Equine glandular gastric disease is a complex syndrome that is distinct from gastric ulceration. A number of studies now indicate that it is an inflammatory gastritis, predominantly at the gastric outflow, which has different causes and risk factors from gastric ulcers. As such, medication effective in treating gastric ulceration may be less effective for this specific condition.
The clinical signs of EGGD are diverse and non-specific and may be mild or recurrent. They may include changes in temperament, changes in rideability, unexplained weight loss, reduced appetite or cutaneous sensitivity manifesting as biting of the flanks or resentment of girthing, grooming, leg aids or rugging. Recommendations for reducing the prevalence of disease, based on putative risk factors, include providing rest days from work, maximising turn-out, minimising management changes and other potential stress factors and minimising changes in equine companions and human carers.
The new guidelines have been published by a group of equine medicine specialists, based on a review of published and unpublished evidence. The intention is to provide veterinary practitioners with up-to-date guidance on risk factors, diagnosis, treatment, dietary management and prevention of EGGD.
David Rendle, an internal medicine specialist at Rainbow Equine Hospital in North Yorkshire who chaired the group and is a consultant editor of UK Vet: Equine said: "Our findings challenge long-standing dogma on EGGD, a condition about which there is currently very little advice available to vets and horse owners. It is becoming increasingly clear that the distinction between disease of the squamous and glandular mucosa is important clinically and the group felt that updated guidance may help to improve management of EGGD in practice."
Provision of evidence based clinical guidelines should enable practitioners to adopt more standardised and logical approaches and base EGGD management decisions on the most current data.
Professor Josh Slater, Professor of Equine Clinical Studies at the Royal Veterinary College said: "Clinical guidelines are commonly used in human health care and have been shown to improve clinical outcomes by condensing data from large numbers of research publications and promoting rapid adoption into clinical practice. These new guidelines represent a step forward in the management of this complex condition by combining a consensus of expert opinion with the best available current clinical research and evidence."
Mark Bowen, Professor of veterinary internal medicine at the University of Nottingham who is based at Oakham Veterinary Hospital said: "Whilst the panel hasn’t come up with miracle cures there was universal agreement that new treatment options have to be integrated in a logical and responsible manner."
"Our understanding of this condition is in its infancy but we hope that the summary document, which also highlights the gaps in our knowledge, will provide a useful framework for vets to follow and will be a stimulus for future research."
The guidelines can be found here: https://www.magonlinelibrary.com/doi/full/10.12968/ukve.2018.2.S1.3
Photo: Marked multi-focal depressed haemorrhagic and fibrinosuppurative lesions
Dr Thomason initially denied both heads of charge, but on the third day of the hearing he changed his plea and admitted the charge in its entirety.
The first part of the charge related to the fact that the seller of the horse was a both a client of Dr Thomason’s practice and a personal friend of his, and he therefore had a potential and/or actual conflict of interest.
Dr Thomason did not disclose this professional and personal relationship to the prospective purchaser before the pre-purchase exam.
The prospective purchaser only discovered Dr Thomason’s relationship with the seller when reading the vetting certificate at home, and stated that, in the past, she had had a similar experience in which the horse was then found to be lame. She later found out the extent of the personal relationship, when invited to join the seller on a social media site.
The Committee found that, in this set of circumstances, Dr Thomason should not have undertaken the pre-purchase exam at all, and, at the very least, disclosed his personal and professional relationship with the vendor.
The Committee also found that although Dr Thomason did have a system in place to inform any prospective purchasers if the vendor was a client of his practice, this failed to work on this occasion and neither the practice nor Dr Thomason told the prospective buyer that the seller was a client before booking the pre-purchase exam. Dr Thomason had no similar system in place to disclose any close friendships with sellers.
Dr Thomason did not consider there was a conflict of interest as he felt confident he could carry out the pre-purchase exam impartially. In addition, it was his belief that the seller had been alerted to the conflict through a system in place at his practice, implemented to safeguard against this type of error. He stated that he in no way attempted to hide his relationship with the seller to the prospective purchaser.
It was not alleged that Dr Thomason had acted dishonestly.
Ultimately, the Committee found Dr Thomason not guilty of disgraceful conduct in a professional respect.
Ian Green, chairing the Committee and speaking on its behalf, said: "Whilst the Committee concluded that the respondent’s view of his obligations to disclose both the professional and personal relationships he had with the vendor was mistaken, it did not find any improper motivation on his part. It has already noted that he sought to disclose to the prospective purchaser through his system the fact that the vendor was a professional client of his.
"The Committee has weighed all these matters very carefully. It is for the client to determine whether or not to proceed with a PPE when in possession of all relevant facts in relation to any potential conflict of interest, and not for the veterinary surgeon to decide. The autonomy of the client must be respected. The Committee was firmly of the opinion that a failure to comply with the Code is very serious. However, taking into account the particulars of this case, the Committee does not consider that the actions of the respondent amount to disgraceful conduct in a professional respect."
Anesketin solution for injection, containing Ketamine 100 mg/ml, is indicated for induction of anaesthesia. It can also be used as a sole agent for restraint and minor surgical procedures where muscle relaxation is not required in cats.
Anesketin was previously available in 10ml or 50ml bottles. Dechra says it has added the new 5ml vial in response to feedback from veterinary practices.
Dechra Brand Manager Craig Sankey said: "Anesketin is one of our most popular products in our range due to its versatility. It can be used in combination with appropriate sedatives and analgesics in cats, dogs and horses for induction of anaesthesia.
"5ml Anesketin will help practices comply with controlled drug legislation, saving time and effort in denaturing out of date stock and reducing wastage."
He added: "The introduction of the smaller bottle demonstrates our commitment to responding to the requirements of veterinary professionals and providing a range of high quality products that provide the most effective solution within day-to-day practice."
Support tools are available for customers to order online at www.dechra.co.uk, including an Anesketin controlled drug register.
The company says that Anallergenic can be used as the elimination diet of choice when working up dermatosis cases. Nutrient intolerance can be determined by feeding the extensively hydrolysed elimination diet for six to eight weeks followed by reintroduction of the pet’s original diet.
For cases where a nutrient intolerance is proven, Royal Canin says Hypoallergenic should be used for long-term nutritional management, although some refractory cases may need to remain on Anallergenic.
Anallergenic has been formulated with feather protein hydrolysate, starch instead of whole cereals and a combination of ingredients to help reduce water loss through the skin and strengthen the barrier effect of the skin.
John O’Connor, Veterinary Marketing Manager at Royal Canin, said: "When a nutrient intolerance is suspected, the cat’s diet should be changed to Anallergenic without any food transition. Dermatosis is complex to understand and identifying the underlying cause can be challenging. Managing cats with dermatosis requires a long-term commitment and it is essential for vets to use nutrition as part of their work up.
"The lower the allergenic potential of the diet, the more reliable the results¹ and nutritional management with Anallergenic can be continued for the cat’s lifetime. With the new, highly palatable² Feline Anallergenic diet, Royal Canin offers the complete nutritional approach to dermatosis."
Alongside the new diet, Royal Canin has produced a range of owner education materials, including a leaflet with top tips and a video about nutrient intolerances to raise awareness of the condition and the importance of owners seeking veterinary advice. The new materials are available via your Royal Canin Veterinary Business Manager.
For more information, visit royalcanin.co.uk/skin
References
Animalcare has launched Buprecare into the UK and Ireland veterinary markets. Buprecare (POM-V) is a veterinary licensed analgesic, containing buprenorphine, for use in dogs and cats. It is licensed for post-operative analgesia in dogs and cats, and potentiation of the sedative effect of centrally acting agents in dogs.
This is the second major product the company has introduced in the last 18 months as Animalcare continues to grow its portfolio of veterinary products with the launch of an ACE inhibitor Benazecare (benazepril hydrochloride) earlier in 2007.
