Companion April2011

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The essential publication for BSAVA members companion APRIL 2011 Asiatic bears First laparoscopic cholecystecomy P4 New Formulary Even more of a benefit P8 Clinical Conundrum Progressive lameness in a Spaniel P10 How to utilise blood products

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Transcript of Companion April2011

Page 1: Companion April2011

The essential publication for BSAVA membersThe essential publication for BSAVA members

companionAPRIL 2011

Asiatic bearsFirst laparoscopic cholecystecomyP4

New FormularyEven more of a benefi tP8

Clinical ConundrumProgressive lameness in a Spaniel P10

How to utilise blood products

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companion

3 Congress News from Congress 2011

4–6 Publications World’s first laparoscopic cholecystecomy in Asiatic black bears, and Manual donation to international charities

7 CPD Old age doesn’t come alone: an insight into dealing with the feline and canine geriatric patient

8–9 Formulary Ian Ramsey describes the new edition

10–13 Clinical Conundrum Consider a case of progressive lameness in a Cavalier King Charles Spaniel

14–19 How To… Utilise blood products in small animals

20 Petsavers The winners of the 2011 Petsavers photography competition

21–23 WSAVA News The World Small Animal Veterinary Association

24 The companion Interview Sue Shaw

25 BSAVA Northern Ireland Congress An update on the forthcoming Congress in May

26 Meet Your Region Spotlight on Northern Ireland Region

27 CPD Diary What’s on in your area

Additional stock photography Dreamstime.com© Margouillat; © Ravl; © Stanislav Perov

companion is published monthly by the British Small Animal Veterinary Association, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB. This magazine is a member only benefit and is not available on subscription. We welcome all comments and ideas for future articles.

Tel: 01452 726700Email: [email protected]

Web: www.bsava.com

ISSN: 2041-2487

Editorial BoardEditor – Mark Goodfellow MA VetMB CertVR DSAM DipECVIM-CA MRCVSSenior Vice-President – Richard Dixon BVMS PhD CertVR MRCVS FRSE

■■ CPD Editorial TeamIan Battersby BVSc DSAM DipECVIM-CA MRCVSEsther Barrett MA VetMB DVDI DipECVDI MRCVSSimon Tappin MA VetMB CertSAM DipECVIM-CA MRCVSPatricia Ibarrola DVM DSAM DipECVIM-CA MRCVS

■■ Features Editorial TeamCaroline Bower BVM&S MRCVSAndrew Fullerton BVSc (Hons) MRCVS

■■ Design and ProductionBSAVA Headquarters, Woodrow House

No part of this publication may be reproduced in any form without written permission of the publisher. Views expressed within this publication do not necessarily represent those of the Editor or the British Small Animal Veterinary Association.

For future issues, unsolicited features, particularly Clinical Conundrums, are welcomed and guidelines for authors are available on request; while the publishers will take every care of material received no responsibility can be accepted for any loss or damage incurred.

BSAVA is committed to reducing the environmental impact of its publications wherever possible and companion is printed on paper made from sustainable resources and can be recycled. When you have finished with this edition please recycle it in your kerbside collection or local recycling point. Members can access the online archive of companion at www.bsava.com .

NEW! EJCAP SPECIAL ISSUE ON DENTISTRyThe European Journal of Companion Animal Practice (EJCAP) has published a special issue on Dentistry. All the articles can now be downloaded from www.fecava.org. This includes; The Importance of Dental Radiology by B.A. Niemiec; The evaluation of dentition and occlusion in dogs by P. Roux, J. Howard; Management of tooth fractures by J. Schreyer; Periodontal disease from the whole body perspective by Z. Pavlica, A. Nemec; Oral proliferative lesions in the dog and cat by L. Verhaert; and Myths and ethics in small animal dentistry by J. Gawor. ■

Win M&S vouchersIn our continued ambition to communicate with you effectively and relevantly, BSAVA is inviting you to once again check and update your profile to make sure we have your details correct

Everyone who completed the questionnaire at Congress, and members who update their online profile by 1st June this year, will be entered into a draw to win £100 worth of

M&S vouchers.Making sure your details are up to date and complete

means we can refine the information we send you. This also helps us to be less wasteful with print resources and save money on our mailings. We might not get it right all the time, but we’d appreciate your help moving towards a more effective communications approach. you can update your profile online at www.bsava.com as long as you are logged in as a member. If you have any questions then please do not hesitate to get in touch – email [email protected] or call 01452 726700. ■

JSAP onlineMake the most of your access to the JSAP archive online

We all know how frustrating it can be, knowing you think you have seen a paper in JSAP that might relate to a tricky current case you are facing but can’t remember its

full title or the issue it was in. Equally, not all of us have the space to save all our printed editions. Which is why is it such a valuable asset to have the rich archive of past papers online. Blackwell, who both print JSAP and host the online archive for us, have greatly improved their website, making it easier to navigate and search for papers. So make the most of your benefit and use the online JSAP archive, which you can access easily once you are logged in at www.bsava.com/jsap. ■

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Congress

Patricia Colville moves from chairing Membership Development into the role of Honorary Secretary and will work with Continuing Education Committee. After working with the PDSA for many years, she is now Manager of the Vets Now hospital in Glasgow. ■

Andrew Ash, owner of the five-site Grove Lodge veterinary group in Sussex, is now President of the Association and will sit as Officer on International Affairs and Publications Committees.

Michael Day takes on the Junior Vice-President role. Michael is Professor of Veterinary Pathology and Director of Diagnostic Pathology at the University of Bristol. He will be the Officer on Scientific Committee.

Grant Petrie, who offers an internal medicine referral service in London at the Portman and Bayswater Referral Clinics, is now Senior Vice-President and will sit on the Journals Management Committee.

Mark Johnston, who heads a practice in Crowborough, East Sussex, is our Vice-President and will work closely with the Regions and Petsavers. Initially Mark planned to serve on a Regional Committee for a couple of years and then stop, but he insists that once you start as a volunteer with BSAVA you just don’t want to stop.

Our Honorary Treasurer, Katie Dunn, will work with Membership Development. Katie has a long history as a BSAVA volunteer and was also JSAP Editor. She now works as a freelance medical writer and copy editor.

All on Board

Congress

All on Board

CONGRESS REPORT – COMING SOON…At the time of going to press, the BSAVA and companion team are still at Congress! So a full report on the event will feature in the May edition. However, visit the website where more and more news, reports and pictures will feature during the month. If you were there we hope you had a really great time, if you didn’t make it, remember that as a member you can access the talks online as MP3 downloads – making Congress last all year long. ■

For the first time BSAVA has filmed some of the behind-the-scenes developments that turn an athletic and music venue into the largest companion animal exhibition in the

world. From the end of April you can go online to see a fascinating time-lapse recording of the creation and dismantling of the vast NIA space that is home to over 240 exhibitors during the event. Everything from rigging banners to laying carpets and dressing the stands – it all might take hundreds of people and hundreds of man-hours – but you can watch it unfold in seconds. Visit the Congress area at www.bsava.com. ■

Grant Petrie’s final act as President on 3 April was to hand the mantel over to Andrew Ash and welcome

Michael Day and Patricia Colville onto the Board. This team leads the direction of the Association, working hand-in-hand with committee chairmen and the Regions. Without this committed team of volunteers there would be no BSAVA.

The Board now says goodbye and thank you to Richard Dixon. Before coming onto the Board Richard had been a committee member and secretary for the Scottish Region, Regions Co-ordinator, and Chair of Publications Committee. His long service to BSAVA is impressive, greatly appreciated and we know that whilst no longer serving as an Officer his support is ongoing.

Congress on film

At the AGM on the Sunday of Congress the BSAVA Board saw a new President and a refreshed team of Officers

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PUBLICATIONS

Romain Pizzi, contributor to the BSAVA Manual of Exotic Pets, 5th edition, was part of the veterinary team responsible for the first minimally invasive surgical removal of gallbladders in Asiatic black bears at a rescue centre in Vietnam

Asiatic black bears (Ursus thibetanus) are classified as a vulnerable species by the International Union for Conservation of Nature

(IUCN). They are kept illegally in Vietnam for bile farming, and are ‘milked’ by repeated needle puncture of the gallbladder, use of an indwelling catheter or creation of a fistula. Bears rescued from bile farms have a high incidence of gallbladder and

World’s first laparoscopic cholecystecomy in Asiatic black bears

Romain Pizzi and Jonathan Cracknell perform the world’s first laparoscopic gallbladder removal in the Asiatic black bear

PUBLICATIONS

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PUBLICATIONS

PIONeeRINg OPeRATION BeNefITS fROm BSAVA mANUAL dONATION

Romain Pizzi (right) and Jonathan Cracknell (centre) presented a copy of the BSAVA Manual of Canine and Feline Endoscopy and Endosurgery to duong duy Cuong, veterinary surgeon at the mekong delta Bear Sanctuary.

Advances in equipment technology coupled with reduction in costs mean that both flexible and rigid endoscopy are now realistic prospects in first-opinion practice. This manual provides a practical guide for those wishing to use minimally invasive techniques, with detailed information on instrumentation, and practical tips and advice on its care. The principles and basic techniques of diagnostic endoscopy and endosurgery are explained and fully illustrated.

