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J A N U A R Y 2 0 1 9

The Webinar Gazette

To your CPD success

Anthony

I hope you had a fabulous break for Christmas and that on-call was not too stressful - if you found yourself on call. It was reasonably quiet for me. We had had a very busy autumn,

so it was good to rest and recuperate. Having said that, doing nothing can be exhausting! It’s nice to be back in and looking forward to VC19 which should have about 9000 delegates which includes 3000 places for vets in developing countries as part of our One4One initiative. Those of you who bought tickets should be proud that you are making it easy for vets in other, less developed areas to watch our high-quality content.

As always, we have some really interesting content to entice you with, some of which is paid and some free. I became a real advocate against single use plastic last year. Part of the reason was meeting three influential women during the year who are doing amazing work trying to wean us off our addiction to plastic, which often ends up in the sea and then kills marine animals. I’ve worked hard to reduce the business’s carbon footprint and my own this year including improving recycling processes. I would love you to come to our keynote talk on Saturday morning at Virtual Congress and get behind the movement to transform our oceans and seas. It’s so important for the future and it starts with all of us as individuals.

Register for our keynote session on Saturday 19th January for free here.

We also will be running the Mind Matters Initiative symposium again on Friday 18th. This year we are looking at positive mindset. I think it’s going to be brilliant! It’s free to anyone involved in the veterinary industry. I don’t like negativity, as I believe it sucks energy out of the negative person and those around them. This will be a real tonic for anyone suffering the mid-winter blues.

Register for the RCVS Mind Matters symposium here.

We also have a One Health symposium and symposium on feline oncology on Friday daytime which is free for members of the New Zealand Veterinary Association, Philippines Veterinary Association, Maltese Veterinary Association and, of course, the British Veterinary Association. Doug Thamm and Radford Davis are amongst the world class speakers.

Register for the BVA Associations Day here.

On Saturday, we will be covering small animal topics and management. On Sunday, we will be covering equine and cattle topics. Check the schedule for more information. If you are a member of The Webinar Vet, you get access to the whole Congress as part of your membership and we would love to see you there.

I do hope that 2019 is a great year for you. Thanks to all those supporting our One4One initiative!

We’d be somewhat remiss if we didn’t place the isoflurane shortage in the centre of this week’s news focus. You’ll undoubtedly have much of the information already, but

for those who have been out of the loop, there is an issue with the supply of the anaesthetic gas isoflurane, due to a mechanical issue on a production line. According to Zoetis, which provides two thirds of the UK’s isoflurane, the shortage will last until March.

BVA President Simon Doherty said:

“We are aware that there are significant problems with the supply chain for isoflurane and we are hearing some worrying reports that suppliers are asking vets to postpone routine operations. Prioritising cases may be a useful precaution, but it is not a long-term solution. It is essential animal health and welfare are not compromised by these supply problems and we would urge all suppliers to seek alternative sources as a matter of urgency.

As the situation currently stands, the Veterinary Medicines Directorate has been investigating alternative sources, and there is hope that a specials manufacturer will step in to produce isoflurane. However, this may take a little time to implement, and it could still be weeks, if not months, before the supply is back to normal levels.

In the interim, the VMD has stated that vets mayuse a suitable alternative product authorised outside of the UK to cover their immediate needs, provided it has been approved through an Import Certificate. If, after suitable consideration, you cannot source any valid alternative, it is permissible to use extemporaneous preparation (for those rusty on the terminology, this is where a drug is specially prepared because an appropriate drug is not readily available). This should only be done as a last resort, however, and Carl Bradbrook, Junior Vice President of the Association of Veterinary Anaesthetists, reminded clinicians to “seek advice when considering the use of unfamiliar anaesthetic protocols.”

Before you get that far, first consider the options which are advised by the BSAVA (the below text is verbatim from the BSAVA, and you can find out more information by visiting their website)

Use low flow anaesthesia

Providing you have a capnograph then you can reduce oxygen flows until just at the point where the capnograph doesn’t reach baseline i.e. it is at lowest flow possible. As a rule of thumb with non-rebreathing systems, flow rates should be turned down until the point where the patient would start rebreathing (seen on capnograph) and with some circle systems the flows should be turned down once the patient is ‘stable’, always ensuring the reservoir bag maintains a suitable residual volume.

Consider sevoflurane as an alternative (MAC 2.3). Note however that you need a specific vaporiser for this.

Use full mu opioid agonists (such as methadone, fentanyl or pethidine) in the pre-medication (if appropriate) as this allows a reduction in the required gaseous anaesthesia doses.

Consider closer monitoring to allow the delivered anaesthetic concentration to be turned down. With potent analgesia it is often possible to reduce the delivered isoflurane concentration to very low levels while maintaining an adequate plane of anaesthesia.

Use Total Intravenous Anaesthesia (TIVA) combinations

Following suitable premedication, induction and endotracheal intubation (to protect the airway and allow provision of oxygen via a suitable breathing system) it is acceptable to maintain anaesthesia with intravenous agents using infusions OR intermittent boluses.

Suitable single agents include propofol, alfaxalone, ketamine OR combinations of these with opioids/alpha-2 agonists/benzodiazepines. An intravenous cannula should be placed in all patients.

For short procedures, intermittent bolus maintenance is suitable using small incremental doses of the induction agent (approximately 1/4th of the induction dose) whenever the depth of anaesthesia appears inadequate, or approximately every 10 to 15 minutes. For longer procedures a constant rate infusion using a suitably calibrated syringe driver, or similar device, can be used. The patient should be carefully monitored as respiratory depression may occur during TIVA and intermittent positive pressure ventilation (IPPV) may be required. The duration and quality of recovery may be different following TIVA, but these effects are minimised by the administration of robust premedication.

Examples of suitable protocols include the following:

• Propofol: 0.1-0.4mg/kg/minute IV in dogs and cats (less evidence in cats). In dogs, this has been combined with fentanyl at rates of 0.1 - 0.2µg/kg/minute IV, in which case the lower propofol dose should be used.

• Alfaxalone: 7-9 mg/kg/hour (0.1 – 0.15mg/kg/minute) IV in dogs and 7-11mg/kg/hour IV in cats. In dogs, this has been combined with fentanyl at rates of 0.1 - 0.2µg/kg/minute IV, in which case the lower alfaxalone dose should be used.

