Skeldale Veterinary Centre reports that it has performed the world's first fish skin graft on a dog that was 'days from death' from a seriously infected wound.

The surgery was carried out in August 2018 and is, they say, the first time it has been performed on a companion animal anywhere in the world. The dog, a five-year old spaniel called Gigha, has now made a full recovery.

Gigha’s surgery was carried out by Dr Guy Killick and featured in a recent episode of The Yorkshire Vet. Guy said: "Gigha provides vital companionship to her owner, Mrs Taylor. She fell into a drainage ditch last summer and this caused a tiny cut on her elbow.

"The initial wound did not seem severe, however, despite intensive decontamination and treatment with broad spectrum antibiotics, the wound proved to have been infected with a resistant Haemolytic E. coli infection, causing a significant loss of skin from the medial aspect of the elbow. During this time, Gigha was hospitalised and was at significant risk of DIC and septicaemia."

"The skin loss was full thickness and, once the compromised tissue was debrided away, she was left with a large wound.

"We managed the wound in hospital for four days with daily dressing changes and an irrigation device to provide local anaesthesia and the delivery of topical antibiotics.

"Unfortunately, skin grafting in her case was not suitable given the infection and a lack of sufficient loose skin to donate. As such, we elected for healing by second intention but, given the large area, we felt it was important to explore novel methods to accelerate the healing process and reduce Gigha’s pain.

"Surgery using Tilapia fish skin grafts was pioneered at UC Davis in the USA and was used successfully on a horse with acid burns in the UK last year. It is still very rare, however, and had not been used to treat an infected wound before. Nor had it been used on a dog.

"Having done our research though and finding that these grafts have a natural anti-infective and analgesic effect, while also reducing the frequency of bandage changes that would cause discomfort and distress to the patient, we felt it was an appropriate treatment for Gigha and carried out the surgery a week after the initial wound."

Guy says the surgery was straightforward and simply involved tacking the skin in place. It adhered to the developing granulation bed, accelerating its growth and providing an antiseptic and analgesic effect. After application, Gigha’s owner reported that she was much brighter and seemed to be in less pain. Pain-scoring during check-ups confirmed this to be the case despite pain relief being voluntarily withdrawn by the owner.

This initial graft stayed in place for two weeks before breaking down and being removed. By this stage, granulation of the wound had been completed and around one cm of neo-epithelisation had occurred. A further graft was then placed which remained for a further two weeks until the wound was 50% of its initial size. No further grafts were placed as the team did not have access to further supplies so they simply bandaged the wound with traditional bandages. It was completely healed within nine weeks. Eight months on, Gigha has made a full recovery and the wound has healed completely.

Guy said: "Given the large wound area and risk of further infection we decided on this novel approach to improve the quality of life for the patient while the wound was healing. While we were naturally apprehensive of making the first attempt at this potentially revolutionary technique, what we knew about fish skin grafts and suggested that they could work in her case so we were determined to give it a try.

"Looking at her now, you wouldn’t believe that she’d been days from death just a few months ago. Her case is a demonstration of the efficacy of fish skin grafts as a treatment for large wounds where there are no other suitable methods of closure – and for their use in dogs. We hope her story and her recovery will be useful to colleagues treating dogs with similar wounds in the future and are happy to discuss the case with them if this would be helpful.

"I would also like to thank Dr Jamie Peyton, Chief of Integrative Medicine Service at UC Davis for her invaluable help and advice during this case and her assistance in the use of the Tilapia graft."

A new study carried out to look at the efficacy of spinosad (Comfortis) in cats has shown that they can acquire a flea infestation even when kept in a controlled laboratory environment. 

The study was conducted on a laboratory colony of 15 cats that had been kept strictly indoors for at least a year, four of which had presented to the dermatology clinics of the Small Animal Hospital of the Toulouse Veterinary School, two with miliary dermatitis lesions and two with symmetrical alopecia.

Further investigation revealed that despite these animals having been confined to quarters for so long, adult Ctenocephalides felis and flea dirt were found on coat brushing. 