To complement the product launch, Animalcare is offering an ampoule breaker to help practice staff to open ampoules safely, together with a practice support package, containing pain scoring pads to aid in the assessment of pain of patients and judging of adequate analgesia requirements. In addition a dosing table and poster detailing common behavioural changes that can be associated with pain are available. Buprecare 0.3mg/ml is available in 1ml ampoules, in cartons of 5 ampoules.
Stephen Wildridge, Managing Director of Animalcare Ltd. said: "We have a very exciting time ahead with the launches of several new pharmaceutical products over the next twelve months, and the proposed expansion of our business into the major European veterinary markets."
Please contact your Animalcare representative, or ring 01904 487687 for more details.
The company says it will be introducing a UK-specific brand in the coming months, but that each practice will retain its independence and culture.
Ben (pictured) started his career in clinical practice but has spent the past decade building and leading organisations across the veterinary and dental sectors, including laboratory services.
Ben Hanning said: “Veterinary professionals are under more pressure than ever – and I’ve lived that reality.
"Vetopia’s UK launch is about creating a new way forward: empowering vets to focus on exceptional care while giving them the support, resources and ownership opportunities that they deserve.
“Our approach is designed to provide the right balance between autonomy and collaboration.
"Together, we can nurture what makes each clinic special while ensuring every team has the tools to thrive.”
A point of difference which Vetopia says sets it apart is its ownership model, through which more than half of the company’s shares are owned by employees.
This enables vets and clinic leaders to benefit directly from the group’s success, while fostering long-term value, collective commitment and a sense of shared purpose across the network.
Peter Thomsen, Group CEO at Vetopia, said: “Vetopia’s success across Europe shows that veterinary excellence thrives when clinicians lead the way.
"Our country-led model combines local decision-making with the benefits of being part of a larger network, giving practices the freedom to deliver care their way while accessing shared expertise, investment and resources.
www.vetopia.com
For the survey, veterinary surgeons and nurses were asked: "Thinking about the last time you (or your OOH provider on your behalf) were called by a pet owner out-of-hours within the last fortnight, was the call ...
a) Something which was clearly NOT an emergency (eg vaccination, nail clip, dematt, pet passport etc.)
b) A condition which should have been seen in normal working hours (either because it has been present for some time already with no deterioration or because - in your opinion - it could have waited till the morning).
c) A genuine emergency, which needed prompt attention to prevent the animal suffering.
475 members took part, 69% of which were vets and the remainder vet nurses.
Of the out-of-hours (OOH) calls they had taken:
28.2% were genuine emergencies, which needed prompt attention to prevent the animal suffering.
64.8% were about a condition which should have been seen in normal working hours (either because it has been present for some time already with no deterioration or because it could have waited till the morning).
6.9% were about something which was clearly NOT an emergency (eg vaccination, nail clip, dematt, pet passport etc.)
So in total, 71.7% of the calls to veterinary surgeons OOH are unnecessary.
This raises a number of important questions, chiefly whether a profession struggling with a staffing crisis can afford to maintain the blanket requirement for all practices to make provision for OOH, particularly now that society places so much greater demands on the profession than it did when the rules were invented, demanding wormers in the middle of the night and then blackening the name of the vet on social media if they refuse. It happens.
Is it time to go the same way as some other countries and let the market meet the demand?
Or can anything else be done to relieve the pressure that OOH places on the profession? Ideas floating around include making all veterinary OOH telephone lines premium rate, charging at least enough to focus the caller's mind on whether it is actually necessary to renew their pet passport at 3:00am. Or perhaps a concerted effort by all parties to communicate the message that OOH is A&E. You shouldn't ring unless you really need to. But that message may not carry much weight when at the end of the day, it's the insurance company footing the bill.
Reducing the number of spurious calls doesn't, of course, help the staffing crisis. But it is surely pertinent to ask whether an obligation for 100% of general practices to make arrangements to service something which is 70% unnecessary is the most efficient way to operate.
Maybe the time has come for the profession to consider OOH and general practice as two very distinct things. Discuss.
The RCVS didn't want to comment.
The hearing took place in Mr Prichard's absence after he failed to respond to Colleges attempts to contact him, including by email, post, telephone and personal service of documents.
However, in its decision to proceed in Mr Prichard’s absence, the Committee confirmed that it would not hold his non-attendance against him or attach any adverse inference to that fact.
Mr Prichard was charged with taking quantities of the controlled, prescription-only drug Vetergesic from the practice’s stock other than for legitimate veterinary use.
He was further charged that he took Vetergesic from the practice by drawing it into a syringe for the purposes of self administration, and that in doing so, his conduct was dishonest.
In another set of charges, it was alleged that on five separate occasions, Mr Prichard had attended the practice to work as a veterinary surgeon whilst unfit to do so.
The final charge related to Mr Prichard’s failure to respond adequately or at all to all reasonable requests from the RCVS for his response to concerns raised about his conduct.
At the beginning of the hearing Nicole Curtis, acting on behalf of the College, read the written evidence from 11 separate witnesses outlining the facts related to the charges against Mr Prichard, including the record of an investigative meeting held by the practice in which he admitted his theft and use of the controlled drug and following which, he was dismissed from his employment.
The Committee found all the charges proven and then considered whether they amounted to serious professional misconduct.
In terms of aggravating factors the Committee found that there was a risk of injury, recklessness, premeditated and sustained misconduct, and that there was an abuse of his professional position in accessing prescription-only controlled drugs for reasons other than legitimate veterinary use.
In mitigation, the Committee considered that he had made admissions as part of the practice’s internal disciplinary investigation.
Overall, the Committee found he had breached aspects of the Code of Professional Conduct related to honesty and integrity, making animal health and welfare his first priority, appropriate use of veterinary medicines, taking steps to address physical and mental health conditions that could affect fitness to practise, responding to reasonable requests from the RCVS, and bringing the profession into disrepute.
Therefore, the Committee found him guilty of serious professional misconduct in relation to all of the charges charges.
The Committee felt that, considering the seriousness of the misconduct, removal from the Register was the most appropriate decision.
Austin Kirwan, chairing the Committee and speaking on its behalf, said: “This is a case involving serious dishonesty, sustained over a period of time, and conduct potentially detrimental to animal welfare, as well as wilful disregard of professional regulations.
“Regrettably, Mr Prichard’s failure to engage with the College and with the regulatory process limited the options open to the Committee.
"Notwithstanding this, Mr Prichard’s disgraceful conduct is so serious that removal from the Register is the only means of protecting animals and the wider public interest which includes the maintenance of public confidence in the profession and the upholding of standards.”
www.rcvs.org.uk/disciplinary
The RCVS Disciplinary Committee has suspended a veterinary surgeon formerly practising in Southampton for failing to make animal welfare his primary concern.
At a hearing this week, adjourned from September 2010, the Disciplinary Committee heard charges against Michael Albring, formerly of VetCall practice, Bitterne, Southampton. Mr Albring was said to have failed to make a home visit to attend Bear, a Newfoundland dog belonging to Mrs Thacker, when he knew, or ought to have known, that there were clinical or welfare grounds making a home visit necessary.
The hearing was held in Mr Albring's absence; the Committee considered that, having postponed the case last year at his request, Mr Albring had had ample time to prepare his case and submit any mitigations, and sufficient opportunity to attend. Additional adjournment would further delay the matter's resolution and not be in the wider interests of justice, or public confidence in either the RCVS disciplinary system or the veterinary profession.
On the evening of 19 December 2009, Mr Albring had been the veterinary surgeon on duty at VetCall, a practice that provides the out of-hours emergency cover for several local veterinary practices, including the one where Bear was registered. When Mrs Thacker's daughter, Ms Davidson, telephoned VetCall to request a home visit as the dog had collapsed, she was told that it was against practice policy for the practice to be left unmanned so this would not be possible. This was despite a written policy which accepted and made provision for the rare occasions when a home visit would be necessary. Phoning again later, the information about practice policy was repeated and Ms Davidson directed to a local animal ambulance service, which attended.
