The essential publication for BSAVA members

Pets & PoisonsWork of the VPIS

P4

How To…Place an oesophagostomy tubeP12

The essential publication for BSAVA members

companionFEBRUARY 2010

BSAVA CongressDentistry highlight 8–11 AprilP21

Investigating haemoptysis in a young Border Collie

01 OFC.indd 1 19/1/10 08:51:32

2 | companion

companion

3 Member BenefitsBehaviour handouts – one of the latest member benefits

4–7 Poison in PetsJohn Bonner on the role of the VPIS and its future plans

8–11 Clinical ConundrumInvestigation of haemoptysis in a young Border Collie

12–16 How To…Place an oesophagostomy tube

17–20 Satellite Meetings at BSAVA CongressDates and times for all the events

21–22 Bit Between The Teeth at CongressDetails of dentistry lectures at Congress 2010

23 EducationCourses from the BSAVA

24–26 GrapeVINeFrom the Veterinary Information Network

27 PetsaversLatest fundraising news

28–29 PublicationsExotic Pets – the classic reborn

30–32 WSAVA NewsThe World Small Animal Veterinary Association

33–34 The companion InterviewCarmel Mooney

31 CPD DiaryWhat’s on in your area

Additional stock photography Dreamstime.com© Anna Utekhina; © Daniel Rajszczak; © Denis Babenko; © Eriklam; © Gerald Bernard; © Isselee; © Judy Worley; © Olena Adamenko; © Robwilson39

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: companion@bsava.com

Web: www.bsava.com

ISSN: 2041-2487

Editorial BoardEditor – Mark Goodfellow MA VetMB CertVR DSAM DipECVIM-CA MRCVSSenior Vice-President – Ed Hall MA VetMB PhD DipECVIM-CA MRCVS

CPD Editorial Team ■Ian Battersby BVSc DSAM DipECVIM-CA MRCVSEsther Barrett MA VetMB DVDI DipECVDI MRCVSSimon Tappin MA VetMB CertSAM DipECVIM-CA MRCVS

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

Design and Production ■BSAVA 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 .

A key benefit of membershipMore and more new titles and editions are released every year, and as a member you get these invaluable and popular additions to your veterinary library at great discounts on the non-member price, making it a key benefit of membership. Add to this unique promotional discounts and special offers for members and your practice library A-Z will soon be brimming with internationally acclaimed veterinary advice and detailed procedures.

New publications your library could be missing

BSAVA Manual of Canine and Feline ■

Behavioural Medicine 2nd edition

This manual builds on the success of the first edition; the editors have again brought together a host of international experts on behavioural medicine of dogs and cats. Designed to be even more practical and user-friendly, this title comes complete with history-taking forms, questionnaires and a collection of client handouts on a CD, so that you have the tools to hand to carry out the recommended actions.

Member price £49.00, subsidised by over a third on the cost to non-members

BSAVA Manual of ■ Exotic Pets 5th edition

This new edition remains the Foundation Manual for information across the range of exotic pets, from small mammals, through birds, reptiles and amphibians, to invertebrates. More common pets retain their place but the Manual covers the ever-increasing range of non-traditional pets encountered by the veterinary surgeon, such as marsupials, ratites and crocodilians.

Member price £49.00, subsidised by over a third on the cost to non-members

Top up your libraryOur huge range of veterinary publications now exceeds 40 titles and includes the latest in veterinary medicine in practice. This, when combined with exclusive member discounts, knowledgeable staff and fast delivery, means that the BSAVA bookstore is your one-stop-shop for your veterinary library. Buy online, over the phone, or in person at BSAVA Congress; there is no better time to top up your practice library

Visit www.bsava.com today for more information on all Manuals in our series and news of special offers, buy online to save on P&P and make sure you continue to develop your knowledge bank and career.

02 Page 2.indd 2 19/1/10 08:56:27

companion | 3

MEMBER BENEFITSMEMBER BENEFITS

BSAVA is adding to the list of member benefits by providing handouts, now available at www.bsava.com, to inform clients

about behaviour issues in cats and dogs

The BSAVA Manual of Canine and Feline Behavioural Medicine, 2nd edition contains a wealth of further information to help the general and aspiring specialist practitioner to expand their knowledge with useful information that can be readily applied to their daily practice. Visit our online bookshop at www.bsava.com or call 01452 726700 for more information and to purchase your copy.

All members of the BSAVA can now get free access to a series of client handouts and questionnaires on canine and feline

behaviour, available to download from the Membership page at www.bsava.com – simply log in, go to the Membership page and click on ‘Access to Manual Handouts’.

These handouts are taken from the new edition of the BSAVA Manual of Canine and Feline Behavioural Medicine and are designed to enable vets to create a detailed and functional treatment plan for their patients. Each document is provided as a PDF file with a text box in the top right hand corner where you can add your practice details before printing out. For those of you buying the Manual, the handouts are also provided on a CD in the back of the book.

Promoting animal welfareBehavioural medicine has advanced rapidly and it is important that practitioners have access to the best and most up-to-date information. The handouts cover a wide range of topics and can be divided into four

categories. The handouts on behaviour problems include issues such as handling aggressive behaviour, house soiling, and stressful situations such as noise, car journeys and visits to the vet. A series of forms on new pets covers training and playing with puppies and kittens, and introducing new pets to the household including adopting rescue animals. Other forms give general training guidance and exercises for owners. Everyone’s aim is to achieve the best for companion animals in terms of their health and welfare, and sharing this new information should help in shedding some of the myths about canine and feline behaviour.

Assessing the pet’s environmentThe final broad category of forms covers how to improve the pet’s environment, including considerations in animal shelter settings. In addition, a series of client questionnaires is included – owners can be asked to complete these before or during the initial consultation. Finally we have also provided the referral form approved by the Companion Animal Behaviour Therapy Study Group, for use when referring cases for behavioural consultations.

You tell usThe BSAVA continually strives to provide its members with tools to assist their veterinary practice and contribute to professional development. We aim to develop and expand the resources available on our website and welcome your suggestions for information that would be useful for your practice. Please email your comments and suggestions to companion@bsava.com ■

Behaviour Handouts now available

about behaviour issues in cats and dogs

issues such as handling aggressive behaviour, house soiling, and stressful situations such as noise, car journeys and visits to the vet. A series of forms on new

03 Page 3.indd 3 19/1/10 08:48:56

2 | companion

companion

3 Member BenefitsBehaviour handouts – one of the latest member benefits

4–7 Poison in PetsJohn Bonner on the role of the VPIS and its future plans

8–11 Clinical ConundrumInvestigation of haemoptysis in a young Border Collie

12–16 How To…Place an oesophagostomy tube

17–20 Satellite Meetings at BSAVA CongressDates and times for all the events

21–22 Bit Between The Teeth at CongressDetails of dentistry lectures at Congress 2010

23 EducationCourses from the BSAVA

24–26 GrapeVINeFrom the Veterinary Information Network

27 PetsaversLatest fundraising news

28–29 PublicationsExotic Pets – the classic reborn

30–32 WSAVA NewsThe World Small Animal Veterinary Association

33–34 The companion InterviewCarmel Mooney

31 CPD DiaryWhat’s on in your area

Additional stock photography Dreamstime.com© Anna Utekhina; © Daniel Rajszczak; © Denis Babenko; © Eriklam; © Gerald Bernard; © Isselee; © Judy Worley; © Olena Adamenko; © Robwilson39

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: companion@bsava.com

Web: www.bsava.com

ISSN: 2041-2487

Editorial BoardEditor – Mark Goodfellow MA VetMB CertVR DSAM DipECVIM-CA MRCVSSenior Vice-President – Ed Hall MA VetMB PhD DipECVIM-CA MRCVS

CPD Editorial Team ■Ian Battersby BVSc DSAM DipECVIM-CA MRCVSEsther Barrett MA VetMB DVDI DipECVDI MRCVSSimon Tappin MA VetMB CertSAM DipECVIM-CA MRCVS

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

Design and Production ■BSAVA 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 .

A key benefit of membershipMore and more new titles and editions are released every year, and as a member you get these invaluable and popular additions to your veterinary library at great discounts on the non-member price, making it a key benefit of membership. Add to this unique promotional discounts and special offers for members and your practice library A-Z will soon be brimming with internationally acclaimed veterinary advice and detailed procedures.

New publications your library could be missing

BSAVA Manual of Canine and Feline ■

Behavioural Medicine 2nd edition

This manual builds on the success of the first edition; the editors have again brought together a host of international experts on behavioural medicine of dogs and cats. Designed to be even more practical and user-friendly, this title comes complete with history-taking forms, questionnaires and a collection of client handouts on a CD, so that you have the tools to hand to carry out the recommended actions.

Member price £49.00, subsidised by over a third on the cost to non-members

BSAVA Manual of ■ Exotic Pets 5th edition

This new edition remains the Foundation Manual for information across the range of exotic pets, from small mammals, through birds, reptiles and amphibians, to invertebrates. More common pets retain their place but the Manual covers the ever-increasing range of non-traditional pets encountered by the veterinary surgeon, such as marsupials, ratites and crocodilians.