All the cats were then combed meticulously twice at the start of the study using an extra fine comb and fleas counted before being replaced on each cat. In total 60 fleas were counted. On the cats showing no lesions there was an average of 5.2 fleas per cat and on the cats exhibiting flea allergy dermatitis it was less than one. Two of these cats had no fleas on them, probably due to excessive grooming caused by pruritus.

Spinosad was found to be 100% effective, with no adult fleas found on any cat from day 15 of the study through to day 90.

The cats with skin lesions were assessed for pruritus levels using the SCORFAD system, an extent and severity scale for feline hypersensitivity dermatitis. The SCORFAD value rapidly decreased throughout the study and achieved 98% reduction by day 90. The skin lesions in the flea allergic cats completely resolved during this time without the use of any other flea control or the use of anti-inflammatory products on the cats.

Researchers Maria-Christine Cadiergues and Charline Pressanti from Toulouse Veterinary School also noted a greater level of palatability than previously reported in clinical trials and there were no side effects in any of the cats.

Reviewing the study, David Grant MBE BVetMed CertSAD FRCVS said: "This study confirms that indoor cats, even in a tightly controlled laboratory environment, can still acquire an infestation of fleas. These can be brought in on the clothes of owners of cats if they have been in the garden, for example, particularly in the summer. 

"In addition, flea allergic cats may have few fleas on them due to excessive grooming caused by pruritus, and it is often very difficult to persuade owners of the diagnosis, even more so with indoor cats. This study provides precise data to support the above statement.

"This study also demonstrates that spinosad can be used as a stand-alone treatment for mild to moderate flea infestation in an indoor environment without the need for environmental insecticides or anti-inflammatory treatment of the cats. This would be a major consideration for many cat owners." 

Reference

1. Marie-Christine Cadiergues and Charline Pressanti, "Efficacy of Spinosad Tablets Administered to a Colony of 15 Indoor Cats Naturally Infested with Fleas," ISRN Veterinary Science, vol. 2014, Article ID 484308, 4 pages, 2014.doi:10.1155/2014/484308

Virbac has launched Milpro, a palatable milbemycin / praziquantel-based broad-spectrum wormer for dogs and cats. 

Milpro is offered in tablet sizes suitable for dogs, small dogs or puppies, cats and small cats or kittens for ease of dosing. It is presented in 4, 24 and 48 packs.

As an aid to owner education and compliance, packs of Milpro use 'Blippar Augmented Reality'. Owners download the Blippar app and scan the front of a pack of Milpro or a dispensing envelope, whereupon the pack becomes animated and various interactive options appear, including educational videos, a built in reminder system and other product information. 

Simon Boulton MRCVS, Marketing Manager for Companion Animals at Virbac, said: "The practice team has a crucial role to play in reminding owners that regular worming is essential for their pet's health. With the introduction of Milpro, we are extending our parasiticide range and offering practices an alternative solution.

"With compliance such an issue, we want to use 21st century communication to help practices to get the message across. The result is the introduction of an interactive element to our packs with the use of the Blippar platform. It enables us to create 'Augmented Reality' experiences through which we can provide comprehensive information to owners in an eye-catching and easily accessible way with the aim of boosting compliance and, ultimately, welfare.

"We believe the combination of the small tablet sizes and the innovative packaging will prove attractive and convenient to owners, making Milpro a successful product for practices".

Practices can also request an interactive waiting room poster which enables owners to watch a video on the poster on the importance of worming.

The Royal Veterinary College has carried out the first ever open-heart surgery to treat a stenotic tricuspid valve in a dog.

The three-year-old Labrador, Mabel, suffered from congenital tricuspid dysplasia. She was referred to cardiology specialists at RVC Small Animal Referrals where her tricuspid valve was found to be completely fused in the middle, with just two very small openings for her blood to flow through. 

In a procedure that took a little over an hour, the RVC team examined and worked on the valve. The College reports that Mabel’s surgery was a success and her stenosis was relieved.