To purchase your copy of this BSAVA manual, contact our membership and Customer Services on 01452 726700, or order your copy online at www.bsava.com.

Member price: £49.00Price to non-members: £75.00

liver disease, with studies showing that >40% of fistulated bears later die from liver and/or gallbladder tumours, believed to result from the chronic inflammation and infections associated with bile collection.

Open surgerymany bears rescued from bile farms undergo open abdominal surgery to remove the diseased gallbladder and limit the development of malignant liver and gallbladder tumours. An open approach to cholecystectomy is associated with large, painful wounds and a prolonged recovery time – it is often necessary to confine the bears for 6 or more weeks to allow the wounds to heal completely.

In humans this approach to gallbladder removal is associated with high levels of postoperative pain, prolonged hospitalisation, slow recovery, and an increased risk of dehiscence, infection and hernia development. Thus, in most developed countries, this type of surgery has been largely replaced by laparoscopic cholecystecomy.

Minimally invasive surgeryIn december 2010, a team from the Royal Zoological Society of Scotland (RZSS) and free the Bears (fTB) performed the world’s first laparoscopic removal of gallbladders from Asiatic black bears at the mekong delta Bear Sanctuary in Vietnam. Romain Pizzi (veterinary surgeon) and Jonathan Cracknell (anaesthetist) were amongst the team undertaking this pioneering surgery.

The team carried out comprehensive health checks (haematology, serum biochemistry and abdominal ultrasonography) on all the rescued Asiatic black bears at the centre. Laparoscopic abdominal examinations were carried out in nine of the bears, and liver biopsy samples obtained. Of these nine bears, three were found to have significantly diseased and fibrotic gallbladders.

The three Asiatic black bears had their gallbladders removed via minimally invasive (keyhole) surgery. This is the first time that laparoscopic cholecystectomy has been performed in these animals. There are significant welfare benefits to this approach compared with open abdominal surgery, including a more rapid recovery from the procedure. Within a week of surgery the bears were engaging in normal activities, including swimming, climbing and social interaction. n

PUBLICATIONS

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PUBLICATIONS

In June 2010, with the agreement of the BSAVA Officers, the International Affairs Committee donated previous editions of

BSAVA manuals in english, Japanese and Spanish, to Worldwide Veterinary Services (WVS) for distribution to animal welfare charities worldwide. WVS was founded in 2002 by Luke gamble, a veterinary surgeon, and registered as a charity in 2003. WVS aims to provide aid and assistance to animal charities and non-profit organisations around the world, with an emphasis on working with local communities.

IndiaThe WVS International Training Centre (ITC) in southern India was opened in September 2010 in association with the India Project for Animals and Nature. The ITC is organising a series of modular training courses for veterinary surgeons, paraprofessionals, kennel hands and shelter workers, in a wide range of animal health and welfare topics. The aim of these courses is to provide advice and support to animal charities and sanctuaries, and to encourage them to work together to ensure best practice techniques.

Several BSAVA manuals have been donated to the WVS International Training Centre in India (above).

Thailand‘Saving one dog won’t change the world, but surely the world will change for that one dog’ is the motto of the Care for dogs foundation in Chiang mai, Thailand. The charity helps to improve the health of homeless dogs by vaccinating them, providing them with veterinary care, and running a feeding project. It also provides a rescue centre, and aims to decrease the number of street and temple dogs by neutering them and promoting responsible adoption. In addition, the charity facilitates the treatment and neutering of cats, and works with nuns at the temples to find new homes for the animals they foster. Last June, an international delegation of three vets from WVS spent 2 weeks at the charity, neutering dogs and cats, and performing emergency surgical procedures. The Care for dogs foundation is now looking for a vet to spend 2 years working at their centre.

JapanThe SALA (Save Animals Love Animals) Network in Tokyo (right) is a non-profit organisation, involved with rescuing abandoned dogs and cats that are victims of the ‘pet boom’ in Japan. The SALA Network estimates that upwards of

BSAVA manual donation to international charities

Jo Arthur, a member of the BSAVA International Affairs Committee, has been instrumental in the recent donation of BSAVA manuals to veterinary charities around the world. Here, she tells us more

Several BSAVA Manuals have been donated to the WVS International Training Centre in India

The SALA Network benefits from BSAVA Manual donation

PUBLICATIONS

800,000 animals have been admitted to public shelters, with little prospect of being reunited with their owners or finding new homes, many are euthanased. After a health check and basic training (for dogs), SALA facilitates finding new homes for abandoned animals, and promotes neutering, name tags and microchipping. In addition, SALA lobbies for improvement in the management of public animal shelters, the provision of ‘dog parks’ and dog training courses.

Around the worldIn addition to the three animal charities above, BSAVA manuals have also been donated to:

n maun Animal Welfare Society in Botswana

n Animal Care Samos and greek Animal Rescue in greece

n Animal Refuge Kansai in Japan n dog Star foundation in Sri Lanka n Animal Aid Unlimited in India n

PUBLICATIONS

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CPD

Old age doesn’t come alone

In May and June, BSAVA will present courses offering new insight into dealing with the feline and canine geriatric patient

With the benefits of preventive programmes, in concert with changing capabilities and expectations, geriatric medicine is an increasing part of the caseload for small animal practitioners. With age comes degeneration and disease; things just don’t work so well as they used to. Multiple problems and co-morbidity make the art of managing the geriatric patient akin to spinning plates; when one problem is sorted, another one appears.

Clive Elwood works in a large referral practice that sees over 4000 new cases per year, many of whom have multiple clinical problems. Rory Bell is in charge of one of the busiest internal medicine referral services in the UK. Between

The number of geriatric cats in the UK is increasing and cat owners want and expect excellent health care, tailored to meet the specific requirements of their aged cat. Recently a number of advancements have been made in feline geriatric medicine, including new strategies to improve recognition and treatment of chronic pain and measures to optimise renal care that are tailored to the individual animal. These updates will be discussed in detail during the course. The themes of the other lectures concentrate on the most commonly seen problems in geriatric cats, including an update on hyperthyroidism, hypertension, renal disease and the diagnostic approach to the cat presenting with weight loss.

While anaesthesia and sedation are commonly required for geriatric

them Clive and Rory have over 20 years of clinical experience in canine referral medicine.

This 1-day course will use a combination of lecture material and interactive case management scenarios to deliver practical and useful advice on how to approach this expanding branch of canine medicine. Covering such diverse yet inter-related topics as GI, renal, urinary, endocrine, cardiac and CNS disease, Clive and Rory will guide the delegates through the difficulties and conflicts encountered when trying to manage these cases optimally.

Given the risks of destabilising what can be a very delicately balanced management, the emphasis will be on

animals, they undergo unique physiological changes that can make safe and effective analgesia and anaesthesia challenging. A lecture on geriatric cat anaesthesia will increase understanding of the physiological changes of aging and promote confidence in anaesthetising this patient population safely. Medical lectures about hyperthyroidism and chronic renal failure will be linked with information about appropriate anaesthetic management of these cases. Tips about how to carry out nerve blocks for dental procedures will be given.

The course speakers, Angie Hibbert and Jo Murrell, are specialists in feline medicine and in anaesthesia and analgesia, respectively, and therefore together can provide a unique practical guide to the management of both healthy and diseased geriatric cats.

OlD DOGS AND NEW TRICKS: CANINE GERIATRICS

OPTIMISING VETERINARy CARE: THE GERIATRIC CATThe course will be designed to

promote interaction between the speakers and delegates in order to maximise information transfer during the day. A number of case-based scenarios will be used to ensure clinical applicability and give the delegates a number of ‘top tips’ that they can immediately apply to their geriatric cat caseload. n

Date: Tuesday 24 MayVenue: Kettering Park Hotel & SpaSpeakers: Angie Hibbert and Jo MurrellFees:BSAVA Member: £213.83Non-member: £320.74

Date: Tuesday 21 JuneVenue: Kettering Park Hotel & SpaSpeakers: Rory Bell and Clive ElwoodFees:BSAVA Member: £213.83Non-member: £320.74

taking a holistic approach, and the guiding principle throughout will be ‘First do no harm’. Delegates should come away from the course enthused and empowered to improve their practice in this challenging yet rewarding area. n

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FORMULARY

New Formulary for 2011

It seems like only yesterday that I was handed my copy of the 6th edition of the BSAVA Small Animal Formulary (forever

to be known as ‘the bright pink one’) at BSAVA Congress. It was my first edition at the helm of the publication and I was looking forward to a long rest. Yet here we are again with another new edition (‘the red one’). The cover might not be as shocking as its predecessor, but its colour will still make it immediately identifiable on the practice pharmacy shelf.

Like its predecessor, this edition is a source of considerable pride to the BSAVA and is one of the most highly valued benefits of BSAVA membership. Editing this piece of BSAVA’s ‘family silver’ has been a privilege. Yes, it is hard work but I also learn a lot in the process. In particular I spend a lot of time reviewing the evidence base behind many drugs. In some cases it is very good, but all too frequently the doses of drugs turn out to have been empirically derived (that means ‘guessed’ in plain English) and simply never challenged or checked. Rather worryingly (or at least you should be worried), the situation in human medicine is not much better. Many doses are based only on experimental animal studies. However, this is often quite helpful for those vets faced with certain ‘exotic’ species!

