The Webinar Gazette The Webinar vet
To provide: The highest quality vet-led content To be: The world’s largest online veterinary community
JUly 2020
To have: The planet’s most confident vets
WHAT’S INSIDE CPD’er of the Month Speaker of the Month David’s Review From the Literature
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s you know, Alpha Vet International’s theme for this year is Regenerating the veterinary world. It’s such an important topic because I be that climate change and the consequent degradation of the planet is our biggest existential threat. I’m thrilled to also let you know that since the beginning of April we’ve pledged to plant over 500 trees as part of our pledge to regenerate our planet- every little helps. We’ve committed to planting 2 trees for every membership we sell. We will also be calculating our carbon this year with Eco Offsets, Chantelle Brandwood’s company and planting further trees here. This month we’ve planted a small wildflower meadow at the Liverpool Science Park and we will be taking some of the team to clean the beach at Waterloo.
I don’t say any of this to brag but to encourage you to do your bit as we are doing. There is so much single use plastic on the beach, some washed up, some left and it reminds me of the huge plastic problem. Please do visit www.plasticfreejuly.org and make your pledge. My wife and I have decreased plastic use by over 90% in the last few years. It is possible but it takes thought. I hope you can join me on the journey https://www.greenpeace.org.uk/
work that Jacqui Byrne, Head of membership, and the rest of the team have been making to improve member benefits. The practice management tracker for practice members allows a clear sight of how everyone in the team is doing with their CPD and our integration with the RCVS’ 1CPD app will save massive amounts of time because you can click on a QR code to register your CPD! You will need to put reflection in but it is a massive time saver. Watch out for the videos.
It turns out that most of our plastic we produce and then recycle gets sent to Turkey and is then burnt. Mr Johnson must put actions with his positive statements on the environment.
I’m thrilled that we are helping my favourite conference, ESVD, happen this September. It was to take place in Porto but has been moved online. I have been to many of these congresses over the years and I would highly recommend them to anyone with an interest in dermatology.
Turning to other matters, I was super excited to see the fabulous
https://www.esvd-ecvdcongress. com/ Finally, I’ve moved over to help launch Simply Vets payroll and recruitment service. We wanted to help solve the resource shortage by making better use of the human resources( ie vets and nurses) that we have. I was going to say manpower which is a word I don’t like but neither do I like human resources as a term for people. Please forgive if I’ve
offended. Most locums now need to be employed so I wanted to provide a service from a company that cares about nurses and vets and will also help to develop them personally and professionally. Please do get in touch if you’d like to know more about this service. Hopefully together we can help keep practices working after a truly brutal 18 months of social distance operating.
Thanks for all everyone is doing for the animals at this very tough time.
To your CPD success, Anthony
CPD’er of the month
This month’s CPDer of the month is
GARETH MORGAN
4. Are you looking forward to any future webinars or events from The Webinar Vet?
1. Which webinar did you enjoy the most this month?
Thank you for selecting me as the Webinar Vet CPDer of the month! This last month I found the overview of ‘Systemic hypertension in cats’ by Sarah Caney to be very informative and practical for everyday practice. The take message I think is that most of us should be measuring blood pressure more for the benefit of our patients, enabling us to identify disease earlier and achieve better clinical outcomes. 2. Did you attend any large events this month? If so, which?
I didn’t attend any large events this month, covid has put those on hold sadly! 3. What was the biggest take-home message you learned this month from our webinars?
Biggest take home message was from the ‘Practical approach to anaemia’ in that these cases are not as scary as they may appear if you work through them logically. Also bone marrow sampling is not as hard as it may appear!
I’m looking forward to Danielle Gunn-Moore’s latest webinar next month on ‘Feline lower respiratory tract disease’, Danielle is such an enthusiastic speaker and there are always lots of take home messages from her presentations. The Webinar Vet has been a fantastic source of education for the whole practice and myself in recent times. It’s so convenient to just login and complete CPD without the associated travel and expenses. The virtual congress was excellent and appears to get bigger every year! The breadth of content is exceptional, with something for everyone on a wide range of topics. I can’t think of anything that’s not well covered from medicine, surgery, imaging, behaviour, sustainability and mental wellbeing, it’s pretty much all there. Almost all webinars have some very useful take home messages which actually change what you do in practice for the better (what CPD should be about). This obviously has benefits across the whole process including client service, animal welfare and job satisfaction for the veterinary team. The recordings from the Webinar Vet are always accessible to review previous content, this makes things a lot easier. It’s easy to miss something first time through in real time.
Speaker of Speaker of the Month the Month With over 40 speakers delivering CPD sessions as part of WCVD9, we wanted to highlight a few of them here for you!
Sophie McMurrough
S
ophie qualified as a Registered Veterinary Nurse in 2011. After passing her AIMVT examinations in Washington DC, Sophie became a Veterinary Technician Specialist in Small Animal Internal Medicine. She is one of 3 Head Nurse’s at Northwest Veterinary Specialists in Frodsham, England.
Sophie’s areas of interest are endocrinology and emergency medicine.
Speaker of the Month – July 2021 – The Webinar Vet Shop
Feedback: “Fantastic Webinar!!! It would be great to have the notes. Thank you very much for such a huge amount of work.” ”THANK YOU, GREAT WEBINAR” “Very advanced webinar for nurses! Really enjoyed it and the release notes were helpful! Amazing for anyone interested in vet nursing medicine” “Great webinar! I love how Sophie included other medical disease also connected to hypercalcaemia too. Very interesting, thank you!”