The ambulance driver found that the dog could not be transported in the ambulance and telephoned VetCall to say a home visit was needed. This was refused by Mr Albring even, the Committee noted, when the ambulance driver offered to collect Mr Albring, drive him to Ms Davidson's home 10-15 minutes away, assist with the euthanasia, and return him to the clinic. In the interim, Ms Davidson had also sought help from a separate practice and, subsequent to Mr Albring's refusal to visit, their on-duty veterinary surgeon attended and euthanased Bear.
The Committee found that Mr Albring's refusal to visit, once it was clear Bear could not be transported, and he knew that a home visit was necessary on welfare grounds, resulted in Bear spending longer than necessary in pain and distress. This was not a case where the pressure of work or the welfare needs of other animals prevented Mr Albring from attending, and it was also relevant that Mr Albring was specifically employed to work out of hours in an emergency clinic. Serious, too, was his failure to reply promptly to communications from the RCVS, or show insight into the seriousness of his conduct.
In mitigation, the Committee accepted that this was an isolated case, and there were no previous findings against Mr Albring. He was in sole charge of an emergency clinic covering 15-20 practices across Southampton and Portsmouth, which would make, in some circumstances, home visits difficult.
Professor Sheila Crispin, chairing the Disciplinary Committee, said: "The Committee is concerned that the actual policy pursued by the clinic regarding domiciliary visits was different to the written one.
"In effect, a no-visits policy existed at the VetCall clinic and this must have added to the pressure under which the Respondent [Mr Albring] was working.
"The Committee is mindful that the object of sanctions is not to be punitive, but to protect animal welfare, to maintain public confidence in the profession and to maintain appropriate standards," she continued, noting that as animal welfare had knowingly been neglected and Mr Albring had demonstrated no insight, a warning or reprimand would not be enough. "A period of suspension would be sufficient to maintain public confidence in the profession and uphold standards," she said.
The Committee directed that Mr Albring's name be suspended from the RCVS Register of Veterinary Surgeons for ten months.
Bovalto Respi Intranasal protects against the two main respiratory viruses – RSV and PI3, using modified live viral strains that have been shown to protect against experimental challenge from recent field isolates1.
The vaccine is delivered as a single shot, from 10 days of age and provides immunity for 12 weeks, from 10 days after vaccination2.
In order to overcome the challenges of effective delivery, Boehringer is offering dedicated administration packs, available directly from its ruminant specialist team.
The packs include a vaccinator, a set of nozzles that deliver the vaccine at the optimum droplet size and a soft Bovalto Respisafe applicator which fits against the calf’s nostril. The aim is to make sure that vaccination is a comfortable process for both farmer and calf, as well as addressing the challenge of the delivery of vaccine to the desired area in the nasal passages.
Correct administration of the vaccine ensures that the spray is delivered effectively to the mucosal surface and local lymphoid tissue, achieving the optimal immune response. If the droplet size is too big, the vaccine may be deposited lower in the airway and run out of the nose. If droplet size is too small then the vaccine may be carried to the back of the throat and swallowed. Time and money is spent vaccinating calves so the process needs to be as efficient as possible to give optimal protection.
Matt Yarnall, brand manager at Boehringer Ingelheim said: "The UK BRD vaccine market is growing each year but, as a management tool, vaccination remains quite low down the list of actions, according to the 2017 Calfmatters survey.
"If adding to the Bovalto range encourages more farmers to vaccinate against pneumonia so improving calf heath and lowering antibiotic use, that can only be a step in the right direction."
The Disciplinary Committee heard that Mr Samuel had been convicted of five animal welfare offences at Leeds Magistrates' Court in January 2016. The charges related to causing unnecessary suffering to a number of animals including twelve dogs and four cats, and failing to take steps to ensure that the needs of the animals for which he was responsible were met. The animals were kept at the Armley Veterinary Practice, for which Mr Samuel was, at the time, practice principal.
Mr Samuel was sentenced to 12 weeks' imprisonment suspended for 12 months on the condition he completed 150 hours' unpaid work and paid a fine of £100. He was also ordered to pay costs of £500 and a victim surcharge of £80. He was also made subject to a disqualification order for three years.
Dr Samuel subsequently appealed against his conviction in April 2018. His appeal was dismissed in respect of five of the charges but was upheld in respect of one charge, which, as a result, did not form part of the College’s case.
Dr Samuel declined to attend the hearing in person and was not represented before the Disciplinary Committee. In considering the facts of the charges against Dr Samuel the Committee found them proven.
The Committee then went on to consider whether the proven charges, both individually and cumulatively, rendered Dr Samuel unfit to practise as a veterinary surgeon.
The College’s case was that the convictions concerned animal welfare and therefore went to the heart of his practice as a vet, that Dr Samuel behaved in a manner incompatible with being a veterinary surgeon, that he failed in his core responsibility as a veterinary surgeon to protect and act in the best interests of animal welfare, and that he maintained he had no responsibility for the animals on his practice premises – an assertion referred to as ‘an extraordinary position for a veterinary surgeon to take’.
Ian Green, chairing the Committee and speaking on its behalf, said: "ust as the judgment of the Crown Court and the Magistrates Court had found, the Committee also found that Dr Samuel must have known that the animals were in distress and were in a neglected state. The Committee was sure that Dr Samuel must have been aware of the animals notwithstanding his continued denial. The Committee concluded that Dr Samuel was unfit to practise because of the facts underlying the convictions. Dr Samuel had an overriding duty of care for the animals and to take action in relation to their health and welfare because they were living under the roof of his veterinary practice."
In considering its sanction against Dr Samuel, the Committee concluded that removal from the Register was the most appropriate option. It took into account the fact that the animals were found starving in a cellar without water, that Dr Samuel had not demonstrated insight into the serious nature of his offences, that he continued to deny responsibility and, furthermore, found no evidence that he no longer posed a risk to animals in the future.
Ian Green added: "The Committee decided that the behaviour found proved was fundamentally incompatible with being a veterinary surgeon because in this case there had been a serious departure from standards as set out in the RCVS Code of Professional Conduct for Veterinary Surgeons…. Furthermore, there had been serious harm caused to a number of animals and a risk of harm to a number of other animals."
Dr Samuel has 28 days from being informed of the Disciplinary Committee’s decision in which to make an appeal to the Privy Council.
The Committee’s full decision and findings can be found here
All bar one of the suspended drugs contain the NSAID flunixin. The other affected drug is the antibiotic, Tribrissen:
Allevinix 50 mg/ml Solution for Injection for Cattle, Pigs and Horses (Ceva Animal Health)
Cronyxin Injection, 5% w/v Solution for Injection, for cattle and horses (Cross Vetpharm Group Ltd)
Finadyne 50 mg/ml Solution for Injection for cattle, pigs and horses (Intervet UK Ltd)
Flunixin 50 mg/ml Solution for Injection for Cattle, Horses and Pigs (Norbrook Laboratories Limited)
Meflosyl 5% Solution for Injection for horses and cattle (Zoetis UK Limited)
Norixin 5% Solution for Injection for cattle and horses (Norbrook Laboratories Limited)
Pyroflam 50 mg/ml Solution for Injection for Cattle, Horses and Pigs (Norbrook Laboratories Limited)
Tribrissen 48% Suspension for Injection for horses, pigs and cattle (Intervet UK Ltd)
The British Equine Veterinary Association says that the decision to suspend the drugs was taken without consultation with the veterinary profession, and is urging the VMD to overturn the suspension in horses not destined for the human food chain, to reduce the potential impact on equine welfare.
Jonathan Pycock, BEVA president said: "BEVA is fully supportive of all attempts to promote food safety, however flunixin is widely viewed as the gold-standard pain killer in horses and is commonly used in horses undergoing both elective and emergency surgery, for the crippling pain associated with laminitis and for severe forms of colic.
