The Webinar Gazette – July 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

JUly 2020

To have: The planet’s most confident vets

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

his morning, I got up early and went to my local nature reserve which is like paradise. It’s quiet except for birdsong and I spent a couple of hours in the gorgeous early morning sun enjoying all the beautiful birds including the emblem of the RSPB, the avocet. I don’t know about you but I’ve found that life has become simpler during the pandemic and I’ve become more grateful for all the good things I have in life. I’ve become annoyed about our government’s handling and integrity during the crisis but it’s probably just confirmed my belief that we have to rely less on the Westminster elite and look to find our own solutions rather than dwell on external problems. The crisis has also increased the change towards digital which I’ve been talking about for several years. I was thrilled in May to have Ben Legg, an ex-COO of Google Europe, speak at the digital symposium during the World Veterinary Association congress. He gave us some of the secrets of Google’s culture and operations which was fascinating.

We both talked about the need for all businesses to consider themselves as digital businesses. I suspect the new normal after the coronavirus will see increased digital learning and we are working very hard to make your journey through our site as educational and enjoyable as possible. As well as WVAC2020, we have helped several organisations to take congresses and meetings online. We’ve also been pleased to serve the profession alongside BVA in delivering regular Covid19 updates on Sundays. Please become a member of BVA if you are not already. I am particularly thrilled that we are helping the World Congress for Vet Derm to go online. I am also sad because the committee had put a great programme together in Sydney and I was hoping to attend in person. Derm is my discipline! enclose a YouTube video which my good mate, George Sinanan, sent to me re The Black Lives Matter movement. I’ve seen people rebutting that all lives matter. The video is an interview with John Amaechi who

talks about why that is hurtful and a bit ridiculous. Unfortunately, we still live in a world were racism is prevalent. Our profession is predominantly white and we as individuals need to do something about that. George worked in Crawford and Crawford on Priory Rd in Anfield. I was brought up on that road. I remember George telling me years ago that he used to leave the practice of a night and have little kids calling him names because he was black. I remember being ashamed about this because they were people from my neighbourhood. Things have improved but there is still so much to do and that is why it is important to concentrate on the fact that Black lives matter. https://www.youtube.com/ watch?v=SG1zVHJKtgs&feature=emb_ logo If you are a nurse or know a nurse, please let them know about our partnership with Bought by Many, an innovative new pet insurer. Together, we are providing 10,000 nurses with free CPD for a year. No catches! I hope you enjoy.

Going back to my first point about nature, I am indebted to my nature gurus, Sean McCormack, John Helps and Sean Wensley who help me to improve my fieldcraft and ID skills. Thanks lads! Mentors matter and we’ve recently supported BVA’s wall of recognition by naming 3 vets who made a difference for me and many other vets. The Three Johns: Tindall, Tandy and Sheridan. What a great initiative by the BVA! If you haven’t got a mentor find one now. Finally, my good friend, Theresa Hamilton, has just qualified as a vet and is helping us short term with improving community engagement. If you are on FB, do look out for our posts and let us know your thoughts.

I hope you are in good shape. Love,

Anthony

Ben Sweeney BVSc MSc (VIDC) Cert AVP MRCVS

Bought By Many

very now and then in business something amazing happens. The stars align, people pull together on a project that is so unbelievably wholesome that it almost beggars belief. What is even better is when these things happen organically and for all the right reasons. With that in mind I want to tell you a little story…

Sadly, last November my much loved #locumlabrador, Max, became very ill very quickly, and despite the efforts of some amazing vets and nurses, he passed away. This in and of itself was tough, but I had switched insurance companies some eight days earlier. So coupled with grief was the very real situation of having to concern myself with finding £2.5k to pay for vet fees. Being a typical vet dog, he didn’t have anything normal-his biopsy reports came back with

‘genetic copper storage deficiency’-better known as Wilsons disease. I had switched both of my dogs to a policy with Bought By Many as it was a lot cheaper than my previous provider and they had a ‘no exclusion policy’ for the 14 days of changeover. Like many, I am sure, I was a little dubious about this, but they could not have been more helpful. I was paid out quickly and in full, they even refunded the rest of the policy. Needless to say, the companies that I recommend to people based on personal experience have changed as a result! I was so impressed by the service and the experience that I reached out to them a little down the line to find out how and why they were doing what they were in the insurance field-I know what you are thinking, that must have been a thrilling conversation! Their attitude and values really resonated with me, so I suggested if they ever wanted to reach out to the veterinary community then I would love to be involved. After a few months passed, COVID hit and the veterinary profession was sent reling. Sarah, their head of veterinary relations came to me and said plain and simple ‘We want to do something BIG to help the veterinary profession’. Being a vet nurse herself, she had a natural affinity for the nursing community, so we decided to go head on into the biggest CPD giveaway to nurses and student nurses ever. They wanted to help as many people as they could, so suggested they offer a years’ worth of CPD to 10,000 nurses and students. After I had peeled myself off the floor with the magnitude of this generosity, we got to work on delivering the package. Spaces are understandably running out, so we are

urging anyone who wants it to sign up fast! (Why wouldn’t you as it is free and the content is amazing-I have learnt stuff from it as a vet with 12 years experience). So, there you have it. Out of something sad and horrible came something absolutely mind blowingly amazing and generous. If you are a vet nurse, or if you know any of them then please do feel free to share this very generous gift with them. There is no obligation to buy a policy or even sell them, just fill in a 2 minute survey and watch a 10 minute video then a years’ worth of CPD is yours. https://bit.ly/2Urmdu4

MCT - even under low power these cells are not adhering together and are lying separated. This is typical of a round cell tumour. These round cells have cytoplasmic granules and this is absolutely diagnostic for a mast cell tumour.

