The Webinar Gazette The Webinar vet
To provide: The highest quality vet-led content To be: The world’s largest online veterinary community
NOVEMBER 2020
To have: The planet’s most confident vets
WHAT’S INSIDE Blog from Ben CPD’er of the Month Jane’s Blog Speaker of the Month Pippa Talks David’s Reviews From the Literature
WELCOME TO THE DIGITAL DECADE!
V
ery few people noticed the reports in the pater when China announced it was having problems with a respiratory virus in early January 2020. Of course, the rest is history! We are living in very trying times and I see the beginning of this year as GROUND ZERO at the beginning of the Digital Decade. I am now hearing of friends who are Covid positive and I have also lost a good friend and a relative. It brings it home forcefully. We don’t know what the next six months will hold but I’m in Liverpool and we are in Tier 3 restrictions and it is tough. Some reading this gazette may be from New Zealand or South Korea or Germany where they seem to be dealing better with the pandemic than our leaders. Well done if you are! We were involved with WVAC2020 in April/May and were impressed with the esteem in which Jacinda Ardern was held. She
has just been returned to power with an increased majority. Many of the countries doing well are led by a woman. Maybe Theresa would have done a better job? We will never know... I’m writing this just before WCVD9 kicks off on Wednesday at 7am. I’ve been thrilled to help my favourite congress to go online. I’ve been attending this congress every 4 years since 1996: Edinburgh, San Francisco, Vienna, Hong Kong, Vancouver, Bordeaux and now online instead of Sydney. The world has changed.... Most of us realise that the new normal will be different with, hopefully, the environment placed front and centre and an acceleration in digital transformation. Over the last 10 years, The Webinar Vet has saved many millions of travel miles. In 2010 there was no online CPD space and nobody had heard of webinars. The Webinar Vet changed that and brought the word “webinar” into the veterinary lexicon.
When you receive this gazette, WCVD9 will have already started, but you will have until the end of April 2021 to watch all of the lectures and view the amazing 3D exhibition. Tickets are still available for all levels of interest in dermatology from GP, to professor of derm at a university! With prices starting at £132 (plus VAT) for nearly 50 hours of high quality vet derm continuing education.
www.wcvd-9.com I hope to see you at WCVD9 or one of our many other events that you will read about in the gazette. I hope you enjoy the read
Take care,
Anthony
We know pets are living longer and due to the increased lifespan of our pets, age associated disorders are becoming more prevalent. Early diagnosis, together with appropriate management and nutrition, is key to getting a head start in supporting these patients. The ROYAL CANIN® VITAL SUPPORT range offers tailored nutritional solutions to help support pets’ Renal, Mobility and Heart function.
Vital Support is the fifth territory to launch from Royal Canin’s Veterinary Health Nutrition range. The launch includes formula improvements, pack size changes and new nutritional solutions. New ROYAL CANIN® EARLY RENAL diets help to support the kidneys at early stages of renal insufficiency.
We would like to invite you to join us on Wednesday 4th November 2020 for the Vital Support Virtual Congress: Get A Head Start During this one-day event, we welcome a number of highly recognised speakers to discuss topics from the importance of early detection and healthy ageing. Scientific speakers from Royal Canin will also provide informative updates on our range of Vital Support diets. The event is equivalent to 1 full day of CPD, 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.
09:00 Welcome from Royal Canin 09:15 ROYAL CANIN VHN Renal products
Clare Hemmings Royal Canin Scientific Communications Manager In this session, we will take a brief look at the ROYAL CANIN® products for the nutritional support of cats and dogs with kidney disorders.
09:45 Feline Healthy Ageing; How to support the middle aged cat Nathalie Dowgrey BVSc, MRCVS, MANZCVS (feline), PG Dip IAWEL The audience will be introduced to the biology of ageing and how the ageing process can potentially be manipulated and slowed down. Discussion will then move to assessing and monitoring the ageing process in the cat with a focus on middle age and the work of the Feline Healthy Ageing clinic at the University of Liverpool. Concluding with how this research can be adapted and applied in general practice.
11:00 Early detection of Chronic Kidney Disease in cats
Professor Jonathan Elliott MA, Vet MB, PhD, Cert SAC, Dip ECVPT, MRCVS
12:00 ROYAL CANIN RENAL DETECT™ Vincent Biourge Royal Canin Scientific Director Delphine Moniot Royal Canin Discover Program Manager Recent breakthroughs in research and harnessing the power of data enables us to provide a new service coming this November, that detects if cats are at risk of developing CKD within 1 year
13:15 ROYAL CANIN VHN Mobility products Hannah Poile Royal Canin Scientific Communications Manager In this session, we will take a brief look at the ROYAL CANIN® products for the nutritional support of healthy joint function for cats and dogs.
13:30 A practical approach to joint disease in the consult room Andrew Tomlinson BVSc CertAVP(GSAS) DipECVS MRCVS EBVS
14:45 Making the most of the senior cat consult
Sarah M. A. Caney BVSc PhD DSAM(Feline) MRCVS, RCVS Specialist in Feline Medicine
Tips for managing cats with concurrent disease will be included in the presentation. Management of many conditions benefits quality of life and may also extend lifespan in some situations. Practising high standards of senior cat care is highly rewarding for clinicians, carers and their cats.
15:30 The Importance of Early Detection - IDEXX
Rebekah Mack DVM, DACVIM-SAIM and Sylvia Conway BSc BVetMed MRCVS
Thanks to increased client awareness and compliance, preventative care (or ‘wellness’) testing is becoming more widely accepted and more widely implemented by veterinary practices. This session summarizes the main benefits of preventative testing for the client, the patient, and the veterinary team.