Editorial boardWork on this latest edition of the BSAVA Small Animal Formulary involved more than 20 people. The scientific editors were recruited from academic, private referral and first opinion practices. All are experts in their various fields, with a wide range of experience and knowledge. Work started in earnest after BSAVA Congress 2010 and most of the monographs were reviewed and rewritten where necessary by October of last year. The hardest decisions are those that involve a drug that is still available being omitted from the book. Some drugs in the Formulary seem to persist without actually being used. How many vets have used acarbose in the last 10 years?

Additions to the FormularyOver 20 new drugs have been added to this edition of the BSAVA Small Animal Formulary. Many of these drugs, such as robenacoxib, chitosan and masitinib, have become available for veterinary use since the publication of the last edition. Others, such as several antiepileptics, have been included on the basis of new evidence of efficacy in cases for which authorised

Ian Ramsey, Editor-in-Chief of the BSAVA Small Animal Formulary, describes the new edition and outlines the ongoing online developments for this indispensible drug guide

medications are not available, have not worked or are contraindicated. The handling of cytotoxic drugs by veterinary practices is likely to come under increasing scrutiny in the coming years. For this reason our new oncology editor, Jenny Helm, has rewritten the guidelines in line with current European College recommendations. The sedative protocols have been overhauled as well. Innovation comes in the form of a table of emergency drugs inside the front cover.

Removed from the FormularyEach edition brings its fair share of ‘goodbyes’ as well as ‘hellos’. This edition is no exception. So it was a sad goodbye to more than a dozen drugs, most of which, in truth, will not be missed. However, the loss of thiopental (thiopentone) sodium, the anaesthetic induction agent that anyone over the age of 35 would have learnt as ‘the standard’, should surely not pass without comment. Intraval Sodium (as it was always known) was the Rapinovet of its day. It was a drug that each small animal practitioner could expect to use every working day. Safe and effective, it has simply been surpassed by newer alternatives and is no longer commercially available in the UK.

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FORMULARY

25 NEW ADDITIONSAlpha-casozepineArginineChitosanDomperidoneFelbamateGlutamineImmunoglobulinsLanthanum carbonate octahydrateLevetiracetamMasitinib mesylateMavacoxibMiltefosineMirtazepineMitoxantronePholcodinePregabalinPyriproxyfenRobenacoxibS-AdenosylmethionineSevelamer hydrochlorideSilybinSodium valproateToceranibTopiramateZonisamide

Members who did not collect their copy of the new edition of the Formulary at Congress will be sent it in the post by the end of May.

Keeping up to dateOver the years new drugs come and old drugs go, but when it comes to their trade names and availability, the speed of change is much faster. Keeping track of what is available (and what the trade names are) is a substantial task on its own. However, the improvements in the Veterinary Medicines Directorate’s website (www.vmd.gov.uk) have made the process simpler and the NOAH website (www.noah.co.uk) and the British National Formulary website (www.bnf.org) continue to be very useful sources for the editor and authors.

Future developmentsIn addition to the PDF version, all members will also have access to the new online searchable version of the 7th edition of the BSAVA Small Animal Formulary. This will have all the information that is currently available in the Formulary, plus sources of information (references and further reading), a classification system based on the therapeutic action, and ultimately links to other useful resources. Watch out for announcements about further online developments.

AcknowledgementsI would like to thank my fellow editors for their efforts and all those people who contacted me. We continue to strive towards perfection in the Formulary, knowing that we can never achieve it, but learning so

14 REMOVALSAcarboseBromocriptineDextransFebantel (now covered under pyrantel)GlibenclamideGlycerolIsosorbide dinitrateMebendazoleMethyltestosteroneStreptokinaseThiopentalThiostreptonVedaprofenWarfarin

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much on the journey and hopefully providing the BSAVA members with a fantastic resource. If you do think we have missed out something, or you spot an error, then please contact us at [email protected]. ■

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CLINICAL CONUNDRUM

Clinical conundrum

Mark Longley and Kinley Smith of Glasgow Vet School invite companion readers to consider a case of progressive lameness in a Cavalier King Charles Spaniel

conundrumSeptic arthritis can result in severely painful

swollen joints, often accompanied by non-weight-bearing lameness. Staphylococcus and Streptococcus spp. are commonly implicated. Most cases are associated with a penetrating injury, though haematogenous spread of bacteria to the joints is more likely in cases of pre-existing OA. Where haematogenous spread of infection is involved, multiple joints may be affected.

Neoplasia (e.g. synovial cell sarcoma), though capable of causing joint destruction and luxation in some cases, is again unlikely to cause symmetrical bilateral disease.

Immune-mediated polyarthritis usually affects multiple joints, may be shifting in nature, and is often symmetrical. The joints are usually swollen and the severity of pain may be variable. In cases of rheumatoid arthritis, destruction of ligamentous structures of the joint may occur in end-stage disease, resulting in luxation of the affected joints.

How would you investigate a bilateral arthropathy?Joint radiography and synoviocentesis are essential diagnostic tools for the investigation of any arthropathy. In addition, further investigation may include full haematology and biochemistry, survey radiographs of thorax and abdomen, and abdominal ultrasonography.

In this case, haematology and biochemistry results were unremarkable.

What abnormalities are visible on the radiographs?Radiographs of the carpi are shown in Figures 1 and 2; severe bilateral changes are evident. There is marked soft tissue swelling around both carpi.

Antebrachiocarpal caudal subluxation and collapse of the middle carpal and carpometacarpal joints is present bilaterally. Both joints have multiple irregular radiolucent foci affecting the subchondral bone of the distal radial and ulnar epiphysis, the carpal bones and the proximal metacarpals. There is periarticular new bone formation suggestive of secondary OA.

Synoviocentesis of both carpi was performed. There was an increased volume of low viscosity synovial fluid. This fluid contained large numbers of

Case presentationAn 8-year-old male Cavalier King Charles Spaniel was presented with a 6-month history of progressive forelimb lameness. Swelling and pain were initially noted in the left carpus, subsequently progressing to involve the right carpus. Meloxicam had been given to control the clinical signs. Despite some initial improvement, the lameness continued to progress. There was then a sudden deterioration, with luxation of the joints.On clinical examination, the dog had marked difficulty in ambulating. There was hyperextension and varus deviation of both carpi, with marked swelling, effusion and pain on manipulation. Other joints were normal on examination. Rectal temperature and the remainder of the clinical examination were normal.

Create a problem list for this patient

■■ Carpal joint swelling and effusions (bilateral)■■ Hyperextension and varus of carpi (bilateral)■■ Carpal pain (bilateral)

What differentials would you consider?Osteoarthritis (OA) is a common condition in older dogs. The presence of OA in multiple joints is common and results in joint effusion, stiffness and pain. Collapse of affected joints is unlikely.

A traumatic incident could result in the sudden onset of severe lameness, joint effusion and luxation, but in this case there was no history of any such event. Furthermore, such an event would be unlikely to be preceded by a progressive lameness or have a symmetrical pattern.

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CLINICAL CONUNDRUM

Figure 1: Dorsopalmar and lateral projections of the left carpus

Figure 2: Dorsopalmar and lateral projections of the right carpus

What are your differential diagnoses for this dog’s arthropathy?Failure to demonstrate the presence of bacterial involvement, together with the changes in the synovial fluid, strongly suggests the presence of a polyarthropathy. Typically, cell counts found in polyarthropathies are higher (>5000 cells/mm3) than those found in uncomplicated degenerative joint disease (usually between 1000 and 5000 cells/mm3), although septic joints usually also have very high nucleated cell counts. Initial investigation of a polyarthropathy involves differentiating the disease into non-erosive and erosive forms.

In the early stages of the disease when there are minimal radiographic changes it may be difficult to separate erosive from non-erosive polyarthritis. In such

nucleated cells (20,000/mm3), predominantly neutrophils with some mononuclear cells, and blood was also present; no bacteria were visible. No bacteria were grown from synovial fluid inoculated into blood culture bottles.

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CLINICAL CONUNDRUM

Clinical conundrum

cases synovial membrane biopsy may be required to make the diagnosis and allow the appropriate treatment protocol to be initiated. In this case the changes on radiography are consistent with an erosive arthritis.

How would you investigate an erosive arthritis?The most common cause of bilateral erosive arthropathy is rheumatoid arthritis. Joint infections uncommonly cause erosive disease.

The diagnosis of rheumatoid arthritis (RA) is made based upon the human system introduced in 1959 by the American Rheumatics Association (ARA) (see Table 1). Typically, the clinical presentation is of a 1–8-year-old, small breed dog showing signs of joint pain in the distal joints. Initially a single joint may be affected but as the disease progresses it becomes bilaterally symmetrical. Clinical pathology is often unremarkable or shows non-specific changes consistent with inflammatory disease. Synovial fluid analysis usually shows increased numbers of white blood cells, mostly neutrophils.

Infections including Ehrlichia sp., Borrelia burgdorferi and distemper virus have been implicated in the aetiopathogenesis of both erosive and non-erosive polyarthritic disease, although evidence for their role in RA is limited. B. burgdorferi has been identified as a possible cause of septic arthritis, and this may be erosive. Erosive arthritis associated with leishmaniasis has also been documented, and erosive septic arthritis due to Erysipelothrix rhusiopathiae has recently been described. Other forms of septic arthritis, if chronic, may result in erosions.

