The Webinar Gazette The Webinar vet
To provide: The highest quality vet-led content To be: The world’s largest online veterinary community
December 2020
To have: The planet’s most confident vets
WHAT’S INSIDE Hot News Monthly Feature News from our community CPDer of the month Speaker of the month Stethoscope Pippa Talks Jane’s Blog JHP Recruitment Job Board David’s reviews From the Literature
Anthony’s introduction: As we come to the end of the year, we have an interesting Christmas to look forward to. Who knows what it will look like this year? 2020 has been a very different year than we expected it to be. It’s fair to say it’s been a rocky ride. I’ve lost a good friend to the disease; my wife is just recovering from the virus and one of her friend’s sister is dying in hospital tonight as I write this intro to our newsletter. My faith has helped me through it. I hope you are coping in these turbulent times. I’m an optimist. I’m so pleased to hear the positive messages about the vaccine progress and I hope that we can come out of this viral-induced lockdown very soon as we begin the vaccine rollout. However, I believe that we must learn lessons from this pandemic. The new normal will be different, we can’t go backwards. Making the right decisions for our environment becomes increasingly important, as governments but also as individuals. Becoming digital businesses has been a necessity for several years, Covid has just confirmed it!
I’ve thoroughly enjoyed enjoyedreading readingDavid DavidAttenborough’s Attenborough’s new book, book, ““AAlife lifeononour our planet” planet” thisthis month. month. It’s It’s a book a full of full book hope. of hope. We canWe sort can thesort planet the out. planet There out.are, There already, fabulous are, already, examples fabulous of environmental examples ofstewardship environmental happening all over the stewardship happening world from all Palau over the to our world very from own Palau Knepp Estate to our invery Sussex. ownI would Kneppdefinitely Estate inrecommend Sussex. I would the book as a stocking definitely recommend filler for Christmas the book as especially a stocking if you fillerbought for it from yourespecially Christmas local bookshop. if you bought The high it from streetyour has taken local a pummellingThe bookshop. during highlockdown street has and taken I think a pummelling it’s important we try tolockdown during support itand whilst I think also being it’s important careful to we not try allow consumerism to support it whilst to detract alsofrom being thecareful real meaning to not of allow Christmas. Perhaps this consumerism to year detract will be from one the where real families meaning reflect on Christmas. of what is really Perhaps important. this year will be one where families reflect on what is really important. We’ve had some fabulous webinars this month. I’ve enjoyed listening We’ve had some to some fabulous of the webinars dermatology thiswebinars month.from WCVD9I’ve enjoyed Danny listening Scott is always to some a highlight of the dermatology if you haven’t heard him from webinars beforeWCVD9but he isDanny one of many Scott brilliant is always speakers. a Danny won highlight if you thehaven’t Schindelka heard award him before at this but year’s he world is one congress. of many I’ve brilliant knownspeakers. Danny forDanny over 20 won years, the Schindelka having shared dinner with award at this him year’s at my first world world congress. congressI’ve in Edinburgh known in 1996 and Danny forspending over 20 years, time with having him shared at Cornell dinner afterwith winning the Frank him at myBeattie first world Travel congress Scholarship in Edinburgh in 1997. Iin love 1996 Danny. He inspires and spending andtime is passionate with him at and Cornell possibly after a little winning crazy! I aspire the Frank to beBeattie a little Travel bit likeScholarship him, whilst embracing in 1997. I love my own identity.He inspires and is passionate and possibly a Danny. Mars Petcare little crazy! I sponsored aspire to be two a little fabulous bit like dental him,webinars. whilst We did a symposium embracing my own foridentity. WVA on the response so far on Covid 19 and Brian Faulkner did a live only webinar on veterinary Mars Petcare sponsored two fabulous dental confidence. webinars. We did a symposium for WVA on the response so far on Covid 19 and Brian Faulkner did a live only webinar on veterinary confidence.
In early December, we will be holding a morning symposium on how the veterinary industry will adapt in the future through a Covid lens and will cover women in leadership as well as how pet owner expectations will change. It’s free and sponsored by Royal Canin. I always find that our clinical webinars get more attendees than management ones but I do think that this is such an important issue and I would urge you to attend and reflect how you might need to change in the next few years to thrive in the new normal. IT’S AN EARLY CHRISTMAS GIFT FROM ROYAL CANIN AND THE WEBINAR VET- ENJOY! Finally, we are preparing our 9th annual virtual congress, VC2021! We were doing virtual congresses when nobody was interested and I’ve reflected that we have been preparing for the last 10 years for the pandemic without realising it. When I started The Webinar Vet 10 years ago there was no online space in veterinary education and the old, traditional companies were happy with the status quo. In fact, when I attended BSAVA in 2010 nobody even knew what a webinar was and I had to explain what the word meant. Now it is the commonest way that vets and nurses learn without wasting time and money travelling to distant centres. I’ve been on social media recently listening to how colleagues are coping in the field and I know it’s exhausting and a struggle. I want you to know that the team at The Webinar Vet are there to support you. Please ask if you need help in any way. It’s why we are there. I was encouraged by several of the vets who despite their busyness, were using the platform to keep energised and up to date. Thank you for your encouragement. Christmas will be strange this year but I still ask you to find peace in the stillness of the cold Christmas night when Jesus came into the world to change it for the better. Happy Christmas, Anthony
Stories you may have missed this month:
Please join us for the launch of the 10th PDSA Animal Wellbeing (PAW) Report, from 12 – 2pm on Thursday 3 December 2020. The PAW Report, the largest and most comprehensive report into the wellbeing of the UK’s pet dogs, cats and rabbits, has reached a milestone year, marking a decade of monitoring and analysing crucial trends in pet welfare. Join our expert panel for a live panel Q & A as they review and discuss these trends, with a focus on pet obesity, preventive healthcare, pet behaviour and pre-acquisition preparation, as well as highlighting early indicators of potential impacts of the first national COVID-19 lockdown, and actions needed from across the veterinary professions and animal welfare sector to drive positive change. Chaired by Vicki Betton, PAW Report project lead at PDSA, the panel features keynote speakers from across the profession: - Richard Hooker, PDSA Director of Veterinary Services - Daniella Dos Santos, BVA Senior Vice President - Jo Oakden, BVNA President - Chris Laurence, Chair of the Canine and Feline Sector Group (CFSG) - Sarah Heath, RCVS and European Veterinary Specialist in Behavioural Medicine - Alex German, Professor of Small Animal Medicine, University of Liverpool - Sean Wensley, PDSA Senior Vet (Communication & Education) - Laura Piggott, Associate Director, YouGov
Please register for your free place on this online event, which is kindly supported by the players of the People’s Postcode Lottery - we look forward to seeing you there!
Are the UK’s pets healthy and happy in 2020? 10 years of the PDSA Animal Wellbeing (PAW) Report Thursday 3rd December, 12pm GMT
Register for this webinar here:
Ben Sweeney BVSc MSc (VIDC) Cert AVP MRCVS
The vet parent conundrum In this modern era of the ‘pet parent’ we often hear about the attitude of millennials and Gen Z towards having family and their ideas on what is important in life. People are waiting longer to buy homes and to have families. I was 35 when my son was born last year-that would be considered almost ancient when it came to my parents and grandparents generation.