16:30 Wrap up and close
Ben Sweeney BVSc MSc (VIDC) Cert AVP MRCVS
“You Matter”
A
s a younger vet social media and digital engagement wasn’t really a big thing. I qualified in 2008 when most of the platforms were just in their infancy, and some hadn’t even been thought of. LinkedIn wasn’t really thought of as a ‘veterinary’ thing and we considered it to be much more focused on city business and so on. One thing that has really come to the fore in 2020 is the reliance on digital engagement of so many organisations for meetings, but another thing that I have watched with excitement is the real evolution of some of these digital networking platforms. I have used them myself to connect with so many veterinary and non-veterinary professionals from all over the world. What is more, many of those contacts have really opened my eyes to the opportunities out there. Physical networking events have a bit of a reputation: middle aged business folk with slicked back hair and cut throat attitudes all quaffing cocktails and drinks while telling each other how amazing they are at what they do. In the veterinary sphere, many of our ‘networking’ events this year have been cancelled. We use big trade shows and conferences to connect with old colleagues, university friends and have a good blow out, as well as
meet new contacts. So, what are our learnings from this? There is a huge gap in the veterinary world for a dedicated platform to digital veterinary networking, so we created one. www.simplyvets.com
What is networking? Networking isn’t just about looking for a job. It is so much more than that. There are learnings to be taken from everyone, from every business: their successes and their failures. On top of all of this, it is a great opportunity to plant seeds, to find people with similar outlooks, to explore opportunities and maybe even to open your eyes to things that you had never even contemplated. Whether you are looking for a job, whether you are looking to build your network of contacts, whether you are just intrigued by what may be out there, Simply Vets is all about connecting the veterinary community.
Who is networking for? Networking is for everyone! Perhaps more importantly, networking is for YOU! Plain and simple! Whether you are a student at
university, a new grad, experienced vet, clinical director of chief executive. You can be clinical or nonclinical. You can be flying high or scraping the barrel.
It is often hard to truly open up on an open source like social media, which is why Simply Vets is a safe closed audience with no external social media footprint.
As a connected community there is the chance that opportunities that were previously unbeknown can present themselves. What is more, even if something isn’t right for you, you may know someone who you think would be perfect for a role or a perfect connection for someone else to make.
How can I get involved?
Why network?
What do I get out of it?
Most genuine opportunities don’t just drop into your lap. Like any good crop, they take time to cultivate and nurture. There isn’t a secret formula to this. In fact, there is a very straight forward recipe: be open to any conversation at anytime with anyone!
Nothing ventured, nothing gained is a phrase that I love. I have always had the good fortune to have an adventurous spirit so I would have a go at anything. The question is, are you bold enough to open up your own possibilities and opportunities…?
A career is a rich tapestry, and those people in your network aren’t just contacts but they are your own personal ambassadors. Your champions. Professional colleagues to be accountable to but also to hold accountable.
With networking events planned for our community starting later in 2020, there is an opportunity to find your very own #vethappy and open doors that you didn’t even know existed previously!
Simply Vets is completely free and you can register and fill in your profile at www.simplyvets.com. We welcome insights from anyone on features you want for and from the community.
JOIN THE GLOBAL VETERINARY NETWORKING PLATFORM TODAY!
R E G IS T E R F R E E
HROUGH T E S A E IS D L A T P E R IO D O N AND THE S E P U O L Y R E G THE SUR NS M IC R O S C O P E L E hnau in Wallis & Jens Ru
GOING LIVE:
TUES 3RD NOV, 8PM Brought to you by The Web
inar Vet
Presented by Corr About the webinar
About the speakers
Canine and feline periodontal disease is one of the most frequent diagnoses in first opinion practice. Research studies have reported that over 80% of dogs over the age of three and the majority of cats are affected by the disease. This webinar will cover the clinical treatment of periodontal disease when scale and polish is not enough. It will also provide insights into the bacterial populations that reside in dental plaque and how these are associated with the disease process.
Corrin Wallis
Learning objectives Recognise the importance of regular dental assessments for all dogs and cats Understand both the importance and limitations of scale and polish Learn simple procedures to a surgical improvement of severe periodontal disease Learn that the bacterial species in canine and feline plaque are different to those in human plaque Recognise that screening dental plaque for bacterial signatures of periodontal health and disease has the potential to improve disease detection in conscious dogs
Dr. Corrin Wallis is a Workstream Leader at the Waltham Petcare Science Institute, the global fundamental science center for Mars Petcare. She has a degree in Microbiology with genetics and a PhD in molecular virology. She worked for ten years as a postdoctoral researcher in academia and then nearly 20 years ago joined the research team at Waltham. She currently works in the Microbiome team performing fundamental research to progress understanding of oral health problems in dogs and cats.
Jens Ruhnau DVM, DEVDC Jens Ruhnau has specialized in veterinary dentistry since 1997. He became a diplomate of the European College of Veterinary Dentistry in 2004 and founded the referral practice TandDyreklinikken in 2007. Since 2018 TandDyreklinikken also houses an education center providing CE courses within the field of veterinary dentistry and oral surgery.
REGISTER FREE: bit.ly/mars-petcare-webinars
CPD’er of the month
Paul Cossey “In the past year Webinar Vet has served me up a cornucopia of CPD, a smorgasbord of subjects, a buffet of professional insights. With more than three decades since qualifying, working mostly in small animal first opinion practice and the last half of my professional life in The PDSA I have been fortunate to experience a varied selection of CPD. I have found Webinar Vet to offer a superb range with a fair content of pragmatic applicable advice as well as advanced techniques. This enables me to
improve my clinical skills, keep abreast of developments in the Veterinary Profession and provides me with the knowledge to offer insightful advice to clients when their inquiries go beyond what I can offer. I have enjoyed the Webinars that I have watched. They have never felt as if I have just been putting in the hours. In a profession where there often feels more life in the week than hours available to live them the convenience of being able to catch up on seminars when I can choose is brilliant. As is being able to play sections back for clarification or pause slides for further study. Working for a charity I am aware that my CPD is paid for by the generosity of others and I feel Webinar Vet provides excellent value for money. I know I have barely explored its potential. I am looking forward to another year and hoping that Webinar Vet can teach an old vet some more new tricks.” Congratulations Paul! As this month’s CPDer of the Month you have won a cash prize of £100.00!
Will you be our winner next month?
The British Association of Veterinary Ophthalmologists (BrAVO) are delighted to welcome Drs Sara Thomasy, Christine Heinrich and Chris Dixon to give us the latest updates and cutting edge information on medical and surgical corneal treatment. BrAVO is for Veterinary Surgeons in the UK and beyond who have a special interest in ophthalmology. Complete the form below to claim your spot at the BrAVO Virtual Winter Conference.
See the full event programme and buy your tickets here: www.thewebinarvet.com/pages/bravo-virtual-winter-conference2020-tickets
SCIENCE COMMUNICATION: IS OUR CURRENT ONLINE SCIENTIFIC COMMUNITY SO DIFFERENT TO VICTORIAN SCIENTISTS?
