Orthopaedics - 5M Publishing
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
SMALL ANIMAL
Diagnosing and
treating feline
demodicosis
page 28
THE UK’S LEADING MONTHLY VETERINARY PUBLICATION APRIL 2019
LARGE ANIMAL
Tackling mastitis
in Africa
page 38
EQUINE
Infectious
aetiologies in
adult diarrhoea
page 45
PRACTICE MANAGEMENT
Introducing the
Good Work Plan
page 48
OPINION
“There is no
place in our
society for this
Orthopaedics archaic, moronic
abuse of sentient
Managing humeral intracondylar
fissure cases animals”
page 23
Plus
ONE HEALTH How to apply the One Health agenda in clinical practice / RABBITS Working M Facebook.com/vetpracticeonline
together on gut stasis / LARGE ANIMAL Health planning in the beef cow / EQUINE Keeping
horses safe / PRACTICE MANAGEMENT Dealing with absence due to mental illness
N @VetPractice_Mag
WWW.VETERINARY-PRACTICE.COM
SEE
WHAT
MATTERS
94% of dermatoses are
unrelated to food allergies(1)
NEW
2 SOLUTIONS TO MANAGE SKIN & COAT DISEASES:
D
RECOVERY DIET FOR SKIN/COAT
The appropriate solution to support the skin function in
case of dermatosis and hair loss FOR MORE INFORMATION,
PLEASE SPEAK TO YOUR
A
ELIMINATION DIET
VIRBAC TERRITORY MANAGER
The targeted solution for adverse food reactions with
hydrolysed salmon protein
(1) Olivry, T., & Mueller, R. S. (2017). Critically appraised topic on adverse
food reactions of companion animals (3): prevalence of cutaneous
adverse food reactions in dogs and cats. BMC Veterinary Research, 13, 51.
B
EDITOR’S WELCOME
“Do young vets respect
careers in general
practice?”
T
he important question, “Do young In small animal this issue, read about
vets respect careers in general managing feline demodicosis and the
practice?” has arisen at several value of teamwork when it comes to
veterinary events over the past few treating gut stasis in rabbits. With
months, particularly given increasing April’s focus on orthopaedics, Miranda
concerns over veterinary capacity in the Aiken provides an overview of the latest
UK. At the 2019 SPVS/VMG Congress, thinking for treating the challenging
Joanne Reeve described a similar trend cases of humeral intracondylar fissure.
towards specialism in the medical pro- Issues with dairy farming in devel-
fession and asked what could be done oping African countries are reported in
to increase respect for those working in the large animal section. At the British
general practice within the two profes- Mastitis Conference, Peter Edmond-
sions. Read the full report in the events son described the work UK veterinary
section, as well as a discussion of professionals are undertaking to help The business column describes the
wider issues regarding recruitment and reduce the incidence of mastitis in government initiative entitled the “Good
retention in a report on the “hot topics” areas where milking conditions are far Work Plan”, which will mean changes
panel session at VetsSouth. from ideal. Also in large animal, Hannah to the current tax systems. Finally, with
Following on from her fascinating Kenway provides a guide to devising a an apparently growing trend towards
talk on brachycephaly at VetsSouth, health plan for beef cow herds. listing post-traumatic stress disorder
Emma Goodman Milne guest authors a Expanding on his piece in last on GP notes, our legal column offers
passionate opinion piece on the many month’s issue, Jon Pycock asks if all guidance on dealing with absences due
welfare issues associated with Crufts. horse owners are paying their share to mental illness.
Elsewhere, in his regular spot, opinion to keep the UK’s equine population
columnist Gareth Cross draws atten- healthy. Jamie Prutton’s feature also
tion to the potential benefits of district follows on from his last article; this
veterinary nurses: a new role which month, he advises on what to do if
could improve patients’ transition from you suspect infectious causes of adult
practice back into the owner’s home. equine diarrhoea. JENNIFER PARKER EDITOR
A lifetime of LIFETIME
£50
the best PET
INSURANCE
healthcare
starts here pets
Find out more at: We
RE
agriapet.co.uk/VPM P E T H E ALTHCnAd with you
or call our friendly, UK team now: FREE r clients to spe
For you
03330 30 10 30
Terms, conditions and excesses apply. Agria Pet Insurance Ltd is authorised and regulated by the Financial Conduct Authority, Financial Services
Register Number 496160. Agria Pet Insurance is registered and incorporated in England and Wales with registered number 4258783. Registered
office: First Floor, Blue Leanie, Walton Street, Aylesbury, Buckinghamshire, HP21 7QW.
AGRIA 1184.1 HS VP Banner Ad 185x62.5mm AW.indd 1 Veterinary Practice | April
21/01/2019 2019
12:09 1
in association with Pet ID
CONTENTS
IN FOCUS
32
Managing humeral
intracondylar fissure
Though the aetiopathogenesis of the condition
is debated and treatment can be challenging,
it is important to diagnose cases of humeral
intracondylar fissure as soon as possible.
36 A look through the latest literature
The latest academic publications providing further
insight into this month’s “In focus” topic.
REGULARS 20 Front-line One Health
How can veterinary surgeons and nurses apply the
One Health agenda in clinical practice?
4 News
A snapshot of the topics currently hitting industry
22 Book review
headlines.
Are We Pushing Animals to Their Biological
13 Events Limits? considers the ethical implications of using
and abusing animals for human benefit.
Read reports on the “hot topics” panel discussion
at VetsSouth and a talk on the value of general
practice at the SPVS/VMG Congress. SMALL ANIMAL
16 Mental health 24 Working together on gut stasis
Letting go of striving can liberate us from the The management of gut stasis in rabbits often
exhausting pursuit of chasing happiness and help requires prompt intervention and the support of a
us to feel fulfilled. veterinary nurse.
18 RCVS Knowledge 26 Nutrition
The latest Knowledge Summaries on interesting, Hiding products in a mouldable product may
practical issues in feline medicine and surgery. improve the lives of the many pets that don’t
receive their medication as prescribed.
19 Insurance
Practices can work with the British Bee Veterinary 28 Dermatology
Association to support bee populations and What to look for in feline demodicosis cases
encourage clients to get involved with local wildlife to ensure you are effectively eliminating
initiatives. the right mite.