Member price £49.00, subsidised by over a third on the cost to non-members

Top up your libraryOur huge range of veterinary publications now exceeds 40 titles and includes the latest in veterinary medicine in practice. This, when combined with exclusive member discounts, knowledgeable staff and fast delivery, means that the BSAVA bookstore is your one-stop-shop for your veterinary library. Buy online, over the phone, or in person at BSAVA Congress; there is no better time to top up your practice library

Visit www.bsava.com today for more information on all Manuals in our series and news of special offers, buy online to save on P&P and make sure you continue to develop your knowledge bank and career.

02 Page 2.indd 2 19/1/10 08:56:27

companion | 3

MEMBER BENEFITSMEMBER BENEFITS

BSAVA is adding to the list of member benefits by providing handouts, now available at www.bsava.com, to inform clients

about behaviour issues in cats and dogs

The BSAVA Manual of Canine and Feline Behavioural Medicine, 2nd edition contains a wealth of further information to help the general and aspiring specialist practitioner to expand their knowledge with useful information that can be readily applied to their daily practice. Visit our online bookshop at www.bsava.com or call 01452 726700 for more information and to purchase your copy.

All members of the BSAVA can now get free access to a series of client handouts and questionnaires on canine and feline

behaviour, available to download from the Membership page at www.bsava.com – simply log in, go to the Membership page and click on ‘Access to Manual Handouts’.

These handouts are taken from the new edition of the BSAVA Manual of Canine and Feline Behavioural Medicine and are designed to enable vets to create a detailed and functional treatment plan for their patients. Each document is provided as a PDF file with a text box in the top right hand corner where you can add your practice details before printing out. For those of you buying the Manual, the handouts are also provided on a CD in the back of the book.

Promoting animal welfareBehavioural medicine has advanced rapidly and it is important that practitioners have access to the best and most up-to-date information. The handouts cover a wide range of topics and can be divided into four

categories. The handouts on behaviour problems include issues such as handling aggressive behaviour, house soiling, and stressful situations such as noise, car journeys and visits to the vet. A series of forms on new pets covers training and playing with puppies and kittens, and introducing new pets to the household including adopting rescue animals. Other forms give general training guidance and exercises for owners. Everyone’s aim is to achieve the best for companion animals in terms of their health and welfare, and sharing this new information should help in shedding some of the myths about canine and feline behaviour.

Assessing the pet’s environmentThe final broad category of forms covers how to improve the pet’s environment, including considerations in animal shelter settings. In addition, a series of client questionnaires is included – owners can be asked to complete these before or during the initial consultation. Finally we have also provided the referral form approved by the Companion Animal Behaviour Therapy Study Group, for use when referring cases for behavioural consultations.

You tell usThe BSAVA continually strives to provide its members with tools to assist their veterinary practice and contribute to professional development. We aim to develop and expand the resources available on our website and welcome your suggestions for information that would be useful for your practice. Please email your comments and suggestions to companion@bsava.com ■

Behaviour Handouts now available

about behaviour issues in cats and dogs

issues such as handling aggressive behaviour, house soiling, and stressful situations such as noise, car journeys and visits to the vet. A series of forms on new

03 Page 3.indd 3 19/1/10 08:48:56

VPIS

4 | companion

Poisons in petsThe Veterinary Poisons Information

Service at Guy’s Hospital in London provides a vital function in our

profession – proven recently when a newspaper article about antifreeze

poisoning caused a furore and potentially more cases. Manager Alex Campbell tells John Bonner

about the role the service plays and its plans for the future

04-07 Poisons.indd 4 19/1/10 08:54:56

companion | 5

VPIS

➥

A poisonous item can prove especially toxic when a story about it gets into the hands of a national newspaper. So after Sunday Times columnist

Rod Liddle made an ill-judged contribution to the animal welfare debate, staff at the VPIS prepared themselves to deal with a flurry of calls asking for advice on treating ethylene glycol toxicity in pets.

Liddle’s big idea was to write a piece applauding the actions of Katherine Hall who left a tray of tuna laced with antifreeze to keep her neighbour’s cats out of her garden. Both cats died and she was ordered to pay £1500 in compensation to the distraught owner. The item brought angry protests from the BSAVA, BVA and welfare charities, and raised concerns at the VPIS over the risks of copycat actions by other people with grievances against their neighbour’s pets.

Alex Campbell says there was some evidence of an increase in enquiries about possible antifreeze toxicity to the unit in the weeks after the article appeared. However, before they can say that there was a significant effect, the staff will have to examine the data carefully, including the information returning from practices on the clinical outcomes.

Certainly, there have been incidents in the past in which people who may not been aware of the toxicity of a commonly available product were motivated to use it after reading about its effects – a spate of suicides in the 1980s caused by people ingesting the herbicide paraquat is the classic example, Alex says. However, unless there is a rash of enquiries from the same area, it may be difficult to pick out a sudden increase against normal background levels, particularly in early winter when there is an increased risk of accidental exposure to antifreeze.

Reporting casesMoreover, not all small animal practices in the country are subscribers to the VPIS and those that have already encountered poisoning cases involving these compounds may no longer need any advice on how to deal with them. So, the VPIS cannot give definitive figures on the total numbers of poisoning cases around the country involving any specific agent, but it can highlight trends, as well as giving invaluable guidance for dealing with specific cases.

In 2009, the 14 full time staff at the toxicology unit handled about 22,000 enquiries from veterinary practices. That is only part of their workload, as their primary role is in taking calls from hospital doctors and GPs on dealing with human poisoning cases. In addition, they offer other specialist services, such as a herbal and traditional Chinese medicine advice line and assistance to the pharmaceutical industry in conducting clinical trials.

About 1100 veterinary businesses and more than 2000 individual clinics subscribed to the service in 2008, according to the unit’s latest annual report. This is a 4% increase on registrations in the previous year. The number of enquiries has also shown a steady 10 to 15% growth over the past few years. Since the total number of incidents is unlikely to have grown significantly, this probably reflects a greater awareness by veterinary surgeons of the value of the service. When the demand eventually does start to plateau, this will probably give a more accurate picture of the overall scale of the problem with poisoning cases in small animal practice, Alex notes.

In the meantime, his colleagues are seeking to fine-tune the service offered to subscribers with a complete overhaul of a database which contains details of more than 160,000 cases. The new system should be up and running by April 2010 and will allow researchers to analyse the data with much greater precision – picking out incidents by individual postcodes and focussing on incidents in specific breeds.

Types of casesThe overwhelming majority of cases on the VPIS files involve dogs, which are much more likely to become the victims of accidental poisoning than cats. The latter will more frequently ingest a toxin when licking off a material that has contaminated their coat – hence incidents involving the pollen of lilies and home decorating products are common reasons for contacting the unit.

Of course, with dogs it is their undiscriminating appetites that get them into trouble – chocolate, analgesic drugs and rodenticides are regular products in the top 10 reports. Labrador Retrievers, Jack Russell Terriers, West Highland Whites and Staffordshire Bull Terriers are invariably among the most common

04-07 Poisons.indd 5 19/1/10 08:54:56

VPIS

4 | companion

Poisons in petsThe Veterinary Poisons Information

Service at Guy’s Hospital in London provides a vital function in our

profession – proven recently when a newspaper article about antifreeze

poisoning caused a furore and potentially more cases. Manager Alex Campbell tells John Bonner

about the role the service plays and its plans for the future

04-07 Poisons.indd 4 19/1/10 08:54:56

companion | 5

VPIS

➥

A poisonous item can prove especially toxic when a story about it gets into the hands of a national newspaper. So after Sunday Times columnist

Rod Liddle made an ill-judged contribution to the animal welfare debate, staff at the VPIS prepared themselves to deal with a flurry of calls asking for advice on treating ethylene glycol toxicity in pets.

Liddle’s big idea was to write a piece applauding the actions of Katherine Hall who left a tray of tuna laced with antifreeze to keep her neighbour’s cats out of her garden. Both cats died and she was ordered to pay £1500 in compensation to the distraught owner. The item brought angry protests from the BSAVA, BVA and welfare charities, and raised concerns at the VPIS over the risks of copycat actions by other people with grievances against their neighbour’s pets.

Alex Campbell says there was some evidence of an increase in enquiries about possible antifreeze toxicity to the unit in the weeks after the article appeared. However, before they can say that there was a significant effect, the staff will have to examine the data carefully, including the information returning from practices on the clinical outcomes.

Certainly, there have been incidents in the past in which people who may not been aware of the toxicity of a commonly available product were motivated to use it after reading about its effects – a spate of suicides in the 1980s caused by people ingesting the herbicide paraquat is the classic example, Alex says. However, unless there is a rash of enquiries from the same area, it may be difficult to pick out a sudden increase against normal background levels, particularly in early winter when there is an increased risk of accidental exposure to antifreeze.

Reporting casesMoreover, not all small animal practices in the country are subscribers to the VPIS and those that have already encountered poisoning cases involving these compounds may no longer need any advice on how to deal with them. So, the VPIS cannot give definitive figures on the total numbers of poisoning cases around the country involving any specific agent, but it can highlight trends, as well as giving invaluable guidance for dealing with specific cases.

In 2009, the 14 full time staff at the toxicology unit handled about 22,000 enquiries from veterinary practices. That is only part of their workload, as their primary role is in taking calls from hospital doctors and GPs on dealing with human poisoning cases. In addition, they offer other specialist services, such as a herbal and traditional Chinese medicine advice line and assistance to the pharmaceutical industry in conducting clinical trials.