A
s part of my PhD I have been joyously reading about the communication of science in the Victorian era. Please don’t fall asleep as there is a direct relevance to the vet world now. I promise. Where we sit in this digital age of remote prescribing, video consults, and online CPD has many people critiquing or criticising the way science is communicated. Possibly now more than ever with the current pandemic situation. However the various roles required for science communication have existed for as long as there has been science to talk about. In a time where Facebook appears to be the most popular source of information have we faced a similar battle between fact and fiction before? I believe that we have, and that the roles in science communication that I have highlighted in the table below existed in the Victorian era and exist today. While clearly much has changed in the mediums of communication and in the way results are reported these roles are still required as part of the process of communication.
Starting with the researchers in the Victorian time labs with being the focus for research as the novelty of purpose-built scientific spaces was part of the way to provide credibility for research but also became a physical filtering system for those allowed to partake in science. While labs and purposebuilt spaces are clearly still required for much scientific research we now see the benefit of being able to conduct research in any place where science could improve our work. Next is the role of the demonstrator which may need some explaining. In the Victorian era there were designated demonstrators for scientific experiments. They had their own levels of credibility and would take experiments from the lab to the public. Choosing their audience as much for their own credibility as for the income they would generate. Demonstrators could now be seen as not required as different media allows for easier direct contact with larger numbers of people. However those who produce secondary research, or present on others research at CPD events could be the modern-day equivalent of demonstrators. Giving the research an
Jane’s Blog Where we sit in this digital age of remote prescribing, video consults, and online CPD has many people critiquing or criticising the way science is communicated. Possibly now more than ever with the current pandemic situation. However the various roles required for science communication have existed for as long as there has been science to talk about.
opportunity to be seen by a wider audience and hopefully gain more supporters. Yes, supporters. These come in many guises and are as clear as the financial sponsors of the research, but then can be those that support evidence because they ‘believe’ or those who support sharing the information because they object to the results. This is where social media takes over from the face to face meetings that would have occurred in Victorian times. As we all know this has positives and negatives! Supporters may or not be also classed as ‘witnesses’. A witness in Victorian times was a person or group who were believed to meet the criteria to have credibility to report their personal observations. As face to face demonstrations of experiments were a ley way to communicate scientific progress in the Victorian era the calibre of the audience was an important factor. Witnesses had to be reliable, well known and
Roles in Science Communication
as per the era were mainly financially well-off gentlemen. These were deemed to be trustworthy individuals and thus the many gentlemans clubs of Victorian London were important in science communication. While this was sharing knowledge with an exclusive set of the general public, social media has allowed science to be accessed by all. However all supporters are not automatically witnesses... but I feel that many people don’t know this! We trust those we know and those who share our views so in social media we can find those aligned with us easily, which again is a positive and a negative! Finally, the ‘credibility’... who to trust to believe their viewpoint is the one to follow? Neither system is perfect, but the roles we all play are still very much in evidence. So while the mediums of communication are new, the problems of trust and credibility are very much old, but not always fake, news.
Then
Now
Researchers
In labs
Anywhere
Demonstrators
Took results to the people
Less as usually researcher presents although now we have secondary research which summarises primary research. Facebook campaigners would fall into this category.
Supporters
Funded research for social status
Funding procurement Oh and social media!
Witnesses
Reliable to support findings – also social status
Viewers online Who do we believe? Those we trust, and we trust those online that share our views very quickly!
Credibility
Of all - especially witnesses
How do we define credibility?
R E G IS T E R F R E E
WHAT – S E R U T C A R F TOOTH NOW YOU NEED TO K -Rivera on & Maria Soltero
GOING LIVE:
TUES 10TH NOV, 8PM Brought to you by The Web
inar Vet
man Johnst
Presented by Nor
About the speakers About the webinar
Norman Johnston
Fractures of teeth are common in cats and dogs and arise from a variety of reasons. Trauma to teeth can be from mild to severe and may or may not expose the pulp. This webinar will cover the initial diagnostic pathway and describe the treatment options available. Included will be a summary of a recent seminal study on the fracture limits of the maxillary fourth premolar (carnassial) tooth in pet dogs under applied forces.
Norman Johnston is a graduate of the Royal (Dick) School of Veterinary Studies, University of Edinburgh and is the founder of DentalVets. His qualifications are unique as he is a current diplomate of both the American and European Veterinary Dental Colleges, a 1991 fellow of the Academy of Veterinary Dentistry and a registered RCVS Specialist in Veterinary Dentistry since 2002. In 1997, he received the Simon Award from the British Small Animal Veterinary Association for outstanding contributions in the field of veterinary surgery and became a Fellow of the Royal College of Veterinary Surgeons in 2016.
Learning objectives Perform an effective oral examination and recognise tooth trauma Learn the diagnostic process of the damaged tooth from gross to radiographic examination Recognise the need for treatment with regard to patient welfare Consider the treatment options for damaged teeth Review the study on fracture limits of the maxillary fourth premolar (carnassial) tooth in pet dogs Discuss the objects likely to damage teeth in a domestic setting
Maria Soltero-Rivera DVM DAVDC Dr. Maria Soltero-Rivera received her DVM from Cornell University in Ithaca, NY in 2008. She became a Diplomate of the American College of Veterinary Dentist in 2014 after completing her residency at the University of Pennsylvania School of Veterinary Medicine. She then moved to the Bay Area and is currently the Medical Director at VCA San Francisco Veterinary Specialists. Dr. Soltero-Rivera is also an associate veterinarian in small animal dentistry at the Veterinary Medical Teaching Hospital of the University of California at Davis.
