The Webinar Gazette The Webinar vet
To provide: The highest quality vet-led content To be: The world’s largest online veterinary community
february 2021
To have: The planet’s most confident vets
WHAT’S INSIDE CPDer of the Month Jane’s Blog Speaker of the Month Pippa Talks David’s Reviews From the Literature
J
anuary has been a tricky month. It’s very difficult going back into lockdown but the scale of deaths is difficult to comprehend. As I write this, we are approaching 100,000 deaths! I spend a lot of time thinking and praying for grieving families. One of my wife’s friends lost her husband over the weekend. My heart goes out to the health workers who are at full stretch and also the teachers who are being dragged from pillar to post by our flippy-floppy PM. As a vet who knows a bit about infectious diseases, why mixing schools for 24 hours after the Christmas break before closing them seemed a good idea I will never know. I’ve decided, broadly, to ignore the news as much as I can and look to control what I can. Exercise is so
important and I am blessed to have the beach a 5 minute walk away. The Mind Matters symposium this year is looking at how exercise affects mental health. It is free to attend for everyone involved in the veterinary industry be they a pharma rep, kennel maid, veterinary nurse or retired vet. Please spread the news around your practice or group of friends. https://www.thewebinarvet.com/ pages/rcvs-mind-matters-initiativevirtual-congress-2021/
As you know, the 9th annual Webinar Vet virtual congress is taking place at the end of February from 22nd to 28th February. We started our virtual congress in 2013 when virtual congresses weren’t even a thing. We’ve led the way for many industries, not just the veterinary. It means we’ve had lots of practice and, as Tina Turner would say, it’s simply the best! https://vc2021.thewebinarvet.com
I’m aware that last year has been hard for everyone in the industry so I have made 6 hours free if you are a member of your local or international association. Tickets are also at the early bird rate until 7th February and you will get 20% of the ticket if you are a member of your association. We are also offering free tickets to vets in developing countries as part of our One4One initiative. We are also including a special stream for vet students to celebrate our acquisition of WikiVet. Many students are telling us how useful
WikiVet and Webinar Vet has been to them during lockdown so we are so pleased to have helped keep this free service for students and vets running. I’m really looking forward to seeing you at the premier virtual veterinary congress of 2021 and to help you get your Continuing education off to a flyer.
To your CPD success Anthony
E T O N Y E K S S RE G N O C L A U VIRT TS H G I L T O P S SPEAKER JULIAN NORTON Julian Norton is a British veterinary surgeon, writer and television host, best recognised for his appearances on The Yorkshire Vet, the Channel 5 TV series. In his talk, Julian discusses his life as a vet, the challenges he had during his student days and how he became the Yorkshire Vet.
CLAIRE LOMAS MBE Claire Lomas is a British paraplegic sportswoman, campaigner and fundraiser and is an inspiration to all. After a horse riding accident stole Claire of the active life she knew, she refused to accept the word ‘can’t’ and overcame adversity, turning her life around showing what can be achieved with the right attitude and approach to life, “Whether you believe you can or whether you believe you can’t - you are right”. Now travelling the world sharing her story to inspire others, Claire is revered for her speaking engagement, combining humour, motivation and powerful storytelling into her talk.
DR SHERIDAN SMITH Dr Sheridan founded Vet Tails in 2017 on board her sailboat SV Chuffed. Her mission is to provide free veterinary health care and welfare improvements to underserved regions of the world to a wide array of species, ranging from sea turtles to elephants, whilst providing inspiration and education to her audience. Sheridan’s talk will look at our relationship with self, and being kind to ourselves first, covering aspects of mindfulness, self-compassion and wellbeing. “How can we, as an industry, continue to provide better care for our patients while also caring for ourselves, our colleagues, our community, and our environment? A new future for veterinary medicine is within our reach, a future where work life balance, animal welfare and one health policies are no longer secondary to profit”
ARE YOU A MEMBER OF ONE OF THE FOLLOWING ASSOCIATIONS? IF SO, YOU ARE ENTITLED TO 6 HOURS OF FREE VIRTUAL CONGRESS 2021 CONTENT! ALL YOU HAVE TO DO IS SIGN UP HERE:
Associations - The World’s Largest Vet Congress - VC2021 - Virtual Congress 2021 (thewebinarvet.com)
Gain access to these incredible webinars:
Association of Charity Vets
Conference 2021 Online meeting
6 February 2021 Saturday 6 February 9am—5pm GMT followed by an evening social
Join us if you are a vet or nurse working directly for a charity, your practice provides services to shelters, you provide charitable help to patients or you are interested in pragmatic care. There will be workshops, discussion on hot topics, a What’s New session and a lecture in our popular “on a shoestring” series. For more details as they become available, and to subscribe to our mailing list visit: www.associationofcharityvets.org.uk #charityvets2021
Association of Charity Vets
Conference Programme 2021 Saturday 6 February 8:30 — 9am Arrival and registration 9 – 9:15am 9.15 — 10am
Welcome
Chair: Ian Futter
Lecture 1: Decision making in charity practice: Ethics on a shoestring Polly Taylor
10.15 — 11am
Lecture 2: Cardiology on a shoestring
11 — 11.30am
Coffee (voting for committee)
11.30 — 12.30pm
Workshops: Session 1 (choose one)
Malcolm Cobb
Get to know you chat groups
Feline heart murmurs (Aga Zoltowska)
The chronic coughing dog (Malcolm Cobb) Rachel Radwell Nursing Workshop Getting good thoracic images – No stress! (Ali Limentani) Research in shelter & charity practice part 3: data analysis (Jocelyn Toner, Lisa Morrow) Well-being: Our clients mental health (Rosie Allister)
1.45 — 2.30pm
Lunch and posters AGM for members What’s new in charity and shelter medicine?