EDITORIAL ADVERTISING ENQUIRIES HEAD OFFICE
Nic Catterall 5m Publishing, Unit 10, Southill Business
MANAGING EDITOR 07730 762136 Park, Cornbury Park, Charlbury OX7 3EW
Ellen Hardy nic.catterall@5mpublishing.com
© 5m Publishing Ltd (2018): no part of
EDITOR Sally Pye this publication may be reproduced in any
Jennifer Parker 07867 357553 form (except for review purposes) without
Veterinary Practice (ISSN: 0042-4897) is an independent sally.pye@5mpublishing.com the express permission of the editor.
monthly publication, free to members of the veterinary DESIGN
EDITORIAL ENQUIRIES
profession in the UK. It is available on subscription: UK
is £40 per year, Europe is £90 per year and the rest of
the world is £120 per year.
5m Publishing
PRINTING
Jennifer Parker
07879 998719
M Facebook.com/vetpracticeonline
Volume 51, number 3 Buxton Press jennifer.parker@5mpublishing.com N @VetPractice_Mag
2
the ultimate microchip solution
LARGE ANIMAL
38 Tackling mastitis in Africa
The problems encountered with milking in
developing African countries are very different from
those we’re used to in the UK.
40 Health planning in the beef cow
A guide to developing health plans with your clients
to encourage positive change on-farm.
EQUINE
44 Keeping horses safe Pet-ID Microchips
Are all horse owners paying their share to keep www.pet-idmicrochips.com tel +44 (0)1273 837676
the UK equine population healthy?
45 Infectious aetiologies in adult diarrhoea
What should you do if you suspect infectious
causes of diarrhoea in horses?
OPINION
23 Emma Goodman Milne
PRACTICE MANAGEMENT “There is no place in our society for this archaic,
moronic abuse of sentient animals”
48 Introducing the Good Work Plan
Though plans have changed due to Brexit, 31 Gudrun Ravetz
practices still need to prepare for changes to tax “Uncertainty puts pressure on individuals,
systems from April 2019. businesses and industries”
51 Dealing with absence due to mental 43 David Williams
illness “Seeing the bright side of the world isn’t
How to manage cases of post-traumatic stress something that should ever be pursued merely
disorder, which seems to be an increasingly cited in moderation”
reason for absence.
52 Gareth Cross
“To help make the cliff edge of patient care
Is your subscription information more of a gradual transition, we need district
up to date? veterinary nurses”
Email vpsubs@5mpublishing.com to update our records
The difference is clear
Manufactured and distributed in NI by: Norbrook Laboratories Ltd, Station Works, Newry, Co. Down, BT35 6JP. Distributed in GB by: Norbrook Laboratories (G.B.) Limited, 1 Saxon Way East, Corby, Northamptonshire, England, NN18 9EY.
Legal Category: UK: Loxicom® contains meloxicam. Further information is available from the manufacturer on request. Use Medicines Responsibly. For further details on these products including the dosage regimens, side effects,
precautions, warnings and contraindications please see the summary of product characteristics (SPC) available at www.vmd.defra.gov.uk/ProductInformationDatabase/Search.aspx | Advice on the use of this product should be sought from the
medicine prescriber. | 4711-SA(C/D)-v1b-UK-23/01/19
Veterinary Practice | April 2019 3
NEWS
UK veterinary schools Drug-resistant
superbug gene
excel on a global stage discovered in
The RCVS was delighted to read
of the outstanding performance of UK dog
the UK’s veterinary schools in the
Bacteria that are resistant to a class of
2019 QS World University Rankings
powerful “last resort” antibiotics – carbap-
announced recently and, in particu-
enems – have been recently reported in a
lar, that the veterinary degree course
dog for the first time in the UK. In a study
at the University of London’s Royal
published in the Journal of Antimicrobial
Veterinary College (RVC) has been
Chemotherapy, an Escherichia coli isolate
ranked the best in the world.
cultured from a wound in a Springer Spaniel
Ranked third in the preceding
was found to harbour a known carbapenem
three years, the RVC clinched top
resistance gene, along with resistance
spot for the first time, overtaking
President Amanda Boag said: “I’d like genes for other commonly used antibiotics,
Cornell University (now fifth) and the
to congratulate everyone at the UK such as cephalosporins.
University of California (now second).
veterinary schools that have fea- “Worldwide there are very few reports of
Utrecht University was ranked third
tured so prominently in these world carbapenem-resistant isolates in pets and
this year.
rankings and particularly the RVC on although the prevalence identified in this
There were also extremely strong
their superb result. This is testament study was low (0.5 percent), it was still sur-
showings for the veterinary degree
to all the hard work and commitment prising,” says Dorina Timofte, who oversaw
courses from the Universities of
of all those helping to provide world- the study at the University of Liverpool.
Cambridge, Edinburgh and Liverpool,
class education and training for the “Carbapenems are not authorised for
which were all ranked in the top
veterinary surgeons of tomorrow, use in EU or UK companion animals, but
10; the Universities of Glasgow and
and a ringing endorsement of the these findings are worrying due to the
Bristol ranked in the top 20; and the
veterinary degree courses on offer close contact between household pets and
University of Nottingham in the top 40.
throughout the UK.” people which may allow bacteria to transfer
Responding to the results, RCVS
between the species.”
The work studied bacterial isolates cul-
Anxious owners seek clarity on
tured from specimens submitted to one UK
diagnostic laboratory receiving specimens
post-Brexit pet travel
from 34 UK veterinary practices between
September 2015 and December 2016.
The researchers say that the “surprise”
Continuing uncertainty around owners by Defra and the BVA last finding highlights the need for routine labo-
Brexit has led to a spike in the num- year, urging them to begin prepa- ratory detection of carbapenem resistance
ber of anxious pet owners visiting rations to take their pet to the EU in companion animal isolates and improved
their vet for pet travel guidance in at least four months ahead of their antimicrobial stewardship in practice.
the last three months, figures from expected travel date. A no-deal situ- During the last two decades, various
the latest BVA survey reveal. ation would bring additional testing multidrug resistant pathogens, such as
The BVA’s Voice of the Veterinary and certification requirements and methicillin-resistant Staphylococcus aureus
Profession survey shows that more require owners to prepare further (MRSA), have been associated with carriage
than 8 in 10 companion animal vets ahead to get pets cleared for travel. and disease in pets. Surveillance of resis-
(85 percent) have been approached While 48 percent of vets said they tance to commonly used veterinary anti-
by pet owners for advice about trav- could respond to most of the clients’ biotics has grown, yet there is limited sur-
elling with their pet in the event of a questions, many felt unable to veillance of resistance to “last resort” anti-
no-deal Brexit, with many express- answer all queries in detail due to microbials like carbapenems, so this type of
ing frustration or anger over the the current uncertainty. resistance can remain undetected.
uncertainty. Almost three-quarters The WHO and UK strategies for tackling
(74 percent) of vets report seeing Guidance on pet travel after
antimicrobial resistance have shown that
an increase in such queries since Brexit can be found at: bva.
there is a need for increased access to
November, with around 40 percent co.uk/brexit/ and gov.uk/
surveillance data as this can help policy-
seeing a significant spike. guidance/pet-travel-to-europe-
makers to revise the recommendations for
It follows warnings issued to pet after-brexit
combating antimicrobial resistance.
