering medicines. Unsurprisingly this escalated to aggression when the owners tried to touch the ear-ear phobia as Sue refers to later. The client expectations of the vet and the treatment process

are summarised in two slides and are important. Essentially the dog should be successfully examined, not frightened or hurt, leading to a diagnosis and an effective treatment that is safe and easy to administer and not time consuming or affecting the owner/pet/bond. There are more interesting statistics included around treatment: -

• Identify and correct chronic otic change

• More than 50% of owners struggle to administer ear treatment

A table of primary causes comprehensively lists these –some 20 or so diseases. However Sue estimates that the most important underlying causes, some 75% of cases, are allergies.

• 70% would like a single dose treatment given by the vet with no home treatment • 86% of owners feel that reducing the stress for the dog is a priority when treating otitis externa From a veterinary point of view, vets would like to make an examination without upsetting the dog or inciting aggression, make a tentative diagnosis, prescribe appropriate treatment to make the dog comfortable quickly, and finally to have a happy client.

Every ear problem has a primary cause, although these may not need investigating in all acute cases. The possibility of such an investigation should be advised however. In all chronic cases primary causes should be investigated.

We move onto the identification and the treatment of secondary infection. In acute disease microorganisms are nearly always cocci/yeast, but this changes as the disease progresses. An excellent illustration demonstrates that with chronicity rods replace cocci and there is a progressive narrowing of the ear canal shown in otoscopic images on the same slide.

• Identify the primary causes

The importance of cytological examination is emphasised and should be used not only to decide on therapy, but also to decide whether an end point-cure, has been established. Some practical advice on obtaining cytological samples is reinforced by superb images of specimens containing Malassezia, cocci and rods.

• Identify and treat secondary infection

Culture is never needed where yeasts are predominant.

The aims in investigation and therapy are succinctly summarised: In order to manage the case effectively and prevent recurrence there is a need to:

Treatment can be empirical with suitable cleaner (should contain wax removing component) and anti-yeast drug. Culture may not be needed with first presentation bacterial cases but may be needed if response to empirical therapy is not satisfactory. Cleaning should be with an anti-septic solution such as lactic acid, or chlorhexidine. Culture is essential if the chance of otitis media is high, e.g. with rods predominating. Cleaning should be with a good Gram-negative activity, tris EDTA for example. The following section is of tremendous practical use. Sue lists suitable drugs for empirical treatment of yeasts, cocci and rods, particularly Pseudomonas. For each of these she tabulates those drugs, along with the glucocorticoid that accompanies them, that are currently available. These tables are worth downloading for easy reference. 90% of all eardrops contain an antibiotic, anti -mycotic and glucocorticoid. It is considered important to have an appreciation of the mode of action, spectrum of activity and potency of each component. Finally because fluoroquinolones are critically important antibiotics, they should be avoided if at all possible. Two phrases that should not be heard in a consultation are ‘Give me a ring if the problem

doesn’t settle down’ and ‘Finish the drops and see how it goes’. The end point, established by cytological examination, should be a microorganism- free sample as seen here in a sequence of illustrations. The essential steps in investigation are now summarised-taking a history, performing a physical dermatological and otic examination, performing cytology and prescribing treatment. A very interesting sequence taken from the Blue Cross advises on assessing the dog’s emotional state in the consulting room ranging from flight, fight freeze or fooling. Time spent using positive reinforcement is time well spent as it aims to make the experience fear free and even pleasant. After all any dog that becomes ‘earphobic’ is going to end up almost impossible to examine and treat. This is the first time I have seen advice on behavioural therapy in a dermatology presentation but it is quite logical when you think about it. We return to ‘Hercules’. He has different problems in his ears as shown by cytology. The logical approach is applied and suitable treatments narrowed down from the previous lists shown earlier. The final part of this excellent webinar covers Neptra. This is a newly launched otic preparation containing mometasone, (potent glucocorticoid,) florfenicol,

(anti –bacterial) and terbinafine, (antimycotic agent.) The essential features of each of these components are summarised. Neptra is long acting and only a single application (by the vet) is needed. A small amount, (1ml) is instilled, following cleaning, and there is no need for the owner to do anything. A follow up appointment in 10-14 days is strongly recommended for examination and repeat cytology. Further details of the product can be obtained from the company rep. Sue’s summary is as follows: ‘Successful therapy is not just using the right drug, in the right way to achieve clinical cure. It’s also about how you get there so that it is a stress free and fear free journey for the vet, owner and most importantly the dog…………………the future is long acting.’ This webinar is as good as it gets, with Sue Paterson on top form. It is a very clear, well thought out logical approach, which should go a long way to helping colleagues to get it right first time with ear problems. Bayer has sponsored the webinar and there are voice -over versions in Spanish, Italian, Czech, German, Hungarian and French. These are fun to dip into if you want to brush up a language and of course of great value to our colleagues in their respective countries.