2.45 -- 3.45pm
Workshops: Session 2
3.45 — 4:15pm 4.15 — 5pm
Tea break Lecture 3: Pragmatic Care of Wildlife
5pm
Poster prize presentation and social chat
12.30 — 1.15pm 1.15 — 1.45pm
Chair: Jocelyn Toner
(choose another from the list above)
Liam Reid
#charityvets2021 www.associationofcharityvets.org.uk
The Webinar Vet Advent Calendar 2020 Prize Winners! 2nd December - Win a Free Ticket to VC2021 and a Bottle of Bubbly! WINNER: Seán Killeen of Co Clare, Ireland 13th December - Win an F&M Luxury Christmas Hamper! WINNER: Ellen Harmer from Devon UK “I have to say after a pretty miserable start to this year, this makes for a very pleasant surprise this "Blue Monday". Who says today should be the most depressing day of the year?- not this year thanks to the Webinar Vet!!”
18th December - Win a Year’s Free Unlimited Membership with The Webinar Vet! WINNER: Sarah Grant
Congratulations to all of the winners from our 2020 Advent Calendar.
CPD’er of the month
This month’s CPDer of the month is
ELISABETH STEMMLER
who watched 126 webinars in the last year:
Always stay curious and never stop learning! Are you looking forward to any future webinars or events from The Webinar Vet? I´m looking forward to the Virtual Congress in February! I attended last year and it was fantastic! Did you attend any large events this month? If so, which? I attended the ECC Congress by Vets now. Fantastic experience!
T
Here you can find out more about me and my practice: www.kleintierpraxis-stemmler.de and Facebook: Elisabeth Kleintierpraxis Stemmler
his was a surprise indeed, to be the CPDer of the month from The Webinar Vet! I am a german vet in my own private small animal practice and have been ever curious to learn more in my profession and do it better! I am always interested in trying out new things and improving myself. So I became a member of The Webinar Vet! Thank you very much for the nomination and your kind support.” Which webinar did you enjoy the most? There are so many, I think I choose: “ Low flow anaesthesia” by Sarah Gibson What was the biggest take-home message you learned this month from our webinars?
Thank you very much! Greetings, Elisabeth
NEW FELINE HYPERTHYROID SUPPORT TOOLS FROM ANIMALCARE York – January 2021. Animalcare has partnered with RCVS Feline Specialist Dr Sarah Caney to provide new educational materials to help vets strengthen their management of feline hyperthyroidism cases. In a short 15-minute video, Dr Caney gives her advice on the key aspects of the medical management of these cases. She also introduces Thermacare®, the strongest oral solution of thiamazole available, launched by Animalcare in 2020. With 10 mg/ ml thiamazole, Thermacare® is double the concentration of the current liquid option, for the lowest dose volume available. Dr Caney has also worked with Animalcare to help produce an eye-catching clinic infographic. It includes practical tips on handling hyperthyroid cats in order to minimise stress, as low-stress handling is known to help benefit treatment outcomes. The infographic also contains tips for owners on transporting cats, gives advice to practices on how to make waiting rooms and consult rooms cat-friendly and suggests considerations for blood-sampling and therapeutic assistance.
James Beaumont, Brand Manager, says; ‘’Hyperthyroid cats can be challenging to treat and to handle. We hope the educational resources we have developed with Dr Caney will support practice teams in strengthening the management of these cases, ensuring higher welfare for affected cats and supporting the human-companion animal bond.”
Both the video and infographic, together with other helpful content, including a client leaflet and social media toolkit, are available to download free of charge from www.the-pac.co.uk
For stronger feline hyperthyroidism management in your practice, contact your local Animalcare representative via email animalcare@animalcare. co.uk or telephone 01904 487687.
ROYAL CANIN WEIGHT MANAGEMENT VIRTUAL CONGRESS
Being overweight puts our pets at risk of developing a number of health concerns. Studies reveal that excess weight is linked with a reduced life span in dogs1 and cats2. Obese cats may have their lifespan shortened by 1.9 years compared to cats with an ideal body condition score (BCS)2 and overweight dogs may live up to 2.5 years less than those at an ideal weight1 It’s vital that as an industry, we work together to ensure we battle this disease and help support owners in managing the weight and health of their pets throughout their life. The ROYAL CANINŽ WEIGHT MANAGEMENT range offers tailored nutritional solutions to support healthy weight and the management of cats and dogs with obesity and diabetes mellitus.
Start adopting and communicating healthy habits today by promoting a healthy weight for cats and dogs.
We would like to invite you to join us on Wednesday 24th February 2021 for the Royal CaninÂŽ Weight Management Virtual Congress. During this one-day event, we welcome a number of highly recognised speakers to discuss topics from prevention, risk factors, concurrent disease, how to talk about pet food and obesity, how to approach unconventional diets and pets with obesity and why tackling obesity makes business sense. There will also be an interactive, real-life case workshop to put your knowledge to practical use. Plus on-demand content will also be released during the event, focusing on the science of obesity, feline behaviour, obesity and osteoarthritis, approach to nutrients for obesity and the evolution of weight management diets. Scientific speakers from Royal Canin will also provide informative updates on our range of Weight Management diets. The event is equivalent to 1 full day of CPD, plus 10 further hours of on-demand content see below the full agenda for the event, you will be able to watch all of these webinars LIVE or as a recording after the live event.
GO TO WEBSITE 1 Salt C et al. Association between life span and body condition in neutered client-owned dogs. J Vet Intern Med 2018;1-11. 2Teng KT et al. Strong associations of 9-point body condition scoring with survival and life span in cats. J Feline Med Surg 2018;1-9.