Mabel was subsequently found to have a moderate amount of regurgitation into the right atrial chamber, but after a few more days of additional monitoring at the RVC she was able to return home. 

The surgery was carried out by Professor of Small Animal Surgery Dan Brockman at the Queen Mother Hospital for Animals. He was assisted by a team of RVC specialists to provide pre and post-operative care, including a perfusionist, a team of three anaesthetists, two surgery nurses, three surgeons and a cardiology veterinary specialist-in-training. In addition, Professor of Veterinary Cardiology Virginia Luis Fuentes and veterinary specialist-in-training Dr Rosie Payne were members of the Cardiology Service’s investigation into Mabel’s condition.

RVC students were also involved in the Mabel’s initial examinations at the hospital, providing them with an insight into the procedure. The examinations included cardiac ultrasound using the newest generation of cardiac ultrasound equipment, which is able to capture 3D and 4D images. The new ultrasound scanner was funded in part by the RVC’s charity, the Animal Care Trust. 

After the surgery, the emergency and critical care (ECC) team and the Cardiology Service took over Mabel’s care, with Professor Brockman remaining involved. This saw up to four senior ECC clinicians, a number of veterinary specialists-in-training and half a dozen highly trained ECC technicians working in shifts around the clock to care for Mabel and ensure a good recovery.  

According to the RVC, there have been previous attempts by veterinary surgeons to open stenotic valves with balloon valvuloplasty. However, because it is very difficult to tear the stenotic valve, this approach has not proved very successful. There is also a high risk when putting canines onto bypass. Canines have fragile blood vessels, and cannulae need to be inserted into several of these vessels, creating a danger that a major vessel tears. 

Commenting on why the RVC team decided to perform this procedure at this point, and on Mabel, Dan said: "Lots of things fed into this decision. First and foremost, we had a patient whose pathology made surgery the best solution. I explained to the owner and was very honest that this procedure would be really breaking new ground. Based on what the human paediatric cardiac surgeons will do, and our limited experience of balloon-valvuloplasty suggests this is the best approach for these dogs

"The operation itself is risky, much worse than most other operations. In our hands, for this type of disease, we have about an 80% chance of getting them through the procedure. The owner has to gamble what life the dog has left against the promise of a more normal quality of life and life-span following the operation."

In relation to Mabel’s prognosis if the surgery had not been undertaken, Professor Luis Fuentes said: "It is likely that the signs of right-sided heart failure would have been more difficult to control. Her ability to exercise would have become less and less, and she would have also been at risk of having abnormal heart rhythms associated with the enlargement of the right atrium. Generally we expect them to develop more and more signs as the disease progresses. These are difficult cases to manage on a long-term basis with drugs. Her life expectancy would have been substantially reduced.

"I thought Mabel was almost a perfect candidate to have the procedure here as Dan has a lot of experience replacing tricuspid valves in dogs with tricuspid dysplasia. In those cases there is usually leaking, but Mabel’s case was unusual in that she has minimal leaking and she was most affected by the stenosis. That means you may not have to implant any additional valve structure."

Speaking two weeks after the operation, owner Annabelle Meek, from Melton Mowbray, said: "Mabel has just come back in from wandering around the perimeter of my garden for the first time since before the operation. It’s more than half an acre and she has been ambling around happily following a scent.

"I would like to thank absolutely everybody. It’s been an enormous team effort on all sides. Every single person I met at the RVC, from the man on the gate to all the hospital staff, was so friendly. After she came home Dan Brockman phoned me every day to see how she was doing. The RVC should be very proud of what they have done for Mabel."

Scarsdale Vets in Derby has announced that it is to host free quarterly evening events to allow vet nurses of all levels to practise key Objectively Structured Clinical Examinations (OSCEs) tasks in a safe and fun environment alongside experienced vet nurses.

The first event will take place at Pride Veterinary Centre (Derby, DE24 8HX) on Monday 26^th November between 6-8pm.

There will be six different tasks set up (including closed gloving & gowning and x-ray positioning) for each nurse to practise, with an extra station for CPR techniques. At each station participants will be given the chance to see elements of the task being completed by a qualified vet nurse from Pride Veterinary Centre, before being offered to have a go themselves.