Further investigation of this case is centred on: investigating whether an infectious agent is involved; and excluding other co-morbidities that might influence treatment choices. Thoracic and hindlimb radiographs were unremarkable. Abdominal ultrasonography identified a small splenic nodule that was sampled by fine-needle aspiration. Cytology was suggestive of benign nodular hyperplasia. This was considered to be an incidental finding and unlikely to be associated with the musculoskeletal disease. PCR tests for Borrelia and Ehrlichia were both negative. Rheumatoid factor was 6u (<5u normal).

DiagnosisThe severely erosive changes visible on radiographs, in conjunction with the joint fluid cytology and other clinical findings, including elevated rheumatoid factor, are diagnostic for RA. In this case, six of the ARA criteria are met.

PathogenesisRA is a progressive condition in which inflammatory cells invade the synovium. Granulation tissue containing synoviocytes and other inflammatory cells develops from the synovial membrane (pannus). These cells release a variety of inflammatory cytokines and enzymes that result in erosion of the articular cartilage and subchondral bone. Ultimately this results in weakening and rupture of the ligamentous structures of the joint, leading to joint collapse and luxation as seen in this case. Although the aetiology remains obscure, it is believed that some form of antigenic stimulus renders the synovium antigenic, leading to binding of IgG, subsequent complement activation and inflammation.

Table 1: ARA guidelines for diagnosis of rheumatoid arthritis, adapted for veterinary use

Criteria:■■ Morning stiffness■■ Pain in at least one joint■■ Soft tissue joint swelling■■ Soft tissue swelling of at least one other joint

within 3 months■■ Symmetrical joint swelling■■ Radiographic changes evident (erosions of

subchondral bone and periarticular osteopenia)■■ Elevated levels of rheumatoid factor (RF)■■ Poor mucin clot on addition of acetic acid■■ Characteristic histopathology of synovial

membrane

For the diagnosis of RA to be made, a minimum of five of the ARA’s criteria must be present. When more than seven are present the case is termed ‘classical RA’. Some authors believe that at least two of the bold criteria must be present to diagnose RA.

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CLINICAL CONUNDRUM

AVAILABLE FROM BSAVAEdited by: John Houlton, James Cook, John Innes and Sorrel Langley-Hobbs

■■ Conditions of joints, bone, tendon and muscle

■■ Assessing and treating lameness■■ Focus on arthritis■■ Postoperative rehabilitation■■ Step-by-step illustrated Operative Techniques

BSAVA Member: £59.00Non-members: £89.00

What is your choice of treatment?The goal of treatment in RA is to slow the rate of progression and alleviate the clinical signs associated with the condition. It is important to inform owners that progression is likely despite treatment. Many cases are eventually euthanased due to inability to ambulate and/or severe joint pain.

Treatment of RA is centred on the use of immunosuppressive therapy. A variety of drugs have been used to control the disease, although in most cases progression is merely slowed rather than prevented. Long-term prognosis is considered poor, due to the severity of joint destruction in most cases. The prognosis is best where minimal joint changes are visible on radiography at the start of treatment.

Corticosteroid therapy alone is rarely sufficient to control affected dogs and additional therapy is usually required. A variety of cytotoxic agents have been used as adjunctive therapy, including azothioprine, cyclophosphamide, ciclosporin and gold salts. All of these drugs may have significant side effects and it is important to discuss these with the owner before initiating therapy.

The aim with all of these treatments is to taper the dose gradually to the minimum level required to achieve control. Ideally, the success of therapy should be assessed on the basis of synovial fluid analysis and adjustments made as necessary. Initial assessment should be made 1 month after the start of treatment. Appropriate response to treatment (a decrease in cellularity) allows tapering of the drug dose.

Analgesia is generally required in most animals since the condition is often advanced at the time of diagnosis, resulting in significant joint pain.

Synovectomy is reported as being beneficial in cases that are diagnosed early. Stabilisation of luxated or subluxated joints is an important element of treatment, relieving the pain of severely affected joints. Arthrodesis, with the incorporation of a bone graft, would be the treatment of choice in an attempt to salvage severely eroded joints. However, the potential for complications following surgery is considerable, both due to the underlying disease process and immunosuppressive therapy being likely to result in protracted healing.

Patient outcomeIdeally this dog would have had surgery for arthrodesis of the carpi. Unfortunately, the quality of the cortical bone in the proximal metacarpi and carpal bones was very poor, causing concerns over the feasibility of screw placement. This patient was therefore a poor surgical candidate. Attempts were made to stabilise the carpi using an external carpal support (Carpo-flex, Vet Instrumentation) to help reduce the pain associated with the unstable joints.

The dog was treated with oral prednisolone (2 mg/kg q12h) and ciclosporin (5 mg/kg q12h) in an attempt to prevent further disease progression. He was reassessed 1 month after initiation of treatment, and synoviocentesis performed. There was marked reduction in cellularity of the joint fluid. The dose of prednisolone was reduced to 5 mg q24h for 2 weeks then to 5 mg q48h. The ciclosporin was discontinued at this time since there was no evidence of progression to involve other joints.

The long-term prognosis for this dog is poor since there is no hope of restoring function to the affected joints and the carpal supports produced only mild improvement in ambulation. ■

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HOW TO…

How to…

How to utilise blood products in small animals

Gillian Gibson, clinical pathologist at Axiom Veterinary Laboratories, helps us make the most of this precious resource

Blood component therapyInitial blood collection, using a suitable anticoagulant and collection system, yields whole blood containing red blood cells (RBCs), white blood cells (WBCs) and platelets suspended in the liquid plasma portion. Historically whole blood has been most often administered to small animal patients, often collected at the time of need. However, blood components can be separated using variable-speed temperature-controlled centrifuges, according to standard blood banking protocols.

Advantages of component therapy include:

■■ Specific replacement therapy – only giving the patient what is needed and reducing the risk of transfusion reactions

■■ One unit of donated blood can be used to help more than one patient

■■ Maximises the storage life of blood products.

The production of components is limited by the availability of specialist equipment and skills (e.g. referral hospitals with in-house blood banks) but, following recent legislative changes, licensed UK pet blood banks are now able to provide components for more widespread use.

The components of whole blood most often used in veterinary transfusion medicine are RBCs and plasma products.

RBCs contain haemoglobin, which is necessary for oxygen transport from the lungs to the rest of the body. RBC transfusions provide the recipient with an additional red cell mass and consequently increased oxygen-carrying capacity. Plasma products are a source of coagulation factors and various plasma proteins that may be used to replace them in states of deficiency. Platelet products are not readily available and will not be discussed here. Table 1 summarises the properties and uses of different blood products.

Blood product preparationTo prevent microbial contamination of any of the component products, a closed collection system must be used, and the transfer of the components from the collection bag to the individual satellite storage bags is achieved by a system of integrated tubing (Figure 1). In these closed systems there is no exposure of the

Figure 1: Closed collection system used for blood component processing

collection bag or its contents to air prior to administration, other than when the needle is uncapped to perform venepuncture at collection.

The collection and processing of blood components following appropriate guidelines provides a supply of products with little risk of microbial contamination and maximal storage times. Plasma is separated from the RBCs by centrifugation; the red cells separate to the bottom of the collection unit and the plasma can be removed and stored separately (Figure 2). The prepared units are sealed with a hand held clip sealer or heat sealer prior to storage.

If blood is collected into an open system, one in which there is one or more additional sites of potential bacterial contamination during blood collection or processing, all components must be used within 24 hours. Using syringes with added anticoagulant to collect blood is an example of an open system.

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How to utilise blood products in small animals

Figure 2: Separation of plasma and PRBCs. (A) Collection bags in a specialised variable-speed temperature-controlled centrifuge. (B) Following centrifugation, the plasma component is gently separated from the RBCs by gentle pressure. The plasma is transferred to a separate empty storage bag that is connected to the original blood collection bag by integral tubing. (C) Plasma and PRBCs are stored separately and may be used for different patients

A B C

Blood component Constituents/properties Storage Indications

Red blood cell products

Fresh whole blood (FWB)

RBCs, platelets, coagulation factors and plasma proteins all present and functional

Must be used within 8 hours of collection

Thrombocytopenia or thrombocytopathia causing severe uncontrolled or life-threatening haemorrhage; anaemia with concurrent coagulopathy

Stored whole blood (SWB)

RBCs and plasma proteins, but not functional platelets or coagulation factors

Stored at 1–6°C for approximately 28 days; depends on anticoagulant used

Anaemia with concurrent hypoproteinaemia

Packed red blood cells (PRBCs)

Red blood cells RBCs separated from plasma, stored at 1–6°C for 20 days; or extended to 35 days with use of appropriate preservative

Clinically symptomatic euvolaemic anaemia (e.g. IMHA, non-regenerative anaemia)

Plasma products

Fresh frozen plasma (FFP)

All plasma coagulation factors, including labile coagulation factors V and VIII, and plasma proteins

Separated from PRBCs and frozen within 8 hours of collection; stored at –20°C for up to 1 year*

Acquired or inherited coagulopathies (e.g. inherited factor deficiencies, vitamin K deficiency, vitamin K antagonist intoxication, DIC, severe liver disease)

Stored frozen plasma

Some vitamin-K dependent factors, albumin and globulin

FFP >1 year of age, or plasma not frozen within 8 hours, or FFP that has been thawed and refrozen. Many useful clotting factors and anti-inflammatory proteins will have been lost. Stored at –20°C for 5 years*

Vitamin K deficiency, vitamin K antagonist intoxication, hypoproteinaemia (colloidal support)

Cryoprecipitate (CPP)

von Willebrand factor, factor VIII, factor XIII, fibrinogen and fibronectin

Extracted from FFP. Stored at –20°C for up to 1 year*

Replacement therapy for deficiencies of von Willebrand factor, factor VIII (haemophilia A) or fibrinogen

Cryosupernatant/Cryo-poor plasma

Many clotting factors, including vitamin K-dependent factors II, VII, IX and X, other anticoagulant and fibrinolytic factors, albumin and globulin

Produced from a unit of FFP by separation from CPP. Stored at –20°C for up to 1 year*

Coagulopathies or hypoproteinaemias not requiring supplementation of the CPP components

Table 1: Summary of blood component properties, storage requirements and indications for use. (*from date of collection)

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HOW TO…

Utilise blood products in small animals

Storage of blood products

RBCs are refrigerated.