Lindsay Calcraft : lindsay.calcraft@royalcanin.com | 07557087609
NEW YEAR NEW DOG
W
ell if 2020 can get any weirder then if you’re a regular follower of my blogs here to shock you. You’ve been with me through the Pekinese years. The dental issues, the eye enucleation, the mobility problems. Losing ebony last year just before lockdown was really hard. It was my first time living there as a pet in probably 15 years. However the 51 weeks I had with her however wonderful were mainly spent at the vets talking to the vet emailing the vets, you get the picture. While I didn’t consciously decide to look at another dog or another breed, my move to a bigger house and a few other things got me thinking.
access a decent area for an off lead run but 2 20 minute walks a day will keep them happy. Living there in Kent there are a number of retired greyhound groups and so it was before Christmas I found myself visiting one of these places.
And so it is clear what I’m going to say but I have a dog with a very big nose. His name is Joey, he’s three years old and he’s honestly the easiest dog I’ve ever rehomed. We had to do some cat work in the first week but he quickly learned that indoor cats can bop you on the nose. He’s been here around a month and I can tell you that all the things that people say about Clearly rescue centres were site homes is absolutely slightly harder to access true. The way to the heart and while I looked online is through their stomach, I I couldn’t see a dog that know only ever cook dinner necessarily was The One. with a greyhound head just Then I decided to take a little about my knee height. They bit of my own advice. Three genuinely do love to sleep, years living in London if he said to 35 minute walks families are working couples today and I’ve never seen a were looking to get a dog. more tired dog. He’s good I tell them about the great with people and he’s good pet that a retired greyhound with other dogs. While I may would make. Minimal have written before about grooming, you inherited turning into that single breed health problems, and loving dog owner it seems genuinely lazy dogs. Suited to there’s room in my heart for town life as long as you can dogs that can breathe.
Jane’s Blog
2020 was maybe a difficult year in many ways for many of us but it’s brought me Joey and I couldn’t be happier.
Speaker of the Month Richard Jackson
Richard Jackson grew up on a turkey farm and had a keen interest in breeding and showing rare breeds of chickens and ducks. He graduated from Glasgow Vet School in 2010 and has worked at St. David’s poultry team ever since. He became the clinical director in 2013. Richard has run a number of training courses and given several webinars on both management and diseases of backyard poultry.
Use discount code
“SOTMFebruary”
for 50% off any of Richard’s webinars!
THE ENDOCANNABINOID SYSTEM (ECS) Dr. Dave Tittle BVetMed CertVA GPCert(WVA&CPM) MRCVS RCVS Advanced Practitioner in Veterinary Anaesthesia
The ECS is understood to be the largest and oldest receptor system in animals, working synergistically with other body systems. Cannabinoid receptors are found throughout the body, especially the peripheral (PNS) and central nervous system (CNS). The ECS encompasses a series of mediators, receptors and enzymes; their autocrine, paracrine, neurological and neuromuscular activity regulates numerous homeostatic functions including inflammation, perception of pain, sleep, appetite, emotions and immune response.
post-synaptic enzyme MGL, remove endocannabinoids from the synaptic cleft, allowing cellular uptake.
Following a noxious stimulus, inflammatory mediators (histamine, prostaglandins, cytokines etc) are released, generating an action potential along the afferent neuron. Excitatory neurotransmitters (e.g. glutamate) are released at the pre-synaptic neuron and bind at the post-synaptic neuron, continuing the action potential towards the CNS. Endocannabinoids (anandamide and AG-2) are released at the post-synaptic neuron, which bind pre-synaptically to CB1 receptors. This activation of CB1 receptors inhibits further release of neurotransmitters, suppressing neuronal excitability. Pre-synaptic enzymes, FAAH and NAAA and
The Entourage Effect
The Inflammatory Response Anandamide targets macrophages and mast cells, acting as an autocrine-paracrine mediator to limit cytokine release. It is known to inhibit TNFα production, which in turn modulates the inflammatory response. As cannabinoids inhibit motility and secretion in the intestine, there is evidence that molecules targeting the ECS could be utilised in the management of inflammatory bowel disease.
Likened to ‘multi-modal analgesia’ it is the utilisation of a number of molecules working synergistically. Terpenes are a group of pharmacologically active lipophilic plant chemicals, which potentiates the effect of the phytocannabinoids (cannabinoids derived from plants) and interact readily with cell membranes and various receptors. When selecting a hemp-based product, it is important to consider one which is full spectrum rather than a CBD isolate. Also consider the benefits of a terpene profile, which offers benefits akin to multi-modal therapy.
Modulation in the Synaptic Cleft
The Pain Pathway From the source of stimulus to the perception of pain involves five defined steps namely, TRANSDUCTION, CONDUCTION, TRANSMISSION, MODULATION AND PERCEPTION. Commonly used pharmaceuticals act at various points.
Modulation of the intensity and duration of the stimulus occurs by several mediators and receptors. A dysregulation in the Descending Pain Pathway is considered to be associated with the development of a chronic pain state; cannabinoids may protect against this.
Modulation of Somatic Pain
As described, antagonism of CBD receptors by endocannabinoids results in hyperpolarisation of the neuron, which diffuses the stimulus affecting transduction. Endocannabinoids released by immune (macrophages and mast) cells stop the release of inflammatory cytokines. CBDA also inhibits COX-1 and COX-2, enhancing anti-inflammatory properties; the anti-inflammatory effects of terpene compounds further amplify the benefit. Transmission of the stimulus at the level of the spinal cord via the dorsal root ganglion is again influenced by the ECS. Cannabinoids have a role here, binding to CB1 receptors on the pre-synaptic neuron and suppressing excitation. By ‘flooding’ synaptic clefts with phytocannabinoids, we are able to block CB1 receptors on the pre-synaptic neuron, suppressing neuronal excitability and decreasing the release of neurotransmitters. Simultaneously, pre- and post- synaptic enzymes begin hydrolysing endocannabinoids. As phytocannabinoids are similar molecules, these enzymes become overwhelmed by the amount of substrate to break down.