WEBINAR CANINE LEISHMANIOSIS: WHAT VETS IN THE UK NEED TO KNOW MYLES MCKENNA MVB MVETSCI MVETMED DACVIM (SAIM) DECVIM-CA MRCVS

ince graduating from UCD in 2013 Myles has accumulated an impressive set of post-graduate qualifications as seen above. Experience gained has included a spell in general practice, an internship at Cornell, a masters programme in Edinburgh and a residency at the RVC. I have listened to several webinars on Leishmaniosis, mainly delivered by specialists from Italy and Spain. This one concentrates on the disease from the UK perspective. It is very well put together, very clear throughout, and a very useful addition to the subject. There are more than 20 species of Leishmania but only one is of importance to colleagues in the UK. -Leishmania infantum. There are two forms- amastigote (ovoid intracellular within the canine host), and promastigote (elongated flagellated form within the sandfly). The life cycle is described and a map shows the current prevalence in Europe-increasingly moving north as a result of climate change. The sandfly is the main

vector but other routes of transmission are possible. These are vertical, sexual, blood transfusion, direct dogdog transmission and other vectors also.

osteomyelitis, meningitis and myocarditis are all possible consequences. We are guided through the myriad of laboratory tests that can aid in diagnosis. Included here are haematology and biochemistry, diagnostic imaging, urinalysis, cytology, histopathology, serology and molecular diagnostics.

Some risk factors are outlined, including age,(less than 2 years), breed, concurrent disease, exposure to outdoors, lack of ectoparasitic treatment and poor sanitation-street dogs Of these, particularly useful are for example. cytology and histopathology, and there are two very good There are three possible illustrations of amastigotes outcomes to infectionwithin a macrophage obtained elimination, subclinical by fine needle aspirate of a infection and clinical disease. lymph node and by biopsy. The latter is associated with unregulated B-cell activity, Elisa antibody tests and giving rise to immune immunoflourescent antibody complexes and vasculitis. tests are mentioned and finally PCR in some instances, There are various systemic although this test, perhaps manifestations - polyarthritis, surprisingly to some, has a low ocular lesions, cutaneous lesions, glomerulonephritis and sensitivity and is therefore not recommended as a first line occasional CNS involvement. diagnostic test. In practice the most common clinical signs are : The widely accepted Leishvet staging system is explained in a • Lethargy, depressed table, giving expected antibody appetite, fever, chronic titres, clinical signs, lab findings weight loss, muscle atrophy, generalised lymphadenopathy, and prognosis for each of the 4 splenomegaly and pale mucous stages. membranes The webinar now deals with those treatments that are • Alopecia and scaling, available. especially round the pinnae, muzzle and periocular regions • Meglumine antimonate. This is given subcutaneously • Renal signs such as polyuria, every 24 hours for 4 to 8 polydipsia, progressive weight weeks. Adverse effects such as loss and poor appetite cellulitis may occur and it also In addition to the above has the disadvantage of being there are other possible difficult to obtain in the UK presentations that depend • Miltefosine. This is on the localisation of administered orally once disseminated amastigotes. daily for 28 days and is an Prostatitis, pancreatitis,

alternative to Meglumine, although it is less likely to result in parasitological cure than Meglumine. It is expensive-between £400 to £800 for a month’s treatment for an average sized dog. • Allopurinol. This drug is low cost and low toxicity. Regardless of the treatment used complete parasitological cure is rare, and relapse, particularly as the dog ages, is common Summarising treatment protocols the current treatment of choice in the UK is: • Miltefosine -2mg/kg by mouth once daily for 28 days • Allopurinol -10mg/kg by mouth twice daily until normal haematology and biochemistry values are obtained along with negative quantitative serology. Potentially given lifelong. Clear and very useful guidelines are given for a recommended monitoring programme, which includes recommended intervals for blood tests and serology. In spite of the great difficulties of obtaining a parasitological cure many of these patients can hope for an improvement in their quality of life with good remissions. Clinical improvement can be expected within one month of treatment,(except where renal disease is present). Complete remission rates of 65100% may be obtained with the recommended protocol mentioned above. But even with dogs on life long therapy with allopurinol, relapse is possible, although this may be treated with a repeat course of miltefosine. The remaining part of the webinar deals with aspects of prevention. This includes vaccination. Of note is the need for an owner to plan ahead at least 4 months before any trip to an endemic area as 3 doses of the vaccine are required initially, at 3 weekly intervals. For those that don’t plan there is some information of the use of domperidone to reduce the risk of contagion, general advice on avoiding the sandfly from dusk to dawn and deltamethrin collars to repel the insect.

A worrying trend, albeit small at present. Is the development of disease in dogs that have not left the UK and this is discussed. Finally some myths are dismantled separating fact from fiction. For example one statement appearing widely on internet forums is that Leishmaniosis is a very treatable disease. Although in many cases this is true it is not the case when renal disease develops. Costs –not just the drugs but also the detailed monitoring protocols may be a deterrent to some owners. As with all veterinary webinars there is a lively question and answer session and some comments about the Facebook sites, which are worth looking at to be forewarned! A very good professional website is www.leishvet.org , which has issued guidelines for the practical management of canine leishmaniosis. This is an excellent veterinary webinar covering everything a UK vet needs to know, as the title promises, about canine leishmaniosis. The details on treatment and monitoring should enable a case to be treated in first opinion practice in many instances.

