Hello and welcome everybody to this webinar looking at GOA field surgical techniques. Part two. This is actually the 3rd in a short series of webinars for webinar vet, the rest which you will find details for on the webinar vet platform.

My name is Ben Dustin. I'm a farm animal only vet working up in Cumbria and I'm also the honorary secretary to the Goat Veterinary Society. So in this final webinar of our 3 part series we're going to focus on 3 more common surgical techniques that you might commonly do on goats out in the field.

We'll touch on disbudding, a word on dehorning. We'll look at how we can remove the eye of a goat and also how we can remove the digit of a goat. So first off, the UK goat sector.

It is a rising population of goats kept within the UK, still a relatively small population if compared to our other ruminant species, but a steady year on year increase up to around about 111,000 goats within the UK at any one time. It's likely to be quite an underestimation because a lot of goats we know are kept in very small numbers as pets. Frequently these 1 or 2 backyard goats are not registered with DeA as they should be and so don't appear in any of the census data.

The UK goat sector is comprised of three large sections, namely dairy, meat, and fibre, dairy being by far the largest, with around 60,000 dairy goats within the UK, something like 50% to 60% of the total UK national herd. The herd sizes can vary markedly with an average unit size of around 600, but some of the larger units can have up to 5 to 6000 goats on one holding. The main breeds involved are salmons, Toggenbergs, alpines, and all kinds of dairy crosses.

The meat section makes up the second largest portion of the industry, and this has been or has seen a rapid growth in numbers over the past decade, something like 17,000 commercial meat goats in the UK at the moment, with the predominant breed being burr or crosses, and a lot now coming out of the dairy industry as surplus. There's been quite an increasing trend over recent years of young Billy kidd meat, with an average kill out range of about 9 months old. The final of the commercial sectors is fibre goats, which has been decreasing in number over the last decade, probably fewer than 5000 true fibre production commercial goats left within the UK and literally only on a handful of commercial units.

As mentioned, we'll very briefly revisit the anaesthetic agents that might be applicable for use within goats. Goats in the UK are derogated as food producing animals, which means that any medicine used within the species must have a maximum residue limit, an MRL set. And unfortunately in the UK, most of the medicines that we have available are actually unlicensed for use in this species, which means we are forced as practitioners to use medicines under the cascade principles.

The Goat Veterinary Society, GVS have produced some cascade requirement guidelines for the clinician. And these are available on our website, the link for which is there on the screen for you. But it should be borne in mind that there are only about 17 licenced products in total available within the UK.

One of those is actually intravenous fluids and water for injection. We do have a licenced euthanasia drug. We do now have a licenced wormer, but it is an epinemectin-based wormer, so we must be mindful of the worming choices.

And we've also got various different vaccines available licenced for use in the goat. We do now have a licenced antibiotic. Unfortunately, however, if we're thinking about the responsible use of medicines, it's actually a fluoroquinolone, so it perhaps wouldn't be our first choice antibiotic.

When it comes to anaesthetic agents, which was the main focus of webinar one in this series. We actually don't have that many options. Xylazine, the alpha 2 agonist, would probably be the most commonly used.

And it's, it's quite marked in its sedative responses. Topping up can be quite difficult, and you do need to give the drug quite a long time to work. Side effects can be quite severe, including bradycardia, hypertension, hypoxia, pulmonary edoema, and it wouldn't be a drug to use if you were thinking you had a urolithiasis goat, because it actually increases urinary output.

When it comes to local anaesthetics, procaine is the licenced, anaesthetic agent for use in ruminant species, not specifically licenced for use in goats, however, so we will be using it on the cascade. Local anaesthetic agents in goats do have a relatively low safety margin. So whenever we're using our local anaesthetic agents, it would be advisable to dilute them fifty-fifty with sterile water for injection.

The regional anaesthetic techniques commonly used in the field situation for goats have been described in the first webinar and would include things like line block, inverted L or para vertical anaesthesia technique, epidurals, or intravenous regional anaesthesia. So I'm not going to go into more detail of those here, but they are covered in detail in webinar one, which is available on the webinar platform for you. So having briefly recapped the anaesthetic agents available to us for use in the goat, we're going to move on now to look at the common field surgical techniques as described, the first being disbudding and a word on dehorning.