Perception by the brain follows translation of the signal into ‘pain’. Once this has occurred, little can be done at this point to modulate it. Although THC may have a role at this level, discussion of this is out with the scope of this article.
Clinical Applications There are some published and ongoing studies with compelling evidence coming to light, regarding the utilisation of hemp-based products as adjuncts in the treatment of osteoarthritis, neuropathic pain, dermatitis, oncology and quality of life, anxiety and seizure treatment. WEBINAR
Practical tips for clinical application of hemp CBD+CBDA extract
Dave Tittle BVetMed CertVA GPCert(WVA&CPM) MRCVS is an RCVS Advanced Practitioner in Veterinary Anaesthesia and is in clinical practice in Devon. He sits on the International Advisory Panel for ElleVet Sciences in the US and provides a consultancy service to ElleVance Sciences in the UK.
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SOURCING QUALITY VETERINARY PRODUCTS
NationWide Laboratories proudly presents a FREE CPD webinar
– 3rd March 2021 at 12:30pm • LUNCHTIME BASIC BITESIZE PATHOLOGY. • SMALL ANIMAL MAMMARY PATHOLOGY. By Sandra Dawson BSc BVMS FRCPath MRCVS Mammary neoplasia is very common in dogs and cats. The diagnosis is confirmed by histopathology and is important for determining treatment and prognosis. In this session, we will look at how to approach diagnosing mammary masses using cytology and histology and what to expect from your pathology report. We will speak about classification and the use of grading for mammary tumours in dogs and cats, as well as discussing some of the more recent helpful prognostic indicators. We will also touch upon mammary tumours in small mammals. So, grab a cuppa and join us this lunchtime! Sandra is a graduate of Aberdeen and Glasgow Universities, gaining a BSc in agriculture with honours in animal science in 1991 and her veterinary degree in 1995. She moved from working in mixed practice in 1997 to take up a residency in veterinary pathology at Edinburgh University, later lecturing in reproductive pathology. After 5 years in the industry, where she gained her FRCPath, Sandra joined Nationwide Laboratories in May 2006. In 2011 Sandra was appointed to the Royal College of Pathologists board of examiners in the speciality of small domestic animals. She enjoys teaching and mentoring and is an active STEM ambassador. Sandra works with surgical biopsies and fine-needle aspirates. She can advise on all aspects of histopathology in a wide range of species.
NationWide Laboratories is committed to making a positive impact on animal health by offering innovative products, technology and laboratory services to your veterinary practice. We have been providing a comprehensive range of veterinary diagnostic services since 1983 for companion, farm and exotic animals.
For more information contact us at info@nwlabs.co.uk and follow us on LinkedIn and Twitter.
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
A Tudor Queen’s Link to ECGs
The Shocking Story of ECGs “Conquer your fear of ECGs” is the title of Kieran Borgeat’s webinar on February 4th. ECGs are a bit like wallpaper, part of the ‘furniture’ but not always valued. As a Trivia Queen, this set me pondering about how and when ECGs were developed Now here’s a surprise …the idea of measuring the body’s electrical activity goes back centuries; a hair-raising fact which involved some shocking experiments.
In our house we have a ritual. When we The first piece of ECG trivia is that Queen Elizabeth I’s physician, William Gilbert, was fascinated by what we know as static electricity. He introduced the term “electra” (from an ancient Greek word for amber) to describe the charge held on an insulator. Why did Gilbert choose amber and hence why this force became known as ‘electricity’? Well, from ancient times it had been observed that rubbing amber resulted in an invisible force which could lift small objects.
Of “Threads, Pores, and Animal Spirits” In the 17th century, around the time of the English Civil War, the French Philosopher Rene Descartes had theories of how the human body functioned. He postulated that a series
of “threads, pores, passages, and animal spirits’’ were responsible for muscular activity and bodily functions. He kept his ideas quiet mainly because other radical thinkers, such as Galileo, were liable to persecution at the time.
Frogs’ Legs and Thunderstorms Jump forward a century to 1786 and Luigi Galvani’s interest in ‘animal electricity’. He experimented with frogs’ legs suspended by a copper hook onto iron railings, and observed the former twitch during lightning storms. Later, he showed that stimulating a frog’s heart with electricity could cause it to contract.
Raising the Dead The first recorded use of electricity for resuscitation dates back to Charles Kite in the 1780s. This early attempt at defibrillation seems to succeed at raising the dead, when an hour of attempts with tobacco, artificial respiration, and frictions had failed. “Electricity was then applied, and shocks sent through in every possible direction; the muscles through which the fluid [electricity] passed were thrown into strong contractions.” Kite concluded that electricity was a useful tool to determine whether a person was truly dead or not!
Moving from Cause to Effect As knowledge grew of the role of electricity in bodily function, so people sought a means of measuring it. Enter the “mercury capillary electrometer” in 1873. This device consisted of mercury in a fine glass tube which was placed vertically in sulfuric acid. This was connected to two electrodes placed at two points on the body. The mercury
expanded and contracted depending on the potential difference between them. Moving on apace, in 1887 at St Mary’s Hospital, London came the first measurements taken from the electrical activity of the human heart. This provided two deflections, which were labelled as V1 and V2. This work was followed in 1888 by readings from a dog, cat, rabbit, and horse. Eventually, the term electro-cardiogrammen was coined by Willem Einthoven, a Dutch physician, in 1893.