■■ Temperature maintained at 1–6°C, checked daily with a refrigerator thermometer.

■■ A dedicated household refrigerator is often suitable, as long as there is low in and out traffic (e.g. it is not used for storing frequently used products such as vaccinations).

■■ Store upright.

Plasma products are frozen.

■■ Temperature maintained at –20°C or below, checked daily with a thermometer to ensure maintenance of adequate storage conditions.

■■ A dedicated household freezer may suffice, but the temperature within the freezer may vary depending on the storage compartment and it is therefore important to check the temperature in each compartment.

■■ When the plasma is still liquid, an elastic band is placed around the middle of the bag to create an indentation (‘waist’) during freezing. The band is removed once the unit is frozen hard. Loss of this waist in a stored frozen plasma unit suggests that the unit has thawed and refrozen, which could compromise the plasma quality.

■■ Care should be taken not to drop the frozen plasma units as they are vulnerable to cracking.

Choosing the appropriate blood product for the patient

RBC productsRBC products may be indicated in any anaemic patient, regardless of the cause of anaemia (haemorrhage, haemolysis or impaired erythropoiesis) if they will benefit from an additional red cell mass and hence increased oxygen-carrying capacity.

■■ Tachypnoea■■ Tachycardia■■ Bounding or poor peripheral pulses■■ Pallor■■ Collapse■■ Lethargy or weakness■■ Decreased appetite.

Plasma productsPlasma products are most commonly used to treat inherited or acquired coagulopathies. Plasma is of little benefit in hypoproteinaemic patients, and other modes of therapy (synthetic colloids, nutritional support) are recommended.

Administration of blood productsBlood types are determined by species-specific inherited cell surface antigens. Incompatibility between species or individuals may result in transfusion reactions or neonatal isoerythrolysis. A more in-depth discussion regarding blood types and cross-matching may be found in the BSAVA Manual of Canine and Feline Emergency and Critical Care, 2nd edn. However, these general guidelines should be followed:

Canine

■■ Blood type of donor and recipient should be assessed prior to transfusion.

■■ If it is not possible to type the recipient, ideally a DEA 1.1-negative donor should be used.

■■ DEA 1.1-negative recipients should only receive DEA 1.1-negative RBCs.

■■ DEA 1.1-positive recipients may receive either DEA 1.1-negative or DEA 1.1-positive RBCs.

Feline

■■ Incompatibility transfusion reactions can be fatal.

There is no precise packed cell volume (PCV) below which RBC transfusion should be administered. Consideration of a number of factors, including volume status, rate of onset of anaemia, ongoing losses and patient clinical condition, must influence the decision to transfuse. General guidelines are offered below.

PCV

■■ Almost all patients with a PCV ≤ 12% would benefit from a transfusion.

■■ Any patient with a PCV ≤ 20% should be considered a transfusion candidate.

■■ Some patients with a PCV >20% may benefit from a RBC transfusion (e.g. acute haemorrhage with ongoing blood loss).

■■ Chronic anaemia is typically better tolerated than acute anaemia due to compensatory mechanisms.

Volume status

■■ Animals with a reduced red cell mass but a normal intravascular volume (euvolaemic anaemia) may benefit from a RBC transfusion but not require the volume of accompanying plasma; therefore a PRBCs transfusion would be recommended. Examples would be animals with immune-mediated haemolytic anaemia (IMHA) or a non-regenerative anaemia.

■■ In animals with volume depletion as a consequence of acute haemorrhage (hypovolaemic anaemia), a whole blood transfusion or the combination of appropriate components (e.g. PRBCs plus plasma) would be recommended.

Clinical signs

Clinical signs are the most important factor in deciding when to administer a RBC transfusion. The following signs suggest that the patient may benefit from additional oxygen-carrying support:

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HOW TO…

■■ Blood type of donor and recipient must ALWAYS be assessed prior to transfusion.

■■ Type A cats should only receive type A blood or plasma.

■■ Type B cats should only receive type B blood or plasma.

■■ Type AB cats may receive either type AB (preferable) or type A (acceptable) blood and ideally only type AB plasma.

Cross-match recommendations

Cross-matching should be carried out:

■■ Prior to first transfusion in cats■■ When the recipient has previously been

transfused (>4 days prior)■■ When there is history of a transfusion

reaction■■ If the patient’s transfusion history is

unknown.

Figure 3 provides a description of an abbreviated in-house slide cross-match method that may be used in an emergency situation if laboratory services are not available.

Route of administration

■■ Blood products are usually administered intravenously.

■■ If venous access is not possible (e.g. neonatal patient) the intraosseous route may be used.

■■ Blood products should not be given intraperitoneally.

Filter

An in-line filter is required for all products with a maximum size of 170–260 µm; this is usually incorporated within a standard blood infusion set.

■■ Filtration removes any small blood clots and particles that could be harmful if infused into the recipient.

■■ Microaggregate filters of 18–40 µm are

Figure 4: Example of a paediatric blood filter that may be used in line with small blood transfusions

Figure 5: Formula for calculating the volume of whole blood required for transfusion

Volume (ml) = 85 (dog) or 60 (cat) x bodyweight (kg) x [ (desired PCV – actual PCV) / donor PCV ]

available and can be placed in line when infusing small volumes of product or blood collected in syringes (Figure 4).

DoseThe amount of product to be given greatly depends on the product type, indication

1. Collect blood into an EDTA tube from recipient and donor.2. Centrifuge tubes to settle the RBCs, remove the supernatant and transfer to a

clean, labelled glass or plastic tube.3. For each donor prepare 3 slides labelled as major, minor and recipient control.4. Place 1 drop of RBCs and 2 drops of plasma on to each slide according to the

following:• Major cross-match = donor RBCs + recipient plasma• Minor cross-match = recipient RBCs + donor plasma• Recipient control = recipient RBCs + recipient plasma

5. Gently rock the slides to mix the plasma and red cells and examine for haemagglutination after 1–5 minutes (presence of agglutination indicates incompatibility); recipient control agglutination will invalidate results.

Figure 3: Abbreviated slide cross-match procedure

for administration, and desired response in the patient. A useful formula to calculate the amount of whole blood required for transfusion is noted in Figure 5. In general most patients will receive:

■■ Whole blood: 10–22 ml/kg■■ PRBCs or FFP: 6–12 ml/kg

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Utilise blood products in small animals

Product quality inspection

■■ Stored RBC products should be examined for any discoloration of the cells or suspension fluid (e.g. brown or purple) and the presence of clots, as these changes may indicate bacterial contamination, haemolysis or other storage lesions.

■■ Plasma bags should be examined for evidence of thawing and refreezing (disappearance of the waist), and cracking or tearing of the bag.

Preparation

■■ Stored RBC products need not be warmed prior to use, unless they are being given to very small animals or neonates.

■■ PRBCs stored without an added preservative may be resuspended or co-administered with 100 ml of physiological saline to decrease viscosity and improve flow (Figure 6).

■■ Frozen plasma products are gently thawed in a warm water bath. The plasma bag should be placed inside a sealed plastic bag prior to immersing in the water bath to protect the injection ports from possible microbial contamination.

Method and rate of administration

■■ Blood products are most commonly infused by gravity flow, although infusion pumps validated for the administration of products may also be used (see Figure 6).

■■ Small volumes (<100 ml) are often delivered by syringe driver or slow, intermittent, small-volume bolus injections (Figure 4).

■■ Animals should not receive any food or medications during a transfusion.

■■ To prevent incompatibility reactions, only 0.9% saline may be simultaneously administered through the same catheter as a blood product.

■■ All infusions should be completed within 4 hours.

The rate of administration is dependent on the cardiovascular status of the patient, and care should be taken when infusing

patients with risk of volume overload (e.g. cardiovascular disease, renal failure).

■■ During the first 20 minutes use an infusion rate of 0.25–1.0 ml/kg/h.

■■ If the transfusion is well tolerated, the rate is increased to deliver the remaining product over 4 hours.

■■ NOTE: If the patient is at risk of volume overload, do not exceed 3–4 ml/kg/h.

