The Webinar Gazette - May 2020 by thewebinarvet

The Webinar Gazette The Webinar vet

To provide: The highest quality vet-led content To be: The world’s largest online veterinary community

M ay 2020

To have: The planet’s most confident vets

WHAT’S INSIDE Blog from Ben Guest Article-1 News from our Community CPDer of the Month Jane’s Blog Pippa Talks Guest Aritcle-2 Guest Article-3 David’s Reviews From the Literature

I believe it is an old Chinese proverb, “May you live in interesting times”.

nprecedented is a word that is getting thrown about and I suppose we must go back to the end of WWI and the Spanish flu epidemic to see anything comparable. That epidemic killed 50 million people who had been weakened by the deprivations of four years of war. I do hope that you are coping in these trying times. We’ ve remained fully open during these times and have been doing all we can to help The Webinar Vet community. In early March, I did the first COVID-19 webinar which was well received. BVA then asked us to help them get all the fabulous information out to the community that they have been putting together. BVA’s value to the profession really comes through at times like these. They are always working behind the scenes, talking to the government and people of influence looking

after animal welfare and, of course, their members too. We have had several thousand vets and nurses watching our weekly BVA updates on COVID-19. I would encourage all of you who are not BVA members to consider joining as it is important that we, as the veterinary community, have a strong unified voice. You can find all of the webinars here Please do feel free to reach out to my team and me during these times. We Shall Overcome! In March, at very short notice, the NZVA asked our help in turning the 36th World Veterinary Association’s congress into a virtual event. We have done this and will have launched the event by the time you read this newsletter. I always get a little frisson of excitement when running big events like our own virtual congress which we ran for the 8th time in February to over 10,000 registrants. Serendipitously, we have been training for these virtual events

for 7 years and suddenly, we see we are world leaders across many disciplines. It’s not too late to join WVAC2020 and tickets are very competitively priced to make them affordable in these difficult times. If you are a BVA or WVA member you also get 20% off. Speak to wvac@ thewebinarvet.com. I’ve been spending my free time playing guitar and uploading them to FB. If you want to have a look just go to my page I do hope you and your family are keeping well and I hope to see you on a webinar very soon.

Take care and God bless,

Anthony

Ben Sweeney BVSc MSc (VIDC) Cert AVP MRCVS

s we find ourselves settling onto the plateau of the covid-curve, it is easy to reflect on the happenings of the last month and think it has felt like years and years of experience rolled into a 30 day period. So much has happened, so much has changed but yet so much has also remained the same. Businesses have been challenged, our way of life has been inverted, tossed and scrambled. Yet we are still here. Personally, I think it is too early to adopt the ‘jolly demeanor’ as I think that there is still a long way to go, not just until we return to work, but on the road to recovery. Our profession has taken a massive hit, and that is not to be scoffed at. Many practices have seen revenue drops of in excess of 50% and cash reserves are running low. How will it look in the aftermath of all of this? Will all of the corporates survive? Will the independents make it? I have seen some ingenious endeavors by practices asking their clients to crowd

fund in return for future credit to keep the doors open. This to me exemplifies the resourcefulness and innovative nature of us all across the profession. I certainly don’t know how we will look on the other side of this, but maybe it won’t be too far displaced from where we were before. Telemedicine has come to the fore….and yet for many of us who were massively excited, it has proved something of a damp squib to some despite all of our earlier anticipation of how it will help us. Yet there is hope. There is a new market avenue for us, it’s not perfect yet but these things can be improved, and you have to start from somewhere. Many have been released by good people with good intentions to offer help and support to a profession in time of need. There is certainly no right answer to all of the problems we face, but my admiration for the profession has been galvanized by seeing so many people come together with one simple collective aim: survival, both personal and professional.

Guest Article Self-Care Ideas for Coronavirus Quarantine Elle - The Positive Vet Nurse

e are all aware and affected in some way by the current situation that is Coronavirus. It is a difficult time for many, especially everyone in the veterinary profession. You may feel stressed and have heightened anxiety levels. You may feel challenged, whether that is mentally, physically or financially. Our routines change and we delve into the wondering of the unknown. Although I cannot make this go away for you, I thought I would share some self-care ideas for those in quarantine and feeling isolated. Make a routine: I can’t stress enough how important it is to still maintain a routine, even if it isn’t the one you had before. This will help to lower your anxiety and to make you feel more in control of your life during this situation. Your routine could include what time you get up every day, mealtimes, workouts and time for yourself. Workouts and exercise from home: For me, not going to the gym is one of the hardest aspects of being in isolation as I used to attend the gym 4-5 times per week. This change has left me unsettled, non the less, I have come up with work out plans inspired by my favourite fitness gurus and also started running. This has helped to alleviate some stress and gives me a sense of achievement. Listen to a motivational speech or an inspirational person: There are plenty of YouTube videos and people on social media who you can listen to every day to help give you a boost and feel good. Podcasts are also really good to listen to too.

Spend time with your pets: If you are lucky enough to have a pet, spend time with them. You may want to spend some time to improve their environment or come up with new enrichment ideas especially if they are a small animal like a rabbit or hamster. Now is the perfect time for positive change. Eat well: Make time for nutritious, healthy foods and try to avoid snacking. Maybe even try a new recipe once or twice per week? Do some planning and set goals: Something that has been very important to me is having a diary where I can write to-do lists, see what events are coming up and what I have planned. Even though we are isolated, I think it is a good idea to write plans for each day or goals you want to meet. This can decrease anxiety levels and make your day feel it has purpose. Clean up and get organised: Isolation at home means you get to do those jobs that have been on your lists for ages but have never got around to doing. Give your house a clean, this will make you feel proactive and give you something to do. Engage in a new hobby: Find a hobby that perhaps you haven’t tried before? For me, I have been learning to bake and I have been also reading more which has kept me busy and feeling less anxious. Other hobbies could include crafts, designing your own social media page, cooking and gardening. Learn something new every day: This is the perfect time to engage your mind. CPD for us is a way to learn more even though we are not practically working. I see it as learning to help your future patients. If I can learn at least one thing every day, I feel that I have been proactive, ultimately learning makes me feel better about myself and makes me feel positive. Call or video call your friends and family: It is important to not only keep in the loop with work but also with your friends and family. Arrange a phone call so that you can talk about your feelings, this will become part of your emotional self-care. I know it is a difficult ride right now, but everything will be okay. Make sure you are engaging in self-care and allowing yourself time to figure things out. I hope you find some use of this blog post and look after yourself during isolation. You can find the rest of Elle’s blogs here.

How can a virtual referral service help you during these unchartered times and beyond? Imagine you are presented with a collapsed dog.

A quick clinical exam reveals abdominal distension, pale mucous membranes and muﬄed heart sounds. It’s been months since you’ve used the ultrasound machine, as one of your colleagues usually scans cases for you…

Now imagine having a Cardiologist right beside you

from the moment you switch on the ultrasound machine. Imagine having guidance on positioning the probe and what buttons to use on your ultrasound machine to get the best images possible. Imagine diagnosing a pericardial eﬀusion and performing a pericardiocentesis with the specialist right there beside you, to guide you through the procedure step-by-step.

Imagine a Diagnostic Imaging specialist then assists you to perform an in-depth abdominal scan to check for metastases and helps you to take ultrasoundguided FNAs of splenic and liver nodules. Imagine that as soon as the cytology results are

back, you can then discuss the case with an Oncologist to decide the next steps.

