Refreshing approach in topic range - Veterinary Practice
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InFocus

Refreshing approach in topic range

IT made a refreshing change to see the range of topics covered by a series of recent CPD seminars run by Virbac Animal Health. Getting the chance to hear experts lecture in the fields of dentistry, dermatology and reproduction in one day doesn’t come along very often so I jumped at the opportunity to attend – and judging by the turnout so did many of my colleagues.

The format of the lectures also provided a rare flexibility to the day, with lectures on different topics run simultaneously in two rooms, allowing vets to select their lectures and whether they wished to attend a full day or a morning or afternoon session.

So hats off to Virbac for understanding the time pressures vets are under and the need for flexibility. The format of smaller groups also allowed delegates to interact and get the most from the lectures.

Dermatology

All vets in practice know that skin disease is probably one of the most commonly encountered conditions that we see, with canine atopic dermatitis being one of the most frustrating skin diseases for both the owner to understand and for the vet to treat.

Dr Tim Nuttall stressed that client expectations of atopic patients need to be carefully managed, ensuring they are fully aware that this is a life-long condition, probably requiring on-going treatment. He was also passionate about the importance of using therapies that have been scientifically proven through an RCT or “randomised controlled trial” – anecdotal evidence is not good enough!

Improving skin barrier function plays an important role in the treatment of atopic dermatitis and, as long as client compliance is good, the use of shampoos can be very effective. Therapies such as essential fatty acid (EFA) enriched diets and EFA supplements can also be useful.

According to Dr Nuttall’s evidence based principles, there is only one shampoo available that is actually scientifically proven to help in the control of pruritus: Allermyl significantly reduces pruritus in dogs and should always be considered as part of a treatment protocol.

Other therapies such as allergenspecific immunotherapy (ASIT) were also discussed, but Dr Nuttall emphasised that when performing ASIT, the outcome can be improved by utilising the expertise of either the laboratory or a dermatologist, and working in consultation with them.

The use of ciclosporin as a treatment for atopy was mentioned and Dr Nuttall stressed that this drug can take two to three weeks to be effective and a full response may take four to six weeks, so again it’s important to manage client expectations.

Steroids

The use of systemic steroids and their side-effects were discussed and it was refreshing to hear that Dr Nuttall also uses systemic steroids along with most of us in general practice. However, he also mentioned that in human medicine the use of topical diester glucocorticoid sprays has become very popular, as very little active drug reaches the circulation, thereby minimising side-effects.

There is now an equivalent licensed product in veterinary medicine: Cortavance,asteroid spray that has been scientifically proven to potently reduce the levelof pruritus without the adverse events seen with systemic steroids.

Dr Nuttall took great pride in telling us that he even recommended it for his mother’s dog. Of course we all know how hard it is to convince our family members of our expertise, and Dr Nuttall expressed his dismay when his mother still sought the opinion of her local vet! Mrs Nuttall now successfully treats Benson with the spray–which raised knowing smiles from the attendees.

Dentistry

Assuming this to be the lecture of least interest, and having never had the desire to attend a dental lecture before, John Robinson soon showed me how wrong I was! Indeed, I’ve been so enthused by the seminar that I’m now trying to find a practical dental session to attend!

Mr Robinson’s passion on the subject of dentistry was truly infectious. In practice we are performing dentals at least once a week on our patients, yet personally I never received any training for it at vet college. So the information given to us by Mr Robinson was invaluable.

In reality, the signs which owners think are commonly associated with their animal having painful teeth are rarely seen or noticeable. These include favouring one side of the mouth, reluctance to eat, and drooling. However, signs which are actually associated with dental pain include lethargy, less willingness to be social and aggression.

Mr Robinson stressed the importance of a brief oral examination on every animal that enters the consulting room, from both a patient welfare and service provision point of view. If dental disease is a concern, a definitive examination can only be performed under a GA using a periodontal probe to evaluate periodontal status.

Resorptive lesions in cats were discussed extensively, with Mr Robinson’s main advice being to extract these teeth at the early stages of a problem. Early detection can be performed by looking for distinct areas of gingival hyperplasia which covers the lesion on the tooth surface.