• Ketamine: induce anaesthesia with 5 to 10mg/kg IV (usually combined with a benzodiazepine) in dogs and cats then maintain with intermittent boluses (around 2mg/kg IV) given every 10-20 minutes to effect. It may be necessary to augment the ketamine anaesthesia with suitable agents, such as medetomidine/dexmedetomidine or benzodiazepines given every 30 to 40 minutes to offset the poor muscle relaxation observed when using ketamine alone. The frequency of administration will depend on the agent used and the clinical signs observed.

Remember, all these rates are suggestions only and will be affected by the pre-medication used. In particular, the use of alpha-2 agonists such as medetomidine and dexmedetomidine will reduce the requirement for all subsequent agents.

H OT N EWS

Rescuing cats in Morocco has its funny and rewarding 5 mins withmoments! The joy of seeing a sick kitten pull through

and finding it a new, secure loving home is wonderful.

So, here’s how and why I became the accidental cat rescuer! In 2008 I bought a little house in Azemmour, Morocco. I imagined it would be a lovely place to rest, indulge in another culture and enjoy my photography. And then I noticed the cats! Some of course are pets, earning their keep as mousers and are healthy and cared for. But in the streets, there were scrawny females suffering a constant cycle of hunger and reproduction, ragged, war-torn males and so many sick and abandoned kittens - it was heart-breaking. As an animal lover I couldn’t turn my back on their need for help and began by encouraging my local friends to adopt the tiny kittens who were too young to survive alone in the medina. I soon ran out of friends who had no cats!

Sabi was alone, frightened and lost in the medina. He was suffering from cat flu, but underneath his crusted firmly-closed eyes were 2 perfect blue ones! After a week of TLC, nourishing food and eye treatments three times a day, he was well and ready to be adopted. He is now 3 years old and is a much-loved family member.

It took over a year to get the paperwork sorted, but in August 2017 we were finally registered. ERHAM (Effective Rescue to Help Azemmour’s Moggies) means ‘take pity’ in Arabic and that’s the message we are spreading throughout the town to help the cats and kittens. We launched the charity in October 2017 with the ‘Miaow Festival’ to raise awareness for the need for sterilisation and to encourage people to care for and celebrate their cats! Everything was cat-orientated with artists, poets, vets, cat face painting, cat care workshops and even cat rap! It was a great success and people are now enquiring about the next one!

Finding homes for cute, healthy kittens is difficult enough, but for sick ones it’s a different story. Alerted by a friend to two kittens who had been abandoned by a rubbish bin with severe eye infections, I realised that my roof top terrace was about to become a kitten hospital! The two kittens quickly became five and that was it for me – Annie the accidental cat-rescuer.

It’s lovely now to see changes in people’s behaviour towards cats. I see many more water and food bowls in the streets and I am often guided to a cardboard box or cupboard where a poor Mum has been given refuge and is being fed to help her produce enough milk for her hungry kittens. Locals approach me in the street these days. They love their cats but cannot cope with the kittens they constantly produce. I usually visit the house to check that their cat is at the right stage in its cycle to be sterilised and to be sure that the people can’t afford to pay for the operation. ERHAM will sterilise not only street cats but pets whose owners clearly can’t manage to pay vet bills. ERHAM has started its sterilisation programme, focusing at first on female cats to rapidly reduce the population. We will carry out campaigns throughout the year and also run other cat-orientated events to constantly remind people that cats are to be cherished!

ERHAM’s sterilisation programme is run solely on donations from friends, family and cat loving humans - and we need your help! We have sterilised 50 in 8 months, treated and fed hundreds of kittens in the streets, and but would love to increase our programme and intend to do so with regular campaigns throughout the year. If you would like to help to continue or work to help stop the suffering, please donate to www.justgiving.com/crowdfunding/erham or www.paypal.me/ERHAMCATS.

If you would like to join us with our work on the streets of Morocco please message Anne Heslop here: www.facebook.com/ERHAMCATS

For more information about ERHAM, visit their Facebook page here: https://www.facebook.com/ERHAMCATS/

Thanks to Anne Heslop, founder of ERHAM, for highlighting these issues the street cats of Morocco are facing. Our 5 mins with… this month is all about the vital work this charity does for the cats of Azemmour.

ERHAM - Offering Hope to the Street Cats of Morocco

Getting the word out about the difficult lives the street cats and kittens endure in Azemmour was essential, so I made a short film to raise awareness and to fundraise for the project.

It soon became obvious that reducing the population by sterilisation was the only humane way to stop these unwanted, unsupported kittens being born into lives of misery, so I went in search of a vet and cat-loving Moroccans. Together, we formed a charity – ERHAM.

CPD’er of the month

CPDer of the month this month is Guy Edgelow from Natterjacks Vet in Bournemouth – he completed 28 hours of CPD. Here’s what he had to say about The Webinar Vet:

“I have found the Webinar Vet such a great help in enabling me to do my CPD. It is so convenient to be able to do CPD in my own time at home or at work and at any time of day or night especially when juggling a busy work and family life with young children. I found the

majority of webinars interesting, relevant and full of useful tips for general practice.”

Congratulations to Guy, we’re always happy to get such great feedback and to know that we’re helping vets across the community achieve their CPD in the most convenient way for them – we especially enjoy when so much CPD is consumed as we know this leads to more confident vets, which in turn leads to exemplary care for our animals.

NEWS FROM OUR COMMUNITY

“We had five adorable pups at our puppy party at Willen last night. Thor started off very shy but soon came out of his shell 😊. Tillie tried stealing all the treats 😋. Teddy, Harperand Halley all played beautifully together. We are looking forward to seeing them all next week 🐩” – Milton Keynes Veterinary Group Via Facebook. You can find more informationhere: https://www.facebook.com/mkvetgroup

Puppy Party!

Tell us a bit about yourself…

I am an exotics vet in Hampshire and a co-owner of our practice- my caseload is entirely avian/exotics/small mammal, both first and second opinion. I am also a consultant to seven zoological collections; consultant to a commercial lab; and a Defra zoo inspector. I have been active away from the clinic too, with recent roles including Presidencies of BSAVA and the European Association of Avian Vets (though thankfully not at the same time!).

