Hello, it's Anthony Chadwick from Webinarett welcoming you all. All of you IVC members and practicers to this webinar, which we're very fortunate today to have one of my old friends, Ian Ramsey, Professor Ian Ramsay to give him his proper title. Er I was at university with me at Liverpool, and I think even then we were, we were, we thought that he might be a professor in the future and I, I usually inhabited this kind of middle to lower echelons whereas he was very much.
Towards the top of the year, and, it's been great cos he's been a great help with Webinar vet over the years. He is professor of Small Animal medicine at the University of Glasgow. He's also an ex BSAVA president.
Ian has a special interest, obviously in small animal medicine, hyperthyroidism, endocrine disease, lots of different areas that Ian's worked in, and, I'm really looking forward to this webinar. We're, we're going to be doing some really cool polls as well. So I think Ian's gonna explain exactly how the pole system is going to work, but I hope you're gonna have a lot of fun being on these.
Just as a final thing, we're gonna take a bit of a break in about half an hour where I'm gonna talk a little bit about the partnership that we're developing with IVC, which is offering you the opportunity of coming on, to experience our full range of webinars. And actually for those people who stay till the end of the webinar, there will be a chance of a prize drawer the top prize is to win a year's membership of Webinar bet, but there's a couple of other prizes as well, so do stick around, we'll see how we get on, and Ian, it's over to you. Great, thank you very much, Antony.
I hope everyone can hear me. it's great to be back with the, the webinar vet and Antony, talking about my favourite subject, which is, internal medicine, and, as Andy said, we're, we're gonna make this, an interactive session, to try to, get, get some, some thought processes going, and have a bit of fun in the process. Now, in order to do this, it, it's helpful if, if you have a separate device.
So if you're listening on a laptop or an iPad, get your mobile phone out. If you're listening on the mobile phone and watching on the mobile phone, you'll probably best just use that. But if you have a separate device, it works quite well, but if not, all the other thing you can do is come up with a, a, a tab, another tab.
So what we do is we, we, if we're on a mobile phone, we go to Apple Store or whatever and we download onto our mobile phone Pole EV. So just putting Pole EV into the, the app, App Store, and it'll give you an app which makes it really quick and easy to use. Or you can go to the website www.poleev.com.
So I'm gonna give you a moment just to do that. And then once you've. Done that, once you've gone to, to the, got your, your PolyV set up, then the, the username is Ian K Ramsey.
there's, there's another Ian Ramsey out there who's already on it, and he's not running, he's not doing this tonight. So there's Ian K. Ramsey's username.
Now, then if you're new to poll poll everywhere, if this is the first time you've done this, you're gonna be asked to put in a name. Now, this is anonymous, so no one else can see what you can, what you're doing. This is in a completely anonymous system.
Nobody else can see what you can do, but I can if you put your name in. So I don't want to know what you're you're doing, so either put your boss's name or your friend's name or your pet's name in somebody who's not you, OK? unfortunately there's no way of, of, .
deleting that, that, that part of the system. Will I be OK, Ian, if I put Liz Truss in? Will that be OK?
Liz, Liz, Liz, Liz Truss has got nothing to do this evening, so, she may well join us. It it is, it is quite possible. It is quite possible.
That's very, very political, Anthony. I'm sorry, I'll shush, I'll shush. Oh, what a day, what a day in Po.
I can't follow it. I can't follow it. I can't I think of it.
Anyway, so, so, as I said, Polly V.com and username Ian Kin Ramsey, and then what you should see is this. A radiograph and you can then put it on just by touching the screen or by clicking on the screen, you can click on to say, answer this question about where is the left atrium.
Don't, don't, don't worry, it's not, it's not a big thing. It's just mainly here to see how we can, yeah, how many people we can get on on this system. Ian, somebody's just said they can see a whisk a whiskey distillery question.
I think that's showing one of your other weaknesses, isn't it? Yes, it is. That's an, that was an old question.
So if you just refresh your page, you'll see the left atrium question. That that that was the last question I was looking at. It was a little joke question.
Great. The whiskey distillery comes up later. Right, so we've got about 53, 54, 55.
Any more for takers, so the, the, that website is up there again, Paul EV.com and the Ian K Ramsey is the username. OK, I think we'll just hold it that we can, other people can can can catch up and, and just, just for, for, things that yes, you're absolutely right, the people who've a big group of people who put it in the middle there, that's the left atrium there and not on the left side of the heart as you look at this right lateral view.
OK. Always have to start with a conflict of interest disclosure, none of which has any particular, relevance here today. I, I have, interest with, with Siemens and, and Decker, and I'm a grant recipient for BSAB Pet Savers.
OK, for these various cases and so forth, we're gonna talk a little bit about what's available, what tests we should do, what blood tests we should do, what, what, what, things we should be doing, and what treatments, we, we should use. For this purpose, I'm gonna pretend for a moment we're all working in this one building, in the Small Island Hospital at the University of Glasgow. We can talk about what happens if you don't work there and you.
You have other equipment or other drugs available and what the options are there but we have to start with a common, common basis of these kinds of questions. So in, in this, in this hospital, you you've got ultrasound, you've got CT, you've got MRI, you've even got in your accelerator, but most importantly, for a medicine vet, the most important bit of equipment, a clean microscope. OK, so that's what you've got, you've got all the equipment you need, and you've got a client who for the most part at least are committed to their dogs.
They will try to find money. They're not maybe necessarily rich, but many people in Glasgow are not rich, but, but we have, certainly a committed clientele. So I'm gonna start with a case and then we're going to talk Antony's gonna come back and talk about this webinar vet IVC partnership, and then we'll have a more rapid fire quiz afterwards.
So we're just going to start with, with a case. And the case you've got today is called Holly. And as you can see, Holly is a Labrador, she is a 5 year old female neutered Labrador.
And she's been presented to you because she's had hemorrhagic diarrhoea. And she's had this er at home and the owner has taken a picture of the state of the utility room that er er Holly has been in. And you can see the fresh blood in the hemorrhagic diarrhoea, you can see the, the, the, the the the non-hemorrhagic portion of the diarrhoea as well.
it's reported to you that she has been in contact with other dogs who've had a little bit of diarrhoea, but not bad. For a Labrador, perhaps unusually, she hasn't eaten her breakfast this morning, and the owner is very, very upset about the state of her utility room. she, she, she wants this problem sorted, and she, she's really quite, in a state about, about this, .
And, so when you examine the dog, however, there is no clonola. The, the, the mucous membranes are moist, the cloy full time's normal, her heart rate's normal. There's no abdominal pain, lymph nodes are all normal, coat looks normal.
Can't find a thing. So here's the question, the first question. In what order do you want to do these tests?
Now, obviously I've, I've just need to clear those responses because that was just that was Anthony practising, so please don't follow his advice. That was Anthony practising earlier on. So this, this is the, the the range of tests that you can do and what you have to do is you have to order these tests.
And then hit submit. So you can pull with little arrows on either side of your screen, you can pull these up and down and assemble an order of what you want to do. And in what order you want to do it, cos I, I think you can argue that all of these are, are potentially something that you could do to this dog.
And, the, the question is, what would you do in what order? So if you tap on, you tap on it and then you can see two little arrows. Yeah, I think that some people are getting the idea that there's some answers coming in there, let's, let's see how we're going, so.
You can see some things. So this is an acute hemorrhagic enteritis. So from this, I'm going to take it that most people believe that the first thing to do when you see a dog with acute hemorrhagic enteritis is to take some bloods.
Then to do a pavo viral test and, and, and I, I guess many people will actually go to a parvoviral snap test, an antigen test rather than actually doing PCR which would be quite slow, because you'd have to send that off. And then parasitology, and I'm not sure I can understand why parasitology here would come above bacterial culture. You've been told by the owner that this dog has been in contact with other dogs, which have been ill, so it's unlikely to be a parasitic disease that's spreading from dog to dog to dog.