BASIC CYTOLOGY The discipline of cytology began in the 1920s when George Papanicolaou developed techniques for examining cervical cells in women in order to determine the stage of the menstrual cycle. After it was pointed out that he could simply ask the women subjects (mostly his wife) he turned to using the technique for pathological conditions. This was principally for the diagnosis of cervical cancer hence the Pap smears that are still in use today. Since then cytological examination of tissues has grown into an entire subject in its own right. In veterinary medicine it has expanded exponentially in the last 15 years and is a useful laboratory test for the identification of pathological processes in tissues especially neoplasia, some other conditions especially in internal organs and examination of various fluids produced by the body. For the examination of tissues, histology is the gold standard, but cytology can provide a diagnosis in some cases, it can rule out differential diagnoses and it can indicate the next step in the clinical workup of a case. Most veterinary cytology is carried out in commercial laboratories by highly qualified and experienced cytologists and there will always be a need for recourse to this expertise. However, probably 50% of cytology samples taken in practice cover only about 10 different specific lesions or type of lesion. If you have an interest in the field of cytology it is worth gaining experience in the interpretation of samples as this will provide immediate information on a large proportion of lesions you wish to investigate. This is best achieved by taking duplicate samples one to be sent for professional interpretation at a laboratory and one to be examined in-house and the results compared. It takes no more than 15 minutes from sampling to examination and preliminary results can be given to your clients before they leave the surger

Histiocytoma – these cells are also lying separated and therefore again typical of round cells but in this case there are no granules. They have a moderate amount of cytoplasm often with nuclei that are eccentric within the cytoplasmic envelope and very is a by nucleated cell here. These are typical of histiocytic cells and characteristic of histiocytoma.

Artefact – cells are delicate. Measurements of the cell membrane vary slightly but are in the region of 10 nm . They are easily broken with rough handling so be gentle. This illustration shows numerous nuclei without cytoplasm, they are beginning to expand and lose characteristics and cannot be identified as from a particular cell, and the nuclear material is being stretched and streaked (blue streaks). This cannot be interpreted and is a very common artefact.

It cannot be emphasised more strongly that before any interpretation, either in-house or by laboratory, the sample itself must have sufficient well preserved cells and this requires practice, practice and practice. If you are interested in interpreting your own cytology, the basics of obtaining good samples for examination and basic principles of interpretation are covered in the webinar entitled “BASIC CYTOLOGY”. Good textbooks are essential for details of sampling techniques and comprehensive examples of interpretation/results of your cases. Even the experts have to “picture match” occasionally. The webinar “BASIC CYTOLOGY” covers the equipment you will need, sampling technique, sample preparation, and basic interpretation. This includes a basic algorithm as well as examples of the different types of cell that you will need to recognise in order to interpret a substantial number of your cytology preparations. With this setup and with practice and comparing your results with those of the professional laboratory you should be able to get the next step in your clinical workup for a good proportion of appropriate cases. However, don’t think you can diagnose everything on your cytology preparations. Consider most cytologies as a guide and remember that histology is the gold standard. Histology will always be necessary for confirmation of diagnosis, for full interpretation especially if aggressive therapy is being considered and if the behaviour of the lesion is not compatible with the cytological interpretation. Only histology can indicate vessel or local tissue invasion, margins of excision, grading and immuno phenotyping. By the way, after a hard day of cytology investigation try underwater hockey, if you have a local team, which is illustrated in the short video clip at the beginning. You may become addicted to both. Recommended texts: Raskin and Meyer.” Canine and feline cytology” Cowell et al. “Diagnostic cytology and haematology of the dog and cat” Merck veterinary manual.” Diagnostic procedures for the private practice laboratory – cytology

Guest Article Zero Waste Veterinary Plastic Free July

ccording to their website

(plasticfreejuly.org), Plastic Free July is a key initiative of the Plastic Free Foundation that allows us to work towards our vision of seeing a world free of plastic waste. It was started by Rebecca Prince-Ruiz (the founder of the Plastic Free Foundation) and a small team in local government in Western Australia, and is now one of the most influential environmental campaigns in the world. Millions of people across the globe take part every year, with many committing to reducing plastic pollution far beyond the month of July. The basis of the initiative is to reduce or eliminate your usage of single-use plastic. Taking part in the challenge, whether at home, school or work, can start from as little as one week to the whole of July (or even indefinitely if you fancy it). You are given the option to give up single-use plastic packaging, takeaway items or go completely plastic free. Of course, these are only guidelines and you are free to complete the challenge as you see fit. There is no denying that single-use plastics have a place in the medical industry. They are cheap, durable and often necessary to maintain a sterile environment. The issue arises after the plastics have done their job. Many plastics we find in practice are not recyclable, nor can they be classed as

biohazards. Unfortunately, this leaves only one place for the plastic to go; general waste. This is the same sorry story that is being told all across the globe, across all countries, across all professions. Once these single-use plastics have been used, they have nowhere useful to go. But where will these plastics end up once the black bags have been collected? Will they end up in landfill, destined to remain there forever? Will they be incinerated, releasing toxic chemicals in to the atmosphere? Or will they end up in the ocean, inside the stomach of a humpback whale? All across the world, plastic pollution is having a direct and deadly impact on wildlife. The same wildlife that we have vowed to help.

Although we will likely never see a plastic free veterinary practice, there are still many ways in which we can scale down the amount of START WITH;

single-use plastic we use. Below I have outlined 20 straightforward swaps to get your practice started. SWAP FOR;

Theatre/Prep Single-use shoe covers

Theatre only shoes (e.g. Crocs)

Single-use theatre caps

Reusable scrub caps

Single-use face masks

Reusable face masks

Single-use drapes

Reusable cloth drapes

Single-use theatre gowns

Reusable cloth gowns

Plastic/single-use kidney dishes

Metal kidney dishes

Dispensary/Reception Plastic carrier bags

Clients bring their own or paper bags

Plastic medication pouches

Cardboard medication boxes

Plastic pill bottles

Return scheme for clients

Katkor

Kit4Cat (hydrophobic sand)

Kennels Plastic food pouches

Tinned food

Cat litter in plastic packaging

Natural cat litter (e.g. Ecograin) in paper packaging

Cleaning Small plastic bottles (e.g. 250ml)

Bulk plastic bottles (e.g. 5L)

Plastic bottles of purified water

Water purifier

Washing detergent in plastic bottles

Plastic free detergent (e.g. Smol) or powder in cardboard box

Kitchen Single-use plates, cutlery etc.