About 1100 veterinary businesses and more than 2000 individual clinics subscribed to the service in 2008, according to the unit’s latest annual report. This is a 4% increase on registrations in the previous year. The number of enquiries has also shown a steady 10 to 15% growth over the past few years. Since the total number of incidents is unlikely to have grown significantly, this probably reflects a greater awareness by veterinary surgeons of the value of the service. When the demand eventually does start to plateau, this will probably give a more accurate picture of the overall scale of the problem with poisoning cases in small animal practice, Alex notes.

In the meantime, his colleagues are seeking to fine-tune the service offered to subscribers with a complete overhaul of a database which contains details of more than 160,000 cases. The new system should be up and running by April 2010 and will allow researchers to analyse the data with much greater precision – picking out incidents by individual postcodes and focussing on incidents in specific breeds.

Types of casesThe overwhelming majority of cases on the VPIS files involve dogs, which are much more likely to become the victims of accidental poisoning than cats. The latter will more frequently ingest a toxin when licking off a material that has contaminated their coat – hence incidents involving the pollen of lilies and home decorating products are common reasons for contacting the unit.

Of course, with dogs it is their undiscriminating appetites that get them into trouble – chocolate, analgesic drugs and rodenticides are regular products in the top 10 reports. Labrador Retrievers, Jack Russell Terriers, West Highland Whites and Staffordshire Bull Terriers are invariably among the most common

04-07 Poisons.indd 5 19/1/10 08:54:56

VPIS

➦

Poisons in pets

victims in these incidents, he says. The numbers of serious incidents involving long-acting anticoagulant rodenticides is a particular concern at the moment following the withdrawal of the only oral vitamin K based antidote available in the UK†. “Often it will be impractical for these animals to receive the number of doses of the injectible product needed every day to counteract an agent with such a long half life. This is something we will be watching very closely,” Alex says.

Working with the professionThe success of the VPIS initiative has been entirely dependent on a two-way exchange of information between the unit and its subscriber practices. Following between 50 and 60% of enquiries, the unit sends a form requesting further details of the case and its outcomes. About half of those forms are returned – an impressively high response rate for any questionnaire survey. “Yes, it helps that we send these out with a reply paid envelope and that most veterinary practices are small organisations in which people remember the details of a case. But I think the main reason why the return rate is so good is that vets appreciate that their efforts matter. The information that they can give goes straight into the database where it helps to refine the advice that we are able to give. Our subscribers feel that they have ownership of this information and long may that remain so.”

Many vets will also know how lucky they are to have a dedicated national veterinary toxicology service. Outside the UK, there are only two comparable initiatives that Alex is aware of. These are a poisons information service run by a leading US welfare charity and a French scheme, which is mainly geared towards farm animal cases. Moreover, the latter does not attempt to provide the sort of 24 hour, 365 day service that VPIS provides.

VPIS has some subscribers in the Irish Republic and also gives advice on veterinary issues to the human toxicology services that operate in many EU neighbours. However, while it has considered the possibility of extending the service to veterinary surgeons abroad, this is not an immediate priority. Alex points out that there are risks in trying to provide advice to veterinary surgeons in situations where there are major linguistic and cultural differences. “Even in countries like Australia and South Africa with a common language, the major differences in the local flora and fauna could affect our ability to provide a comprehensive information service.“

Future of the ServiceSo the long-term future of the service will depend on Alex’s employer, the Guy’s and St Thomas’ NHS Foundation Trust, reaching an equitable arrangement with its veterinary customers that will allow the service to at least meet its running costs.

This is bound to result in changes to the current arrangements under which subscribers pay a single annual fee based on the numbers of veterinarians employed in the practice. Alex points out that this may not be an attractive option for a small practice which rarely has any need to contact the service. On the other hand, it is often a very attractive arrangement for large practices and those providing a dedicated emergency service providers, which make a growing proportion of the out-of-hours calls.

Future arrangements are likely to be more like a mobile telephone contract, with all subscribers paying a small annual registration fee and then buying a call package which allows them so many enquiries over the period of the contract. Under this sort of pay-per-use arrangement, the cost of each enquiry will be set at a notional £20 to £25; being more transparent than the current arrangements, this can then be charged back to the pet-owning client. VPIS managers have considered whether the charges should include a time element to take account of the complexity of the enquiry or whether it was made as an evening or weekend call. However, for simplicity, it is likely that all enquiries will be treated exactly the same.

Practices should find these arrangements easier to manage, particularly after the VPIS has finalised the development of a software package that will allow client practices to monitor their account online and to buy credit for further enquiries whenever it is needed. VPIS hopes these arrangements will be in place by the end of next year.

One situation in which these arrangements may not suit the practice is in the case of triage calls – where the pet owner’s initial telephone enquiry does not result in a chargeable consultation. In that scenario, the veterinary practice will either have to overcome the profession’s traditional reluctance to charge for telephone advice – or they should simply accept the financial penalty of having to make a call to the VPIS, Alex notes.

CommunicationTo date, the VPIS has kept a fairly low public profile, dealing almost exclusively with medical professionals and making little effort to interact with the general

†See: www.bsava.com/News/FeaturedArticles/AvailabilityofVitaminK/tabid/706/Default.aspx

6 | companion

04-07 Poisons.indd 6 19/1/10 08:54:56

companion | 7

VPIS

WHEN REPORTING A POISONFor any member of staff at a veterinary practice who takes a call about a presumed toxicological emergency, it is a good idea to begin the conversation by taking the client’s contact details, in case the connection is lost. They should then try to get the essential details from the client that will shape the later clinical management of the case – but be warned, this is no simple task if the client is distressed.

The first questions should relate to the patient. It is vital to know the following details:Species ■

Breed ■

Age ■

Sex ■

Weight (a best estimate may have to do) ■

Other details – past medical history, whether pregnant or lactating and whether on any current medication ■

The client should then be asked essential details about the presumed poison:Full name of the product (as it appears on the packaging) ■

The strength/concentration of the active ingredients ■

The manufacturer’s name ■

Other components (including solvents and excipients) ■

Presentation or packaging details (tablets, capsules, bottle, etc.) ■

Presentation during the incident (whether concentrated or diluted, etc.) ■

For plants and other natural materials – which part was consumed (leaves, berries, etc.) ■

Quantity of material ingested (it can be helpful to ask how much remains in order to assess how much has been consumed) ■

The practice will also need to know some other details, such as when the exposure occurred. The first obvious step is to prevent any further contact with the toxin and to check on the safety of any other animals that are not currently showing clinical signs. Clients should be warned to avoid coming into contact with the presumed toxin themselves. If it is appropriate for the client to attend the surgery with their animal; they should be asked to bring along a sample of the product or packaging.

There are many sources of useful information, such as standard toxicology textbooks, that can be useful in directing treatment of the patient. The Internet can be a helpful tool in obtaining details about a particular drug or plant but staff should be aware that much of the information available online is unreferenced and may only relate to the effects of toxins in human patients. So the VPIS is the best source of data specific to veterinary patients and can be accessed by any registered veterinary professional.

The service moved in November 2009 to new offices. Its full address is VPIS, Medical Toxicology Information Service, Mary Sheridan House, Guy’s Hospital, Great Maze Pond, London SE1 9RTTel 020 7188 0200 Fax 020 7188 0700 Email vpis@gstt.nhs.uk

public. However, in another change of policy, its staff are planning to start communicating more directly with pet owners by posting information on its website – www.vpisuk.co.uk – on toxicology issues. Much of this will involve brochures and other downloadable documents produced in association with animal charities and veterinary organisations. They hope that improving the quality of information publicly available will reduce the number of false alarms, causing less stress for the owner and avoiding needless activity for their veterinary staff.

VPIS is also planning to improve the quality of the

dialogue that it has with its subscriber practices. This will include the production of a newsletter drawing attention to issues such as that mentioned earlier – the recent withdrawal of a key treatment used against a common cause of poisoning in pet animals. For many years, VPIS staff have provided regular training for veterinary students and now plans to extend their CPD activities with one-day courses for veterinary surgeons and VNs. There are also plans for VPIS staff to meet their clients face to face, with stands in the exhibitions at BSAVA Congress and other major professional meetings, Alex explains. ■

VPIS

I think the main reason why the return rate is so good is that vets appreciate

that their efforts matter. The information that they can give goes straight into the

database where it helps to refine the advice that we are able to give…

04-07 Poisons.indd 7 19/1/10 08:54:58

VPIS

➦

Poisons in pets

victims in these incidents, he says. The numbers of serious incidents involving long-acting anticoagulant rodenticides is a particular concern at the moment following the withdrawal of the only oral vitamin K based antidote available in the UK†. “Often it will be impractical for these animals to receive the number of doses of the injectible product needed every day to counteract an agent with such a long half life. This is something we will be watching very closely,” Alex says.

Working with the professionThe success of the VPIS initiative has been entirely dependent on a two-way exchange of information between the unit and its subscriber practices. Following between 50 and 60% of enquiries, the unit sends a form requesting further details of the case and its outcomes. About half of those forms are returned – an impressively high response rate for any questionnaire survey. “Yes, it helps that we send these out with a reply paid envelope and that most veterinary practices are small organisations in which people remember the details of a case. But I think the main reason why the return rate is so good is that vets appreciate that their efforts matter. The information that they can give goes straight into the database where it helps to refine the advice that we are able to give. Our subscribers feel that they have ownership of this information and long may that remain so.”