I would have thought bacterial culture there for me would have been at a higher, higher range. the, the value of ultrasound as we run it is really, really limited. In acute enteritis, it is very unlikely we're gonna find anything on ultrasound or radiography.
So, so actually I would have put that no tests would be my next thing above ultrasound and radiography, below that, they're, they're definitely not. Now, here's the question. Are rou do we routinely do bloods on these things?
Do we need to do bloods on something that is a clearly an acute. Infectious enteritis, it has spread from dog to dog. And, and I'm not sure what those bloods are going to tell you.
They can tell you a bit about the metabolic state, perhaps, perhaps worried about that, but we know the dog is relatively well at this stage. There is a rush in medicine, and, and I, and I'm sort of doing this little campaign event. Medicine starts with doing routine bloods.
And actually, acutely, I'm not sure you necessarily need to, to do that. with acute enteritis, it would not be unreasonable to say for the cost of the bloods that actually, Other tests will be more important, those infectious diseases tests are actually more important, and, and for me at any rate, given that this dog is vaccinated. And it's not showing signs of vomiting and depression that I would expect with Parva virus, and canine coronavirus does not produce this kind of syndrome anyway, that actually parvoviral and coronavirral PCRs are are really quite far down the list, so for me.
And this is where we might have a bit of debate for me. Bacterial culture. Is the most important.
Why do I say that? I say that because there are significant pathogens of dogs that are infectious to our owners, to ourselves, and which can cause problems, and those include things like salmonella, Clostridium difficile, some of the Campylobacter islets, and in this case, as you can see, we've got a positive culture of a beta hemolytic E. Coli and a Clostridium profringens.
And an intratoxigenic . Organism that is known to be associated with acute hemorrhagic enteritis. So this bacterial culture step is something that really needs to be first and foremost in acute diarrheas.
In my view, the first thing you need to do with an acute diarrhoea, if you're going to do any test at all, is not to do routine bloods, but to do a faecal culture. The dog's got diarrhoea, faecal culture seems to be a more logical first step test. To get that off and get that sent off, and, and the routine bloods really depend on the metabolic state of the dog, and evidence of dehydration and so forth on clinical exam will drive me forwards to, to, to routine bloods, but just doing a the the faecal culture probably should be.
Front and centre. Whether you do parva virus or, or, or, or, or, or coronavirus tests will depend really on your local prevalence of those conditions, but in a vaccinated dog, a 5 year old vaccinated dog, parva virus is gonna be really, really, really, really rare. So that goes down and probably I would do bacterial culture, probably then a a haematology biochemistry or at least a biochemistry, and then I would leave it at that, at, at the moment for, for no more for do more, no more tests than that.
Straight off. However, we do have faecal parasitology there, so, so let's just, just like that. What do we do with that faecal parasitology?
I mean, acutely, and the thing, what are we going to look for? What are we gonna look for some for some eggs or, or, or whatever that might be caused. So here's my next question to you.
Which one of these eggs, or more, or more could be several, are likely to be the cause of a cholitic type diarrhoea? In a dog, you can have all 4 or none. It could be that there's .
Some of these have no clinical significance, and, and others may cause colitis. Which ones are the ones that cause colitis? So somebody's just put in the chat box a very good question about the bacteriology.
They say, bacteriology takes a few days to get back, yes, but that's OK. That is absolutely OK, because it's better to know right off and front and centre. That the the bacteriology has got salmon and if it comes back, then you can do something with it.
You don't have to do anything with that result, result, but you do have to know it, and if you don't send it off now, then you'll, you'll not get the result back for more days. So actually, the fact that it takes a few days is an argument for sending off, and there's absolutely no evidence, none whatsoever, that delaying treatment is going to cause you problems. OK, so back to the eggs.
So, the, the egg on the, now just let me. the, the egg on the . Let me just give you laser pointer.
So, hopefully you can all see my laser pointer now, yes. Can you see my laser pointer? Hopefully, anyway.
So the, the, the top left here is an unsinaria egg. Can that cause colitis? Yes.
So, if you put your doctor on the top left, great. Bottom left, it's toxicara canus, it does not cause colitis. Toxocara canus is a small intestinal worm and is not associated with colitis.
So that would be an incidental finding. Top right is tricurus, and that can cause colitis. Bottom right is dipolidium caninum, the canine tapeworm.
Again, an incidental finding, unlikely to be associated with colitis. So the top two would be the significant findings in a dog with cholitic type diarrhoea, the bottom two rather less so. OK, I should say Holly had none of these.
So what treatments will you give Holly? You sent off your bacteriology, you sent off some parasitology perhaps, you've sent off your routine bloods, perhaps. What treatments will you give Holly?
And I think you're allowed more than one treatment. I can't remember. I, I think you are allowed.
That's 3 treatments. OK, so, I, I, and, and this is really interesting because, you know, hemorrhagic enteritis is something that, or colitis is something we all see lots of. And yet there is a disagreement here with some people giving some drugs and some people giving others.
So let's just, let's just go from from, from the baseline. the, the, the, from the bottom there, the, the antacids, H2 blockers act in the stomach. This is the colon.
So the fact that there's blood coming from the colon will not be influenced at all by H2 blockers. So, so that would be an inappropriate level of, of, of there's no evidence of gastric ulceration in this animal. It is, it is coming from the colon.
So, not, not, not a good one. The, similarly, this dog has shown no evidence of vomiting. So I don't think any anti-emetics would be particularly indicated, er, either.
Nil Paros, now, now Nil Paros used to be absolutely de rigueur. That we will give nil perro when, when we have a, a, an entersis, but we know that the colon actually receives its nourishment from the food, and if we've got damaged colon, they actually need it more. So in many ways, this, this dog actually does need food.
It's not eating at the moment very well, but we should, it's trying to tempt it to eat. Spasmolytics may, may, may have wrong. I'll I'll come back to that.
That's certainly, we know that human beings who suffer from this will feel in horrible intestinal spasms, and, and it would be reasonable to give, give that as a as a as a as a thing, yes. So, IV fluids, now there's quite a lot of you went for IV fluids, but a few did not, and I think that that really is a a tension in in the thing. Is this dog dehydrated?
Answer? No, it didn't look dehydrated, its heart rate was normal and so forth, so what are you giving IV fluids for? But equally well I understand that when you see that amount of fluid coming out of the dog.
You can't help but think that hm maybe it's going to become dehydrated, so we ought to do something. So I'm, I'm, I, you know, I, I accept there's a, a, a tension there in the IV fluids. But then we come to the two biggies.
Antibacterials, probiotics, or both. Let's just have a look at the, the antibiotics, for, for a moment. There, there's a really, this is a really important paper, it's an interesting paper published in 2011.
And in this, Stefan Unterer, a colleague of mine, from Munich, did a really quite brave thing. At the time this was, quite brave avant-garde, one might, might say. He took 60 dogs with hemorrhagic enteritis.
And he gave half of them. Antibiotics for 7 days. And the other half, he gave a placebo.
And he randomly assigned these dogs. To those two groups. There was no difference that he could detect.
Between the death rate. The duration of hospitalisation, the severity of the clinical signs, the duration of the clinical signs. And, and this was really quite an important study in many ways, because it really says antibiotics have really very little place to in hemorrhagic enteritis, hemorrhagic gastroenteritis, unless there are signs of sepsis, unless I mean there were some, some dropouts in this study, although the dropouts were the same in both groups, the, the dropouts of dogs, there were a few dogs that went into sepsis and, and it didn't matter whether they were on antibiotics or not.
They went into sepsis and they were then in, obviously treated for, sepsis. And that answers the point about what, what, you know, should, should we wait and, and not give antibiotics until we know what the culture says, and that, that's, that's, that's, the, the reason for that is that you should monitor these dogs for sepsis, but giving antibiotics isn't gonna prevent that. So this, this study was really quite revolutionary, and there were a lot of people who didn't like this study because it, it, it, it really suggests that antibiotics aren't aren't, aren't useful.