BEING A MARINE MAMMAL MEDIC WITH THE BRITISH DIVERS MARINE LIFE RESCUE By Head of Memberships, Jacqui Byrne It was June 2020 when a Fin whale became stranded in the Dee estuary. Despite tireless efforts by the British Divers Marine Life Rescue and one successful refloating, the whale sadly restranded and passed away. Sitting at home a stones throw away, following the progress of the whale and the sad outcome, I resolved myself to achieving what I had looked into 10 years previously – becoming a Marine Mammal Medic. Flash forward then to a rainy day on the Wirral in August 2020. Having spent the day before swotting up on online lectures on marine mammal biology, identification and first aid/rescue techniques, myself and roughly 15 medic wannabees gathered (socially distanced) in our wetsuits and masks to gain our certification. We spent the morning focusing on seal rescues learning how to assess and give first aid to a seal in need (without losing any fingers). We practiced our newly learned techniques on the cutest life sized models you ever did see, attracting a fair bit of attention on the beach as we struggle to get the sheer weight of a seal into a crate for transport to a rehab facility. I had signed up for the ‘wet’ course which meant that after lunch we developed quite an audience as we focused on whale and dolphin rescues in the water. Its not every day you see a Killer whale off the promenade in New Brighton! By the end of the day we were wet, a little cold but had learned SO much and had a whale of a time (sorry I couldn’t resist). We had all passed and the dream had come true – I was a Marine Mammal Medic! Now to share the dream, The Webinar Vet have teamed up with the British Divers Marine Life Rescue to bring to you this fantastic 4 part course introducing you to non-captive marine mammal medicine in the UK. This will not qualify you to be a Marine Mammal Medic but it will give you the skillset to assist as veterinary professionals should your practice ever be called out to help a rescue. Gain access to the course and find out more about the sessions here. If you are interested in furthering your knowledge and qualifying as a medic yourself then visit (bdmlr.org.uk) and book onto the next course near you!
An Introduction to Non-Captive Marine Mammal Medicine in the UK A brand new 4 part online CPD course with Dr. Natalie Waddington.
FIND OUT MORE
COMING SOON to THE Vet Exhibition…
Royal Canin!
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t has been another fantastic month over at THE Vet Exhibition and I am so excited to share that Royal Canin will soon be moving in to build a point of access to their very own Event Centre! More details to follow in the coming weeks, but for now, here is a sneak preview of their premium front window location!
Visit THE Vet Exhibition now! www.thevetexhibition.com
We are also thrilled to be hosting the 32nd World Veterinary Dermatology Congress coorganised by ESVD-ECVD-ISVD from the 16th – 18th September 2021! So far, we have 11 exhibitors who will be present in the commercial exhibition which will be open to all ticket holders! During the online congress, scientific invited lectures will be streamed, including live Q&A. All lectures will remain available on demand until 31 December 2021. A virtual commercial exhibition area will be available with digital booths of each sponsor and exhibitor. The commercial exhibition will also remain accessible until 31 December 2021.
THE Vet Exhibition has also begun streaming our Sponsored Webinars through Auditorium 3 – our very own sponsors suite! We had a fantastic turnout for the IDEXX and NationWide webinars and look forward to hosting many more. For information on hosting a webinar or event through THE Vet Exhibition or information on how to watch through the platform, email Stephanie@thewebinarvet.com!
BSVP Summer Meeting. Lockdown Learning Part 2 (We’re Still Here!)
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signed off my Autumn Meeting report by wishing all my pathology friends a very safe and peaceful year, until we meet again virtually or (hopefully?) in person. I suspected at the time that this was a piece of heroic optimism rather than a genuine belief, and so again I signed up for the BSVP Summer Meeting online. Thanks once again to the Webinar Vet. My online meeting skills have been honed and vaccinations gratefully received. I think I have made progress towards the new normal and my immune system has certainly been educated, so with grateful thanks to our sponsors NationWide Laboratories and IDEXX Laboratories onwards and upwards we go! This meeting was titled, From the Clinic to the Scope & Back Again. Clinicopathological Correlations in Small Animal & Equine Medicine. A first glance of the programme seems like a pot pourri of mixed topics and presentations, but these are exactly the kinds of watercooler discussions we pathologists tended to have in the days when we were able to meet in person. We’d share interesting, unusual, and frankly frustrating cases, bemoaning the fact that we don’t have enough/representative/intact tissue or incomplete/absent clinical history and if only we had the right information, what clinically relevant/erudite reports we could write. Of course, circulating our problematic cases around two or three of our colleagues nearly always elicits four…… or five different opinions. As was pointed out by Prof. Paul Stromberg in his afternoon presentation, “How can two board certified pathologists shown the same slides come up with two different opinions?” I do think that this meeting has attempted to address some of these issues and help us go at least some way to coming to terms with our occasionally rather wordy narratives and inability to commit to a cast iron diagnosis. The meeting began with an excellent presentation from down under by Prof. Sharanne Raidal of Charles Sturt University on equine gastric ulcer syndrome from the clinician’s point of view. Sharanne’s extensive knowledge and personal experience was extremely helpful in updating us on this frustrating condition. Prof Francisco Uzal from UC Davis gave a masterclass on interpreting gastrointestinal biopsies with a particular focus on equines. Audience participation was expected, and I hope we did not disappoint. Dr Penny Watson and Dr Fernando Constantino-Casas from Cambridge University led us through a case-based presentation of the importance of communication between the clinician and the pathologist when assessing liver disease in dogs and cats. Dr Laureen Peters from the Universität Bern shared her immense experience of assessing liver cytology, indicating areas where cytological evaluation is most helpful when working up potential liver disease.
Finally, Prof Paul Stromberg from The Ohio State University gave an excellent and thought-provoking presentation on Cognitive Errors in Diagnostic Pathology: Why We Make Mistakes and How to Mitigate the Risk. This was followed up by an interactive slide review with Dr Norelene Harrington from RVC covering a few particularly tricky cases that might warrant some of those rather wordy narratives I mentioned earlier. The joy of a virtual event is being able to hear some genuinely world class speakers, whilst being mindful that some of our speakers gave up part of a well-earned night’s sleep to talk to us, Nevertheless I really do look forward to seeing all my friends and colleagues face to face……Maybe next time!