Michelle Staniforth-Trengove a Veterinary Nurse at Scarsdale Vets said: "Here at Pride Veterinary Centre we are extremely enthusiastic about helping the next generation of vet nurses in their professional development, and one of the ways we try to accomplish this goal is by hosting these OSCE events. We recognise how important it is to practice key techniques prior to taking OSCE exams, so we look forward to welcoming lots of vet nurses to Pride for an evening of education and fun."

Upon arrival all attendees will receive a goodie bag which contains handy hints and tips to accompany the tasks demonstrated at each station.

Attendees will also be offered a tour of Pride Veterinary Centre, which opened in 2011. The tour will show prospective employees the state-of-the-art facilities, including operating theatres, CT, MRI and x-ray imaging suites, an on-site dispensary, hydrotherapy pool and water treadmill – to name a few!

To attend, email:pride.events@prideveterinarycentre.co.uk.

If the cuff no longer works on your ET tube - cut if off!  I know that sounds drastic but it will stop other staff members from trying to inflate it!

I find often that the stoppers on the cuff come undone, so after you have inflated it - use the cover of a needle to place over and that ensure it stays done!

Blue Cross has announced the results from its National Equine Health Survey (NEHS) which show that lameness is three times more likely to be caused by conditions such as osteoarthritis in the limb rather than problems in the foot.

Blue Cross runs NEHS in May each year, in partnership with the British Equine Veterinary Association (BEVA). It is sponsored by SPILLERS and Zoetis and supported by the UK’s leading equestrian organisations and charities. This year saw a 35% increase in participation compared to 2014, with survey records returned for almost 15,000 horses, ponies, donkeys and mules.

The charity says that whilst of course the horse’s foot is fundamental to soundness and performance, NEHS results have shown consistently that limb lameness, as opposed to foot lameness, is in fact the biggest syndrome affecting horses.

In the latest survey, conducted in May, a total of 18% were recorded as lame. 13.5% of these were recorded as suffering with lameness such as osteoarthritis, also known as degenerative joint disease (13.9% in 2014 and 14.8% in 2013).

Meanwhile foot lameness was recorded in 4.5% of returns, a similar figure to previous years.

Josh Slater from the Royal Veterinary College, who is member of BEVA’s Health & Medicines Committee and analysed the NEHS data, said: “NEHS is now producing important evidence that is replacing subjective opinion. While the lameness figures were initially surprising, given that the foot has been generally regarded as the main problem area, the fact that these figures have remained consistent over the past three years gives constructive credibility to the data. Our findings will help owner vigilance with day-to-day healthcare as well as help prioritise on areas for future veterinary education and research.”

The six most notable disease syndromes identified in the 2015 National Equine Health Survey were:

1. Lameness 18% with 13.5% having limb lameness such as osteoarthritis (degenerative joint disease) not relating to the foot, compared to 14.8% in 2014, 14.8% in 2013 and 9.3% in 2010-12 and 4.5% with foot lameness compared to 4.6% in 2014, 3.8% in 2013 and 4.5% in 2010-12.
2. Skin diseases 17.2% (sweet itch, mud fever and external parasites) compared to 18.3% in 2014, 14.6% in 2013 and 15.2% in 2010-12.
3. Back problems 7% compared to 7.7% in 2014, 5% in 2013 and 3% in 2010-12. 
4. Recurrent Airway Obstruction 6.7% was the most frequently recorded respiratory problem, compared to 6.9% in 2014, 4.2% in 2013 and 3.6% in 2010-12. 
5. Laminitis 6.4% compared to 7.1% in 2014, 4.4% in 2013 and 3.6% in 2010-12.
6. PPID (‘Equine Cushing’s Disease) 6.4% confirmed or suspected compared to 5.6% in 2014, possibly reflecting increased surveillance through sponsored testing programmes as opposed to true increases in prevalence from the pre-2014 surveys. 