And following on from that, a few more studies, 2018. Now this isn't an antibiotics versus nothing, but this is actually saying that when you take amoxicillin claudullaninate dogs, or you give them. amoxicillin, trivulate, and metronidazole, so that, that, that this was randomised.
There was no significant, so metronidazole has absolutely no role to play in the treatment of this. So that effectively says that there is one antibiotic, even when under the cover of another, that isn't going to, to particularly help. So.
And I've just highlighted these two studies. There are other, plenty of other studies out there, which are increasingly showing no role for antibiotics in the treatment of hemorrhagic enteritis until they actually start to develop signs of sepsis. And those antibiotics will not prevent that development of sepsis.
So it's not a preventative, and it's not helping. So why are we giving antibiotics? and, and I think that's something that we need to talk about in our practises and have a, have a think about because this is a bit of a a difficult thing for some people.
What about probiotics, Ian, can I just, drop in there because I think it's really significant as well, just while people are listening, that, obviously antimicrobial stewardship is, is really important and actually. There's going to be an amnesty for people returning medicines as well. I know you're probably going to talk about this at some other time, but it just seemed like the right time to talk about it with it in about 4 minutes.
Oh well there we go. Well, we, you've got that to look forward to, but we just do need to use antibiotics much more sensibly. I read an article, you know, the.
The number of deaths now that are attributed to antimicrobial resistance are staggering, aren't they, in the human world. Yeah, yeah, yeah, absolutely. I'll let you crack on.
Thank you, thank you, Andy. OK, so, . The what about those probiotics?
Well, this was an early study from 2010 which showed very little effect of probiotics. I mean, you could argue that, that, that this was days of treatment, so that actually the further to the right you are in this graph, the, the longer you're spending on treatment. And probiotics seemed on this relatively small scale study to.
Have a slight advantage. So that was developed into a larger scale study, and we have this one here showing a a significant but small benefit of using probiotics in these cases with acute diarrhoea. Now I would emphasise some of these had acute diarrhoea with haemorrhage, some of these had acute diarrhoea without haemorrhage.
So it's not quite comparable with, with, with, with this. The work is still to be done specifically on the haemorrhage hemorrhagic enteritis. But this shows clearly that probiotics certainly do no harm in that group and may in fact help.
And certainly the duration of diarrhoea in terms of hours was significantly shorter if you use probiotics. So for me, at any rate, probiotics would be a, a, a very good, good choice here. So this whole question about antibiotic selection is, it really is starting to come into the fore now with the idea that really we should be doing cultures first.
There, there is good evidence from the human world that unless the human being, you have got time to make the culture, to get the culture, to get the results back, OK? This clearly requires some communication with owners, because they need to explain to owners and, two things that you can help you with that. The first is having a good practise policy about this so that you're not actually put in the situation of of trying to defend it individually but rather saying no our policy is to do this because this is the evidence based.
Approach that practise policy could be based on the cascade and things like protect me and remembering that just because you're not giving antibiotics doesn't mean to say you're not doing anything. You can be giving fluids, anti-spasmodics, probiotics, nursing and so forth, which shows that you are doing something which is really, really important. It can help to use things like no prescription.
Prescriptions. Yes, there are no antibiotic prescriptions. These have been shown in human medicine to reduce antimicrobial prescriptions by up to 20% in practise.
In human practise, no antibiotic prescriptions actually reduce it because it's something you can terminate the consultation with. It's something you can say, this is what I'm gonna do, this is why we're doing it, and you don't need antibiotics. And it, it sounds a bit trite.
But it has been shown to work and to reduce antibiotics. This is why if you look at, Protect me, which is the sort of, probably the, the most common guide set of guidelines on antimicrobial prescribing, that under the gastrointestinal infections, we have, antimicrobials are not indicated for acute vomiting, acute diarrhoea, including acute hemorrhagic cases, not indicated for pancreatitis and quite a number of carriage of organisms and so forth. So that, that, that, that's quite a strong recommendation, and I accept that not all practises have, have protect me, and not all practises embrace protect me, but, that's certainly the current evidence-based guidelines, for this.
So I one thing that I, I would be interested in finding out is, how many of you have protect me posters in your practise? Are they on the wall? Are they filled in?
Are they on the wall, but they're not filled in, they're just guidelines, yes, you've got one somewhere but they're basically buried under a pile of old magazines. It will be interesting for me to find out how we're doing. On that.
So 42% have, that's, that's great, 36%, no, I, I, I would beg you, please, to try to get at least an antimicrobial policy in your practise, if you don't use protect me then use something else, . So, so that's good. What, what, what, what happened with Holly?
Well, what happened with Holly was that, she, she received probiotics, spasmolytics, and, did not get IV fluids, but I would accept that, she probably did. This one, this case is very personal to me, because what I didn't tell you was that the client was my wife, and this was my dog, and that was my kitchen that you saw. And, we were going on holiday and Holly had the most horrible bloody enteric diarrhoea.
And the pressure on me from my beloved to give antibiotics was real. And it's important that we try to stop and look at the evidence. Holly recovered absolutely fine in 3 days, and this was her pictured a few, literally 2 or 3 days later, on, on the mountain, happily, happily playing on the mountain, after that horrible hemorrhagic enteritis.
As Anthony says, we have an antibiotic amnesty coming up. this is a an attempt to try to remove antibiotics from the environment. You're going to be hearing a lot more about this, I hope in the next few weeks.
We're trying to get owners to bring these antibiotics back rather than let them go into the watercourses and into the environment and to be used on other animals and to be used on the same animal again. And try and get some of these antibiotics we know are sitting in people's cupboards unused. You may even have some antibiotics in your own house, only part used, to get these back and can get them disposed of properly.
This, has been, been worked. With with IVC Linnaeus, rumour, Beaver, BSABA BVA, the RCBS, we're all behind this, and we'll hopefully be be telling you a lot more about this in the near future. So keep an eye out for this antibiotic amnesty.
What I and and webinar vet as well. Oh sorry, yes, yes, webinar vet, yes, yes, yes, sorry, forgot that one. But it, yeah, it is so it is so important.
I, we've just had a question and Martin was saying this was a study on antibiotic on amoxcla. Are there other antibiotics, and then Claire has said opinion on Tylan, please, Tylerson. Sorry, hold on.
OK, so. Oh gosh, lots, so, so, OK. Guards, yeah, somebody said about Guardia snap, that's fine, yes, that would be that.
Do I do a 3 day sample for, no, a 3 day samples that would be more appropriate for animals that are, chronically have chronic problems, a 3 day sample would be problem. Do you use sulfurzalazine if it drags on, if hemorrhagic enteritis drags on, then yes, absolutely, but, most of these are are self resolving, . Opinion on Thailand, thylacine, as far as I I understand, is, is not readily available for small animals, and that it used to be something that we used, quite a bit of, but I personally would reserve Thai Thailand for those animals.
That have demonstrable thylacine sensitive infections, the, the, the general thing is, is not, not to, but again, I would be careful because we're we go, we're straying out here into the realms of chronic diarrhoea and treatment of chronic diarrhoea. This is all about acute diarrhoea, so it's the acute response to diarrhoea that we're talking about here. Even something like I know you had in one of your slides here with salmonella, giving antibiotics can in fact induce carrier statuses and things, can't it and make it worse.
And but but I think one of the the questions was about, about what recognising when sepsis might be starting to occur, and high levels of, of white blood cells, and increasing white blood cell count, a decreasing platelet count, and, most particularly obviously clinical deterioration. I mean the the the they're really. Sick dog that, you know, that sepsis is not a, a thing that these animals walk in and, and you can't find anything on clinical examination.
They're tachycardic. They're, they're starting to get into problems. They're dehydrated, none of which was the case in Holly's case, and I, I think that the most important first step is making sure that that on that clinical exam, whether this is a a a problem confined to the intestine or is starting to become systemic.
