Laurence Webb's Activities

How would you treat hypercalcaemia and hyperphosphataemia in a dog with CRF?

Laurence Webb — Wed, 13 Sep 2023 11:04:30 GMT

I have a 3yo Cocker that suffered a presumed acute kidney injury when young and has been left with CRF. She has recently developed a heart murmur and on ultrasound there are echogenic deposits in the ventricular walls, which I suspect may be dystrophic calcification.

We have persistently struggled to control hyperphosphatemia and at a recent blood sample she also has hyercalcaemia. Her last readings were 3.16mmol/l phosphate and 3.03mmol/l total calcium. She is currently using Ipakitine 2 scoops bid in food for the phosphorus, but this is obviously insufficient. She refuses kidney diets.

She is also on a combination fo Fortekor and Semintra for proteinuria and amlodipine for hypertension

Due to the hypercalcaemia I woudl previously have used aluminium hydroxide, but I understand that it is no longer available, unless anyone knows otherwise so am looking for suggestions for non-calcium containing phosphorus binders I can use.

I have read about prednisolone or bisphosphomates for the calcium but have been wary of preds due to the possible adverse effects on the kidneys or heart. Would alendronate be worth trying?

Any suggestions gratefully recceived! Her long term outlook is bad, but she is a happy little dog who does not realise that she is unwell.

Digital eyepiece for fibreoptic endoscope

Laurence Webb — Tue, 08 Aug 2023 21:03:05 GMT

Musing aloud, but I was wondering if anyone had any experience of using a telescope digital eyepiece to atttach to a fibroptic endoscope as a cheap alternative to a proper video endoscope.

I'm aware image quality would not be as high as a proper videoscope, but less time spent squinting down a fibroptic eyepiece would be nice.

This is the sort of thing I was thinking about... http://green-witch.com/acatalog/Minox_Digital_Camera_Module.html or at the cheap end of the scale http://www.ankaka.com/digital-eyepiece-for-telescope-2304x1728-videophoto-output_p46515.html

You could also use this to store images on computer

Small Animal Vet

Laurence Webb — Thu, 13 Apr 2023 11:12:07 GMT

Midsomer Veterinary Centre is an independently owned small animal practice on the edge of the Mendip Hills in North Somerset

We are looking for locum cover to help with holiday and maternity leave over the coming months.

In particular we are looking for locum cover on 9th June to allow travel to a conference

Well equipped single site practice
Newly upgraded DR X-ray with dental sensor
Newly upgraded ultrasound with cardia and abdominal probes
In-house IDEXX laboratory suite (Catalyst, Procyte, Sedivue)
15 minute consults with admin time built in

Regular weekday and Saturday (consulting) shifts are available as well as block booking and occasional days.

For more information call Laurence

Small Animal Vet

Laurence Webb — Mon, 27 Mar 2023 15:24:25 GMT

Midsomer Veterinary Centre is an independently owned small animal practice on the edge of the Mendips.

We are looking for enthusiastic colleagues to expand our team. Some experience and confidence in routine surgeries would be preferred, but we are happy to consider colleagues who are still building their skills. This would also be a fabulous opportunity for someone more experienced to join an established practice with a strong client base, with CPD supported and encouraged.

The position would suit a full-time vet on a four-day week with a share of Saturday mornings, or a combination of part-time colleagues. We are happy to discuss job-sharing and accommodate flexible working.

Out of hours care is outsourced but occasional overnight in-patient care is offered.

We are a well-equipped single site practice with:

Newly upgraded DR X-ray and dental X-ray
Newly upgraded ultrasound with cardiac and abdominal probes
In-house IDEXX laboratory suite (Catalyst, Procyte, Sedivue)
Multiparameter monitoring with capnography
15-minute consults with built in periods for lab reporting etc.
Employee benefits include a Health Cash Plan, Cycle to Work Scheme, Childcare Vouchers and more.

Midsomer Norton is a semi-rural town in Northeast Somerset, situated 40 minutes from Bristol and only 20 minutes from the beautiful Georgian city of Bath, with Roman Baths, theatres, music and comedy venues on hand. Midsomer Norton hosts its own music festivals but if you are looking for something bigger, Glastonbury Festival is nearby.