Sandra Dawson BSc BVMS FRCPath MRCVS Veterinary Pathologist at NationWide Laboratories
IDEXX Laboratories feature for BSVP Webinar Vet Gazette IDEXX Laboratories UK are proud sponsors of the BSVP Summer Conference “From the Clinic to the Scope and Back Again: Clinicopathological correlations in small animal and equine medicine”. The subject of the conference, encouraging close collaboration between pathologists and clinicians, is closely aligned with IDEXX’s reference laboratory operations, where anatomic and clinical pathologists collaborate with internal medicine, dermatology and oncology consultants to provide specific and tailored information and support for submitted samples. IDEXX also 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. (PIctured: Dr Elena Riccardi, IDEXX Anatomic Pathologist and Dr Tamara Veiga-Parga, IDEXX Anatomic Pathologist; IDEXX Anatomic Pathology UK team)
The Webinar Vet have partnered with AFSCAN to deliver their 1st African Small Animal Veterinary Congress
J
une 2021,
The Webinar Vet have partnered with AFSCAN who are excited to announce that their first virtual African Small Animal Veterinary Congress, an event taking place on Tuesday 29th June, Thursday 1st July and Saturday 3rd July 2021. The 3-day event will be delivered by expert speakers covering a variety of veterinary topics on Cytology, Canine Atopic Dermatitis, fluid therapy for cats and dogs as well as practical blood transfusions and regular Q&A sessions. In addition to educational webinars, each day will consist of a roundtable which will highlight important topics such as emotional and mental health (wellness) in the African Veterinary Profession and will encourage discussion from participants, as well as looking at what the future holds for the industry.
The 3-day event will be hosted through The Webinar Vet’s virtual Vet Exhibition platform. THE Vet Exhibition is a new feature for The Webinar Vet, where members will be able to access a complimentary learning, networking and exhibition space, virtually. The digital environment includes an exhibition hall and networking lounges for the community to utilise, as well as auditoriums to attend events and watch webinars.
The full event programme across the 3 days can be viewed here: https://www.thewebinarvet.com/pages/afscan-1st-african-small-animalveterinary-congress-tickets/
Speaking about the partnership, Dr Gabriel Varga, President of the AFSCAN society and Director at Zoetis said: “This is an exciting event for the African companion animal veterinary community. We have assembled a team of exceptionally well-qualified and enthusiastic veterinary specialist who will deliver some fantastic presentations and latest research from across the globe. We are very grateful to our sponsor Zoetis, which continues to provide the core funding for AFSCAN. This is the first congress to emerge from the highly successful AFSCAN project, which celebrated its fifth year of working in Africa in 2018.”
Anthony Chadwick, Founder of The Webinar Vet added: “Are you spending clinical time seeing dogs and cats for your clients. The WSAVA Foundation and AFSCAN have got together to develop a fabulous virtual congress which we are helping them to deliver. As you know, The Webinar Vet is the world leader in virtual veterinary congresses, having run our first one in 2013! We’ve got fabulous speakers such as Vanessa Schmidt from my ex-uni, Liverpool as well as Remo Lobetti, Mike Lappin and Andrew Mackin covering topics such as fluid therapy, management of the trauma patient and atopic dermatitis. I have a special place in my heart for Africa having visited Zimbabwe and Zambia in 1988 as a student and then spending two months on sabbatical in East Africa in 2005. What a diverse, beautiful continent! I can’t wait to see you at the conference!”
Tickets can be purchased, starting from £10 for students here: https://www.thewebinarvet.com/pages/afscan-1st-african-small-animalveterinary-congress-tickets/
ABOUT THE SPEAKERS Vanessa Schmidt – Cytology: an essential tool for your dermatologic patients – Tuesday 29th June at 13:20 (GMT)
Vanessa qualified in 1994 at Queensland University, Brisbane, Australia. After several years in both mixed and small animal practice in Australia and the UK, she gained the European Diploma of Veterinary Dermatology in 2009, and was granted RCVS specialization in 2014. Vanessa completed a four-year PhD at the start of 2014 before taking up her current position of Senior Lecturer in Veterinary Dermatology at the University of Liverpool. Vanessa is currently head of the dermatology service and enjoys her involvement in clinical work, teaching and research. Her research interests include infectious and zoonotic diseases.
Andrew Mackin – Practical blood transfusions in the dog – Thursday 1st July at 14:10 (GMT)
Dr. Andrew Mackin is currently Professor and Head of the Department of Clinical Sciences at Mississippi State University. Andrew is a 1983 graduate of Murdoch University in Western Australia, and after graduation completed an internship and residency in small animal medicine at the University of Melbourne, followed by an internal medicine residency at the Ontario Veterinary College. Andrew became a Fellow of the ANZCVSc in 1993, and a Diplomate of the American College of Veterinary Internal Medicine in 1994. Andrew has a clinical and research focus on hematology, hemostasis, immunosuppressive therapy, and transfusion medicine. In 2006, he received the Carl Norden-Pfizer Distinguished Teacher Award and, in 2010, the MSU-CVM Dean’s Pegasus Award.
Michael Lappin – Hot topic on zoonosis –Saturday 3rd July at 14:00 (GMT)
Dr. Michael Lappin earned his DVM degree at Oklahoma State University and his PhD in Parasitology as well as his ACVIM board certification at the University of Georgia. He is currently the Kenneth W. Smith Professor at Colorado State University where he oversees the Centre for Companion Animal Studies. Dr. Lappin studies infectious and immune mediated diseases of dogs and cat and has special interest in probiotics. Dr. Lappin has won several awards, including the Beecham Research Award and the Norden Distinguished Teaching Award. He sits on the editorial board for Feline Medicine and Surgery and Compendium for Continuing Education for the Practicing Veterinarian. He is editor of the textbook Feline Internal Medicine Secrets, and the former chairperson of both the AAFP Panel on Feline Zoonoses and the AAFP Bartonella Panel. Dr. Lappin is the Chair of the WSAVA One Health Committee.