4
Vet-Tome®
The atraumatic extraction
system that greatly reduces
extraction time and saves bone!
The Vet-Tome with its patented technology is unlike any other
periotome or Luxator!
The iM3 Vet-Tome is an automated electric periotome with foot
Today, with the Vet-Tome, pedal operation that offers precise tooth extraction with minimal
I had one of the most or no alveolar bone loss and less trauma.
satisfying professional • Ultra-thin tips allow easy insertion into the periodontal ligament
space on all canine & feline teeth
experiences of my career!
• The flexible tip bends (unlike rigid tips) and follows the curve of
Thank you.” the root, the tip (40mm long) will reach the apex of most canine
teeth, making it ideal for canine extraction.
Dr Nick Taylor BVSc(Hons) GPCert(SAP)
Dip. Mgt. ESVPS MRCVS (N7011) • The mechanical in and out action of the tip generated by the
electric handpiece advances the tip into the PDL reducing the
physical work normally associated with extractions
• The replaceable tips come from the end of the handpiece
(straight out) allowing better access to the tooth unlike other
systems where the tip functions at right angle to the Handpiece
• The non-twisting action of the Vet-Tome results in minimal tissue
damage (see video below) compared to units that reciprocate or
use gentle vibration. The Vet-Tome tip does not generate heat
• 10 adjustable power settings and different sized veterinary
specific tips for small cats to large dogs (even lions)
• The Vet-Tome operates independently from your air driven dental
unit allowing both units to function at the same time, increasing
overall dental efficiencies
• Educational extraction videos performed by Dr Anthony Caiafa
See the video of the Vet-Tome in use: BVSc BDSc MANZCVS are supplied with the system.
https://youtu.be/UEejzbWjpFY
• Satisfaction guaranteed or your money back -
Vet-Tome®
manufactured by iM3
V2000 Vet-Tome extraction system Cat. No
Complete with 2 standard and 2 heavy S/S tips. V2000
VET DENTAL UNITS | VET DENTAL X-RAY | ULTRASONIC SCALERS | HAND INSTRUMENTS | ACCESSORIES & CONSUMABLES
iM3 Pty Ltd - The Veterinary Dental Company | www.im3vet.com.au | Tel 02 9420 5766
Veterinary Practice | April 2019 5
If you're ready to invest in
veterinary imaging equipment,
Brexit statement released
IT PAYS TO SEE THE by VMD and NOAH
BIGGER PICTURE. With Brexit negotiations ongoing, uncertainty remains over
how the UK’s exit from the EU might impact the veterinary
profession. To provide some reassurance, the Veterinary
Medicines Directorate and National Office of Animal Health
have agreed a joint statement in relation to Brexit planning.
“The majority of veterinary medicines used in the UK
(and ingredients and components to make them) are either
produced in or enter via the EU. The government is working
with animal health companies who have been carrying out
extensive contingency planning for all EU Exit scenarios,
including no deal. These plans cover all aspects of their sup-
ply chains, from regulatory compliance and stocking levels
to logistics and customs. They also include, as appropriate,
increasing stocks of products in the UK, changing supply
routes, transferring marketing authorisations and other
regulatory processes.
“To reduce any risk to medicines availability in the UK,
detailed planning is ongoing to ensure that supply chain
measures are appropriate to address the sector’s complex
needs and priorities.
“Much work has been done by companies with the objec-
tive of ensuring fair and appropriate distribution of this inv-
entory to avoid disruption. Supply is expected to cope with a
normal ordering pattern with adequate forward planning and
communication with suppliers. With this planning in place,
we are confident that we have made every effort to ensure
continuity of supply of veterinary medicines in the UK.”
New research grants
available from the Mind
Matters Initiative
Applications are now open for the RCVS Mind Matters Initia-
tive (MMI) first Sarah Brown Mental Health Research Grant.
One £20,000 grant will be awarded each year for five years
(making a £100,000 total by 2023) to fund research that
focuses on mental health and well-being within the veteri-
nary professions.
Applications are welcome from individuals at all stages of
their research careers, with research proposals relating to
any aspect of mental health or well-being in the veterinary
professions. Researchers must be affiliated with a university,
and ethical approval must be in place.
Applicants should send their research proposal, along with
a CV and short biography for all lead researchers, to Lisa
Quigley, Mind Matters Initiative Manager, by 5pm on Friday
31 May 2019. The winner of the grant will be decided in June
2019, with the winner receiving their award at Royal College
01923 237521 Day in London on Friday 12 July 2019.