For those that like the outdoors, we are on the edge of the Mendip Hills, with fabulous walking, horse riding and world class climbing and caving just a few minutes away, including Cheddar Gorge and Fairy Cave. Vobster Quay diving centre is a 10-minute drive away if you like getting your feet wet, or if you prefer being up in the clouds, ballooning and gliding are nearby. With ready access to the South Coast, Devon and South Wales you will never run out of options. Train and motorway links to the rest of the country are easily accessible.

£35,000 to £65,000 pro-rata dependant on experience with relocation assistance available.

Small Animal Vet

Laurence Webb — Fri, 07 May 2021 14:06:15 GMT

Midsomer Veterinary Centre are looking for an enthusiastic Vet to join our team. We are a two vet independent small animal practice close to Bristol and Bath on the edge of the Mendip Hills and would like to take on a third vet to enable us to continue to provide a high quality service to our patients.

This position would be ideal for a new or recent graduate who would like to grow their skills with support from our vet and nursing team. As your skills grow you will have the opportunity to investigate and treat both medical and surgical cases with regular discussion and help from the rest of our team.

We are well equipped with an up-to-date IDEXX laboratory suite, digital X-ray including dental and are currently upgrading our ultrasound. Visiting advanced orthopaedic practitioners and a Specialist imager enhance our services, assisting with more complex cases. Out of hours care is provided by a neighbouring practice except for occasional inpatient care, which is equally shared as well as Saturday consults.

For more information please contact Laurence Webb or Danielle Doughty on 01761 412132 or email admin@midsomervets.co.uk

feline contraception

Katarina Lakatova — Mon, 20 Apr 2020 21:36:51 GMT

Hi All,

I would like to ask about medical option for feline contraception, any recommendations?

What happens to the pets when the owners are in hospital?

Liz w — Thu, 19 Mar 2020 06:36:18 GMT

What are your thoughts on what should be done with pets of owners with CV in hospital? Presumably they carry a risk to any fosterers ( of which there could potentially be plenty) ?

Might this be Alabama Rot?

Laurence Webb — Fri, 11 Oct 2019 18:41:16 GMT

I saw a dog tonight with a lesion of the caudal aspect of its metatarsals that had been there for 1-2 days, Apparently the dog is well in itself and has not showed the lesion any attention. The dog is a 9yo female neutered cocker spaniel

On clipping there is a discoloured area of skin that is slightly weeping but it does not look like broken skin. The surrounding skin is mildly erythematous. The popliteal lymph node is normal and the dog has a normal temperature. General clinical exam is otherwise unremarkable and I can not detect any renal pain (can't actually feel its kidneys, but there is no reaction to pressing in that area).

Whilst this is probably traumatic it did occur that this may be a case of cutaneous and renal glomerulor vasculopathy so I have run bloods that show normal creatinine and urea but a marginally raised SDMA of 15ug/dl (normal 0-14).

How do other think we should proceed with this case? We are slightly hampered by his owners planning to get the ferry from Portsmouth to Santander on Tuesday!

What are these urine crystals?

Laurence Webb — Thu, 25 Oct 2018 12:06:12 GMT

These crystals are from the sediment of a cat that presented with 2 days inappetence. He is hyperthyroid and well controlled although had a mild azotaemia at his last routine check 3 months ago.

Physically he looks well and has no signs of dehydration but he now has a marked azotaemia and high UPC (4.8). I recognise the crystals but can't remember what they are and can't find them in my text books but I am concerned in case he has had access to a toxin instead

Risk of hydroxyurea to children in the family

Laurence Webb — Tue, 26 Jun 2018 15:04:17 GMT

We have a patient that had a meingioma removed from the cervical spine but also had a mass in the cerebellum that is still there and is suspected to be a meningioma as well.

We have been advised that hydroxyurea may be of benefit for the remaining mass and that it is generally very well tolerated.

The client has a young child so is concerned about the risks of excretion in faeces/urine and I am struggling to get advice on whether this carries a significant risk.

If anyone has advice I would be happy to learn!