I think that was really key. If you've got a healthy dog in front of you, you've got time to play, haven't you with it's, it's not a, this isn't a really sick dog, and I think supportive treatment, as, as you said in, in some of the studies have been shown to be as effective as putting antibiotics and other things in. Another question there is about spasmolytics, which ones do you use?
A general span scarpan. Right, OK, great. I, I, and, and actually it's a kind of an old drug really, but I was using it in a dog the other, the which had had all sorts of chronic problems and you go and use muscarpan and suddenly the dog looks a lot calmer, a lot nicer, and, and it really does er er er er help.
So, so I think obviously don't use busarpan in cats. That's obviously I think remembering back to our equine days at Liverpool University Busquepan was much better than using Philidine, which of course just ended up, the horses looked great until they dropped down dead. Yeah, yeah, yeah.
And Julie said, would you give a shot of Culversone just in case, or in this case? No, this is not a steroid disease, and, there is no advantage of using steroids in this case. that, that this is an inflammatory and in this case this is an infection, clostridium proffirons, it, it's not going to help.
It is potentially ulcergenic in the stomach, of course, and will cause all sorts of changes in the blood, like increased liver enzymes and so forth. So you, you know, I don't think I would use steroids in an acute hemorrhagic enteritis, and yeah. And the the dog is basically.
Sorted itself out, hasn't it? It's been a self-limiting infection which you obviously had to, you know, look and, and keep an eye on, particularly with your wife breathing down your neck. So you're a brave man, not to cave there, I know I'm I'm very impressed.
Thank you. Fantastic. Are we gonna take just a little break for me to just.
Yes, that's what I thought I will stop sharing screens. I will share my screen and get into. Yeah, so thanks everyone for coming on.
It was, just wanting to share with you, what is happening with our relationship with IVC. Just to let you know, those of you stay on till the end, we are gonna do a little draw, we'll do it, tomorrow morning and we'll let you know, but we've actually got some fruit for your practise. One of you can win a bottle of champagne and then we've also got an annual unlimited membership.
So those of you on live. And stay on till the end, you've got the opportunity of winning one of those prizes and we'll email you all tomorrow so you know what's happened with that. Just wanted to go back a little bit in time to 2009 and what happened BW, which of course is before webinars.
And it was quite a busy year actually. Bitcoin, obviously with all the turmoil on the currency markets, Bitcoin and cryptocurrencies are seen as maybe part of the solution, and the first Bitcoin was mined in 2009, at the beginning of 2009. I can remember that I opened, or my, I moved my practise up the road, from Croxford Park up to Muirhead Avenue, and the day that we were having our open day, I felt really sick with flu.
Now we didn't have all the testing like we have with COVID, but it could have been swine flu. I felt really sick and of course swine flu pandemic was actually announced. In 2009, so history repeats itself.
You may also remember that we had the the plane that landed on the Hudson River and thank goodness everybody survived. Barack Obama was named as the 44th US president. Slumdog Millionaire was the won the Oscar for best film.
Couple of companies you may have heard of, Uber was launched in 2009, and Bing, Microsoft's Google search equivalent was also launched, and then the very cool dude Usain Bolt broke the world record at the World Championships. In 2010 though, and I, I'm saying this because I, I'm, I'm pretty sure that some of you will be on the line who perhaps qualified after 2010. I'm not really aware of the fact that there was really no online provision in 2010, and actually I attended an internet conference.
Heard somebody talking about webinars, went and did my first webinar within about 6 weeks in early March. It was on practical approaches to managing pruritus is, is on the site. So if you do become a member, do go and have a look at it.
It will be a bit dated now. Shortly after that, I went to BSAVA and spoke to people about webinars on the various stands and said you should be doing webinars, and most of them said, well, what is a webinar? So I had to explain that first.
And there was, I think a little bit of disinterest that, you know, a slightly mad vet in first opinion practise telling people how they should be doing things completely differently. And but but in fairness, Stuart Lawton from Mary I said, well, I'd like to try this, and we did our first ever sponsored webinar on feline infectious diseases. And then Hill's pet nutrition came and we did a series on the cats, so, the cat was very much favoured early on in webinar vet, and of course we still love cats, and in fact I was adopted by a cat during the pandemic and.
Here is a picture of Buddy who basically left home, wanted a quieter house, it's just me and my wife in the house, and he has retired to our place and spends most of his time ignoring us, but occasionally demands a little cuddle. So it's been great to get Buddy in the house. My wife is actually allergic to cats, but Purina developed a food called Live Clear and the cat eats the food and my wife's allergy is a lot better as well.
And we did a recent survey, net promoter score is a sign of how likely people are to, tell their friends about you. And we have a big community of about 55, 60,000 vets and nurses from all over the world. And when we look at the whole sort of community, they give us a net promoter score of 41.
But those people who join membership, that net promoter score goes up to 60, so people who buy a membership with us, who invest in themselves, find that they really enjoy the webinar that and are much more likely to recommend. And then, again, this survey that we've done is, is slightly biassed because it's only to our community, and we get about a 5% response to that, so it's probably the ones who, you know, really like us as well. But from a quality perspective and from a general service perspective, we score very well on that compared with our benchmarks.
As I say, Webinar vet was, established in 2010. We are really wanting, as our vision is to create the world's largest veterinary community to have the best quality content on the site. And because people are looking at the training, following the training, we believe that people will become better vets, more confident vets and nurses, that they'll actually go into the consulting room and and feel that they can do a better job than without doing the training and the mission when I started it was very much to make world class education available.
Accessible and affordable to vets across the world, and it's a big thrill to see so many people use the free service from, you know, countries that aren't as developed and perhaps don't have the education opportunities that we have in the UK. So that's been a big thrill to see vets in well over 100 countries and nurses following our training. We've got about 2300 webinars on the site.
We also, launched Vet Chat, which is our podcast channel. It's the leading UK veterinary podcast channel. I just did a podcast today with Juliet Davenport, who is.
Is the founder of Good Energy. So as well as doing clinical, podcasts, and we did another podcast today on hyperthyroidism, we do also look at things like some of the sustainability, development goals from the UN like, Life on land, like, gender equality and so on. So there's a really mixed bag of podcasts in there and, it's been really well received by people.
We do weekly webinars for members. Our site is seamlessly connected with the RCBS one CPD app via QR code so that you can very quickly put your training on. And all of the training that you do on our site is tracked and you get personalised certificates.
We don't just cover small animal medicine, we cover a whole range of clinical topics. But also things like wellbeing, positive mindset, practise management, as well, so it's really very complete what we're actually showing on the site. We did a competition over the summer that some of you might have seen.
This was with people who were already members of the webinar from IVC, and, we, we had a competition, for those people who were doing the most CPD in their individual practises, and then at the end of that we actually picked out one winner at the end of 3 months, and that was Hannah, Hamlet James from Treff Forest Veterinary Clinic. Who's won a 1000 pounds cool stays voucher and I'm sure you can all read that she obviously enjoys the service and has found it a real help for her. Gayle is obviously the director of Veterinary Professional Development and Alistair is the deputy Chief Medical Officer, and Gayle's spoken to us before she worked at IVC when she was at Nottingham University, a fantastic speaker.
And obviously, I think with IVC with their commitments to sustainability, they understand that using this online resource is is also good for the planet as well. And can help with work-life balance when you don't have to travel quite as much to do your CPD. It's something that's very much at the heart of what we do.
I'm very committed. To, making the environment better, to regenerating the veterinary world and . This is just a few of the things that we do.
We are an investor in the environment green business. We're also carbon negative, so we are trying to reduce our carbon use as much as possible, but that, that we do have left, we do offset, as well as offsetting when people buy a membership at the webinar vet, we have buy one, get 23. And we have in fact planted over 4000 trees and we're hoping to to get to 5000 by the end of this month.
We're a carbon neutral business, carbon negative business, but the negative is because we actually, in the pandemic year, we recognised that this wasn't a normal year and we actually offset twice the amount of carbon. And, and in fact, at the beginning of the year we held a sustainability summit to help practises to become more sustainable themselves. We had 300, vets and nurses on that from all over the country and overseas.