REGISTER FREE: bit.ly/mars-petcare-webinars
Speaker of the Month
Ron Ofri https://www.thewebinarvet.com/speaker/ron-ofri Ron Ofri was a member of the charter class of the Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Israel. Upon his graduation he traveled to the University of Florida, where he spent the next 4 years undergoing clinical training in veterinary ophthalmology and obtaining his Ph.D. During this time Ron developed an interest in the physiology of vision, focusing on retinal electrophysiology and animal models of retinal diseases. Upon his graduation Ron returned to Israel and joined the faculty of his alma mater, where he is currently a Professor in veterinary ophthalmology and winner of numerous Teacher of the Year awards. At the Hebrew University of Jerusalem, Ron expanded his research interests to include comparative visual physiology in wildlife species, and gene therapy of retinal diseases, and to date has published more than 90 refereed papers. Ron is also a very popular international speaker, having been invited to talk in more than 30 countries and 6 continents, lecturing in continuing education seminars, national meetings and world congresses for general practitioners, including BSAVA, SEVC, WSAVA, WVC and NAVC. He also
lectures frequently in advanced training courses for veterinary ophthalmologists, including lectureship at the Basic Science Course of the American College of Veterinary Ophthalmologists (where he has been speaking since 2002) and numerous other forums. Ron is a contributing author to the Gelatt’s classic textbook Veterinary Ophthalmology (3rd, 4th and 5th editions) as well as a co-author of the popular textbook Slatter’s Fundamentals of Veterinary Ophthalmology (4th, 5th and 6th editions). Ron is a Diplomate of the European College of Veterinary Ophthalmology (ECVO), a former ECVO Executive Board member and in 2002-2005 he served as President of the European Society of Veterinary Ophthalmology. Ron has delivered an impressive 21 webinars for The Webinar Vet so far! For a discount on any of Ron’s webinars, please visit our shop and apply the code “RONOFRI” https://www.thewebinarvet.com/shop/productcategory/speaker-of-the-month-november-2020/
BSVP Autumn Meeting 2020 (Lockdown Learning) I have always made time for the BSVP Autumn Meeting. Not only has the inception and development of BSVP mirrored my own career in veterinary pathology but I love reconnecting with the friends I have made and exploring parts of the country that are either unfamiliar to me or that I remember well. So, it was with some trepidation that I registered for the 2020 virtual Autumn Meeting. Let’s not go over the reasoning behind moving to a virtual platform. We are all painfully aware.
What I can say is that I am in awe of how Lou Dawson, Rachel Pittaway and the BSVP council have made the transition to a virtual meeting under the guidance of The Webinar Vet team (what would we have done without them this year?). This meeting was entitled “A Holistic Approach to Lymphoma Diagnosis “. I don’t know about you but some of the finer nuances of lymphomas have always eluded me and I occasionally develop a crisis of confidence when signing off on a lymphoma diagnosis, not least because now it does make a difference. I was therefore grateful to be led through the salient cytological features and workings of flow cytometry by Dr Butty Villiers followed by in-depth reviews and updates on the WHO histological classification and grading by Prof. Amy Durham. It was fascinating to hear some comparative pathology involving human lymphoma from Dr Bridget Wilkins. One benefit of a virtual conference is the online chat during the presentation and I really valued Bridget’s comparative notes during the veterinary talks. Dr Mark Stidworthy demonstrated the array of lymphoma-like conditions in other species and Dr Ana Lara Garcia and Dr Suzanne Turner updated us on the oncological advances in animals and the most recent research techniques, in this case large cell anaplastic lymphoma in children. Finally, an excellent set of case studies showed some of the more unusual and controversial lymphoma diagnoses. I am very proud to have participated in this BSVP virtual autumn meeting and to have been part of the NationWide Laboratories sponsorship team. I wish all my pathology friends a very safe and peaceful year, until we meet again virtually or (hopefully?) in person. Sandra Dawson
Access to buy recordings here: https://www.thewebinarvet.com/pages/bsvp-autumn-meeting-2020-tickets/
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
I’m a dinosaur from prehistory…)
Out with the Old and in with the New: Reflections on Hyperthyroidism Over your career, how has the management of hyperthyroidism in cats changed? I ask because I remember as an undergraduate sitting in the tiered PM room at the Garscube Estate, Glasgow University, when the case under discussion was a cat with a ‘new’ condition, called hyperthyroidism. This was when feline hyperthyroidism merited just three lines in the fourth year medical notes and there was no established treatment. (I know, I know,
Since those Dark Age days, the light of knowledge has shone brightly on this common condition. Clinician’s in first opinion practice now manage hyperthyroidism in a sophisticated manner that has real benefits for the patient’s quality and quantity of life. But it’s salient to remember that all medicine starts somewhere, and what seems laughable now once reflected the state of knowledge at that time. So, as a vet that graduated in the 20th century, I take some comfort from the progress made since the 19th Century.
Dr Google…19th Century Style We get a picture of small animal medicine in Victorian times from popular books of the day (their equivalent of Google.) The books of Charles Henry Ross, Edith Carrington, and Lady
Cust took pride of place in the well-informed cat lovers’ bookshelves, giving advice such as: Vomiting: “When the vomiting first comes on, give the Cat half a teaspoon of common salt in two teaspoon of water, as an emetic for clearing the stomach. Then to stop the sickness, give half a spoonful of melted beef marrow free from skin. If this is not found sufficient, the dose may be repeated.” Anorexia: If the cat’s appetite was poor, then small doses of “brimstone should be administered, to act as a mild aperient,” And for those wondering what ‘brimstone’ is, this is the common term for the yellow powder form of sulphur. And when the cat did start eating again, a good convalescent food was “a light biscuit spread with butter” or “a teaspoon of pure meat gravy given now and again.” Diarrhoea: “ As soon as it [diarrhoea] is discovered, give the cat some lukewarm new milk, with a piece of fresh mutton suet…melted and mixed in it. …If there is no bile, you should give the Cat (full grown) a grain and a half the grey powder used in such cases. If the diarrhoea continues, Lady Cust suggests “a teaspoon the chalk mixture used by human beings, be tried, with seven or eight drops of tincture of rhubarb, and four or five of laudanum, every few hours until the complaint ceases” Laudanum, an alcohol tincture of opium, was widely used in the 19th century. Little wonder then that Lady remarks this therapy results in ‘fixed eyes’ for several days.
Seizures: Much emphasis is placed on seizures and their management, which makes it appear the condition was more common then than now. One supposed cure was to let a female cat have a litter of kittens, after which she would be cured unless “frightened into them [seizures] which cats frequently are.” An alternative, presumably for male cats, was to offer “ half a teaspoonful of common salt in two teaspoonful’s of water”. Even more bizarrely, presumably a hangover from the idea of bloodletting, was “If it [the cat] have a regular fit with frothing at the mouth, quivering limbs etc….one of the ears be slightly slit with a sharp pair of scissors in the thin part of the ear. …have some warm water ready and hold the ear it, gently rubbing and encouraging the blood to flow, a few drops even will afford relief.” Needless to say, don’t try any of these remedies at home…
Today is Tomorrow’s Yesterday… But before you get cocky and sneer at these primitive treatments from the past; ponder this: People did their best with the information available at the time. What will future clinicians make of our management of diabetes? Perhaps they will snort with derision at the thought of daily injections and regard insulin infusion pumps as old hat, as they replace ineffective organs with stem cells engineered for the purpose. Anyhow, for those wanting to stay abreast of current hyperthyroid therapy, look to Sophie MacMurrough’s webinar on hyperthyroidism to shed light on the latest thinking.