What’s your favourite holiday destination?

My favourite holiday destination is probably anywhere away from work…it’s been a busy year. I do enjoy travelling so probably no single favourite place. However, my favourite holiday has to be a family walking trip in Normandy where we achieved a perfect compromise between their love of walking and my love of eating…we walked between hotel restaurants, while our luggage was driven for us!

What’s your favourite thing to do of a weekend?

Weekends I love cooking…so a day of cooking lunch and prepping some food for the week, while enjoying a decent red and listening to the football/cricket commentary on the radio.

What area do you specialise in?

I am an Advanced Practitioner in zoological medicine.

Why did you choose this career path?

As a career path, it kind of chose me. Originally, I wanted to be a small animal dermatologist, which doesn’t really answer why I started as a farm vet! However, I always had an interest in birds and tortoises, and that side of the practice just grew and grew, and so did my interest. It is a fun area as you are always picking up new stuff that just isn’t in the books (yet!).

Tell us a funny animal story!

Funny stories are hard to relate when I have to consider what is fit for printing! However, probably the dumbest thing I have done was to shin up a wobbling ladder (held by two keepers) to collect a bacteriological swab from a salivary gland abscess in a giraffe (who was none too chuffed with the idea) - halfway up I remembered that I also have vertigo.

Do you have any animal related jokes to share?!

The jokes are either; 1. Definitely unsuitable for print, or 2. Dad jokes.

What do you enjoy most about your job?

I actually like most aspects of the work…and on a day that is slightly less than manic, I genuinely enjoy my clinical work whether operating or consulting. In particular, I have loved learning CT techniques and reading over the last couple of years. Not quite so keen on the management tasks though!

Speaker of the month

John Chitty

the dumbest thing I have done was to shin up a wobbling ladder (held by two keepers) to collect a bacteriological swab from a salivary gland abscess in a giraffe

What are some everyday challenges you face in your profession?

There are many challenges. Clinically, while seeing new and exciting presentations is fun, it can also be a challenge constantly working from first principles. Over the whole practice, there is no doubt that the veterinary industry is under great strain; shortages of experienced vets and RVNs really has an effect in an expanding practice especially one that still does its own on-call.

If you weren’t doing this career, what do you think you would be doing instead?

I’ve never really had plans to do anything other than be a vet- that was my aim from around five years old and I still like being a vet. I’m also not exactly multi-skilled, so if I wasn’t a vet, I’d probably be unemployed.

Are you on social media and happy for people to connect with you? If so, what are your contact details?

I am on social media and while doing the BSAVA Presidency I got a little hooked on Twitter (ideal medium for a 50-year old man!!) and now have my own twitter handle,@johnchittyvet. My kids have (forcibly!) persuaded me not to just rant or constantly bang on about cricket. Instead it is aimed at making people smile by showing some fun cases, odd things at work, and some of things I get up to away from work…and also features my appallingly behaved dachshund, Slug.

EThey also spend millions on sick pay where staff are off with stress or other mental health related issues, many of which can be directly attributed to the work they do. But instead of addressing this, it is largely ignored or given very little priority. In fact, in some areas it’s not spoken about at all as if acknowledging the fact that the work itself could be damaging to an employee’s mental health would be admitting some sort of liability!

What is it about the veterinary profession that makes this the case? Vets do report high levels of stress and there are many theories about the causes which include, poor workplace relationships, career concerns, issues with clients and unrealistic expectations. Rosie Allister, chair of Vet Helpline, points out that ‘the veterinary profession has an occupational culture of perfection and self-sacrifice, independence and omni-competence which is totally unachievable.’

"The natural consequence of stress resulting from caring for and helping traumatised or suffering people or animals" – Charles Figley

Case Study – Animal rescue centre

EF training was asked to go into an organisation by the management and human resources team as they were experiencing some difficulties which they attributed to compassion fatigue within the team. Prior to the training all staff were given a pre-course questionnaire designed to assess their level of compassion fatigue and how they were feeling about their job and the people/animals they were caring for.

Pre-Course Questionnaire Results

The main findings of this questionnaire showed that the staff were feeling pressured to work when they were ill, working longer hours than they were paid for and thinking about work while they were at home on a regular basis. Some additional comments included:

• “My family tell me to quit as I'm stressed all the time”

• “Always feel like I’m not doing a good enough job”

• “Work dominates my life”

Three 6-hour training sessions on compassion fatigue were delivered to a total of 53 staff who included the CEO, management team, animal rescue staff and admin and grounds staff.

Three-month follow-up questionnaire results

The follow-up survey showed that 100% of respondents believe an awareness of compassion fatigue has helped them cope better with the work they do; 100% agreed the training was a positive experience for the team; and 71% of respondents said they have found more time for themselves.

Comments three months after the course was delivered:

• “Work is a calmer place”

• “The divide between staff and managers is less”

• “Staff are more likely to recognise when one of their colleagues has an issue”

Conclusions

Following the training staff realised that they were not alone in feeling the way they did and had started to come to HR more with issues as they felt more supported and listened to. The atmosphere of the whole centre had begun to change, and staff were looking out for each other and caring for each other better. Over the summer they had a tragedy and lost some animals; a bereavement counsellor agreed to go in and work with them which was very helpful, and they said would definitely not have happened before the training.

New

s Art

icle

very year employers and governments spend millions developing and implementing training and strategies to help keep staff and customers physically safe in the workplace.

Could it also be that it is the type of person attracted to the profession that makes them more likely to suffer from stress and compassion fatigue? Former West Australian Turf Club veterinarian Peter Symons, who has himself suffered from stress and related medical issues, explains that “vets are often do-ers (working to get through many jobs in a busy day), perfectionists (a trait required to get good marks to enter the course, and to survive the intensive tuition) and carers (the reason why they were drawn to the profession in the first place).”

Could it also be that it is the type of person attracted to the profession that makes them more likely to suffer from stress and compassion fatigue? Former West Australian Turf Club veterinarian Peter Symons, who has himself suffered from stress and related medical issues, explains that “vets are often do-ers (working to get through many jobs in a busy day), perfectionists (a trait required to get good marks to enter the course, and to survive the intensive tuition) and carers (the reason why they were drawn to the profession in the first place)"

When you examine the evidence, you see that the profession attracts high achieving young people who are unused to failure, have a very strong compassionate drive, are highly motivated and are perfectionists. They are joining a profession that is very hard on itself with very unique stressors and this combination can for many people be a recipe for disaster.