Real plates and cutlery

Takeaway coffee cups / plastic water bottles

Reusable coffee cups / water bottles

Misc. Disposable prophy heads

Reusable metal prophy head

Plastic cotton buds in plastic box

Bamboo cotton buds in cardboard packaging

Toilet paper in plastic packaging

Plastic free TP (e.g Who Gives a Crap or Bumboo)

These changes are a great place to begin, but they must not be where we stop. We must collectively, as a profession, continue to advocate for our wildlife and our planet. Making these swaps will slow the demand for single-use plastics. If every vet practice made these changes, companies would have no choice but to rethink and redesign their products. We must

continue to tell companies what we want; we want to reduce our plastic consumption and conserve the environment without compromising on our patient care. We must do this throughout July and onwards. For further information on Plastic Free July, check out the website plasticfreejuly.org

NEWS FROM OUR COMMUNITY

his month’s news from the community comes from the team at Paragon Veterinary Referrals who have saved the life of a cocker spaniel with suspected heart problems after discovering she was actually suffering from a rare endocrine tumour. Ten-yearold Poppy was referred to the Wakefield centre with suspected high blood pressure and an irregular heartbeat after she fell off the sofa and started to go lame and was eventually discovered to have phaeochromocytoma – a rare type of tumour that intermittently releases adrenaline, and was causing the high blood pressure and abnormal heart rhythm. You can find out more here

CPD’er of the month

Congratulations to our CPDer of the month for July, Jagath Weerasinghe!

“Very informative, clear, good quality webinars. It’s a great way to achieve further knowledge and hugely improve my confidence, especially in exotics.Hoping to put this new knowledge into practice soon. Thank you all.”

Unintended Consequences of Covid-19 Lockdown There is growing evidence of the rise in cases of domestic abuse during the Covid-19 lockdown. Vet teams have a key role to play in instances of suspected abuse. The necessary sanctions on movement and social interaction we have all experienced over the past three months have been necessary, however the Links Group recently highlighted one unintended consequence which affects thousands of people and will have an impact on the veterinary profession. Since the beginning of lockdown on 23 March, calls to the National Domestic Abuse helpline have increased by 25%. Similarly, in the two weeks to 31 March, domestic homicides in England and Wales doubled. The link between violence to people and violence to animals is well documented; the family pet is often part of the domestic abuse cycle with perpetrators using the pet to exert power and control over their victim. Given the statistics, it is very likely that there will be an increase of non-accidental injury (NAI) and violence towards animals in these situations. In light of this, it is more important than ever that colleagues in the veterinary profession consider NAI / deliberate injury as a differential in cases of traumatic injury in pets, especially as there should be fewer road traffic accidents with lower traffic volumes and limited movement at this time. If colleagues have concerns or suspicions of NAI, we would encourage admission of an animal for observation to allow for time for investigations to be conducted. In an emergency where there is an immediate threat to either a person or an animal then the police should be called using the 999 system. You can also join us for a live webinar on the impact of Covid-19 on Non-Accidental Injuries on 14 July @ 12:30pm https://www.thewebinarvet.com/pages/links-group-register-free-animal-abusedomestic-violence-vet-teams-during-covid-19-and-beyond/ This will take the form of a panel discussion with Paula Boyden BVetMed MRCVS, Chair of the Links Group, Mike Flynn – Scottish SPCA Chief Superintendent, Caroline Allen MA VetMB CertSAM MRCVS – RSPCA Chief Vet, David Martin BVSc MRCVS – Veterinary Expert Witness. The Links Group is currently designing an online course based on their ground-breaking Links Veterinary Training Initiative. The course is due to be launched in the next few weeks. You can find out more and register at www.thelinksgroup.org.uk/training.

Animal history? Where are the animals?

Why is this relevant here?

It’s relevant because understanding our past will improve the path we take in the future and sometimes we need CPD out with our usual space to make us see that. Many CPD titles are PD options for me focused on the disease rather are pretty amazing than the patient – what is in my PhD. Every day termed the ‘medical model’ is learning something new of care. The medical model about our profession and I is criticised as it can mean had the joy of meeting fellow the focus is on the one issue animal historians last week. the patient presented for. The Animal History Group Get that better and you’ve held a fabulous online session successfully treated them, with great presentations and even if other issues remain forums. However they asked unsolved. Or the species is an interesting question ‘Do named and maybe a case you consider yourself an study given. But you then animal historian?’ need to take that information and apply it to your individual I answered ‘No’. patient – who may have other needs not considering in the Most people have assumed CPD given. So our knowledge my PhD is going to be partly is sometimes given in an an animal story and while abstracted way from the animals are clearly the focus for us veterinary professionals patient and then needs to be applied to the patient in front you may struggle to find of you, and then the medical animals in my work. The story I am telling is definitely model can struggle. Holistic care is a buzzword right a human focussed one and now, but something we have animals are there but in the done for a long time, when primary sources I am using they are peripheral to what is your patients can’t talk you take on more responsibility happening. for troubleshooting their problems. So why was I in an animal history event then, you may ask? Well, one of the things I hope to come out of my PhD is an explanation of why this isn’t an ‘animal’ story and explore the issues around that.

Jane’s Blog So, I am an animal historian? If we still have this disjointed way of discussing our patients today it is no wonder that our history does not explicitly mention animals. So am I an animal historian in an abstracted way? I face the same issues of the ‘medical model’ if I focus purely on vet histories and need a holistic view to ensure I tell our story well. Animals may be hard to find in my archive work but I’ll find them and make sure their part in our story is told. More info on PhD 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.”

