Researchers at the Royal Veterinary College’s Queen Mother Hospital for Animals (QMHA) say they've made a ground-breaking discovery in the treatment of the deadly canine disease, Alabama rot.

Alabama rot, properly known as Cutaneous and Renal Glomerular Vasculopathy (CRGV) first emerged in Alabama in the 1980s, hence the nickname. The lack of understanding on how it spreads or can be stopped has led to high fatality rates for dogs who develop it.

The reason for its sudden appearance in the UK six years ago also remains a mystery.

The disease causes small clots in blood vessels, which eventually result in skin ulcers, tissue damage, and kidney failure in many cases.

Many theories have been put forward about the cause; anything from E. coli-produced toxins to parasites and bacteria. However, without knowing the exact source it is impossible to develop an effective cure.

The treatment offered by QMHA is known as Therapeutic Plasma Exchange (TPE) or ‘plasmapheresis.’ This method involves filtering all the patient’s blood so that toxic substances, including whatever causes CRGV, are removed. Once filtered, the blood is returned to the patient.

The development of this treatment was made possible by the discovery of the similarities between Alabama Rot in dogs and thrombotic microangiopathy in humans, which is also treated with plasma exchange.

The QMHA academics reported that two out of six dogs who underwent plasmapheresis made a full recovery.

The full findings of the research have been published in Frontiers in Veterinary Science¹.

Dr Stefano Cortellini, an author of the study and Lecturer in Emergency and Critical Care at the RVC, said: "Despite the fact that only a third of dogs treated with TPE recovered from their disease, this is the first time that dogs so severely affected by CRGV have been reported to survive and so we remain optimistic that TPE may play an important role in the treatment of this deadly disease."

Reference

1. Ragnhild Skulberg, Stefano Cortellini, Daniel L. Chan, Giacomo Stanzani and Rosanne E. Jepson, Description of the Use of Plasma Exchange in Dogs With Cutaneous and Renal Glomerular Vasculopathy, Frontiers in Veterinary Science, https://doi.org/10.3389/fvets.2018.00161

West Midlands-based veterinary nurse Laura Jane Garfield has been struck off by the RCVS Veterinary Nurse Disciplinary Committee after it found that she had misled and been dishonest with a charity.

The Disciplinary Committee heard that Mrs Garfield had told a representative of the Retired Greyhound Trust (RGT) that she had possession of a greyhound called Lola, that she proposed keeping Lola living with her as an adoptee, and that she would not relinquish possession of Lola except to the RGT. This was despite the fact that, at the time of signing the adoption agreement, she had already given Lola to another charity named Greyhound Gap and that, as a result, her conduct was misleading and dishonest.

In considering the facts of the case, the Committee found the charges and all constituent parts proven and went on to consider whether this amounted to disgraceful conduct in a professional respect. 

Judith Way, chairing the Committee and speaking on its behalf, said: "The end result of the respondent’s decisions and conduct meant that RGT was persuaded to pass lawful possession and ownership of the dog Lola to the respondent when it would not have agreed to do so had it been told the truth by her.

"In truth, the respondent was not going to adopt and re-home Lola herself. Instead the respondent’s plan and intention was that Lola should be passed on to a third party who had been recommended by a rival dog rescue charity for rehome and adoption."

Judith added: "The consequence was that a social media dispute broke out when the rival dog charity decided to attempt to take advantage of the erroneous belief of the respondent that a decision had been taken by RGT to put Lola to sleep. The publicity generated by the respondent’s erroneous belief… was obviously adverse…. The gravamen [seriousness] of the respondent’s dishonest conduct was that she set one dog rescue charity against another, caused them to spend publicly raised funds on a legal dispute about who should be allowed to retain Lola when those precious funds ought, instead, to have been spent on their charitable objectives."

The Committee judged that the charge and its parts constituted serious professional misconduct and went on to consider the sanction against Mrs Garfield. 

In considering the proportionate sanction the Committee took into account both mitigating and aggravating factors. In terms of aggravating factors the Committee considered that the dishonesty was pre-meditated, that she accused members of a rescue charity of lying and demonstrated no or only minimal insight into her wrongdoing. In mitigation the Committee considered that Mrs Garfield had cooperated with the College in its investigations, that she had acted in the genuine belief that she was acting in the best interests of Lola and that her conduct did not put Lola at risk or cause her to suffer any adverse consequences as a result. The Committee also accepted the testimonials and positive evidence from colleagues. 

However, the Committee decided that removal from the Register would be the only appropriate sanction.