I've covered dissbudding for webinar vet before in a webinar in 2019, the link for which is listed at the bottom of the screen for you if you wish to revisit it. So today what we'll do is we'll recap the principles behind disbudding and look at the actual procedure itself in a little bit more detail. Disbudding is a mutilation in the UK and it remains a vet only procedure, but not all breeds are commonly dysbudded.

The example on the right hand side there of a feral bagot goat, they are often left horned, as are many pygmies and meat breeds. Why do goats have horns in the first place? Well, being prey species, it's linked back to defence.

It also enables them to establish a hierarchy, and it's thought there might be a role with it in body temperature control as well. So it's important to consider why we might actually need to dispod our goats. Often within the UK it's because of the management and environmental conditions in which we keep them.

Certainly when you look at the commercial sector, goats are kept in close confinement in large group pens, and so the risk of goats injuring themselves or each other becomes quite real. It's not unusual, for example, for horned dairy goats to push forward under the goat in front on the milking parlour and yank those backward facing horns under the under the udder and sort of gore injuries are. What ends up being the case.

With the horns pointing backwards as well, they can often be getting themselves into trouble when they push through and look through feed fences or pig netting and get themselves stuck. We shouldn't be keeping horned and horned less goats together. They will know that they have horns and will use them against those who don't as they start to look to establish hierarchy.

Another good reason why if you have horned lesser goats, you wouldn't introduce horned goats into that group. Why don't we have polled goats? Well, we have looked at the genetics behind horns, and it turns out that it's linked to intersex.

So the more you breed for poled goats, the less fertile they become, and you end up with intersex. The budding itself should be done on neonatal kids, ideally between the age of 2 to 7 days old. If necessary, or the kids are particularly small, you can do it up to around 10 to 14 days.

But beyond that age, the horn has grown quite large relative to the size of the skull, and the risk of complications increases. The horn buds are particularly fast growing, so unlike our calves, we have a very large horn bud to skull ratio. They differ from calves in another respect in that the horn buds themselves are innervated by two nerves, so simple local infiltration with local anaesthetic is probably unlikely to be sufficient, and the volumes that you require are going to be very close to the toxic threshold for using goats.

So generally speaking, goat kids are disbuded under general anaesthetic. More, more details for which, on the next slide and in the original webinar, as previously discussed. One of the key differences between disbudding calves and goat kids is the diameter of these horn buds, and they are significantly larger than what you might be expecting if you think about the calves that you might be more familiar with.

So whereas a disbudding iron for use in calves might have a diameter of around about 0.8 centimetres, in goat kids you're looking for at least a diameter of 2 centimetres. So in the picture on the right hand side of your screen.

The iron on the far right hand side is actually the iron that we would use for goat kids, so it's it's nearly double, it's over double the size that we would traditionally expect to use for calves. It's often useful if your goat kids are a little bit older, so getting close to that sort of 7 to 10 day mark to have a pair of horn nippers, and I'm just using a pair of foot trimmers there, and that's the picture on the screen next to the irons just to take the tip of the horn buds off so that when you do sight your disbudding iron onto the skull, it sits neatly and uniformly across. You don't have to sort of wobble over an exposed horn bud tip.

Other useful bits of kit to have in your dis budding equipment would include swabs so you can soak these in cold water to immediately cool down the skull after application of the hot iron. Some tiny little insulin syringes so you can give an accurate dose of your general anaesthetic, some scale. To weigh the goat kids so that you're using the correct amount of anaesthetic agent for your neonatal babies, some kind of topical antibiotic or antiseptic spray, obviously your anaesthetic drugs and some towels to wrap up and keep these goat kids warm.

More details coming next. The specifics of anaesthetics and analgesia for goat kiddy budding is covered in a lot more detail in the webinar from 2019. There's also this GVS and BVA position statement available on the BVA website, which talks about the need for goat kids to get supplementary analgesia out with the anaesthetic that they are disloded under.

Remember, of course, that these are food producing animals, so our options are limited, and below on the bottom half of the screen is an example protocol of a legal. A dis budding mixture that you can use for general anaesthetics, so ketamine, xylazine, and butrophenol, which would be given by intravenous injection. I generally do this into the jugular vein and I do all my disbudding out in the field on farm, so this works particularly well.