Small Animal Vet

Laurence Webb — Tue, 12 Sep 2017 15:05:04 GMT

Due to practice growth we are looking for a part time veterinary surgeon to join our team

Situated next to the Mendip Area of Outstanding Natural Beauty, close to Bath and Bristol, we provide first opinion care in a 100% small animal, independent practice.

We are looking for someone with a friendly and approachable attitude, who our clients will enjoy talking to, but is also confident with routine surgery and investigations. 15 minute consultations and great case continuity allow you to develop a strong relationship with our clients to provide excellent patient care.

We are well equipped with the IDEXX Catalyst/Procyte suite, digital X-ray (including dental), ultrasound, ECG, infusion pumps, Bear huggers etc. Our team of qualified nurses, receptionists and nursing assistants give a welcoming and supportive environment to our clients and to each other.

Salary from £40,000 (pro rata) dependent on experience.

Perioccular swelling in a Bearded Dragon

Laurence Webb — Mon, 20 Jun 2016 18:13:11 GMT

I saw a 2yo female Beardie this evening with severe perioccular swelling. Unfortunately the history is rather vague as it was brought in by the owner's sister but from what I can tell the swelling has been there for a month (though I suspect longer), initially waxed and waned but is now there all the time. They report that she is OK in herself although I doubt that as the swelling is so marked that vision must be extremely limited if present at all. Apparently she was egg laying profusely up until a few days ago.

On exam she is thin (probably can't find her food). The swelling is marked, more so on the right side and the right eye was covered in clotted blood. On cleaning bloody fluid came from inside the conjunctiva but the limited view that I got of the globe suggests that it is OK. There is a draining sinus on the lower lid on that side as well. The left eye was stuck closed but after cleaning the globe appears OK.

I suspect this is hypovitaminosis A (husbandry questions were pointless) but as we see so few exotics I wondered how best to investigate (may not happen due to funds) or treat. I have suggested referral but this may not happen either!

Small Animal Vet

Laurence Webb — Mon, 25 Apr 2016 13:29:16 GMT

We are looking for a small animal vet to help with Saturday morning consultations in our friendly single site practice.

Typical hours are 9.00am until 1.00pm and with 1 or two shifts every 3 weeks.

We are situated about 20 minutes drive from Bath and 30 minutes from Bristol and Langford Vet School. This position would suit someone with children returning to work or looking to top up their income.

Short term holiday cover may also be available.

For more information contact Laurence for an informal chat.

Are the IDEXX Catalyst One and Procyle/Lasercyte any good?

Laurence Webb — Wed, 16 Mar 2016 12:21:51 GMT

IDEXX have proposed buying new in-house lab equipment with the offer of big discounts on using their lab and consumables for 5 years.

I am happy with our current in-house set-up (Vet-Test and Epoc then sending samples away) so this is mainly a financial decision - will the ability to move more testing in-house and the discounts on external fees/consumables make a saving that offsets the cost of the new equipment. I'm therefore not looking at other manufacturers kit

What I am interested in though is peoples experiences of these machines - there is no saving if they are not good enough to replace a lot of external lab work.

In particular how reliable do people find the Catalyst results, in particular electrolytes, and is the extra expense of the Procyte vs the Lasercyte worth it. We'd still need to send blood slides away for slide examination.

The other factor is the quality of IDEXX's pathological interpretations. We moved a lot of lab testing to TDDS a few years ago because of previous dissatisfaction with poor interpretations or 'press the button' type answers. Are people generally happy with the service they provide nowadays?

All views gratefully received!

iphone ECG app (AliveCor)

Laurence Webb — Mon, 14 Sep 2015 15:51:23 GMT

Our ECG has broken and it is uneconomic to repair. At the moment we don't do a huge number of ECGs so I don't want to invest much into a replacement. I'm happy to get an ex-NHS one from the medical auctions but I also came across Woodley's AliveCor gadget which works through an Iphone.

Of course I'm not expecting it to be as good as a traditional ECG and it only runs 1 lead, but as a basic screening tool for first opinion practice will it fit the bill? It is pretty cheap but I like a natty gadget, but I'm worried it may be too basic or temperamental.

Any opinions (especially those of anyone with actual experience of one) would be great!