Jaw-Dropping Musings on the History of Pain Relief in Cats Does anyone remember ketofen tablets for cats? There was a time…not so long ago…when there were no licensed medications for long term pain relief in cats. The best we could offer an owner was ketofen tablets, one a day for five days. Then, at last along came a licensed, liquid, non-steroidal product - meloxicam. Yeah! Finally something we could offer arthritic animals…albeit from memory, initially licensed for short term use only.

Pippa Elliott BVMS MRCVS

Cats Catch-up The reason for the above reminiscence is to illustrate how things have changed, even in relatively recent history. Dial things back further still and we find truly jaw-dropping attitudes to medicating cats and keeping them comfortable.

Enthusiastic Amateurs Time travel back to the 19th century and there were no feline medical textbooks written by veterinarians (these didn’t start to appear until the 20th century). Indeed, your typical Victorian vet would feel insulted to attend a feline patient as illustrated by this quote from Charles Henry Ross’ 1868 title, The Book of Cats. “… Someone suggested seeking the aid of a

veterinary surgeon, whose dignity seems [sic] just a little bit ruffled at being, called in for a cat…and when he did come, did not bring his instruments.” At this time feline healthcare was largely in the hands of enthusiastic cat owners. One such personage was Lady Mary Anne Cust, who wrote The Cat, its History and Diseases; in which she reflects the prevailing attitude to feline health: “…the cat is not considered worthy of notice, or its life worth preserving”. Lady Cust did her best to promote cat health and welfare, but with limited knowledge. Her recommendation and those of like-minded people promoting feline welfare was to treat cats like small humans (a step up from being treated like a small dog?) And what was the medication most people had on their shelf at home but laudanum. Lady Cust’s recommendation for many feline ailments was indeed a dose of laudanum.

Laudanum Controversy Laudanum was as common in the 19th century as aspirin today.(and equally as dangerous to cats) Laudanum was described as a tincture of opium, containing codeine, morphine, and opium alkaloids. A reddish-brown liquid with a very bitter taste, it was the go-to treatment for pretty much all mental and physical ailments of the day. There was controversy amongst physicians over laudanum’s mode of action. William Cullen (1808) postulated it paused the flow of fluid around the brain causing “a cessation of all sense of pain or other irritation arising from any part of the [nervous] system.” Whilst another theory was it increased and rarefied the blood, which then had an effect on the brain. Whatever laudanum’s mode of action, horror

stories relating to usage were woven through history like a damask pattern in curtains. It was used to calm teething toddlers and send babies to sleep so poverty-stricken mothers could work, but not without considerable risk.

Throwing the Baby Out with the Bath Water In 1854 it was estimated that three-quarters of opium deaths in children occurred in the under-fives. One such example being a baby that died after receiving four-drops of laudanum over a nine-hour period. But hold on, because the dose touted for a cat with diarrhoea was four to five drops of laudanum every few hours. Maybe the diarrhoea did improve but whether the cat survived the treatment is another thing.

Modern Attitudes and Appropriate Pain Relief Thankfully, things have moved on from the attitude reported (1896) by the animal rights campaigner Edith Carrington: “[T]hough cats are as plentiful as blackberries, few people think it worthwhile to consider their pains.” Happily for the small animals in our care, things have improved immeasurably. These days, a cat in pain has better options than the ketofen tablets of a couple of decades ago. Not only is there an armoury of effective medications to control pain, but we are better informed about how to use them safely. But don’t take my word for it. Instead, step off our virtual time machine and view Elke Rudloff’s webinar The multi-modal approach to pain in the ICU- Thursday, 2 July 2020 for an insightful and practical approach to the subject.

WEBINAR DO DOGS REALLY SEE IN B&W Facts and myths about animal vision RON OFRI DVM PhD DECVO Koret School of Veterinary Medicine Hebrew University of Jerusalem, ISRAEL

Davidâ&#x20AC;&#x2122;s Review

As with all veterinary ophthalmology webinars this one is intensely pictorial, which makes it a little bit more difficult to review. Nevertheless it is thoroughly recommended as a fun way to sit back and be educated for an hour. Ever been asked whether dogs and cats can see in colour, or if cats see better at night or have sharper vision than us? This and many other questions are posed in this webinar. As Ron says-it will provide you with answers at dinner parties and in the clinic. And in the pub quiz nightwhenever that may be!

he webinar begins with some anatomy and physiology on photoreceptors. Here we learn about the outer segments of rods and cones. They contain photopigment - opsin (absorbs photons) and retinal (transduces energy). There are some anatomical line drawings, which help to explain these terms. Further detail on opsin follows. Rods have scotopsin absorbing 495-500 nm (green). Cones have three types of phototopsin absorbing red, green and blue. Colour vision in humans is based on three elementary colours and their overlap. These are orange, yellow and green and thus human vision is termed trichromatic. There is a discussion on colour abnormalities in human beings. True colour blindness (no cones) is called achromotopsia, with a prevalence of 1:30,000. People with dichromotopsia have 2/3 cone populations, usually missing green or red. You can test yourself

at this point. In other species true achromotopsia is very rare and seen in deepwater fish and in one lizard species. These have no colour vision and poor acuity. One of the most fascinating aspects of this webinar is that for each abnormality discussed a picture is shown, as we would see it, alongside what the abnormality would look like in other species. A few species of nocturnal species are monochromats, including raccoons and hamsters and all aquatic mammals. These only have red cones because infrared penetrates deeper water. Primates and some fish and reptiles are trichromatic, while there are some that are tetrachromatic, mainly fish and avian species. A series of photographs of a landscape demonstrates the human view compared to the avian view and some amazing information on how predators are able to locate their prey. Most mammals are dichromatic. Although cats have three cone

populations, they behaviorally do not exhibit colour vision. Dogs lack the green pigment. We are shown this by comparing a landscape as viewed by a dog, and even more striking when we see what a macaw looks like to a canine-complete absence of green! Guide dogs therefore need to rely on auditory/visual clues when working. Horses and cattle lack the red photopigment and there are a series of photos comparing what we see compared to horses and cattle. The most amusing of these is a photo of a matador (with the wrong coloured cape of course-someone ought to tell the aficionados). Red flag to a bull might need revising too.