This is another indication as to why we need the insulin syringe because it's a very tiny dose. We're looking at just 0.1 of a mL per 5 kg given IV and again where.

Scales come in useful, particularly these sort of postal spring scales where you can actually sort of hang, suspend the goat kid in a small carrier bag or sack off your postal scale so you can get a very accurate body weight to enable you to give the right amount of your anaesthetic to the goat kid. So we'll take a look at the actual disbudding procedure itself now, and it's important right from the outset that you have the room or the area on farm that you're going to bud in prepared to try and reduce any potential complications. For example, hypothermia is a particular risk in neonatal kids.

They have a very low brown fat ratio to body weight and means they're very susceptible to hypothermia. So the area in which you're going to do budding needs to be warm, needs to be cleaned, needs to be draught free. It's a good idea to have your hot irons warming, and they need to be glowing a bright cherry red when they're hot enough.

So you'll see here the image on the bottom left is the iron actually in the process of being warmed up. It's not yet hot enough. That end will be glowing cherry red.

Have anybody who's going to assist you with disbudding ready and informed, and if they haven't done disbudding or seen disbudding done before, it's worth taking a little bit of time at the beginning just to let them know, what you're going to do and what their roles are. When you're ready to do your disbudding, I would generally do all my disbudding out on farm as I've mentioned before, and using the anaesthetic protocol that was described on the previous slide, I will often anaesthetize 3 to 5 goats at a time, as seen here in the second image, and I would arrange those in a deep straw bed or wrapped up individually in towels and lie them under a heat lamp again trying to reduce the risk of hypothermia. When we're ready to just bud the first goat kid, I would have that picked up by my assistant, usually wrapped up in a towel and placed on a table, and then we'll use some clippers to clip the hair from around the horn buds.

Once we have the horn bud areas clipped, we're ready to apply our hot iron, and we're going to do that in one clean circular uniform motion, pushing down onto the skull in a gentle and controlled fashion. We're going to try and apply the hot iron to the skull for as little time as possible. Even now I'll still count the time that the that the iron is in contact with the skull on, and I'll count it off.

So 123, and then off with the iron. I'll let it recover for 123, and then put it back on the skull just to finish removing the bud. Remove the bud in its entirety.

Don't leave any material behind. It's just going to act as an idis of infection. Once you've removed one side, I would then put the iron down back in the flame, pick up a cold water soaked swab, and just instantly try and cool down the horn bud area that you've just removed with that cold swab.

Then I turn the kid over and do the same on the other side. On both sides are removed and as you can see there in the 5th picture from the right, I would then be applying the topical antiseptic spray, which is the image on the far right hand side. Then they will be returned back onto the heat lamp to recover.

You'll often give your supplementary analgesia. Often I'm using a non-steroidal at this point. And if you are disbudding any .

Male kids, now is the perfect opportunity to castrate them if you're going to be using the rubber ring because our goat kids for disbudding should be under 7 days old and so it's a convenient time to do it whilst they're under general anaesthetic. Recovery, it's important to have the assistant ready and aware that the recovery can take quite a long time. So the use of the towel, rubbing and stimulation of the goat kid to try and bring them round is important and reduces the risk of the goat kids falling back asleep under the anaesthetic.

Before we move on to talking briefly about dehorning, it is worth stating that in the original dis budding webinar on the webinar that platform, there's a lot more detail on the complications or potential complications of disbudding, so it's worth reviewing those if you're likely to be doing some disbudding in the future. Dehorning on the other hand, is an invasive, hemorrhagic and stressful procedure. It's really a procedure of last resort.

So if we have an emergency situation, a goat badly injured, or there's some kind of a welfare concern associated with the way in which a horn is growing, then this might be a procedure that we would undertake. This wouldn't be something to go into or undertake to do for purely cosmetic reasons. And some of the reasons for that is that the horn base is exceptionally large and contacts the skull in a large area and opens up directly into the frontal sins of the goat's skull.

This is going to be often anaesthetic of an adult goat really, which is going to be a full general anaesthetic, which of course is comes with its own risks. And once we got the actual horn removed from surgery, it takes a very long time for these wounds to heal over and close, leaving a large infection risk, a significant haemorrhage risk, and depending on the time of year, of course, in which you're doing this, a significant fly risk as well. What would be preferable would be to actually remove the tips of problematic horns if necessary, and you'll notice or you'll be aware that in cattle the last couple of inches of horn is actually insensitive, doesn't have a blood supply or a.