There is no ‘one size fits all’ answer to this problem and to suggest that there might be is totally unrealistic and simplistic. It is absolutely clear to me that the ‘elephant in the room’ can no longer be ignored – it’s presence must be acknowledged, and the profession must go further and embrace it as part of the solution.

Compassion Fatigue

In the late 1990’s, American Traumatologist Charles Figley realised through his work supporting staff who cared for traumatised people and animals that, as a result of vicarious trauma (our inability to effectively differentiate between trauma that has happened to us and that which we witness), these staff were showing the same symptoms as those they cared for. He called this compassion fatigue. EF Training is the leading provider of Mental Health

Training that includes Compassion Fatigue Awareness in the UK.

David’s Review

An interesting quote at the end of the webinar is that ‘A ferret is a cat that looks like a weasel’. John makes the point that colleagues not familiar with ferrets will be on the right lines if they consider them similar to cats in many aspects.

Why watch this webinar?

• A clear description ofthe clinical signs andtreatment options forthis quite commonferret problem

• Lots of clinicalillustrations of greathelp in making thediagnosis

• Many practical insightsbased on extensiveexperience

• Good description of thepathophysiology

• Valuable to residentsin dermatology andanybody else interestedin the discipline

• Also, to those studyingfor postgraduatequalifications in exoticanimal disease.

John begins this veterinary webinar, generously sponsored by Burgess Excel, with a revision of ferret

reproduction indicating that these animals are seasonal, monoestrus, and induced ovulators that are adapted to solitary life.

An important point is immediately made. Adrenal gland disease in ferrets does not involve cortisol. It is a hormonal problem involving sex hormones. It is a very common problem in ferrets associated with neutering predominantly, with other factors such as day length, diet and longevity possibly playing a part.

The role of increasing day length, reduced melatonin, increased GnRH, FSH/LH leading to gonadal hormone increase is explained. In the entire ferret negative feedback controls the process. This is lost in neutered ferrets resulting in increasing LH surges in particular, no feedback and a resultant overstimulation of the adrenals leading to hypertrophy and in some cases adrenal tumour.

The main clinical signs are listed including:

• Hair loss-possibly continuous• Pruritus-an important sign• Weight loss• Possible polyuria/polydipsia• Possible skin thinning• Dysuria

Some excellent clinical pictures leading to a discussion of the differential diagnosis follow this:

• Mange• Pyoderma• Dermatophytosis + pyoderma• Rat tail• Ovarian remnant• Cryptorchidism

Out of these, the main differential is rat tail and the clinical signs of this are discussed with some pictures. Dermatological investigation of a suspected case could involve skin scrapings, cytology, hair plucks and possibly fungal culture, although in the progressive case signs are very suggestive.

In some cases, the enlarged adrenal gland can be palpated but, in most, radiography or ultrasonography will be required. Of these the latter is used by John including Doppler, and there are some very good clinical pictures of this.

Next there is a discussion of hormone level in diagnosis. Only the sex hormone levels are of any use including androstenedione, 17 hydroxy progesterone, oestradiol and possibly dehydroeplandrosterone (DHEA). These are expensive and may not distinguish between ovarian remnants or cryptorchidism.

WEBINAR

ADRENAL DISEASE AND

NEUTERING OF FERRETS

JOHN CHITTY B.VET.MED. CERTZOOMED MRCVS

ANTON VETS

ANTON MILL ROAD

ANDOVER

The scale of the cattle industry is highlighted in the first slide of this excellent veterinary webinar. There are 10 million head of adult cattle and calves in the

UK. This is broken down to various segments including 1.9 million dairy cows and the total beef production alone accounts for £3 billion per year.

This is followed by the astonishing statistic that 1.9 million calves are affected by pneumonia each year. Further statistics gleaned from the Welsh Dairy Youngstock Project (2015) revealed that 20% of all heifers were treated for pneumonia, which was the main cause of death of heifers over 12 weeks of age and of these, disease occurred most commonly between 3 and 6 weeks of age. 66% of farms had at least one calf with pneumonia symptoms at the time of the survey visit.

A further study this year showed the equally alarming fact that 40.6% of all beef calves were treated at least once for pneumonia between the ages of 4-16 weeks. This has welfare, cost, and environmental sustainability effects as well as significantly impacting on antibiotic resistance. A useful resource is recommended. This is entitled ‘A logical approach to BRD management’ and information is given

on how to access this.

The bulk of this webinar is made up of three strands:

1. Animal Disease Immunity

• Colostrum antibody transfer• Species characteristics• Stocking rate• Nutrition

2. Environmental Issues

• Housing design, moisture, drainage• Ventilation• Temperature (prevention of hypothermia)

3. Pathogen Issues

• Key viruses, role of BVDV• Emerging pathogens e.g. Mycoplasma bovis• Biosecurity; purchased stock• Role of vaccination• Effective and responsible therapies

WEBINARBOVINE RESPIRATORY DISEASE

HOW CAN WE BREATHE EASY?

OWEN ATKINSON BVSC DCHP MRCVS

DAIRY VETERINARY CONSULTANTS LTD

In practice John normally takes clinical signs and the general health of the ferret into consideration before investigating with ultrasound and possibly blood tests or exploratory laparotomy, if doubt exists.

The pros and cons of an exploratory laparotomy are listed in a concise useful table and continues with a description of left sided adrenalectomy. This is much easier than right sided (due to the glands’ proximity to the vena cava). Fortunately left sided adrenal tumour/hypertrophy accounts for the majority

(70%) of cases. A series of clinical pictures takes us through the operative procedures.

Right-sided adrenalectomy is difficult, for the reasons already mentioned, and in addition the gland is often invasive into the vena cava. This requires resection of the vena cava and a mortality rate of 25%.

A compromise solution is to remove the left gland and debulk as much of the right as possible.

For medical treatment GnRH analogues

are the most effective and currently Desrolin implants are the treatment of choice. We are reminded that this treats the signs but not the cause. There is information on when to use these implants and a discussion of the relative merits of 4.7mg (not licensed, but widely used) versus 9.4mg (licensed for males). A slide explains how to perform the implant procedure and the effects that one would expect to see. There is also a discussion of whether to do vasectomies in some instances, and also if there is still a place for surgical castration.