Tejco Vision is India’s trusted ISO 13485 & CE certified biomedical speciality brand in Human and Animal Dermatology Segment serving veterinarians & speciality VET clinics, hospitals globally. Our exclusive range includes high quality speciality devices and instruments like Biopsy Punches, Vet Viewer, Vetscope, Woodslamp for day-to-day diagnosis
PFMA confirms dramatic rise in pet acquisition among Millennials Today, the Pet Food Manufacturers’ Association releases its brand NEW Covid-19 Pet Survey[i] confirming a staggering rise in pet acquisition: • Over one third (35%) of young adults (age 24-35) have already embarked on lives as new pet owners – or are planning to add a pet to their families • 2.1m (19%) collected a new pet in lockdown • 1.8m (16%) are planning to add a pet to their household[ii] Although this research highlights a spike among younger owners, 11% of all households have already welcomed a new pet and 10% plan to do so. Looking at all new pet owners, 15% work and 20% have children. Londoners are the most likely to have added a pet to their family with almost one in five (18%) having picked up a pet and 13% planning to make the change.
Nicole Paley, PFMA Deputy Chief Executive, comments:
“With millions working from home or furloughed from their jobs, many have clearly considered the numerous benefits of pet ownership. Now, more than ever, we know that the companionship and joy pets can bring to people’s lives shouldn’t be under-estimated. However, we’re keen to highlight the longterm responsibilities of bringing a pet into our life. This is an unprecedented period with unusual working conditions. New owners need to seriously think about future possible obstacles that could make life with a pet slightly more challenging. Owners need to consider their pet when thinking about return to work plans, any possible future hit on finances, less time available and the possibility of separation anxiety for their pet.” “Also, when looking for a new addition, families need to do lots of research. Sadly, there are unscrupulous breeders out there who are willing to take advantage of the rising demand. And, as highlighted by Lucy’s Law, it is so important to buy from a recognised breeder and please don’t forget the importance of rehoming too.”
Kiera recently became a pet parent. She explains:
“Although I’m only 23, I’ve always wanted a pet. During the pandemic I was furloughed and realised that I’d have more time and would love a new companion. I did loads of research and found Rosie, a cockapoo, who is hypo-allergenic and was suitable with my mild allergies. I obviously had time to help settle Rosie into life at home, but the responsibility was testing! I didn’t quite realise how much time puppies do take up, with training and toilet training, teething etc, but she is making a fab companion and she has helped my mental health massively...she brings me so much joy. I’m lucky that my mum is great too and helps out now that I’m back at work for longer hours.”
PFMA research also examined the types of pets adopted with dogs the most popular (57%) and cats a close second (38%) and small furries third (8%). Dogs are the first choice for young adults with 70% choosing a dog. This reflects feedback from rehoming charities and breeders and online marketplaces that have witnessed an unrivalled demand for dogs and cats.
Linda Cantle, Director of Pet & Owner Support Services at Wood Green, The Animals Charity confirms:
“Demand for pets over the past few months has soared. Enquiries increased by more than 253% during lockdown and over 20,000 people contacted Wood Green about getting a new pet between April and June – more than half of which were for dogs. This sudden surge in demand has been felt across the sector, with charities and breeders inundated with hopeful, prospective pet owners.”
Beyond analysing the ongoing impact of COVID-19 on pet population figures, the PFMA works closely with those in the pet industry to ensure that new pet owners can access good information to help them become and remain responsible pet owners. For top tips, owners should visit https://www.pfma.org.uk/ pet-care and for more pet data please visit https:// www.pfma.org.uk/statistics. To read more about Lucy’s Law visit: gov.uk
For more information on statistics, health advice or case-studies, please contact Nicole@pfma.org.uk or Michael@pfma.org.uk
[i] PFMA Household Survey among 2555 households, July / August 2020 [ii] The UK population is 67.8m. 16.7% fall into the 25-34 year old range, which equates to 11.3m people. 19% of this segment is 2.1m and 16% is 1.8m (worldometers.info and statista.com)
WEBINAR WEBINAR: GENERAL DIAGNOSTIC APPROACH TO PRURITIC SKIN DISEASE IN CATS DANNY SCOTT DVM JAMES SCOTT PROFESSOR OF DERMATOLOGY EMERITUS COLLEGE OF VETERINARY MEDICINE CORNELL UNIVERSITY ITHACA, NEW YORK USA
David’s Review
David Maggs is a graduate of the University of Melbourne (1988) and has had extensive experience in practice followed by research training at the University of Missouri. Since 2000 he has been at Davis as professor of veterinary ophthalmology and is one of 7 ophthalmologists in the university ophthalmology service. He is, along with Ron Ofri and Paul Miller, author of the standard textbook ‘Slatter’s Fundamentals of Veterinary Ophthalmology’ now in its 6th edition.
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s I write this the 9th World Congress of Veterinary Dermatology is well and truly up and running. What an achievement to get this to us on line, and more delegates have registered than ever before. Danny Scott retired (?) in August 2016 after more than 40 years in the one institution-Cornell. However he continued to work part time –particularly in clinics and in teaching his major loves. He has been tempted out of retirement for this congress giving the option for younger colleagues of hearing, probably for the last time, one of the greatest in our discipline. Having been a world-leading expert for decades it is fitting that he should receive the Shindelka medal at this conference. This award is given to recognise the contribution of world ranking veterinary dermatologists. First recipient was George Muller in 2008, four years later it was awarded to Prof Richard Halliwell and in 2016 to Prof David Lloyd. Dr Shindelka was a professor in the Vienna veterinary school and published the first veterinary dermatology textbook in the world in 1903.
their award and I made sure to listen to Danny’s contribution and I strongly recommend that you do too. He gave a highly personal, at times emotional, and frequently very amusing account of his life, from cleaning out kennels at the local vet practice to Cornell University. Cornell turned out to be the ideal fit for Danny and his young family, and we saw pictures of family holidays in the wilderness of New York State. Even though he is a native southern Californian he and his wife accepted Cornell, as ‘far away from southern California’ as possible. And in order to see as much as possible as their country they undertook the journey across the USA to Cornell in a VW camper van. What followed was a family history account including the veterinary dermatology family. Along the way 700 publications, 10 textbooks, 27 residents in dermatology and more than 700 in pathology. Add to that over 5,000 veterinary students. Leading up to full retirement he now plays in a rock band called ‘The Tarps’. You can see them on Facebook. This lecture was so entertaining I didn’t want it to end.