PRESS INFORMATION New Chair for WSAVA’s Global Nutrition Committee Dr Cecilia Villaverde BVSc, PhD, DACVN, DECVCN (EBVS ® European Specialist in Veterinary and Comparative Nutrition), a Catalan veterinary nutritionist working in Ireland, has been appointed Co-Chair of the World Small Animal Veterinary Association’s (WSAVA’s) Global Nutrition Committee (GNC). A member of the GNC for eight years, Dr Villaverde succeeds American veterinarian Dr Gregg Takashima and will work with fellow Co-Chair Dr Marge Chandler DVM, MS, MANZCVS, DACVN, DACVIM, MRCVS and the GNC’s members to provide continuing education and resources to support optimal nutrition for dogs and cats. Dr Villaverde qualified from the Universitat Autònoma de Barcelona (UAB), Spain, in 2000, before completing a PhD in animal nutrition. She undertook a small animal nutrition residency at the University of California, Davis, before returning to UAB to head the nutrition service at its teaching hospital until 2016. She has been boardcertified in veterinary nutrition since 2010 and currently works as a clinical nutritionist and a nutrition consultant in Ireland. The GNC is one of the WSAVA’s longest-serving Committees and promotes the importance of high-quality nutrition for companion animals and the central role of the veterinary healthcare team as the expert source of nutritional information. It has created a set of WSAVA Global Nutrition Guidelines, together with a regularly updated Global Nutrition Toolkit, for use by veterinary teams. Both are available in a range of languages. The Committee’s members are based around the world and hold different roles within the profession. They lecture and publish widely on all aspects of nutrition for companion animals. Commenting on Dr Villaverde’s appointment, Dr Marge Chandler said: “Working with Gregg Takashima was a joy and we miss him very much. He made an immeasurable contribution to the GNC. “I am delighted to welcome my new Co-Chair, Dr Cecilia Villaverde, an ACVN and ECVCN diplomate. The GNC has already achieved a great deal this year, including the updating of the resources in our Global Nutrition Toolkit. We have even more planned for the second half of 2021.”w Dr Villaverde said: “Owners want the best for their pets but face an onslaught of confusing or simply wrong information about nutrition and it can be hard for them to navigate their way. Veterinary healthcare teams should, of course, be the first port of call for advice on nutrition. “We hope they will find that the educational resources we have created in the Global Nutrition Guidelines and accompanying Toolkit, give them the confidence to engage proactively with owners on the subject of nutrition and put them on the right path to feeding their pets an appropriate and well-formulated diet.” She added: “I am very excited to be working even more closely with Dr Chandler, who is a role model for me.” The GNC’s work is generously supported by WSAVA Industry Partners the Purina Institute, Hill’s Pet Nutrition, and Royal Canin. The Committee carries out its work independently of its Industry Partners. The WSAVA represents more than 200,000 veterinarians worldwide through its 115 member associations and works to enhance standards of clinical care for companion animals. Its core activities include the development of WSAVA Global Guidelines in key areas of veterinary practice, including nutrition, pain management and vaccination, together with lobbying on important issues affecting companion animal care worldwide. 22 June 2021 For further information: Rebecca George, George PR Tel: 01449 737281/07974 161108/ email: rebecca@georgepr.com
WEBINAR WHY CATS GO BLIND? RON OFRI DVM PHD DECVO HEBREW UNIVERSITY OF JERUSALEM ISRAEL
David’s Review
T
he outline of the current veterinary webinar is as follows: -
I expect many colleagues have been following Ron’s excellent lectures. There are five in the WebinarVet archives (including this one) and he reminds us that there will be one more, which I will be eagerly waiting for, on Inherited Retinal Diseases in Dogs. This will be on the 23rd. of September 2021
• Feline Uveitis • Cataracts and Glaucoma • Hypertensive retinopathy • Other feline retinopathies We are reminded of the large number of potential causes of uveitis in dogs, with fewer causes in cats. Even this list can be narrowed down to the situation in the real world. Leading causes of posterior feline uveitis are shown: • FIV, FeLv, FIP, toxoplasmosis • Fungal diseases (in endemic regions) • Tumours-consider these in unilateral cases in elderly patients An article from North Carolina veterinary school documents
120 cats with uveitis: • Toxoplasma 23.7% • FIP 15.8% • FIV, FeLv 10% • Neoplasia 5% • Idiopathic 40.8% (Some cats had more than one disease.) Even though the cause in many cases is idiopathic it is essential to look for known underlying causes before applying symptomatic treatment. This involves history, physical and neurological examination, haematology and biochemistry, PCR, IFA and ELISA, urinalysis, imaging and potentially at referral institutions aqueous paracentesis for serology and cytology. After a review of the relevant literature there is a summary of treatment emphasising that because systemic disease is only diagnosed in 40-70% of cases only 33-56% of cats
will respond to treatment. Symptomatic treatment relies on topical steroids, with some caveats, and importantly atropine. This causes mydriasis, reducing the risk of synechiae and is effective as an analgesic. Ron mentions that people who have had uveitis have told him how beneficial atropine is in reducing the painful spasm of ciliary muscle. Having had a solitary attack of uveitis years ago I can agree with that. It is an intensely painful condition. The specialist correctly said I would feel a lot better after the atropine drops went in. Speaking of specialist treatment we are advised (probably at referral level) to consider the intraocular injection of Tissue Plasminogen Activator (TPA) to prevent/ breakdown adhesions. Amazing before and after pictures demonstrate the effectiveness of this treatment. Uveitis is not without a proportion of complications including cataract, secondary glaucoma and if retinal detachment occurs blindness. These are all considered with the usual high standard of illustrations, a hallmark of Ron’s webinars. Measurement of glaucoma is demonstrated with two tonometers, the tonopen and the tonovet. Both give reproducible readings but the tonovet is much closer to the true intraocular pressure. Medical treatments for glaucoma are reviewed Feline cataracts are often secondary to uveitis (22-36% of cases) and therefore require a full investigation for this disease when they occur. In dogs the reverse is true cataracts cause uveitis. Hypertensive retinopathy most often presents in elderly cats with acute blindness. A series of illustrations demonstrate detached retinas and also a surprisingly almost identical correlation between a histological slide and ultrasound findings. Yet another use for ultrasound! Figures are given for normal and abnormally high blood pressure. Many of
these cats had an underlying chronic kidney disease and/or hyperthyroidism and , and with good control of the hypertension vision may recover in some cats. The final part of the webinar looks at inherited retinal degeneration, less common in cats than is dogs. There is information on the condition in Bengal cats. Some feline retinopathies can be avoided. Those mentioned are taurine deficiency, enrofloxacin toxicity and iatrogenic ones-blindness caused by mouth gags during anaesthesia, (20 cases in a report in the Veterinary Journal) and a further six cases recently reported following eye enucleation with optic neuropathy developing in the contralateral eye. Ron Ofri’s webinars are superb and I would recommend searching in the WebinarVet archives to watch his other contributions in this series-and as I suggested in the beginning of this summary, reserve the date (23rd September) for the last one on inherited retinopathies in dogs.