And then just about a month ago, I did an annual green discussion forum at Brockho's Nature Reserve to see how we could as an industry, begin to look at hitting targets like the COP 26 targets, but also how could we protect biodiversity, how could we recycle and reuse more. Just as an example, our, our last carbon calculation showed that we were using about 73 tonnes of carbon, and we had about 180,000 hours of webinar views on the site. That meant that one webinar cost us approximately 0.004 tonnes of carbon dioxide.
I then worked out that if you travelled to a conference in a car and maybe did about 100 and 100 miles in the car to go to the conference, you watched 10 hours of webinars there, that would cost you about 0.006 tonnes of carbon, which is 15 times more. And actually our calculation takes into account, you know, all the costs of the people working in the business, the office building, etc.
Whereas obviously if you drive to a conference, that's not looking at any sort of scope for emissions, which is the responsibility of the conference. So it, it is definitely a, a less carbon, expensive way of doing your CPD. And these are some of the trees that we've planted, sometimes people say that, you know, trees, planting, obviously not really absorbing a lot of carbon, and that's absolutely true at first, but as they get older, they do start absorbing more.
But really the reason that we're planting trees as part of the membership. Is to support countries, people in poorer countries. This helps with things like biodiversity, it helps to create shade for the people and their animals as well.
And obviously, it's the local people who plant the trees, so they get actually paid for for planting the trees in those places and this is a a gold standard scheme, so we know it can be measured and is UN approved. We're we're planting trees in places like Nepal. And Madagascar, Mozambique, Kenya, in Indonesia, Haiti, the Philippines, Ethiopia, and Brazil.
Well, with our actual offsetting, we have protected some of the Amazon rainforest, which at the moment is emitting more carbon than it's absorbing, which is really frightening because of all the fires that are burning there. And we also support women, women refugees in Africa with solar stoves, so they don't have to cut down trees, which obviously then releases the carbon back into the atmosphere, so the solar stoves work really well. What we're offering to IVC employees at the moment is the opportunity for you to enjoy membership access until the 1st of January 2024.
There'll be a quarterly webinar like this specifically for IVC members to enjoy. We have a great customer service team. I, I really pride myself on the quality of the people in the team.
They really care and they, you know, want to serve you. So if you're having problems with the service or you're not sure how to find something or how the website might work, they're there to, to help you. We are also going to do a quarterly draw for IVC vets and nurses.
That you've got the opportunity like Hannah had of winning 1000 pounds in a prize draw, provided you've done at least 6 hours during that quarter. And what we're also doing for the rest of this month is instead of buy one get 2 tree, it'll be buy one get 4 tree, which is even better because obviously I think that sort of benefit to carbon but also biodiversity is, is massive. We are limiting this to 500 vets and 200 nurses, and we're trying to keep it to make it fair that it's a maximum of 2 vets or 2 nurses per practise as well.
And then finally you don't need any credit card or anything for that, we can invoice your employer IBC Evidencia directly with a form that we can show you at the end. I think Dawn is gonna pop that into the chat box. So to do that with our pricing at the moment, it would be 600 pounds for vets and it would be 240 pounds for nurses.
We're conscious across the board that everybody is struggling, there is political turmoil. There's obviously, you know, bigger, bigger bills for everybody in personally and in practise. Obviously this is going to impact perhaps whether people want to come into practise if they're in difficult situations themselves.
So I think globally we are gonna decrease the price fairly shortly, but only a small amount. But you know, what we can afford to try and help the profession. But for this month until the 31st of October, we're offering you the opportunity of having it for.
Less than half price, so for, for vets it will be 300 pounds instead of 600 pounds. For nurses instead of 240 pounds, it will be 50 pounds. So, these are massive reductions.
If we haven't sold all of the memberships by the 31st of October, we will continue to offer them, but it will go up to 330 pounds for vets and 100 pounds for nurses. So if it is something you want, you're in fact getting this for 15 months. Instead of 12 for a price that is much below our annual membership as well.
There's the the URL there, so if you want to make a copy of that or I think Dawn will be putting it into the chat box, please do go and look at that and if you fill that in, I think we can just then invoice IBC Evidencia direct, so you don't have to worry about things like credit cards and so on. As I mentioned, these are the prizes that we've made just to make it a little bit of fun tonight. So one of you will not have to pay anything cos you'll get an unlimited veterinary membership for free.
And then we've also got a nice little fruit basket, that we can send to you. You can either have it all yourself or you can take it into your practise, and then also a bottle of champagne for somebody else as well. So that is basically .
The, the, the, the offering, I do hope you'll take it, you know, we'd love to see many, many more of you on the site and enjoying webinars like this, but obviously also the, the the site has. Many, many hours on it, covering lots of different areas. So it really is a video library, and some people have used it almost, they have a problem case.
I remember somebody with a, a feline diabetes case that they were struggling to control. They watched one of Ian's webinars. There were a couple of others that were around the subject and At the end of that, they were able to control the cat's diabetes a lot better.
So thanks for listening for that. We're gonna go back, back into the quiz, Ian, just in case anybody else has come in a bit late, perhaps we can just tell them about the pole system again, but if you want to take the sharing back again, we can, we can crack on with the with the quiz and the fun. OK.
So let me just share my screen here quickly. And there we go. OK, so, just before we, left, there were a few questions about that, that, that case, and, particularly about the role of diet, and should we change the dog's diet?
My, my, my view is this, that the colon definitely benefits or rather does not benefit from a high fat diet, so avoid a high fat diet. So my first question to an owner is, what are you currently feeding your dog? And if it is an appropriately low fat, bland diet, then I wouldn't seek to change it, because dietary change is also not going to be good for that dog.
If on the other hand, the dog is receiving a very high fat. Diet, then it is appropriate and reasonable, to start talking about changing it to a low fat diet for the duration of the clinical signs. Some people talk about high fibre diets.
The these do help in chronic colitis, but there's no evidence for, for them really in acute colitis, because by the time you've given the diet and changed the diet, then the, the, the situation may well have almost self resolved. If you look at those 60 dogs that Stefan Unterer had, the situation was resolved in 5 days in most cases. So the, the, the idea that the diet is gonna have that much effect is, is, is, I don't think correct.
So, high fibre diets for chronic colitis, colitis type things, that's fine. But, but a low fat, low fat if it's not already low fat might be quite, quite a useful thing. Another very good question is that I, I, I skirted around it about the role of spasmolytics.
there's good evidence that spasmolytics are spasmolytic, they do stop spasm. Do they alter outcome? Do they shorten hospital stay?
Do they make the dogs have less days of diarrhoea? Probably not. but spasmolytics do deal with intestinal spasm, and, from the point of view of relieving suffering.
If you think that that dog is, is having the same sort of experience that a human being would be having, then it is not unreasonable to use spasmolytics as a, and I hate to pain relief, but perhaps symptom relief or or spasm relief and relieve the suffering of the animal, that would seem a reasonable justification for doing it. But do we need more studies on this, on the role of diet, on the role of Spasmolytics on the role of different approaches with with and and yes if you believe antibiotics then let's do some more studies on that. We do need to do this, but this is, this is actually stuff that goes most of these cases are seen in primary care practise, so it's very difficult for referral referral vets to do this.
We can do it through our out of hours clinics and emergency clinics which we which we see quite a lot of these cases through. At Glasgow, but it is still, much better if it is a primary care practise, doing that, and, I'll have a, we plug there a lot of research funds out there, for vets in primary care, but BSAVA pet savers would be particularly interested in. Funding those kinds of studies properly designed, properly controlled, with proper ethical approval before anyone starts rushing off and having a go, get ethical approval.
But there is a need for this kind of study, not just in gastroenterology, but in many things that we see in primary care practise. OK. So, on to a quick, quick quiz now, and, and, for those of you who've just joined, then, as I said, this is an interactive session.