ABCDE or PQRST? The ECG wave form might have been called ABCDE, were it not for a mathematical convention, dating back to Descartes, dictating that letters from the second half of the alphabet were used. With the letter ‘N’ already assigned another meaning, and ‘0’ used to mark timelines, this made ‘P’ the next logical choice for naming these new waves. With the weight of history behind the ECG, don’t let this invaluable tool blend into the background. Take up Kieran’s offer to overcome your fears and get up-to-date with ECGs.
WEBINAR MANAGING EQUINE DENTAL FRACTURES DR SAM LUIS HOLE BSc (HONS) Cert AVP (EP) Dip EVDC (EQUINE) BAEDT MRCVS RCVS & EBVS EUROPEAN VETERINARY SPECIALIST IN EQUINE DENTISTRY RCVS ADVANCED PRACTITIONER IN EQUINE DENTISTRY AND EQUINE PRACTICE VETERINARY SURGEON & CLINICAL DIRECTOR POOL HOUSE EQUINE CLINIC STAFFORDSHIRE UK
David’s Review
Sam is incredibly well qualified to give this veterinary webinar on the subject of equine dental fractures. A glance at his extensive CV includes, as you can see from above, two undergraduate degrees, two postgraduate veterinary certificates, and the prestigious Dip ECVD-only a few colleagues in the UK have this. What follows is a tour de force. It will mainly interest 100% equine practitioners, or any other colleague regularly seeing horses as part of their normal workload. It is extensively and very well researched with numerous articles cited. This will prove invaluable for vets undergoing certificate and diploma training.
F
ractured teeth are commonly encountered in equine practice. In spite of this only a small percentage of horses with fractured teeth show clinical signs., and in one study 39% were asymptomatic. Nevertheless another study found fractures to be the cause of 20% of apically infected mandibular cheek teeth. Clinical signs may include: • Pain • Masticatory problems (dysmastication/quidding) • Weight loss • Bitting problems and behavioural problems • Halitosis • Periodontal disease • Facial swelling • Pyrexia Teeth may be fractured due to trauma, dental disease, or iatrogenically, and can be described in this way (references are given in the literature for each of these.) Fractured teeth can also be described by the dental tissue and anatomy involved. A table established by the American
Veterinary Dental College (AVDC) to classify dental fractures is illustrated followed by an interesting and extensive literature review into the prevalence of equine dental fractures, which shows quite a variance over the years. One article caught my attention, citing an incidence of 0.71% in German Cavalry Horses published in 1945 by Becker. I mean to follow this one up! These preliminary observations are now followed up by a great deal of information on prevalence for all teeth. Included are incisor and canine crown fractures, CT fractures, maxillary CT, and mandibular 08s and 09s. Previously fractured teeth with no known history of trauma have been classified as idiopathic fractures. These are usually a consequence of dental disease, such as infundibular caries, infundibular hypoplasia, peripheral caries and pulp necrosis. However more descriptive terminology is needed. Idiopathic equine CT fractures include: • Midline sagittal fractures • Lateral slab fractures • Medial slab fractures.
ust to illustrate again how meticulously this presentation has been put together there is a list of more than a dozen publications citing the prevalence of midline sagittal fractures, with the observation that 100% of cases result in apical infection. More detail follows on lateral slab and medial slab fractures. The final part of this detailed review deals with fissure fractures.
We move on to extraction, which is the therapy of choice for the majority of acute or chronic apically infected cheek teeth. A list of no less than 8 possible techniques is given, with supporting articles for each one from the literature. This is followed by high quality illustrations of these techniques.
Sam continues this webinar with the diagnosis, which follows a standard approach -history, clinical signs, clinical examination, full oral examination (includes suggestions on sedation, lighting and equipment), and additional imaging with endoscopy, radiography and computer tomography. We are reminded that a lack of clinical signs does not equate to endodontic health and there is a sizable section on sequelae listing 21 possible.
• All treatments have advantages
Sam summarises management strategies by stating that; • Disadvantages • Associated complications –seven are listed • Insurance considerations • Careful counselling of owners on costs, risks and likely outcome
The amazing amount of detail in the preceding part of this webinar (Sam did warn about this!), is a necessary prelude for a better understanding of management strategies. In outline these are: -
The final section discusses prevention using restorative materials, and as always any statement is backed up by full reference to the literature, noting that further peer-reviewed research is required to validate techniques.
• Conservative treatment and monitoring
Sam concludes with his take home messages: -
• Extraction (exodontia), either oral/simple/open or surgical/complicated/closed
1. Lack of clinical signs does not equate with endodontic health
• Tooth preserving techniques (restorative and endodontic techniques) and monitoring.
2. Most, if not all fractures have dentin-pulp complex involvement
Any fractured teeth should be left in situ if there is any concern regarding associated supporting bone fractures. Tooth removal can take place once osseous healing has occurred.
3. Maxillary CT commonly suffer pathological fracture –especially Triadan 09s
Conservative management includes antiinflammatory and antibacterial medication, splinting, management of any associated malocclusions, dietary modification and a maximum period of 3 months to monitor for sequelae. Extraction is indicated if there is no resolution of clinical signs or evidence of apical/periapical infection. We are warned about costs, technical challenges and risks associated with extraction. All teeth with complicated fractures require either extraction or an attempted tooth preservation technique.