Many vets will also know how lucky they are to have a dedicated national veterinary toxicology service. Outside the UK, there are only two comparable initiatives that Alex is aware of. These are a poisons information service run by a leading US welfare charity and a French scheme, which is mainly geared towards farm animal cases. Moreover, the latter does not attempt to provide the sort of 24 hour, 365 day service that VPIS provides.

VPIS has some subscribers in the Irish Republic and also gives advice on veterinary issues to the human toxicology services that operate in many EU neighbours. However, while it has considered the possibility of extending the service to veterinary surgeons abroad, this is not an immediate priority. Alex points out that there are risks in trying to provide advice to veterinary surgeons in situations where there are major linguistic and cultural differences. “Even in countries like Australia and South Africa with a common language, the major differences in the local flora and fauna could affect our ability to provide a comprehensive information service.“

Future of the ServiceSo the long-term future of the service will depend on Alex’s employer, the Guy’s and St Thomas’ NHS Foundation Trust, reaching an equitable arrangement with its veterinary customers that will allow the service to at least meet its running costs.

This is bound to result in changes to the current arrangements under which subscribers pay a single annual fee based on the numbers of veterinarians employed in the practice. Alex points out that this may not be an attractive option for a small practice which rarely has any need to contact the service. On the other hand, it is often a very attractive arrangement for large practices and those providing a dedicated emergency service providers, which make a growing proportion of the out-of-hours calls.

Future arrangements are likely to be more like a mobile telephone contract, with all subscribers paying a small annual registration fee and then buying a call package which allows them so many enquiries over the period of the contract. Under this sort of pay-per-use arrangement, the cost of each enquiry will be set at a notional £20 to £25; being more transparent than the current arrangements, this can then be charged back to the pet-owning client. VPIS managers have considered whether the charges should include a time element to take account of the complexity of the enquiry or whether it was made as an evening or weekend call. However, for simplicity, it is likely that all enquiries will be treated exactly the same.

Practices should find these arrangements easier to manage, particularly after the VPIS has finalised the development of a software package that will allow client practices to monitor their account online and to buy credit for further enquiries whenever it is needed. VPIS hopes these arrangements will be in place by the end of next year.

One situation in which these arrangements may not suit the practice is in the case of triage calls – where the pet owner’s initial telephone enquiry does not result in a chargeable consultation. In that scenario, the veterinary practice will either have to overcome the profession’s traditional reluctance to charge for telephone advice – or they should simply accept the financial penalty of having to make a call to the VPIS, Alex notes.

CommunicationTo date, the VPIS has kept a fairly low public profile, dealing almost exclusively with medical professionals and making little effort to interact with the general

†See: www.bsava.com/News/FeaturedArticles/AvailabilityofVitaminK/tabid/706/Default.aspx

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04-07 Poisons.indd 6 19/1/10 08:54:56

companion | 7

VPIS

WHEN REPORTING A POISONFor any member of staff at a veterinary practice who takes a call about a presumed toxicological emergency, it is a good idea to begin the conversation by taking the client’s contact details, in case the connection is lost. They should then try to get the essential details from the client that will shape the later clinical management of the case – but be warned, this is no simple task if the client is distressed.

The first questions should relate to the patient. It is vital to know the following details:Species ■

Breed ■

Age ■

Sex ■

Weight (a best estimate may have to do) ■

Other details – past medical history, whether pregnant or lactating and whether on any current medication ■

The client should then be asked essential details about the presumed poison:Full name of the product (as it appears on the packaging) ■

The strength/concentration of the active ingredients ■

The manufacturer’s name ■

Other components (including solvents and excipients) ■

Presentation or packaging details (tablets, capsules, bottle, etc.) ■

Presentation during the incident (whether concentrated or diluted, etc.) ■

For plants and other natural materials – which part was consumed (leaves, berries, etc.) ■

Quantity of material ingested (it can be helpful to ask how much remains in order to assess how much has been consumed) ■

The practice will also need to know some other details, such as when the exposure occurred. The first obvious step is to prevent any further contact with the toxin and to check on the safety of any other animals that are not currently showing clinical signs. Clients should be warned to avoid coming into contact with the presumed toxin themselves. If it is appropriate for the client to attend the surgery with their animal; they should be asked to bring along a sample of the product or packaging.

There are many sources of useful information, such as standard toxicology textbooks, that can be useful in directing treatment of the patient. The Internet can be a helpful tool in obtaining details about a particular drug or plant but staff should be aware that much of the information available online is unreferenced and may only relate to the effects of toxins in human patients. So the VPIS is the best source of data specific to veterinary patients and can be accessed by any registered veterinary professional.

The service moved in November 2009 to new offices. Its full address is VPIS, Medical Toxicology Information Service, Mary Sheridan House, Guy’s Hospital, Great Maze Pond, London SE1 9RTTel 020 7188 0200 Fax 020 7188 0700 Email vpis@gstt.nhs.uk

public. However, in another change of policy, its staff are planning to start communicating more directly with pet owners by posting information on its website – www.vpisuk.co.uk – on toxicology issues. Much of this will involve brochures and other downloadable documents produced in association with animal charities and veterinary organisations. They hope that improving the quality of information publicly available will reduce the number of false alarms, causing less stress for the owner and avoiding needless activity for their veterinary staff.

VPIS is also planning to improve the quality of the

dialogue that it has with its subscriber practices. This will include the production of a newsletter drawing attention to issues such as that mentioned earlier – the recent withdrawal of a key treatment used against a common cause of poisoning in pet animals. For many years, VPIS staff have provided regular training for veterinary students and now plans to extend their CPD activities with one-day courses for veterinary surgeons and VNs. There are also plans for VPIS staff to meet their clients face to face, with stands in the exhibitions at BSAVA Congress and other major professional meetings, Alex explains. ■

VPIS

I think the main reason why the return rate is so good is that vets appreciate

that their efforts matter. The information that they can give goes straight into the

database where it helps to refine the advice that we are able to give…

04-07 Poisons.indd 7 19/1/10 08:54:58

8 | companion

CLINICAL CONUNDRUM

Clinical conundrumconundrum

Create a Problem List based on the history and physical examinationa) Coughing and Haemoptysisb) Tachypnoea with shallow breathing, and abnormal

lung soundsc) Pallord) Lethargy, inappetence and weakness

What differential diagnoses should be considered at this stageThe causes of haemoptysis following a period of coughing can be split into those associated with pulmonary or cardiac diseases. Defects of coagulation, either congenital or acquired (rodenticide toxicity), are unlikely to cause coughing for a prolonged period prior to the development of haemoptysis but cannot be completely excluded on this basis.

V n ascularCardiogenic pulmonary oedema (left-sided –heart disease) – typically pink-tinged rather than haemorrhagic fluid

Ruptured arteriovenous fistula (rarely causes –haemoptysis)Bacterial endocarditis (rarely causes –haemoptysis)Pulmonary hypertension: Congenital or –acquired cardiac defects that result in shunting of blood (rarely causes haemoptysis)Pulmonary thromboembolism: secondary to –neoplastic, endocrine, cardiac, metabolic disease (rarely causes haemoptysis)

I n nflammatory/InfectiousChronic bronchitis/bronchiectasis –Bacterial pneumonia –Pulmonary abscess –Parasites: – Angiostrongylus vasorumEosinophilic bronchopneumopathy –

T n rauma: Pulmonary contusion; tracheal rupture; foreign body (FB)A n nomalous: Lung lobe torsion (rarely causes haemoptysis)N n eoplasia: Primary lung and tracheal tumours; metastatic disease.

It is most likely that the tachypneoa, abnormal lung sounds and shallow breathing pattern are caused by the same pathology as that causing the coughing and haemoptysis.

Pallor is indicative of poor perfusion and could be associated with compromise of the cardiorespiratory system or by anaemia. Investigation of the differentials of haemoptysis should elucidate if this clinical sign requires investigation in its own right,

Lethargy, inappetence and weakness are non-specific signs of systemic disease, and investigation into the system-specific problems is likely to elucidate their cause.

What initial investigations would you consider?Thoracic radiography will be the first step in this case. It will give information to further localise the cause of the haemoptysis to the cardiovascular or respiratory system and will provide some information as to the nature of the pathological process occurring. In light of the pallor, and the (slight) possibility of a coagulopathy, blood samples should be taken to assess PCV, platelet number and clotting profile.

Gawain Hammond of the Faculty of Veterinary Medicine, University of Glasgow and Chairman of EAVDI (British & Irish Division) invites companion readers to consider the investigation of haemoptysis in a young Border Collie

Case presentationA 2-year-old male Border Collie presented with a one week history of progressive lethargy and inappetence, with shallow breathing, coughing and the development of haemoptysis in the last 48 hours. Treatment with antibiotics and non-steroidal anti-inflammatories had produced little improvement.

On physical examination, the mucous membranes were pale, and bilaterally increased harsh lung sounds were discovered on thoracic auscultation. The patient was weak, but without obvious neurological deficits and there was evidence of tachypnoea and shallow breathing.

08-11 Clinical Conundrum.indd 8 19/1/10 08:42:01

companion | 9

CLINICAL CONUNDRUM

➥

What is your interpretation of the thoracic radiographs (Figure 1)?Right lateral, left lateral and dorsoventral thoracic radiographs are shown. On both of the lateral radiographs there is a diffuse patchy alveolar pattern over the cardiac silhouette, with a further area of increased pulmonary soft tissue opacity in the caudodorsal thoracic cavity. This area appears more rounded and well-defined on the right lateral radiograph compared to the left lateral radiograph.