Supply and can be removed quite safely. The same applies in goats. So providing that you're careful, you're just taking the first couple of inches off the horn tip, you can use embryotomy wire or claw trimmers and safely remove problematic horn tips, and that's a much safer way of managing problem horns rather than going through, as I've mentioned before, particularly invasive hemorrhagic and stressful procedure, which actually is what dehorning is.

So having discussed disbudding and also dehorning briefly, we'll move on now to look at the removal of an eye, so a nucleation. In nuation of the eye is going to be indicated when we have a globe rupture or the eye has suffered extensive trauma, perhaps even neoplasia, or there's intractable infection within the eye. To remove the eye will require the goat to be at least heavily sedated or possibly even under a general anaesthetic which carries its own risks.

The first webinar in this series deals with the risks posed by sedation and the anaesthetic agents which you might use if you were looking to do this procedure in the field. Once the animal is in lateral recumbency, make sure you have the eye to be removed uppermost and clip and surgically prepare the area around the eye. Sometimes placing a drape over the eye will help keep the area clean and easy for you to put your instruments around.

You're then going to put some local anaesthetic in both eyelids. Now this should be a local anaesthetic diluted 50/50 with sterile water for injection, so that we're always keeping the amount of local anaesthetic agent that we use to a minimum. Infiltrate both eyelids as said and then suture the eyelids closed together with a simple continuous suture pattern.

The actual regional anaesthetic technique that we're going to use to remove the eye is the retrobulb block, which is described in detail in a recent in practise article that I've written, published January February of 2023, and the reference for that is listed at the end of this webinar. So if you want more details or specifics about the block, then that's available for you in that reference. Generally speaking though, we're going to place our local anaesthetic and sterile water solution using a 3 inch or 1.5 inch spinal needle which we've curved.

Now if we're curving this ourselves, it's best to curve the needle with a stilet in place so that we don't get kinks along the needle shaft. Now the insertion points for the spinal needle are roughly the points of the compass, so north, south, east, west, or if you prefer dorsal, ventral medial and lateral. And we're placing the needle through the conjunctiva using a gloved finger inserted into the socket, so the closed socket because the eyelids have been sutured together, and just using our finger to guide the needle point behind the globe through the conjunctiva.

Once situated behind the globe, we're depositing roughly 1 to 1.5 mLs in a pygmy goat, maybe slightly more up to 2 to 3 mLs in a larger goat of our local anaesthetic and sterile water for injection solution at each of those sites. This might seem like a reasonably larger volume.

To deposit at the back of the eye, but when you think about the amount of local anaesthetic within it, it is diluted 50 to 50 with our injection for with injection for water. So it is a small volume of local anaesthetic used, and you might find that you get a little bit of resistance and therefore you've obviously put sufficient at each depot site. So once your block is placed, we're then going to be making an elliptical incision through the skin all the way around the eye, keeping as close as possible to the eyelid margins so that you're sparing as much.

Of the eyelid skin itself to affect a good postoperative skin closure. We then undermine the skin to the bony bony orbit using a combination of blunt dissection and sharp cutting motions, and the eyeballs gradually separated from all the associated bulbar musculature within the bony orbit. The eyelid suture actually helps you as almost providing a sort of surgical anchorage point really, but you've got to be careful not to pull on the eye itself or the globe too much as this can actually split the nerves travelling through the optic eyes and could cause blindness in the opposite eye.

Once you've freed the globe and you're about to cut through the optic nerve and the blood vessels at the back, these don't actually require ligation in the majority of cases, but once you have cut through, remove the eye and put a large sterile nonwoven swab into the orbit and pack it to affect hemostasis. This buys you a little bit of time so that you can then pack it and bring the eyelid margins together. If you've not been able to spare enough of the eyelid margin, you might have to place a couple of tension relieving sutures to try and get the wound edges as close together as you can for a simple continuous, or a simple interrupted suture pattern.