Monitoring the transfusion patient

The patient’s vital signs should be measured prior to (baseline) and every 15–30 minutes during, as well as 1, 12 and 24 hours following the transfusion. These include:

■■ Attitude■■ Rectal temperature■■ Pulse rate and quality■■ Respiratory rate and character■■ Mucous membrane colour and

capillary refill time.

Any change in plasma or urine colour indicative of haemolysis may be significant and should be noted. Blood samples to reassess PCV or clotting times are usually obtained at some time point after completion of the transfusion, unless deterioration of the patient requires otherwise. Repeating these parameters provides an assessment of efficacy as well as helps to determine whether a further transfusion is required.

Transfusion reactions

Any undesired side effect noted as a consequence of a blood product transfusion is considered a transfusion reaction. Reactions are classified as immunological, non-immunological and delayed. Prompt recognition and treatment of potential adverse transfusion reactions is essential.

Figure 6: PRBC transfusion being administered to a dog. Note the use of a specialised blood infusion set that allows co-administration of physiological saline. When a preservative has been added to the PRBCs prior to storage, co-administration with saline is not required. An intravenous fluid pump validated for the administration of red cells is being used in this case

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HOW TO…

REGISTERS AND BANKSThe Animal Blood Register (www.animalbloodregister.com) is a national donor database for UK pets, and Pet Blood Bank (www.petbloodbankuk.org) is a not for profit charitable organisation offering a full range of transfusion products. These organisations give veterinary surgeons in practice previously unattainable access to lists of matched donors and to blood products respectively. This freedom from the necessity for individual practices to health screen and cross match local donors and be proficient in blood collection allows the use of blood products more widely than has previously been possible.

See the BSAVA Manual of Canine and Feline Haematology and Transfusion Medicine and BSAVA Manual of Canine and Feline Emergency and Critical Care for useful information.

RBC incompatibility reactions (immunological) may cause acute haemolysis and can be life-threatening.

Signs may include:

■ Pyrexia ■ Tachycardia ■ Tachypnoea ■ Weakness ■ Salivation/vomiting ■ Diarrhoea ■ Haemoglobinaemia ■ Haemoglobinuria.

Non-haemolytic immunological reactions are acute allergic/anaphylactic reactions, signs of which include:

■ Oedema ■ Erythema ■ Pruritus ■ Urticaria ■ Vomiting ■ Dyspnoea.

Non-immunological transfusion reactions may often be avoided by rigorous donor screening and adherence to blood banking protocols. Such reactions include:

■ Anaphylactoid (often a consequence of rapid infusion rate)

■ Volume overload ■ Transmission of infectious disease ■ Hypocalcaemia (secondary to

excessive citrate anticoagulant) ■ Polycythaemia and hyperproteinaemia

(excessive volume of blood product administered)

■ Dilutional coagulopathy ■ Microbial contamination (signs may be

similar to acute haemolytic reaction) ■ Hyperkalaemia, acidosis,

hyperammonaemia, hypophosphataemia (storage lesions)

■ Air embolus.

Treatment of acute transfusion reactions

1. Stop transfusion: a In case of allergic/anaphylactic

reaction, if reaction subsides may restart transfusion at 25–50% of previous rate

b If signs of acute haemolytic reaction, do not continue with transfusion.

2. Donor and recipient blood type, product type and expiration date should be confirmed, and a cross-match may be performed (if not done prior to transfusion).

3. Treat any clinical signs of shock, including fluid therapy.

4. Antihistamines: a Chlorpheniramine: Maximum

recommended dose 0.5 mg/kg q12h (dogs and cats)i. Dogs: small to medium,

2.5–5 mg/dog i.m. q12hii. Dogs: medium to large, 5–10

mg/dog i.m. q12hiii. Cats: 2–4 mg/cat orally q12h.

b Diphenhydramine 1–2 mg/kg i.m. q12h (dogs and cats).

4. Corticosteroids: Dexamethasone 0.5–1.0 mg/kg i.v.

5. Monitor for development of fluid overload.

6. Monitor for development of hypotension or oliguria.

7. Administer H2 blockers, colloids, dopamine and/or aminophylline as needed.

8. Samples of both donor and recipient blood should be evaluated for haemolysis, and saved for microbial culture and infectious disease testing if required.

9. Broad-spectrum antibiotics may be administered if bacterial contamination is suspected.

Delayed haemolytic reactions may be recognised by an unexpected decline in the PCV or by jaundice developing at some time 2–21 days post-transfusion. These often do not require any specific therapy.

FinallyIt is important to note on the patient’s file that it has received a blood product transfusion, and to make the owner aware that this information should be passed along to other veterinary surgeons that may be caring for their pet in the future. ■

lists of matched donors and to blood products respectively. This freedom

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PETSAVERS

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16+ category 1st Place – In Love with My Foster Mum by Mandy Fielding of Middlesex

2nd Place – Launch! by Catherine Speakman of North Yorkshire

3rd Place – Golden in the Snow by Andrew Hilton of

Shropshire

Junior category 1st Place – Badger the Surfer Mouse by Benedict Coward, age 15 of Dorset

2nd Place – Jack by the River by James Arbuckle, age 14 of Mansfield

3rd Place – Autumn Shadows by Owen Arbuckle, age 11 of Mansfield

2nd Place – River 14 of Mansfield

3rd Place – Shadows age 11 of Mansfield

Each year Petsavers runs a digital photographic competition, inviting entries from vets and their clients.

In a change to previous years, the 2011 competition did not have a theme, which allowed entrants to submit any picture that they felt demonstrated their photographic expertise or showed off the individual personality of their much-loved pet.

This year the competition was a great success with over 600 entries, many of which were of an extremely high quality, giving the judges a very hard task indeed. However, we think that the winning pictures are really great and hope you will see that they made the correct decisions. The photography competition was open to all UK and Ireland residents who are amateur photographers, including pet owners, vets and veterinary nurses. Entrants were judged in two categories: adults (16 and over) and junior (under 16s). Prizes have been awarded in the form of photography vouchers to the photographers of the top three photos from each category: 1st prize = £200, 2nd prize = £100, 3rd prize = £50.

The winning pictures were exhibited at Congress but, in case you missed them, here they are… ■

Pet pictures win prizesAnd the winners of the 2011 Petsavers photo competition are…

For more details about Petsavers and submitting a picture for the 2012 competition please visit www.petsavers.org.uk or email [email protected]

Improving the health of the nation’s pets

A

A

D

E

F

B

C

BC

D

E

F

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The WSAVA One Health Committee (OHC) held its inaugural meeting over two days preceding the NAVC meeting in Orlando, Florida, in January

2011. The OHC was launched officially at the 2010 Geneva WSAVA Congress.

‘One Health’ proposes the unification of the medical and veterinary professions with the establishment of collaborative ventures in clinical care, surveillance and control of cross-species disease, education, and research into disease pathogenesis, diagnosis, therapy and vaccination. The concept encompasses the human population, domestic animals and wildlife, and the impact that environmental changes (‘environmental health’) such as global warming will have on these populations. The WSAVA OHC was established to ensure that small companion animals have a prominent role in the global One Health agenda.

Progress towards One Health

Michael Day reports on the inaugural meeting of the WSAVA One Health Committee and the first One Health conference

CORE MEMBERS OF THE ONE HEALTH COMMITTEE:

■ Michael J. Day (Chair; University of Bristol, UK)

■ Jolle Kirpensteijn (WSAVA Board; Utrecht University, the Netherlands)

■ Alex Thiermann (OIE; Paris, France) ■ Carol Rubin (CDC; Atlanta, USA) ■ Michael Lappin (Colorado State University,

USA) ■ Sarah Cleaveland (Glasgow University, UK) ■ Chand Khanna (NIH; Maryland, USA) ■ Clarisa Palatnik-de-Sousa (Federal University

of Rio de Janeiro, Brazil) ■ Umesh Karkare (Practitioner Representative;

Mumbai, India)

Members of the WSAVA One Health Committee at the inaugural meeting: (L-R): J. Kirpensteijn, M. Lappin, M.J. Day (Chair), C. Rubin, C. Palatnik-de-Sousa, C. Khanna

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WSAVA NEWS

At the January meeting, the OHC agreed that there are three key areas of One Health with which it should engage:

■ The human–companion animal bond ■ Comparative and translational medicine ■ Zoonotic infectious disease.

It was decided that the initial focus of the committee will be in the area of zoonotic infectious diseases. There are already many excellent initiatives related to key zoonotic diseases (in particular rabies) and the committee will endorse and support such initiatives.

The strength of the WSAVA lies in scientific education and communication, and an immediate output from this committee will be the provision of quality information for the global practitioner network. In order to disseminate the One Health message and such information, the OHC has established a web page (accessible from the WSAVA website) and has registered the first One Health Facebook page. WSAVA members should check the OHC website for the latest One Health information and are encouraged to interact directly with us through Facebook.

The WSAVA OHC has already had one review

paper published (Veterinary Record 2010; 167: 847) and has another in press (Parasites and Vectors). The committee presented two papers at the 1st International One Health Conference in Melbourne, Australia, in February 2011, ensuring that companion animals are strongly represented in this first truly global discussion of One Health.