"BEVA is calling on the VMD to immediately enable limited batch release of flunixin for use in horses not destined for the human food chain in the interests of animal welfare. The equine veterinary profession has always been open to consultation with the VMD on a range of important matters relating to responsible medicine use, antibiotic resistance, horse identification, passports and the horse meat issue. BEVA is perplexed as to why the VMD failed to consult with the equine veterinary industry on the animal welfare impact of withdrawing such an important drug.”
RIP Fleas, the environmental flea treatment from Genitrix, has been given a new formulation to ensure it acts more quickly in the killing of adult fleas and that it continues to kill fleas as they emerge from pupae for up to 12 months.
Now known as RIP Fleas Extra, the product is also licensed for the control of house dust mites in the environment for up to 12 months.
According to Genitrix, the reformulation makes RIP Fleas Extra the only environmental flea treatment to contain three active ingredients while complying fully with new EU Biocides regulations. It is the only such treatment to be fragranced and is also the only product to be presented in a volume which will cover 120 square metres – ie the size of an average house. RIP Fleas Extra contains:
Tetramethrin – a second generation synthetic pythrethroid and a contact insecticide with a rapid knockdown action of insect pests
Permethrin – a potent insecticide with a powerful contact action on insects but with a low toxicity to most mammals
Methoprene – a compound that mimics the insect juvenile hormone and arrests development of fleas and house dust mites in the environment.
When used synergistically, Tetramethrin and Permethrin provide a rapid knockdown and kill of fleas as they hatch from pupae. Studies have shown that this combination works four times more quickly than Permethrin alone.
NEV was first identified in 2013 by veterinary surgeon Dr Isabel Fidalgo Carvalho, who went on to found Equigerminal to develop a commercially viable NEV diagnostic test that can be used by veterinary surgeons, vet labs and horse owners.
Isabel says that NEV - the equine equivalent of HIV - is often misdiagnosed or hidden by other diseases that induce similar symptoms, like anaemia and neurological issues in horses. It is most commonly confused with the Swamp Fever virus (EIAV) and Equine Herpesviruses (EHV).
Indeed, when they tested a number of horses with anaemia, Equigerminal researchers first believed they had found the presence of a divergent strain of the Swamp Fever Virus (EIAV) - because the horses cross reacted with EIAV, but were negative in the official tests. Subsequent research found they were actually suffering from NEV.
Equigerminal says it is believed that NEV is present in up to 10% of horses. Isabel said: "We did test 213 samples from Ireland and found 7% of positive samples for NEV. These Irish horses were horses that usually travel to UK and other locations for sports events."
For the new test, a veterinary surgeon needs to take a blood sample which is sent to the Equigerminal lab.
Isabel says treatment is currently targeted towards improving the general well-being of the horse, health monitoring, and boosting the animal’s immune system. The next stage is to find a treatment, and ideally a cure for NEV. Meantime, Isabel said: “We now need to raise awareness of the problem and help vets to diagnose this disease correctly.”
The motion was introduced by Kate Richards MRCVS, Chair of the RCVS Standards committee, who explained that it'd been driven by three things, namely: the Vet Futures Initiative, the RCVS Strategic Plan signed off by Council in 2017 and the RCVS telemedicine consultation that took place earlier this year.
The latter of these showed that 69% of vets opposed the idea of prescribing without a physical exam, which rather beggars the question why it's being discussed at all. However, as Kate explained, when asked whether certain types of products could be remotely prescribed, the answer was more equivocal: 52% of vets said "yes".
Kate also explained that over the last two years, there had been a number of good quality discussions at Standards Committee and Council, but that decision-making had been "hampered by a paucity of evidence on the opportunities, risks and benefits of telemedicine to animals and the public".
The full wording of motion was: "Council is invited to consider the recommendation of Standards Committee to conduct a limited and time-bound trial to assess the benefits and risks of allowing the remote prescription of POM-V (excluding opiates, sedatives and potentially also critically important antibiotics) where there has been no physical examination."
However, in order for the trial to take place, it would be necessary to make a temporary change to the Supporting Guidance of the Code of Professional Conduct concerning the definition of "Under his care" (Ed's note. C'mon RCVS, isn’t that a bit anachronistic? Both your CEO and your President are now "her". "Under Care" would do it.), adding the words in italics to para 4.1: "A veterinary surgeon cannot usually have an animal under his or her care if there has been no physical examination; consequently a veterinary surgeon should not treat an animal or prescribe POM-V medicines via the Internet alone, other than in circumstance where a telemedicine service is a part of the RCVS telemedicine trial".
In the best interests of animal welfare
Amanda Boag (MRCVS, Vets Now, RCVS President) then reminded everyone that: "RCVS Council needs to act in the best interest of animal welfare and the public, and whilst sustainability of veterinary services is important, it isn't our role to promote anything novel or to protect traditional models."
Really? Strikes me that the sustainability of veterinary services isn’t just "important", it's an essential part of ensuring good animal welfare. Surely, therefore, it most certainly is the role of Council to protect traditional business models or, for that matter, to promote novel methods if (and I stress "if") doing so protects or enhances animal welfare.
Don’t confuse telemedicine with remote prescribing
Jo Dyer (MRCVS, small animal locum, Devon) opened by pointing out that this is not about telemedicine per se. Telemedicine has been going on since the invention of the telephone in the late 1800s, supplemented over the last 20 years or so by photography and video sent over the internet. Telemedicine does not, in and of itself, require a change in regulation.
What this is about, she explained, is the much narrower act of remote prescribing without physically examining the animal, something which would require the profession to redefine "under his care", which in turn "makes up the foundation of what forms the relationship with the owner and the animal in order that we can safeguard the use of medicines, safeguard the animals under our care and safeguard our clients."
No evidence remote prescribing increases access to veterinary services
Jo argued that the only reason Council should be considering the prescription of medicines without a physical examination would be if it were in the interests of animal welfare. And yet, she said, there is no evidence to support this idea.
Some have suggested that it could increase access to veterinary care. However, Jo said she had been unable to find any evidence to support this idea either. Not just in the veterinary profession, but in the medical profession in the Western and the developing world.
Jo also noted that the trial proposal was to use commercial organisations which have a financial interest in a positive outcome, which would render the results biased and unreliable.
She then raised the issue of antimicrobial resistance, highlighting the use of cytology and culture sensitivity to make sure the right antibiotics are used. Remote prescribing, she said, would be a retrograde step, even if only non-critical antibiotics could be prescribed remotely.
Spawning a new class of limited service provider
Next she highlighted the impact of the trial on 24-7 cover. Under the proposal, "Those under a trial would be required to actively support clients in identifying a veterinary practice that could physically see their animal in both routine and emergency situations."
As Jo pointed out, this would by definition mean that any veterinary surgeon, not just those practising telemedicine, could set themselves up as a limited service provider and refer all cases they didn’t want to see (whether OOH or not) to a local practice. This, she argued, should only happen after a proper debate, and not be just the unintended side-effect of regulation change to allow remote prescribing.
In fact, there is evidence that this is exactly what is happening in human medicine. Only the following evening, the BBC aired Diagnosis on Demand: The Computer Will See You Now, a documentary about telemedicine and artificial intelligence in human medicine. It should be required watching for all RCVS Councillors.
The programme makers visited GP at Hand, a telemedicine business based on the Lillie Road in Fulham, London that has been formed in partnership with Babylon. Coincidentally just up the road from where I used to live, it's a pretty nondescript sort of a place, but now home to the fastest-growing GP surgery in the UK. Since late 2017, it has amassed a staggering 30,000 clients from across London, virtually none of whom will ever visit the place. The problem is that GP at Hand has skimmed away fee-paying clients from across the capital that had in effect been helping to subsidise local care elsewhere.
More information needed for such an important decision
Jo concluded by saying that a decision of this magnitude, particularly when it seems to go against the wishes of the majority of the profession, demands checks to ensure no conflicts of interest, legal advice and wider consultation with organisations such as the VMD, Defra, the BVA and its subdivisions and the VDS. Therefore, she would propose a new motion to delay the decision until more information is made available.