WEBINAR FELINE URETERAL OBSTRUCTION-PART 1 CLINICAL PRESENTATION, DIAGNOSIS AND INITIAL TREATMENTS DR BENOIT CUQ DR. VÉT., DIP ACVIM-SAIM MRCVS
B
enoit decided on an academic career as soon as he qualified from the University of Toulouse Veterinary College, France. He enrolled in internships at Toulouse, Montréal and Guelph. This led to a small animal internal medicine residency at Guelph from 20142017, diploma status of the ACVIM in 2018 and a PhD in pathophysiology, also at Guelph in 2016. He is now an Assistant Professor at the UCD School of Veterinary Medicine in Dublin, where in addition to the qualifications outlined above, he is a recognised specialist in small animal internal medicine from the Veterinary Council of Ireland. Benoit speaks very clearly in English and like many of our European colleagues in more than one language, in his case French, English and Spanish. I looked forward to this webinar as it deals with a subject of which I was completely ignorant. I was not disappointed. Benoit begins his presentation with a nod to Shakespeare by ‘To SUB or not to SUB –that is the question.’ If that doesn’t
make sense you may not be alone. Later in the presentation he lets us know that it stands for Subcutaneous Ureteral Bypass, a new technique he describes as the ‘gold standard’ treatment. This gives me the opportunity of letting you know that the follow up to this webinar will be going live at 8.30 pm on Thursday 12th, August entitled: -
Feline Ureteral Obstruction Part 2 Subcutaneous ureteral bypass devices (SUB) Indication, placement and long-term follow up. Returning to part 1, there are 10 possible causes of UO listed. Ureterolithiasis is the most common at 65.5%, followed by strictures (16.1%), combination of these (16.7%) and then the less common ones. There has been a 30 fold in identifying UO secondary to Ureterolithiasis over a recent 12-year period. Calcium oxalate stones cause 87% of the cases, and a further 11% contain calcium. 75% occur in the proximal ureter, 20% in the mid portion and 5% in the distal third of the ureter. Medical management for stone dissolution is not effective, nor recommended.
Obstructive nephropathy occurs with loss of renal function (40% at 24 hours) after the initial insult. If this is unresolved fibrosis and remodeling of the kidneys will result (big kidney, little kidney presentation). Clinically these cases have a median age of 9 years, and are mostly DSH. Signs are vague and non-specific: • Poor appetite-77% • Weight loss-64% • Vomiting-56% • PU/PD-31% • Haematuria-25% • Dysuria-23% • Oliguria or anuria-14% There is usually more than one sign on presentation with a median duration of 2 weeks. Physical examination reveals, in 82% of the cases, renal asymmetry (big kidney/small kidney). There may be heart murmurs in 66%, varying degrees of hydration, nausea, hypersalivation, uraemic ulceration and a normal or empty bladder. Significant biochemical abnormalities include azotaemia in 95% of patients and
hyperkalemia is an additional common finding. In 25% of cats there is ionised hypercalcaemia. Haematological abnormalities include anaemia in 68% of the cats, accounting for haemic murmurs. There are also varying urine sediment abnormalitieshaematuria, pyuria, epithelial cells, crystlalluria, bacteria and casts. Calcium oxalate stones, and calcium- containing stones are radio-opaque when exceeding 5mm in size. Radiographs are diagnostically very useful and are indicated to assess the entire urinary tract for nephroliths, ureteroliths and cystoliths. Benoit advises using both radiography and ultrasound to increase diagnostic sensitivity. He continues with very high quality radiographs and ultrasound images of
typical cases. There is ample explanation of, in particular, the technical aspects of ultrasound measurements. Ultrasound must surely be the most diverse and useful diagnostic technique available in veterinary medicine in all species? There are some examples of its use in several cases in quiz form before collating all the diagnostic information so far by demonstrating a ragdoll cat called Yukiko, which presented with UO. Benoit summaries his presentation: • UO is a challenging diagnosis. • US sensitivity 77% • US + radiography 90% sensitivity • Clinical findings on presentation, clinicopathological data and imaging findings are
required for the diagnosis • Time is of the essence -40% loss of nephrons after 24 hours and medical management is extremely limited, with only 10% success. As mentioned in the beginning, subcutaneous ureteral bypass (SUB) is a new emergency surgery for these cases and he ends by describing a success story -a cat that was treated in this way at UCD. This is a very good webinar. It will be of use to anyone that treats cats, and I am looking forward to the follow up on August 12th. 2021. In that webinar he will explain in detail the use of the SUB technique, and presumably from his quotation of the Bard, whether to use it or not.