One thing is for sure, when you do have a child, clichĂŠ thought it may sound to say, everything changes. Your priorities shift. Your desires for yourself are altered amongst a mixture of parenting induced exhaustion and that most prehistoric of instincts to protect and nurture your offspring so that they want for nothing.
But where does work fit into all of this? After all, if we want to give them the best life surely that needs paying for, no matter how lavish or simplistic that life may be.
One thing that has saddened me since embarking on my own parenting endeavors, is how many of my professional friends and colleagues have approached me with truly sad stories about how their employed roles had become untenable with the life they want to be able to have and enjoy as parents. I can honestly say that these are some of the hardest conversations that I have had in my professional career: these are not vets and nurses who are looking for a way out of the profession, but ones who feel that their circumstances in the profession offer them no alternative other than to look to other solutions to facilitate their family life. I could get on my soapbox about how it all starts with UK maternity and paternity packages and how they are hardly a blip on the radar compared to such countries like Sweden which seems, from the outside at least, to be some sort of western utopia for the amalgamation of family and work life, but that is only the first blip on the radar. Ultimately mat and pat breaks need to be paid for by someone, or we need to have a significant nest egg saved up to guide us through those periodscontroversial though it may sound, should that be an employers responsibility or one for ourselves to plan for and make appropriate financial planning arrangements?
I think it is safe to say that, sadly, we are part of a profession where those desires to be there for all of our child needs are, in many cases, simply not conducive with a progressive career in clinical practice. Many of us miss out on meal times, on vast swathes of our children’s early and formative experiences where they spend long periods in nursery, bed times and other experiences like school sports days and sports matches. There are of course exceptions, but for many of us, the choice is often between career and parenting rather than combining the two in a successful meshing of the fabled work-life balance.
For me, the crux comes to the sheer lack of flexibility that is offered by our profession in a return to work capacity. Sure, many of us have the capacity to work a four day week nowadays, but how many of us can truly say that our four day week isn’t in excess of 40 hours, so may we be better working 5 shorter days anyway? After all, that offers the same time and resource capacity to our clients!
Is it any wonder that there are many experienced vets and nurses turning to locum life and teleconsulting services to offer the mythical flexibility that we read about others achieving in their various blogs, facebook pages and other sources of information and insights.
I genuinely find it hard to believe that there are not employers out there who recognize the need, as well as the opportunity, to offer true flexibility as part of the work day. Sure, the veterinary profession relies on a certain physicality that other professions and industries don’t, but do we need to have the strictly regimented hours that we have come to recognize as ‘the norm’ or can we find a way to liaise with our staff before they return to work to find hours to suit them and their home life?
The fact of the matter is that I know this can be achieved-I have seen it. In rare lessons to rival some of those from Greek mythology, some employers do go to great lengths to make things viable for their team. These are people to be learnt from, who appreciate and understand the need for a more versatile veterinary workplace. It cannot be achieved as a whole profession overnight, but these small glimmers of hope and visionary leadership are things to shine a light on and highlight for the wider profession. It is possible, we just have to think outside of the box. In fact, sometimes we have to take a hammer to the box and then rebuild it in a way to suit the new circumstances.
So, to those of you who have found a way to get a balance between parenting and family life alongside clinical life then I commend you. How have you managed to get it to work for you?
So, I hope this piece hasn’t just sounded like a ginger scouser who is sleep deprived ranting at his computer while typing away at 2am, instead I hope you can see what I have, that there is hope, and that if we take collaborative learnings from how different workplaces, as well as other professions, make things work for the parents in their teams, then as a profession we can very much shape a brighter future for the whole team, not just the parents in them-after all, people should not miss out on flexibility just because they don’t have children.
There is a huge opportunity for this next evolution in practice life to benefit everybody!
If you work in a practice who have managed to get the balance right for you then please do get in touch, I would love to hear your story of how you have worked together to identify the right solution.
Please send your stories (both good and bad) about workplace adaptations to help better flexibility for parents and non-parents to ben@simplylocums.co.uk.
Use sustainable decorations
Guest Article
Zero Waste Veterinary 8 Ideas for a Greener Christmas in Practice
A great way to help the environment this Christmas is by switching to LED Christmas lights. LED lights use less energy than standard incandescent lights which makes them a more energy efficient choice. Instead of using ‘traditional’ decorations to decorate your practice tree, how about letting clients decorate it instead? Using old Christmas tags, reused Christmas cards or simple paper decorations, clients can dedicate a decoration to a beloved lost pet and hang it on the tree. Clients really seem to like this idea and it saves you having to buy carbon-emitting, plastic decorations.
Use a real Christmas tree
Donate to charity instead of sending cards to clients Although it is lovely to select your client Christmas card list each year and hand-write cards to your favourite clients, these cards may be producing a bigger footprint than you think. According to Imperial College researchers, an astonishing 1.5 BILLION Christmas cards are thrown away by UK households every year! This year, instead of sending Christmas cards, why not make a donation to your favourite charity? Not only will you be helping to support vital work of charities, but you will also be cutting your carbon footprint (as well as saving a lot of time!). But don’t forget to tell your clients! A social media post thanking them for ‘their’ contribution would be a lovely gesture.
Choose sustainable cards If you can’t bear to think of not sending cards to your loyal clients, then at least make sure you are sending sustainable and ethical cards. Ensure your cards are forest friendly by checking they hold the FSC logo. Perhaps you could even go a step further and use plant-able cards? Once they have been admired, they can be planted to produce beautiful flowers for your clients. Alternatively, you could send all your clients a Christmas e-card, cutting your carbon footprint, saving trees and saving your practice money too! You could include a photo of your team or some of your favourite festive patients.
According to The Woodland Trust, artificial trees are less environmentally-friendly than real trees as most are made from non-recyclable plastic. The carbon emissions generated to produce artificial trees are also very high. If you do opt for an artificial tree (or already have a practice one), try to use it for as long as possible to reduce the environmental impact. Perhaps the most environmentally-friendly option is to buy a tree with roots, meaning it can be planted again after Christmas. Remember to look out for that FSC accreditation again when picking your tree. The smell of a real Christmas tree in the waiting room is guaranteed to bring Christmas-y joy to everyone! Some garden centres and tree nurseries even offer a Christmas tree rental scheme! This allows you to rent your Christmas tree in a pot and return it to the growers afterwards! The tree is then reused in future years. Once Christmas is over, remember to recycle your Christmas tree properly. Local councils will often have a recycling programme where the tree will be shredded and used as mulch.
Hold a collection for charity
This year, more than others, charities need our support. Why not hold a collection for your local animal charity? Ask clients to donate pet food, toys, bed etc. You could even get your reps involved too and see what companies can offer! Or instead of an animal charity, you could support your local food bank and ask for donations of food and toiletries to support your local community. Food banks will often have a list of specific items they need on their website. Clients may even have these items already in the back of their cupboards, which could help to reduce food waste.
Reduce food waste
The generosity of our clients knows no bounds, and I don’t think even Covid could stop them spoiling us with delicious, sugary food this Christmas! I have worked in a practice where the Christmas tradition was to ‘raffle off’ the Christmas gifts kindly given by clients (you know, those 12 half-eaten boxes of biscuits in the staff room...). The gifts were kept until there was enough for everyone, then each gift was given a number and every staff member picked a number to receive their gift! It worked really well and added a little fun to the day! If you are feeling extra generous this year, you could donate any unwanted (term used loosely!) gifts to your local foodbank to spread the love.