a television set has the lower values a dog will only see flickering images, which may explain why many dogs do not watch TV (at least older models). More illustrations, including line diagrams, demonstrate the considerable difference in visual fields in predators, horses and dogs. We are all familiar with normal human acuity being 6/6 (20/20). Figures are given for horses, dogs and cats. Cats, surprisingly, do not have good visual acuity. In fact it is rather poor-they are very short sighted as seen on the sight-testing chart that we are all familiar with. A summary slide indicates that the horse has 0.6 times the acuity of humans, 1.5 times the acuity of dogs and 3 times that of cats.

Leaving colour behind Ron turns to night vision with a comparison of corneal thickness and dilated pupil area in cats and humans. Thus at night feline retinal illumination is 5.2 times that in humans. This is followed by some detail on retinal anatomy and physiology, and we learn that not only do cats see better at night, but also dark adaptation is longer and greater.

So in summary for the dinner party, pub quizzes etc. the points to remember are that: -

There is a fascinating section on Flicker Fusion Frequency (FFF). This is the interval needed by a photoreceptor to recover between responses to two subsequent flashes. FF values for rods in both humans and dogs is 10 Hz. But for cones the values in dogs are much higher (70-80 Hz) compared to humans (30-45 Hz). The relevance of this is that if

• And finally-invest in a good TV!

• Our patients are not colour blind • Visual fields are determined by feeding strategy • Acuity in horses is greater than dogs flowed by cats (due to photoreceptor pathways, ganglion cell concentration and tapetum) This is an excellent webinar-great fun but seriously educational. https://www.thewebinarvet.com/webinar/do-dogsreally-see-in-black-white-facts-and-myths-aboutanimal-vision

WEBINAR WHAT’S NEW IN DERMATOLOGY JON HARDY MA VETMB MVM DipECVD MRCV

his is an excellent idea for a veterinary webinar with a very qualified speaker. Jon Hardy, who works for Willows Veterinary Centre and Referral Service in Solihull, chose a straightforward plan for his presentation:-

NEW DRUGS • Neptra • Cytopoint • Isoxazolines for parasitic diseases • PEA-um • Immunotherapy –SLIT and ILIT

NEW TESTS • Allergen serology • PCR for dermatophytes NEW DISEASE DESCRIPTIONS • MCLE For each of the drugs Jon made a useful summary of the information available from the data sheet, and added some of his own experience along with recent articles from the veterinary literature. For Neptra he summarises that the product ‘looks to be a useful addition to the market and is aimed at first presentation cases.’ With cytopoint, having reviewed the data sheet, he cites two recent studies, both published in the journal Veterinary Dermatology, demonstrating its safety. He

summarises: • Very welcome addition to the treatment options fpr canine atopic dermatitis • Well tolerated, quick to work • Expensive • Not effective in all cases The isoxazolines are a relatively new group of acaricides and insecticides that were initially licensed for fleas and ticks a few years ago. More recently they have been shown to be effective against mites too. A graph lists those currently licensed with some relevant information about each one. Jon cites the WAVD clinical consensus guidelines for the treatment of demodicosis in dogs and cats, recently published in Veterinary Dermatology. This is comprehensive and provides information on all the treatments known to be effective for demodicosis. There is no escaping the fact that the isoxazolines have, in my view, wiped out the opposition. Jon is more circumspect in his summary of these drugs: • An excellent choice for canine demodicosis and the preferred option for many • Safe and well tolerated • Can be continued long term (although Jon poses whether this might be a problem long term)

• Likely to make demodicosis very rare? I think for dogs on these drugs, providing compliance is good, demodicosis will not likely be seen in the future. For the current and next generation of colleagues demodicosis will continue to be diagnosed-but not in dogs on isoxazolines! I am sure that all my colleagues will be aware of these new and very valuable drugs but perhaps not so many will have read about the next drug described in this webinar- Palmitoylethanolamide, (hitherto referred to as PEAfortunately!) Jon asks a reasonable question‘What is it?’ The answer is that it is a naturally occurring bioactive lipid compound + endocannabinoid-like molecule. PEA and related mediators produce on-demand response to stress and tissue damage with a resulting regulation of cutaneous inflammation and immunity. They may also have actions on mast cells, reducing itch and pain. Levels of PEA in the skin of dogs with allergic dermatoses are 30 times higher than normal. There have been two studies documenting its use in dogs (2015) and cats (2019). Chiara Noli and colleagues published both studies in Veterinary Dermatology using an ultramicronised commercial preparation PEA-um. They were

able to demonstrate a significant reduction in clinical lesions and pruritus with an improvement in quality of life for the dogs. In the more recent study 25 cats, with non-flea hypersensitivity dermatitis, were enrolled into a treatment and placebo group. Lesions were controlled with prednisolone and those cats being treated with PEA showed a significantly longer time to relapse compared with the placebo group. In summary PEA-um may be a promising addition to the treatment options for allergic skin disease, although more studies are needed to confirm initial findings. Currently PEA is not available. Jon summarises immunotherapy-available for many years. A few studies have evaluated adjuvanted immunotherapy. The principle of these is that adjuvants stimulate the immune system to improve both efficacy and safety. Large randomised studies are now needed. Sublingual immunotherapy has been available for some years and may offer an improvement in some dogs that have previously failed subcutaneous immunotherapy. Otherwise it offers comparable efficacy. It is applied once or twice daily and is also suitable for needle shy dogs (and their owners). Based on the most recent information intralymphatic immunotherapy long term benefit is only seen in a small number of dogs. Most of these will require continuous intralymphatic injections. These are given in small amounts (normally 0.1 ml) into the submandibular or popliteal lymph node. It may an option for the future. Traditional immunotherapy possibly has a 60% response- properly conducted placebo controlled studies are surprisingly few. There is some interesting new information on allergen serology. For some time clinicians have