Chris Barker (MRCVS, small animal practice, Cumbria) was up next. He felt that the RCVS consultation was very effective and gave a good picture of what veterinary surgeons see as the risks inherent in remote prescribing. However, he felt that the analysis has been marshalled to suit an agenda and minimises the concerns of general practitioners.
Fragmentation and multiple consultants leading to a loss of responsibility
The trial, he said, will lead to fragmentation of veterinary provision and send the message to the public that it is quite OK to go to more than one vet for advice and treatment, and that will lead to confusion and the loss of individual responsibility for the veterinary care of an animal that exists today.
An inspection with no history: not a proper examination.
Chris argued that the act of prescribing demands a physical examination, but that a video consultation could only ever be an inspection. He also highlighted the importance of patient histories and argued that the immediacy of telemedicine simply doesn’t allow a practitioner to get the patient history from another vet.
Chris also argued that the profession is not structured to allow for clients to consult multiple veterinary service providers simultaneously: once a client leaves his practice, he has a duty under GDPR to expunge much of their records, and he for one didn’t much care for the idea of re-registering a client at 2:00am.
Some of the issues Chris raised may of course be solved by technology in the foreseeable future. GDPR already calls for data portability, presumably it will not be long before owners expect the same data portability for their animals' clinical histories.
Who wants clients who only ever call when telemedicine has failed?
Still, his overall point was an important one: whether or not there will be vets out there who are happy to pick up and see failed telemedicine cases at 3:00am in the morning from people who are not clients of their practice and who don’t otherwise contribute financially to the business.
90% of vets say remote prescription is high risk or inappropriate
Lastly, Chris drew attention to a question in the RCVS consultation which asked respondents what risk they thought there would be in a remote consultation when the consulting vet did not know the owner, did not know the animal and does not know the situation in which the animal is kept: "90% of responding veterinary professionals either chose it as high risk or simply not appropriate at all. I know of no better body of people than practitioners in Britain to understand the welfare and the risk to the welfare of animals."
The risk of misdiagnosis
Martin Peaty (MRCVS, equine practitioner, Wiltshire) spoke next, highlighting the risk he saw to animal welfare from misdiagnosis. He drew attention to concerns raised by the Quality Care Commission in human medicine, in particular that there is no access to the long term medical records of the patient, and the risk of misdiagnosis: "And that’s in human patients who can fluently articulate their symptoms", he said, "I think we should be much more cautious in exercising care before allowing remote diagnosis and prescription."
Martin's point seemed especially apposite in the light of an article which appeared in The Times two days later: 'NHS app 'no match for trip to the GP', in which Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs expressed concerns about online consultation systems, particularly for vulnerable groups, such as children.
Remote prescribing demands that vets sacrifice principles
Martin also outlined the three principles which underpin current practice: physically examining the animal, considering its history and providing 24 hour care, the latter in part in case of a reaction to a prescribed medicine.
"These proposals ask us to sacrifice these principles for telemedicine businesses whilst for good reason they remain in place for other veterinary practices. I think that is hypocritical. I think it is wrong."
Not enough follow-up
Sue Paterson (MRCVS, a referral specialist who offers a dermatology telemedicine service to the profession and the public, Merseyside) jumped in next. She was unashamedly enthusiastic about the benefits of telemedicine, in particular how it allows practitioners to engage with the public and make veterinary advice more accessible, not to mention because: "I am sick to death of people coming into consults when they have been on Facebook or they’ve been on to talk to Dr Google."
However, despite her enthusiasm and despite finding that users of her service do not want antibiotics, just advice, help and reassurance from people they trust, Sue was still against the idea of remote prescription: "I don’t want to prescribe because I can't follow those cases up, because I can’t maintain the level of client care that I think is really important, so for me, I would not want to see this change to the code."
We won’t know what we missed, or the consequences of what we missed
Caroline Allen (MRCVS, charity veterinary director, London) said the biggest issue for her is that without a physical examination, she won’t ever know what she missed (the heart murmur, the goitre, the subtle muscle wastage), or for that matter, the animal welfare consequences of what she missed.
As others had done, Caroline highlighted the importance of getting a weight every time and how difficult it is for clients to measure accurately.
Lastly, she made the thought-provoking point that allowing the remote prescription of drugs without a physical examination would risk legitimising Dr Google in the eyes of the public. After all, if no veterinary physical exam is needed, surely owners can just look it up on the internet for themselves?
In defence of the RCVS
At this point in the discussion, RCVS CEO Lizzie Lockett addressed the suggestion that the whole process of investigating and voting on telemedicine was being driven by hidden agendas, something she absolutely and eloquently rejected. She explained that sure, some parties had been more engaged in the whole process than others, but emphatically denied there had been any influence. Council, she said, had asked Standards to investigate and develop a proposal, which it had done diligently. Now it is down to Council to decide whether the proposal stands or falls; the College exists to implement the decision.
RCVS Vice President, Professor Stephen May went further, saying that many present would be aware that he'd been a vocal critic of the way that a number of other regulators in modern society push things out to court for decisions, rather than taking decisions collectively and then sticking by them. "I’m really proud that we are discussing this and I’m really pleased that this is up to us how we move things forward in the interest of animal health and welfare and supporting the public in that."
The need for a more nuanced, less polarised debate
However, he said he was worried about the way the debate was being polarised into a yes or no when he felt the profession should thinking about how it should adapt to the changing circumstances, thinking about cases which are amenable to a distant relationship and in what context that is appropriate, taking into account the risks.
Remote prescription is already happening, illegally
Melissa Donald (MRCVS, small animal practice, Scotland) questioned whether telemedicine and remote prescription is what the public wants. She said that remote prescription is already happening, illegally from abroad, and that the College needs to have a more robust response than "it’s not our problem". She therefore recommended a further period of consultation, particularly with public focus groups, and internet research to see how much remote prescription is already happening.
Vets are professionals
Tim Walker (Lay) said he was struck by the need to assemble better evidence. He felt there needs to be more thought given to the transference of responsibility for cases between a telemedicine provider and a traditional practitioner. Tim also felt that the definition of "under his care" will almost certainly need to be rethought in the not-too-distant future, because the idea of a patient being under the care of just one practitioner is starting to look dated; in the human sphere, patients are looked after by teams of people.
Tim highlighted the approach he said is taken by the GMC, which obliges doctors to be able to demonstrate that they have done sufficient due diligence to prescribe, not that they can simply do so automatically under certain circumstances. That, he said, is what professionalism should be about.
Taking the lead
Mark Castle (Lay) said he thought that the public was looking for a choice, that technology is constantly throwing up new opportunities, and he expected that in the future more and more will be able to be done remotely, so he wanted the RCVS to take the lead in this area.
Lucy Goodwin (MRCVS, BSAVA Head of Education) was positive about the idea of conducting a time-limited, controlled trial: "We say we want evidence, so let’s go and collect it", but had a number of reservations. Not least of these was the fact that the participants in any trial would be on best behaviour, so it may not be able to extrapolate the numbers to the profession at large. Beyond that, she was also concerned that the scope of the trial should be better defined, in particular which categories of drug could be included within it.
Vets don't want a trial of telemedicine
Mandisa Greene said that whilst she is positive about telemedicine as it had been described, and not averse to a trial, she didn’t see the point in a trial when the people who actually do the prescribing don’t want it.
A voice in favour
Chris Tufnell (Past President) began by declaring that he consults to the Affordable Pet Care Company which is shortly to launch a telemedicine service, although he said the service would be unaffected by the decision being taken by Council. He was also at pains to stress that he hadn’t had any other fingers in this particular pie, in particular that he hadn’t been to any of the Standards Committee meetings or presented to them, or been involved in formulating the proposed trial.