Summing up Judith Way said: "The reputational consequences for RGT were potentially significant bearing in mind that it is a rescue organisation with some 57 or so branches across the country. All of these consequences, actual and potential, stem from the respondent’s premeditated act of dishonesty in relation to which the Committee considers she showed very limited insight prior to this disciplinary hearing, as she did during the course of this hearing.

"In the result, it is the conclusion and decision of this Committee that the only proper sanction that can be imposed in this case is that the respondent’s name should be removed from the Register.”

Mrs Garfield has 28 days from being informed of the Committee’s decision to appeal.

The BVA has joined forces with International Cat Care to highlight the welfare issues faced by brachycephalic cats and to urge cat-lovers to avoid choosing pedigree breeds of cat designed to have extreme or unusual features, such as flat faces or folded ears.

The association has released figures from its Voice of the Veterinary Profession survey in which 86% of 671 veterinary surgeons polled in May/June last year had treated conformation-related health problems in brachycephalic cats, such as Persians and Exotic Shorthairs.

The most common conformation-related treatments carried out by these vets were for:

• Eye problems (69%)

• Breathing/respiratory problems (60%)

• Dental issues (45%) and

• Skin problems (32%).

The survey also found that on average, 28% of the flat-faced cats vets see in their practices have had or would benefit from having treatment for conformation-related health or welfare problems.

Respondents also said that only a quarter of brachycephalic cat owners were already aware of the potential health issues and just one in twenty were aware of the additional costs associated with the breeds before choosing their pet.

BVA Senior Vice President Gudrun Ravetz said: "Everyone knows that the internet loves cat photos and videos. But as time passes we’ve noticed a growing appetite for novelty creeping in - with quirky and unusual cat breeds proving increasingly popular on social media.

"Currently the UK population of pure breed cats is very small as most cat owners opt for regular non-pedigree ‘moggies’. However, we are worried that the popularity on the internet of breeds with extreme conformation, such as the very flat-faced Persians and Exotic Shorthairs, or gene abnormalities such as cause the ears to bend forward in the Scottish Fold breed, may prompt increased demand among consumers who are unaware of the potential serious health and welfare issues associated with such breeding.

"These figures show that many, many owners are choosing pets without understanding either the possible welfare implications of their extreme features or the potential cost of treating them." 

The BVA, which has been campaigning to curb the growing popularity of brachycephalic breeds of dog for some time, says it is keen to emphasise that health and welfare issues relating to extreme conformation are not limited to dogs or to brachycephaly. To that end, it will be launching a wider position statement on extreme conformation in animals later this summer.

For BVA #BreedtoBreathe campaign materials, including infographics and videos which draw attention to the serious health issues experienced by brachycephalic animals, visit: www.bva.co.uk/brachys.

Photo: Shutterstock/Piyato

The RCVS Disciplinary Committee has directed the Registrar to remove Greater Manchester-based Viktor Molnar from the Register after he pleaded guilty to illegally importing puppies to the UK.

Mr Molnar had been convicted at Manchester and Salford Magistrates’ Court in March 2018 of five counts of importing puppies to the UK in contravention of the Rabies (Importation of Dogs, Cats and other Mammals) Order 1974.

At that court hearing he also pleaded guilty to one count of keeping premises as a pet shop without the authority of a licence granted by a local authority.

As a result of his conviction Mr Molnar was sentenced to 270 hours of unpaid supervised work and was ordered to pay compensation of £2,683.93 and costs of £250.

The Committee, which proceeded with the hearing in Mr Molnar’s absence, found that the RCVS charges against Mr Molnar were proven and went on to consider whether, individually and cumulatively, they resulted in Mr Molnar being unfit to practice being a veterinary surgeon.

Ian Green, chairing the Committee and speaking on its behalf, said: "The Committee accepts the College’s submission that the fact that they [the puppies] were imported contrary to the law of the UK, because they were underage and had not been properly vaccinated, undermines the integrity of a system which is designed to ensure that effective vaccination and precautions against disease take place in every case.

"The Committee also notes that the convictions in this case were directly linked to the respondent’s veterinary practice, as they related to animals sold from his veterinary practice address. By operating an unlicensed pet shop, and by doing so through an email address that referred to his occupation as a veterinary surgeon, the respondent was abusing his position as a veterinary surgeon, and acting in a way that was liable to undermine the reputation of the profession."

The Committee therefore found that, because Mr Molnar’s conviction was directly linked to his veterinary practice and posed a substantial risk to animal welfare and public health, his conviction meant his conduct fell far short of what was expected of a professional.

In considering the sanction for Mr Molnar the Committee considered that, while he had no previous convictions or adverse professional findings against him, the case against him was very serious "because of the risk of serious harm both to animals and the public, as well as being for financial gain."