4. With midline sagittal fractures 100% will get apical/periapical infection, and in Sam’s opinion most other types of dental fractures will also suffer from these infections. An extraordinary amount of meticulous work has gone into the preparation of this brilliant webinar and allied to the training and experience of the author it is difficult to imagine that you will find a better account of the subject. Baileys Horse Feeds generously sponsored the webinar.
WEBINAR VETERINARY CARE IN THE FACE OF COVID-19: IS CANCER AN EMERGENCY? CLARE KNOTTENBELT BVSc MSc DSAM MRCVS RCVS specialist in small animal medicine
T
his veterinary webinar is one of a series sponsored by Virtual Veterinary Specialists. They aim to help colleagues in practice grappling with the stringencies imposed by Covid 9, specifically involving decision making as to what constitutes an emergency and what can reasonably be done.
and which cases to prioritise. Advice from Virtual Veterinary Specialists is suggested as a resource and Clare is the oncology adviser for the group. The current situation we find ourselves in is likely to add delay as a major limiting factor and the impact of this is discussed with strategies to deal with it.
Clare graduated from Bristol in 1994 and after a year in mixed practice she embarked on specialist training in small animal medicine at the Dick Vet. In 1999 she obtained the RCVS diploma (DSAM) and then joined the Glasgow school, initially as a clinician, before ascending the ranks of academia to be awarded a personal chair in 2010. At the same time she worked in the oncology service for 11 years. She decided to leave the security of academia to set up an advisory service for our profession, (Hawk and Dove), in oncology but also in veterinary welfare generally. She has also achieved ‘One of Many Certified Women’s Coach’ status in addition to her veterinary qualifications, and is in my view ideally placed to deliver this presentation.
13 major tumours seen in practice are now summarised. These are: -
She begins with some general comments on the incidence of cancer in UK pets. For example 1 in 3 dogs will develop cancer and of those dogs older than 10 years 47% will die of the disease. We are reminded of general advice as to whether owners are allowed to travel to the vet. General considerations are outlined too as to whether cancer is an emergency. There is a list of 11 obvious oncological emergencies, and many of these have a poor prognosis. Further general observations follow such as potential risks to colleagues and clients, whether any sort of surgery can be offered, whether working in separate teams is possible,
• Oral melanomas in dogs
• Splenic hemangiosarcomas in dogs • Mast cell tumours in dogs • Sarcomas in dogs • Feline injection site sarcoma • Lymphoma in dogs • Lymphoma in cats • Osteosarcoma in dogs • Mammary carcinomas • Urothelial carcinoma in dogs (previously transitional cell carcinoma) • Anal sac carcinomas in dogs
• Rectal polyps/carcinomas in dogs • Nasal tumours Each one of these gets a slide or two of basic information, which will be very useful when discussing options with owners. Taking just one example-that of osteosarcoma in dogs. We are advised: • Chest radiography should be done at the same time as bone radiography • Amputation provides the best pain relief and approximately 6 months survival. Due
to the pain from the bone cancer the dog will often be walking on three legs, which gives a good assessment of how well the dog will be able to walk post-operatively • The procedure is well tolerated with minimal postoperative follow up. • Chest metastasis will be inevitable but euthanasia is best advised according to quality of life assessments, and not the radiographic appearance. There is an incredible amount of information in the webinar and each tumour could easily occupy an hour of Clare’s time and more. She manages somehow to cover the absolute essentials in one hour before her last two summary slides. The first of these lists the BVA guidelines for remote consultations and those requiring a physical examination. The final slide is a list of what constitutes a potential oncological emergency based on Clare’s personal experience. Taken together with the previous concise information throughout the webinar it should make decision-making in potentially trying circumstances very much easier. And don’t forget if you find yourself facing despair trying to juggle too many conflicting issues Clare is there for you* and you are certainly not alone. * www.hawkandovevets.co.uk
WEBINAR REPTILE EMERGENCIES DR. LOUISE ABUZET BVM&S Cert AVP (ZOOMED) Cert AVP (ECC) BSc (Hons) MRCVS
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his is a veterinary webinar that contains something for everyone whether you see a lot of reptiles, a few or even like me none! There is a huge amount of clinical information presented in a no nonsense way. Louise has obviously benefited from a great deal of clinical exposure evidenced by the number of case illustrations from her own material. She starts as she means to go on with general common sense advice on reptile emergencies. Many will have underlying Metabolic Bone Disease, often due to poor husbandry, and it is important to consider not just the emergency but likely underlying factors. Also reptiles do things slowly, whether it is getting ill, dying, or getting better, and therefore owner commitment and financial concerns need discussing from the outset. The next session covers history taking and physical examination. We are advised not to panic, but instead complete the investigations much as we would do with dogs or cats. Even auscultation is possible in chelonians by putting a wet gauze over the shell to increase contact with the stethoscope., and a Doppler is very useful. There are tips on how to access heart sounds in chelonians, lizards and snakes, and even on body palpation. Analgesia is important in emergency situations. There is very little information on efficacy and most, if not all, agents are off-license. Louise summarises information on the drugs most commonly used, and
continues with the basics of fluid therapy, mostly with Hartmann’s, (an astonishing nine possible routes) and not forgetting the benefits of soaking. There are two important sections on anaesthesia and euthanasia, and even a discussion of CPR. Here there is a lot of practical information for various species and I was amazed that CPR can be applied to a tortoise-you will have to watch the webinar to find out how to do this! The second part of this webinar covers common emergencies and is liberally illustrated throughout with some, at times fairly gruesome examples, particularly the shell injuries. First up are respiratory emergencies, with advice on investigation and a list of seven procedures for treatment. All the emergencies are dealt with similarly, with clinical pictures, advice on how to approach them and how to treat them. Apart from respiratory emergencies the other emergencies discussed are: • Corneal injuries • Spectacle injuries • Bites, trauma and shell damage • Burns (particularly a snake problem) • Cloacal prolapses • Dystocia and Follicular stasis For such a young colleague I was intrigued to find out how she has already accumulated such a wealth of experience by taking a look at her CV. She completed an integrated BSc at Liverpool University in Veterinary Conservation Medicine before moving north to the Dick Vet to complete her veterinary degree in 2011. She worked in a busy first opinion practice in Southend for four and a half years, where in addition to first opinion and emergency work she set up and ran an exotic animal service. Subsequently she moved north
again, to Manchester, working in a busy 24-hour emergency hospital and completed not one but two CertAVP certificates by 2017(in Zoological Medicine and Emergency and Critical Care.) Louise now works at Vets Now Referral Hospital Manchester as part of the ECC and OOH team, seeing a huge range of small animal and exotic animal cases. With just under 10 years experience she is already an RCVS Recognised Advanced Practitioner. Great things undoubtedly lie ahead for her and I hope further webinars will follow. This one is highly recommended and as Bruce Stevenson, the chair on the live session commented-‘absolutely fascinating.’ I think you will agree.