Whether you agree or disagree with Chris, it was at least good to hear someone speaking in favour of the motion. Chris opened by arguing that veterinary surgeons are good at making decisions based on imperfect information: "Client histories, as we know, are of variable quality. We make decisions daily on whether we are happy with the information we get from the practice lab or whether we need to send the sample to a reference lab. When I started in practice, practice lab machines were routinely described as random number generators."
"We make decisions on a daily basis on what the limitations of our abilities are. It’s called professional judgement and what we are proposing here is actually a test of our definition of 'in our care'. We’re talking about testing the possibility of making remote prescriptions. The responsibilities around prescribing won’t change, and those responsibilities include the responsible use of antibiotics."
Chris then argued that all the motion was calling for is a trial of something that unlike, for example, deregulating advertising and practice ownership, is not going to give a slice of the consultation fee to non-vets. He also pointed out that people will always be able to highlight cases that would be completely unsuitable for remote prescribing, but that this is not about replacing the consulting room.
Filling the void
What it is about, he said, is removing barriers to care; filling the vacuum between a concerned owner, and the £60 - £100+ they’ll be charged for a consultation. It’s a vacuum that is currently filled by the 'free' (except it's not) phone advice given out by practices, by Facebook and by Dr. Google.
He then pointed to an example from the US, where 83% of people who visited https://www.whiskerdocs.com for pet advice and thought their problem was suitable for home treatment, were in fact wrong and ended up being instructed to visit their veterinary practice. This, he said, could lead to better productivity in practice.
Could telemedicine help retention?
Telemedicine, he said, could also provide a role for people thinking of leaving practice, which is potentially an important factor at a time when retention is proving such an issue.
Evidence-gathering, clinical freedom and professional judgement
Like others, Chris argued that the trial is about putting the RCVS at the forefront of progression in our increasingly digitised society, at a time when remote information from wearables is going to become more and more common. In summary, he said: "This trial is about an evidence-based profession looking for evidence, it’s about clinical freedom and it’s about putting professional judgement in the hands of the professionals."
A two-tier service
Lynne Hill (Past President) said her main concern is about having to redefine "under his care" and how remote prescribing via telemedicine would lead to a two-tier level of care, which she thought would be wrong.
She also highlighted that the College had debated the definition of "under his care" in relation to farm animal practice, where some farmers have multiple vets, some of which offer herd health care and nothing else. Deregulating to account for this has, she said, been responsible for the demise of farm animal practice. Quite simply there are less vets around to see animals.
Show me the money
Lynn also noted the altruistic nature of the debate thus far, and reminded everyone that this is really about business and making money. The companies that are set up to provide telemedicine and possibly take part in the trial will not be in it for the welfare of animals, but to make money.
She also scoffed at the idea that telemedicine and remote prescribing will mean the 10% of people who do not currently have a vet are "now going to get madly involved in telemedicine." The reason they don’t have a vet at the moment, she said, is because they don’t want to pay. Telemedicine doesn’t change that.
Lastly, as others had done, she highlighted the difference between human medicine, where patients can describe their symptoms, and veterinary medicine, where they can’t.
Leadership is about taking the right decision, not jumping on the bandwagon
"Leadership is not always about jumping on the bandwagon and going forward because something is out there. Leadership is actually about looking and deciding and making the right decision."
The disingenuous antimicrobial argument
Dave Leicester (MRCVS) was up next, arguing that it would be wrong to say that a body of professionals can be trusted to make decisions about animal welfare, but not about prescribing. He also felt it was a little disingenuous to do a lot of hand-wringing over antimicrobials when, as a profession: "We’ve managed to make a 3rd generation cephalosporin the most prescribed antibiotic in cats."
Finally, Dave made the point that in his 15-year experience working for OOH emergency service providers, they’d managed to work very successfully without access to patient medical histories.
Setting veterinary standards
Claire McLaughlin (Lay) reiterated that the role of the RCVS is to set veterinary standards, something it can’t very well do without knowing what is going on in practice, and finding out how these things work in practice. “We need to be in a process which takes us to able to set those standards. Whether the trial that is proposed is the right trial or not, we can’t just say no, it’s fine as it is because people will work within their professional competence. As Eleanor [RCVS Registrar] will tell you, they don’t work within their professional competence because they come before disciplinary committee all the time. I think we would be remiss if we didn’t start a process now or continue this process in a way that allows us to set appropriate standards.”
Colonel Neil Smith (MRCVS, Chief Veterinary Office for the Army) began by declaring that he provides telemedicine services for animals in disparate parts of the world as part of his day job, but these animals are very much under care and there is an existing relationship with patients. He is also involved with the provision of limited veterinary services for homeless people via StreetVet, a charity which has had to form relationships with practices that can cover the 125 hours per week when it is not present.
Lowering veterinary standards
Neil explained that his "massive" concern with the proposal lies in particular with the part that says: "Given the limited nature of the service that can be provided by telemedicine alone, however, it is proposed that those under a trial would be required to actively support clients in identifying a veterinary practice that could physically see their animal in both routine and emergency situations."
This, he said, would lower veterinary standards, if all somebody providing telemedicine has to do is point people in the direction of a practice.
For that reason, Neil said, he could not support the proposal as is, and would instead recommend that it goes back to Standards and is then brought back at the next council meeting with a clearer idea of what the trial is all about.
Accessible care
Caroline Allen then jumped in again, saying that whilst she agreed with the idea that more data is needed, she also thought that telemedicine and remote prescription is being driven by the issue of accessible care, and it is that, in fact, which needs to be investigated and understood and debated first.
The digital age
Past President Professor Stuart Reid highlighted that the veterinary students of today live their lives in the digital environment and their world will be very different from ours. The same goes for pet owners. He reiterated that as the regulator, the RCVS needs to be ahead of the game, and that if this is what the public wants, then it has to find a way of regulating it.
Stuart finished by saying that he felt conflicted about the vote; that he had significant problems with the proposal and is not entirely sure that a trial is the right thing, but: "In the referendum we're about to have, I want to say yes but I want to see what the deal is as well." He added: "I didn't vote out by the way, in case this gets back to my employers, but I do think we have to think very carefully about throwing the baby out with the bathwater here."
Pressure to prescribe
Martin Peaty then recounted how at a Vivet Conference last year, a provider of telemedicine (which he thought was Babylon) explained that doctors on its system were retained on the basis of a post-consultation customer satisfaction survey. That, he thought, would make it difficult for practitioners not to prescribe things when they know it will affect their job.
David Bray (Lay), said he believed the telemedicine and remote prescribing will come and it will become more common to have pets treated by multiple vets, so he was fully supportive of a trial.
When it came to the vote ...
Guessing at which way the people who spoke might have voted, it seemed as though there were probably enough councillors with sufficient reservations about the motion, which would have given the go ahead for the trial, for it to be voted down.
That said, the overall sentiment in the room seemed to be that the discussion about the regulation of telemedicine and remote prescription needs to continue, and not get kicked into the long grass simply because of a disagreement over the proposed trial.
At this point, Jo Dyer and others stepped in to argue that the decision to proceed with the trial should not be made until the issues raised in the debate had been addressed. There was then a lot of going backwards and forwards, discussing whether this would need a new motion, which is not allowed under Council rules, or whether the existing motion could be amended, which is allowed.
In the end, the decision was taken to hold two votes, the first being to refer the issue back to the Standards Committee which was carried by 18 to 12, with one abstention.
The second vote was:
"Council is invited to consider the recommendation of Standards Committee to prepare and develop a proposal for a time-bound and limited trial to assess the benefits and risks of allowing the remote prescription of POM-V with appropriate stakeholder engagement and with consideration of the issues that we've discussed today and the detail on them, including 24/7 care and classes of drugs, especially antimicrobials. So we are asking for the detail on that to be worked up on the basis that it will at some time come back to Council."
The second vote was carried by 21 to 8 with 3 abstentions.