Stock sustainable pet gifts
Many clients will be looking for gifts to spoil their fluffy friends this Christmas, so why not offer them something sustainable this year? For example, Beco Pets usually do an adorable Christmas range of sustainable pet toys. See what your suppliers have to offer or check out local businesses.
Feed local wildlife
If you are lucky enough to have an outdoor space at your practice, why not add a bird feeder to help your local wildlife through the cold months? Plummeting temperatures can make it very hard for birds to find food over winter, which is why it’s nice for us to provide them with a helping hand. If you want to go all out, you can even install a bird bath too to provide a fresh water source. As with any of our patients, remember to keep these areas clean and hygienic at all times to prevent the spread of diseases. Not only does this help your local wildlife, but things like this can even have a positive effect on staff too, helping to lower anxiety, stress and even depression. Win win!
Whatever you choose to do this year, remember to REDUCE REUSE RECYCLE.
VET MANAGEMENT FOR THE FUTURE
Vet Management for the future Tile Visual attached in email
Royal Canin are delighted to invite you to an exciting virtual event for you to engage with a diverse and dynamic panel of speakers who will address how as an industry we adapt for the future. The topics up for discussion are, of course, the view through the COVID lens, how millennials are leading the way as our pet care consumers, how do we develop veterinary team strengths and enriching diversity with women in leadership.
To register for this exciting event, click here.
Wednesday 2nd December 2020 09:30 - 14:00
Carlos Michelsen, MD & Founder CM Research - Carlos is the MD and founder of CM Research, a market research agency that works exclusively in the veterinary and pet owners’ sectors across the world. He has over 30 years’ experience in Market Research. During the pandemic he has helped many veterinary pharmaceuticals gauge the effect the pandemic is having on veterinarians. Discussing - COVID Lens - There is one thing that can be said about what the future will look like: it will not look like the past. Instead of trying to hope for a return to what once was, we need to act and prepare for what can be.
Discussing – No longer do Baby Boomers represent the largest portion of pet owners; that title now belongs to Millennials. Brands who will thrive in the Pet Ecosystem understand how our Millennial consumers differ from the other generations. Rising per capita income and growing pet adoptions for companionship lend to an increase in spending on pet care which will continue to boost the market. Oke Eleazu is Chief Operating Officer of Bought By Many (BBM). BBM is one of Europe’s leading Insurtech startups, focused on disrupting traditional insurance markets by using digital to provide customers with better insurance experience. This seems to be working as within 3 years of launching their pet insurance products, they have an NPS score of 78, have been awarded Feefo’s Platinum status and recently won the Moneywise Most Trusted Pet Insurance award… which is voted for by customers. BBM has also featured in the Sunday Times Tech Trach 100 for the last 3 years, making them one of the fastest growing Fintech businesses in Europe. Oke has held several senior roles in major organizations, all centred on improving the experience of customers. He was Director of Customer Experience for Sainsbury’s, where he created and executed a new strategy for delivering ever improving service for Sainsbury’s 24 million customers a week. Previously he was Customer Service and Operations Director for Bupa and Customer Service Director at Prudential. Oke has recently stepped down from the Board of Bromford Group after 7 years. In September 2016, he published his first book, ‘The Cult of Service Excellence’. The book is about how to create the culture in any business to ensure there are engaged employees delivering exceptional customer experience.
Andrea Jeffery MSc, FHEA, DipAVN (Surg), Cert Ed, RVN Chief Nursing Officer Linneaus
Discussing - Women now account for more than half of the veterinary profession and this number is rising. The industry has undergone a great demographic shift over the past 25 years and this change is starting to be reflected within leadership positions. Is there a need to be better represented in these leadership roles if we’re to deliver on the promise of veterinary medicine to society?
Andrea began her nursing career in the NHS where she trained as an orthopaedic nurse she then moved into veterinary nursing and worked in both primary care and referral businesses, it was here that her passion for educating the next generation of veterinary nurses began, Andrea moved firstly into further education and then into higher education and spent many years at the University of Bristol Veterinary School responsible for undergraduate veterinary nursing provision. While at Bristol Andrea co-developed the first graduate training programme for veterinary nurses as well as introducing a Masters by Research programme for veterinary nurse Andrea is a Fellow of the Higher Education Academy , has an MSc in the area of e- learning and its value to a veterinary nurse curriculum and achieved her PhD earlier this year which reviewed the factors which influence retention within the veterinary nursing profession. In April 2019 Andrea was appointed as the Chief Nursing Officer within Linnaeus, the only veterinary nursing executive post in the UK. Andrea has served as an elected member on the RCVS VN Council and as such has had a pivotal role in driving forward the professionalisation of veterinary nursing in the UK.
Carolyne Crowe BVetMed (Hons), BSc (Hons), MSc, Dip Coaching, Dip Stress Management and Wellbeing, FRCVS Head of Training, VDS - Carolyne is an experienced equine vet, an award-winning high performance coach, mentor, international speaker, researcher, and lecturer. Carolyne has a Masters degree in Workplace Health and Wellbeing. She is a master trainer in DISC behavioural profiling, a CPCAB trainer in Stress management and Wellbeing, a certified trainer in Resilience, a Mental Health First Aider, and an Honorary Lecturer of the University of Liverpool. Discussing - Support your Team Strengths - Common goals for veterinary practices and hospitals across the country tend to focus on client retention and practice growth. For the practices we surveyed, a crucial component to reaching these goals is a skilled, dedicated and engaged team. Having an effective team who feel valued and developed is key to delivering these outcomes. During this session we will cover how to get the best out of each person in your team, how to develop and engage them and how to play to their strengths.
Louise Brennan BBs BSc RVN NLP Coach - ROYAL CANIN Having qualified with a Business Degree in Marketing, Louise spent the early part of her career in business development within banking before moving into general veterinary practice whilst qualifying as a RVN. Her interests in practice were nutrition, behaviour and the role of Nurses in practice growth, before joining ROYAL CANIN® in 2010. Through sales and marketing roles with ROYAL CANIN® across the UK, Ireland, Louise has brought her veterinary, business acumen and coaching skills to support veterinary teams reach their full potential. In her current role as Europe Perfect Clinic Manager, she actively champions communication excellence to grow the quality of pet owner journey. Louise qualified as a NLP coach this year. Discussing – Nutrition 360° - At Royal Canin we understand the challenges UK & Ireland vet clinics face. We know time, now more than ever, is a precious resource for all veterinary professionals. Pet owners rely heavily on vet guidance for pet product purchases, including nutritional advice(1). Yet pet owner expectations are higher than ever with research showing more than 50% of pet owners want advice on nutrition.(2)With only 3% of pets fed through vet clinics(4) in a market worth £2.7 billion(5) we believe your clinics can DIRECTLY BENEFIT from the growth potential that exists in the pet nutrition market. Collaboration is Key - This is why we bring you Royal Canin’s Nutrition 360° which offers a practical programme, tailored to your clinic, that incorporates a whole team approach to simplify nutritional recommendations and grow your business. Your team’s collaboration is key and allows for everyone in the clinic to contribute to the recommendation.