WEBINAR WHY DO OUR PATIENTS GO BLIND? ACUTE BLINDNESS IN DOGS
RON OFRI DVM PhD DECVO KORET SCHOOL OF VETERINARY MEDICINE HEBREW UNIVERSITY OF JERUSALEM ISRAEL
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his is the most recent veterinary webinar from Ron Ofri on ophthalmological themes with more to come later this year. The topics are always very clearly explained with great illustrations and this presentation maintains the very high standards that have been set previously. Ron begins by emphasising the importance of the history and physical examination with three important questions. • Is the onset of blindness sudden or gradual? This helps distinguish acquired from inherited causes. • Preferential loss of night vision? • Is the dog healthy? Looking for signs of neurological disease, and signs of systemic disease Several subcortical reflexes are outlined. These are the pupillary light reflex (PLR) and the dazzle reflex. Surprisingly, if you are new to the discipline, or revising, in an animal with cortical blindness the PLR and dazzle reflex will be normal. Also minimal stimulation can still elicit these reflexes, in animals with advanced cataracts and inherited retinal degeneration for example. The physiology for this is explained with a simplified line diagram of optic nerve pathways. This ‘simple guy’s approach’ continues with a table contrasting normal and abnormal ophthalmological examinations with expected PLR response.
The next part of this webinar examines how to localise the lesion, according to the preceding table, with the first question ‘Can light reach the retina?’ Problems such as blepharospasm, corneal oedema, hypopyon/hyphema/ cataracts and various opacities are summarised. The second question asks if the retina is normal looking? Here progressive retinal atrophy (PRA), also known as outer retinal degeneration, and chorioretinitis are discussed. Depending on the examination and PLR findings further conditions may be suggested and confirmed. Included are glaucoma, retinal detachment, proximal optic neuritis, diseases of the distal optic nerve, chiasm or proximal tract, and the condition known as SARDS. This is described in some detail at the end of the webinar. Finally there is a comprehensive list of congenital lesions, metabolic causes, infectious causes, inflammatory CNS diseases, toxins, (e.g. lead) and finally forebrain disease (refer to neurology if you can!) The remaining section of the webinar looks at acquired retinal diseases. • Retinal haemorrhage • Retinal inflammation • Retinal detachment • SARDS
This is an exceptionally good section crammed full of world-class illustrations. The first of these, retinal haemorrhage is a clinical sign, not a diagnosis. The underlying diseases that could account for the sign are listed and reference is made to a recent article from Cornell University, which demonstrated that diabetes, systemic hypertension, hypothyroidism, chronic renal disease and a few cases of Cushing’s disease and multiple myeloma accounted for 50 of 83 dogs. Beautiful retinal pictures of haemorrhage due to thrombocytopenia, hypertension and trauma continue, followed by suggestions for investigation and treatment. Next is retinal inflammation containing information on anterior uveitis (which has numerous causes) and posterior uveitis (which is mostly infectious). The numerous causes of anterior uveitis are tabulatedgetting on for 70! This is made less arduous by citing the most recent academic articles evaluating the condition retrospectively. Causes of feline uveitis are also listed –a more manageable 22 with just four considered leading causes. These are FIV, FeLV, FIP, and toxoplasmosis. In some parts of the world fungi are important. A series of fundus photographs illustrate inflammatory signs before considering treatment. Retinal detachment is a separation between the sensory retina and the retinal pigment epithelium (RPE) and
underlying choroid. The retina usually remains attached at the ora serrata and optic nerve head. A histology slide demonstrates this very well, and I was amazed that an ultrasound image produced an almost identical picture. The pathogenesis can include serous detachment, traction detachment and rhegmatogenous detachment. These are all clearly explained and the latter is the most common. Retinal detachment usually results in a blind eye developing acutely. A series of tests and results of ophthalmological examinations takes you through the diagnostic process. An extraordinary picture shows a detached retina moved up against the lens. The retinal vessels can be clearly seen without the need of an ophthalmoscope. Some aspects of treatment follow before moving on to the detailed description of SARDS I mentioned earlier. SARDS is the condition known as Sudden Acquired Retinal Degeneration Syndrome. It results in acute blindness with negative electroretinography, but initially with a normal looking fundus. The pupils may respond slowly to white light, but no response to red and responsiveness to blue light, (using specialised equipment.) It is a condition of older dogs (mean age 7-10 years) of which 60-90 % are female. It is most common in mixed breed dogs and small breeds. There is often weight gain, lethargy, polydipsia, polyuria, and polyphagia. These
signs may precede blindness or occur simultaneously. Curiously polyphagia may increase in severity with other signs decreasing or disappearing completely. Some of these signs suggest Cushing’s disease with similar haematological abnormalities but only 20% of dogs are diagnosed with Cushings, with only 2 SARDS cases reported in dogs with pre-existing Cushing’s. It has been suggested that the condition resembles autoimmune retinopathy in people and this condition is outlined. Currently there are no peer-reviewed studies indicating a definitive cause in dogs. It is possible to find purported ‘cures’ on line but Ron cites two recent articles that state categorically that • There are currently no proven safe and effective treatments available for dogs with SARDS (Oh et al, 2019) • It is generally believed that vision loss with SARDs is permanent and that there is no treatment that can prevent or reverse SARDs related blindness (Komaromy et al, 2018) I thoroughly recommend this webinar for its clarity and inspiration. I can imagine a whole generation of young colleagues interested in specializing in ophthalmology after watching Ron Ofri’s contributions. As I mentioned at the beginning more to come this year, including sudden blindness in cats. Worth waiting for!