In other words, the trial will not now go ahead unless Standards can develop a new proposal which addresses the concerns raised by Council.
VetSurgeon Conclusion
Looked at solely in terms of its impact on animal welfare, this debate seems to come down to one question, which is whether more animals will benefit from easier, cheaper access to veterinary services available via telemedicine and remote prescription than will suffer as a result of misdiagnoses and missed diagnoses that will surely be the inevitable consequence of veterinary surgeons working only from the more limited, and potentially inaccurate or even false information they will get from a video consultation.
For sure, more wearables are coming, and they will overcome some of the problems caused by the fact that animal patients cannot describe their symptoms. Doubtless someone will also invent a set of weighing scales that makes it possible for owners to do the job reliably accurately. Patient histories will surely become more portable. But these things are not with us just yet.
In any event, it is not just about the immediate impact on the quality of care delivered to patients. The way the trial has been framed thus far takes us in the direction of a two-tier profession. What happens if more veterinary surgeons prefer, or make a better living from working from the comfort of their own home without the added responsibility that comes with providing the physical care. Who’ll do the ‘real' vetting?
If you look at the popularity of human telemedicine, the 30,000 patients who have signed up for telemedicine at the small practice in the Lillie Road in London, it seems obvious that patients want the convenience of consulting online, without having to schlep to the practice and find a parking space. It also seems self evident that if online consultations are offered at a lower price point, it will inevitably lead to more pet owners availing themselves of veterinary advice, though as Lynn Hill said, it’s unlikely to cause a mad rush whilst Dr Google is still free.
Perhaps, though, there is another valid way to solve this conundrum. Rather than rushing headlong into a trial that could irrevocably change the very nature of the profession, how about establishing some pragmatic ground rules from the outset. For example, that unless by unanimous agreement of Council in the future, telemedicine should only be allowed as an extension of the service offered by existing bricks and mortar practices to their existing clients.
When it comes to remote prescribing, surely the safest way to regulate it (if you’re going to allow it at all) is to do so on a drug-by-drug basis. Perhaps trial it with the endo- and ecto-parasticides for existing clients of existing practices. Find out whether the convenience of the online consultation leads to higher standards of parasite control for greater numbers of pets. If it doesn’t, then ditch it. Either way, it doesn't preclude trying another category of drug.
That’s my tuppence worth, for what it’s worth, which probably isn’t quite tuppence!
The petition was set up by veterinary surgeon and journalist Pete Wedderburn, after discussion with colleagues, in response to an open letter to the profession from Jemima Harrison, producer of the Pedigree Dogs Exposed documentary broadcast in 2008.
In the letter, Jemima notes that Kennel club registrations of Pugs rose from 2,000 in 2005 to 10,000 last year. Over the same period Bulldog registrations more than doubled to 7,000 and the number of French Bulldogs increased 4000% to 14,607.
All vets do, she says, is 'organise CPD days on how to manage the increasing numbers of creatures that turn up at your practice doors gasping for air', 'refer clients on to soft-tissue specialists who do their best to remedy the deformity that has been bred into them', and 'section that Bulldog and say nothing to the breeder about how wrong it is that the dogs are no longer capable of birthing their own pups'.
She argues that there is 'institutional kow-towing to the Kennel Club and a reluctance to do anything other than accept their platitudes that they have to take things slowly or risk "losing" the breeders'.
In response, Pete's blog and petition calls for a working party to develop concrete proposals to tackle the issues as a matter of urgency: 'Despite the evident appeal of short-nosed pets to many of our clients, it is our duty as vets to not just treat these animals, but also to lobby for reform in the way they are bred – in particular the 'extreme' brachycephalics such as Pugs, Bulldogs, French Bulldogs and flat-faced Persian cats'.
The Dog Breeding Reform Group has welcomed the petition. Chris Laurence MBE, DBRG Trustee and former veterinary director of the Dogs Trust who has signed the petition, says: "Vets in companion animal practice see dogs with inherited breathing difficulty almost every day and are frustrated that there seems to be no end to the daily suffering of these breeds. The DBRG is delighted that vets are now getting together to highlight the issue and to plead with breeders to stop producing puppies with such malformed heads that they are unable to breathe easily."
The petition, which has already gathered nearly 1000 signatures, can only be signed by veterinary surgeons and nurses. You can sign it here.
Carbodote Prime is the first activated charcoal product for cats and dogs to contain a cathartic, which speeds up intestinal transit time so that bound toxins are expelled more quickly.
Carbodote Repeat is for those situations where repeated administration of plain activated charcoal is needed due to the type of the toxin involved.
Carbodote Repeat can be administered to the patient every 4-6 hours over 24-48 hours.
Both products are presented as a ready-mixed, easy to swallow gel formulation, for less mess and reduced risk of aspiration.
TVM says the 60ml ‘dial and dispense’ syringes make administration easy for both veterinary staff and pet owners.
For more information, visit www.tvm-uk.com/carbodote or contact your Territory Manager.
The group reports that over 150 veterinary professionals have registered on its website and pledged their support.
The campaigners say they've been astonished with the response and believe the dozens of practices that have received legal letters and signed up so far could just be the tip of the iceberg.
Since the story first came to light, VetSurgeon.org understands IVC has sent follow-up letters to a number of practices saying it has decided to offer a stay of execution and extend the deadline to comply until the 31st December 2025, before it considers taking further legal action.
However, the campaigners estimate that to rebrand so many ‘Pet Health Clubs’ will cost £250,000 and £350,000 in total, so they have now appointed an intellectual property lawyer to provide specialist advice on whether such a common term can be protected with a word mark.
Alex Green of Broadway Vets said: “Initially we set up We Are Spartacus to bring all the affected practices together to support each other, and while we’ve done this, we’ve also brought the wider veterinary community together who want to stand up to IVC Evidensia and the ridiculous word mark.
“Lots of practices have had a ‘Pet Health Club’ for more than 10 years and the majority of those that have come forward were using the term long before IVC registered its word mark in 2019, so it’s clearly an issue that people feel very passionate about, especially when it’s likely to cost each practice a significant amount of money and time to rebrand.
“We’ve been overwhelmed by the number of people who have registered to support us, especially those that aren’t affected but who want to stand shoulder to shoulder with us against such an unnecessary and underhand way of doing business.
"However, there are still several practices that are affected that we haven’t heard from, and we’d urge them to come and join us now.
“We’re also keen to hear from those that received initial letters and haven’t yet had a follow-up offering a stay of execution until the end of the year.
"Whilst we’re delighted that IVC has extended their deadline, it does not resolve the fact that their threats are unacceptable when every practice in the country provides animal, or ‘pet’, healthcare, or ‘health’, in a community-based service, or ‘club’.
“They don’t need to fight or worry about this on their own and we’re stronger as a collective, especially when it comes to pooling resources and expertise.
"We’ve already appointed a specialist IP lawyer to advise us, and the view is that given the extensive prior use of ‘Pet Health Club,’ it would be crazy to allow this to escalate to court when it can be amicably resolved.
“It’s also come to light that IVC has even registered ‘It’s not what we do, it’s why we do it’ which does rather sum it all up.
Spartacus just wants to know why IVC is doing what it’s doing.”
www.wearespartacus.co.uk
The new Vetscan Imagyst AI dermatology application analyses impression smears and ear and skin swabs to identify yeast, inflammatory cells and bacteria.
It provides results in about ten minutes, depending on your upload speeds, which VetSurgeon understands is probably how long a dermatologist would take to perform the task (compared to a GP, who might take twice as long, depending on skills, available equipment, volume of tests, etc).
In terms of accuracy, Zoetis says the application is comparable to that of a clinical pathology expert.
In addition, it fires out a report, including images, which can be shared with the client, adding more value to the consultation.
According to a 2006 study, something like 72% of vets' derm diagnosis and treatment recommendations are based on presenting clinical signs and physical examination alone1.