Ian Green said: "The Committee considered that the respondent, as a veterinary surgeon, must have known the serious implications and consequences of what he was doing by importing these puppies unlawfully. The public should expect to be able to trust a veterinary surgeon to ensure that his conduct does not put at risk the health of both animals and humans."

Mr Green added that the Committee felt that the only appropriate sanction was to direct the Registrar to remove Mr Molnar’s name from the Register.

Virbac has announced the launch of VeggieDent Fr3sh Dental Chews, designed to reduce canine halitosis.

The new chews incorporate Fr3sh technology, which Virbac says cleanses, cools and addresses the digestive causes of bad breath.

According to the company's research, the new chews provide significant daily breath improvement from Day 1 for a full 24 hours¹, as well as continued breath improvement over a 2-week period. 90% of owners highlighted an improvement in bad breath following use of the chews¹.

Virbac says the product is also scientifically proven to reduce calculus and plaque when given daily.² 

Product Manager Claire Lewis said: "With 2 out of 3 pet owners having a least one dog with bad breath³, we are delighted to be able to add new VeggieDent Fr3sh to the Virbac range of oral healthcare products."

For more information, contact your Virbac Territory Manager. 

References:

1. Chala V, Chaix G, Navarro C, Espuna G. Evaluation of breath freshening effect in dogs following chew administration: an open field trial. Voorsjaardagen congress, The Hague, NL, April 2018 (accepted for communication).
2. Clarke DE, Kelman M, Perkins N. Effectiveness of a vegetable dental chew on periodontal disease parameters in toy breed dogs. J Vet Dent. 2011;28(4):230–235.
3. Data on file, Kynetic market research, 2016. Virbac.

The RCVS Disciplinary Committee has decided to postpone its decision on the sanction for a Dyfed-based veterinary surgeon convicted of drink-driving for a second time, this time for a further twelve months.

Lynn Jo Ann Davies MRCVS first appeared before the Committee in January 2018 to face a number of charges related to two drink-driving offences, breaching the terms of her undertakings to the College as part of its Health Protocol, and being under the influence of alcohol on three occasions while she was on duty as a veterinary surgeon in December 2016. 

Dr Davies admitted all five charges against her and admitted that this meant she was unfit to practise veterinary surgery and that she was guilty of disgraceful conduct in a professional respect. The Committee accepted her admissions and found, with the exception of one allegation, that her conduct was disgraceful in a professional respect.

At its first hearing the Committee having considered both aggravating and mitigating circumstances decided to postpone the hearing for six months on the basis of Dr Davies’ entering into a new set of undertakings, including one not to practise veterinary surgery and to remain abstinent from alcohol during the period of postponement.

At the second hearing, in July 2018, the Disciplinary Committee resumed its sanction inquiry decision. Dr Davies’ Counsel submitted on her behalf that Dr Davies wished to return to practise and the Committee reviewed her witness statements, documentary proof and medical records that she provided to demonstrate she had complied with the her undertakings given at the last hearing. 

Stuart Drummond, Chairing the Committee and speaking on its behalf, said: "Having had the opportunity to see and hear from the respondent when she gave evidence and when she answered the questions put to her, the view formed of her current state of health was favourable. All members of the Committee considered that the account she gave of herself in the witness box was confident and they were reassured by her evidence as to how she now sets about managing her levels of stress and how she reacted to stressful incidents.

"Such concerns as the Committee had about her return to practice concerned her ability to receive support from a third party who would act as a mentor…the Committee therefore requires the Respondent to identify, within a period of one month of today’s date, a veterinary surgeon who would agree to act as her mentor. That mentor would have to be a veterinary surgeon acceptable to the College as someone suitable to act in that capacity and that mentor would have to be approved before the Respondent could resume practice.

"A further requirement of the Committee would be that the Respondent should make a disclosure to any new employer of the fact of her appearances before this Committee in January 2018 and in July 2018 and of the decisions of the Committee in relation to both such hearings. The final requirement of the Committee in this respect is that the respondent should not accept a 'sole charge position' at any time during her employment during this next period of postponement of sanction."

The Committee directed that the hearing be postponed for a further 12 months.

The British Equine Veterinary Association is reminding veterinary nurses and practices that there is a dedicated nursing stream all day on the Saturday of this year’s Congress 12-15 September 2018.

The BSAVA has announced the publication of a fully revised Manual of Canine and Feline Dentistry and Oral Surgery, including the most relevant, evidence-based, step-by-step operative techniques, and full-colour illustrations and photographs.