Best to use non-absorbable sutures at this point. It's not usually necessary to pack the orbit or leave any swab material within the, within the eye globe, because once you've removed the, wadding material, the skin closure itself is usually going to provide sufficient pressure, to build and cause hemostasis. Might be worth leaving a small 3 to 5 millimetre opening in the skin closure, usually at the medial canthus just to allow for drainage if necessary.

These surgical cases are certainly going to need postoperative pain relief and antibiosis. Generally speaking, I would be providing at least 3 to 5 days' worth of non-steroidal cover, often in the way of meloxicam. And a broad spectrum antibiotic, often a long acting penicillin or daily penicillin injections, to maintain high levels of systemic penicillins once the eye starts to heal.

I've discussed drainage on the previous side. It's usually pertinent to leave a 3 to 5 mil gap at the medial campus to affect drainage. These do these cases do require some progress checks and follow up.

I would normally like to revisit at the 48 hour interval and then get a follow up telephone conversation 7 days later to make sure everything's progressing nicely. And if we are removing eyes in the summer months, it's worth having some fly repellent on board to keep these fly free. And for our final common field surgical technique, we're going to have a look at digit amputation.

So the amputation of a digit is only ever going to be a salvage procedure or a procedure of last resort. It shouldn't shouldn't be undertaken lightly and is done to improve the goat's health and welfare whilst maintaining a useful function within the herd. That might be to continue producing milk or getting through to kidding if the doe is already pregnant or even achieving a necessary live weight for economic slaughter.

The indications for digit amputation may include intractable pedal bone infection or a non-weight bearing lameness of a specific claw or even deformity, and we've touched upon those in more detail in the first of this three part webinar series. It's not appropriate to amputate the digital claw if any infection extends beyond the level of the proximal interphalangeal joint and or it goes to the other claw of the same limb. I do not undertake this procedure lightly and only perform it after you've had a thorough discussion of the advantages and disadvantages of the individual animal with the owner.

The digit is going to be amputated under the regional anaesthesia technique intravenous regional anaesthesia, and we've described that in more detail in the first part of this webinar series as well. It would be a good idea to provide antibiosis and analgesia before the operation takes place. And the limb distal to the tourniquet needs to be clipped and surgically prepared.

The image on the far right hand side here shows the distal limb clipped up and the superficial vein where we're going to place our intravenous regional anaesthetic exposed. This will be the area where once the anaesthetic has been placed, we surgically clip ready for the removal of the digit. Once the affected distal limb is surgically prepped and ready to go, we're going to take some clean new embryotomy wire and cut directly through roughly the mid shaft of P2 in an approximately perpendicular angle to the ground when the animal is standing.

The embryotomy wire should be used quickly, steadily, but firmly to achieve good hemostasis by cauterization as the limb is worn away. Once removed, the bone edges should be inspected so that any sharp fragments or bone chips can be removed, usually with forceps. And the exposed stump can then be prepped for bandaging.

I like to directly spray some antibiotics, topical antibiotic spray directly onto the stump and then place over that a soft padded non adhesive Alen type bandage where you can actually apply the topical antibiotic spray to the pad as well as onto the stump. So you've got a sort of a double sided antibiotic covering. And then taking some soft wadding material, wrap the digit and the pad, and then apply over the top of that some elastic containing bandage material so that starts to keep a little bit of pressure on the stump to effect continued hemostasis.

And then on the top of that some sort of typical vet wrap or water waterproof bandage material to try and protect the stump yet further. These cases certainly require postoperative pain relief and antibiosis. Once again, I would usually provide supplementary analgesia for at least 3 to 5 days, again using meloxicam and systemic antibiosis probably for 5 to 7 days depending on how the wound is healing.

Immediately, postoperatively, I have a tendency to put the individual goat into a smaller pen, usually the individually penned or penned next door to a mate so that they can remain calm and have direct eye contact with each other, and that generally allows the bandage to stay on a little bit better, goats being so inquisitive, they tend to pull those things off quite quickly unless you provide some kind of movement restriction. The first bandage change is usually 48 hours unless the goat determines otherwise and manages to pull your first bandage off, and this provides you with the ideal opportunity to inspect the stump. It needs to be clean.

It needs to be fresh. At this stage, 48 hours postoperatively, it will still have a certain amount of fresh blood. But it provides you with the opportunity to reapply your topical antibiotic spray, and you can refresh the Aleven type pad and likewise provide more topical antibiotic spray directly onto the pad and then rebandage.