www.plhmedical.co.uk
Unit 4 Dakota Court, Amy Johnson Way,
6 Blackpool Business Park, Blackpool, FY4 2RP
We are specialists in
Surgical
instruments
www.fclveterinary.com
FCL Veterinary (Apex Vets) FCL Health Solutions Ltd
Hawthorns House, Halfords Lane
Birmingham, UK. B66 1DW
32 Longbridge Lane Tel: +44 (0)121 272 1885
Ascot Business Park
Derby DE24 8UJ www.fclhealth.com
United Kingdom T: +44 (0)133 232 1818 www.fclveterinary.com
Veterinary Practice | April 2019 7
NEWS
First black RCVS Council Finalists announced for the 2019
member elected as Junior PetPlan Awards
Vice-President With over 40,000 nominations Vet Nurse of the Year
received for this year’s Petplan Sarah Barnett, Watkins and Tasker
The RCVS Council has elected Veterinary Group, Yatton, Bristol
Veterinary Awards, the follow- Jasmine Kilpatrick, Casvet, Chelten-
its first black Council member
ing veterinary professionals ham, Gloucestershire
to be Junior Vice-President of Craig Tessyman, Rutland House Veter-
have been named as finalists:
the College for 2019 to 2020, inary Surgery, St Helens, Merseyside
making her the first person
Practice Support Staff of the
from a minority ethnic back- Vet of the Year
Year Hannah Capon, Canine Arthritis
ground to be elected to the Graham Skelton, Orchard House Veteri- Management, Shoreham By Sea, West
College’s Officer Team in its 175-year history. nary Centre, Hexham, Northumberland Sussex
Mandisa Greene, who was first elected to Council in Sharon Scarratt, Blue House Veterinary Danielle Greenberg, The Liverpool Vets,
Centre, Stoke-On-Trent, Staffordshire Liverpool, Merseyside
2014 and was re-elected last year, is currently Chair Zoe Pickering, Orchard House Veteri- Brian Hogan, Black’s Veterinary Hospi-
of the Practice Standards Group, which coordinates nary Centre, Hexham, Northumberland tal, Dudley, West Midlands
the RCVS Practice Standards Scheme, and a member
of the Primary Qualifications Subcommittee and the Practice Manager of the Year The winners will be revealed
Legislation Working Party. She has also served on the Katie Bull, Vale Vets, Portishead, North at the ceremony on 4 April
Somerset
Standards Committee as well as chairing the Extra- Helen Coe, Ledbury Park Veterinary 2019. The awards celebrate
Mural Studies (EMS) Coordinators Liaison Group. Centre, Ledbury, Herefordshire the nation’s most outstanding
Rachel Duncan, 387 Veterinary Centre, vets, vet nurses, practices,
Born in the UK and raised in Trinidad and Tobago in
Walsall, West Midlands
the West Indies from the age of two, Mandisa moved practice managers and
back to the UK aged 18 to study for a BSc in Biological support staff who have been
Vet Practice of the Year
and Medicinal Chemistry at the University of Exeter. Blue House Veterinary Centre, Stoke- nominated by their clients and
She then gained her veterinary degree from the Royal On-Trent, Staffordshire colleagues for their hard work,
Wendover Heights Veterinary Centre, dedication and continually
(Dick) School of Veterinary Studies in 2008. Since grad- Halton, Buckinghamshire
uating, her interests have lain in small animal practice White Cross Veterinary Group, Derby, going that extra mile to keep
and emergency and critical care. Derbyshire the nation’s pets healthy.
NE
No new ry
int
Why wait 6 weeks when
in ucto
w s pa
ro
W
d
av m ck
ail all si
nutraquin+ works in 7 days ab er ze
le
Fast acting joint support for dogs, cats & horses
s
Natural fast acting joint support
to aid & soothe stiff joints.
✓ Promotes mobility & flexibility
✓ Supports the natural systems that control
inflammation
✓ Exclusive to Veterinary Practices
✓ Loyalty scheme for your clients
✓ Wide range of FREE marketing materials
✓ FREE CPD training / lunch & learns
✓ Our Account Managers are trained Veterinary
nurses (not sales people)
✓ Guaranteed next day delivery
Register to become an Authorised Stockist at www.nutravet.co.uk
Support British manufacturing
www.nutravet.co.uk
8NEW From the makers of Milbemax™
(milbemycin oxime and praziquantel)
Ticks and fleas CAN
turn my world
Down Ups i d e
Prescribe me Credelio™ (lotilaner) -
a small and palatable1 monthly
chewable that acts fast2,3 to treat
puppies and dogs* like me when I
TOUGH ON TICKS AND FLEAS
have ticks and fleas. 2,3
EASY ON ME
*Approved from 8 weeks of age and 1.3 kg or heavier
1. Cavalleri, D. A randomised blinded controlled field study to assess the safety and efficacy of lotilaner tablets (CredelioTM) in controlling fleas in client-owned dogs in European countries. Parasites and Vectors (2017) 10. 526.
2. Cavalleri, D. Assessment of the speed of flea kill of lotilaner (CredelioTM) throughout the month folllowing oral administration to dogs. Parasites and Vectors. (2017) 10. 529.
UKCACCRD00006(1)
3. Murphy, M et al. Laboratory evaluation of the speed of kill of lotilaner (Credelio™) against Ixodes ricinus ticks on dogs. Parasites and Vectors. (2017) 10. 541.
Credelio® chewable tablets for dogs contains lotilaner. Legal category POM-V UK. For further information call Elanco Animal Health on +44(0)1256 353131 or write to: Elanco Animal
Health, Lilly House, Priestley Road, Basingstoke, Hampshire RG24 9NL, United Kingdom. For further information consult the product SPC. Refer to the product packaging and leaflets for
information about side effects, precautions, warnings and contra-indications. Always seek advice on the use of medicines from the prescriber. Use medicines responsibly www.noah.co.uk/
responsible. Credelio, Elanco and the Diagonal Bar are trademarks of Elanco or its affiliates. ©2018 Elanco or its affiliates.
Veterinary Practice | April 2019 9
For more information, visit www.credelio.co.ukNEWS
Big Issues announced BVA responds to latest
data on government’s
for 2019 BSAVA Congress badger control
On 21 March 2019, Defra published data
This year BSAVA Congress’s Big supply despite crises”. They will
relating to wildlife controls that form part
Issues stream aims to help the explore the unpredictable challen-
of the government’s programme of bovine
profession steer its way through ges, whether dependent on Brexit
tuberculosis eradication. Of particular interest
uncharted waters by focusing on a or other factors, that can potentially
is bTB surveillance data from the first year of
central theme of “How to navigate the threaten the supply of medicines
badger control operations in eastern Cumbria.
unpredictable and the unexpected”. vital to companion animal veterinary
Commenting on the documents released by
As part of BSAVA Congress, to practices and how these unexpected
Defra, BVA President Simon Doherty said:
be held at the Birmingham ICC and events can be tackled and resolved
“We continue to support a comprehensive
Arena Birmingham from 4 to 7 April by working together.
and evidence-based approach to tackling
2019, the Big Issues stream on Philip Lhermette, together with
bovine tuberculosis, including the principle
Friday 5 April will aim to keep del- Mauricio Lopez of APHA and Michael
of badger controls within the Low Risk Areas
egates up to speed on key develop- Stanford, will share for the first time
(LRAs) of England where there is a demon-
ments and challenges affecting the the results of the BSAVA 2018 OV
strated need. We welcome this evidence,
profession. This year speakers will survey in looking at “The perils
which demonstrates that there was significant
address some unpredictable issues of passports and certification” and
bTB infection in the wildlife reservoir in the
that are integral to the veterinary will endeavour to better equip
Cumbria hotspot and that whole genome
landscape of today and highlight and support vets in companion
sequencing has shown this to be the same
that, despite these, many recent animal practice to manage the
strain that is present in cattle in this region.
successes have been achieved. unpredictable.