Alexander Reiter and Margherita Gracis formed the new editorial team and selected an international collection of leaders in their fields of expertise to contribute to this latest edition.

Alexander said: "This is a timely publication, as veterinary dentistry is a field that continues to grow in importance for the general veterinary practitioner. We found it important to add 'Oral Surgery' to this new edition, as many procedures performed in and around the mouth involve surgical techniques."

The BSAVA Manual of Canine and Feline Dentistry and Oral Surgery, 4th edition, is an accessible source of core information for general small animal veterinary surgeons, nurses/technicians and students interested in developing their theoretical knowledge and practical skills in dentistry and oral surgery.

The manual is now available from the BSAVA website (www.bsava.com/shop), the BSAVA Library (www.bsavalibrary.com/manuals), or by phone: 01452 726700.

Researchers at the Royal Veterinary College report that they've made a significant breakthrough in the search for a durable treatment for Duchenne muscular dystrophy (DMD).

Working in collaboration with researchers at University of Texas, Southwestern (UTSW) Medical Center, the team has succeeded in using gene editing techniques on dogs to restore the expression of the dystrophin protein that is absent in DMD patients’ muscles to levels that could be life changing.

DMD is the most common, fatal, genetic disease that affects children. The same disorder also occurs in many dog breeds. It is caused by mutations in the gene that encodes dystrophin, a crucial protein that helps protect muscle fibres and the heart when they contract. Patients with the disease produce effectively no dystrophin protein, so their muscles and heart become damaged during contraction, leading to inability to walk, skeletal deformities, breathing problems and heart failure. Patients with DMD have a life expectancy that does not go far beyond their twenties.

Researchers say that this preliminary research, published in Science, demonstrates an approach that could lead to an effective, in principle one-time treatment for DMD for the most common genetic mutations affecting human patients. Through a single intravenous injection, researchers have been able to modify the dystrophin gene in many muscles of the body, including the heart, with the result that some muscles now had almost the normal amounts of dystrophin protein.

The team, led by Eric Olson, Ph.D., professor and chair of the Department of Molecular Biology at UTSW Medical Center and founder and chief science advisor of Exonics Therapeutics, and Richard Piercy, Ph.D., MRCVS, Professor of Comparative Neuromuscular Disease at the RVC, identified a naturally-occurring mutation in the dystrophin gene in a dog brought to the RVC’s Small Animal Referral Hospital.

Working now with relatives of this first dog, the combined group has used a technique called ‘SingleCut CRISPR gene editing’, where the researchers target a specific region of the subject’s own DNA. Harmless viruses encoding the gene-editing protein CRISPR/Cas9 were used to express the enzyme in muscle to cut the dogs’ own DNA at a precise location in the dystrophin gene through use of a molecular guide. The body’s own processes then repair the cut, which results in removing the negative effects of the existing mutation.

The researchers have demonstrated that dogs treated in this way had restored ability to produce large amounts of the dystrophin protein in their muscles and heart, and in the dog with the highest dose, cardiac muscles were found to have restored dystrophin protein to up to 92% of normal amounts after the single treatment.

The team believes this is the first time that this form of gene editing therapy has been conducted after birth in an animal larger than a rodent. With further longer-term research, efficacy and safety testing, it is hoped that this breakthrough will have human application. This treatment may be a significant step toward developing a gene editing therapy to repair genetic mutations for DMD, as well as a range of diseases caused by genetic mutations.   

Richard Piercy, Professor of Comparative Neuromuscular Disease at the RVC, said: "Researchers have been looking for an effective and durable treatment for Duchenne muscular dystrophy for many years. This SingleCut gene editing approach, pioneered by Dr. Eric Olson’s group, has the potential to be a one-time treatment that could restore dystrophin protein. It is hugely exciting that through a single intravenous injection we’ve been able successfully to modify the dogs’ own DNA so they start generating dystrophin protein again. There is more work to be done, but with this exciting breakthrough, we feel we are a significant step closer to finding an effective treatment.

"A great many genetic diseases affect humans, dogs and other species - many, like DMD - with tragic consequences and this form of gene editing treatment might well be applicable in many of them. We’re hopeful that we’re paving the way for future research into treating some of the most serious genetic conditions that affect us today."

Leading veterinary dermatologist Sue Paterson has raised concerns that veterinary surgeons are not prioritising pain relief in otitis externa (OE) cases, in a new series of videos commissioned by Elanco Animal Health for Osurnia Gel.

Sue, an RCVS and European Specialist in Veterinary Dermatalogy and Senior Vice President of the European Society of Dermatology, says the failure to prioritise pain relief is having a "profound effect on the quality of life of both dogs and clients."