The committee also decided that, in order to raise the global profile of the One Health initiative, a WSAVA Global One Health Award will be established. This award will be given to an individual who is very prominent in One Health and will be presented at the WSAVA Congress accompanied by a One Health lecture. A second award will be made to the Congress presentation that best encapsulates the One Health philosophy; it is hoped that this will encourage younger members of the profession to engage with One Health.

The next meeting of the OHC will be held at the Centers for Disease Control and Prevention in Atlanta, Georgia, in the autumn of 2011.

The work of the WSAVA OHC is made possible by a consortium of industry sponsors who have contributed to the WSAVA Foundation specifically to fund this project. The OHC is grateful to our sponsors who include at the time of writing (in alphabetical order): Bayer Animal Health, Hill’s Pet Nutrition,

Who’s speaking on skin?A preview of the dermatology sessions to be held at the 2011 WSAVA World Congress in Jeju, Korea

Masahiko NagataASC, Japan

Lecture topics: ■ Clinical approach to

pruritus in dogs ■ Clinical approach to

alopecia in dogs

Ralf MüllerLudwig Maximilian University Munich, Germany

Lecture topics: ■ Atopic dermatitis in dog

and cat – An itchy problem ■ Adverse food reaction in dog and

cat – Food for thought ■ Fungal skin disease in dog and cat

– Can look like any dermatitis

Sonja ZabelColorado State University, USA

Lecture topics: ■ Shampoo and topical

treatment ■ Common feline skin disease ■ Pyoderma

Chiara NoliEuropean Society of Veterinary Dermatology, Italy

Lecture topics: ■ Demodicosis in dogs

and cats: how to diagnose and treat it successfully

■ Cytology in dermatology: how to perform and interpret it correctly

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WSAVA NEWS

Volcano Fountain Show at Lotte Hotel, Jeju

2011 WSAVA·FASAVA WORLD CONGRESS SECRETARIATSun-in Bldg. 773-7 Yeoksam-dong, Gangnam-gu, Seoul, KoreaTel: +82-2-3461-1140Fax: +82-2-3461-1340Email: [email protected] website: www.wsava2011.org

Intervet/Schering-Plough Animal Health, Mérial, Nestlé Purina, Novartis Animal Health, Pfizer Animal Health, Waltham and the WSAVA itself.

One Health conferenceThe Commonwealth Scientific and Industrial Research Organisation (CSIRO) recently hosted the 1st International One Health Congress in Melbourne, Australia (14–16 February 2011).

Over the past few years, the One Health concept has brought together experts working in the areas of animal and human disease. One Health has provided a new synthesis for public health and veterinary communities, particularly in the United States, Europe and Australia. However, there is an urgent need and a growing interest to broaden the agenda to incorporate a truly global perspective and to include environmental issues.

This 1st International One Health Congress aimed to achieve these goals by focusing clearly on the risks and challenges brought about by the interactions between animal and human health and the environment. These were considered in the general context of the science and research being undertaken, but critically the focus was on the outcomes that need

to be achieved to manage the growing risks to global health effectively.

Speakers included:

■ Laureate Professor Peter Doherty ■ Dr Alex Thiermann ■ Dr Henrik C. Wegener ■ Professor Mark M. Rweyemamu ■ Dr David Heymann ■ Professor John Mackenzie ■ Dr Peter Daszak ■ Dr Martyn Jeggo

The Congress programme featured keynote plenary sessions, expert panel/debates, Out of the Box Sessions and the development of outcomes across the following themes that ran throughout the Congress:

■ Setting the scene ■ Disease emergence ■ Environmental drivers ■ Trade, food security and food safety ■ Science, policy and political action ■ Global survival ■

The Fountain Show recreates the spectacle of a volcanic eruption and was produced by SPECTRA Company, the producer of the Volcano Show at Mirage Hotel in Las Vegas. It describes the battle between the spirits of water and fire, the natural forces that formed the ancient Jeju, and the giant dragon that suppressed the battle. The Fountain Show features dazzling special effects such as an exploding rocky mountain and a fire-breathing dragon. The 12-minute performance begins at 8:30pm every day in the outdoor garden on the 1st floor of Lotte Hotel, Jeju. ■

KEY DATES REMINDEREarly Bird: Ends 30 April 2011

Pre-Registration: 1 May–30 September 2011

Visit www.wsava2011.org to register or find more information.

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THE companion INTERVIEW

Sue ShawBVSc(Hons) MSc DipACVIM DipECVIM-CA FACVSc Cert Arts (Arch) MRCVS

QYou have become known within the profession through your work in highlighting the threat

from exotic diseases. How did you become involved in that area?

APrior to arriving in the UK, I had travelled and trained in countries where a wide variety of infectious

diseases were present, and lectured in this subject while at Murdoch. It was an unusual situation for me to work in a country where infectious diseases were primarily viral and limited by vaccination; the rest were considered exotic. This changed in 1998 with the Kennedy report and I expected there to be a rapid increase in exotic diseases being imported into the UK. I established the Acarus Laboratory in 1999 as I knew there would be demand for information and diagnostics.

Were you in practice earlier in your career?Yes, about five years of private practice in Australia including 18 months in mixed practice in southern Tablelands of NSW, 12 months of locums travelling throughout Australia and two years in exclusive small animal practice in Melbourne.

What do you consider to be your most important achievement during your career?Establishing the Acarus Laboratory.

What has been your main interest outside work?Landscape archaeology as it relates especially to buildings. They are still standing and so can be studied using techniques that are not invasive, i.e. no destructive excavation. I have special interest in old maps and relating these to existing landscape features around villages.

Where and when were you happiest?I am happiest outside in the landscape with a map and book for wildlife identification. The western coastal landscapes of UK and Ireland are favourites.

Sue Shaw was born in Sydney and grew up in Canberra and Launceston, Tasmania. Her father was a teacher and her mother a physiotherapist. She has two siblings, a brother and a sister, both younger. She graduated in veterinary medicine from the University of Sydney in 1973 and then spent six months backpacking around Europe. She gained postgraduate qualifications in the US before returning to Australia in 1982 to take up a lectureship in small animal medicine at Murdoch University in Perth, Western Australia. In 1991 she moved to the UK and was senior lecturer, Department of Clinical Veterinary Science, University of Bristol until her retirement in December 2010. She is a diplomate of both the American and European Colleges of Veterinary Internal Medicine and Fellow of the Australian College of Veterinary Scientists. At Bristol her research interests were in the epidemiology and immunopathogenesis of vector-borne and zoonotic infectious diseases of dogs and cats. She also set up the Acarus Unit for investigation of companion animal arthropod-borne infections. She has been an independent member of the Veterinary Policy Group of the BVA and was a much-valued chairman of the BSAVA Scientific Committee

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NI CONGRESS

BSAVA Northern Ireland Congress

Following an extremely successful conference last year, BSAVA Northern Ireland is

looking forward to returning to Belfast for our 2011 Congress. Our conference will be held over the weekend of 20–22 May 2011 in the Europa Hotel, Belfast.

We will be concentrating on all things orthopaedic this year and we are delighted to welcome the Bionic Vet himself, Noel Fitzpatrick, to give the veterinary lectures. He will be bringing us right up to date with current procedures for the common orthopaedic conditions encountered in practice.

As always, the BVNA are holding their conference alongside us and they will also carry the theme of orthopaedics. The nursing lectures will be given by Julian Hoad, whose enthusiasm for his subject ensures that he is always a popular lecturer.

We are looking forward to our return to the Europa Hotel in Belfast. Its recent refurbishment affords us excellent conference facilities in luxurious surroundings. In particular, we will have a first-class exhibition hall for our Trade Exhibition which will also include a nail bar and cocktail masterclasses, which have proved extremely popular.

Alongside the first-rate CPD on offer, we will be kicking up our heels at our Annual Gala Dinner. This is held in the opulent Grand Ball Room in the Europa and will be followed by dancing the night away to the live five-piece band ‘Brazil’.

Holding our conference in Belfast provides convenience for our vets and nurses in Northern Ireland to access high-quality CPD. However, with Northern Ireland’s two main airports within 30 minutes of the hotel and the ferry terminal only a bus ride away, this conference is also a great option for our colleagues on the mainland. Only a short flight from the UK and you have a great weekend break in Belfast along with superb, cost-effective CPD – what more could we ask for?!

You can register for the BSAVA Northern Ireland weekend conference by visiting the BSAVA website – www.bsava.com – or by returning the registration form on the back of the conference brochure, which you can also download from this website. ■

Who has been the most inspiring influence on your professional career?Professor Bill Clark at Murdoch for all aspects of teaching and Professor Ed Breitshwerdt for vector-borne diseases.

What was your most important decision, and why?Moving from Australia to the USA for my postgraduate training. There were no opportunities in Australia for residency training in small animal medicine at that time.

What has been the most frustrating aspect of your working life?Trying to keep up with university expectations in all three areas; clinical, research excellence and teaching, at the same time as coping with the insidious increase in administrative duties associated with increased student/staff ratio.

What is the most significant lesson you have learned so far in life?If you’ve achieved all that you can in a phase of your life, don’t hang round harking back to the old days. Move on to another challenge.

If you were given unlimited political power, what would you do with it?Drop it and run fast in the opposite direction!

If you could change one thing about your appearance or personality, what would it be?I would wear my heart on my sleeve less often and shut up more frequently!