Clearly it is not yet possible to assess how
The prestigious panel of speakers, Kate Richards, Thom Jenkins,
effective the culls have been in containing
which includes CVOs and the Chair Richard Guest and Simon Doherty
that threat.
of the Canine and Feline Sector will discuss “Telemedicine: patient
“Bovine TB is a devastating disease and it
Group, will look at “The ABC of care in the digital world”. The panel
is vital that we use every available tool in the
achievements, Brexit and challen- will aim to help delegates navigate
toolbox to support the government’s aim to
ges”, including the practical implica- relatively unchartered territory and
make England bTB-free. We are pleased to
tions and potential impact for vets make informed decisions, despite
see the expertise of veterinary and scientific
who are involved in work relating to unexpected challenges, on the
colleagues in government being fully utilised
companion animals. future of telemedicine and its pot-
in Cumbria, with a strong focus on surveil-
Peter Borriello and Dawn Howard ential impact on not just them, but lance and the application of whole genome
will discuss “Medicines: ensuring also their clients. sequencing and epidemiological analysis.
Only by better understanding bTB and
Insistor added to
applying that evidence to the eradication
process can we hope to be successful in
Chanelle opioid
halting its spread.
“We continue to call on the government to
range
use the targeted and humane method of cage
trapping and shooting only, rather than the
Chanelle has introduced its latest current method of controlled shooting. This
product, Insistor 10 mg/ml solution for report emphasises the additional benefits of
injection for dogs and cats. Insistor is a cage trapping as a method in that it allows
better analysis of the culled badgers, leading
premedication for general anaesthesia
to an improved understanding of the relation-
or neuroleptanalgesia in combination
ship between infected wildlife and disease
with a neuroleptic drug. The active
spread in cattle.
ingredient of Insistor is methadone
“A considerable evidence base has now
hydrochloride. Insistor is now available
been gathered that will inform the progres-
in the UK in a 10 ml bottle for use in
sion of the eradication programme in the High
dogs and cats; legal category is POM-V.
Risk Area of England. We hope this will allow
The product can be used for analgesia
the government to provide greater clarity on
in animals experiencing post-operative
the methodology that will be applied going
pain or pain caused by trauma.
forward.”
10The only
event devoted Brexit updates from the
to Official Chief Veterinary Officer
Veterinarians
Christine Middlemiss has communicated the latest infor-
mation for vets to ensure the profession is prepared for a
no-deal Brexit.
The Official Veterinarian Conference allows you to The government’s top priority is maintaining friction-free
trade whilst managing biosecurity risks; as such, there
hear from renowned experts, including the APHA and
won’t be any changes to the checks of animals and animal
Defra, about the latest developments relating to the
products coming into the UK. “We won’t have access to the
profession. Create your own CPD programme to suit UK TRACES system so will be providing our own UK health
your needs – choose to attend talks from Small Animal, certificate, but it is in effect a mirror of the EU one,” Christine
Farm Animal or Equine conference streams. explained. The situation will remain the same for pets and for
horses currently eligible for the Tripartite Agreement (TPA)
coming into the UK from France and the Republic of Ireland.
Keep up Animals and animal products moving from the UK is more
to date complicated. The application to be a listed third country is
The latest updates from underway, and it is hoped that the UK will be listed “very
APHA and Defra to shortly”. There are various health statuses for third country
ensure you are aware of
developments regarding animal movements and we don’t yet know which we will
your responsibilities as have. “Depending on the status, there are more or fewer
an OV
tests to be done,” she said. Until we know the status, pets
are required to have an up-to-date rabies vaccination, wait 30
Cutting edge days and have a blood sample before moving. Other animals
CPD require export health certificates and will have to go through
High quality CPD for border inspection posts.
Small Animal, Farm
Animal and Equine OVs Horses also have different levels of disease status; we
don’t yet know how we will be listed, Christine said. There
will be no TPA once we are a third country. For horses, ID
Engage with documents from a registered breed society, stud book or a
industry national branch of an international organisation for racing or
experts competition will be recognised by the EU; if the owner does
A unique chance to not have one of these, they will need to apply for a govern-
network and socialise
with your colleagues ment-issued ID document.
from across the OV Christine explained that the big change in certification
community under one
roof demands will be around products of animal origin. To ensure
increased needs are met, the process has become more
electronic, certification support officers have been introduced
(there are 200 training places and applications are being
processed now), free OV exports training is available and the
APHA is working with the contractors and employers of vets.
When asked if 200 certification officers will be enough,
Christine explained that most of the demand will be for food,
which involves big operators with contracted vets. “Generally,
it will be those moving large volumes on a regular basis, so it
[should] be relatively well planned and managed.”
“We’re reasonably confident about the numbers coming
through the system,” she said, though there are questions
over, for example, whether there are enough qualified people
25 - 26 September in the right parts of the country.
The biggest challenge in the event of a no-deal Brexit
Alexandra House, Swindon will be communication, Christine said. It will be ensuring
“people [have] the right information at the right time so they
can make the best decisions”. She urged any vets who are
Book your ticket at unsure of what is happening to read the resources on gov.uk.
officialvet.com
12 #OVConf2019EVENTS
Do we need to rebrand general
practice?