raised concerns on false positives with in vitro crossreactivity being a concern. One possible explanation is cross-reactive carbohydrate determinants (CCDs). A recent study (2019) found that sera containing CCDs, from carbohydrate portions of plant and insect glycoproteins for example, had many false positives. By using a solution that blocked these IgE antibodies it has been found that results of allergy serology are in better agreement with ID testing. The result of this new research is that many laboratories have started to test for anti-CCD antibodies in samples, and removed them. This hopes to ensure improvement in the reliability of results. PCR testing for dermatophytes is relatively new. Hairs, skin scrapings and squames are collected. PCR initially detects to genus level-Microsporum or Trichophyton. This can be followed by species PCR if the results are positive. There is a result in 3-4 days. The final part of the webinar reviews briefly the various forms of lupus erythematosus in dogs before an extensive summary of mucocutaneous lupus erythematosus. This is based on a publication in Veterinary Dermatology in 2015, by Thierry Olivry and colleagues, of 21 cases. Jon includes all the clinical photos that were published. The diagnosis rests on the clinical signs, which are distinctive, and histopathological examinations of biopsies. Treatments, including the use of glucocorticoids, are discussed and generally the prognosis is good, as remission was obtained in all but one dog. Long-term treatment was required in 82% with remission off drugs in 18%. https://www.thewebinarvet.com/webinar/whats-newin-dermatology

WEBINAR

later was thought to have been introduced the same way.

In Africa there is a reservoir of ASF in wild pigs and in soft AFRICAN SWINE FEVER ticks. The virus is relatively –WHAT ALL VETS NEED stable in infected /wild boar meat or meat products. It TO KNOW is also very stable in the JOHN CARR AND SUSANNA carcasses of wild boars that WILLIAMSON have succumbed to infection. ASF arrived in Europe in 2007 and a series of maps graphically illustrate its spread his veterinary webinar, throughout Europe since then. There is surveillance for ASF sponsored by the pig in wild boar in the EU. Testing Veterinary Society and wild boar found dead is the Huvepharma, is a double act most effective and finding delivered by two eminently more than one dead wild boar well-qualified specialists. is an important sign. Susanna Susanna Williamson begins by outlines climatic, agricultural, defining the two swine feverssocial and biological reasons African -DNA virus (Asfivirus) for increased wild boar and Classical -RNA virus population in Europe and the (Pestivirus). There are similar clinical signs with these viruses, resultant timeline of spread in the EU from 2015 up to May which John Carr expands in detail in the second part of the this year is illustrated. Even so, webinar. For practical purposes wild boar spread is relatively slow, and large geographical both are notifiable diseases jumps can be blamed on and when suspected there is human activity. Examples of no distinction made between this include illegal trade and them. Duplicate samples are feeding/discarding infected collected and tested for both meat products. Control of viruses. individuals carrying food items A map illustrates the current across borders, or internally, UK status. African swine fever are hard to control and added has never been detected to this farm biosecurity is here and the last outbreak variable. Some of the current of classical swine fever was wild boar control measures in in 2000. This was thought to affected EU countries are listed have been introduced (ham with relevant websites to visit sandwich theory) in swill fed for more details. Surprisingly, pigs. Similarly the foot and (at least to me), there have Mouth disease epidemic a year been wild boar sightings in

GB. Single sighting does not necessarily mean that a viable population exits, however. A website is given as a means of reporting any sightings of feral pigs. The EU rules on controls in domestic pigs are listed in full. The first report of ASF in China was on the 3rd. of August 2108 and a map shows the devastating spread that subsequently occurred. As far as the UK is concerned the main risk of introduction of ASF is via infected pork/ wild boar meat or products, and the preventative measures currently in place are listed. The vet’s role consists of the following: • Remind owner feeding of meat products is illegal • Don’t allow meat products anywhere near pigs to avoid accidental access • Use dedicated clothing and boots for staff and visitors entering pig premises • Exclude potentially contaminated vehicles/ equipment from pig premises • Explain the disease risks and limit visitors • Use signs and prevent unnecessary access • Identify weaknesses and provide advice Early detection of ASF is vital for rapid control and in a box

in red are clear instructions of how to report a suspect swine fever case. This includes the relevant helplines in England, Wales and Scotland. Susanna briefly mentions some differential diseases and then lists 11 websites for further information. The second part of this excellent webinar is by John Carr of Howells Veterinary Services, James Cook University, Australia. He begins by the comment that there are two ways of being a famous vet! This is by diagnosing foot and mouth disease or missing it, and now we have a third-ASF. I am certain that the clinical detail that follows goes a very long way in preventing you becoming famous due to missing ASF. One of the most prominent clinical signs is ‘death and more death’ in all age groups but not all pigs-30-70%. Many clinical pictures are shown from various parts of the world. Striking are the red ears and feverish pigs as seen on an infrared camera. We are told sows will abortall of them. Others will become uncoordinated and fall over. They may appear cold and huddle together. Other signs include constipation followed by dysentery, and bloody discharges from elsewhere in the body. The incubation period is 3-15 days, with death occurring after a few days. Post mortem findings include an enlarged spleen, (there is a handy practical method of enabling you to decide whether a particular spleen is enlarged), gall bladder abnormalities, ‘spotted’ kidneys and lymph node abnormalities. All of these findings are amply illustrated. Beneath each post mortem finding is a clear instruction of what to do next as part of the reporting protocol.