Chaired by Ben Sweeny of Vet Chat and Simply Locums To know more about Royal Canin’s Nutrition 360° approach, watch this video to see the programme in more detail.
To register for this exciting event, click here.
Guest Blog - Jayne Laycock Sinonasal aspergillosis diagnosis and treatment
I’m pleased to say sinonasal aspergillosis is not a condition I see very often in either cats or dogs as I know it can be challenging to diagnose and manage. However, after watching Simon Tappin’s webinar on this very topic I now know when confronted with patients suffering from sinonasal aspergillosis, I will be much better equipped to steer these cases in the right direction. Simon firstly explained that aspergillus fumigatus is an opportunistic organism found in the soil and does not necessarily always cause disease. Aspergillosis may develop secondary to other issues such as the presence of a nasal foreign body, neoplasia or trauma. There are also certain breeds, such as the GSD and Rottweiler, that have issues with their cell mediated immunity making them more prone to developing Aspergillosis. For this reason it is always important to remember that if aspergillus is found in cytology (usually after performing a nasal flush), it’s presence must always be interpreted in context to the clinical picture of the patient. A negative serology result for aspergillus must also be interpreted with caution. Antibody testing for aspergillus is highly specific meaning if you get a positive result then a false positive is highly unlikely to occur. However it only has moderately sensitive meaning false negative results are more likely. So if Aspergillus serology is negative for your patient but the clinical picture fits for aspergillosis then further diagnostics should be performed to rule out or rule in this diagnosis. These further diagnostics include imaging of the nasal cavity using x-rays, CT, MRI and nasal rhinoscopy. Simon explained the pros and cons of each technique and also explained how to perform a nasal rhinoscopy. Nasal biopsies are however the key to making a diagnosis and again this technique was explained within the webinar. After nasal biopsies Simon explained that these patients do tend to bleed a lot post biopsy and may need to have their nose packed and/or have their nasal area flushed with iced saline. Simon also sometimes uses acepromazime as a
sedative on recovery which also helps to reduce blood pressure slightly. He would also always recommend keeping these patients hospitalised overnight. Once cases of Aspergillosis are confirmed with nasal biopsies, treatment can be instigated either orally or topically. Simon explained that oral treatments are not as effective as topical treatments. Prolonged treatments with oral drugs such as fluconazole or itraconazole are necessary for 6-8 weeks. Vomiting, anorexia and hepatotoxicity are common side effects associated with these treatments and unfortunately only offer between 40-60% efficacy. Topical treatment, however, is a lot more effective, but a key part to this treatment’s success is to ensure that as much fungal material as possible has been debrided endoscopically first. Simon then talked us through how to perform sinus trephination to allow flushing of the nasal cavities. Once this has been performed Simon explained he then flushes with saline to aid in the debridement process followed by a further five minute flush with a 1% solution of clotrimazole. Finally a depo of clotrimazole cream is then administered. For those of us who are less keen on the surgical process of sinus trephination, Simon also described how to perform a nasal soak where the nasal cavities are soaked with. 1% clotrimazole solution for 60 minutes. If these cases do recur then it will be necessary to resort to rescue therapies which usually involves the placement of an indwelling catheter allowing for the daily installation of an antifungal such as imaverol, or if we are really struggling to resolve the problem, it may be necessary to perform a rhinotomy as a last resort. This was a highly informative webinar packed with advice on how to manage these challenging cases and will act as an excellent reference point for when a case of sinonasal aspergillosis is presented to us in practice.
NEWS FROM OUR COMMUNITY Insights during Covid working for The PDSA How has Covid changed my experience of working for the PDSA? In some ways very little. There is still the manic demand for our services which exceeds our resources but that somehow we stretch so that hopefully every one receives attention and the best treatment we can offer in good time. Unfortunately our resources are finite and sometimes the hardest part of the job is having to say we cannot help, or to say we cannot help in the way the owner would like. During Covid we are having to say no more often, perhaps more often than to be honest I feel comfortable with, but I know this is only a temporary situation. There is still the brilliant team work and the support of colleagues. There is still the culture of care for our clients and working for an organisation that acknowledges and values the safety and welfare of its employees. I appreciate all the changes that have been introduced to make working as safe as possible. Often our clients are drawn from the most vulnerable of society and many have serious chronic health conditions and I know from feedback that they appreciate our working practices and feel safer as a result. I spend more time on the phone these days. Consultations are fewer in number and take longer. Surgery is less adventurous and never routine. We do our best knowing that our best is not always enough and that we do not always get everything right. Occasionally our clients can be lacking in understanding and patience but these are difficult times. Everyone is struggling and those who start from a place of very little are probably struggling the most. I do not believe our clients choose to use us because of a lifestyle choice in the same way no one chooses to use a food bank. Hopefully we are there for people and their pets when they need us, when realistically they have no other options. However crappy the odd day may be with all the negative aspects of being in small animal practice there are days for our clients when for them we do appear to work miracles . I feel very fortunate to work for The PDSA. It is a privilege.
CPD’er of the month 1. Which webinar did you enjoy the most this month? Ron Ofri & David Maggs, I just watch everything they teach! Best lectures in ophthalmology, they make it easy to apply to my day to day cases and they teach you things you wish you were taught years ago. 2. What was the biggest take-home message you learned this month from our webinars? I need more time to study new techniques, and apply them in my surgery. 3. Are you looking forward to any future webinars or events from The Webinar Vet? Looking forward to some more exotic animal lectures, plus more lectures from the ophthalmologists. Can we have some more ultrasonography lectures?
Carriage of Animals
2.6 The number of Animals that can be transported between EU Member States is limited to 5 per person, unless the Owner is taking part in a competition, show or sporting event. Above that limit, Carriage will be refused unless the Owner provides proof of participation to such an event. https://www.eurotunnel.com/uk/legal/carriage-of-animals/ The petition that I saw was claiming that this will negatively impact the ability of those organisations that rescue animals abroad and bring them to the UK for rehoming. I personally can’t comment on this but I do have an opinion on this move. While I’m not sure if it will make the biggest impact I feel that any tightening of animal movements into the United Kingdom can only be positive for animal welfare. I know this may take away from the genuine rescues complying with rules and doing good work but I do think one person travelling with five or more animals at one time must be incredibly stressful for both person and animal. In this instance it is mainly a dog issue but there is a rise in cats arriving from overseas too. So well done to Eurotunnel for making this across all relevant species. Although this may be one small move for one company I’m hoping it shows a general shift in attitude in the many ways that we can support improving animal welfare. As part of my PhD I have been pondering at what point did vets become responsible for all animals everywhere. I feel this is very much how the public see us at the moment and while that is a great honour it is not a role that is necessarily viable nor one that the veterinary industry is structured for. We do need external support and sharing of this kind of knowledge to help each other improve welfare. While this isn’t my usual Christmas message, I would like to say to Eurotunnel - Thank You for considering animal welfare at a time when I’m sure their company has many other battles to fight. May we see in 2021 and in future years further improvements in regulations for the transporting of animals for all purposes. Stay safe and see you all next year.
Jane’s Blog In a break with tradition my December article will not have a festive focus. Nothing to do with Covid or lockdown instead some travel news from France. By way of a petition against this decision I found out that on the 19 November 2020 Eurotunnel has changed the limit on the number of animals that may travel with them in certain circumstances. I personally have no idea what this limit was before this date but now there is a limit of five animals per person travelling for personal reasons. From the reaction of the petition I saw this would seem to be a reduction in the previous numbers.