Why graduates fail to recognise the of many experienced practition-
ers by making them question
value of general practice was discussed nearly everything they know”.
at the SPVS/VMG Congress As a long-standing critic of
the EBM concept in primary
T
he veterinary and human medical Royal Colleges care, Joanne strongly agreed,
must work together to increase the respect and insisting that it was designed
resources afforded to those working in general prac- for the “specific requirements
tice, practitioners were told at the SPVS/VMG Congress in of hospital-based medicine and
Newport on 26 January 2019. selected populations referred
Joanne Reeve, professor of primary care research at the in for specialist diagnosis
Hull and York universities’ medical school, argued that the and treatment of disease”. Its
NHS and veterinary practice faced the same problems in application to general practice is questionable “given the
recruiting and retaining staff that want to work in a general complex, dynamic and uncertain nature of much of the
practice setting. By forming a multiprofessional alliance, illness that is treated,” she said.
the RCVS and the Royal College of General Practice may be Joanne believed that there needs to be a change in the
better able to persuade the government that these issues mindset of new graduates emerging from medical and
need to be addressed, she said. veterinary schools so that they recognise the value of the
Joanne said general practitioners in both areas do them- skills and knowledge acquired in general practice. “We have
selves no favours by continuing to refer to their role as a to reimagine what it is to be a generalist and find different
“Jack of All Trades”. Instead, first opinion practice should ways to tell that story,” she said.
be regarded as a medical specialism in its own right, with Tom Mowlem, a general practice vet based in Dorset,
unique skills, involving particular expertise in “decision believed that the veterinary profession was failing to sell to
making and managing uncertainty”. its newest recruits the idea that great satisfaction can be
In both human and veterinary medicine, a situation has derived from a GP career. “It is the responsibility of practi-
arisen in which the acquisition of postgraduate qualifica- tioners to show to students doing EMS placements that the
tions in specific clinical disciplines has become the only work that we do is fun.”
measure of professional progress. In a parallel session, Lynne Gaskarth of Drove Vets in
A change occurring in both human and veterinary medi- Swindon questioned her audience on what they regarded
cine is the emergence of general practitioners as leaders of as the main attractions of their jobs. She argued that above
teams of associated professionals. This was a concept being a certain level, satisfaction was not gained from status or
promoted within the NHS as a means of dealing with the money but from a combination of three factors – mastery
economic and manpower pressures that result from grow- of a learned skill, autonomy in the tasks performed and
ing numbers of patients with chronic multiple conditions. purpose in achieving some socially useful goal.
A study published last year by Chris Salisbury of the Working in general practice offered opportunities to meet
University of Bristol examined the effects of the so-called all three criteria proposed by Lynne, said her co-presenter
3D approach (based on dimensions of health, depression Colin Mitchell, an equine practitioner with XLVets in
and drugs) on the care of around 1,500 human patients in Hexham. He argued that new graduates need the self-
primary care practices with complex medical needs (Lancet awareness to understand their own personality type before
392, 41-50), Joanne explained. They were managed by an deciding what branch of the profession they should join. For
interdisciplinary GP-led team of pharmacists, specialist him, one of the biggest attractions of his job is that he is not
nurses, etc. Although the study’s initial findings showed confined to working within a particular clinical discipline.
no measurable improvement in the patients’ quality-of-life This meant that he faced different challenges every day.
scores, it did produce significant results in other areas Another huge advantage of general practice is the
and further research is needed to develop this integrated opportunities that it offers to develop a portfolio career,
approach to primary care, she said. pointed out Lucy Millard, also from Drove Vets. “You can
From the audience, Leicestershire-based cattle practi- go into teaching, mentoring, professional politics, business
tioner Peter Orpin argued that the current drive to develop management, marketing, journalism, charitable work – the
evidence-based medicine has “undermined the confidence possibilities for broadening your role are huge,” she said. VP
Veterinary Practice | April 2019 13EVENTS
Evaluating shortfalls in the
profession
Recruitment and retention were the key CPD at getting those people, who are a tremendous asset,
to come back happily into the profession.” A member of
areas of discussion in the “hot topics” the audience commented that perhaps there should be
panel session at VetsSouth 2019 discounts available for vets coming back into practice, who
often struggle to find the unpaid time needed to complete
F
or the interactive question and answer session at the necessary CPD.
VetsSouth on 6 March 2019, BSAVA President Philip For veterinary nurses, the issue is very much with reten-
Lhermette, BVNA President Wendy Nevins and Uni- tion, rather than recruitment. Finding out why veterinary
versity of Cambridge representative David Williams were nurses are leaving practice and making changes to prevent
tasked with answering the delegates’ questions on hot such significant numbers dropping out is where we need to
topics facing the profession today. Chaired by Jon King, the focus our energy, Wendy said.
session provoked lots of discussion, particularly surround- So why are veterinary professionals leaving the prof-
ing recruitment and retention issues. ession? The panellists agreed that it is multifactorial.
Kicking the session off, a member of the audience asked “Certainly, the feminisation of the profession means more
how we are going to face the shortfall in “veterinary man- [women] are leaving to have families. We’re also feeling
power” during the coming decade. Just over half of new more under stress nowadays – that issue has come to the
veterinary surgeon registrants each year are from non-UK fore over the last few years and we’re learning to deal with
EU countries, which could be an issue after Brexit, Philip that; there are a lot more resources now,” Philip said. “Cli-
said, and surveys have shown that many vets leave the ents are also more demanding. They’re looking at Dr Google
profession at around three to five years after graduating. and coming in with various other diagnoses of their own,
As for how we might tackle that issue, Philip noted that [listing] what drugs you can and can’t use and why you
Nottingham University’s announcement that they are should or shouldn’t vaccinate… In some ways it’s a good
doubling their annual intake should help to increase the thing; in other ways it causes a lot more stress.”
number of UK-graduated vets, particularly if Brexit is going Another big problem is in dealing with failure, he said.
to have an impact; “The question is whether that will over- Children are put through examinations earlier and earlier at
come the shortfall,” he added. school; most vets succeed at exams throughout their lives
One area that the profession could certainly improve, but when they leave vet school, they suddenly have to deal
David suggested, is in supporting vets and vet nurses to with failure. It is inevitable that there will be cases where
re-enter the profession following a period of leave. In his the owners can’t afford the treatment, where mistakes are
experience, a lack of self-confidence is stopping parents made and where animals will need to be euthanised. With-
from coming back to the profession after a break to raise out the right support, this can have a significant impact on
their children. “I think we need to be providing more direct the well-being of recent graduates.