A truly collaborative clinical experience ALL possible within your own practice –how does that sound? https://youtu.be/u0rNITqnZJY

Your patient has accessed world class multidisciplinary specialist care without having to leave the room. Your client knows their pet received gold standard care, from multiple specialists, whilst they waited safely at home. You can be conﬁdent you have treated that case in exactly the right way, working directly with specialists AND you have earnt CPD at the same time! Extra revenue has come into the practice rather than being lost to an external referral centre.

Imagination is no longer needed - this is the daily reality for many vets like you in progressive first opinion practices throughout the UK, who are already working with Virtual Veterinary Specialists (VVS). It’s simple: “Learn as you Earn!”. What’s not to be excited about? Vets working with VVS certainly are! VVS are the first company in the world to offer this seamless way of working with specialists and we have assisted with thousands of cases over the years. VVS is THE pioneer and world leader in specialistto-vet virtual referral services.

FREE WEBINAR SERIES FOR VETS

VVS.VET/COVID-19

info@vvs.vet

VVS.VET

NEWS FROM OUR COMMUNITY

CPD’er of the month

Some VetPartners practices have also been able to donate ventilators to hospitals to help treat patients who may have to be hospitalised with COVID-19.

Congratulations to our CPDer of the month - Nigel Swayne (Swayne & Partners) who completed 44 hours of CPD!

his month’s news from the community comes from VetPartners, who have been supporting the NHS during the coronavirus pandemic by donating ventilators and personal protective equipment.

Under social distancing guidelines from the veterinary profession’s governing body, the Royal College of Veterinary Surgeons, routine work has been postponed and vets are seeing only emergency and urgent cases at the practice, while offering routine care via telephone and video. The changes have enabled practices to donate surplus PPE.

Supporting practices

In the current situation with Covid-19, it is important clients feel they are still able get treatment for their pet. If you are looking to reduce non-essential visits to the practice by your clients, please remember many dermatology issues can be managed with many of the products in our range. The Vetruus Dermatology range, already used by veterinary surgeons, can also be dispensed by nurses and reception staff (or posted) in the event owners are unable to get to the clinic see a veterinary surgeon. There is no substitute for seeing the patient, however, we are dealing with a new reality whereby this may not always be possible. Vetruus is here to help should you need it. Our European Dermatology Specialists are available for advice on our Helpline to support you during this difficult time. Tel: 01494 629979 Email: salesenquiries@vetruus.com Web: www.vetruus.com

Veterinary Dermatology is our field.

Vetruus Ltd, Oakridge House, Wellington Road, Cressex Business Park, High Wycombe, Bucks HP12 3PR.

Itâ&#x20AC;&#x2122;s what we do!

FOREVER GRATEFUL

eading into the second half of my first year back as a student and I can’t help but think back to how learning ‘used to be’. This makes me very grateful for completing a PhD in a time of online access and amazing software. It seems apt to put this in the WV Gazette whose ability to work quickly and content out to so many has been tried and tested and is much valued at this very moment for their Sunday webinar collaborations on COVID.

History I’m a medical history student now and was a medieval history student back in the 90s and A LOT has changed since then! Libraries are still the main stay of our knowledge but it is no longer necessary to visit them to access information. I recall the stress of accessing books from my first degree. Leaving a seminar to rush to the library to book next weeks core reading for a 4 hour slot was a constant issue. One that seems to no longer be an issue. I leisurely plan my week knowing that I have 24/7 access to pretty much everything I need right now. The only issue is its now up to me to dictate my working pattern and some days my time management skills might need a bit of a push!

Geography The location of knowledge resources has also expanded out of the libraries. I sit here

typing in my office in my garden accessing online databases and archives that contain the information that I need. We’re beyond the excitement of Google and Google Scholar now and I can access my historical documents due to the fab archive work at RCVS Knowledge. It’s not the same as an archive trip, but less stressful as I can read AND drink tea while the documents are well out of harms way online. For me with my horrible back issues constant archive and library work is really painful so I am even more appreciate I can sit in my special chair, rolling around on my physio ball as I think about the past. No longer is my location of key importance to the completion of my project.

English The most beautiful words I know for studying right now are ‘copy and paste’. When I am updating spreadsheets of information and archive locations being able to transfer relevant info quickly and easily is so handy. I recall writing my original university essays on a state of the art ‘Word Processor’ that let you edit only the last 3 lines of text on a tiny screen. I now marvel at what a fab student I must have been to produce 3 years of historical essays with no internet, no Word and no computer. What kind of stuff did I even produce? I would hate to look back and see!

Jane’s Blog

The future It’s not all perfect, Google isn’t everything and sometimes sitting with the documents written on and touched by those you are seeking to understand is very inspiring. Yet in this new life of limited travel I will take the new advances and thank my lucky stars I waited until now to do a PhD!

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

Can Dogs ‘Watch’ TV?

Can Dogs Watch TV: Scent-sational Facts about Dog Senses Take a few minutes of pleasant diversion to read this post, inspired by Ron Ofri’s forthcoming webinar “Do Dogs see in Black and White” - 21/5/2020. Let’s lighten the mood with some fascinating facts about how dog’s perceive the world.

In our house we have a ritual. When we have a carry-out curry, on goes TiVo to watch “Columbo”. (Curry and Columbo is a ‘thing’ with the Elliotts.) The only problem is, whenever Columbo’s Bassett hound comes on screen, we have to mute the volume. If that dog barks, Pogs goes berserk. However, she doesn’t seem bothered when watching without the volume. Which raises the important question about how well do dogs see a TV image? As it happens, the answer depends on the age of the TV set. Let’s turn to science for the definitive explanation. Dogs can perceive individual flashes of light at a frequency of around 80 Hz. This is in contrast to the human eye, which can perceive flashes at a frequency of just 50 – 60 Hz.

The old cathode ray TVs took advantage of the latter fact by updating the screen image at 60 times per second – just fast enough to fool the human eye into seeing a steady image. Contrast this with a dog. A cathode ray image updated at 60 images per second means the dog perceives individual flickers of light, rather than a smoothly moving picture. However, all this changes with modern flat screen TVs. These commonly refresh the screen at 120 Hz, well above the rate at which the dog sees individual flashes (80 Hz). Thus, you can breathe a sigh of relief. Your dog is able to comfortably watch TV…and whether or not they decide to do so depends on the quality of the program.

Scent-sational Sniffing We all know how dogs love to sniff and catch up on pee-mail, but perhaps without us really appreciating just how special their sense of smell is. [Oh, and here’s a thought: If a web log is a ‘blog’, is a dog’s sniffing log a ‘snog’?]

Droopy Ears Aid Scenting Typically, scent hounds, such as Columbo’s Bassett, have long pendulous ears. It turns out this is no accident. As the dog scoots along nose down, the gentle flapping of those extralong pinnae stir up micro-air currents near the surface of the ground. In turn, these currents offer up valuable scent molecules to the nose, making for maximum sniffing efficiency. And in case you are wondering about the optimum time for scenting, this is early morning and early evening. This is when the ground is slightly warmer than the air, and combined with a little moisture, makes it the ideal time to detect scents.

Improving on Nature Oh, and to improve their sense of smell further, a drop of caffeine may do the trick (not that I’m recommending this.) A study looking at trained police dogs found their noses to be more sensitive after caffeine… although the effect had a ‘honeymoon’ period. Used frequently, caffeine had the

opposite effect and dulled the German Shepherds’ sense of smell.