23.2% of horses were reported as being overweight with a Body Condition Score of 3.5-5, continuing the upward trend seen in previous years (16.9% in 2014 and 7.8% in 2013). Next year’s survey will explore links between obesity and the possible associated rise of obesity-related diseases such as equine metabolic syndrome (which was reported in 2.4% of 2015 returns) and laminitis.

The survey also enables participants to report on any health problems not covered in the survey questions, giving them a chance to shape future survey subjects.

Gemma Taylor, Education Officer at Blue Cross explains: “This year 11% of our free text answers mentioned gastric ulcers giving a valuable insight into the prevalence gastric ulcer syndrome in the principally leisure horse NEHS population. As a result we will be adding new questions to the 2016 survey to help us find out more.”

The 2015 NEHS survey results are now available from http://www.bluecross.org.uk/nehs2015results. To register for next year’s survey, visit www.bluecross.org.uk/nehs

The British Small Animal Veterinary Association President John Chitty is calling on everyone in the profession to take a moment during today's World Mental Health Day to think more deeply about the mental health of their practice teams and the wider veterinary community, and aim to help reduce feelings of isolation and depression.

John said: "This is a great opportunity to raise awareness for what is a very serious problem in our profession - we all know someone within the veterinary community who has had mental health problems - and I am very proud that it is a strong community trying to tackle this issue.

"But it is not just about one day – we can’t forget about it for the rest of the year. We all live extremely busy lives and if we are not functioning as people, we are not going to function as professionals."

John says veterinary professionals must take a balanced and holistic view of their lives and develop strong teams at local, regional, national and even international level, to build resilience in dealing with stress and dispelling the stigma about mental illness that may prevent people seeking help.

Mental ill-health will affect one in four people over the next 12 months[i] and in England, one in six people experience a common mental health problem (such as anxiety and depression) in any given week[ii]. There are particular issues within the veterinary profession, with higher than average rates of suicide, and patterns of distress, anxiety and depression, among other illnesses.

The BSAVA will launch a new ‘Beyond the Clinics’ personal development stream at Congress next April, including a non-clinical series of lectures on physical and mental health, and, with RCVS, it hosts a series of Mind Matters CPD courses across all 12 regions – all of which were sold out in 2016.

John added: "I’m looking forward to inviting colleagues to Beyond The Clinics on the Sunday of Congress, which is a great opportunity for the whole profession to think more deeply about how we look after each other, by increasing knowledge about mental wellbeing, building resilience in dealing with stress and dispelling the stigma about mental illness that may prevent people seeking help.

"I’m also very proud of the BSAVA’s involvement in the Mind Matters initiative, set up by the Royal College of Veterinary Surgeons. All 12 of our regions hosted sold out courses during 2016, which is part of the profession’s response to research showing that the stress of working in modern veterinary practices has taken a heavy toll on the mental wellbeing of many staff."

Limited places are available for the BSAVA’s Mind Matters regional meetings – more information is available at www.bsava.com/Education/CPD/Mind-Matters

The meetings provide training for all members of the practice team to help them recognise any signs of mental problems in their colleagues – and, perhaps, in themselves. The training aims to help individuals know how to communicate with people they are concerned about and offers tips on stress management and staying well.

John, who has suffered mental health difficulties himself, says it is important to reach out and respond as a profession to this serious problem.

"My main advice is to be aware of others, be supportive, understand and appreciate them, notice when someone isn’t acting normally, and also remember that you are in a team together with people to talk to and you should do that. You can’t take stress away completely but you can’t put everything on the practice owner, this is a whole team responsibility – upwards, sidewards and downwards."

References

1. McManus, S., Meltzer, H., Brugha, T. S., Bebbington, P. E., & Jenkins, R. (2009). Adult psychiatric morbidity in England, 2007: results of a household survey. The NHS Information Centre for health and social care.
2. McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016). Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014. Leeds: NHS digital.

The RCVS reports that the Department for Environment, Food and Rural Affairs (Defra) has now finalised the new microchip regulations for England, which include a provision that dog breeders and other individuals who wish to implant microchips and have no previous approved training, must undergo a compulsory training course.