You'll need to go to the website PolyV.com or, or you go to the app store and get PolyV. You then type in your username, which is Ian K Ramsey.
that's Ian K Ramsey, not Ian Ramsay, Ian K Ramsey. And then you'll be asked to sign up with a name, please use your favourite cat's name or whatever, not your own name, because I don't want to know, who's answered what. So, Polly V and, Ian K.
Ramsey, I'm guessing most people here are already on it, so, let's just, have a quick, quick look at this, and see who's, who's on. I, I cleared the poll already, so, it's, how many people have we still got going? So if you, if you're on, please just put it on so so I know roughly how many people are answering.
Oh, OK, so we've got about 50, 50 or so people answering. That's great, that's more than enough. The answer was Lagaulle, on the Isle of Isla.
My other dog, by the way, is called Isla. I wish I'd call my other dog Paris. It would have been a much nicer holiday.
But Isla with Lagaulen was not bad at all. I digress. OK, 65.
Wow, things are going. OK then, so, let's just clear those responses. Because then we're going to ask.
How do you test for auto agglutination in dogs? Mix an equal volume of fresh blood and saline. Mix 2 parts CDP blood and 1 part water, 3 parts heronized bloods with hormons.
Mix an equal volume of EDTA blood with saline. Mix washed red blood cells with the patient's plasma, none of the above. Also glutination being an important test for an immune-mediated hemolytic anaemia and an important test for primary care practise to perform on any anaemic animal coming in particularly dogs, of course, because they, commonly get IMHA.
Let's, let's see what we got, got there then. OK then, so let's see what the responses are. OK then, so, if you take fresh blood.
And you mix it with saline, what you get is a clot. It has to be, it has to be EDTA blood. Because you have to prevent coagulation.
That's what the EDTA does is it stops coagulation. So this blood should never clot. So when you mix, well yes, and suddenly everyone's changing.
Oh, quick, quick, change, change, change. No, I really meant EDTA blood with saline. So it is important that you use EDTA blood.
We, we do get quite a lot of cases sent in with IMHA. Which are said to be all glutination positive. And yet when we do the test, it is not.
And this is quite a common mistake to make is that you take the blood straight out of the animal and mix it with some saline. What you get then is clotting. So, what's important is you take one drop of EDTA and another 1 or 2 drops or 3 drops of saline.
Some people do it very well. Most, most people go for 2 drops with a, with a. a dog, and what you'll expect to find in a normal dog is something like the upper slide.
In a really rip roaring IMHA what you'll get looks more like the bottom slide. So these, these auto glutination are happening, these red blood cells are being clumped together by the . antibiotic.
If you just mix blood with saline, then what you will get is coagulation and you'll see these clumps and so forth, but they're actually coagulation. OK, sometimes what you get is the top version up there, apparently normal. And in those cases, you should examine it by microscopy to look for micro agglutination.
So I guess the next question is, this is a cat, not a dog, but same principle. What is happening in this slide? Is this a glutination, autoglutination, coagulation, parasitism, rulelo formation, or none of the above?
I'll give you a moment to look and then I'll give you a moment to answer. The question slide is next. Question slide is next.
So look at this and decide which one of those and then we will go to what is happening in this cat's blood. OK, great. The reason why we check under the microscope is to look for a glutination, but we have to know except that when we look under the microscope, we may see rulelow formation.
And what you can see here in this slide is a stacks of coins these. Red blood cells are lining up. They're not forming bunches of grapes.
They're lining up in the line. And at that point, that makes this reo formation and is not, not all glutination and therefore this cat does not have IMHA on the basis of this slide anyway. So the answer is rulelo formation.
OK, next one. Seeing a lot of imported dogs, recently, a lot of a lot of them coming in, some of them turn out to have lymphadenopathy. They come in from, Romania, from, Hungary, from France, from Spain, from Italy, sometimes we do these see these dogs with these, .
Lymph nodes, which one of these, or ones of these several ones of these, slides represent dogs which have an infection in their lymph nodes? And you can answer 123 or 4. Just put a drop on.
Right, I'm not sure if you can see my laser pointer here, but, anyway, so, on the, the, let's start with the bottom left. Bottom left, everybody went for, I think that shows a, leishmaniasis, leishmaniosis, absolutely, this is infectious. This On the bottom right.
There's a mast cell tumour. So this is Marcel's. From, or should I say a metastasis from a Mart cell tumour.
So this is not infectious. On the top left. We have dull bodies.
Toxic neutrophils can develop these dullboids, DHLE. These are a sign of a toxic neutrophil, but of themselves are not infectious. All that means is you've got toxic chains.
Now you may see dull bodies in infections, but you cannot say this is an infection. And finally, the top right, what you're seeing there are large nuclei with very, very big prominent nucleoli, often 2 or 3 or 4 of the nucleoli in those cells, with a thin rim of dark blue staining, cytoplasm around them. This is lymphoma.
This is a a malignant lymphoblast that we can see here in the top right. So the answer to this question is only the top bottom left, only the bottom left is actually an infection. And at least 2 of them, one of them is, is probably a, a treatable condition and the two on the right probably are treatable with chemotherapy.
OK. Next question. This is an eight year old West Highland white terrier.
we're just going to play the video here. Oh. No, no, no, no, let's go back.
Sorry I have to. Pointer options. There we go.
Apologies. So have a look at that little, little dog. West Highland white terrier.
Should be able to see him walking up and down the screen. So my question to you is. What is the most likely cause of these signs?
There's a lot of people who are less sure on this, but, yes, the myotonia has it. This is the myotonia of dogs with hyperadrenal corticism. Important to recognise this.
Often these dogs have mild signs of Cushing's disease, and this is the presenting sign, this, this stiff gait, and sadly with, with, with, even with effective treatment of Cushing's, this, this gait will not likely get much better. But if you treat the Cushing's effectively, it won't get worse. If you can't control the Cushing's, then the gait will get worse.
And, there is some interesting figures coming out from, a multi-center international study, that we took part in which showed that the, the outcome for these cases is really rather poor, and, and worthwhile, being aware of that when we start treatment. OK. Two examples for cats with oral ulceration, 11 mild, and one quite severe with declamation of most of the tongue of the of the kitten on the left, but the kitten on the right only has a small lesion on the tip of the tongue.
Which one or more of these viruses are associated with oral ulceration in a cat? OK, so yes, absolutely. Cali virus is, is really high up there as, as a poss thing.
Herpes virus, actually, no. Herpes virus is rarely associated with oral ulceration. It is more commonly associated with ocular ulcers with, with conjuncti sorry, corneal ulcers.
Immunodeficiency virus is not a feline immunodeficiency virus is not directly associated with oral ulceration. it, it has no, the clinical signs of FIV are, are really rather, rather mild on their own, and, there's no interaction really yet shown between, FIV and, oral ulceration. So really the answer to that is Kay Cyrus and.
That which you've forgotten is cowpox virus. So we do see with cowpox virus or lacerations on occasions, but that's a, a pretty rare thing. Next question.
Again, the, the, the question slide will come up, in a moment, but, what sort of crystals are these? This is, crystals in the urine of a two year old female entire dog, with cystitis. Some options there for the crystals.
Let's just see what they are, what, what sort of crystals are these then? What sort of crystals are those? OK, so cystine crystals are sort of hexagonal or or polygonal, flat blades of crystals.
Birate are small with little spikes sticking out, and those were bioate crystals. So these aremonium birate crystals in this dog, and that would suggest to me that it's quite possible that this dog either is a Dalmatian. Or, has a port of systemic shunt.
So we'll be looking very carefully in this dog with cystitis by performing a bile acid stimulation test for evidence of a shunt, despite the presentation not being to do. See cystitis as a sign of presentation of shunts. Yes, we do.