Speaker of the Month Simon Tappin MA VetMB CertSAM
Biography Simon graduated from the University of Cambridge and after two years in practice under took a residency at the University of Bristol in Small Animal Medicine and Intensive Care, where he gained his European Diploma in Small Animal Medicine. He is currently head of internal medicine at Dick White Referrals where he sees cases in all areas of internal medicine. Simon had delivered 6 webinars for The Webinar Vet, all of which are very popular on the site!
Head over 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.”
Pippa Elliott BVMS MRCVS
The PAW Report PAWs for Thought: Barking Mad Treatment of Animals
As a nation, we have a reputation as being animal lovers. But this wasn’t always the case. Indeed, it was Queen Victoria (no slouch when it came to pet ownership) who once wrote, “The English are inclined to be more cruel to animals than some other civilized nations are”. But how can this be? Well, in a nutshell, times have changed since then… for the better.
Bringing us up to date is 3 December’s webinar Are the UK’s pets happy and healthy in 2020? (Link text to https://www. thewebinarvet.com/webinar/are-theuks-pets-healthy-and-happy-in-2020-10years-of-the-pdsa-animal-wellbeing-pawreport-1) This presentation reviews the 2020 PDSAs Animal Welfare report into the state of the nation’s pets. Last year’s survey revealed that 26% of owners were unaware of the ‘five freedoms’ or basic needs they are required to provide for their pets. With issues highlighted such as lack of vaccination and animal obesity, our welfare issues are different to those of the past, but every bit as important to keep front and centre of public awareness.
Animals as Servants Key to this conundrum is viewing animal ownership through the lens of history and the beliefs of the day. Before the 19th century, the prevailing attitude was animals were not sentient, and were part of creation put on earth to serve man. This was a get-out-of-jailfree card for the conscience of those people minded to do harm, since it was their right to do so. Also, many animals were working beasts whose purpose was to make life easier for us and were viewed with less sentimentality. Casual animal abuse was everywhere from the lady turning a blind eye to the emaciated carriage horse to those attending dog fights or baiting wild animals. Then there were ‘entertainments’ such as bear or bull baiting, cock stoning, dog fighting, and competitive ratting. Deliberate animal cruelty (repellent to many at the time) was so common as to be featured in art works, such as Hogarth’s “The Four Stages of Cruelty” which showed youths inserting an arrow into a dog’s anus… and worse. But in the awareness of such poor treatment lies hope. As Hogarth stated in notes (1751) for “The Four Stages of Cruelty”, he undertook the works “‘in the hopes of preventing in some degree that cruel treatment of poor Animals which makes the streets of London more disagreeable to the human mind…. the very describing of which gives pain.” This isn’t to say everyone was cruel, there were people who doted on their animals or sought to improve the lot of those around them. What was needed was a wholesale revolution in public attitude, such that cruelty was seen as barbaric and kindness as a sign of civilization. And this is what began to happen with the dawn of the 1800s.
An Awakening Conscience Things got off to a bumpy start. The first animal protection bill, put before the House of Commons in 1800, was to abolish the ‘sport’ of bull baiting. The attendance was poor, and those that did turn up poked fun at the bill, with a future Prime Minister defending bull baiting saying “the amusement inspired courage”, whilst the Times newspaper pronounced the bill as “beneath the dignity of Parliament.” In1821 a different bill was passed in parliament, to prevent improper treatment of cattle (but not as yet ban bull baiting). At around the same time, in 1822, the founding members of Society for the Prevention of Cruelty to Animals (SPCA) met in a London pub with the aim of creating “a revolution in manners”. Over the next ten years this movement gathered a head of steam as they set about lobbying for humane legislation, promoting prosecution of those guilty of cruelty, and generally raising awareness of welfare issues. The SPCA has tough fight on its hands. A Bill in 1824 to protect dogs and cats from cruelty was dismissed as “a petty trumpery kind of legislation”, with some regarding the SPCA’s activities as eccentric. But as the saying goes, it’s not what you know but who you know, and in 1840 Queen Victoria agreed to add her “Royal” patronage to SPCA, to become the RSPCA, giving valuable authority to the organization. (Oh, and here’s an interesting fact: The NSPCC, for the protection of children, was founded forty years after the RSPCA.) The war was being won with a shift in thinking that identified Englishness with an obligation to reject cruelty to animals. A new generation of children grew up with books specially written for them (an innovation) to educate youngsters on the importance of kindness to animals. “…to infuse benevolence …[by] teaching little ones early to consider every part of nature as endued with feeling”.
WEBINAR: SKIN CYTOLOGY A CASE ORIENTED APPROACH DR OTTO FISCHER (AUSTRIA) DR KURT SICK (AUSTRIA) DR CARMEN LORENTE-MÉNDEZ (SPAIN) David’s Review
WCVD9 Reviews This month’s webinar reviews are taken from the Practitioner section of the recent World Congress of Veterinary Dermatology 9. I have found them to be uniformly excellent and I am still only half way through. However as you know, by registering for the congress, and up until the end of the year, you have until April 2021 to get through them. So far I have particularly liked the ones you see here, and the lecture by Peter Hill on the diagnosis of atopic dermatitis. The whole programme is magnificent though.
Cytology has developed massively in dermatology cases in recent years yet many colleagues struggle to either get meaningful samples or interpret them. This session in the general practitioner section of WCVD9 is ideal to increase knowledge and confidence. The entire section lasts four hours and ten minutes –clearly too much in one bite, unless you are a massive fan of the subject and have great powers of concentration. However it is easily accessible in three segments. The first of these is by Dr. Kurt Sick, a pathologist of many years standing in Austria. His subject is: INTRODUCTION TO SKIN CYTOLOGY (Duration 33 minutes) He begins by citing some of the advantages of cytological examinations in dermatology including easy accessibility, good diagnostic value, quick results that are also cheap. This is followed by detailed advice on how to sample solid tissues, fluids, skin and mucous surfaces, employing either fine needle aspiration, impression smears, swabs, or skin scrapings. Various techniques of slide preparation are described with the aim of producing a monolayer on the slide surface. Systematic evaluation of the slide follows from low to high magnification. This evaluation defines the cell content, the quality of staining, usually DiffQuick, and the background. scrapings. Various techniques of slide preparation are described with the aim of producing a monolayer on the slide surface. Systematic evaluation of the slide follows from low to high magnification. This evaluation defines the cell content, the quality of staining, usually DiffQuick, and the background.
Low power microscopical evaluation, (here suggested as 20X), checks cells to see if they are inflammatory, tissue cells/neoplastic cells or a mixture. A higher magnification (40X, 60X, or 1000X) is required to examine individual cells, identify criteria of malignancy and identify organisms. Kurt has devised a checklist of seven questions that are suggested as an aid to evaluation of cells. After discussing these he gives a summary of the questions to conclude his presentation: - - - - - - -
Enough cells? Sample representative? Inflammatory/non-inflammatory/ mixed? Category of inflammatory cells? Category of tissue cells? Criteria of malignancy? Mixed process-neoplastic/inflamma tory?