WEBINAR: A SURGEON’S PERSPECTIVE ON THE CURRENT TRENDS IN THE MANAGEMENT OF DEGENERATIVE JOINT ISSUES David Dycuss DVM MS CCRP DACVS-SA
D
avid Dycuss is the co-founder and Co-
Diagnosis of osteoarthritis is based on the history such
director of Veterinary Sports Medicine and
as reluctance to exercise, or jump up for example, which
Rehabilitation Institute (VSMRI) www.vsmri.com
will be familiar to colleagues in small animal practice. An orthopaedic examination will be necessary to
He begins this veterinary webinar, sponsored by
improve diagnostic sensitivity. A list of typical findings in
Protexin, with a series of radiographs that ask if these
dogs and cats is given.
patients need the same type of management. It leads
Radiography as a diagnostic technique is discussed
on to the Learning Objectives/Goals of the presentation.
next. It only provides bony information (osteophytosis
These are: -
and sclerosis). Osteophytosis is useful to diagnose OA but it is not pathognomonic, and its value for staging
• Recognise that osteoarthritis affects the entire joint • Appreciate the ebb and flow of osteoarthritis with periods of calmness followed by flare-ups • Appreciate the multimodal management of osteoarthritis Osteoarthritis (OA) is the most common form of arthritis in dogs and cats, 20% of adult dogs and 60% of adult cats have radiographic evidence. 31% of owners report bone and joint problems with their pet, and in the United States osteoarthritis is the number one cause of chronic pain in dogs. Accordingly OA should be considered as a global disease process rather than an isolated disease entity, and is the final pathway of a failing joint. Articular cartilage is part of an organ with cross talk among other tissues, and in dogs OA is always a secondary phenomenon. In cats it is typically primary and idiopathic. By means of a coloured line diagram of the joint, aspects of the pathophysiology of osteoarthritis and degenerative disc disease are well explained, before emphasising that there are moments of calmness or remission. During this phase treatment concentrates on joint supplements, weight reduction and daily exercise.
is controversial. Frequently osteophytosis does not correlate with clinical signs. A series of high quality radiographs follows with some subtle bony changes. An important statement attributed to Denis MarcellinLittle (Professor at UC Davis) advises that: ‘We must move from a RETRO-active approach to OA management to a PRO-active approach to OA management’ This leads on to the recently proposed tool for staging canine osteoarthritis: Canine Osteoarthritis Staging tool (COAST) The COAST approach is a staging tool that allows for recognition of ‘at risk’ patients before onset of clinical signs. It also allows standardised scores to be used to guide management efforts. A series of charts, including those filled in by clients demonstrates how this works in practice. We are asked what are our goals in the management of OA. Suggestions are: • Improve quality of life
In flare up cases the focus is on getting the patients
• Improve pain
back under control with analgesia and multimodal
• Decrease flare-ups
management
• Improve daily activity • Improve animal/human bond
• Decrease body weight
Included also is useful advice for owners on regular
(And that it must be patient centred and specific and
exercise. Running round the back yard is not exercise -it
NOT a cookbook approach.)
is more like play. Walks should build up to 20 minutes on flat ground twice daily, which doesn’t sound too
A diagram summarises the main concepts in
arduous.
management. These include: The second group of dogs with previous primary • NSAIDS/analgesics • Joint supplements • Physical rehabilitation • Daily exercise
problems with onset of OA need baseline management but with a focus on analgesia to control flare –ups. We can do better than just offer NSAIDS and tramadol (likely no benefit), and the former use in the smallest dose possible.
• Intra-articular injections • Omega 3 fatty acids • Weight reduction David divides management into two categories: 1. Those that have a primary problem and have or will develop OA, those with OA as an incidental finding, and those with ‘preclinical OA’ Examples include ruptured anterior cruciate ligament, a 6 month old puppy with developmental elbow disease and a dog with acute gastroenteritis with OA noticed on an abdominal radiograph as an incidental finding 2. Those that had a primary problem and now suffer from OA with typical signs such as slowing down, unwilling to rise and ‘trouble with stairs’ Using coast baseline management for cases that have ‘incidental’ OA or ‘preclinical’ OA we are advised to
Owner education is key and there is a need to advise that OA is progressive and new baselines will be required to monitor progression and any therapeutic benefit. Flare-ups will occur and management will continuously evolve for an individual patient. Some of the drugs/techniques that are now described include intra-articular injections (hyaluronic acid, steroids,) and a very good video illustrates this technique clearly. The new product Librela is briefly described. It is not yet available in the United States. I liked the term for those dogs that flare up at the weekend (the weekend warrior syndrome’.) These are dogs that are lazy during the week, and their owners make up time at the weekends. This excellent webinar ends with an algorithm summarising the management of OA. Surgery gets a small box at the end and in the text is described as a last stage/salvage: -
be pro-active rather than retro-active, as this gives owners a clear expectation of the future. It also enables
• Arthrodesis
warnings to be given about future flare-ups. These are
• Salvage-e.g. femoral head osteotomy
the cases where we can have the most profound effect
• Total joint replacement
on the course of the disease.
(Flushing and debridement is no longer recommended.)
We are introduced to personal thoughts on Joint
I didn’t expect a surgeon to recommend surgery as the
Supplements-a difficult area to recommend particular
last stage. Instead we get a very thorough, thoughtful
products, (deep dark world), as many do not have
and careful examination of all the factors that can
to meet claims. He notes that Dasuquin –combined
lead to OA with steps to slow down progression at all
glucosamine/chondroitin sulphate has a demonstrative
stages and enable a good quality of life. The webinar
efficacy and protective effect. Other products mentioned
is recommended to all in small animal practice, and
here include omega n-3 fatty acids, polysulphated
for surgeons in training or specialist. David obviously
glycosaminoglycan and the benefits of weight control in
enjoyed giving this webinar-you will enjoy watching it!
obese dogs (10%body weight at a rate of 1-2% weekly.)