From the Literature – February’21 I hope many of you will have registered for the excellent WCVD9 and I am about a third of the way through the lectures at the moment. But there is still plenty of dermatological information elsewhere and the best go-to for this is Veterinary Dermatology. The December 2020 edition has some interesting research articles plus 5 case reports. Several of these are in exotics. Successful treatment of Ophionyssus natricus with afoxolaner in two Burmese pythons (Python molurus bivittatus)
Braulio A Fuantos Gámez and others Veterinary Dermatology 2020 31 496-497
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natricus (the snake mite) is a common cause of parasitic dermatitis in captive snakes, where it may be found under scales and around the nostrils, infraorbital cavities and eyes. Relatively little evidence is available regarding treatment options for this mite. Pyrethrins and pyrethroids have been used for treatment of mites in reptiles. However both drugs have the disadvantage of needing to be removed by aggressive rinsing in order to avoid systemic absorption and toxicity. Other insecticides either include a risk of toxicity or need repeat applications with insecticidal treatment of the enclosure also being necessary.
adverse effects. Environmental samples collected from the snakes’ terrariums were negative for dead mites by day 30.
In this study a single oral dose of afoxolaner at 2mg/kg eliminated live mites from the skin of two Burmese pythons beginning on day 3 of evaluation, demonstrating rapid kill. Both snakes remained negative for live mites through to day 30 without
I was quite amazed by the case report of grass allergy in an African spur-thighed tortoise.
There are some good pictures of the infected snakes and the mite. This is a very well written and interesting account, whether you are into snakes or not, from seven Mexican colleagues. Six of them are in private practice with the remaining one in academia in Mexico City. Mexican veterinary dermatologists are amongst the most active in Latin America and frequently publish in Veterinary Dermatology.
Orchard grass allergy in an African spur-thighed tortoise (Centrochelys sulcata) confirmed via intradermal allergen testing and provocative testing Brittany Liguori and others Veterinary Dermatology 2020 31 491-492
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ey to the diagnosis of grass allergy in this excellent case report was the clinical appearance of the eyes on challenge with orchard grass hay following resolution of the signs after removing the tortoise from contact with the hay. In addition there were positive reactions to intradermal testing with Orchard grass and Timothy grass, with exacerbation of the clinical signs during the testing procedure. There are some very good clinical illustrations of the eye lesions (chemosis/hyperaemia/ and protrusion of the nictitating membrane.) Also illustrated are the positive intradermal reactions. I was not aware that reptiles do not possess IgE and there is an interesting summary of reptile immunology and its differing characteristics from mammal immunology. Reptiles have IgD, IgA, IgM and IgY. Multiple IgY subclasses with different expression patterns have been described in snakes, and it is thought that in reptiles the IgY subclass may potentially serve a function similar to IgE in mammals. This is the first case describing an allergic reaction in a tortoise confirmed by intradermal testing and provocative exposure. It supports the potential presence of IgE- like reactions in reptiles as previously hypothesised in birds. Grass allergens present a significant management challenge for herbivorous tortoises and may be underdiagnosed. This case would have been a good candidate for hyposensitisation but it was not reported as being attempted. For something a little bit different there is an article in the same edition on Straelensia cynotis mite in red foxes. If you are not familiar with this mite you’re probably not alone, as it has only been reported as a problem in dogs in France, Spain, Portugal and Israel. Its nodular and pathognomonic appearance histopathologically enables a diagnosis. Straelensia in the adult stage is a freeliving trombidiod mite, similar to Neotrombicula, with larvae causing skin lesions in dogs. It has been postulated that it is a mite of foxes, a statement backed up by this report of straelensiosis in three red foxes. The article contains a succinct summary of what is currently known in dogs plus the description of lesions in the three foxes, along with a beautiful histopathological slide demonstrating the larval stage in the follicular lumen.
First report of straelensiosis in red foxes (Vulpes vulpes) Roberto F J Sargo and others Veterinary Dermatology 2020 31 482-485
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wo of the foxes were initially treated with ivermectin, which did not improve the clinical picture after 3 weeks. All three foxes were then treated with the combination of permethrin/imidacloprid (Advantix. Bayer) topically, and then moved to an outdoor enclosure to avoid habituation with people.
Theoretically straelensiosis ought to be selflimiting and this has been reported. The difficulty lies in the length of time required for a cure to occur. In one study this was stated to be within 12 months. With these three foxes all were cured after 3 months and subsequently released back into the wild. We await, I imagine, a report on dogs or foxes being treated with one of the isoxazolines. These drugs are now popping up everywhere and appear to be highly effective with the ectoparasites.