Not Always in the Name But, did you know in the dog that detection of scents isn’t just down to the Olfactory Nerve (CN1)? Two branches of the trochlear nerve (CN IV) also play a part in the canine sense of smell. However, there are certain scents, such as lavender, cloves, and asafoetida only the olfactory nerve can pick up.

Compared to People Speaking of which, a hound’s sense of smell is around 100 – 10,000 times more sensitive than the human nose. Which raises the question of why anal gland secretion smell so foul (And for those that take life literally, the bad smell is down to the valeric acid, methylvaleric acid, methylbutonol, isobutyric acid, along with the individualized piquance provided by the pH, percentage of oil, and personalized microbial load in the anal sac.)

Coming Up Smelling of Roses…or Lavender! But with a sense of smell this acute, why can’t the anal sac secretion be less potent…or at the very least smell of lavender rather than rancid fish? Now there’s a thought not to be sniffed at!

Eight out of ten vet practitioners are unaware of critical infection prevention measures

important for infection prevention within their respective practices.

Research by Miele Professional finds that many vet practice workers have not heard of the Water Regulation Advisory Scheme

· 41% of those surveyed claim to throw heavily contaminated items away to reduce infection, whilst 57% wash these soiled items within their practice.

The professional division of Miele, the world's leading manufacturer of commercial laundry appliances, conducted research among over 100 veterinary professionals, including vets, nurses and assistants, at the 2019 London Vet Show. Research found that more than eight out of 10 respondents had not heard of the Water Regulations Advisory Scheme (WRAS), which ensures any fluid presenting a serious health hazard, such as faecal material, harmful bacteria and pathogens, does not contaminate the main water supply. This is critical information, as vet practices are meant to use commercial washing machines tested and approved to WRAS category five.

The findings suggest a need for more awareness surrounding laundry processes and its ability to help control infection and reduce waste.

Key findings: · 81% of vet practice workers are unaware of important infection prevention standards they need to comply with to minimise hygiene risks. · 46% of respondents either suspect or know for definite that their current laundry equipment does not meet the required times and temperatures needed to kill bacteria. · Lack of awareness comes despite 97% of respondents agreeing that laundry processes are

Simon Hart, national account manager at Miele Professional said: “Minimising infection is a high priority for vet practices, but it appears as though many practice workers are unaware of the prevention methods available to them and the standards they need to comply with when it comes to laundry. Making sure the washing machines within their practice are able to reach the required times and temperatures to kill and prevent the spread of harmful bacteria, and ensuring staff are educated on correct laundry procedures will reduce associated risks. Employees should be aware that health guidelines state that to kill bacteria, contaminated laundry should be washed at above 65°C for at least ten minutes, 71°C for at least three minutes or 82°C for at least one minute.” If you would like to learn more about Miele Professional and the steps needed to comply with WRAS, you can visit the website here: https://www. miele.co.uk/professional/veterinary-insights-1206. htm

About Mieleâ&#x20AC;&#x2122;s professional division: The professional division of Miele is the worldâ&#x20AC;&#x2122;s leading manufacturer of commercial laundry and dishwashing appliances, as well as washer-disinfectors and sterilisers for use in medical and laboratory applications. Designing and building every part of its products, Miele is recognised around the world for the manufacturing of quality appliances, founding its reputation by ensuring quality is delivered across each area of the organisation. The Miele Company was founded in 1899 and is now in the fourth generation of family ownership. The company has eight production plants across Germany as well as one plant each in Austria, the Czech Republic, China and Romania. For more information, please visit https://www.miele.co.uk/ professional/index.htm For media enquiries: Please contact Rebecca Brown at Skout PR, rebeca.brown@skoutpr.com Tel: 01625 869418

Guest Article Snake handling gives me the shivers! Livvy - Scales, Feathers and Tails

arning this blog could change your perception of how to handle a snake in the future.

Yes you heard it right I said snakes. So I have been browsing the web and posting on my social media pages and it occured to me just how many people handle snakes in the same way whether they are veterinary professionals or not and it gives me the shivers. The amount of people putting snakes of all different shapes and sizes around their necks and posing for photos and it seems to be the in thing as there were only a handful that weren’t wrapped around someones neck. This has to stop! That’s right you heard me it has to stop and stop now before someone gets seriously hurt. Snakes can get frightened just as quickly as any other animal and as they react with vibrations too they are more sensitive. With snakes such as constrictors their instinct when worried or frightened is to hold onto or squeeze their body tighter around whatever it is they are gripping onto and if that happens to be your neck you know what happens next. Don’t assume this is just constrictors as other snakes can also do this; it is just that their grip is not as tight or strong but can still have the potential to cause damage. The same goes for them wrapping around your arm or your leg too as once they are wrapped tightly it is a struggle to get them to loosen their grip.

Now I know what you are probably thinking after reading this that snakes are dangerous and I don’t want to handle them again blah blah blah but please don’t think this. There is a right way to handle a snake and a wrong way. The right way to handle a snake would be to hold the upper half with one hand and the bottom half in the other hand. If the snake is over 6ft or aggressive then it should be handled by two people for the health and safety of the snake and the handlers. There are many tools you can use to handle and restrain them, providing they are used properly such as a snake hook, a pillow case, a snake tube or just handling them and restraining them with your hands. Educate the owners when they come in for consults as for most the first thing they will do is get their snake out and put it around their neck; educate them that it isn’t appropriate at the vets as the snake will be apprehensive. Educate school children on school visits or at fairs, educate clients that are looking at getting a snake in the future and educate people when on holiday and they try to sling a snake around your neck for photos. Education, encouragement and collaboration is all you need to spread the word. Now you have read this, let the education begin! You can find the rest of Livvy’s blogs here.

Guest Article

could go in my curb-side bin and I recycle glass and bread bags separately. This ensures that only truly non-recyclable items are sent to landfill.

Compost Bin

Zero Waste at Home (Part 1) Where I Began Merryn - Zero Waste Veterinary

As an avid gardener and hater of food waste, it was very important to me to be able to have composting facilities at home. Two of my favourite items I introduced into my home when I began my journey were a small food waste caddy in the kitchen and a large compost bin in the garden. Nothing fancy, just a standard 500 litre compost bin from B&Q. Even if you don’t have a garden for a compost bin, most councils (if not all) will collect food waste from households

Disclaimer - I am well aware that being able to worry about waste at a time like this is an absolute privilege and it is not lost on me that there are far more pressing matters happening in the world right now. Saying that, I am also mindful that a lot of you are either furloughed from work or working from home at the moment, so I wanted to make this months article more relevant to that. The purpose of this blog is to give a lighthearted insight into how I began my zero waste journey.

find it much easier to achieve low waste at home because I am in control of everything that enters my home; where it comes from and where it will end up. Many of the products I use aren’t new inventions, they are things which have been around for many years but have unfortunately become largely forgotten and replaced with plastic versions. Some of these do work out a little more expensive than if I were to buy a cheap, plastic version but I find that overall, it tends to balances out with the other ways I save money (such as only buying second hand clothes).

free of charge and send it to local composting facilities. In my opinion, food waste should never be sent to landfill!

The Basics The first swaps I made were the ‘obvious’ swaps which are the first things you’ll come across if you research ‘ how to become zero waste’. These include reusable shopping bags, a reusable water bottle and a reusable coffee cup. The other big ‘basic’ I introduced in to my home was recycling. I checked with my local council to see what

Bamboo Toothbrushes This is one of the items which works out a little more expensive than the plastic alternative, but I personally feel is definitely worth the swap. To keep costs down, I order mine in bulk online and they work out around 80p per brush, which is a lot better than if you buy

them from the high street (usually around £3 each!). At the end of their life I remove the (plastic) bristles and either reuse them or compost them.