The preventable measures outlined by Susanna are emphasised. Keep ‘wild’ pigs off the farm, prevent them eating contaminated pork products, no accidental access, restrict people as vectors, and keep your hands washed (sounds familiar?). Finally pigs are everywherewe must keep them out. Apart from that the number 1 and 2 controls are border controls and rapid reporting. The ‘Take Home’ message on the last slide is straightforward: _ • Pig with red ears, a high temperature and an enlarged spleen? • Call • Do not leave the farm • Recognising the first case is the key to protecting the UK Susanna Williamson and John Carr, speaking from opposite ends of the planet, make for a superb double act. Dr Williamson is a veterinary lead for the pig expert group at AHPA and is a past president of the Pig Veterinary Society. She obtained a PhD while at the Centre for Tropical Medicine in Edinburgh and since then, like John, has travelled widely before joining APHA in 2000. John has travelled all over the world since obtaining his PhD on urinary tract disease in pigs. He is a diplomat of the European college of Pig Health Management and has taught production medicine in several universities in the UK, USA and currently in Australia. I doubt you will find a better account of this devastating disease anywhere. It is of special interest to colleagues that deal with pigs but will be enjoyed by anyone with an interest in contagious diseases-and that must mean everyone currently in these very strange times.

A detailed differential list is summarised in a slide with the advice, repeated many times in following slides, of calling for advice if there are any concerns. For example if you are worried you must call, send GPS, send pictures, close the https://www.thewebinarvet.com/webinar/ holding, bag the pig and wait. african-swine-fever-what-all-vets-need-to-know

WEBINAR GLUCOCORTICOIDS: THE BEST LITTLE WHITE PILLS IN PHARMACY PROFESSOR IAN RAMSEY BVSc PhD DSAM DipECVIM FHEA FRCV University of Glasgow Veterinary School

his veterinary webinar begins with an account of the natural hormones, cortisone and cortisol and their synthetic derivatives, prednisone, prednisolone, methylprednisolone, dexamethasone/betamethasone and triamcinolone. For the synthetic ones there is a chart defining glucocorticoid effects, mineralocorticoid effects, equivalent oral dose and the biological halflife. The effects of glucocorticoids are summarised under the headings metabolism, water and electrolyte homeostasis, immunity, inflammation and others. According to Hill and others glucocorticoids are used in 20% of dermatology consultations, and although there is a huge amount devoted to them in the literature there are few conclusions. This has led to dilemmas on the cost benefit analysis, influences from human medicine and a ‘love-hate’ relationship. There is a certain amount if fear associated with steroids concerning their well recognised side effects and horror stories due to the following possible sequelae: • Diabetes mellitus • Collapse

There is a huge amount in the literature-just googling glucocorticoid in PubMed will bring up 228, 817 hits (right up to date, June 2020). Ian comments on the relatively rare numbers of papers in dogs. Articles usually compare steroids to steroid plus one other. Comparing doses of steroids, and types of steroid is rare and justifying a particular dose is virtually unknown. Some theoretical concepts follow describing the mechanism of action. These are brilliantly explained with a colour diagram depicting glucocorticoid receptors and chaperone proteins and the effect the glucocorticoid receptors have once they gain entrance past the nuclear membrane of the cell. This is followed up with the genomic, non-genomic and chromosomal mechanisms of action. This rather detailed information leads to the main practical clinical indications for glucocorticoids: 1. Maintenance –as in Addison’s disease for example 2. Anti-inflammatory 3. Immunosuppressive 4. Anti-neoplastic 5. Anti-insulin

• GI ulceration

6. Anaphylaxis

• Massive polydipsia and polyuria

Ian emphasises the importance of considering the individual

• Severe alopecia

patient and having a plan before initiating glucocorticoid therapy. It is important not to adopt the ‘Try this and See’ approach. Elements in the planning include: • Starting dose • Length of initial course • Recheck points • Methods (parameters) of monitoring • Likely dose reductions It is also very important to ‘Tell the client’! Glasgow use a BSAVA document designed to inform clients about steroids. Included here are” – • Why using-disease, why will work • Improvements-expected and including minimum • Side effects • Time course-both absolute and relative • Need for rechecks There is some interesting information about high dose pulse therapy in humans with pemphigus and whether this might benefit dogs. Ian continues with a discussion on doses, length of treatment, and when to reduce the dose. This can be after noting objective parameters such as platelet counts or PCV in autoimmune blood disorders but

also by measuring acute phase proteins. Alternatively just adopt ALARA principle (As Low As Reasonably Achievable). There is a considerable amount of discussion on alternate day therapy (ADST) and surprisingly, although widely adopted, there hasn’t been a great deal of research on the concept. Ian, I think it’s fair to say, is skeptical about its value and even questioning whether it is even necessary. In terms of its practical use Ian summarises as follows

which of course is very topical. The final slide summarises the golden rules of steroid therapy: 1. Use enough, but no more, to control clinical signs and double the dose until you have control 2. If not working soon -try something else! 3. Only switch to ADST once signs controlled 4. Use other treatments to reduce steroid use

• Only when disease controlled

5. Monitor the animal individually

• No point in the short term

6. Taper doses by 50% increments

• Use with other therapy

7. Do not use as a preventative treatment

• Not essential-just another way of lowering the dose.

8. Do not use in shock.

The last point would make a very good discussion point with the dermatologists I suspect!

Finally you may have noticed the question mark in the webinar title If not here’s the title again.