Vetscan Imagyst list price is just shy of £18,000, but there are a variety of commercial deals that can be discussed with your Zoetis Account Manager. Each AI analysis costs in the order of a tenner.
So the question is whether the new system is worth the investment - for the 72% in terms of a more accurate diagnosis over an educated guess, and for the 28% in terms of the time-savings over a manual analysis.
Sophie Duguid, Diagnostics National Veterinary Manager at Zoetis UK said: “The ability to accurately and reliably identify inflammatory cells, bacteria and yeast, at the time of visit can make a huge difference for busy clinics, ensuring better outcomes and happier patients and owners.
"Performing cytology is a critical component of the dermatology work-up, however this can often be challenging for veterinary healthcare teams to deliver given the considerable time pressures in clinical practice.
"Vetscan Imagyst AI dermatology allows clinicians to rapidly detect the presence or absence of skin infection in canine and feline dermatology cases which allows for clinically informed decision making."
Reference
16 clinics are affected by the investigation, namely Penrose Veterinary Group Limited, Kevin Castle (Pet Care) Ltd, Swayne & Partners Ltd, Treforest Veterinary Clinic Ltd, Mercer & Hughes Limited, Swaffham Veterinary Centre Limited, Anglesey Pet Clinic Ltd, Chiltern Equine Clinic.
It's not the first time, of course, that the CMA has intervened in the veterinary profession.
Earlier this year, it investigated the acquisition of Quality Pet Care (trading as The Vet) by CVS, and then Vet Partners' acquisition of Goddards, which led to CVS selling The Vet and Vet Partners selling eight of the 47 Goddards sites to Linnaeus.
An IVC spokesperson said: “IVC Evidensia is working closely with the CMA and engaging constructively with this review."
Bayer has introduced a new microchip scanner which is capable of reading all chips, including encrypted ones.
The company says the new Tracer Advance Isomax V scanner offers exceptional reading distances of more than twice those of other scanners on the market, making it a very versatile tool ideally suited for use in companion animal practices or for detecting microchips in larger animals such as horses.
The technology that gives this scanner its backward compatibility with non ISO standard chips means practices can now save money by only having to buy one scanner, whereas previously two were required to be able to read all types of chip.
Other features of the device include digital signal processing (DSP), which protects against radio interference from TVs and PCs, and connectivity via USB, RS232 or optional Bluetooth interface.
The Tracer Advance Isomax V scanner is available from Bayer and is priced at £499.95. It comes with a 30-month warranty. Contact your Bayer territory representative for further details.
Having investigated alternative sources of isoflurane, and alternative products, the associations proposed ways that the VMD might mitigate the risks to animal welfare including consenting to the use of unlicensed (“special”) isoflurane formulations.
The VMD responded rapidly and positively. It is understood that one specials manufacturer is now intending to produce isoflurane to fill or partially fill the gap in supply. This should be available in three to four weeks.
David Rendle, a member of BEVA’s Health and Medicines Committee commented: "BEVA has a close relationship with the veterinary pharmaceutical industry and will always work swiftly and collaboratively to help develop practical solutions to supply problems for our members."
BSAVA President Philip Lhermette praised the VMD for such prompt action. He said: "The VMD listened to our concerns and acted immediately. By doing so they have addressed and helped to prevent any potential welfare risks associated with a lack of isoflurane."
Carl Bradbrook, AVA Junior Vice President, reminded clinicians to "seek advice when considering the use of unfamiliar anaesthetic protocols."
The associations say that the situation doesn’t give vets free rein to ignore the medicines legislation; the cascade must still be followed, and client informed consent obtained if an unregulated anaesthetic is used.
Extemporaneous products are the last tier of the cascade. Vets are expected to use either an authorised human medicine or an EU authorised veterinary medicine before an extemporaneous preparation. If, after diligent attempts to source a product higher up the cascade, the vet has not been successful they could consider using an extemporaneous preparation for the immediate need. However, should an authorised product or a human product become available vets are obliged to use it over an extemporaneous preparation.
BEVA, the BSAVA and the AVA have each produced general advice on the use of specials or anaesthesia options at https://www.bsava.com/News/ArticleID/2535/Isoflurane-supply, https://www.beva.org.uk/Resources-For-Vets-Practices/Medicines-Guidance/Veterinary-specials and https://ava.eu.com/
As well as raising awareness of suicide and mental health, Maria Mylne, Mary Hall, Callum McRoberts and Kirsty's partner Chris Burn are raising money for two charities: Vetlife and The Canmore Trust.
The Canmore Trust was set up by the parents of another vet who took his own life, and works with individuals, communities, practices, workplaces, schools, colleges and universities that have been affected by suicide, as well as trying to prevent suicide.
The four vets will set off from Land’s End on September 23rd and will arrive in John O’Groats on October 18th.
On the way, they will be stopping off at Bristol, Harper Adams and Keele, Liverpool, University of Central Lancashire, Edinburgh and Glasgow vet schools to speak to students about suicide prevention.
Kirsty was a trusted and respected colleague and vet, and her death had a devastating impact on her partner and colleagues who are fundraising in her memory.
Maria said: “We want to share a message of hope that suicide is not inevitable, and just because somebody has experienced suicidal thoughts, does not mean they will feel this way forever.
"Together we can break the cycle of suicide and keep building suicide safer communities in practice.”
Chris said: “Kirsty was my rock. If you wanted something organised or something fixed, Kirsty was your woman.
"We don't want anybody else to go through the pain we have.
"We want everybody to know that no matter what your mind may tell you, the world is better with you here, in this world.”
www.justgiving.com/team/lejogawareness
https://www.facebook.com/profile.php?id=61559943272380
https://www.instagram.com/lejog_awareness2024
https://thecanmoretrust.co.uk
https://www.instagram.com/the_canmore_trust
lejogawareness@gmail.com
https://www.vetlife.org.uk
Part 1 of "Comparison of veterinary drugs and homeopathy", by Peter Lees, Professor Emeritis in Pharmacology at the RVC, Ludovic Pelligand, Senior Lecturer in Veterinary Clinical Pharmacology and Anaesthesia at the RVC, Martin Whiting, Lecturer in Veterinary Ethics and Law at the RVC, Danny Chambers, an RCVS Councillor currently working at Langford Veterinary Services, University of Bristol, Pierre-Louis Toutain, a European Veterinary Specialist in Pharmacology and Toxicology, and Martin Whitehead Co- and Clinical Director at the Chipping Norton Veterinary Hospital, is published in last week's (August 12th) edition of the Veterinary Record.
The paper considers some of the reasons why medicinal products work and the errors in human thinking which make them seem to work when actually they don't. It also takes a look at the history of veterinary and homeopathic medicine, which helps explain how something as scientifically implausible as homeopathy ever gained traction in the first place.
VetSurgeon.org Editor Arlo Guthrie said: "As the parent of a child with a severe, chronic and highly variable disease, I’ve had prolonged first-hand experience of just how easy it is to fall prey to the sorts of errors in human thinking that can make you believe a treatment is working when in reality it is not. It’s something I continue to have to fight against, despite being well-educated about things like cognitive bias and regression to the mean.
"I believe all veterinary surgeons, and doctors for that matter should constantly remind themselves of these errors and importantly keep them front of mind when advising clients. Not just so they can explain cogently why quack medicine offers nothing more than false hope and a thinner wallet, and why randomised, double-blind, placebo-controlled trials are so important, but also to improve their own assessment of a patient’s response to treatment."
The paper can also be downloaded here: http://veterinaryrecord.bmj.com/content/181/7/170
Part 2 of the paper is due to be published in next week’s edition of the Veterinary Record.
STOP PRESS VetSurgeon.org has funded the Open Access publication of this paper, so both parts are now available for all to read here:Part 1: http://veterinaryrecord.bmj.com/content/181/7/170Part 2: http://veterinaryrecord.bmj.com/content/181/8/198
Photo: The father of homeopathy, Samuel Hahnemann, Wikipedia