On the dorsoventral radiograph, the increased caudodorsal pulmonary opacity can be seen to be affecting the left caudal lung lobe area, with a moderately well-defined consolidated lung lobe with some air bronchograms (indicating an alveolar pattern) seen in the left caudal thoracic cavity, adjacent to the apex of the cardiac silhouette. There is a lobar sign at the cranial and medial margins of the left caudal lung lobe (giving sharper delineation of the margins of the affected lobe) indicating that there is lobar consolidation. There is no evidence of mediastinal shift to suggest collapse of this lung lobe.

The radiological diagnosis is that of consolidation of the left caudal lung lobe and some suspicion of a diffuse alveolar pattern affecting the more cranioventral lung fields.

What is your interpretation of the haematology results?

Parameter Result Reference range

RBC 5.7 5.5–8.5 x 1012/l

Hb 14.2 12.0–18.0 g/dl

PCV 38 37–55 %

MCV 66.7 60.0–77.0 fl

MCH 25 19.5–24.5 pg

MCHC 37.4 32.0–36.0 g/dl

WBC 24.5 6.0–12.0 x 109/l

Neutrophils 21.07 3.0–11.8 x 109/l

Lymphocytes 0.98 1.0–4.8 x 109/l

Monocytes 1.47 0.15–1.35 x 109/l

Eosinophils 0 0.1–1.25 x 109/l

Basophils 0 0 x 109/l

Platelets 93 200–500 x 109/l

Table 1: Haematological results

Figure 1: Thoracic radiographsA – Right lateralB – Left lateralC – Dorsoventral

A

B

C

08-11 Clinical Conundrum.indd 9 19/1/10 08:42:04

8 | companion

CLINICAL CONUNDRUM

Clinical conundrumconundrum

Create a Problem List based on the history and physical examinationa) Coughing and Haemoptysisb) Tachypnoea with shallow breathing, and abnormal

lung soundsc) Pallord) Lethargy, inappetence and weakness

What differential diagnoses should be considered at this stageThe causes of haemoptysis following a period of coughing can be split into those associated with pulmonary or cardiac diseases. Defects of coagulation, either congenital or acquired (rodenticide toxicity), are unlikely to cause coughing for a prolonged period prior to the development of haemoptysis but cannot be completely excluded on this basis.

V n ascularCardiogenic pulmonary oedema (left-sided –heart disease) – typically pink-tinged rather than haemorrhagic fluid

Ruptured arteriovenous fistula (rarely causes –haemoptysis)Bacterial endocarditis (rarely causes –haemoptysis)Pulmonary hypertension: Congenital or –acquired cardiac defects that result in shunting of blood (rarely causes haemoptysis)Pulmonary thromboembolism: secondary to –neoplastic, endocrine, cardiac, metabolic disease (rarely causes haemoptysis)

I n nflammatory/InfectiousChronic bronchitis/bronchiectasis –Bacterial pneumonia –Pulmonary abscess –Parasites: – Angiostrongylus vasorumEosinophilic bronchopneumopathy –

T n rauma: Pulmonary contusion; tracheal rupture; foreign body (FB)A n nomalous: Lung lobe torsion (rarely causes haemoptysis)N n eoplasia: Primary lung and tracheal tumours; metastatic disease.

It is most likely that the tachypneoa, abnormal lung sounds and shallow breathing pattern are caused by the same pathology as that causing the coughing and haemoptysis.

Pallor is indicative of poor perfusion and could be associated with compromise of the cardiorespiratory system or by anaemia. Investigation of the differentials of haemoptysis should elucidate if this clinical sign requires investigation in its own right,

Lethargy, inappetence and weakness are non-specific signs of systemic disease, and investigation into the system-specific problems is likely to elucidate their cause.

What initial investigations would you consider?Thoracic radiography will be the first step in this case. It will give information to further localise the cause of the haemoptysis to the cardiovascular or respiratory system and will provide some information as to the nature of the pathological process occurring. In light of the pallor, and the (slight) possibility of a coagulopathy, blood samples should be taken to assess PCV, platelet number and clotting profile.

Gawain Hammond of the Faculty of Veterinary Medicine, University of Glasgow and Chairman of EAVDI (British & Irish Division) invites companion readers to consider the investigation of haemoptysis in a young Border Collie

Case presentationA 2-year-old male Border Collie presented with a one week history of progressive lethargy and inappetence, with shallow breathing, coughing and the development of haemoptysis in the last 48 hours. Treatment with antibiotics and non-steroidal anti-inflammatories had produced little improvement.

On physical examination, the mucous membranes were pale, and bilaterally increased harsh lung sounds were discovered on thoracic auscultation. The patient was weak, but without obvious neurological deficits and there was evidence of tachypnoea and shallow breathing.

08-11 Clinical Conundrum.indd 8 19/1/10 08:42:01

companion | 9

CLINICAL CONUNDRUM

➥

What is your interpretation of the thoracic radiographs (Figure 1)?Right lateral, left lateral and dorsoventral thoracic radiographs are shown. On both of the lateral radiographs there is a diffuse patchy alveolar pattern over the cardiac silhouette, with a further area of increased pulmonary soft tissue opacity in the caudodorsal thoracic cavity. This area appears more rounded and well-defined on the right lateral radiograph compared to the left lateral radiograph.

On the dorsoventral radiograph, the increased caudodorsal pulmonary opacity can be seen to be affecting the left caudal lung lobe area, with a moderately well-defined consolidated lung lobe with some air bronchograms (indicating an alveolar pattern) seen in the left caudal thoracic cavity, adjacent to the apex of the cardiac silhouette. There is a lobar sign at the cranial and medial margins of the left caudal lung lobe (giving sharper delineation of the margins of the affected lobe) indicating that there is lobar consolidation. There is no evidence of mediastinal shift to suggest collapse of this lung lobe.

The radiological diagnosis is that of consolidation of the left caudal lung lobe and some suspicion of a diffuse alveolar pattern affecting the more cranioventral lung fields.

What is your interpretation of the haematology results?

Parameter Result Reference range

RBC 5.7 5.5–8.5 x 1012/l

Hb 14.2 12.0–18.0 g/dl

PCV 38 37–55 %

MCV 66.7 60.0–77.0 fl

MCH 25 19.5–24.5 pg

MCHC 37.4 32.0–36.0 g/dl

WBC 24.5 6.0–12.0 x 109/l

Neutrophils 21.07 3.0–11.8 x 109/l

Lymphocytes 0.98 1.0–4.8 x 109/l

Monocytes 1.47 0.15–1.35 x 109/l

Eosinophils 0 0.1–1.25 x 109/l

Basophils 0 0 x 109/l

Platelets 93 200–500 x 109/l

Table 1: Haematological results

Figure 1: Thoracic radiographsA – Right lateralB – Left lateralC – Dorsoventral

A

B

C

08-11 Clinical Conundrum.indd 9 19/1/10 08:42:04

10 | companion

CLINICAL CONUNDRUM

➦

Clinical conundrum

The haematology shows a marked leucocytosis and neutrophilia, some showing toxic changes, suggestive of an acute inflammatory or infectious process. There is also a mild thrombocytopenia. Clotting profiles were within normal limits.

In light of the radiographic and haematological findings refine your differential diagnosis listDifferential diagnoses for a lobar consolidation include lobar pneumonia (bacterial, foreign body, fungal, etc.), lobar neoplasia, lobar haemorrhage, atelectic change and lung lobe torsion. In this case there is no evidence of mediastinal shift towards the affected lobe to suggest atelectasis (collapse) and there is no evidence of pleural effusion or distortion of the bronchial tree seen to suggest lung lobe torsion. The major differential diagnoses for the more diffuse alveolar pattern seen cranioventrally include pneumonia, pulmonary haemorrhage, pulmonary oedema and possibly pulmonary neoplasia.

Haematological changes are not consistent with a coagulopathy as the cause of the observed clinical signs but instead could be caused by any infectious or inflammatory focus.

What further diagnostic procedures could you consider without anaesthetising the patient?Where there is pulmonary lobar consolidation, ultrasound investigation of the lung can be considered.

As long as there is not aerated lung interposed between the thoracic wall and the consolidated area of lung, the lung can be viewed via an intercostal approach. This will require a transducer with a small footprint or contact area – phased array and microconvex transducers are particularly useful for this.

The parenchyma of the consolidated lung can be assessed for the presence of bronchial structures and gas bubbles (which may give a “starry” appearance of brightly echogenic foci with distal shadowing) and also for the homogeneity of the lung parenchyma. A diffusely hypoechoic lung with uniform echotexture may be seen with atelectasis, lobar pneumonia, lobar haemorrhage or lung lobe torsion – in these cases the lung often resembles the ultrasonographic image of liver.

A more heterogenous parenchyma with loss of the normal shape and occasionally more defined rounded areas may be seen with lobar neoplasia, granuloma formation or abscessation. Where the lung is completely consolidated, bronchi may be seen as structures with parallel slightly hyperechoic walls and an anechoic centre due to the presence of fluid within the bronchial lumen.

What is your interpretation of ultrasound images from this case?Both are still images taken of the consolidated left caudal lung lobe using an intercostal approach.