Sue is urging vets to think about the impact that pain has on both the dog and owner in cases of OE: "Otitis externa is painful, it’s debilitating, and the degree of discomfort is often underestimated by both the veterinary surgeon and by the client."

Sue also says vets should not underestimate the owner’s concern about pain in their dog. Owners recognise the clinical signs associated with the pain of OE and determine treatment success by their dog recovering from these distressing symptoms.

To help manage the pain associated with OE, Sue recommends a multi-modal approach: "In addition to systemic pain relief, which is really important, a potent topical steroid is really useful to reduce the inflammation inside that dog’s ear, and make it much more comfortable."

Sue also highlights OE treatments which are able to coat the ear canal and stay there long enough to treat the pathogens and provide sustained pain relief: "When you put it into the ear, Osurnia Gel coats the lining of the external ear canal which gives prolonged contact with the lining of the canal to help treat the pathogens inside that dog’s ear."

Elanco says that despite Osurnia entering the market two years ago, some vets are still saving it for difficult cases. Sue said: "Too many vets use this [Osurnia] as a second-line drug and it should be used as a first-line product on the first occasion the dog comes through the door."

To watch the full series of videos and to find out more from Sue Paterson on treating otitis externa in dogs, visit: www.Osurnia.co.uk

Virbac has announced the launch of Zenifel, a feline facial pheromone plug-in diffuser billed as the first and only alternative to the current market leader.

Zenifel contains synthetic feline facial pheromones which imitate the facial F3 pheromone which has been found to be significantly important when it comes to cats creating areas they feel safe and relaxed in¹.

According to the company, Zenifel contains a 48ml vial of the same synthetic F3 feline facial pheromone as the market leader, but, thanks to its own diffusion system and a higher concentration of F3, lasts up to 6 weeks; i.e. 50% longer. This, says Virbac, means that Zenifel is both more economical and more environmentally friendly.

Alongside the launch of the new product, Virbac is offering a practice support pack which includes things you need to create a calm area for feline visitors and promote the benefits of pheromones to pet owners. The company is also running a promotion in which practices could be eligible for a year’s free supply of Zenifel.

For more information, contact your local Virbac Territory Manager.

Reference

1. Amat M., Camps T., Manteca X. (2016) Stress in owned cats: behavioural changes and welfare implications. J Feline Med Surg. 18(8):577-586.10.1177/1098612X15590867

The Royal Veterinary College has performed world-first surgery to correct a combination of congenital heart defects in a dog that needed a repair to its tricuspid valve and common atrium.

Lottie, an 11-month-old Labrador puppy was found to have a very loud heart murmur during a routine check before being spayed. 

An ultrasound revealed that she had several congenital defects. The two major ones were a malformation of her tricuspid valve and a very large defect of the common atrium.

Lottie was referred to the RVC’s cardiothoracic department where she underwent further ultrasound and a CT scan. The team at the RVC, which is led by Dan Brockman, Professor of Small Animal Surgery, had already performed several cutting-edge surgeries, including a world-first treatment to save the life of a dog born with a malformed tricuspid valve.

Repair of the tricuspid valve has only been performed a handful of times and has not been done at the same time as repair of a common atrium. 

Lottie’s owners decided to proceed with the operation, which was undertaken at the end of July. Lottie's heart was stopped for the procedure and her circulation maintained with a heart lung machine run by perfusionist Nigel Cross from Great Ormond Street Hospital.

Poppy Bristow, Fellow in Cardiothoracic Surgery at the RVC, said: "Altogether 10 people were involved in her operation and many more for her care before and after surgery, including veterinary specialists, veterinary nurses and veterinary specialists-in-training from surgery, cardiology, anaesthesia and emergency and critical care, as well as Lottie’s referring cardiologist and her local veterinary practice. 

"Lottie’s heart was stopped for an hour and a half, with the whole operation taking four hours. Her malformed tricuspid valve was released by cutting its abnormal attachments and artificial chords using Gore-Tex material were placed. Her single atrium was then divided into two using a large patch of Gore-Tex. Lottie has made a good recovery so far and was walking around and eating from the day after her surgery. She was discharged back to her owners after six days and has continued to thrive at home."

Professor Brockman added: "In Lottie, we had a young energetic dog with such a serious and life-limiting heart condition, that we were desperate to try and help her. The repair was complex but incorporated a combination of surgical manoeuvres that we had done before. With careful pre-operative planning and using our previous experience, we were able to design and execute the surgical treatment. It is still ‘early days’ but the initial signs suggest that Lottie is going to enjoy an excellent quality of life, following this operation and, we all hope, a normal lifespan."