There has been some new thinking of a concept known as relative adrenal insufficiency in intensive care units. Ian in true academic fashion picks holes in the theory and sides with a statement that ‘administration of glucocorticoids adds cost without benefit and with increased risk.’ Another firm statement is that steroids should not be given to animals if they have shock-unless electrolyte abnormalities are documented and they have been tested for Addison’s disease. There is a brief mention of the subset of people in human ICU with septic shock who may benefit from glucocorticoids,

‘Glucocorticoids: the best little white pills in pharmacy?’ Ian’s conclusion is- ‘Yes, if you use them properly.’ This is a very good webinar containing some interesting academic and clinical information and one for the whole practice as adopting a standard steroid policy would be of great benefit. https://www.thewebinarvet.com/webinar/ glucocorticoids-the-best-little-white-pills-in-pharmacy

From the Literature – July’20 I expect many will be aware of Purina launching their new diet to help people that suffer allergy to cats. The diet has been mentioned in several mainstream newspapers in the UK and cat owners may ask about it. The diet is called Pro Plan LiveClear. I have looked at a couple of the original research articles leading up to the product being launched. Going to Google Scholar and typing in ‘Fel d1 reduced by diet’ and specifying articles published since 2019 will locate both the articles I mention here, (both open access), and many others.

Reduction of active Fel d1 from cats using an anti-Fel d1 egg IgY antibody Ebenezer Satyaraj and others Immunity, inflammation and Disease Volume 7 Issue 2 June 2109 pages 68-73

he background to this study as summarised in the abstract is that Fel d1 is the most important allergen from cats. It is produced primarily in saliva and spread to the hair coat during grooming and then transferred to the environment via hair and dander.

allergen.

A novel approach to reducing allergenic Fel d1 exposure was evaluated involving binding the Fel d1 with an anti-Fel d1 polyclonal egg IgY antibody. The hypothesis was that hair from cats that had been fed foods containing anti-Fel d1 would show a significant reduction in active Fel d1

The introduction to the article is concise and excellent. It updates on allergy to cats and outlines the difficulties in removing contaminated hair from homes. It is even found in homes where there are no cats! The discussion is also a very good revision on the subject and there is an interesting comment concerning the effect the reduction of Fel d1 in the home. Just a reduction of 6.8% of baseline levels significantly improved symptoms of nasal allergy. This raises the prospect of avoiding relinquishing of the cat by owners with severe allergic signs. Surprisingly this information comes from an article written as long ago as 2003 by Björnsdottir and others, (reference 19 in the text).

Hair collected from 105 cats completing a 12week study was evaluated for active Fel d1 via ELISA. Hair was collected four times over a 2-week baseline period, then weekly during 10 weeks of the treatment period during which time cats were fed food containing the anti-Fel d1 IgY Baseline active Fel d1 varied greatly among the cats in this study. From week 3 there was a significant reduction in in mean Fel d1 with an overall average of 47% by week 10, ranging from a 33-71% decrease from baseline. Cats with the highest baseline levels showed the greatest decreased levels of the

The conclusion is that feeding anti Fel d1 IgY to cats successfully and significantly reduced allergen on their hair coat with the greatest reduction seen in cats with initially high levels.

The second article that I recommend covers much of the ground of the previous one. It is more clinically oriented and also compares a study group of cats fed the anti-Fel 1 diet with a control group.

Anti-Fel d1 immunoglobulin Y antibody containing egg ingredient lowers allergen levels in cat saliva SATYARAJ E AND OTHERS

Journal of Feline Medicine and Surgery Volume 21 Issue 10 2019

he study confirmed earlier reports that feeding the diet containing anti-Fel d1 gammaglobulin Y significantly reduced the allergen in saliva within 3 weeks. Although additional research is needed these findings show promise for an alternative approach in the management of allergies to cats.

As in the previous article I have mentioned the introduction is very good and even more extensive. It covers more information on the human condition of cat allergy with very surprising statistics. It also documents the main therapies available for people and the fact that an ultimate solution, removing the cat is unacceptable to most. The difficulties of ASIT are summarised, mainly cost, length of time required and side effects, before describing the novel approach of inoculating chickens and harvesting immunoglobulins from egg yolks for insertion into cat food. This approach is very well described and it is hoped that it will benefit cats by providing an alternative to relinquishment and by allowing more quality interactions between cats and their allergic owners. Both articles are very well worth reading and, although they cover a lot of the same ground, together they give a full account of what looks like being a very interesting way of solving an ancient problem. The latest edition of Veterinary Clinics of North America is superb and a must go-to for anyone interested in cats.

Veterinary Clinics of North America: Small Animal Practice Feline Practice: integrating Medicine and Well-being Part 1. Volume 50 number 4 July 2020

Comorbidities • Distinguishing between Dermatologic disorders of the Face, Nasal Planum and Ears: Great Lookalikes in Feline Dermatology • Integrating Science and Well Being Each of these articles has Key Points so you already know what you hope to gain from reading them. The amount of work and attention to detail is incredible. I particularly liked Terry Marie Curtis’ introduction to her article on Behavior Problem or Problem Behavior. Dr Curtis has three key points:

Edited by Maggie Scherk

1. What are the behavior problems versus problem behaviors? It usually depends on the individual client

Here is an idea of what you will find in this edition: -

2. The goal with objectionable or annoying behaviors is always to solve the problem, so creativity is the key

• Stress and feline health • Environment and feline health: at home and in the clinic • Behavior as an illness indicator • Behavior Problem or Problem Behavior? • Feline Aging: Promoting Physiologic and Emotional well-being • Analgesia: What Makes Cats Different/Challenging and What is Critical for Cats • Feline Chronic Pain and Osteoarthritis • Feline Neuropathic Pain • Complex Disease Management: Managing a Cat with

3. It is important to remember that these problem behaviors are normal behaviors for the cat The author has lived with cats all her life, was a feline only practitioner then a veterinary behaviorist with extensive training. She continues: ‘given all of that, people would think that I know cats. On the contrary, after all this time, I can say with confidence that I do not think anyone knows cats. However, what I do know is how to solve a problem, and that is what veterinary behavior is: solving a problem (real or imagined) for 1 or more humans living with 1 or more cats’ There is a lot more to enjoy in this edition and it is all open access. Brilliant!