Plastic Free TP One of my earlier swaps was changing to plastic free toilet paper. I originally began buying bulk toilet paper online which came wrapped in paper packaging (Whogivesacrap). However, I have recently discovered another sustainable company who offer unpackaged bulk toilet paper (Bumboo). The only packaging it comes with is a large cardboard box which can easily be reused, composted or recycled. Again, this is a swap which may work out more expensive compared to buying own-brand supermarket toilet roll in plastic packaging, but for me it is one of my favourite swaps!

Soap Bars Switching from plastic bottles of hand-wash to bars of soap (unpackaged or in recyclable packaging) was an easy swap and I personally don’t find it any more expensive. Soap bars have also replaced my plastic bottles of shower gel too.

Safety Razor I used to buy disposable, plastic razors but now I use a metal safety razor with disposable blades which I can recycle. I have had the same razor now for years and it is swtill in excellent condition. This swap has definitely saved me a lot of money and stopped hundreds of plastic razors (and packaging) from ending up in landfill.

Zero Waste Pets I used to feed my cat on food which was packaged in unrecylable plastic. The amount of waste they produced really bothered me so I began searching for more sustainable alternatives. I have since changed her to the Lily’s Kitchen dry diet. Not only is it a great food (made in Britain) and suits her well, but Lily’s Kitchen are an ethical pet food company. The food comes in compostable packaging which goes straight in my compost bin to break down. The cat litter I now use is Ecograin cat litter which is 100% natural and biodegradable and comes in paper packaging. I also have a Beco bamboo litter tray which I have had for years and it is still in great condition. You can read the rest of Merryn’s blogs here.

ADVERTISING FEATURE

Neptra® has launched in the UK – how can it help you overcome common otitis challenges? Neptra®, the single dose treatment for acute otitis externa in dogs is now available to UK vets after becoming the number one selling treatment for acute otitis externa in the US under the name Claro1.* Ken Kwochka, DVM, DACVD, President of the World Association for Veterinary Dermatology, reflects on what we can learn from our American colleagues about using the product most effectively to overcome common otitis treatment challenges.

Solving the compliance challenge Across the hundreds of practices I have visited in the US, frustration from persistent or recurrent canine otitis externa (OE) used to be all too familiar for first opinion vets. And the central challenge was always the same – reliance on owner application of treatment for a successful outcome. However, four years ago, vets regained control of OE treatment when Neptra’s US counterpart was launched. By administering a single dose in the practice, they were able to bypass the compliance issue and relieve owners of the treatment burden. I think it’s fair to say it’s been revolutionary for vets, pets and owners. “I’ve seen vets in the US go from being initially sceptical that a single dose product could be effective and replace the need for a lengthy home treatment course; to it being their product of choice for everyday cases.” But this transition hasn’t happened overnight – getting used to a new product takes time. There are a few key learnings from our US experience which can help you be confident you’re taking the best approach to treatment selection and management of acute OE.

Do cytology – every time! Treatment choice should be based on cytology, which should be done for every acute otitis case. Why guess when a diagnosis takes 10 minutes? It also enables you to monitor cytological response at recheck, get nurses involved and it can be a great revenue driver – all while supporting good medical practice.

70-90 % of the time in first-line acute cases you’ll see spherical coccoid bacteria signifying the presence of Staphylococcus pseudintermedius and/or snow-shoe shaped organisms indicating Malassezia pachydermatis.2 Based on cytology results, you should then choose a narrowspectrum product that’s effective against these organisms.

Choose appropriate first-line actives Too often in the past through no fault of our own, we’ve used inappropriate, broad-spectrum formulations for first-line cases – those which should be reserved for use against our more resistant gram-negative infections. The beauty of florfenicol, Neptra’s antimicrobial component, is its relatively narrow-spectrum action against S. pseudintermedius while being a ‘niche’ antimicrobial that’s not needed for other diseases in companion animal medicine, making it a responsible choice. The antifungal agent, terbinafine, when used topically is highly effective against M. pachydermatis and the anti-inflammatory component, mometasone furoate, is the most potent topical steroid available in veterinary otic formulations but is also rapidly metabolised. So Neptra is an ideal first-line choice for most common cases. “Initially in the US vets were reserving the product for difficult cases when it should be used for your everyday cases. It’s vital that vets in the UK feel confident to use Neptra for the majority of their cases - not save it for the difficult minority.”

Evaluate ease as well as efficacy Achieving sufficient treatment volume can be challenging with traditional OE medications, especially when the owner is applying treatment at home. However, it’s crucial that any topical treatment delivers enough volume to coat and fill the ear canals to resolve the infection. We find that vets like the convenience of Neptra’s premeasured 1ml dose which is suitable for dogs of all breeds and its aqueous consistency that’s easy to get into the horizontal canal. And because it doesn’t need refrigeration, it can be grabbed off the shelf and administrated without pre-warming.

Don’t underestimate the client challenge It’s easy to underestimate how challenging owners find treating their dog at home. Even the most well-meaning, committed owner can struggle but won’t necessarily admit this to their vet. And even if the owner thinks they can administer the treatment, it doesn’t mean they want to! When asked, 70% of owners will choose a single-dose, vet-administered treatment over home treatments.3 They appreciate that this helps protect the bond with their pet. I’ve seen it help many practice-client relationships too, especially where clients might have had bad experiences with OE treatment in the past. Over the past four years, it’s been really satisfying to see treatment of acute OE transformed from what’s historically been a negative experience, to an overwhelmingly positive one. And I’m excited that now UK vets can benefit too.

References: 1. North American sales figures MAT Dec 2019. 2. Malayeri HZ, et al.: Vet Res Commun 2010,34:435. Bouza-Rapti P, et al.: Vet Dermatol 2016,27:106. Ngo J, et al.: Vet Dermatol 2018,29:425. Angus J. Vet Clin North Am Small Anim 2004,34:411. Crespo MJ, et al.: Med Mycol 2002,40:115. 3. Owner Compliance Evaluation, June 2019, n=2000 dog owners from FR/IT/ES/DE/NL/BE/UK/AU.