Figure 2a shows consolidated lung parenchyma with a heterogenous appearance – the cursors

BAFigure 2

08-11 Clinical Conundrum.indd 10 19/1/10 08:42:05

companion | 11

CLINICAL CONUNDRUM

indicate the margins of a rounded fairly well-defined nodular area with uneven echogenicity within the lung parenchyma. Figure 2b shows a tubular structure with anechoic luminal content traversing the area of consolidated lung being imaged. Within the lumen of this tubular structure is a linear hyperechoic structure (indicated by the cursor). In addition, in this section of the consolidated lung lobe, multiple hyperechoic speckles, some with faint distal reverberation, can be seen, consistent with air bubbles within the parenchyma of the lung. The tubular structure may be a fluid-filled bronchus or a blood vessel – however no flow could be detected in this structure using Doppler imaging, suggesting a bronchus was more likely.

The sonographic findings indicate consolidation with alteration of the parenchyma of the left caudal lung lobe, suggesting abscessation, granuloma formation or neoplasia. The hyperechoic structure within the bronchus was suspected to be a bronchial foreign body (possibly a grass seed).

What are your final conclusions from the results of the imaging studies?Combining the results of the radiographic and ultrasonographic studies, the suggestion is of a lobar pneumonia (± lobar haemorrhage) with abscessation or granuloma formation due to the presence of a bronchial foreign body. There is also a suspicion of more diffuse pneumonia and/or pulmonary haemorrhage affecting other lung lobes.

What further steps and therapy could be considered?In this case, after the patient was stabilised and anaesthetised, bronchoscopy was performed. However, the haemorrhage within the bronchial tree prevented a final diagnosis being reached. At this stage, options for further investigation would include thoracic CT or surgical exploration.

The patient was taken to surgery, where a left 7th intercostal thoracotomy was performed. The left caudal lung lobe was swollen and solid on palpation, with visible abscessation formation at the caudodorsal tip. There were multiple areas where the parenchyma was disrupted, and no functional tissue

EAVDI-BID ABsTRACT PRIzEThe British and Irish Division of the European Association of Veterinary Diagnostic Imaging (EAVDI-BID) organises two annual meetings (one pre-BsAVA satellite meeting in Birmingham the day before BsAVA Congress, and one two-day autumn meeting, usually in October or November) covering a wide range of imaging topics. Membership is open to anyone with an interest in veterinary diagnostic imaging. starting in 2010, the Division is creating a prize to be awarded to the best abstract presented in the Diagnostic Imaging stream of the Clinical Research Abstracts presented at the annual BsAVA Congress. The prize will consist of a book voucher, as well as free registration for the subsequent EAVDI-BID Autumn meeting, where the winning author will be invited to present the abstract. If there are any queries, please visit the EAVDI-BID website (http://cheval.vet.gla.ac.uk/EVDI/ea-bed.htm) or email g.hammond@vet.gla.ac.uk

could be identified in the lobe. The entire lobe was removed, and when the bronchial tree was opened, a chain of multiple grass seeds was found in the bronchial tree. No evidence of pyothorax or mediastinal disease was found.

The patient recovered well following surgery, and was discharged four days after surgery. A swab taken from the excised lung lobe showed a significant growth of Escherichia coli.

Use of ultrasound in pulmonary diseaseUltrasonography of the thoracic cavity is not limited to echocardiography. As long as there is not aerated lung interposed between the transducer and the structure of interest, ultrasound examination can add valuable information to that obtained from thoracic radiography regarding pulmonary, pleural and mediastinal disease. The easiest method is to identify the area of the thoracic wall overlying the lesion from the thoracic radiographs, and to place the transducer between the intercostal spaces in this area.

If the lesion is in contact with the thoracic wall, the parenchymal appearance can be assessed. In addition, fine needle aspirates of peripheral pulmonary or large mediastinal masses or pleural effusions can be obtained under ultrasound guidance for further analysis. n

08-11 Clinical Conundrum.indd 11 19/1/10 08:42:05

10 | companion

CLINICAL CONUNDRUM

➦

Clinical conundrum

The haematology shows a marked leucocytosis and neutrophilia, some showing toxic changes, suggestive of an acute inflammatory or infectious process. There is also a mild thrombocytopenia. Clotting profiles were within normal limits.

In light of the radiographic and haematological findings refine your differential diagnosis listDifferential diagnoses for a lobar consolidation include lobar pneumonia (bacterial, foreign body, fungal, etc.), lobar neoplasia, lobar haemorrhage, atelectic change and lung lobe torsion. In this case there is no evidence of mediastinal shift towards the affected lobe to suggest atelectasis (collapse) and there is no evidence of pleural effusion or distortion of the bronchial tree seen to suggest lung lobe torsion. The major differential diagnoses for the more diffuse alveolar pattern seen cranioventrally include pneumonia, pulmonary haemorrhage, pulmonary oedema and possibly pulmonary neoplasia.

Haematological changes are not consistent with a coagulopathy as the cause of the observed clinical signs but instead could be caused by any infectious or inflammatory focus.

What further diagnostic procedures could you consider without anaesthetising the patient?Where there is pulmonary lobar consolidation, ultrasound investigation of the lung can be considered.

As long as there is not aerated lung interposed between the thoracic wall and the consolidated area of lung, the lung can be viewed via an intercostal approach. This will require a transducer with a small footprint or contact area – phased array and microconvex transducers are particularly useful for this.

The parenchyma of the consolidated lung can be assessed for the presence of bronchial structures and gas bubbles (which may give a “starry” appearance of brightly echogenic foci with distal shadowing) and also for the homogeneity of the lung parenchyma. A diffusely hypoechoic lung with uniform echotexture may be seen with atelectasis, lobar pneumonia, lobar haemorrhage or lung lobe torsion – in these cases the lung often resembles the ultrasonographic image of liver.

A more heterogenous parenchyma with loss of the normal shape and occasionally more defined rounded areas may be seen with lobar neoplasia, granuloma formation or abscessation. Where the lung is completely consolidated, bronchi may be seen as structures with parallel slightly hyperechoic walls and an anechoic centre due to the presence of fluid within the bronchial lumen.

What is your interpretation of ultrasound images from this case?Both are still images taken of the consolidated left caudal lung lobe using an intercostal approach.

Figure 2a shows consolidated lung parenchyma with a heterogenous appearance – the cursors

BAFigure 2

08-11 Clinical Conundrum.indd 10 19/1/10 08:42:05

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CLINICAL CONUNDRUM

indicate the margins of a rounded fairly well-defined nodular area with uneven echogenicity within the lung parenchyma. Figure 2b shows a tubular structure with anechoic luminal content traversing the area of consolidated lung being imaged. Within the lumen of this tubular structure is a linear hyperechoic structure (indicated by the cursor). In addition, in this section of the consolidated lung lobe, multiple hyperechoic speckles, some with faint distal reverberation, can be seen, consistent with air bubbles within the parenchyma of the lung. The tubular structure may be a fluid-filled bronchus or a blood vessel – however no flow could be detected in this structure using Doppler imaging, suggesting a bronchus was more likely.

The sonographic findings indicate consolidation with alteration of the parenchyma of the left caudal lung lobe, suggesting abscessation, granuloma formation or neoplasia. The hyperechoic structure within the bronchus was suspected to be a bronchial foreign body (possibly a grass seed).

What are your final conclusions from the results of the imaging studies?Combining the results of the radiographic and ultrasonographic studies, the suggestion is of a lobar pneumonia (± lobar haemorrhage) with abscessation or granuloma formation due to the presence of a bronchial foreign body. There is also a suspicion of more diffuse pneumonia and/or pulmonary haemorrhage affecting other lung lobes.

What further steps and therapy could be considered?In this case, after the patient was stabilised and anaesthetised, bronchoscopy was performed. However, the haemorrhage within the bronchial tree prevented a final diagnosis being reached. At this stage, options for further investigation would include thoracic CT or surgical exploration.

The patient was taken to surgery, where a left 7th intercostal thoracotomy was performed. The left caudal lung lobe was swollen and solid on palpation, with visible abscessation formation at the caudodorsal tip. There were multiple areas where the parenchyma was disrupted, and no functional tissue

EAVDI-BID ABsTRACT PRIzEThe British and Irish Division of the European Association of Veterinary Diagnostic Imaging (EAVDI-BID) organises two annual meetings (one pre-BsAVA satellite meeting in Birmingham the day before BsAVA Congress, and one two-day autumn meeting, usually in October or November) covering a wide range of imaging topics. Membership is open to anyone with an interest in veterinary diagnostic imaging. starting in 2010, the Division is creating a prize to be awarded to the best abstract presented in the Diagnostic Imaging stream of the Clinical Research Abstracts presented at the annual BsAVA Congress. The prize will consist of a book voucher, as well as free registration for the subsequent EAVDI-BID Autumn meeting, where the winning author will be invited to present the abstract. If there are any queries, please visit the EAVDI-BID website (http://cheval.vet.gla.ac.uk/EVDI/ea-bed.htm) or email g.hammond@vet.gla.ac.uk

could be identified in the lobe. The entire lobe was removed, and when the bronchial tree was opened, a chain of multiple grass seeds was found in the bronchial tree. No evidence of pyothorax or mediastinal disease was found.

The patient recovered well following surgery, and was discharged four days after surgery. A swab taken from the excised lung lobe showed a significant growth of Escherichia coli.