While veterinary surgeons were exempted from this training, Defra initially envisaged that veterinary nurses would be required to undertake it. In a joint letter, that was followed by negotiations with Defra, the Royal College of Veterinary Surgeons (RCVS), the British Veterinary Association (BVA) and the British Veterinary Nursing Association (BVNA), stressed that registered veterinary nurses are already sufficiently trained to be able to safely implant a microchip, and would be doing so under the direction of a veterinary surgeon.

Defra subsequently has agreed that registered veterinary nurses are already sufficiently qualified to implant microchips, and will therefore be exempt from further training requirements when new legislation comes in for England. Wales and Scotland are currently considering the details of implementation.

The Royal College says it is also aware of new Defra microchipping guidelines for England which make it compulsory to report adverse reactions (including migration from the site of implantation) or the failure of a microchip. Gordon Hockey, RCVS Registrar, said: "There is some concern in the profession about this requirement, but Defra have said that they would not enforce this regulation via the courts, or seek to impose fines. The RCVS is likely to amend its supporting guidance later this year to clarify that veterinary surgeons should make appropriate reports, similar to reports for adverse reactions to veterinary medicines.  In each case reports can be made online to the Veterinary Medicines Directorate."

To help veterinary surgeons and veterinary nurses, as well as practices, raise awareness of owners' legal obligation to microchip their dogs, the BVA has posters available for all three regions (England, Scotland and Wales) that can be displayed in waiting rooms and surgeries. The posters are available to download from the BVA website: www.bva.co.uk.

BVA President John Blackwell said: "As a founding member of the Microchipping Alliance, which campaigned for compulsory microchipping together with dog welfare organisations, local authorities and others, BVA is delighted with the progress that has been made and it is very good indeed to be less than a year away from mandatory microchipping across the UK.

"But this is where the work begins for veterinary surgeons and nurses. We need to work hard to make owners aware of the new law throughout this year, with animals microchipped as far in advance of the deadline as possible.

"We also need to ensure that microchipping does the job it is intended to do. This process will be helped very much by not compelling veterinary nurses to undertake additional training when they already undertake minor acts of veterinary surgery that are much more complex procedures than implanting a microchip."

Vetsonic has launched Otimectin vet, an ivermectin-based topical preparation for the treatment of Otodectes cynotis infections in cats.

The new product offers a once-weekly dosing alternative to traditional ear mite treatments, which commonly require twice daily administration over 7 to 21 days.

Presented as a gel in a 10g tube complete with application spout, Otimectin vet is a 1 mg/g ivermectin preparation. It does not contain an antibiotic or steroids.

Elisabeth Richardson MRCVS, Senior Clinical Training Scholar in Veterinary Anaesthesia at Queen’s Veterinary School Hospital, University of Cambridge, is conducting a new survey designed to give a deeper insight into the conduct of anaesthetic monitoring in small animal practice in the United Kingdom.

All practising veterinary nurses and student nurses are invited to take part in the survey, the purpose of which is to ascertain the extent of anaesthetic monitoring, attitudes towards it and how confident people monitoring anaesthetics are.

The survey also aims to identify particular strengths and any areas of weakness, with the overall objective being to optimise vet and nurse student education and promote professional development if necessary.

The survey, which is anonymous, can be found at: https://goo.gl/Vwq1CJ. It should take 5-10 minutes to complete.

Elisabeth said: “I’d like to emphasise that all veterinary nurses and student nurses are invited and encouraged to take part. Your opinions and experiences are extremely important to us, and we’re very grateful for your help with the survey.”

Merial has announced the launch of NexGard Spectra, a broad spectrum oral parasiticide for dogs.

NexGard Spectra contains afoxolaner, which kills fleas and ticks on dogs, and milbemycin oxime, which is effective against roundworms, hookworms and whipworms.

The new product is delivered in a beef flavoured chew to help compliance. 

NexGard Spectrum is available in five different weight ranges to suit puppies and dogs of all sizes.