Use Medicines Responsibly. *Claro ® (North American name) is the same product as Neptra®. Neptra contains 16.7 mg florfenicol, 16.7 mg terbinafine hydrochloride, equivalent to terbinafine base: 14.9 mg, and 2.2 mg mometasone furoate POM-V UK. Advice should be sought from the medicine prescriber. Further information from the datasheet at www.noahcompendium.co.uk or on request. ®Registered Trade Mark of Bayer AG. Bayer plc, 400 South Oak Way, Green Park, Reading, RG2 6AD. Tel: 0118 206 3000. L.GB.MKT.03.2020.21237

WEBINAR EVERYTHING YOU ALWAYS WANTED TO KNOW ABOUT SMALL MAMMALS. EXPLAINED BY JOHN CHITTY (BUT WEREN’T AFRAID TO ASK)

JOHN CHITTY BVetMed CertZooMed MRCVS

David’s Review John Chitty is a RCVS Advanced Practitioner in Zoological Medicine. He qualified from the Royal Veterinary College in 1990 and gained RCVS Certificate in Zoological Medicine in 2000 and is CoDirector of a small animal/ exotics practice in Andover, Hampshire with a 100% avian/ exotics/ small mammal caseload- referral and first opinion. John is the Author of various book chapters and papers on a range of species and was President of European Association of Avian Veterinarians 2015-17, on the editorial board of the Journal of Exotic Pet Medicine and President of the British Small Animal Veterinary Association 2017-18.

his veterinary webinar is quite different. Instead of the speaker writing to a set subject, colleagues were invited to send in their questions in advance to which John would then respond. So effectively an audience generated webinar. This resulted in a very interesting session and very wide ranging. John really had to work on this one and wasn’t let off the hook at the end as the questions kept on coming in. The last one partially stumped him-but this was live so one of the participants helped him with the answer-I strongly suspect google generated because I was a few seconds behind with the same solution! John is a great enthusiast and happy to tap into his audience experience and invites colleagues to contact him-either for free advice or to provide information about their own cases. What followed was a huge amount on a variety of topics with a lot of tips and general advice. I will give some idea of what was covered here but as there is so much I can only give you a flavour while strongly advising you to watch the webinar if you have an interest in small mammals. John begins with some suggested reference sources such as the BSAVA formulary and Manual on Exotic Pets (now in its 5th edition). It’s difficult to imagine the first opinion practitioner needing moreespecially with WebinarVet including more and more material on exotics. There is some general advice on how useful (or not) biological data is in practice, and to consider remote monitoring by the owner. John doesn’t advise on drug doses and

always recommends using a reliable source such as the BSAVA formulary. Can rabbits and guinea pigs live together, better phrased as can or should? Should not is the standard answer but vets are frequently confronted with a fait accompli. There are some general management suggestions before moving on to managing blocked tear ducts in rabbits. Some good quality x rays illustrate how dacryocystitis comes about. Flushing the tear ducts provides symptomatic relief but does not address underlying disease, which therefore must be investigated. This will involve radiography and CT scanning where available. Advice is given on tear duct stenosis, including the use of small metal tubes. Degus are increasingly popular as pets. They are quite large hystricomorphic South American rodents. Two hazards are biting and tail slip. A bonus though is that they sing, (It’s true-I checked it on YouTube!) In this section anaesthesia, routine neutering, dental disease, cataracts, respiratory, cardiac and neoplastic conditions are covered before a quite detailed discussion on the use of antibiotics in small animals. John explains where the cascade system fits in including the exemption scheme. Diagnosing bacterial infection in these species is not always easy. The difficulties of culture and sensitivity are well summarised by a series of questions: •Likely to find pathogens? •Likely to find commensals

•Likely to get contamination? •Likely to find anything? •Aerobic v anaerobic •Significance of results and where the sample was taken from •Are the results relevant? This brings us to a pragmatic approach on first use of antibiotics with basic drugs. Those suggested are trimethoprim sulphonamides, tetracyclines, basic penicillins,(injectable) metronidazole and first and second generation cephalosporins. Rabbit abscesses are discussed together with the significance of Pasteurella. The possible causes of antibiotic failure are listed: Consider •Dose rate •Penetration of drug •Drug activity •Failure of culture/sensitivity •Underlying causes •Chronicity

A section on neutering ferrets outlines the problem with adrenal disease and how Desrolin implants can be used instead of surgery, and also following castration if adrenal disease develops. A couple of slides summarised current information on Cushing’s disease in hamsters, which will be familiar to many. I wonder how many colleagues are seeing increasing numbers of African pygmy hedgehogs on the other hand. I started from a base of zero knowledge so I found this part of the webinar fascinating. Diet, as always with exotic species is important, and something owners frequently get wrong. There is a list of suitable ingredients to feed these animals on and a general warning in capitals to ‘beware of obesity.’ The radiograph that follows this statement is unbelievable-just see it for yourself. It had not occurred to me before how valuable a simple lateral x ray can be to diagnose obesity. Not surprising then that tumours are quite common too, as are heart disease and arthritis, both of which are diagnosed by radiographs. There were some interesting thoughts on whether corticosteroids are of any use in the treatment of E.cuniculi and struvite crystals in rats. John has not seen these and asked for help from anyone who has-inevitably help was at hand at the end of the webinar.

There is a comprehensive section on neutering in rabbits and guinea pigs asking ‘Why do we do it?’ There are plenty of pitfalls. Those mentioned here include anaesthetic risks, and with guinea pigs ‘only if you have to?’ There is quite a long list of post castration issues in guinea pigs discussed -to be aware of.

The webinar finishes with a comprehensive account of respiratory disease in rats-a very good update. There is a very lively Q&A session –not to be missed as suggested at the beginning of his summary. Hats off to John-this webinar is very entertaining and educational with lots of enthusiasmsomething we need right now.

Rabbit castration is described with various anaesthetic protocols including one to use if oxygen isn’t available.

You can watch this webinar here.

https://www.thewebinarvet.com/pages/royal-canin-gastrointestinal-virtual-congress/

WEBINAR 10 THINGS YOU NEED TO KNOW ABOUT GUINEA PIGS LIVIA BENATO DVM MSCR CERT ZOOMED DIP ECZM (SMALL ANIMALS) MRCVS

hese mini veterinary webinars are a great idea. They can easily be accessed in a lunch break, for example, particularly in this case if a guinea pig consultation is scheduled in the afternoon! The webinar takes just over half an hour of your time and is packed full of useful information. Even colleagues with experience of guinea pig medicine will find some useful tips. Livia is well qualified to present the webinar, as you can see from her qualifications. She lectures clearly in English. The webinar begins with some basic information on husbandry with advice on pen size, the need to provide hides and a reminder of the need for vitamin C. Some examples of plant sources rich in this vitamin are given with another reminder that guinea pigs like their routine. It is well known that guinea pigs are gregarious animals and need at least one companion guinea pig. This is good for reduction of stress and bonding by grooming each other, for example. Guinea pigs are no different from any other species that we deal with in many aspects. For example, knowledge of what is normal is valuable. This, of course, could be obtained by owning guinea pigs, but later Livia in the webinar advocates 6 monthly checkups, and over time a vet would accumulate lots of information on individual and general guinea pig behaviour. For the owner this applies equally, because one of the first signs of disease is often a reduction in activity. Physical examination following observation in the cage is ‘head to tail’. Livia introduces us to the very useful aid to bodily condition, which is available on

the web, and designed to help owners evaluate the condition of their guinea pigs. This is the ‘Guinea pig Size -0-Meter’. This would be a good graph to download and have available in the consultation room. www.pfma.org.uk/guinea-pig-size-ometer It is a particularly valuable resource, because obesity is a common problem due to incorrect diet, excessive food, daily treats, and a lack of space for exercise. Obesity can lead to pododermatitis, urine scalding, hepatic lipidosis, pregnancy toxaemia, increased incidence of cardiac diseases and, as you might expect, a reduced life expectancy. Incorrect diet can also lead to dental disease. Diets rich in starch and low in abrasive fibre are the most important culprits. Trauma, infections, and congenital malformations also play a part. Investigation of dental disease in guinea pigs often involves radiography and computed tomography if available, both requiring general anesthesia. Ovarian cysts are very common along with endometrial hyperplasia (a gigantic uterus is on display in this section). Uterine neoplasia is also quite common, and therefore neutering at an early age is advisable. Bilateral flank ovariectomy is the most common procedure, although more experienced surgeons may elect to perform the procedure via a single flank incision. A useful line diagram illustrates the landmarks for the surgical approach. Another condition requiring surgical treatment gets a mention next along with a radiograph demonstrating the problem. This is urolithiasis and there are some