14Evaluating shortfalls in the profession
A member of the audience highlighted that veterinary they need to provide; some students say they are told to
nurses have a similar issue, whereby they are well qualified stand in the corner of the room and watch what happens,”
from university but become disillusioned in practices where David said.
it can be difficult to utilise them to their full ability. Wendy The Royal College is looking at how students are devel-
agreed and emphasised the importance of celebrating oped during EMS and how they go through the first-year
vet nurses in general practice – not just those who have skills. In the meantime, Philip said, we need some joined
specialised. This issue is significant for veterinary sur- up thinking from the universities at how they communicate
geons and nurses alike and the importance of encouraging with practices. He commended the Association of Veterinary
students to recognise the value of being a general practice Students, which has produced a document for students
professional resurfaced in later discussions. which lays out how they should structure their EMS. The
If vets were better prepared for practice life, would it help document can be given to practices to help clarify what
the retention issues? Perhaps veterinary degrees don’t the students should be doing and what skills they need to
effectively prepare new graduates for life in practice, a learn. Ask EMS students for that form, Philip advised.
delegate implied. Philip responded: “I don’t think you should The final question in the discussion considered corporati-
expect a new graduate to be able to do emergency surger- sation and whether the trend is positive, negative or neutral
ies straight off the bat.” Learning these skills takes time and for vets, owners and the animals. Philip had mentioned
the amount of practice experience that students receive in earlier in the discussions that one of the causes of the
universities is perhaps less than it was when the panellist shortfall of vets is that we’re losing some vets who are
graduated. Students do a considerable amount of EMS, but retiring early and selling their practices to corporates.
it depends on which practice they go to as to how much Philip owns an independent practice but said that he
experience they might get, he said. “They need constant thinks it’s an inevitable conclusion – it will go the way opti-
mentoring during their first year of practice.” cians have gone. “I think it’s something we have to learn to
Wendy added that we need to look at the paraclinical live with. There are some very good things about it; in many
skills too, such as dealing with clients, communicating ways it has improved the ways new graduates are brought
effectively and dealing with failure. David agreed: “So much up. There are good practices and bad practices, and that
of this training is a ‘hidden curriculum’. It’s not what we’re will always be the case.”
telling them but what they see happening in a consulta- Wendy aptly wrapped the discussion up by condemn-
tion.” He highlighted the importance of EMS placements ing the phrase “corporates are bad and independents are
as the place where students can see what happens in the good”. Generalising in that way divides the profession; “we
real world. “It would be much better to have some way of are all veterinary professionals working for animal welfare.
organising EMS so that vets were helped in seeing what That’s what we need to focus on,” she concluded. VP
New Veterinary Books from 5m Publishing
Animals, Ethics and Us Research and Study Skills for
Madeleine Campbell Veterinary Nurses: A Practical
Everyone has a view about animal ethics. Each Guide for Academic Success
of us, for example, has an opinion about whether Jane Davidson
we should eat meat; whether animals should be
used for scientific research, or whether the use of As the veterinary nursing profession continues to develop
animals in sport is acceptable. But very few of us beyond the traditional caring and support roles, more
stop to wonder about the basis of our views, or to and more academic rigour is expected of veterinary
rationalise them. In this book, Madeleine Campbell nurses. Exams, CPD and repeated testing and study
aims to enable us to do so, by addressing a series throughout the nurse’s career are now requirements.
of questions such as: ‘When does animal use
become abuse?’; ‘Why do we treat some animals Aimed at veterinary nurses and technicians this book
differently from others?’; ‘Are there some things will guide the reader through the various research and
which we should never do to animals?’ and ‘Just study disciplines required of them. It examines how to
because we can, should we?’. complete written assignments, how to reference properly,
how to approach different test questions, how to respond
Animals, Ethics, and Us offers a stripped back, to oral exams, how to complete OSCEs and how to do
balanced and moderate perspective, based on work-based practical assessments.
logical argument, philosophical principles and
sound science. It is a thought-provoking read Research and Study Skills for Veterinary Nurses
aimed at a broad readership including informed provides information and advice – from successful exam
owners and animal enthusiasts, as well as a useful technique, to revision ideas, to study styles – for student
primer for students of animal ethics, welfare and vet nurses who need a reliable resource to guide them
veterinary medicine. through their course.
April 2019 March 2019
9781789180497 9781789180138
£18.95 £24.95
Order online at 5mbooks.com
à marketing@5mpublishing.com d @5mpublishing c /5mPublishing
Veterinary Practice | April 2019 15MENTAL HEALTH
Letting go of striving
After years of yearning, getting that disappointment. This is what makes disappointment such
a complex and confusing feeling. Many of our desires
promotion may not bring the happiness that we pursue are unconscious, sublimated and frequ-
and fulfilment expected ently contradictory.
Paradoxically, we may even become disappointed when
LAURA WOODWARD we get what we want. For example, in Sigmund Freud’s
LAURA WOODWARD COUNSELLING 1916 essay “Some character-types met with in psycho-
analytic work”, he explored the paradox of people who
Laura Woodward has been the surgeon at Village Vet
Hampstead for over 10 years. Laura is also a qualified were “wrecked by success”. Unconsciously, these people
therapeutic counsellor and is affiliated with the ACPNL believed that their success was unjustified, so achieving it
and the ISPC. She runs Laurawoodward.co.uk – a
counselling service for vets and nurses. didn’t feel satisfying to them.
In the December 2017 issue of Veterinary Practice maga-
S
hakespeare once said, “Expectation is the root of all zine, I wrote about “imposter syndrome”. First described by
heartache.” By striving for someone or something to psychologist Suzanne Imes in the 1970s, impostor syn-
come and make us happy, we are inevitably saying drome occurs amongst high achievers who are unable to
to ourselves that until that person/thing/state of mind internalise and accept their success. They feel that they are
arrives, we are going to remain unfulfilled. a fraud and about to be “found out” instead of being able
Our greatest pains and disappointments arise from those to celebrate their well-earned successes, big and small. In
things we try so hard to grasp on to and secure. We are essence, they strived, they achieved and they were left anx-
constantly struggling to achieve and possess or to feel ious and empty. In other cases, even when we do get what
“things” which we don’t yet have and, ironically, those very we want — and think we deserve it — we may discover that
things we want (or think we want) often don’t even exist. Or, what we wanted so badly doesn’t bring the expected bliss
if they do exist, they rarely satisfy according to our illusions. and happiness we expected.