Otto Fischer now takes over with his presentation: -
PART 2 SKIN CYTOLOGY –INFLAMMATORY LESIONS (56 minutes) I have known Otto as a friend and fellow lecturer on many ESAVS courses and I have listened to his lectures on cytology on numerous occasions. I never fail to learn something new each time. The following webinar is no exception and it is Otto at his best. I recommend that you watch this on your computer and take photos. Over the years Otto, and his cytologist colleague in the Vienna veterinary school Ilse Schwendenwein, have collaborated on a large number of cases and in the process amassed what I believe to be the largest collection of cytological material anywhere in the world. You will find the quality of the cytological slides to be superb without exception. Otto begins by asking the most important questions when dealing with the cytology of skin lesions. These are: -
- - - -
Inflammatory or neoplastic? (Differ ential diagnosis dysplastic) If inflammatory? Microorganisms? If dysplastic -neoplasia? If neoplastic? Malignant?
An algorithm summarises cytological interpretation of inflammatory lesions. This begins with ensuring an adequate cytological preparation, identification of cell type into inflammatory cells and tissue cells, with the possibility of a mixed population. This is followed by the first of a series of very good illustrations, particularly for those new to cytology. These include normal keratinocytes in all their forms, abnormal keratinocytes including keratohyalin granules, cocci and parakeratosis. Beautiful pictures of the important cell types and keys to easily recognise them demonstrate neutrophils, eosinophils, lymphocytes, plasma cells, macrophages, macrophage variantsepitheliod cells and giant cells. There are five categories of inflammation listed: - - - - -
Purulent inflammation-greater than 80% neutrophils Pyogranulomatous inflammation – mixed 50% neutrophils Pyogranulomatous inflammation greater than 50% macrophages Eosinophilic inflammation-greater than 10% eosinophils Lymphoplasmacytic inflammation – greater than 50% lymphocytes, plas ma cells
A detailed chart puts this information in a handy format with typical causes for each inflammatory pattern seen. Now you have a chance to try to diagnose cases armed with the self-confidence the preceding information is sure to have given you. Each case illustrates one of the categories of inflammation More tissue cells, notably acanthocytes, are shown and this gives an opportunity to distinguish non-degenerate neutrophils from
degenerate. From here we see very good examples of cocci, rods, and foreign body reactions to hair shafts in pododermatitis, among others. Also useful pictures of fungal spores, Leishmania organisms, and some plant based artifacts and a pollen grain. Nothing is missed out! In total there are more than a dozen clinical cases with high quality pictures supplemented with equally good cytological findings. The last case-a Persian cat will surprise you unless you are very experienced. PART 3-12 CASES (2 HOURS 40 MINUTES) Dr. Otto Fischer (A) Dr. Kurt Sick (A) Dr. Carmen Lorente-Méndez (E) We find Kurt and Otto together introducing this part in a lighthearted frame of mind inviting you to enjoy the collection of cases that they have put together. You certainly will! Carmen joins in later. My suggestion is to do three of four of these cases at a time. They are quite exceptional. Otto leads on this section but it is very much a double act. The first case sets the scene. The dog has an interesting name … ‘Escobar’ –I wonder if the owner was Colombian? ! You are given the history and clinical pictures, followed by cytological specimens. A great idea here was to video the way the pathologist examines the slide in a systematic way beginning with the 20x objective. We see the slide being scanned with salient features commented on at each level of magnification. This format is followed in all 12 cases. Instead of you being unable to ask questions the two experts constantly ask each other questions that you would have wanted to ask yourselves. And of course we arrive at a diagnosis with each case. Carmen Lorente-Méndez demonstrates cases 5, 6, 7 and 8. Carmen graduated from the veterinary college in Madrid in 1988 and in 2005 obtained a PhD from the same university. She is a diplomate of the
ECVD and has had a varied career including posts in academia. Currently she has her own referral clinic in Madrid and is also a consultant for Laboklin. There is an exotic case in this collection with a good cytological diagnosis-will you get it? With the last four cases we are back to the Austrian double act but with Kurt leading this time. It’s the same format throughout but it gets better and better. The double act works well with some nice soundbites such as ‘always do cytology first to be a happy vet’ and comments that epithelial cells like to clump together (no social distancing!) and little insides to the names of the pets. One of the cats is called ‘Herzi’ a very common name for pet cats in Austria and also for your other half-it means (my) little heart! This is a magnificent introduction to the cytological examination of mainly inflammatory lesions, with some neoplastic cases added where inflammatory conditions were high on the differential list. Take your time to go through it carefully –it’s inspirational. So where to go next after such an educational exercise? Obviously staying in the practitioner section I went for the lecture on superficial pyoderma by Doug DeBoer. Otto had remarked that atopy with secondary pyoderma is a ‘bread and butter’ case in primary practice and we had seen lots of bacteria, so for me it was a logical choice. Doug is Professor of Dermatology at the school of veterinary medicine of the university of Wisconsin-Madison, where he teaches 3rd and 4th year students. Recurrent pyoderma is one of the main research interests of his group. little insides to the names of the pets. One of the cats is called ‘Herzi’ a very common name for pet cats in Austria and also for your other half-it means (my) little heart! This is a magnificent introduction to the cytological examination of mainly inflammatory lesions, with some neoplastic cases added where inflammatory conditions were high on the differential list. Take your time to go through it carefully –it’s inspirational.
So where to go next after such an educational exercise? Obviously staying in the practitioner section I went for the lecture on superficial pyoderma by Doug DeBoer. Otto had remarked that atopy with secondary pyoderma is a ‘bread and butter’ case in primary practice and we had seen lots of bacteria, so for me it was a logical choice. Doug is Professor of Dermatology at the school of veterinary medicine of the university of Wisconsin-Madison, where he teaches 3rd and 4th year students. Recurrent pyoderma is one of the main research interests of his group.