Recipients give a lecture following
The first lecture I watched at this
congress was inevitably going to be by Danny. ‘The general diagnostic approach to pruritic skin disease in the cat.’ Cutaneous allergies are the most important cause and he listed them: • Atopic dermatitis • Food allergy • Flea-bite allergy • Mosquito-bite allergy • Adverse cutaneous drug reactions • Contact allergy • Intestinal parasitic allergy He gave some statistics from his own institution for the incidence of these with a much lower percentage of fleabite allergy than we would see (at least in southern parts of England). It’s pretty obvious why this might be from a couple of pictures at the beginning of his talk of the contrast of what he left behind-a lovely local sunny beach at home in California and a picturesque but very snowy Cornell scene. It snows in Ithaca apparently from October until May! He moves on to list the allergic reaction patterns in cat skin: • Symmetrical, initially lesion free pruritus • Eosinophilic granuloma complex • Self-induced lesion free hair loss (‘fur mowing’) • Papulocrustous (‘miliary ‘) dermatitis • Urticaria, angioedema, exfoliative dermatitis, and plasma cell pododermatitis (ALL RARE) These reaction patterns do not indicate a specific allergic disorder. They can sometimes be seen in various combinations in the same cat, and can also be produced by non-allergic diseases. Danny now deals with these reaction patterns showing numerous excellent clinical pictures (I counted 52 in all) and for each pattern a differential
diagnosis. Each of the illustrations had some information on diagnostic tests, often with little anecdotes, before he listed 10 necessary steps/ investigations that will fulfill the diagnostic approach. For me this was a very good start to this congress and it is thoroughly recommended. I would also recommend as the second one to start with by hopping over to the general practitioner section and watch the first of Ralf Mueller’s contributions. Ralf has had a very interesting and well-travelled career taking in three continents. He is now Professor at the Munich Veterinary School in his native Germany. Diagnostic approach to the itchy dog without over servicing In this lecture Ralf Mueller looks at the problem in dogs and comes up with a couple of interesting ideas. Whenever there is something that he feels is absolutely essential to know he puts a large dungeon like key in red in the slide to remind you. It works! The second very useful idea is to offer choices to the owner for the investigation in a unique way. Clients will be offered the ‘Bicycle’ option. This option has the minimum amount of investigation that Ralf is comfortable with. He calls a more involved approach the ‘Ford’ option, where more investigations are involved, and finally (you’ve guessed it) there is the ‘Mercedes’ option. This is the kind of investigation that would be common in a referral institution. One of the interesting aspects of human psychology is that when options are presented in this way clients seem to go for a more expensive option than they might have been expected to. The net result is good for the practice revenue but also, especially in the more difficult cases, better for the welfare of the patient. By introducing some straightforward cases that one would expect to see in first opinion practice Ralf shows that this approach works well. The first two lectures in this congress have also worked well for me with lots more to come!
WEBINAR DISC DISEASE-WHAT’S THE LATEST WITH STEROIDS AND REST SIMON PLATT BVM&S Dip ACVIM (Neurology) Dip ECVN MRCV
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imon has an extensive CV including internship at Guelph, a residency in neurosurgery and neurology at the vet college in Florida, assistant professor in Georgia, head of neurology at the AHT (from 200-2006) and since then back at the vet school of the university of Georgia where is currently a professor.
• Grade 4 • Grade 5
Paraplegic Paraplegic, absent deep pain perception
This is followed by a series of high quality self explanatory videos depicting grades 2-5. Progressive myelomacia a softening of the spinal cord is a serious complication occurring in 10% of dogs with severe His webinar is a must for anyone in practice faced with IVDD that usually occurs in the first 72 hours. There will be having to make decisions on dogs with disc disease. He profound pain in these cases with lesions ascending the spinal reminds us the anatomy of the discs, comprising every space cord with subsequent loss of reflexes, anal tone, continence from C2-C3 caudally to L7-S1. A line diagram demonstrates and in the most severe respiration. the nucleus pulposus, (central, gelatinous and with a Type 2 disease is slower in onset and may not be so painful. high water component,) and the outer annulus fibrosus The onset tends to be slower and become chronic. (containing collagen type 1.) The next section of the webinar deals with various diagnostic A clever analogy using a jam doughnut with jam spilling out tests. Consideration is given to plain radiographs, myelograms, of it illustrates what happens with disc extrusion. I doubt you CT and MRI and each has accompanying illustrations of very will ever look at a doughnut again in quite the same way. high quality. The terms herniation, protrusion and extrusion as they relate to intervertebral discs are defined, before a consideration We are asked whether treatment should be medical or of acute disc herniation. Herniation in acute disease leading surgical. The aim of any treatment is a dog that can walk to nuclear extrusion has been classified as Hansen’s type 1. without assistance, free from pain, and is continent both with This is a problem mainly of chondrodysplasic breeds. In these urine and faeces. dogs disc degeneration starts at 6 months. By one year of age 75% of discs are affected and by 2 years, astonishingly 90% Returning to the grading system statistics for medical of discs are degenerative. The pathophysiology of acute disc treatment prognosis are given as follows: herniation is summarised by a single slide reviewing primary and secondary effects such as concussion, compression, and • Grade 1 pain 90% neurogenic shock, along with associated biochemical and • Grade 2 ambulatory paraparesis 90% electrolyte changes. • Grade 3 nonambulatory paraparesis 70% Chronic disc herniation with annular protrusion is classified • Grade 4 paraplegic 50% as Hansen type 2. This is seen in non-chondrodystrophoid • Grade 5 paraplegic, absent DPP less than 5% dogs and characterised by cord compression. There is a slide on a proposed third category of Hansen type nuclear The figures for prognosis following surgical treatment are the extrusion due to high velocity low volume, possibly as a same for grades 1 and 2 (with differing rates of recurrenceresult of trauma. There is cord contusion in these cases but se later). Grade 3 dogs do better surgically (90%) and no spinal cord compression. encouragingly even paraplegic dogs achieve 80-90%, but with grade 5 dogs timing is crucial if any progress can be achieved. An important grading scheme is outlined for acute disc 50% of dogs may do well within 24 hours with timely surgery. disease 24-48 hours later is unknown territory and after 48 hours it reverts to less than 5% of dogs recovering. • Grade 1 Pain • Grade 2 Ambulatory paraparesis Traditionally, high dose steroids were the main stem of • Grade 3 Nonambulatory paraparesis therapy. Experience in human cases mirrored in dogs now
discards this method of treatment. Currently non-surgical sub-acute therapy is based on : • Strict cage rest-4-6 weeks • Non steroidal anti inflammatory drugs • Muscle relaxants-diazepam, methocarbamol • Low dose prednisolone-0.5 mg/kg • Others-notably gabapentin, opioids
• Refractory pain • Deteriorating patients Key to decision making is a neurological examination with surveillance. During hospitalisation the need for supportive care –particularly from nurses is emphasised.