There is a list of the four key viruses, the three main bacterial infections, and two Mycoplasma species not forgetting the parasite Dictyocaulusviviparus.

The webinar continues with some thought-provoking information on warmth. A graph illustrates the difference in warmth requirements between dairy and beef cows and calves of various ages. Astonishingly, heat production in a dairy cow is the equal of that provided by 40 calves. This brings us on to the essentials for calf comfort. They require:

1. Warmth-not too dissimilar than whatyou or I would feel as comfortable. Ifyou were feeling the cold so would bethe calf. Older animals produce muchmore heat.

2. Fresh air

3. Being Dry

The challenge is fresh air but warmth. A great deal follows on these themes, including simple effective methods such as calf coats and the importance of calf bedding. There is a calf bedding score illustrated with photos emphasising the need to keep calves dry. A calf will produce approximately 4 litres wet per day. A simple, amusing method of assessing whether bedding is sufficiently dry is the ‘wet knee test!”

Drainage, especially of the feeding area, is very important. An ingenious cost-effective method of ensuring the three important components for comfort is one in which calves choose their environment from within igloos or to the outside as they get older. Building on these concepts Owen explains stack effect ventilation, which is suitable for older calves, and there is a great deal of quite technical information on calf house design. Simple methods of assessing the environment by measuring wind speed, temperature and relative humidity are outlined. This needs minimal cost equipment.

With all the technical information thoroughly discussed Owen concludes it’s probably easier to allow self-regulation and another photo of an

igloo containing contented calves both inside and outside concludes this section.

Before moving on to therapy there is a graph showing colostrum-derived antibody levels (or lack of) in calf blood samples and the impact this has on disease.

To introduce the therapy part of this webinar there are more sobering statistics.

• Only 25% of calves routinelyvaccinated against pneumonia

• 40% of dairy-bred calvesreceive at least one antibiotictreatment for pneumoniain addition to prophylactictreatment

• Over 20% of all dairy heifercalves are treated at least oncewith antibiotics for pneumonia

• An estimated 75% of all calvesreceive at least one courseof prophylactic antibiotictreatment for pneumoniaduring their lifetime

There are many actions vets should take to improve calf health and welfare. Those listed are environmental audit, review of treatment data including outcomes, investigate nutritional management, monitor colostrum management success, calf vaccination service, and weighing and benchmarking.

A poll question at the end of this webinar sought to find out what percentage of vets, on the night, were doing all of the above. Watch the webinar to compare your practice with your colleagues. It makes for another uncomfortable statistic.

The final slide emphasises the need to do more-much more - and we are reminded of the factual statement made at the beginning of the webinar. 1.9 million calves are affected by pneumonia each year with costs of £60 million per year. Owen suggests that this is a gross underestimation and the true costs could be five times higher.

Why watch this webinar?

• We need to do moreto counteract theappalling welfare deficitcaused by respiratorydisease in calves, oftensuffering cold and wetconditions

• Simple measures arevery well explained onhow to ensure calvesare warm, dry andthriving

• Good advice onpreventative medicine

• Benchmark your ownpractice in comparisonto others and assesswhether you need toimprove

• If improvement isnecessary, this webinarwill help you achieve it

• Banning of prophylacticantibiotic use isinevitable and soon.Ideally get goodpreventative measuresin place before this isenacted.

WEBINAR AN UPDATE ON CRGV (ALABAMA ROT)

LAURA HOLM BVM&S Cert SAM MRCVS

ANDERSON MOORES VETERINARY SPECIALISTS

WINCHESTER

Cutaneous Renal and Glomerular Vasculopathy (CRGV) is a canine

disease that was first described in the UK in 2012. It is a seasonal disorder that has so far defied establishing a cause. Those cases with severe acute renal disease have

a very high mortality rate. For this reason, the possibility of disease is a big worry for dog owners living in areas where it has been diagnosed. Not surprisingly it finds itself in the national media with regularity.

This veterinary webinar is the most recent up to date account from Laura Holm, part of a team leading the investigation into the disease.

To begin with there is a discussion of the pathogenesis demonstrating that it is a thrombotic microangiopathy. The microthrombi occlude small vessels, particularly in the skin and renal glomeruli causing organ damage leading in some cases to organ failure and death. In addition, microangiopathic haemolysis can lead to anaemia and jaundice.

There are some human thrombotic microangiopathy (TMA) conditions that resemble GRGV. These are Haemolytic Uraemic Syndrome (HUS), Atypical Haemolytic Syndrome, and Thrombotic Thrombocytopaenic Purpura. The essential features of these are summarised.

Alabama Rot was first described in racing greyhounds in the United States and Laura briefly reviews this and other TMAs in animals since the initial report in calves in 1973 and compares some reported cases of HUS in dogs, suggesting that they are different conditions.

Most cases (92%) of CRCV in the UK have been seen between November to May and this webinar reports on the current case number-169 dogs. There are some good clinical pictures of typical variable skin lesions and a comprehensive list of clinical signs. These include: -

• Anorexia• Diarrhoea and Vomiting• Lethargy• Pyrexia (early sign)• Hypothermia (if azotaemia

develops)• Icterus• Lameness (skin lesions tend

to be painful even to 10/10 lameness)

• Petechiae• Neurological signs• Bleeding (epistaxis,

haematochezia, haematemesis)

The aetiology is unknown and there is an extensive list of those agents suspected at one time or another without any evidence to date. The disease appears to be non-contagious between dogs and humans, but barrier nursing is recommended because a main differential is leptospirosis.

A major difference between cases seen in the UK in comparison with the United States is that in the UK a wide variety of breeds are affected, whereas on the other side of the Atlantic only Greyhounds have been affected.

Current research in the UK is focused on serum C3 concentrations and alternatively thepossible involvement of Aeromonas. The interest in serum C3 concentrations is based on a low C3 in some human patients (30-50%) suffering from atypical HUS. In these patients there is an uncontrolled

activation of the complement pathway.Genetic screening of dogs with CRCG would be an important factor in research to answer the question ‘Is CRCG actually atypical HUS?’

