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BEVA Congress 2012 – How Horse Vets Keep Up to Date

Equine Education (Part 1 - CPD) As vets, we're always trying to do the very best for our patients. However, veterinary medicine is constantly changing - every year, hundreds, even thousands of new papers are published, new drugs become available, and new machines and tools come on the market. What was the "gold standard" of treatment for a disease ten years ago might now be proven to be more harmful than helpful! At a recent conference (BEVA Congress - see below for more on that...), John Walmsey, one of the foremost and best respected members of the profession, gave the plenary lecture talking about the massive changes that have taken place in equine veterinary care in the four and a half decades since he graduated. The drugs we have now are far more effective, the machines and tools more robust and more useful. Even ten years ago, MRI in the horse was really rare and (to be honest) unreliable; now it's a standard tool in working up a complex lameness. As a result, with the field of knowledge constantly changing, it's more important than ever for vets in practice to keep up! The process of keeping up to date is known as CPD (Continuing Professional Development), and we are expected to do at least 5 days a year. It can be made up in a number of ways, including lectures, seminars, webinars, practical courses and reading journals and papers. Like most equine vets, I receive the big journals Equine Veterinary Journal and Equine Veterinary Education, which (respectively) publish papers on equine science and equine surgery and medicine. I also try to attend relevant courses and lectures as often as I can. In September, I was at the BEVA (British Equine Veterinary Association) Congress in Birmingham. This is one of the biggest gatherings of horse vets in the world, and I try to go most years. Congress lasts for three days of lectures and seminars, as well as a large commercial exhibition. It's a great place to go to pick up the latest ideas, new treatments and medicines, and catch up with colleagues from across the country. I sometimes think we learn almost as much from talking over cases with colleagues as we do in the lecture theatres! This year was notable for...
  • The debate over firing of tendons. (Quick recap on that one - the Royal College, our regulatory body, does not permit firing of tendons etc; some equine vets think firing should be permitted again in certain circumstances; however, others disagree. The argument goes on!).
  • Andy Bathe from Rossdales in Newmarket had some hilarious stories about working at the Olympics, as well as a number of thought provoking points. For example, some of the showjumpers were receiving a wide range of different (legal) medications to keep them performing at their peak throughout the competition; and every single dose of every single medication had to be certified by an official vet on a separate form. That led to a HUGE pile of forms for the FEI vets to certify each day!
  • There was also a long session on current approaches to laminitis - unfortunately, none of the existing theoretical studies are an exact match for the real disease, and researchers are still plodding along, gathering information. Sooner or later, we will have a good understanding of the condition; however, at the moment we have to be content with identifying horses and ponies who are at high risk, and managing them to minimise the risk. There aren't any easy tests available to measure how high the risk is, however, so it still comes down to the clinical judgement of the vet on the ground.
  • New work being done on RAO (Recurrent Airway Obstruction, what used to be called COPD). Almost all the vets in the audience, as well as the panel of experts, agreed that this year has been especially bad for summer pasture associated RAO, and that cases seem much more resistant to normal treatment than usual. No-one knows why, but it seems likely that the unusual weather has resulted in more pollen than usual (or at least, more of the particularly reactive pollens). One lecturer from Switzerland had a fascinating paper to present on the genetic basis of RAO - he and his team have identified at least 2 different genes that can cause it, one of which is also associated with extra resistance to worms and other parasites. Unfortunately, though, it looks like it will be a long time before there is a simple genetic test, because there are another 11 genes that are also involved... as usual with any horse disease, nothing is as simple as it at first appears! However, he did have one useful tip... In Switzerland, a horse with summer-RAO is routinely moved into the mountains, which seems to reduce the severity. Obviously, this isn't always practical here, but one UK-based expert on the panel suggested moving to the coast for the same reason - to remove the horse from the source of the allergens that are causing the problem.
  • As well as the main lectures, there is always one lecture theatre devoted exclusively to Clinical Research - vets and scientists (and mostly people who are both) present their papers on all sorts of subjects, ranging from Soft Tissue Surgery to Reproduction to Imaging to General Medicine. If I tell you that papers presented include "Carbon Dioxide laser surgery with adjunctive photodynamic therapy as a treatment for equine peri-ocular sarcoid: Outcome and complications in 21 patients" and "Validation and reliability of orthoganal ultrasonographic projection dimensions of the kidney in the horse", you should get some idea of the level of science being presented!