When examining under GA, a stream of air should be directed at these hyperplastic areas of gum. In simple hyperplasia there will be a lifting of the gingival margin but when there is a resorptive lesion, the soft tissue adheres to the tooth surface. If early lesions are left untreated, frequently the roots will become replaced with bone and a routine extraction is no longer an option.

Turn off the heat

When it comes to polishing and scaling, Mr Robinson stressed the importance of not generating too much heat on the tooth. He recommended using the scaler at half power, to keep cool with water and to use the side of the tip. If it is to be used subgingivally, as a crude rule of thumb the scaler should be used at a maximum depth of 2mm for no more than two seconds.

To the surprise of most delegates, the act of polishing can also generate a lot of heat – significantly more than the scaler, and Mr Robinson believes that following a simple polish a lot of our patients could be waking up with toothache.

He recommends using a polisher ata low speed (3,000rpm), with light pressure and for a maximum of a few seconds on each tooth. The animal under GA cannot tell you it is too hot, so if you are unsure, try putting it on your thumbnail, you might get a surprise!

Also, the paste used should be fine and not coarse – this is important as coarse paste will act as an abrasive, so making the surface even more difficult to keep clean and plaque-free.

Finally, Mr Robinson emphasised that scaling and polishing teeth was completely pointless if patients are not going to receive any post dental homecare. Active control by daily toothbrushing is still by far the most effective method of preventing plaque accumulation. Passive control by using food treats, chew toys and carriers for chemical agents are not an alternative to toothbrushing but do play a role.

Starting his career as a human dentist, Mr Robinson was horrified at the low uptake of toothbrushing by the pet-owning population, and believes not even 1% regularly brush their pet’s teeth.

As Mr Robinson put it, “You have to believe that toothbrushing is important in order to persuade the client of its importance.” I now consider how I recommend dental care to my patients and I am left in no doubt that if discussed with a little more conviction, more clients can be encouraged to try brushing their pet’s teeth.

Reproduction

Reproduction is rarely covered at CPD events, but if we are to handle the “difficult” breeder who walks into our consulting room with confidence, then it is certainly a topic we need to keep on top of.

Angelika Von Heimendahl runs the Veterinary Reproduction Service at Cambridge and has extensive experience of breeders expressing concern that they feel misunderstood by their vet. She asked us to remember that breeders are knowledgable animal owners and that we need to take a careful history to focus the investigation.

Costs and prognosis are important to make clear, especially as many breeders are known not to want to spend a lot of money at the vets.

Mrs Von Heimendahl explained that when using ELISA tests to predict ovulation, it is important to begin testing prior to ovulation. Starting at around day five is sensible if a breeder is concerned about several failed matings.

Re-testing should be sensibly spaced, with the shortest interval being 48 hours. When ovulation has occurred, two matings should be recommended either +1 and +3 days post ovulation or +2 and +4 days post ovulation, depending on which is most convenient for the owner.

The ELISA test can also be used to predict parturition – particularly useful when an owner is pushing a practice to performacaesarean due to concern that a bitch may be overdue. The progesterone levels of the bitch will always drop 12-24 hours before parturition and this can be determined by an ELISA test.

Several new reproduction drugs have recently been introduced onto the market, including aglepristone (Alizin) and deslorelin (Suprelorin). Aglepristone is used for misalliance in bitches, and is given as two injections 24 hours apart. As this injection can be given anywhere between 0 and 45 days, it was suggested that leaving the injections until the end of the bitch’s season may be wise in case of any repeat matings.

Deslorelin, a GnRH superagonist, acts as a non-surgical male contraceptive and is injected as a slow-release implant which lasts for six months. Although off-licence, Mrs Von Heimendahl mentioned it could also be used in bitches as an alternative to spaying, especially if owners of breeds such as setters are concerned about coat change post-spaying.

Another off-licence use is for ferrets as an alternative to neutering, as it helps to prevent hyperoestrogenism and hyperandrogenism.

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