Use of ultrasound in pulmonary diseaseUltrasonography of the thoracic cavity is not limited to echocardiography. As long as there is not aerated lung interposed between the transducer and the structure of interest, ultrasound examination can add valuable information to that obtained from thoracic radiography regarding pulmonary, pleural and mediastinal disease. The easiest method is to identify the area of the thoracic wall overlying the lesion from the thoracic radiographs, and to place the transducer between the intercostal spaces in this area.

If the lesion is in contact with the thoracic wall, the parenchymal appearance can be assessed. In addition, fine needle aspirates of peripheral pulmonary or large mediastinal masses or pleural effusions can be obtained under ultrasound guidance for further analysis. n

08-11 Clinical Conundrum.indd 11 19/1/10 08:42:05

12 | companion

HOW TO…

How to…

Place an oesophagostomy tube

Clinical nutrition is an often neglected but crucial part of patient management, and nutritional support may be required for a variety of patients. Using material from two exciting new BSAVA publications, co-editors Nick Bexfield and Penny Watson explain when and how to place and use an oesophagostomy tube

When to consider nutritional supportSpecial nutritional support (i.e. a change to a high-calorie, high-protein diet and/or assisted (tube) feeding) should be considered in cases of:

Recent weight loss: ■■ Has the dog or cat lost >10% of its bodyweight not due to dehydration or obvious fluid shifts (e.g. diuresis)?– This is relevant even in obese animals: weight

loss in an obese, sick animal will predominantly be attributed to loss of lean body mass rather than fat and this is undesirable. Weight loss and anorexia in an obese cat are particularly worrying because of the risk of hepatic lipidosis.

Partial or complete anorexia for >3 days: ■■ Has the dog or cat eaten <85% of its calculated resting energy requirement (RER) for the last three or more days?

Animal in very catabolic state or at risk of overt ■■

malnutrition:– Does the animal have: severe burns; draining

sepsis, such as pyothorax or septic peritonitis; malabsorption or protein-losing enteropathy; or nephropathy?

– If so, is it receiving enough calories and/or protein?

– Is there an obvious loss of weight or lean body mass to suggest it is not?

Routes of enteral supportThere are a few important general rules for feeding hospitalised animals:

1. IF THE GUT WORKS, USE IT (applies to the vast majority of our patients).

2. If only PART of the gut works, use THAT part of the gut.

3. When feeding enterally, use the simplest route possible which avoids stress to the animal.

4. Appetite stimulants are NOT very effective acutely and are best reserved for when the patient has been discharged home and is recuperating.

There are a number of advantages of feeding animals enterally, which is why every effort should be made to feed animals in this way. Note: Before nutritional interventions are initiated, the patient must be stable cardiovascularly and have had any fluid, electrolyte and acid–base abnormalities addressed.

There are many enteral feeding methods available to the practising veterinary surgeon, ranging from oral or force-feeding to a number of tube-feeding methods. When using any syringe- or force-feeding method, it is important to ensure that the animal is receiving a significant amount of its daily caloric requirements. If it is not, or if it is becoming stressed by the procedure, some sort of feeding tube should be placed.

The choice of tubes includes:

Naso-oesophageal■■

Oesophageal■■

Gastrostomy (placed at laparotomy or as a ■■

percutaneous endoscopic gastrostomy (PEG))Jejunostomy.■■

12-16 How To.indd 12 19/1/10 08:40:57

companion | 13

HOW TO…

➥

The feeding route selected for a particular animal is based on the following decision-making process. Jejunostomy tubes are used only if there is a specific contraindication to placing a tube more proximally in the GI tract.

The decision-making processIs the feeding tube going to be required long ■■

term? If so, consider gastrostomy/PEG or oesophagostomy tube and NOT naso-oesophageal tube.Is there a specific contraindication to one or ■■

more tube types? For example, a naso-oesophageal tube would be contraindicated in nasal disease; both oesophagostomy and naso-oesophageal tubes are contraindicated where there is oesophageal disease (such as megaoesophagus or oesophagitis).Is there an anaesthetic risk that makes tube ■■

placement under anaesthetic an unacceptable hazard? If so, naso-oesophageal tube placement should be considered as it does not require a general anaesthetic. This could be used as a temporary measure until the animal was well enough for a general anaesthetic and more long-term tube placement.What types of diet does the patient require?■■ Naso-oesophageal tubes require liquid diets, whereas gastrostomy and oesophagostomy tubes are of a wider bore and so a greater range of gruel diets can be used.

It is extremely important to include the owner in the decision-making process, as they must be willing and able to provide the necessary nutrition if the animal is to be able to go home. Many owners can handle the three or four feedings per day that are typically required for oesophagostomy or PEG tubes.

Oesophagostomy tubes offer advantages to practitioners over PEG tubes. Oesophagostomy tubes can be placed without specialized equipment or expertise. In addition, whilst they require anaesthesia for proper placement, the amount of time required is much shorter than for other procedures. For these reasons, these tubes are a useful method of providing enteral nutrition in the practice setting.

Oesophagostomy tubes should not be placed in animals with the following conditions:

Comatose, recumbent or dysphoric animals at risk ■■

of aspirationPersistent vomiting – the tube may be expelled or ■■

retroflexed into the nasopharynxOesophagitis or severe oesophageal dysfunction ■■

(e.g. megaoesophagus).

Cellulitis is the major complication seen after oesophagostomy tube placement. Oesophageal stricture formation and fistula formation are possible but very rare.

Placement techniqueThe equipment you will need is listed in Box 1. General anaesthesia is required. The patient is placed in right lateral recumbency, and lateral and ventral aspects of the neck prepared aseptically over an area from the angle of the jaw to the shoulder.

Box 1

EqUIPMENTOesophagostomy tube (red rubber tube, ■■

standard polyurethane feeding tube or silicone feeding tube):– Cats: 10–14 Fr; 23 cm long– Dogs: 14–24 Fr; 40 cm long

Long curved forceps, e.g. Rochester–Carmalt■■

No. 15 or 20 scalpel blade and holder■■

25 mm wide adhesive tape■■

Non-absorbable suture material, needle and ■■

needle-holders

Sterile dressing to cover the tube site■■

Light bandage for the neck■■

Cotton wool or soft swabs■■

4% chlorhexidine gluconate or 10% ■■

povidone–iodine

70% surgical spirit■■

1 sterile fenestrated skin drape■■

12-16 How To.indd 13 19/1/10 08:40:58

12 | companion

HOW TO…

How to…

Place an oesophagostomy tube

Clinical nutrition is an often neglected but crucial part of patient management, and nutritional support may be required for a variety of patients. Using material from two exciting new BSAVA publications, co-editors Nick Bexfield and Penny Watson explain when and how to place and use an oesophagostomy tube

When to consider nutritional supportSpecial nutritional support (i.e. a change to a high-calorie, high-protein diet and/or assisted (tube) feeding) should be considered in cases of:

Recent weight loss: ■■ Has the dog or cat lost >10% of its bodyweight not due to dehydration or obvious fluid shifts (e.g. diuresis)?– This is relevant even in obese animals: weight

loss in an obese, sick animal will predominantly be attributed to loss of lean body mass rather than fat and this is undesirable. Weight loss and anorexia in an obese cat are particularly worrying because of the risk of hepatic lipidosis.

Partial or complete anorexia for >3 days: ■■ Has the dog or cat eaten <85% of its calculated resting energy requirement (RER) for the last three or more days?

Animal in very catabolic state or at risk of overt ■■

malnutrition:– Does the animal have: severe burns; draining

sepsis, such as pyothorax or septic peritonitis; malabsorption or protein-losing enteropathy; or nephropathy?

– If so, is it receiving enough calories and/or protein?

– Is there an obvious loss of weight or lean body mass to suggest it is not?

Routes of enteral supportThere are a few important general rules for feeding hospitalised animals:

1. IF THE GUT WORKS, USE IT (applies to the vast majority of our patients).

2. If only PART of the gut works, use THAT part of the gut.

3. When feeding enterally, use the simplest route possible which avoids stress to the animal.

4. Appetite stimulants are NOT very effective acutely and are best reserved for when the patient has been discharged home and is recuperating.

There are a number of advantages of feeding animals enterally, which is why every effort should be made to feed animals in this way. Note: Before nutritional interventions are initiated, the patient must be stable cardiovascularly and have had any fluid, electrolyte and acid–base abnormalities addressed.

There are many enteral feeding methods available to the practising veterinary surgeon, ranging from oral or force-feeding to a number of tube-feeding methods. When using any syringe- or force-feeding method, it is important to ensure that the animal is receiving a significant amount of its daily caloric requirements. If it is not, or if it is becoming stressed by the procedure, some sort of feeding tube should be placed.

The choice of tubes includes:

Naso-oesophageal■■

Oesophageal■■

Gastrostomy (placed at laparotomy or as a ■■

percutaneous endoscopic gastrostomy (PEG))Jejunostomy.■■

12-16 How To.indd 12 19/1/10 08:40:57

companion | 13

HOW TO…

➥

The feeding route selected for a particular animal is based on the following decision-making process. Jejunostomy tubes are used only if there is a specific contraindication to placing a tube more proximally in the GI tract.