STAPHYLOCOCCAL PYODERMA. AN
UPDATE ON DIAGNOSIS AND MANAGEMENT DOUGLAS J DEBOER DVM DIPLOMATE ACVD UNIVERSITY OF WISCONSIN-MADISON This lecture begins by noting that pyoderma is common in dogs, but less so in cats, and is usually secondary to some underlying condition. Secondary pyoderma often obscures the primary disease and therefore its treatment is a common first step in evaluating a patient. Staphylococcus pseudintermedius is the primary pathogen. It is a normal resident and therefore some cutaneous insult is necessary to induce infection that results in pyoderma. Eight underlying primary causes are listed. Doug defines pyodermas into superficial and deep along with the lesions typically seen. A very good and useful pictorial session follows, with some 14 or so illustrations of the variability of lesions that can be seen. Having made a clinical diagnosis of pyoderma confirmation with cytology is necessary. The next set of slides is very much complementary to the cytology lectures of the world congress reviewed above. In them you will find advice on where to take the sample, how to process it and how to interpret the slide. Further advice is given on when to adopt culture and susceptibility and how best to collect samples. The lecture moves on to the problem of antimicrobial resistance, with reference to MRSP and MRSA. The former has recently emerged as a major problem. If an organism is ‘methicillin resistant’ in the laboratory it will be clinically resistant to all penicillins and cephalosporins (and in some cases to other antibiotic classes). A sub-optimal response to antibiotic treatment should prompt a mandatory culture
and susceptibility testing. It is hazardous to guess at susceptibility. Two main reasons to culture are given: - Susceptibility-thus helping plan treatment - Speciation –thus identifying a human or canine strain and help with isolation precautions Recommendations are given for the isolation of the pet, hygiene in the clinic, owner education and the home environment For treatment we are advised –think topical first and a case illustrates the concept. This is a dog with multi-resistant MRSP, and you would not want to see a laboratory report such as the one seen. Some thoughts on how antimicrobial resistance develops are explored before describing topical therapy as primary treatment. Chlorhexidine is one of the mainstays with or without clotrimazole or miconazole. You may not know that both these kill staphylococci, even resistant strains, often in synergism with antibiotics or antiseptics. They also of course kill yeast. Deep pyodermas need antibiotics. A summary is given on recommended guidelines for their use by an international working group, and based on a publication in Veterinary dermatology**. Possible antimicrobials are classified in three tiers (tier 3 comprising ones that should not be used as they are reserved for difficult infections in humans.) The reasons for recurrence of pyoderma are based on the eight underlying causes mentioned at the beginning of the lecture, with allergy described as a very common cause. Finding the underlying cause and treating it is essential for prevention of recurrence. Maintenance topical therapy, for example with chlorhexidine twice weekly has a role in recurrence prevention, and in some countries staphylococcal bacterins are useful. Colleagues are strongly advised to avoid pulse therapy. The lecture ends with an important section on sanitation and public health considerations. After reviewing some relevant articles on the subject key sanitation measures are listed: - - - - - -
Hand washing and disinfection Wearing gloves when appropriate Protective clothing, frequent laundering Cleaning/disinfection of premises One room for dermatology cases Education of staff and owners
** Guidelines for the diagnosis and antimicrobial therapy of canine superficial bacterial folliculitis. (Antimicrobial guidelines working group of the International Society for Companion Animal Infectious Diseases) Andrew Hillier, David H Lloyd and others Vet Derm 2014 25 163-e43 This very valuable article is free to access.
WEBINAR: CLINICAL SIGNS AND DIAGNOSIS OF ATOPIC DERMATITIS PROFESSOR PETER HILL UNIVERSITY OF ADELAIDE SOUTH AUSTRALIA This is one of the many excellent lectures in the general practitioner programme of the online world congress of veterinary dermatology 9. Peter Hill is the most qualified of world status veterinary dermatologists. Not only has he studied in three continents, he has a PhD from the University of Edinburgh, and is a diplomate of the ACVD, ECVD, and the RCVS. I have listened to dozens of lectures on the diagnosis of atopic dermatitis in the dog, but this one stands out. It is superb and thoroughly recommended. The reasons for that endorsement is that the lecture is delivered in a measured and carefully thought out way. It also has numerous clinical pictures, testament to the busy small animal clinic in the Adelaide veterinary school. The webinar is teaching at its very best. The first slide summarises the approach, beginning with the history, physical examination, and then prioritisation of the differential diagnoses. This is followed by ruling out parasites and infection, before investigating food, contact and atopic dermatitis. Pretty standard stuff you might think but there is a lot more in this webinar and it is peppered with practical tips, based on extensive experience. For instance, the advisory board of veterinary dermatology board in Australia has designed a detailed form that can be emailed to clients prior to their appointment making history taking easier, particularly in a first opinion setting where consultation time may be less than in a referral clinic.
There is extensive and new information, gleaned from the Australian experience regarding lesion distribution in atopic dermatitis. Nine breeds commonly seen in the Adelaide clinic had lesion distribution mapped-showing some surprising, and often subtle differences. A more complicated line diagram lists all the common atopic sites with percentages, again in south Australia. Peter also refers to the similar European experience with articles by Wilhem, Koval and Favrot. This is followed by the diagnostic criteria for atopic dermatitis, of Favrot and others, very clearly summarised and indicating an 85% chance that a dog has atopic dermatitis. As you might hope, there is a wealth of clinical cases that highlight the physical and dermatological examination. Using a Westie as the example, we are taken through the most comprehensive gallery of atopic westies that I have ever seen in one publication. It starts with a normal looking, (but pruritic) dog, and the cases get increasingly worse ending with some true horror stories with severe excoriation and lichenification. Peter makes the very practical point that after a full evaluation, the treatment plan will be designed to push back these clinical signs to the lesion free dog and then aim to control inflammation. But this presentation is all about diagnosis and an important part follows. He begins with ruling out parasites from the differential diagnosis. One slide simplifies this-a colourful depiction of the various isoxazolines on offer! To be fair he mentions skin scrapings and hair plucks and shows a couple of slides of the inevitable mange cases that somehow get missed before referral. These will surely soon be a thing of the past I wonder?
There is a nice discussion of the microbiome of the skin and the effect of dysbiosis, beautifully illustrated and demonstrating how Staphylococci quickly become predominant in inflamed skin. The consequence of this is shown in a dog with superficial pyoderma, before and after treatment. The importance of cytological examination is emphasised with some pictures of microorganisms. This ought to be a taster for the session on cytology and it certainly was for me-and I will report on that next. Once infection has been ruled out we move on to a discussion of diet trials and then allergy testing. As others have said allergy testing is not always necessary unless immunotherapy has been decided on after a discussion with the owner. Otherwise there are excellent symptomatic treatments that are available, and these are listed, and of course are comprehensively discussed in other lectures in the general practitioner section. A succinct explanation of the principles of allergy testing comprises three slides followed by a discussion of allergy testing compared to IgE serology. Peter reports on interesting investigation that he authored comparing the correlation of these tests in two separate referral institutions- giving food for thought. We finish this lecture with an ingenious way of testing for contact allergy-not something I have seen before. In summary this is a great way to finally get to grips with the diagnosis of atopic dermatitis or as a revision for those who have nonetheless seen many cases. In this world congress there is more to come on this subject, including in the advanced
MANAGEMENT OF ACUTE OTITIS EXTERNA CRAIG GRIFFIN DVM DACVD ANIMAL DERMATOLOGY CLINIC CLINICAL PROFESSOR OF VETERINARY MEDICINE WESTERN UNIVERSITY OF HEALTH SCIENCES This is one of two lectures on the management of otitis externa, with the second one on chronic otitis externa, by Peter Hill. They form part of four lectures devoted to the subject in WCVD9. Peter kicks off with the approach and Craig follows up with pathogenesis. Both are strongly recommended before the clinical discussions that I will briefly review here. The goals of Craig Griffin’s presentation are as follows: - Recognise what is acute otitis and specifically how it compares to chronic otitis - Be familiar with early detection and recognition - Learn about the value of effective home ear cleaning - Understand the value of topical glucocorticoids - Be familiar with antimicrobial ingredients and therapy in the acute case. He begins by reviewing the literature on the definitions of acute and chronic, within the context of his lecture, with surprising differences. An alternative view to the standard published work is to divide acute otitis into truly acute, (AOtitis) -within days with no previous history, and now acute (NAotitis). There are subtle differences between the two and their likely underlying causes, which can be teased out by a careful history. Another comprehensive literature review defines the incidence of ear disease in various settings and emphasises the importance of the history and in particular whether owners regularly clean their dogs’ ears.