There is active research into the possible role of Aeromonas, a gram-negative bacterium that is widely distributed throughout fresh water, estuarine and marine environments. It is a pathogen for humans, dogs and fish. Interestingly in the latter it causes renal failure, skin and gill ulceration. In humans, cellulitis and necrotising fasciitis have been noted.

The disease has been widely reported throughout England and Wales but curiously not in East Anglia. It is not notifiable and currently the Forestry Commission is not providing signage in known affected area to warn owners of dogs. They would do this if directed by central government. (Don’t hold your breath)

An initial approach to a suspected case is outlined. This involves haematology, biochemistry urinalysis and possibly a skin biopsy. Some results obtained from confirmed cases are shown. If these prove to be negative, ideally a patient could be hospitalised for fluid therapy and monitoring. Even without hospitalisation, monitoring should be for at least 4 days and up to 10 days as this is the time frame for the development of the severe complication of acute renal failure.

Advice is given if azotaemia is identified. Essentially rule out differentials for common causes such as ethylene glycol, grapes, raisins, lilies, non-steroidal analgesics and leptospirosis. This is followed by a quite detailed description of the management of acute renal injury (AKI) and colleagues are encouraged to take a look at the International Renal Interest Society (IRIS). This organisation was set up to advance the scientific understanding of kidney disease in small animals, and Laura refers to this organisation’s AKI grading with a very useful IRIS table.

Standard management of azotaemic cases is dealt with in some detail, including initial fluid therapy, description of signs associated with dehydration and various formulae for calculating intravenous fluid therapy on an hourly basis in some cases. There are numerous tables reproduced here and they would be valuable downloaded for use in practice protocols. This whole section is as detailed as you can find on the management of acute renal failure.

Cases that fail to respond to the detailed therapy described here would either require dialysis or unfortunately euthanasia. There is a brief description of peritoneal dialysis, a technique possible in first opinion practice, but only indicated if oliguria or anuria persists after medical management.

There is now a brief description of Continuous Renal Replacement Therapy (CRRT), a form of Haemodialysis. This is a relatively new extracorporeal blood purification modality used for the treatment of acute kidney injury in dogs. In the UK it is currently only offered at the RVC.

There is a slide summarising the treatment of human HUS. Of note here is the use of plasma exchange, whereby overactive complement is removed and replaced. In addition, the use of Eculizumab, a drug that binds to C5 thus inhibiting the complement cascade at this point is mentioned. It doesn’t come cheap, though, as it is still patented. I think I heard this right - the princely sum of

£400,000 per patient per year! A small number of CRCV cases in dogs have been treated with plasma exchange at the RVC. Of the 6 treated, 2 responded.

There are no reliable statistics on the prognosis as the disease is non-notifiable. There may be cases that develop skin lesions but not kidney disease and go on to make an uneventful recovery. Those that do develop azotaemia have a much poorer prognosis. This is near to 100% mortality in severe cases although less severe signs of kidney disease may respond to treatment.

The final part of this excellent webinar details some gross post mortem findings along with histopathogical signs in the skin and kidneys

Here is the summary: -

• CRGV is a disease of dogs causing skin ulceration• In some cases, there are AKI and haematological

abnormalities• Aetiology unknown• Preventative strategies unknown• Seasonal (highest incidence November to May)• Prognosis guarded when AKI develops• Optimal therapy remains unknown

Why watch this webinar?

• Laura speaks very clearly and doesn’t overwhelmwith over-complex detail

• Well-constructed throughout and is right up to date• This is the time of year you may see a case• And also, the time clients may be worried -

especially if a story appears in the national press.You will have everything you need to advise your clients of the latest information

• Useful references and sources of information• Lots of downloadable material that would be

useful for formulating practice protocols for the management of acute renal disease

WEBINAR DIAPHRAGMATIC HERNIA REPAIR:

TIPS AND PITFALLS

JOHN BERG DVM MS DACVS

John Berg was born and brought up in Southern California and received his training in

Colorado State University. Fairly quickly in his career he jumped at the chance of a faculty position giving him the chance to follow his main interests- teaching and research. This was in the colder climes of Boston at Tufts University where he has remained since 1987.

He begins this veterinary webinar with some background information on diaphragmatic hernia. It is especially common in young dogs resulting from blunt trauma with an open glottis and occurs in 2% of animals with musculoskeletal trauma. Additional thoracic injuries include rib fractures, pleural fluid or air, pulmonary contusions or cardiac contusions. Surprisingly 12% of cases have an associated cardiac arrhythmia.

The most common location is the ventral part of the diaphragm and less commonly there is avulsion of the diaphragm from the body wall. The various possibilities for abdominal organ presence in the thorax is described and if liver herniation is a feature this may cause significant pleural fluid.

The clinical signs are listed and diagnosis in most cases is with a lateral x-ray. An interesting table taken from a 1989 JSAP article describes the radiological findings

and their percentages, with the diaphragm obscured in 97% of cases to just 34% showing pleural fluid.

Lateral chest x-rays in dogs and cats demonstrate typical findings. If, however, a chest x-ray is uncertain the next most useful procedure is ultrasonography with CT scans being required in rare cases. Some ultrasound images follow.

Diaphragmatic hernia does not necessarily require emergency surgical repair and there is advice on stabilising the patient first, including the use of analgesia, oxygen and chest drains if necessary.

Chronic hernias are best avoided by early diagnosis and intervention and there is some information on 34 dogs and 16 cats that were not identified initially. These cases require much more complex surgery and an overall 14% mortality. Recorded clinical signs in these cases are listed.

Some really excellent videos are shown, making the operation to repair the hernia look straightforward. This is a hallmark, of course, of the true expert.

A useful tip is to place the chest drain during the surgical procedure rather than afterwards.

The aftercare protocol is described, and an interesting prognosis statistic is that there is a higher mortality if the surgery is performed in the first 24 hours, emphasising the

importance of prior stabilisation.

The final part of this excellent webinar deals with the less common congenital peritoneopericardial diaphragmatic hernia. The typical clinical signs are listed along with radiological signs. Surgical repair of this hernia is not an emergency and the patients do not require assisted ventilation. In fact, in some cases, usually in older patients in which the defect is an incidental finding, repair may not be necessary at all.

More videos follow showing uneventful repair of some cases. These are excellent.

