What’s in a name?
Yes, yes, I know, I was very lucky to be asked to travel to Orlando, Florida to represent The Webinar Vet team! Funnily enough, I was just getting settled in my seat and planning the films I was going to watch during the flight when I overheard the couple who were sat next to me discussing how many vets they thought were on the flight from Manchester to Orlando! I’d made some friends already! The NAVC app informed me on the first day that a big announcement was going to be made on the first day. Fanfare please… The conference is having a change of name to Veterinary Meeting and Expo (VMX). The reason behind the change was to reflect the networking opportunities alongside CPD and the expo aspect reflects the mammoth exhibition hall and the relationship with sponsors of the event. Speaking of mammoth, this blog is on the large side so I’m going to break it up into sections, starting with internal medicine.
The title of the first presentation I decided to attend immediately caught my eye because it’s a question that I often deliberate over myself, “Steroids – Friend or Foe?” Elisa Mazzaferro presented published data relating to the use of steroids for a range of conditions, for example, spinal injuries and brain injuries. Elisa advises that before reaching for steroids, you should; consider the potential harm, contemplate if the benefits outweigh the risks and review the evidence to support the use of steroids. If you do decide to use steroids, remember that they vary in potency.
Feline pancreatitis was something I found tricky to manage in practice. Steve Hill explained that pancreatitis should be on your differential diagnosis list for any cat that presents with anorexia, lethargy and dehydration. Steve presented information on diagnosis and treatment including new nuggets of information such as a new appetite stimulant, capromorelin (Entyce), which at the moment is only licensed for dogs. I visited Aratana Therapeutics’ stand to find out more about this product and I was informed that this product isn’t available in the UK… Yet! Let’s watch this space! Also I was chatting to the lovely team on the stand about another one of their products which is a non-COX-inhibiting prostaglandin receptor antagonist indicated for the control of pain and inflammation linked with osteoarthritis in dogs. Back to Steve’s presentation, another golden nugget was further experimental research on maropitant citrate (Cerenia) has shown visceral analgesic effects in addition to the antiemetic action which could help to alleviate abdominal pain associated with pancreatitis.
Frederic Gaschen provided a presentation on tips for successful treatment of exocrine pancreatic insufficiency (EPI) in the dog, the first of which was to accurately diagnose EPI using trypsin-like immunoreactivity. The management of EPI is focused on pancreatic enzyme supplementation. Frederic explained that the powders are preferred to the tablet form because the powdered form has a superior effect. Such treatment is lifelong and expensive. There are support groups that are available to owners with dogs suffering with EPI. Frederic advised that support groups could help to maintain owner compliance in the management of EPI.
Mike Willard provided a couple of excellent webinars during our Virtual Congress last month on hepatology. I had the pleasure of meeting Jonathan Lidbury who works at the same university as Mike and also has an interest in liver disease. Jonathan presented on how he deals with cases of hepatic encephalopathy (HE) in dogs. The most common cause of HE is a portal systemic shunt, however, the pathogenesis can be multifactorial and is related to ammonia levels, increased blood manganese concentration, aromatic amino acids, oxidative stress, neurosteroids and inflammation. In addition, the following are believed to exacerbate hepatic encephalopathy in dogs: infection, inflammation, hypokalaemia, hyponatraemia, alkalosis, gastrointestinal bleeding, high protein meals, dehydration, constipation and frusemide use. Whenever possible, the primary cause of HE should be treated, which for most cases would involve surgical intervention. Jonathan updated my knowledge on this condition where now, it is no longer recommended to implement a strict no protein diet. A low protein diet is preferred in order to avoid protein malnutrition. Regarding the use of antibiotics, Jonathan advocates the use of metronidazole at a reduced dose rather than neomycin which can cause ototoxicity and nephrotoxicity.
One of the highlights for me during NAVC were the ‘Cytology Superstars’ (who I’ve decided are now in a band for the purposes of this blog!) consisting of Guillermo Couto as the lead singer (aka speaker), Rick Alleman on drums (driving the microscope) and Jim Meinkoth on backing vocals (talking through the microscope images). They were a great team! I attended the ‘Diagnosis of Anaemia 101: It Is That Easy!’ presentation and they certainly made me feel capable of diagnosing anaemia with relative ease. Later that day, I attended Jim Meinkoth’s presentation on cytology cases which Jim started by saying to the audience, “It’s amazing what a needle goes through sometimes!”. Jim provided an example of a blood smear containing thyroid cells from a jugular blood sample and warned the groupies (delegates!) not to interpret them as something else! Jim also warned us about sample contamination and recalled the time when he was sent a sample from a biceps muscle mass in a mare containing sperm cells! Yikes, this would be confusing on your first glance down the microscope having read a history concerning a muscle mass!
I know ophthalmology isn’t usually considered within medicine but it was certainly an eye-catching session so I decided to keep it in this section! I found the title of Michael Brown’s presentation very appealing because he was providing ten ways to help improve delegates ophthalmology practice.
- First up, Michael advised to “put the needle away” because corneal debridement should only be used for indolent corneal ulcers however, Michael explained that over the last 15 years or so, he has noticed a trend of “every corneal ulcer attracting a needle.”
- Secondly, Michael recommended investing in a tonometer and using it! The development of an eye examination fee which includes a range of diagnostic tests could prove useful for the tonometer to pay for itself plus having the clinical freedom to use all the tests necessary included in the fee to reduce encountering resistance from pet owners for charging for each diagnostic test (also see number seven).
- Tip three was to keep looking! Ectopic cilia are hard to find. Yes, I agree! This one has caught me out before.
- Handy hint number four, lenses do NOT ripen. I must admit I’ve never heard about ripening lenses. Michael informed attendees that cataracts must be treated in order to prevent inflammation.
- At the half-way point, Michael stated that you should know why you’ve chosen the drug(s) to use in each case. Think about the problem and the mode of actions of the drugs available to you.
- Take amazing photos! To help the referral practice help you, take lots of photos and send the best ones to a specialist.
- Having a fee that covers several ophthalmic tests can help to reduce animosity when working up an ophthalmology patient.
- Practise practise practise… Indirect ophthalmology. After all, it makes perfect! Examine both normal and abnormal eyes so that you can become confident identifying differences.
- The penultimate top tip was not to grid cat ulcers because they are often caused by feline herpes virus. In Michael’s notes, he states that usually it’s ok to debride cats’ corneas with a dry cotton bud but grid keratotomies can lead to the formation of a corneal sequestrum.
- The final word of advice from Michael was concerning ophthalmic surgical techniques and is very similar to number eight, practise! Michael sees cases where the first surgical intervention was unsatisfactory so gaining adequate training is necessary to help to reduce postoperative complications.
Part two of my NAVC blog will be available on the website tomorrow (7th March 2017)