Otoscopic examination is now described and it is noted that many dogs with acute otitis actually start with signs of pruritus and look normal so here again the history is critical. The next most common sign is the development of mild erythema, and later once Malassezia overgrowth occurs excessive wax is produced. Moving on to treatment Craig emphasises the importance of cleaning ears. It is essential for a thorough examination, improves response to therapy and goes some way to preventing chronic disease, as it prevents drug inactivation by exudate, (especially polymixin and aminoglycosides). Across a whole range of predisposing causes of ear disease ear cleaning is considered important in the majority of cases. The techniques of ear cleaning and suitable agents are described. In the treatment of acute otitis two problems need to be dealt with. These are: - -
Overgrowth of organisms. This can often be managed with regular clean ing +/- antiseptics Inflammation. This is treated with topical steroid. These are described in detail and divided into high, moder ate and mild potency
The final part of this presentation describes antimicrobial therapy. Most acute (and recurrent) otitis cases will have Staphylococcus or Malassezia or both as main secondary pathogens. First line antibiotics are neomycin and polymixin. Antifungals are miconazole, clotrimazole or posaconazole. Antiseptics can be included but don’t forget that cleaners may be as effective. Long acting treatments are advised to get round compliance issues. The two products described, with ingredients and instructions for their use, are Claro (Bayer), effective for 30 days with one treatment and Osurnia (Elanco), effective for 45 days with two treatments a week apart. Finally there is a section on yeast therapy.
MANAGEMENT OF CHRONIC INFECTIONS IN DOGS PROFESSOR PETER HILL UNIVERSITY OF ADELAIDE
EAR
Peter defines chronic ear infections as those that don’t resolve following an appropriate course of eardrops, having illustrated a horrific case to begin proceedings. He follows up with a box full of otitis preparations, brought in by a referred client. that had failed to resolve the problem. I counted 19 different products in the box! He begins by emphasising that the two lectures on the approach and pathogenesis are best viewed before this presentation, although he reviews some of the salient points. He describes an initial ear infection with commensals-Staphylococcus pseudintermedius, Streptococcus canis and Malassezia pachydermatis. The next slide is a cytological specimen demonstrating the development of resistant Pseudomonas overgrowth. How could this have occurred? A series of excellent slides dramatically shows how prior treatment can lead to not only a multiresistant infection, but also organisms encased within a biofilm to make things infinitely worse. An otitis case is shown along with its laboratory report of multi-drug resistant Pseudomonas otitis media. A line diagram depicts the development of otitis media with otoscopic pictures and a CT scan of a typical case. So how do you deal with a resistant Pseudomonas? The answer is a seven-point plan outlined here, and which is used in the rest of this presentation. - Hit it hard first time - Don’t just try every ear drop on the list - Flush the ear canal out very thoroughly to remove bacteria - Remove/breakdown biofilms - Use adjuvants and antiseptics - Choose the right antibiotic - If otitis media is present it will need a middle ear flush
Suitable flushing solutions include normal saline, but a whole litre bag will be needed with some severe cases. Indispensable is a video-otoscope, and you will not need convincing once you have seen the superb videos that show exactly how to flush ears, get rid of biofilms and flush the middle ear. The pros and cons of antimicrobial culture are discussed before advice on selecting appropriate antimicrobials. We are, of course, spoilt for choice and eight very good products are shown, along with some compounded formulations. One of the main causes and risks of otitis developing is allergic dermatitis. Three illustrations depict typical cases and there is a summary of the management of allergic otitis. Another aspect discussed is the failure of the self-cleaning mechanism and subsequent development of cerumenoliths. Five ear cleaners are listed together with their
active ingredients, and this complements Craig Griffin’s presentation. The lecture ends with a couple of slides showing ear canal hyperplasia, fibrosis and narrowing. Very good before and after illustrations demonstrate that even seemingly intractable cases can be significantly improved with steroids prior to treating the otitis. The last slide shows a truly awful ‘end -stage’ otitis case. This sort of case is clearly one for the surgeons-total ear canal ablation and bulla osteotomy. It made me smile since years ago a common refrain from surgeons was ‘there is no medical treatment for otitis externa’. This excellent series of four hours of lectures on otitis externa in the practitioner section of WCVD9 is great value and along with the other four hours on cytology that I have also reviewed is bound to inspire, and tickets for WCVD9 are available until the end of the month. Don’t miss out -the lectures are world class!
From the Literature – December’20 I managed to drag myself away from the excellent 9th. World Congress of Veterinary Dermatology to have a look at other disciplines. The Veterinary Clinics of North America: Small Animals is guaranteed to be good value. There is always a main topic supported by in depth meticulously researched articles. The latest edition is devoted to gastroenterology. Even though its publication date is January 2021 it is available on line now. I looked at a couple of the articles
Acute Hemorrhagic Diarrhoea Syndrome in Dogs Stefan Unterer and Kathrin Busch Veterinary clinics of North America: Small Animal Practice Volume 51 Issue 1 2021 pages 79-92
Many colleagues will be familiar with this dramatic and unpleasant syndrome. AHDS is characterised by a sudden onset of severe bloody diarrhoea frequently associated with vomiting as a first clinical sign. Dramatic loss of fluid into the intestinal lumen leads to hypovolaemia, giving rise to clinical and laboratory findings. When if first saw this disease, within a few weeks of practice we used to call it haemorrhagic gastroenteritis (HGE). However it turns out that this is inaccurate because mucosal lesions are restricted to the small and large intestines.
The diagnosis is based on the typical clinical course and by ruling out other known causes of acute haemorrhagic diarrhoea. A full differential diagnosis list is included in the main article. In addition a positive polymerase chain reaction (PCR) for Clostridium perfringens encoding for the pore-forming toxin NetF supports the diagnosis of AHDS. The authors state that
there is strong evidence that clostridial overgrowth and toxin release may be responsible for the intestinal epithelial necrosis. In most cases clinical recovery occurs within 24-72 hours with fluid and symptomatic therapy. However, if not treated, mortality can be high (compared to 10% of hospitalised dogs). Life threatening conditions arise due to a combination of shock, sepsis from translocated intestinal bacteria, and from hypoproteinuria. A discussion follows on criteria for the use of antibiotics in this syndrome. There is some evidence that after an episode of AHDS there is an increased risk of the development of chronic diarrhoea later in life.
On another subject: -
Fecal Microbiotica Transplantation in Dogs Jennifer Chaitman and others Veterinary Clinics of North America: Small Animal Practice
examples of reduced hospitalisation times and time to cure in puppies with parvovirus infection. Another finding was that a single administration of FMT was superior to metronidazole in the treatment of acute enteritis.
Volume 51 Issue 1 January 2021 pages 219-233
FMT, an increasingly used treatment, has been successfully used for some time in the treatment of recurrent Clostridium difficile infections in people, and its benefits in other areas and organs are the subject of research currently. There are some reports of its use in dogs, and when administered by enema it seems to be beneficial in acute gastrointestinal disorders. There are also some
Whether this success in treating chronic gastrointestinal disorders is replicated lacks documentation, although there are case reports and small case studies that suggest that the technique may be beneficial in some instances. The authors note that there is a need for well-designed studies further investigating the benefits of FMT in dogs with intestinal dysbiosis in due to acute and chronic GI diseases and disorders of other organ systems. No doubt the considerable research currently being conducted in people will guide further research in dogs.
Puzzle Answers