Of course, after Congress, every delegate takes home a copy of the Proceedings - a (big fat) book containing a summary of all the lectures and papers presented. In addition, all the lectures are recorded and vets can access them online, if there was a lecture in particular that they missed. For a lot of us, Congress is only the beginning - on the train home, or over the next few weeks, vets across the country will be reading up on papers and lectures in their particular areas of interest. At most practices - including mine - whenever anyone has been on a course or conference, they then have to boil it down into practical, "hands-on" information. We then present it to the other vets (and nurses etc, if it involves new techniques or machines), so that everyone's patients can benefit from the new knowledge. Sometimes it's hard - it can be very difficult for all of us to accept that a long-cherished treatment has been proven not to work! - but for the sake of all our patients, we work hard to use the most up to date information, and not to be trapped in old, comfortable ideas that aren't as effective. The other side of veterinary education, of course, is the education and teaching of students that happens in practice. I'll be talking about that in my next blog!
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Who would win Olympic events between humans and animals?

The London Olympics have captured the full attention of the public and the mainstream media: there's something compelling about watching humans pushing themselves to extraordinary athletic achievements. Yet in comparison to some animals, even exceptionally talented humans are slow and weak. One of the UK's top sports scientists happens to be a veterinary surgeon. Professor Craig Sharp qualified as a vet in 1956, starting out in mixed practice in Crieff. In his leisure, he was a serious athlete, at one time holding the record for the fastest run to the peak of Mount Kilimanjaro in Africa. He soon began to take a serious professional interest in the science of physical exercise. In 1971, he took up a lectureship in the (then) innovative Department of Sport and Exercise Science at the University of Birmingham, the start of an illustrious academic career. He's been described as the founder of sports science in Great Britain, working closely with Olympic athletes and coaches. In last week's Veterinary Record, Professor Sharp published a detailed academic article comparing the athletic abilities of different animals with humans. His findings make even top athletes seem like puny weaklings compared with the power and speed of the animal world. In sprint distance races, humans are left standing. A greyhound ran 100m in 5.8 seconds, compared to Usain Bolt's best effort of 9.58 seconds. Over 200m, a cheetah has been timed at 6.9 seconds, a horse took only 9.98 seconds, and a greyhound ran it in 11.2 seconds. Meanwhile, Usain Bolt's world record is 19.19 seconds. A horse has run 400m in just 19.2 seconds, and a greyhound has done it in 21.4 seconds. The fastest human takes over 43 seconds. Animals beat us over longer distances too: the pronghorn antelope can run 800m in 33 seconds (the human record is 1 minute 41 seconds) and the same animal can cover a mile in 1 minute 30 seconds (compared to 3 minutes 43 seconds in humans). Humans do a little better over longer distances and varied terrains. On the flat, a horse can run a marathon in 1 hour and 18 minutes, compared to the human record of just over two hours, but when a "man versus horse" race takes place on hilly farm tracks, forestry roads and rough moorland, the gap narrows. Humans are good at charging through undergrowth, rushing up steep banks, leaping off ledges and running down steep hills. Over one 22 mile race, the horse still won, but the winning margin dropped from 30 minutes to just under a minute.   Humans have even beaten horses over some long distances, although arguably it's not fair: horses are obliged, under animal welfare rules, to take lengthy breaks for food and water, whereas humans are allowed to stagger on without stopping. Running through the wilderness was important to our hunter-gatherer ancestors, and we've evolved with anatomical features to do this well. Compared to great apes, humans have long legs and narrow waists. We have short toes: if they were 20% longer, this would double the mechanical work of the foot and make us slower. And our big toes are parallel to our other toes, creating a push-off lever when running. Apes' big toes stick out sideways, similar to our thumbs, making their feet better for gripping objects and for climbing trees, but less good at running. Our lower legs are biomechanically efficient, with elastic tendons on the soles of our feet, and well developed Achilles tendons above the back of our heels. The tendons stretch under our weight then contract like springs, pushing us off at speed, like pogo sticks. Our lack of body fur and all-over sweat gland distribution (only equalled by horses) prevent us from overheating during prolonged exertion. We have an efficient fuel system too, storing around twenty miles worth of energy-providing glycogen in our running muscles. Whatever about speed and endurance, humans don't fare at all well compared to the best in the animal world when it comes to strength. While the human world record for the "clean and jerk" lift is 283kg, an African elephant can lift 300kg with its trunk, a Grizzly Bear can hoist a weight of 455kg, and a Gorilla can carry 900kg. Humans do, however, possess one crucial advantage over the animal world: the large cerebral cortex in our brain allows us to think and plan. The impressive raw speed and brute force of nature is outplayed every time by the cunning human mind.
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