practical tips. The final disease in the webinar is mite infestation, which in severe cases may manifest as seizures, along with severe pruritus. Often considered a secondary problem, it is therefore important to look for suboptimal management or the presence of chronic conditions. Two drugs are mentioned in the treatment of mites. These are ivermectin for its acaricidal effect and midazolam to induce sedation where necessary. The last slide cites a 2017 publication of an evaluation of drugs for use in pain relief in this species. This lists in table form the drug, its dose, and some excellent information on behaviours indicating pain. The drugs mentioned here are meloxicam, carprofen, buprenorphine, butorphanol and tramadol. This is another slide worth downloading and keeping to hand in the consulting room. The Yorkshire pet food manufacturer Burgess Pet Care generously sponsored this very informative webinar. There is a charming introduction at the beginning of the webinar to the company, which goes back a few hundred years, and then some information on new products, including a new cat food. The company is a great source of valuable information on the correct feeding of guinea pigs, and can also supply to owners a complete package. This company is a very good friend to the veterinary profession and to owners of small furry pets in particular. The website is packed with information for vets and their clients. www.burgesspetcare.com You can watch this webinar here.

Effectiveness of a Dietetic Dermatologic Food on Pruritus in Atopic Dogs‡ Becvarova I.1, Meyer H.1, Witzel A. L. 2 , Murphy M. 2 , Werre S. R. 3, Cadiergues M. C.4

INTRODUCTION

RESULTS

dogs met inclusion criteria June

July

weeks exclusively fed Derm Defense

Eligibility

ectoparasites or skin infections

> – 5/8 Favrot's criteria displayed5

standard CAD therapies if constant during the 8 weeks

Fig. 1 70

Dermatological site score

The median total dermatological site score assessed by veterinarians was significantly lower at 4 weeks and at 8 weeks (*p-values < 0.05) when compared to baseline. Using a scale from 0 (normal) – 4 (severe), veterinarians evaluated the presence and severity of erythema, lichenification, excoriations, and alopecia in 12 body regions (Fig. 1). Owner assessments of skin condition showed significant improvements in least squared mean (LSM) of pruritus/scratching of all skin and ears, erythema/redness and licking at 4 weeks and of pruritus/scratching of all skin and ears and erythema/redness at 8 weeks (*p-values < 0.05) when compared to baseline (Fig. 2).

* 50 40 30

20 10 0

Baseline

Week 4

Week 8

8 Fig. 2

Baseline

Incidence of skin condition 0 (not present) – 10 (always present)

The study

European countries

Canine atopic dermatitis (CAD) is characterised by a vicious cycle of inflammation, pruritus and excoriation, leading to repeated skin damage. It is often a lifelong problem. This study sought to determine if a food designed to improve skin barrier function and lower inflammation (Prescription Diet Derm Defense Canine) would reduce pruritus and clinical severity in client-owned atopic dogs.

Week 4

Week 8

6 5 4

* *

2 1 0

Pruritis

Licking

Ear scratching

Erythema

Exclusions

Supplements: fatty acids (FA), glucosamine & chondroitin sulfate, antioxidants

Major systemic disease Food allergy

Food acceptance and enjoyment was rated by pet owners as very good to excellent at weeks 4 and 8.

CONCLUSION Dogs demonstrated marked improvement as reported by both pet owners and veterinarians (although a placebo effect cannot be ruled out). The results of this study support the clinical benefits of feeding specially formulated dermatologic food in addition to standard medical management, since the clinical picture of the dogs has improved without any changes in medical management during the study period. Data were analyzed using Friedman’s Chi-square (veterinarian scores) and mixed model ANOVA (owner assessments).

WEBINAR TOWARDS THE ELIMINATION OF RABIES SARAH CLEAVELAND UNIVERSITY OF GLASGOW

his is a truly one health webinar by one of the leading experts on rabies worldwide. Sarah’s qualifications speak for themselves, and I will mention these at the end of this summary. Throughout this excellent webinar her passion and clarity of expression are inspirational. A webinar not to miss! This also applies to our Spanish-speaking colleagues, as there are professionally produced subtitles in Spanish. Sarah begins by emphasising that rabies is an ancient disease known for thousands of years, with the signs and the link with ‘mad’ dogs long understood. Some of the remedies lacked evidence based medicine including putting a hair of the mad dog in the wound inflicted on its victim. From whence comes the expression ‘hair of the dog’. Not just for a hangover then. There are many different species of Lyssavirus species and these are listed together with their distribution in the world and whether they are capable of causing human deaths. Further classification into 3 phylogroups follows. Rabies has a very wide footprint throughout the world and it is capable of infecting many mammals and several host species have been implicated as reservoir hosts. We are taken through the typical passage of the virus once it has been inoculated into an animal. Initially it is taken up by muscles and peripheral nerves and at this stage it is still vulnerable to attack by the immune system. But once it spreads to the CNS the animal will almost always die. When the virus reaches the brain, with massive replication, clinical signs

appear. The incubation period is very variable with death usually occurring within 7 days of the onset of clinical signs. The clinical signs in humans are listed. These are: •Change of behaviour •Agitation, aggression, biting •Muscle tremors, incoordination, seizures •Hydrophobia, aerophobia (not in animals) •Paralysis, coma and death There is a harrowing photograph of a dying child, attended by his helpless paediatrician, exhibiting the response to a breath of air, which is similar to that produced by exposure to water. There are some statistics concerning vaccination in humans including post-exposure prophylaxis (PEP). 29 million people are treated per year at a cost of $1.7 billion/year. A course of vaccination needs to begin within 24 hours of exposure. Official results greatly underestimate the true burden of rabies and the reasons for this are explored, but taking just Tanzania as an example, it is thought that the number of deaths from rabies is 100 times that officially reported. The global burden of rabies is considerable with annual deaths from rabies between 59,000 and 159,000, or looking at it another way -150 human lives lost every day. Every hour more than 3,000 people in rabiesendemic countries are faced with life threatening emergencies when bitten by dogs -horrible statistics. This is particularly the case in Africa and India and in stark contrast with Latin America, where recent figures are 182 deaths. Lessons from this are explored later in the webinar. In rabies endemic countries it is overwhelmingly poor communities that suffer the most, with inadequate access to health care or simply being unable to afford PEP. More harrowing photos show wounds inflicted on a man by his rabies infected daughter, and an entire family in contact with a

rabid puppy. They were lucky because the research team was able to support the family in getting PEP, but many thousands are not so lucky. We are asked about the consequences of doing nothing about rabies now. The answers are succinct: •Over 1 million people will die of rabies before 2030 in the 67 rabiesendemic countries •Demand for human PEP will continue to escalate A powerful argument for a one-health solution to the problem advocates PEP access alongside scaling up mass dog vaccination. Mass dog vaccination protects those who struggle to access PEP and is the only way to eliminate canine rabies. Graphs show that PEP +dog vaccination dramatically reduces human death toll. There are heartening photos of large orderly queues of villagers waiting to have their dogs vaccinated. Equally heartening is the news that there is a worldwide political consensus agreement for reaching a target of zero human deaths from dogmediated rabies by 2030. Valuable lessons learnt from Latin America are that data from 2015 identified 182 human deaths in the entire continent compared to 37,300 deaths in Asia over the same period. The difference between the two figures is that there has been much more canine vaccination along with human PEP in Latin America. It is a model that shows quite clearly that canine rabies can be eliminated and deaths in humans potentially brought to zero. Several common misperceptions have hampered progress in dog rabies control in Africa and Asia. Examples are: •Rabies in wildlife makes it futile to control or eliminate rabies in dogs •There are too many stray dogs in Africa and Asia •It would be impossible to vaccinate enough dogs