From the Literature â&#x20AC;&#x201C; Augustâ&#x20AC;&#x2122;20 IA couple of articles in the most recent edition of the Journal of Veterinary Internal Medicine caught my attention. Both are open access so no need to belong to any organisation- anyone can view them. The first is highly academic and will delight immunologists. But it was the conclusion that struck me.

Autologous cancer vaccination, adoptive T-cell transfer, and interleukin-2 administration results in long-term survival for companion dogs with osteosarcoma Brian K Flesner and others Journal of Veterinary Internal Medicine. First published July 10 2020

he background to this study, from the university of Missouri veterinary college, is the observation that osteosarcoma in dogs is an aggressive bone tumour with frequent chemotherapy failure and translational relevance to human health. The hypothesis was that these dogs could be treated safely with ex vivo activated T cells that were generated by autologous cancer vaccination. In support would be interleukin -2 treatment. A proposed objective for the study was survival more than twice that reported for amputation alone. 14 dogs were enrolled, with an additional four healthy dogs treated as a safety study. There is considerable detail on the immunological methods employed. Minimal toxicity was noted during the study. Median disease free interval for all dogs was 213 days. One dog developed cutaneous metastasis

but then experienced spontaneous complete remission. Median survival time for all dogs was 415 days and 5 dogs survived for greater than 730 days. The authors conclude that this immunotherapy protocol, without cytotoxic chemotherapy, is safe and tolerable with survival notably prolonged when compared to historical amputation reports. As might be expected following these encouraging results further studies are warranted, not just to replicate the results but also to understand in more detail the underlying immunological process. . In the same edition but quite different is a study evaluating claims for commercial senior cat foods. This is also quite academically rigorous-the lead authors are from Oregon State University College of Veterinary medicine, and the conclusions are blunt.

Evaluation of nutrient content and calorific density in commercially available foods formulated for senior cats Stacie C Summers and others Journal of Veterinary Internal Medicine July 2020

at foods for senior cats, (those above 7 years), are available to owners. The variability in the nutritional content of these foods is unknown. The objectives of the study were to measure the calorific density and calorific distribution of crude protein, crude fibre, crude fat, phosphorus, calcium, magnesium, sodium, potassium and vitamin D3 in commercially available foods for senior cats and to compare nutrient content with foods for adult cats. Sampling involved 31 senior and 59 adult commercial nontherapeutic cat food products. An astonishing amount of bench work was involved with such a number of foods and ingredients. They are meticulously documented and the results will at least partially satisfy the manufacturers. Without exception all the foods met the values of the Association of American Feed Control Officials Cat Food Nutrient Profile for Adult Maintenance. Foods for senior cats had significantly higher crude fibre content compared to foods for adult cats (P .0001) otherwise there was no significant difference between the foods.. In conclusion the authors note that foods marketed for senior cats are highly variable in their calorific density and nutrient content and except for crude fibre are similar to foods for adult cats. Vets are recommended to avoid broad recommendations regarding commercially available foods for senior cats and dietary recommendations should reflect the patient’s individual needs. I am not quite sure what to make of that since all foods met the values mentioned above. So does the fibre confer an advantage? Is it just marketing? And how do you ascertain the needs of an individual cat regarding its nutritional requirements when all the foods seem adequate? Obviously I am not a nutritional expert-but there is plenty in this article to chew over (sorry). Finally this month another interesting article along broadly similar lines to the previous two, this time in the Veterinary Journal.

Immune function and serum vitamin D in shelter dogs: a case study The Veterinary Journal Volume 261 July 2020 I .N Allison and others

here seems to be a lot of interest in vitamin D currently, especially with the suggestion that low vitamin D levels are associated with a poorer Covid 19 survival. About a year ago I was found to have very low vitamin D levels as part of a general investigation, and I have been taking supplements ever since. Again, as for the article on osteosarcoma, there is a great deal of background information for the immunologists beginning with the statement that vitamin D has potent immunomodulatory effects in a diverse spectrum of species that confers protective effects for the host. 7 references, all of recent publications, back this up.

Helpfully this journal is one that highlights findings before you get stuck into the immunology. They are: • Immune function and serum vitamin D concentrations were assessed in shelter dogs • Shelter dogs had decreased phagocytic/oxidative burst function compared to controls • Serum vitamin D was weakly associated with the intensity of oxidative burst • Serum vitamin D was moderately inversely associated with TNF-a In conclusion dogs housed in a shelter for 7 days or more demonstrated immune dysregulation in vitro that could be a contributory factor to the high occurrence of infections in shelter dogs. Furthermore the findings suggest the possibility that oral vitamin D supplementation in shelter dogs has the potential to improve immune function. Therefore, as always, ‘further studies are warranted”. Have you had your vitamin D level measured in these challenging times?