There is a colourful diagram (using pink pigs instead of dachshunds) indicating likely rates of recurrence with medical treatment alone. This is very useful when discussing the problem with owners. The good news is that 25% respond and do not recur. 25% recur after one year, a further 25% after two years and the remaining 25% deteriorate over a short period of 24-72 hours. These dogs require surgical intervention.
• Disc disease can be acute or chronic and type 1 or 2 • Different pathophysiologies give rise to different clinical signs with different treatment options • Ruling out other diseases is important • Ultimately the prognosis depends on the neurological examination
An obvious question is next ‘Treatment-what needs surgery?’ and the advice is: • Paralysed patients • Recurrent patients
The summary points of this webinar ends Simon’s contribution
This veterinary webinar is a superb example of teaching at the highest level. It is easy to follow throughout with very good clinical and diagnostic illustrations. It will make the management of these cases very straightforward with clear guidelines as to when a specialist orthopaedic surgeon is optimal for the most favourable prognosis, but with realistic advice when finance makes this difficult.
WEBINAR GASTRIC DILATATION-VOLVULUS HENRY L’EPLATTENIER PhD Dip ECVS MRCVS EUROPEAN AND RCVS SPECIALIST IN SMALL ANIMAL SURGERY
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his is an excellent revision of the subject delivered by a Swiss, Henry L’Eplattenier, brought up in the French speaking part, trained in the German speaking part (Bern vet school), experience in large animal practice near to Basle having completed a doctorate with Novartis in the same city. He then went to Zurich vet school to complete a residency in surgery. Enough you might think, but a move to the Oslo vet school and then the Utrecht school followed from where he obtained his PhD. He settled in VRCC Veterinary Referrals in Laindon, Essex, UK (now Southern Veterinary referrals) in 2006 and he is currently clinical director. This must mean that he speaks at least 5 languages (and probably more) including English without any trace of a foreign accent. How do our Swiss friends, in particular, do it?! He begins by emphasising the need for rapid and aggressive management of the condition, which otherwise has a high mortality. Large breed dogs are predisposed and there are a series of line diagrams explaining and illustrating very well how the
pylorus moves along the body wall from dorsally on the right side to dorsally on the left side. This makes it very easy to make sense of the intraoperative photos that follow.
discussed under the headings of fluid therapy, gastric decompression, the use of antibiotics and an ECG recording, as premature ventricular contractions are commonly seen.
Various aspects of the resulting pathophysiology are discussed with the headings
Anaesthetic considerations are clearly described before covering surgical treatment. General advice for this is :
• Blood flow • Cardiac function • Gastric wall necrosis • Bacterial translocation • Re-perfusion injury A typical history will include abdominal distension, nonproductive vomiting, restlessness and hypersalivation. A physical examination will determine shock and its severity, tympany and in some cases splenomegaly. Confirmatory diagnosis is with right lateral recumbency radiographs and the diagnostic pointers are well illustrated in two radiographs. There are also some useful laboratory parameters –in particular elevated lactate( above 6.0 nmol/l) which indicates gastric wall necrosis with a guarded prognosis. Pre- operative management is
• DO NOT DELAY SURGERY! • Reposition the stomach • Remove necrotic wall • Fix stomach to body wall. The remainder of the webinar contains many tips and advice on the surgical procedures with excellent pictures and a video. Like all experts he makes it look simple. It certainly should take the fear out of the operation, however, for those faced with it (inevitably from memory in the early hours of the morning.) This webinar is very clearly delivered throughout and will benefit all surgeons irrespective of their experience since it contains a lot of useful practical information gained from many years of practice in referral institutions.