•It would be too expensive to vaccinate enough dogs Sarah’s research group undertook sophisticated studies identifying infection reservoirs integrating several lines of evidence. These were epidemiological studies, phylogenetic studies and intervention studies in the Serengeti. They are described in detail in the webinar. The conclusion of this work found no evidence for independent wildlife cycles. There are some astonishing photos of a rabid dog attacking a lion and locking on to its lower jaw. The locking on is a feature of rabid dog bites, which unsurprisingly produce horrendous wounds. The lion appears perplexed as he is probably not accustomed to this sort of canine behaviour, and he eventually trots off-no doubt to a very unpleasant death. Results of studies confirm that the dog is by far the major rabies reservoir and transmission of the virus to wildlife and humans can be prevented by a mass campaign of dog vaccination. The misconception about too many stray dogs is dealt a blow by the next series of photographs showing a very orderly line of dogs waiting to be vaccinated. Although many dogs appear to be strays, in reality there is usually one person willing to take care of it, often a child who is able to control it well. We are asked what level of vaccination coverage is needed to protect against a viral disease. The answer is that it depends on its transmissibility (Ro). We have all heard about Ro with the ongoing coronavirus crisis. Here it is explained very clearly •The more transmissible the virus the higher the value of Ro •The higher the value of R0 the higher the proportion of the population that needs to be vaccinated to control the disease

apart from major animal welfare implications. Empirical data support the arguments made previously. In the Serengeti, where dog rabies has been controlled, rabies in wildlife has also disappeared. Can we reach 70% coverage? Sarah is absolutely confident that we can, bearing in mind that, as mentioned before, even apparent ‘street dogs’ very often have someone in the household with an interest in their welfare. An interesting aside is the popular names given to these dogs. ‘Obama’ was a favourite, replaced by ‘Bush’ and now increasingly ‘Trump!’ Another important point, born out by research, is that dogs of all ages can be successfully vaccinated and mount an effective immune response. The remainder of this excellent and thought-provoking webinar deals with planning and outlining what is required to reach zero canine rabies by 2030. Sarah also touches on the broader benefits to health systems along the ‘One Health’ theme, including providing a platform for surveillance of Guinea Worm in dogs, and integrated dog vaccination and treatment of people against soil -based helminths. In summary Sarah asks ‘Can we eliminate rabies?’ In answer to this she states: •We have the evidence, tools, partnerships and strategies to eliminate human and canine rabies •We have high level commitment and support •We now have to scale up and coordinate activities •It can and must be done!

For me one of the most powerful messages is next. It compares the Ro values with some important viruses as follows: -

This was spoken from the heart and will, I am sure, make a substantial impression on all who listen to the webinar. Sarah speaks with great clarity and I was spell bound throughout. She modestly doesn’t include her qualifications in the webinar title, and as I mentioned at the beginning of this summary, they speak for themselves. I’ll include some information here as it gives an insight to a remarkable colleague.

Smallpox…………….3-5

Professor Sarah Cleaveland

Rinderpest………….5 (approximately)

OBE BSc MA VetMB PhD FMedSci FRSE FRS MRCVS

•To achieve control vaccination needs to bring the value of R0 to less than 1.

Measles……………….10-15 Polio……………………5-7 Rabies………………..1-2 It seems obvious from these values that the elimination of canine rabies should be feasible from mass dog vaccination, especially considering that two diseases from the above list have been eliminated, and one is nearly so. Furthermore the Ro values for rabies throughout the world are remarkably constant, indicating that 70% campaign coverage should be effective. A powerful series of arguments are made about the ineffectiveness of dog culling with an equally powerful picture of a massive pile of dead dogs. Culled dogs are rapidly replaced in practice,

Professor of Comparative Epidemiology Institute of Biodiversity, Animal Health & Comparative Medicine University Of Glasgow A large part of her work has involved the initiation of mass rabies vaccination programmes for domestic dogs in the Serengeti, which has not only indirectly prevented hundreds of human deaths, but also protected wildlife species such as the endangered African wild dog. It confirmed the feasibility of eliminating rabies in Tanzania, enabling her to make a pivotal contribution to the development of international strategies for global rabies elimination. You can watch this webinar here.

WEBINAR INFLAMMATORY LIVER DISEASE: DIAGNOSIS AND TREATMENT OF CHOLANGITIS IN CATS

JAMES MCMURROUGH BVSC CERTAVP(SAM) CERT AVP (VC) MRCVS

ames begins his veterinary webinar by stating that inflammatory hepatobiliary diseases are the most common feline hepatic conditions in the UK. They are a common cause of morbidity (but infrequently mortality) in cats. Biliary diseases can be classified as cholestasis, biliary cysts, cholangitis, and cholecystitis. This webinar is mainly concerning cholangitis, which can also be considered as feline inflammatory liver disease. There are four main categories of cholangitis. These are: •Neutrophilic •Lymphocytic •Destructive (primarily dogs) •Liver fluke associated Other differentials for hepatobiliary disease in cats include •Hepatic lipidosis (primary or secondary) •Infectious disease (FeLv, FIP, Toxoplasmosis) •Hepatobiliary neoplasia •Amyloidosis •Toxic causes This webinar is mainly about neutrophilic cholangitis, but before getting into detail clinically there is a useful revision of the anatomy and physiology of bile secretion. Included here are its composition and function and its transport pathways to the duodenum. This is summarised by an excellent colour diagram.

More revision follows concerning the hepatic enzymes. There are primary and secondary causes of enzyme elevation and the secondary causes are listed under the general headings of drugs, inflammation, endocrine, and hypoxia. Mild elevations are considered 5 times normal, moderate 10 times and severe more than 10 times. The severe elevations may be seen with feline cholangitis. The hepatic enzymes are divided into hepatocellular markers and cholestatic markers. The hepatocellular markers are alanine aminotransferase (ALT), considered to be the most specific hepatocellular marker, and aspartate aminotransferase (AST) considered to be less specific due to its presence in muscle and red blood cells. There is a marked difference in the half-life of these enzymes when comparing cats to dogs-the values given are quite striking. ALT/AST elevations tend to be highest with inflammation and necrosis, with more modest elevations with neoplasia and biliary tract disease. The elevations in themselves are not prognostic. Cholestatic markers described here are alkaline phosphate (ALP) and gamma-glutamyl transpeptidase (GGT). ALP is attached to cell membranes and released when there is cholestasis due to the detergent effects of bile ducts. As with the hepatocellular makers there are marked differences in the halflife between dogs and cats, which need to be taken into consideration when interpreting values. The proportion of elevation of cholestatic versus hepatocellular markers can