It tends to be in the older dogs, which presumably have relatively small shunting fractions and seem to be less affected neurologically, but they do come in with cystitis, and indeed with urothiasis. Ian, I'm just conscious it is about 9:09 now. So what I'm suggesting is if people want to go, you're very welcome to go, but will you still do another 1015 minutes of this for us?
I'll carry on doing another. I've got another 5 or 6 questions, yes. Yeah, that'd be great.
I just to clear up, and I know Vicky's on the line who's helping with this membership offering for you. I've gone to that page and obviously you can pay with credit card if you want to, but if you want to just sign up without having to do the credit card and to invoice directly, probably the easiest thing is just to send an email to Rob ROB at the webinar vet.com, and then he can sort out your access and so on and and take your details because that page looks like it is taking you to.
The shopping cart and to to put your credit card details in. So just do send an email to Rob ROB at the webinar vet.com and he can certainly take that forward with you and get you get you signed up for the membership.
Write in, back to you, but if people want to go, you're very welcome to. We will include all of you in the draw, we'll let you know, tomorrow how you all got on. Great, OK then, so, this is a a cat that has a scab on the back of its head, as it were, just between its ears or or slightly to one side, and, the question is what microbial organisms might produce this?
And you can just type the answer in. And obviously the more people who type in the bigger the word gets, so . So I, I would suggest that, that, that, a scab covers an ulcer.
So I'm not sure that ringworm particularly would cause ulcers. It, it does unless there's some self-induced trauma, so I think it would be fair enough to, to, to screen the cat for ringworm, but the answer in this case actually is that this is cowpox. So this is, this is a, a cowpox, lesion, and the, the, the main thing to remember about, about cowpox is that it gets worse if you put steroids on it.
So, and, as indeed would ringworm, but, this is not a, a mycobacterium, particularly this, mycobacterium would have to have hard indurated nodules, hard skin, and, that, that would, if you've got a, a skin, thing, and it would be mycobacterium, not TB, tuberculosis. Mycobacterium tuberculosis is a, respiratory pathogen, so not, not skin. This was, and interestingly, this cat also had pneumonia.
Now, I couldn't prove that this was cowpox pneumonia, but it is recognised as being something that you can see in these cases. So it could have been, cowpox pneumonia. Of course, the, the worry is that these, these scabs are, are mistaken for millary eczema and, are, are treated as, as, as if the animals have flea allergy and steroids are given, but mall eczema, of course, is much more widespread.
Plenty great stances in a nine year old domestic short-haired cat, you can see here the the dropped hocks that you can see here. Again, I'll give you some options there, and we'll just flick through to that. What is the most likely cause of this plan of great stances?
OK, so the, the answer for this one is hypoglycemia. This is diabetic neuropathy. Hypokalemia would tend to cause cervical ventral flexion, so the, the, the cats will go down and they, they, they'll be too weak to go.
There'll be more generalised weakness. This is just a hind limb neuropathy. So this is, this is a diabetic neuropathy in a cat, and they can present with just this, again, no, no history of diabetes, they just walk in, as it were, like this, only they don't walk in.
And again, strict control of the diabetes is essential to prevent progression, and with time, many of these animals will recover their function. But this particular cat, even with good diabetic control, took nearly 6 months to get fully back to strength, and to be able to jump up onto the window ledge. Another blood, this is not lymph node smears, these are blood smears.
Which ones is or are infectious? Hey good. Hey booty.
Anthony, do you want to put your mic on? I'm sorry, the cat's just come in and saying hello to me. Right, OK then, so, top left.
Is Babesiosis. So, so that clearly is infectious and has been reported not only as an imported infection in in dogs, but has also become endemic. There was an endemic outbreak in parts of Essex, Essex a few couple of years ago.
Top right is Mycoplasma hemophilus, so then, yes, that is infectious. Bottom left are howl Joli bodies, nuclear remnants, nothing infectious about bottom left. Bottom left is not a mycoplasma.
Mycoplasma is what you see in the top right. Those are far too dense, far too thin, and most importantly, they're not on the periphery of the cell, which is where you usually find some mycoplasmas. OK?
And finally, bottom right are target cells, and they are not infectious. So the, the correct answer is the top two. OK, radiograph from an 11 year old dog.
It is vomiting, bile and food for 3 days. It's getting worse. It's now 6 times a day.
It's no longer holding down water. It's had no history of diarrhoea, no history of drug administration, or of scavenging. And the question is, what is your diagnosis?
Is it GI obstruction, hepatomegaly, loss of abdominal contrast, normal for its age, so there's nothing to find, or renomegaly. So again an 11 year old dog vomiting bile and food and it's getting worse. So this is the radiograph.
So it's GI obstruction, hepatomegaly, loss of abdominal contrast, normal for age, or renomegaly. Right, OK, interesting. All right, so let's just go back and have a, a quick look at that radiograph then.
It seems like quite a lot of people want phantomgaly, quite a lot of people want loss of abdominal contrast, quite a lot of people want normal for age, . So I think a lot of people get confused by this radiograph because they don't identify the spleen as well as the liver. So this, what you see here, there has to be a spleen somewhere in this, in this radiograph.
there's no history of splenectomy or anything. So this, what you see protruding beyond the coil arch is actually the spleen. The liver in this dog, if anything, is quite small.
It's smell well within the Casillas. So hepatomegaly, no. What I do see is above the spleen.
In a dog that has a fair degree of fat, that suddenly we get rather poor abdominal definition. So, so for me, at any rate, this, this is a radiograph with, which shows some evidence of, of, of loss of abdominal, contrast. The, the kidneys are, always hard to appreciate sometimes on, on, on, lateral radiographs because, particularly the right kidney is, is, is hard to see nestling up there.
and at, at 3, at 3, lumbar vertebrae, it, it is at the top end of normal, so, it's a bit of renomegaly, but, that, that I, I think the overall finding mainly would be of a loss of abdominal contrast, and indeed, the, the snap PL was high in this dog, and, it had ultrasonographic evidence of, pancreatitis. What is the most likely cause of these signs in a 4 month old collie puppy? So have a look at those, there are some options there and again we'll, we'll fire up questions.
What is the most likely cause in this path? Fantastic, yes, absolutely. This is, this is tetanus and a and a and a puppy.
Great. Well done, everyone. 6 month old malet crossbred dog, with depression and acute vomiting.
Simple question, is this surgical? Yeah it's probably an obstruction as well. Right.
So this is a toughie. Let's go back and have a look at that. You can see that there's a gas filled viscous coming down there in in the colon, so that that doesn't count in the colon.
You've got a number of gas filled viscouss here, but they are actually all folding on on on the cells, and it's hard. To identify any one loop that is 1.6 times the lum.
These are big lumbar vertebrae up here, so it has to be 1.6 times at least, and some people would say 2.3 before you can actually say for sure, this is, you know, got real, real confidence.
None of those gas loops there are more than 1.6. This dog has parvovirus, actually.
It went on to have diarrhoea the following day, but in the immediate presentation, it, it, it, it, it looked like a foreign body and that radiograph might give you call. So I think I would, I would just go back and perhaps review those papers looking at the the size of the gas filled loops that you need to confirm that this is a . A surgical foreign body that would send you in there to to to to do that because this, this is actually not, not a foreign body.
This is not surgical and the gas filled loops are not yet big enough to say with any degree of confidence that this is actually a a a surgical case. Last question. Back to the imported case, peripheral blood smear of a sick anaemic young cat imported from Romania.
OK. So this is an anaemic young cat. They've done a blood smear, we've looked at it, and this is what we see.
Now you can't run all the tests, but I'm gonna give you 3. Which ones do you want to run? Good.
So hemoplasmaphilus is something that you would see in, in a red blood cell. I, I, I can see where you might think a lick, a licker comes from. Let's just, just go back and have a look.
So, so what we've been looking for, for here is, is something on the red blood cell for hemaplasma files, but clearly the, the, this, this is not a normal. Normal white blood cell. This has a, it's, it's a huge, huge white blood cell.