There is also a full half hour of questions afterwards.
From the Literature – July ‘21
FELINE URETERAL OBSTRUCTION: A CASE – CONTROL STUDY OF RISK FACTORS (2016-2019) Alexandra J Kennedy and Joanna D White Journal of Feline Medicine and Surgery. June 2nd 2021
I misread this initially as urethral obstruction, a problem all small animal colleagues will be very aware of. But this is ureteral obstruction and I can’t recall making this diagnosis. This article compliments the excellent webinar on the subject, by Benoit Cuq, which I have reviewed in this edition of the WebinarVet Newsletter.
• Ureteral obstruction (ureteroliths 13/18: unknown 5/18-confirmed with pyelography)
The authors, who both work in referral practice in Australia, state their objectives. Unilateral obstruction in cats, (UO), causes acute kidney injury and typically requires surgical intervention. There is a need for information about potentially modifiable risk factors to inform prevention strategies.
• Controls were defined as cats without evidence of UO on history, physical examination and abdominal ultrasound.
In order to investigate these a case control study was performed. Cases were defined as cats with either of the following: -
• A creatinine concentration greater than 140 μmol/l with both UO (ureteroliths: 6/10; blood clots: 3/10; pyonephrosis 1/10 and pyelectasia greater than 5mm on abdominal ultrasonography.
• Age sex and breed were documented with housing (indoors or mixed) • Diet (predominantly dry, mixed, or predominantly moist) was evaluated for a possible association with UO.
In total 168 cats (28 cases, 140 controls) were included. Age, sex, breed, housing and total calcium were not significantly associated with UO. However, diet was. Compared with cats eating a predominantly moist diet, cats fed a predominantly dry food diet were 15.9 times more likely to develop a UO. There was no difference in the association between diet and UO in cats fed a mixed diet in comparison to predominantly moist food. In conclusion the authors state that diet formulation could provide a simple and economical method to reduce the risk of UO. It would be interesting to see a similar study with urethral obstruction. At the Harmsworth the majority of cats with blocked bladders had been fed dry diets. Many of these cats whilst recuperating in hospital refused to eat anything but dry food. Of course many cats, fed dry food only, do not suffer from urethral
Sudden cardiac death: A comparative review of humans dogs and cats Celine Brugada-Terradellas, Pascal Smets, Arnaut Hellemans, Pedro Brugada THE VETERINARY JOURNAL VOLUME 274 AUGUST 2021
T
hree of the authors are from the small animal department of the Faculty of Veterinary medicine at Ghent University. Pedro Brugada is a professor and chief of the cardiovascular division of the University hospital in Brussels. It is a tremendous coup to get Pedro involved in this review. He is considered a world expert in this field and is the discoverer along with his brothers of the inherited ‘electrical’ cardiac disease, without structural abnormalities, known as Brugada syndrome. His life story is interesting, and you can find an interview with him online published by Radcliffe Cardiology www.radcliffecardiology.com (An interview with Professor Pedro Brugada, discoverer of the syndrome that bears his name). He is now in his late sixties but still fired up with enthusiasm for research and teaching. When asked by the Radcliffe interviewer
blockage. My theory is that it could be that blocked bladder cats fed on dry food have, for a variety of reasons, insufficient access to water prior to developing the problem. Anyone watching the game between Finland and Sweden will have heaved a sigh of relief when prompt action by the medical staff saved the life of Christian Eriksen, who had collapsed with acute heart arrest. Seeing him collapse, with CPD being given and the sight of defibrillation in use was horrific. I have often wondered why these events happen in very fit young people and how they seem to be rare in dogs. I recently got called out to a neighbour’s dog (we are never truly off duty), which dropped dead in her garden with no warning signs. With this in mind I was interested in the recent article in the excellent Veterinary Journal
how he got into medicine he replied that his mother pushed him. Philosophy and music might have taken precedence otherwise. Getting a residency after qualification was no easy matter either. Initially refused in haematology (too young) he found a post in cardiology in the University hospital in Barcelona. His wages barely paid the bills, as his wife was expecting their first daughter, but after his mentor and supervisor offered him a post in cardiology, he was asked to do additional work by helping with cardiac catheterisations of children. At the time he could barely afford a sandwich at lunch. Following the history and examination of these young patients, and the results of investigations he was asked to give a diagnosis-get it right and he was bought lunch! It was very interesting to hear his advice to young cardiologists. Take a proper history and listen to the patient before jumping in with the considerable sophisticated diagnostic techniques currently available. He sounds just like a dermatologist. Interesting to see another Brugada in the authorsit seems that one of his daughters has followed his path-but in veterinary cardiology! The article highlights the scarcity of data for genetic mutations in animals as compared with humans. Prevalence data for sudden cardiac death in animals in general is lacking and could be an area of fruitful collaborative research.
In humans it is one of the most common causes of death in Western countries, in the USA accounting for approximately 400,000 deaths annually, and approximately 85% of these deaths are cardiac in origin. In dogs and cats sudden cardiac death (SCD) also commonly occurs, but fewer pathophysiological and prevalence data are available. Many SCD cases in animals show similar underlying arrhymogenic mechanisms to humans. Numerous mutations on multiple loci have been related to SCD in people but only a few in dogs. This is considered one of the important areas for future research. The article gives a brief summary on mechanisms of arrhymogenesis, and continues with an overview of the most important structural, electrical and ischaemic heart diseases in humans, dogs and cats that often lead to SCD, focusing on prevalence, pathophysiology and generic similarities. Diseases described in great comparative detail
include: • Dilated cardiomyopathy • Hypertrophic cardiomyopathy • Arrhymogenic right ventricular cardiomyopathy • Channelopathies • German shepherd inherited arrhythmias • Catecholamine-dependent arrhythmias • Coronary Artery Disease (CAD)-a rare cause of SCD in dogs and cats. (There is an interesting discussion of why this is the case.) This is a very comprehensive article of particular value, I would think, for cardiologists and those in training.