John delivers the webinar in a very clear straightforward way. He never seems to be in a hurry yet transmits a great deal of information including many practical tips.

He clearly enjoys teaching and there is something for everyone in the webinar from surgeons starting out in their careers to experienced surgeons.

Why watch this webinar?

• Extremely clear delivery

• Superb images and videos

• Many practical tips

• Aimed at first opinionpractitioners

Comparison of two inoculation methods for Microsporumcanisculture using the toothbrush sampling technique

Mattia D and others

First published 10thDecember 2018

The fungal culture toothbrush method is a common method of obtaining material for fungal culture in the diagnosis of dermatophytosis. The optimal technique for inoculation onto the agar surface has not been studied. In this article two inoculation techniques were compared. The first involved pressing the toothbrush on the plate surface. The second used the same technique but in addition transferred hairs and scales from the bristles. It was thought that the second technique would increase the likelihood of obtaining positive cultures.

Using 26 cats from a cattery, two groups were randomised as to which technique and the investigator was blinded.

21 cats were positive for Microsporumcanis. The first technique resulted in a significant number of positive plates (20 of 21) compared to the second technique (7 of 21). These results can be explained by a higher plate invasion of contaminant mould using the second technique.

The authors’ conclusions are that the optimum inoculation technique is to press toothbrush bristles onto agar plates to maximise growth of M.canis and minimise the introduction of contaminant inoculation.

In the same edition of Veterinary Dermatology is an interesting study of louse treatment in peacocks, which

perhaps has widespread implications for poultry in general. The article is from the Universidad Autónoma in Mexico where there is a very active group in dermatology and parasitology. It demonstrates another use of an isoxazoline drug as an ectoparasite. This class of ectoparasites has revolutionised the treatment of hitherto very difficult dermatoses, such as generalised demodicosis in dogs, and newer indications as here are frequently published.

From the Literature –January’19

I am summarising a couple of straightforward interesting articles from the latest edition of Veterinary

Dermatology (December 2018).

Effect or oral afoxolaner on naturally occurring infestations of peacocks by the louse Goniodespavonis

Jaramillo E and others

Veterinary Dermatology, First published December 2018

Metronidazole –induced neurotoxicity in 26 dogs

Tauro A and others

Australian Veterinary Journal, First published November 2018

Ectoparasitism of ornamental birds including captive species in zoos represents a serious health problem. Up to 13 species of lice have been reported to infect peacocks worldwide and heavy infestations may cause anaemia.

23 peacocks with natural infestation with Goniodespavoniswere divided into 2 groups. One group was treated with 2.5 mg/kg of afoxolaner once orally and the othergroup was not treated.

The treated group responded with a significantly lower number of birds positive

for lice (13 of 15 total elimination of lice) and haematocrit values increased. The untreated group (not surprisingly) did not show any decrease in lice and haematocrit values worsened in the 35-day time interval of the study.

The author’s state that the treatment of lice, ticks and mites in birds has traditionally involved disinfection of the environment with 3 or more weekly applications of products such as pyrethroids, avermectins or fenylpirazoles in addition to removal of the parasites. These treatment regimens are

time-consuming and not always effective. The safety, as evidenced in this study, efficacy and ease of administration makes this class of drug a promising tool for the treatment of ectoparasites of domestic and exotic birds.

For something quite different there is a cautionary tale for small animal colleagues in an article in the latest volume of the Australian Veterinary Journal.

Metronidazole is an antibacterial antiprotozoal and anthelminthic medication commonly used in veterinary medicine. The authors describe cases of neurotoxicity associated with the drug’s administration. Medical records between 2004 and 2017 from four veterinary referral hospitals were reviewed.

Of the 26 dogs identified with metronidazole toxicity the median

age at presentation was 7.2 years and the median treatment dosage was 21 mg/kg every 12 hours. The mean time for clinical resolution once treatment was discontinued was 3 days.

MRI scanning was performed in 19 dogs but only one had brain lesions. These were affecting the dentate nuclei similar to the MRI appearance in humans with neurotoxicity due to metronidazole.

The authors conclude that evidence was found of neurotoxicity at much lower doses than previously reported, and they suggest caution when administering metronidazole at doses greater than 40 mg/kg every 24 hours, regardless of the duration of the treatment.

Gender bias in the veterinary industry – we can all helpA couple of weeks ago I was excited to attend London Vet Show (LVS) and I was really looking forward to attending the BVA Congress lectures on the current workforce situation. This situation doesn’t just affect vets, it affects vet nurses too and the whole veterinary team as well as the clients. I was really interested to see the results of the research they had commissioned to specifically look at the role the gender of vets plays in their careers. See the report summary -click here.There were two reports produced which showed that men were more likely to receive “distinctive treatment” and thus more likely to feel valued, ambitious and less likely to leave the profession. The second report highlighted the gender pay gap for female vets. In my words the results are that while many people think there are currently no issues with gender discrimination in the workplace, there is still an issue - and if you don’t think there is a gender bias you are more likely to demonstrate a gender bias.

Response in the roomThe question session after the summary of the report was given revealed that the very people with a lack of awareness of their own gender bias were in the room, as suggestions were made about ‘what female vets could do’ to improve the situation for themselves. There were thankfully a higher number of positive comments and questions with people (male and female) asking what they can do now,and in the future, to help resolve this issue.From my experience it is rarely female vets who own clinics or make the decisions on hiring, firing and salaries. We need the whole team to be working towards reducing the gender pay gap. Therefore, the issue is not ‘what female vets can do’ about the situation but what we can all do to improve the situation. The gender bias women experience is ingrained in society and is evident in many ways in the veterinary world. Maybe it’s time to explore just a few of these veterinary specific gender bias issues?

Making appointmentsThere can be a gender bias from our

clients and I have heard the phrase ‘is it an older male vet that is available?’ from more than one client and in more than one clinic. Clients should be encouraged to see that all vets are able to support them and treat their pets. While there are clearly specialist vets and vets you can communicate with more effectively on a personal level, in most first opinion situations any vet in the clinic can help.Reception staff and the nursing team as well as the vets can support their colleagues and ensure that a client’s gender bias skews the diaries of vets.