be useful. Also discussed are low blood urea nitrogen, hypoglycaemia (seen with more than 75% loss of liver function), hypoalbuminaemia, hypercholesterolemia, and hyperbilirubinemia. There is a role for the bile acid stimulation test, Clotting factors (apart from V111) may be altered in hepatic dysfunction leading to increases in both prothrombin time(PT) and activated partial thromboplastin time (aPTT). However, spontaneous bleeding is rare. Neutrophilic cholangitis is further divided into acute and chronic forms. The acute form used to be called suppurative cholangitis. It is a bacterial inflammation most likely acquired via the common bile duct as an ascending infection from the small intestine, although another theory proposed would involve the portal system. A revision slide, with a simple but informative line diagram reminds us of the term ‘triaditis.’ This occurs when there is concurrent inflammation of the pancreas, liver and small intestine. It may have infectious, autoimmune or physical causes. It is considered to be more common in cats because they have a dual entry of common bile and pancreatic ducts into the duodenal papillae, and a reportedly higher bacterial colonisation of the duodenum. Some clinical features of neutrophilic cholangitis are discussed. It rarely results in liver failure and is more common in young to middle aged (median 9 years old) cats. A typical history could include decreased appetite or anorexia,

vomiting, weight loss and occasionally jaundice. Physical examination is sometimes unremarkable. Some typical blood results from complete blood count, biochemistry and bile duct stimulation are listed. Further diagnostic evaluation usefully involves ultrasonography with two very clear images and in some cases, although of less value, radiography. Histopathology is required for definitive diagnosis and also cholecystocentesis. For hepatic biopsy a laparotomy is advised enabling wedge sample to be taken for cytology, culture and sensitivity. Surgeons get a look in when there are choleliths or complete biliary obstruction. When bile culture is undertaken most cats have a single pathogen isolated, commonly E. coli but there are other possibilities and these are listed. The cornerstone of therapy is with antibiotics based on culture and sensitivity. Often this is with amoxyclavulanic acid +/- metronidazole, and while the optimum duration of activity is uncertain 3-5 weeks is recommended. Appropriate supportive care includes intravenous fluid therapy, nutrition, analgesia and a highly digestible moderate fat diet. Three useful supportive drug therapies are well summarised, including mode of action and suggested dosing. These are ursodeoxycholic acid

(destolit), S-adenosyl-methionine (SAMe), N-acetyl cysteine and silymarin. The prognosis with acute disease is good with median survival times of 29 months although some cats can live for many years. Poorer outcomes are associated with concurrent disease such as pancreatitis, and chronic inflammatory enteropathy (formerly described as inflammatory bowel disease). There is a brief summary of chronic neutrophilic cholangitis in which there is fibrosis and bile duct proliferation. Antibiotics are used based on culture but may be combined with anti-inflammatory doses of prednisolone. The final part describes lymphocytic cholangitis. This disease is caused most probably by immune mediated mechanisms. Also possibly incriminated are H. pylori and Bartonellosis. It can be confused with hepatic lymphoma and the diagnosis is by histopathological examination and immunophenotyping. A definitive histopathological diagnosis is necessary as the treatment is with immunosuppressive doses of prednisolone. Otherwise these cases benefit from supportive care as for neutrophilic cholangitis. The prognosis is generally good with a median survival time of around 3 years. You can watch this webinar here.

Orthomed are delighted to announce the launch of their new neurologic brand â&#x20AC;&#x201C; neuromed. This new brand of products and education is the culmination of a significant amount of clinical and engineering collaboration to create a range of solutions focused on the under-served neurology and neurosurgical needs of veterinary medicine The ethos of the neuromed brand focuses on high quality products, support and training backed by a team that all have the same goals; better patient welfare, increase owners trust and install confidence with the surgeons. Over the coming weeks and months, Orthomed will be sharing short videos from our Key Opinion Leaders about new products and neurologic topics. You can sign up to these by visiting: www.neuromedvet.co

From the Literature – May’20 In the latest edition of the Australian Veterinary Journal (always worth looking at) is a retrospective analysis of 736 (!) cases of gastric dilatation and volvulus by K. Song and others.

Retrospective analysis of 736 cases of canine gastric dilatation and volvulus K. Song, SE Goldsmid, J Lee and DJ Simpson 06 April 2020

his article, written by specialist surgeons from an Australian referral veterinary hospital aimed to identify factors influencing the survival of confirmed GDV cases referred to them. Of the 736 dogs 276 were ‘humanely killed’ and the remaining 460 were surgically treated. A large number of varying factors were analysed. The survival rates of patients operated on by general surgeons and specialists were 81.7% and 88.7% respectively. Both incisional gastropexy and belt loop gastropexy were clinically effective in treating GDV, with no significant difference in survival rates. Intraoperative mortality rates for general surgeons and specialists were 7% and 2.9% respectively. The odds of mortality in dogs operated on by general surgeons were 2.03 times those operated on by specialists. Other mortality odds were considered. Dogs presented between 3 am and 9 am were 3.57 times more likely to die following the procedure than

those presented between 9 am and 9 pm. Virtually all my cases seemed from memory to have occurred in the former time slot! The odds of mortality in dogs where the duration from presentation to completion of surgery was more than 3 hours were 2.53 those of dogs where time lapsed was less than 3 hours The authors concluded that survival rate was better when: •Admission time was during the day •Dogs were operated on by specialists •Clinicians aimed to stabilise and complete the surgery as soon as possible

In the March 2020 edition of Veterinary Clinics: Small Animal Practice is an article on chronic rhinitis

Chronic Rhinitis in the Cat Veterinary Clinics: Small animal Practice Volume 50 Issue 2 pages 311-329 Nicki Reed BVM&S Cert VR MRCVS Veterinary Specialists Scotland

his is a comprehensive study, as is to be expected with this journal. The main points covered in this article are that: Around 35% of feline nasal disorders can be attributed to chronic rhinitis

The most common initiating factor is feline herpes virus 1 (FHC-1), which initiates turbinate damage. Inhaled allergens may contribute, although evidence for this is unclear at present Secondary microbial infection contributes to the clinical picture, although precise agents are not clearly established. Another excellent journal worth visiting every month is the Journal of Feline Medicine and Surgery Open Reports. There are always interesting case reports and they are open access. The latest edition has some interesting cases, including a very unusual presentation of Cryptococcus neoformans complete with a set of high quality photographs, and an equally unusual presentation of a case of feline toxoplasmosis, which I summarise here.

Lameness, generalised myopathy and myalgia in an adult cat with toxoplasmosis Journal of Feline Medicine and Surgery Open Reports Volume 6 issue 1 March 2020 Daniel R Butts, Sorrel Langley-Hobbs

his is a case that had been on-going for 18 months before referral to the authors. The cat was a 2-year-old neutered female DSH with a history of intermittent lameness on all four limbs. When first seen on referral the cat was lame on all four limbs, and alternated between toe walking, walking on the dorsal aspect of the carpi or adopting a hunched posture. Hissing while walking was another feature and the cat would lie down tentatively. Unsurprisingly the cat seemed to be happiest when lying down. Otherwise when not lying down the cat

would avoid putting weight on the front limbs and instead adopt a kangaroo stance. Physical examination was resented in general, but the main pain loci were the calcaneus bone and the Achilles tendon on both sides. Investigations subsequently revealed an elevated creatine kinase, a positive Toxoplasma gondii IgG titre, and toxic neutrophilic inflammation within the Achilles tendon bursae. A chronic diffuse myelopathy was established by nerve conduction velocity studies and histopathological examination. Treatment was initiated with a six -week course of clindamycin. What is particularly impressive about this case was that considering the period of 18 months that the cat was suffering from joint pain, within just 3 days of treatment the cat had improved. Full clinical resolution was noted at 3 months and after a 20-month follow up the cat remained clinically normal. The journal is full of cases like this and worth a regular visit as I mentioned above -and completely free.