The Evolution of Cannabinoid Medicine Dr. Dave Tittle BVetMed CertVA GPCert(WVA&CPM) MRCVS is an RCVS Advanced Practitioner in Veterinary Anaesthesia and is in clinical practice in Devon. He sits on the International Advisory Panel for ElleVet Sciences in the US and provides a consultancy service to ElleVance Sciences in the UK.
Chinese herbalists referenced the use of cannabis from around 3000BC. Around 1450BC, the use of cannabis (kaneh-bosem) is described in the Old Testament in the Book of Exodus. Over six pounds of a substance identified by researchers as cannabis, was extracted and dissolved with other herbs, into a gallon and a half of olive oil. The resultant potion was used as holy anointing oil.
rheumatism, malaria and ‘absent mindedness’. In the New Testament, Jesus is said to have anointed his disciples with a potent psychoactive oil and sent his apostles out to do the same. After Jesus’ death, it was suggested that anyone of the Christian faith who was unwell should be anointed with oil.
Documented from 1200BC onwards, the ancient Egyptians utilised cannabis for the treatment of glaucoma, uterine inflammation, enemas and managing haemorrhoids. Moving to 1000BC in India, Bhang was a drink of cannabis mixed with milk and used as an anaesthetic and anti-phlegmatic. Subsequently, it was used here to treat a number of different medical conditions. By 600BC, people believed that it would quicken the mind, prolong life, improve judgement, treat headaches, decrease fever, manage insomnia and cure dysentery; Indian medicine had progressed and it was then thought to be a cure for Leprosy and the treatment of pain, as well as treat sunstroke and relieve pain during labour.
Around 70AD, the Roman army medic, Pedanius Dioscorides reported in his text, ‘De Materia Medica [On Medical Matters]’ the benefits of cannabis for earache and for the suppression of sexual longing! At a similar time, Pliny the Elder stated that cannabis roots boiled in water aided gout, cramped joints and similar ‘violent pain’.
Jumping to 200BC and over to ancient Greece, cannabis is used to treat earache, oedema and inflammation. By 1AD and ancient China, marijuana is used to manage gout,
Modern Uses
The Chinese surgeon Hua Tuo (c.140–208) used cannabis (má) as an anaesthetic after powderising it and adding to wine, which was given before surgery. Interestingly, the Chinese word for anaesthesia (mázui) translates to the meaning ‘cannabis intoxication’, whereas má means ‘numbness or senseless’! In the medieval Islamic world, the diuretic, anti-epileptic, anti-inflammatory, analgesic, anti-pyretic and anti-emetic properties were utilised (800–1800AD). Chinese texts (c1600AD) state the use of marijuana for the treatment of vomiting, parasitic infections and haemorrhage; it continues to be used in China for the management of diarrhoea and dysentery and to stimulate appetite.
Fast Forward… We now move to more recent times where in the 1930’s, Eli Lilly and Parke-Davis each produced a cannabis tincture. These were distributed in the US until the Marijuana Tax Act was introduced, halting production. Cannabis became tightly regulated in many countries over time with the exception of the Netherlands where it was decriminalised in 1976.
Figure 1: Bhang Shop - by Satish Krishnamurthy from Bombay, India. (en.wikipedia.org/wiki/Bhang)
Since the late 1960’s, much research has been undertaken looking to understand and explore cannabis-based medicines. Following the discovery of the cannabinoid receptor system and then endocannabinoid receptors in the 1990’s, there has been a drive towards more targeted research. In the UK, this has led to the legalisation of medical marijuana on prescription in 1998.
In 2018 the US legalised industrial hemp production, meaning that cannabinoid products with very low levels of the psychoactive element of cannabis (tetrahydrocannabinol – THC) were able to be produced, without the constraints of a product containing prohibitive substances. This allows reputable companies to produce high quality, purified products, capable of targeting specific endogenous receptors. Modern extraction techniques, alongside current regulations and quality control measures, means these targeted products are considered inherently safer. UK legislation now allows for the provision of these cannabinoid products on the market and there is a significant drive to study the benefits and effects of CBD/CBDA products globally, with some compelling data becoming increasingly evident as research gains pace and funding.
Figure 2: Image: Bottle of Cannabis, USP (Eli Lilly & Co., Indianapolis) (commons.wikimedia.org/wiki/ File:Lilly96A.jpg)
Famous (Medical) Users of Cannabinoids in History! The Bard himself (William Shakespeare, 1564–1616) smoked cannabis as a stimulant. At a similar time, Robert Burton (1577–1640) suggested in his book of 1621, ‘The Anatomy of Melancholy’, that cannabis had a use for the treatment of depression.
Queen Victoria is alleged to have used it to treat period cramps (dysmenorrhea). It was usually administered as an extract in alcohol (tincture) rather than smoking.
Napoleon brought cannabis back to Europe in 1799, as a result of his invasion of Egypt. The Victorians used it for treating muscle spasms, dysmenorrhoea, rheumatism, tetanic convulsions, rabies and epilepsy;
Further information available on request from: www.ellevancesciences.com or by email: customersupport@ellevancesciences.co.uk
References: medicalmarijuana.procon.org/historical-timeline/ en.wikipedia.org/wiki/History_of_medical_cannabis indianapolismonthly.com/longform/eli-lillys-hazymemory-marijuana time.com/3990305/william-shakespeare-cannabismarijuana-high/