What is our image in the media?However, it’s hardly surprising that clients view male vets as more important or skilled as the media representation of our industry is heavily biased towards men. The main TV shows on at peak times focus on male senior/lead vets:

- Supervet- Vet on the Hill- The Yorkshire Vet

Even my beloved The Archers has a lead male vet as the only practitioner and at times apparently the only member of staff in his entire (SA/mixed/equine, covers own OOH) clinic. I wrote on the issues of the vet nurse being hidden in the media image of our industry and at the time commented that the same factors affect female vets. Davidson (2017) stated:

‘When faced with a pet having treatment, owner’s minds may go to the image they know from TV shows. This is often an older male vet leading a team of females, whose roles are not clearly identifiable.’

Therefore, we cannot expect our clients to be aware of the gender bias they may have, but we can work to change it. Clearly identifying staff as vets or nurses or other rules with clear uniform charts and name badges. Use the #hellomynameis to reinforce a connection with the staff member the client is talking to. Make each role visible and obvious to clients.

Gender bias in vet nursing There is and always has been a gender bias in vet nursing and this has been one of the factors in the low salaries offered to vet nurses.

Jane’s Blog

Genderbuzz (2016) in Davidson (2017) states:

The gender pay gap in the United Kingdom is a recognised issue. It relates to the lower pay women receive compared to men. This is related to vet nursing as there are two clear issues:

• lower pay for the same roles

• lower pay in female dominant sectors

Genderbuzz 2016 There are other issues related to low vet nurse remuneration but as this gender bias has a historical basis in the vet clinic, it’s not a surprise that female vets also suffer from this. The joint impact on longevity of careers and the opportunity of progression limits the sense of fulfilment that should be achievable from these roles.

How we perceive each other is influenced by so many other factors than just the individual’s ability to do the job. We need to raise our awareness of where we get our influences and ideas from and work to make sure in our individual teams that we support each other equally. We can all work together to reverse the gender bias.

Virtual Congress

is made possible by the generous

support of our various level sponsors.

Virtual Congress 2019 starts very soon! On the 18th January we kick off with the Associations Day, with BVA and RCVS bring you a host of sessions including One Health, oncology and the positive approach. Virtual Congress is again brought to you by our very generous sponsors. You’ll have seen that we’ve been gushing about them for a few months now but here’s a quick recap of who is sponsoring this year’s event.

Our Gold sponsors at this year’s event are JHP Recruitment who are bringing you the nurse stream and the Wikivet stream, both on Saturday; MSD Animal Health, bringing you the youngstock stream on Sunday afternoon as part of our Large Animal day; BurgessPet Care who bring you the small furries stream on Saturday morning; and MWI Animal Health who bring you the Practice Management stream on Saturday afternoon.

Silver sponsors include Norbrook who are sponsoring a session within the Tool-Kit stream on Large Animal day – “Antibiotic use in agriculture – practical tips for

encouraging change on-farm”. Hallmarq Veterinary Imaging sponsor the neurology stream this year, on Saturday evening from 9pm GMT. Boehringer Ingelheim sponsor another Toolkit session on Sunday morning, - Championing BVD control – You can get bloods from a stone! Andersen Products are also one of our Silver sponsors – look out for their contribution to the Virtual Congress goody bag!

Our Bronze sponsors include Simply Keyhole, Moore Scarrott, Huvepharma, VetPartners, VetShare, Vet Dynamics, MS Rubric Solicitors and Pet-ID Microchips. Check out our Meet the Sponsor blogs (http://www.thewebinarvet.com/pages/) on our website to learn more about these fantastic companies and what they bring to the veterinary industry.

Do join us for Virtual Congress – this year promises to be our best yet. Get your tickets here and don’t forget, if you’re a paid member of The Webinar Vet you can attend free of charge!

JHP Recruitment Job Board

Here are the veterinary roles JHP Recruitment are advertising this month:2019 Locum RVN *Maternity Cover 1 Year* – South Yorkshire http://www.jhprecruitment-veterinary.com/job/2019-locum-rvn-maternity-cover-1-year-south-yorkshire-ref/A lovely practice are in the need of a locum RVN to join them for approximately 1 year starting January/February5 days per week on a mixed rolling rota. 40 hours per week on average, weekend rota is 1:4 which has a degree of flexibilityRef: 10072

Permanent Full Time Registered Veterinary Nurse **No OOH’s** – Glasgow http://www.jhprecruitment-veterinary.com/job/permanent-full-time-registered-veterinary-nurse-no-oohs-glasgow-ref/Glasgow practice has an exciting opportunity available for an enthusiastic RVN to join their busy team on a permanent basis.The position would be full time, working roughly 40 hour per week with weekends on a 1:3 rota and no OOH’s, making for a great work life balanceRef: 10951

Lead Veterinary Surgeon – Cheshirehttp://www.jhprecruitment-veterinary.com/job/lead-veterinary-surgeon-cheshire-ref-12032/Experienced Veterinary Surgeon required to join the team in Cheshire.The bright, air-conditioned surgery is purpose built to industry leading standards and has state of the art equipment including dedicated operating theatre, digital X-ray/in-house laboratory/ultrasound and dentistry facilitiesRef: 12032

Full Time – Permanent – Veterinary Surgeon – Essex -**NO OOH**http://www.jhprecruitment-veterinary.com/job/full-time-permanent-veterinary-surgeon-13/An Essex surgery is looking for a full time Vet to join their team on a permanent basis. 40 hour - Full Time hours - which is based on a 4-day working week. Weekends are 1 in 3 - Saturday Morning Only. Maybe some sole charge on a SaturdayCPD is fully supported, Certificates are encouragedRef: 12294

Locum RVN needed – 18th Feb onwards – Bristol http://www.jhprecruitment-veterinary.com/job/locum-rvn-needed-18th-feb-onwards-bristol-ref/Locum RVN needed from the 18th Feb in BristolThis will be based on a 4-day week with some weekend work. Shift times are 8.30am-6pm.Ref: 10023

Full Time – HRVN – London http://www.jhprecruitment-veterinary.com/job/full-time-hrvn-london-ref/London practice is looking for a Head Nurse to come in and lead their brand new teamStrong client focus on being affordable whilst providing a fantastic service for their patients.This is a fantastic opportunity for an RVN looking for a new challenge or a HRVN with previous managerial experience.Ref: 13374