The next bandage can typically stay on a little bit longer, 4 to 5 days, assuming that the goat keeps it on for that long, and we're going to be doing the same sort of thing. We're going to check that stump all over again, reapply our topical antibiotic spray as necessary, and then replace the bandage. The third bandage is often the final bandage that we apply, and we're going to be looking to change that around about the 7 to 10 day mark depending on how the goat is progressing.

And at this bandage check, if the stump is looking clean, reasonably dry, and evidence of nice granulating tissue, it's often OK to leave the stump unbandaged at that point and just apply some topical antibiotic spray to the stump daily when you check it to make sure it's still clean and continuing to heal. We're basically wanting to remove that bandage and allow the stump to heal in the open air basically from 7 to 7 to 10 days postoperatively, and the picture on the right hand side there is the stump at day 5 of a bandage change ready for one final bandage dressing before we look at that stump and say, right, that's OK, it's dry enough and granulated sufficiently for us to leave the bandage off. And so to summarise this webinar, the 3rd in the 3 part series on anaesthetic and common surgical field techniques for goats, we've summarised the current UK goat population and how the sector is made up, namely comprising of the three commercial areas, so dairy, fibre, and meat, and those that don't quite fit into any category, sort of pedigree and smallholders.

We reviewed the current UK medicine legislation and how we can prescribe for these food producing animals trying to stay the right side of legal. We've discussed the disbudding of Goat Kids and reviewed the technique and signposted you also to previous webinars on Goat Kid disbudding from 2019. We then looked at the removal of eyes and signposted again there to the previous webinar in the series on regional anaesthesia.

And finally we've discussed the removal of digits and how we can affect good wound healing and digit stump maintenance using our bandage dressing changes. As ever, I'd like to signpost you to further reading and the references cited within this webinar series to help you if you'd like any opportunity to read further and get more detail on anything. In particular, I'd highlight the In practise article on Dibudding of Goat Kids at the top there 2019, and of course I have mentioned it already, the webinar on Dibudding of Goat Kids also 2019.

The second reference there is the most recent one, performing surgery in goats Part one in the recent In practise, January, February 2023. And in here you'll find more detail on the regional anaesthesia techniques that we've described in webinar one of this series and also specifics on the retromover block. I'd strongly recommend people have a look at the Harwood and Muller book, Goat Medicine and Surgery.

It's got some fantastic pictures and descriptors of, various goat surgeries, and medicine cases. John Matthews' Common Surgical procedures in the goat is a fantastic article in the Goat Veterinary Society journal which is available online to all GVS members, so I strongly recommend joining the society if you haven't already, so you can access this hugely valuable resource and lots of very useful and interesting articles on all things goat related in fairness. And finally, just before I let you all go, a quick plug for the Goat Veterinary Society, which, as I'm sure many of you will know, it's a specialist division of the British Veterinary Association.

And was formed back in 1979 with the idea really to try and promote interest in and also improve the knowledge of goats within the veterinary profession, but not just veterinary professionals, actually goat keepers and commercial farms as well. And because of that and to effect that end, membership is open to all veterinary surgeons, veterinary students, research fellows, but also farmers, commercial farmers, hobbyists, anybody who has an interest really in goats. We hold at least one on-farm meeting each year and provide also virtual and online conferences as well.

We produce the Goat Veterinary Society Journal, which is distributed to all members and is available on the GVS website as well. If you have any questions at all or you would. If you like any more information about anything that we've talked about, please don't hesitate to get in touch.

I've left my email address there at the bottom, which is the GVS. [email protected].

I'm more than happy to get back to anybody with any questions via email, so please do just get in touch if you wish. And a final huge thank you to all the contributors to this webinar series. I'd like to highlight particularly David Harwood and Karen Muller, who've provided many of the images and for their input and advice and particularly my GVS colleagues, so David Harwood again, Nick Perkins, who's the current GVS president.

Bryony Kendall, who's our GVS treasurer, and John Matthews, who's the past president of GVS, have all provided invaluable help, support, and input into the webinar series. Again, just to reiterate, if you do have any questions, please feel free to email me. The address there is on the screen, and I look forward to seeing you on another webinar sometime soon.

Thanks very much for watching.