It's, it's what? 2 times the width of, of, of a red blood cell, at least, and the other two lymphocytes, or at least one of things are actually really quite big. Again, 1.5 times the size of a red blood cell, which a normal lymphocyte should, should only be sort of 10 microns, 12 microns.
This, this is close to 15, and this is closer to, to, to 20 something like that. So you, you're looking here at actually 2 lymphoblasts. And a mitotic figure.
This is acute leukaemia. So actually, If you have a cat with acute leukaemia, then you should do feline leukaemia virus testing. And just to, it was an interesting case, it just reminded us that they, we still have, these things coming in from countries where leukaemia virus vaccinations are not that common.
So, and control mechanisms, so we're actually gonna see some of these, more older diseases, coming in as well from these imported dogs. So few take home messages, please, you know, we're all into reflection now, reflect on what you've got right. And why did you get it right?
What led you to getting it right, because that, you know, let's let's focus on our successes here as well. Reflect on your mistakes, yes, but I, I have to say nobody gets 100% on this, and, and certainly not me. I have the advantage of an answer sheet, .
Many of these cases, the history and the clinical examination are absolutely at the core of good medicine and interpreting the resultant situations. it is really important that we do not allow these tests to dictate. Over and above our clinical assessment of the animals.
And, and, test selection is determined by your differentials, really important to think about your differentials, and then choose your tests rather than going haematology, biochemistry, ultrasound, radiographs, snap PL now what's the question? But do it the other way, what do we actually think is going and therefore, what is likely to distinguish between those differentials? And finally, without any resorting to any MRI, any any CT, but just for the most part using blood tests and ultrasound, sorry, blood test, ultrasound and microscope sites, you know, your microscope is your best friend.
in, in, in clinical practise, and we, we all need to, to practise that all the time so that when we do, have to see cases at, inconvenient times of the year like Christmas and so forth, we feel confident at looking at those microscope sites. I'd be happy to take any questions. I'd just like to say thanks very much to the webinar vet for, allowing me to come on.
Thanks to you guys for, for listening, and, and thanks also for taking part in our, antibiotic amnesty. Thank you very much. Thanks Ian, that was great as always.
I just because I was struggling to find it, the very, very tiniest writing you can get at the bottom of this page I'm showing you, you can see it says invoice your employer. So rather than the big one, which is the email address, which will take you to a shopping cart, and I haven't spotted this before we started, just look at that invoice your employer if you do want to take up. Membership this month and invoice IBC Evidencia direct for it.
Grey, let's see if there are some questions. I know a few more had come through. Somebody was asking about meropotent, if that is something that you advise as an analgesic for abdominal pain.
OK, so, so, so yeah, so there's, there's 22 questions here because that actually the, the, the other question was, about whether it may be nausea, so maybe this, this is nausea. Meropotent is not primarily an analgesic, and does not act as an abdominal analgesic in any real measure. I mean, it, it, it, it, it, it's, it has some analgesic, it's a bit like, you know, you know, the old story about metronidazole being immunomodulatory and so forth.
There might be something there, but in in clinically, I don't find neuroppotent works as a, as an abdominal analgesic, that's not. Going on, so, I, I don't think that's an argument for Meropotent, is it to use it as an analgesic. I think the question about whether this dog might be nauseous.
Is a much more good one and and that that really is a question about looking at the signs of nausea. Dogs that have nausea, you know, will slobber and slather and look miserable and down in the dumps. And if you feel that's going on, and actually it could be going on in hemorrhagic enteritis, because it could be hemorrhagic gastroenteritis, then absolutely I think it's perfectly reasonable to give.
Nepotent. There are no absolute answers in this, you know, so if you want to give Moropotent to this, dog, absolutely go ahead. I'm not, I'm not saying that we know the answers, you know, so, so you could use moreropotentin, you could use spasmolytics, you could use probiotics.
What I would urge you strongly is to think very carefully before you give antibiotics. Yes, that's, that's the take home message from Holly's case. It's not that we're getting sidetracked into the studies that have not yet been done on hemorrhagic enteritis and whether mropotent probiotics or mropotent and probiotics or what, what combination works, those studies haven't been done and, and clinical judgement and things.
But as far as I'm aware. We're not sitting here worrying about contamination of the environment with neropotent or contamination or or or mropotent resistance. We, we're worrying about contamination of the environment with antibiotics and antimicrobial resistance, and the veterinary profession has an important role to play.
In limiting that spread of antimicrobials in our environment because it is coming back to haunt us. One interesting statistic I learned in all of this, is that the antibiotics to get into sewage, sewage pumped into the sea, and now when you look at. At the surfers, if you look at surfers, they have a 30% higher carriage rate of antimicrobial resistant organisms, which, which also is another reason what you start to think of it through with actually, do you really want to be surfing around the coast of Britain?
I think it's also interesting, just a lot of it is empirical evidence, isn't it? I was reading a paper about length of antibiotics, you know, we often give, or doctors particularly give 7 day courses, you know, 5 might be enough, maybe 3 is even enough as well, so I think there's a lot to learn in that whole area as well, isn't there, Ian, about, you know, how long do we need to treat if we are going to treat with antibiotics. Mhm.
Yes, oh yeah, yeah, that's a, a huge, but, but again, unfortunately, debate debate debate on that is, is huge. Yeah, it's being asked here what's your recommended treatment for tetanus? So for that puppy, for that puppy, we treated it with fluid support, very quiet, calm environment, which might be better at home rather than in a busy practise, it depends, and, gentle syringe feeding of food.
More severe cases may require hospitalisation, and more direct fluid support, and, it is most important to keep them unstimulated. Those are the, you know, basic nursing will see these animals through, just fine. It is, it is also reasonable to use ACP to that that's one of those uses of ACP to, to, to keep both as a, as a bit of a sedative but also as a muscle relaxant, to, to help them through.
And, then the most severe cases I'd be contacting a neurologist to see, see what else we could do. But all the cases I've ever treated, and, and I've only treated 10 or 15 in my life, so not hundreds, I, I, I have got through with just quiet, calm, and, fluid support where they're unable to drink and just good nursing, and they get better. Fantastic, Ian.
A few people are already saying thank you so much, they've enjoyed it, . Yeah, from, Yeah, thank you. Wonderful webinar.
Brilliant, huge thanks. We've got Kirsten here, as you may remember, I had you for my first year animal husbandry exam, and you hated the pet travel scheme and said all these diseases were going to come over to the UK and you've probably been proven right with certainly some of them. We, we're certainly seeing things like Leishmania more than, we did 20 years ago.
The, the one that concerns me is brucellosis. Yeah, I, I mean we've, we've seen 5 or 6 cases at Glasgow. We know there are many more out there.
The, the Bru Brussella is a zoonotic infection, and you should be worried about brucellosis going to the UK, but I'm hoping, we were hoping one of the advantages, one of the very few advantages of Brexit, was that we were able to actually limit. The importation of dogs and put a condition on that they had to be over 6 months, which would not make the whole process, but, but sadly. And then today I have to say, but without an effective government to to do that change we we are going to be stuck here still seeing people importing puppies legally from Romania for some time to come.
Yeah, it's a, it's a, it's a concern, isn't it? Peter saying, thank you very much for this wonderful webinar. Thank you from Konstantinos as well.
So lots of, positive thanks. I will just remind you again because I, I, it was really tiny, just if you can see me with my pointer, rather than you having to work around and find credit cards and things. If you do want to take up the offer, it's very small on that left hand side, right at the bottom.
Invoice your employer, it's probably the smallest font we could possibly find, so we will make that a bit bigger on, on the page, but it's there for people who want to make use of it. Ian, thank you so much. I always enjoy coming on and and chatting, chewing the could with you.
These have been great cases and I must admit I, when I was doing my dermatology, I loved my microscope as well, so it's our feeling is, is mutual on that one. OK, thank you very much, everybody. I hope you have a great evening and I look forward to speaking again to you sometime soon.
Take care, thanks everyone. Bye bye bye, bye bye.