What is your most important possession?My dual passports.

What would you have done if you hadn’t been a vet?Landscape historian involved in interaction between conservation and sustainability. ■

PRICES BSAVA Members Non-members

EARLY BIRD PRICES (before 9 April 2011)

Whole weekend £260 £440

Friday pm £90 £150

Saturday £160 £280

Sunday am £90 £150

LATE REGISTRATION PRICES (after 9 April 2011)

Whole weekend £320 £500

Friday pm £120 £180

Saturday £190 £310

Sunday am £120 £180

Bel

fast

Cat

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ral:

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aria

Tos

cano

| D

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…if you’ve achieved all that you can in a phase of your life… move on to another

challenge…

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REGIONS

BSAVA Northern Ireland Committee■■ Kerensa Scott – Chair

Kerensa qualified from Liverpool in 2000. She spent 4 years in mixed practice, including TVI work during the FMD outbreak. She also practiced in Australia and New Zealand. She has since concentrated on small animal practice. She has recently opened her own practice and is enjoying the challenges of running her own ship. When not working, she spends much of her time stopping her 2-year-old son doing whatever it is he’s not meant to be doing. Sometimes she finds time for a yoga class or a walk along the beautiful East Antrim coast where she lives. She dreams of snowboarding holidays and sunny beaches in no particular order of preference.

■■ Barbara McConnell Lowry – Treasurer

Barbara graduated in 2002 from Edinburgh University and after 4½ years in mixed animal practice, she opened her own small animal clinic. She combines this with some work as a TVI in the local Southern Ireland abattoirs. She is married to a farmer and has two small children aged 2 and 3 years. She has been a BSAVA regional officer for 4 years and is currently Treasurer.

■■ Lynsey Hamilton – SecretaryLynsey qualified from the Royal Veterinary College, London in 2001. Since then she has worked in small animal practice and currently works in an 8 vet first opinion and referral small animal clinic in Belfast. Lynsey gained her General Practitioner Certificate in Small Animal Medicine in 2007 and still enjoys regular CPD on this topic.

■■ Laura Wallace – Committee member

Laura graduated from University College Dublin in 2006. She initially worked in mixed practice on the Tyrone Donegal border before joining a small animal practice in Belfast in the summer of 2009. Being the most recent recruit of the veterinary team she states ‘I enjoy being part of such a large and busy practice, availing myself of the knowledge and skills of my experienced colleagues’. Outside of work she enjoys the outdoors, country walks with her hubby and black lab, the occasional weekend of retail therapy...with her most recent interest being in the restoration of old furniture!!

■■ Joan Hilland – Committee member

MeetYourRegionNorthern Ireland ADDITIONAL 2011

NORThERN IRELAND CPD COURSESThursday 5 May Day Meeting

DispensingSpeakers: John Hird, Philip Sketchley, Steve Dean, Fred Nind, Pam Mosedale and Mike Jessop■■ Park Plaza, Belfast International

Airport BT29 4ZY

Thursday 8 September Evening Meeting

Wound managementSpeaker: Georgie Hollis■■ VSSCo, Lisburn BT28 2SA

Thursday 6 October Evening Meeting

Abdominal surgerySpeaker: Liz Welsh■■ VSSCo, Lisburn BT28 2SA

Thursday 3 November Evening Meeting

CardiologySpeaker: Alistair Gibson■■ VSSCo, Lisburn BT28 2SA

Thursday 1 December Evening Meeting

Forensics and the lawSpeakers: John and Margaret Cooper■■ VSSCo, Lisburn BT28 2SA

For further information on events in the Northern Ireland Region, email [email protected], or visit the www.bsava.com .

As part of a continuing series, this month companion features Northern Ireland Region

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CPD diaryDAy MEETINg – SuRREy AND SuSSEx REgION

Thursday 21 AprilBody cavity effusionsSpeakers: David Walker and David KillickLeatherhead Golf Club, Kingston Road, Surrey KT22 0EEDetails from [email protected]

EVENINg MEETINg – NORTH EAST REgION

Thursday 5 May The downside of foreign travelSpeaker: Susan ShawIDEXX Laboratories Wetherby, Grange house, Sandbeck Way, Wetherby, West Yorkshire LS22 7DNDetails from [email protected]

DAy MEETINg – METROPOLITAN REgION

Sunday 8 MayFeline endocrinologySpeakers: Hattie Syme and Lucy Davisonholiday Inn, Elstree, Barnet Bypass, Borehamwood WD6 5PUDetails from [email protected]

WEEKEND MEETINg – NORTHERN IRELAND REgION

Friday 20 – Sunday 22 May Northern Ireland 2011 Congress – “From Bone to Bionic”Speaker: Noel FitzpatrickEuropa hotel, Great Victoria Street, Belfast BT2 7APDetails from [email protected]

DAy MEETINg – SOuTH WEST REgION

Monday 9 May“Two Sides to Every Story”Medical and surgical management of tumoursSpeakers: Tom Cave and Prue NeathRedwood hotel and Country Club, Bristol BS8 3TGDetails from [email protected]

DAy MEETINg – SOuTH WEST REgION

Monday 23 May“Two Sides to Every Story”use it or lose it: management, surgical and rehabilitation care of the spinal patientSpeakers: Helen Mathie and Malcolm McKeehallmark hotel, Gloucester GL4 6EADetails from [email protected]

EVENINg MEETINg – SOuTH WEST REgION

Monday 23 May Itchy dogs and catsSpeaker: Natalie PerrinsRoom 011, Roland Levinsky Building, Drake Circus, Plymouth University, Plymouth, Devon PL4 8AADetails from [email protected]

DAy MEETINg – EAST ANgLIA REgION

Sunday 22 May CardiologySpeakers: Simon Swift and Sonja FonfaraThe Cambridge Belfry, Cambourne, Cambridge CB23 6BWDetails from [email protected]

EVENINg MEETINg – MIDLAND REgION

Tuesday 17 May Surgical updateSpeaker: John WilliamsThe hilton Warwick, A429 Stratford Road, Warwick, Warwickshire CV34 6REDetails from [email protected]

DAy MEETINg – SuRREy & SuSSEx REgION

Wednesday 18 May Avian medicineSpeaker: Simon Girlingholiday Inn Gatwick Airport, Povey Cross Road, horley Rh6 0BADetails from [email protected]

EVENINg MEETINg – SOuTHERN REgION

Wednesday 4 MayPractical tips on emergency proceduresSpeaker: Dominic BarfieldPotters heron hotel, Romsey SO51 9ZFDetails from [email protected]

EVENINg MEETINg – MIDLAND REgION

Wednesday 4 May A practical approach to collapse and exercise intolerance in small animalsSpeaker: Malcolm CobbBest Western Premier, Yew Lodge hotel, Kegworth, Derby DE74 2DFDetails from [email protected]

DAy MEETINg

Tuesday 26 AprilRespiratory diseases of dog and cat: a comprehensive review Speaker: Brendan CorcoranBSAVA headquarters, GloucesterDetails from [email protected]

DAy MEETINg

Thursday 5 MayBSAVA Dispensing CourseSpeakers: Phil Sketchley, Steve Dean, John Hird, Fred Nind, Pam Mosedale and Mike JessopPark Plaza hotel, Belfast AirportDetails from [email protected]

DAy MEETINg

Tuesday 10 MayEmergency medicine part II: trauma patientsSpeakers: Sophie Adamantos and Dan Chan BSAVA headquarters, GloucesterDetails from [email protected]

DAy MEETINg

Thursday 12 MaySeizures: managing your epileptic nightmareSpeaker: Mark Lowrie BSAVA headquarters, GloucesterDetails from [email protected]

DAy MEETINg

Tuesday 24 MayToo much fluid, too low flow: caring for the patient with heart disease Speaker: Jo Dukes McEwanBSAVA headquarters, GloucesterDetails from [email protected]

DAy MEETINg

Wednesday 25 MayAdvanced pain nursingSpeakers: Gwen Covey Crump and Vicky Ford FennahBSAVA headquarters, GloucesterDetails from [email protected]

DAy MEETINg

Tuesday 24 Maygeriatric catsSpeakers: Angie Hibbert and Jo MurrellKettering Park, NorthantsDetails from [email protected]

DAy MEETINg

Thursday 28 AprilEndocrinology II: endocrine emergencies, collapse and effect on blood pressure Speaker: Mike Herrtage Radisson SAS, Manchester AirportDetails from [email protected]

EVENINg MEETINg – KENT REgION

Wednesday 4 MayCSI for vets: forensics and the lawSpeakers: John and Margaret Cooperhilton Maidstone hotel, Bearsted Road, Weavering, Maidstone, Kent ME14 5AADetails from [email protected]

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For more information or to book visit www.bsava.com, email [email protected] or call the Membership and Customer Services Team on 01452 726700

seizuresManaging your worst epileptic nightmarewith Mark Lowrie

Thursday 12 May 2011Woodrow House, Gloucester

Fees:BSAVA Member: £218.00Non-member: £327.00

■ With an insightful video tour of seizure-mimicking events in dogs and cats, this interactive day course aims to provide the general practitioner with tips and tools for managing these diffi cult cases, which will help them to apply a logical step-wise approach and take realistic management plans back to the practice.

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