We live in a world of a rampant imagination running wild You may be striving to become head vet in a busy practice,
and dictating our thirsty cravings. If you drop your iPhone to be head surgeon in a referral institution or to manage your
in the toilet, you can’t replace like with like. Apple insists own branch in a corporate, but be careful what you wish for,
you have an upgrade to satisfy your ever-increasing needs, and try not to rely on it as your only true chance of happiness
further encouraging your desires to have more apps, a or fulfilment. You may get there. You may believe you des-
better camera, faster downloads, etc. erve it. Enjoy it for what it is without putting yourself under
pressure to be blissfully happy and complete.
“ When we reach the place
where we can let go of
How do we “let go” of striving?
Jon Kabat-Zinn relates a tale of a cruel practice in India,
where there is a method of catching monkeys that involves
striving, we are liberated
“
cutting a small hole in the top of a coconut, then attaching
the coconut by a wire to the base of a tree. A banana is put
from the exhausting pursuit inside the coconut. When a monkey slides its hand in to
of chasing happiness get the banana and holds onto it, its closed fist is too big to
slide back out. The monkey becomes trapped as it does not
want to let go.
During mindful meditation we can decide to “let go” of our
What is striving? striving for the perfect life/thing/person. By accepting what
Striving is not aiming to achieve a goal or a good intention. we already have as good, we can be liberated from the
That’s commendable. Striving is an unsatiated and insatia- nagging need for more and more and more.
ble yearning which doesn’t leave us. When we reach the We don’t have to stop improving ourselves or our skills.
place where we can let go of striving, we are liberated from We don’t have to cancel all CPD or social engagements.
the exhausting pursuit of chasing happiness. As Chögyam It’s about accepting ourselves as we are, while enjoying
Trungpa Rinpoche said, “There is no need to struggle to be the journey of self-improvement. It’s about noticing what’s
free; the absence of struggle is in itself freedom.” good about something, someone or some feeling, without
Before we learn to let go of striving, we will experience worrying about what’s not perfect about it.
disappointments. Given the convoluted nature of desire, Then, like a butterfly, just when you’re least expecting it,
there are no experiences that are completely free of happiness and completeness may land on your shoulder. VP
16G D ET
RE F
CP D V
AN
AT OR NU
VA VE RSE
VETS NORTH
ADVANCING VETERINARY KNOWLEDGE
LU TS S
E
12-13 June 2019 - MMU Business School, Manchester
ENGAGE WITH LEADING EXPERTS
AND TRANSFORM YOUR CPD
• Hear the latest insight and discover new
approaches to improve your performance.
The conference programme covers
three key topics: endocrine system,
emergency medicine and surgery and
emergency and critical
care nursing
• Get hands-on with the most advanced
products and equipment from across the
sector which could help improve your
practice life
• Discover the latest developments in the
veterinary industry by engaging with
renowned experts and hearing from
leading veterinary speakers with
plenty of opportunity for interaction
and discussion
View the programme and book your ticket from £109 + VAT
Visit us at www.vetsnorth.com or
call on 01865 237 737
Veterinary Practice | April 2019 17MENTAL
RCVS KNOWLEDGE
HEALTH
Recent evidence in feline
medicine and surgery
New Knowledge Summaries consider
management of hyperthyroidism and
stabilisation of coxofemoral dislocations
R Reluxation rates following different techniques
CVS Knowledge has recently published two Knowl-
edge Summaries that may help vets undertake more for open stabilisation of feline coxofemoral
evidence-based feline medicine and surgery. The dislocations
first considers iodine-restricted diets for hyperthyroidism There is currently insufficient evidence to identify if
and the second asks which technique is best for managing transarticular pinning or a toggle rod technique result in
coxofemoral dislocations. lower rates of reluxation following surgical management
of craniodorsal coxofemoral luxations in cats.
Can iodine-restricted diets normalise serum Both transarticular pinning and toggling using the
total thyroxine (TT4) and subsequently improve Arthrex Mini TightRope system with Arthrex FiberWire
clinical signs in cats with hyperthyroidism? suture resulted in 0 percent reluxation rates at short-term
There is some evidence that iodine-restricted diets can help radiographic follow-up. Longer-term follow-up of joints
to renormalise serum TT4 in cats with hyperthyroidism, stabilised using transarticular pinning found 16.6 percent
though this is not always effective and there is a lack of reluxation (2/13 joints) when radiographed at least six
compelling evidence to suggest this is associated with a months after surgery.
resolution of clinical signs in the long term.
“
Whilst there is limited literature investigating the efficacy
of iodine-restricted diets as a treatment for feline hyper-
It appears that reluxation
“
thyroidism, all the studies so far have documented a 100
percent improvement in serum TT4 when cats have been rates for all three
started on an iodine-restricted diet, though this did not
always guarantee a return to euthyroid status.
techniques compare
A limitation of all the studies into this subject is the diffi- favourably
culty in maintaining and proving 100 percent compliance,
as all the patients enrolled in the studies were client-owned
and potentially allowed outdoor access. Toggling using an IMEX toggle (IMEX Veterinary Inc.) and
There is a lack of consensus regarding the resolution polydioxanone (PDS II, Ethicon) suture had a reluxation rate
of clinical signs. Documenting an improvement in clinical of 14 percent (2/14 joints) at 3.5 to 6 weeks after surgery.
signs is difficult, given the subjective nature of the task, and It appears that reluxation rates for all three techniques
made more complicated by the fact that the cats were only compare favourably to generally quoted reluxation rates
assessed by veterinarians at set intervals. following open reduction and that the use of all reported
Further to this disparity amongst the literature, the techniques can be justified for these cases in cats.
limited number of studies and the limitations of those It is important to consider if reluxation is the most clin-
studies mean a prospective study with large sample ically useful outcome measure. Long-term degenerative
size and lifelong follow-up would improve the evidence joint disease may be a more important clinical comparator
base greatly. between surgical techniques and more objective outcome
No cats were removed from any of the studies due to con- measures such as measuring ground reaction force on
cerns about the safety of the diet, or as a result of any side pressure sensitive walkways could be considered.
effects, so it can be concluded at least that the diet is safe. In general, the studies fail to generate any descriptive ration-
ale for the selection of one surgical procedure over another. VP
The full Knowledge Summary can be viewed at:
veterinaryevidence.org/index.php/ve/article/ The full Knowledge Summary can be viewed at: veteri-
view/176/280 naryevidence.org/index.php/ve/article/view/185/275
Author: Oliver Gilman Author: Elly Russell
18You can also read