WEBINAR SEDATION AND GENERAL ANAESTHESIA IN RUMINANTS
GAYLE HALLOWELL MA VetMB PhD Cert VA DipACVIM-LAIM Dip ACVECC PFHEA FRCVS
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ayle qualified from the Cambridge veterinary school in 2002 and in a relatively short time has accumulated a lot of experience in her field as seen from her qualifications. Following a PhD investigating aortic valve prolapse in the horse at Nottingham University veterinary school she stayed there and is now Professor in Large Animal Internal Medicine and Critical Care She manages to distill all her exceptional academic knowledge and experience into a highly practical, clearly delivered veterinary webinar, which will be of value to anyone in large animal practice and also for students contemplating mixed/large animal practice. Gayle introduces the triad of anaesthesia-hypnosis, analgesia and muscle relaxation before outlining the content of this webinar: 1. A brief session on analgesia 2. A discussion of the following sedatives • Xylazine • Detomidine • ACP • Diazepam/midazolam • Chloral hydrate 3. Anaesthesia • Procedure -similarities and challenges compared with other species • Drugs that have been used-nothing licensed As a general comment and as an aside Gayle says we do a great job with very little. Human specialists that Gayle recently gave a talk to were amazed by the paucity of drugs available in comparison their patients. Some useful clinical information is detailed on those drugs that we do have available beginning with Xylazine. Death has been reported in bulls with IV administration -possibly inadvertently
given intra-arterial when coccygeal vein used. Accordingly IM administration is recommended. There are some considerations regarding when its use may be contraindicated. Each of the drugs in the list above is treated in the same way-uses, dose, side effects and whether it has a licence for various species and more. My memory, admittedly many years ago, of time in large animal practice was that we had even fewer drugs available and the main one I recollect was ACP. These days it is not recommended as it significantly increases regurgitation even in mildly sedated animals. It is not licensed and there are no EMEA meat and milk withdrawals. The only other agent I had available was chloral hydrate and on one occasion I assisted my boss of the time, Norman Fowler, a fantastic vet, in sedating a very large bull in order to sort out a foot problem. Gayle was wondering if anyone was still using it as although inexpensive it does not produce adequate anaesthesia or analgesia. Nevertheless there is a full account of its use and side effects. Interestingly it is an effective euthanasia agent when given IV. There is a separate session on the sedation of neonates and young calves before an account of the main sedation problems in cattle and advice on why things may have gone wrongadministering the drug intra-fat, for example, surprisingly easy to do in large bulls. There is also advice on how to deal with very fractious animals, what to do when a cow goes down and needs to be standing with some reasons why this might happen, apart from it being ‘a cow thing’, and always at the most inconvenient time! Gayle introduces the next section, on general anaesthesia, by the surprising comment (at least for me) that it is not particularly complicated. Apart from ruminants being much sicker than
they look and requiring fluid therapy, the main problem is intubation. The requirements are a laryngoscope with a relatively long blade and thin thickskinned arms when dealing with adult cattle! There is an extensive list of indications for general anaesthesia in calves and adult cattle, many of which are comparable to conditions in small animals. There is extensive advice too on preparation, particularly on the need for starvation (adult ruminants 24 hours for example) and much less obviously for younger animals. Following detail on premedication and induction agents there are some useful tips on how to intubate young calves and the need for lateral recumbency in adult cattle-not forgetting a Drinkwater gag. Isofluorane in 100% oxygen can then be used for maintenance using a circle circuit attached to a small animal anaesthetic machine. There is advice on the size of re-breathing bags for adult cattle and for calves, small ruminants and camelids. Isofluorane does not have meat and milk withdrawal periods but the EU medicines directorate states that this is no problem provided that the animal is not sent for slaughter immediately after treatment (considered unlikely). There are no major differences in monitoring compare with other species and these are described with clinical illustrations. Ruminant specific issues are saliva (huge amounts are produced) and regurgitation. In addition the eyes should be protected with lacrilube to avoid the risk of saliva induced corneal ulceration. Hypothermia is also a risk in calves and some practical suggestions are described in order to prevent it. The final part of this excellent webinar deals with post-operative care, including when to introduce food, monitoring for bloat ( the risk period is in the first 12 hours after surgery) and the essential need for analgesia for 3-5 days as required.
From the Literature – November’20
Effect of attire on client perceptions of veterinarians Bentley E and others The Veterinary Journal Volume 265 November 2020
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very interesting idea to publish this study by academics from the School of Veterinary Medicine of the University of Wisconsin-Madison in the USA. It’s quite a detailed study as you might expect from this prestigious journal and I will summarise the main points in the abstract. Over the years I have seen many different attires and the one that surprised me most was vets consulting in expensive suits in central London in the 70s. It didn’t seem to worry the clients much as they forked out equally expensive fees and the practice was extremely successful. This article reflects USA values but it would be interesting to do a survey in a UK practice to see what clients like best and compare. The study examined the effect that veterinarian attire and gender (my italics- didn’t see this in
the title!) had on perceptions of veterinarians in a large academic specialty hospital. Clients volunteered to answer a survey in the small animal waiting area over a 3-month period. The survey consisted of demographic information, information about the nature of the appointment with the pet, and questions regarding clients’ levels of comfort with and the perceived trustworthiness of a Caucasian male and a Caucasian female model in four different types of attire. These were surgical scrubs, surgical scrubs with white lab coat, business casual, and business casual with white lab coat. 505 clients participated in the study yielding a total of 6217 completed survey questions. Clients perceived veterinarians wearing white lab coats as more competent and reported more comfort with those veterinarians (P 0.0001).
When comparing surgical scrubs with no white coat to business attire with no white lab coat, surgical scrubs resulted in higher perceived competence and comfort levels (P 0.0001). Wearing a white lab coat over both surgical scrubs and business casual increased clients’ perceived competency and comfort levels compared to not wearing a white lab coat. From this study in first place is the white lab coat (whatever the pets would say if they could). In second place surgical scrubs and last business attire -by far the most expensive option for the vet with a good relationship with the local dry cleaner factored in.
The discussion is very interesting with detailed analysis of perceived differences regarding gender. These were minor as it happens-quite right too. There have been a couple of studies along these lines but this is the largest and most comprehensive to date. It also includes analysis of the ‘white coat syndrome’ and mentions edicts such as the one from the UK NHS banning below the elbow attire in an attempt to reduce bacterial resistance. A different slant on ‘White Coat Syndrome’ in cats evaluated the clinical location on stress in cats, quite scientific too as it was a randomized crossover trial
The article is quite fun to read and it is open access.
Evaluation of clinical examination location on stress in cats: a randomized crossover trial Griffin F C and others Journal of Feline Medicine and Surgery October 15 2020
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hese authors are from the college of veterinary medicine, University of Florida, Gainesville, USA. The study had a simple aim. It was to quantify the effects of owner separation and physical examination on fear, anxiety, and stress (FAS) behavioural indicators in cats. As I would expect from this journal and the authors’ institution, the study was carefully crafted, ultimately leading to evidence based recommendations affecting feline stress and of direct relevance to first opinion practice. The method for this study was a prospective, non-blinded, two -period, and two- treatment crossover trial. Healthy adult cats presenting for wellness or dental evaluations at a single veterinary teaching hospital received three physical examinations, a baseline assessment (owner present) followed by physical examinations in both a treatment area (owner absent) and an examination room (owner present). These procedures were randomised with uniform low stress handling techniques. The primary endpoints were heart rate (HR) and FAS as measured by five specific behaviours. These were body position, tail position, ear position, eyes and vocalisation. Scores were 1 present and 0 absent. The results were not surprising I imagine to colleagues experienced in feline practice. Nevertheless the results were statistically significant and demonstrated that owner separation and physical examination location can result in increased stress in cats, thereby compromising vital sign assessments. The recommendation is that whenever possible physical examinations and procedures should take place with the owner present along with separation from unfamiliar dogs and cats.