The decision-making processIs the feeding tube going to be required long ■■

term? If so, consider gastrostomy/PEG or oesophagostomy tube and NOT naso-oesophageal tube.Is there a specific contraindication to one or ■■

more tube types? For example, a naso-oesophageal tube would be contraindicated in nasal disease; both oesophagostomy and naso-oesophageal tubes are contraindicated where there is oesophageal disease (such as megaoesophagus or oesophagitis).Is there an anaesthetic risk that makes tube ■■

placement under anaesthetic an unacceptable hazard? If so, naso-oesophageal tube placement should be considered as it does not require a general anaesthetic. This could be used as a temporary measure until the animal was well enough for a general anaesthetic and more long-term tube placement.What types of diet does the patient require?■■ Naso-oesophageal tubes require liquid diets, whereas gastrostomy and oesophagostomy tubes are of a wider bore and so a greater range of gruel diets can be used.

It is extremely important to include the owner in the decision-making process, as they must be willing and able to provide the necessary nutrition if the animal is to be able to go home. Many owners can handle the three or four feedings per day that are typically required for oesophagostomy or PEG tubes.

Oesophagostomy tubes offer advantages to practitioners over PEG tubes. Oesophagostomy tubes can be placed without specialized equipment or expertise. In addition, whilst they require anaesthesia for proper placement, the amount of time required is much shorter than for other procedures. For these reasons, these tubes are a useful method of providing enteral nutrition in the practice setting.

Oesophagostomy tubes should not be placed in animals with the following conditions:

Comatose, recumbent or dysphoric animals at risk ■■

of aspirationPersistent vomiting – the tube may be expelled or ■■

retroflexed into the nasopharynxOesophagitis or severe oesophageal dysfunction ■■

(e.g. megaoesophagus).

Cellulitis is the major complication seen after oesophagostomy tube placement. Oesophageal stricture formation and fistula formation are possible but very rare.

Placement techniqueThe equipment you will need is listed in Box 1. General anaesthesia is required. The patient is placed in right lateral recumbency, and lateral and ventral aspects of the neck prepared aseptically over an area from the angle of the jaw to the shoulder.

Box 1

EqUIPMENTOesophagostomy tube (red rubber tube, ■■

standard polyurethane feeding tube or silicone feeding tube):– Cats: 10–14 Fr; 23 cm long– Dogs: 14–24 Fr; 40 cm long

Long curved forceps, e.g. Rochester–Carmalt■■

No. 15 or 20 scalpel blade and holder■■

25 mm wide adhesive tape■■

Non-absorbable suture material, needle and ■■

needle-holders

Sterile dressing to cover the tube site■■

Light bandage for the neck■■

Cotton wool or soft swabs■■

4% chlorhexidine gluconate or 10% ■■

povidone–iodine

70% surgical spirit■■

1 sterile fenestrated skin drape■■

12-16 How To.indd 13 19/1/10 08:40:58

14 | companion

HOW TO…

➦

Place an oesophagostomy tube

3. Bluntly dissect through the subcutaneous tissues and make an incision into the oesophagus over the tips of the forceps.

4. Push the tips of the forceps outwards through the incision to the external surface.

5. Measure the oesophagostomy tube from this point to the 7th intercostal space (distal oesophagus) and mark the tube with a piece of adhesive tape.

8. Disengage the tips of the forceps, curl the tip of the tube back into the mouth and feed it into the oesophagus.

7. Draw the end of the feeding tube through the oesophagostomy incision and rostrally into the pharynx to exit the mouth.

6. Open the tips of the forceps and grasp the distal end of the feeding tube.

11. Secure the tube by placement of a “Chinese finger-trap”/”Roman Sandal” suture.

12. Take a thoracic radiograph to confirm correct tube placement: the tip of the tube should be in the distal oesophagus, not the stomach. If the tube does have an integral radiodense marker, iodinated (not barium) contrast medium can be instilled into the tube to aid visualisation.

13. Cover the tube site with a sterile dressing and place a soft padded loose neck bandage.

1. Insert the curved forceps through the mouth and into the oesophagus, to the mid-cervical region.

2. Turn the tip of the forceps laterally and use the scalpel to make a 5–10 mm skin incision over the point of the tips.

9. Visually inspect the oropharynx to confirm that the tube is no longer present in the oropharynx.

10. The tube should slide easily back and forth a few millimetres, confirming that it has straightened.

Ilustrations drawn by Samantha Elmhurst (www.livingart.com) and reproduced with her permission

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companion | 15

HOW TO…

➥

Meeting energy requirementsDetermining the exact energy requirements of individual patients is unfeasible in clinical practice as it would require some form of direct or indirect calorimetry. A more practical and sensible approach is to calculate the patient’s resting energy requirement (RER), which corresponds to the number of calories per day it needs to meet basic needs. This is a very rough estimation and may need adjusting in the long term, depending on patient weight loss or gain. Recent studies show, perhaps surprisingly, that there is not a great increase in energy requirement associated with trauma, sepsis or major surgery in dogs. Therefore, the RER is now used as the ‘baseline’ energy recommendation for hospitalized dogs and cats, regardless of the disease or surgery. A number of equations are used to estimate RER; the simplest are shown in Box 2.

RESTING ENERGy REqUIREMENTRER (kcal) = 70 x bodyweight (kg) 0.75

orRER (kcal) = 30 x bodyweight (kg) + 70

To convert kcal (Cal) to kilojoules (kJ) multiply by 4.185

Box 2

estimated protein requirements for hospitalized dogs and cats are:

Dogs: 5–7.5 g protein per 100 kcal fed■■

Cats: 6–9 g protein per 100 kcal fed.■■

Feeding scheduleNote that calculated food intake should not be given immediately on the first day but introduced gradually over 2–3 days to allow the animal’s metabolism and gastrointestinal tract the time to adapt. This is particularly important if using feeding tubes. The stomach’s capacity may reduce by up to 50% after as little as 48 hours of anorexia. In addition, reduced gastric tone and emptying are features of anorexia, along with changes in gastrointestinal flora and metabolic changes, all of which need time to adapt to the new diet.

Feeding can commence as soon as the patient ■■

has recovered from general anaesthesia.The daily requirement should be divided into ■■

multiple (5 or 6) feeds per 24-hour day.Before and after feeding each time■■ , the tube should be flushed with small amounts (5–10 ml) of lukewarm tap water.

An anorexic cat being fed through an oesophagostomy tube(Courtesy of Rachel Lumbis)

The RER can then be divided by the caloric density of the diet to calculate the amount to be fed. It is worth noting that EU petfood labelling regulations prohibit the inclusion of the caloric density of diets on the tin or bag, but the information can be obtained from product guides or by contacting the manufacturer.

The RER should be viewed as a starting point and the amount fed adjusted upwards (if continued weight loss is apparent) or downwards (if the patient cannot tolerate this amount, e.g. it vomits).

Meeting protein requirementsIf using a balanced dog or cat diet, protein requirements are typically met when the calculated calories are fed. However, as a general guideline,

12-16 How To.indd 15 19/1/10 08:41:03

14 | companion

HOW TO…

➦

Place an oesophagostomy tube

3. Bluntly dissect through the subcutaneous tissues and make an incision into the oesophagus over the tips of the forceps.

4. Push the tips of the forceps outwards through the incision to the external surface.

5. Measure the oesophagostomy tube from this point to the 7th intercostal space (distal oesophagus) and mark the tube with a piece of adhesive tape.

8. Disengage the tips of the forceps, curl the tip of the tube back into the mouth and feed it into the oesophagus.

7. Draw the end of the feeding tube through the oesophagostomy incision and rostrally into the pharynx to exit the mouth.

6. Open the tips of the forceps and grasp the distal end of the feeding tube.

11. Secure the tube by placement of a “Chinese finger-trap”/”Roman Sandal” suture.

12. Take a thoracic radiograph to confirm correct tube placement: the tip of the tube should be in the distal oesophagus, not the stomach. If the tube does have an integral radiodense marker, iodinated (not barium) contrast medium can be instilled into the tube to aid visualisation.

13. Cover the tube site with a sterile dressing and place a soft padded loose neck bandage.

1. Insert the curved forceps through the mouth and into the oesophagus, to the mid-cervical region.

2. Turn the tip of the forceps laterally and use the scalpel to make a 5–10 mm skin incision over the point of the tips.

9. Visually inspect the oropharynx to confirm that the tube is no longer present in the oropharynx.

10. The tube should slide easily back and forth a few millimetres, confirming that it has straightened.

Ilustrations drawn by Samantha Elmhurst (www.livingart.com) and reproduced with her permission

12-16 How To.indd 14 19/1/10 08:40:59

companion | 15

HOW TO…

➥

Meeting energy requirementsDetermining the exact energy requirements of individual patients is unfeasible in clinical practice as it would require some form of direct or indirect calorimetry. A more practical and sensible approach is to calculate the patient’s resting energy requirement (RER), which corresponds to the number of calories per day it needs to meet basic needs. This is a very rough estimation and may need adjusting in the long term, depending on patient weight loss or gain. Recent studies show, perhaps surprisingly, that there is not a great increase in energy requirement associated with trauma, sepsis or major surgery in dogs. Therefore, the RER is now used as the ‘baseline’ energy recommendation for hospitalized dogs and cats, regardless of the disease or surgery. A number of equations are used to estimate RER; the simplest are shown in Box 2.

RESTING ENERGy REqUIREMENTRER (kcal) = 70 x bodyweight (kg) 0.75

orRER (kcal) = 30 x bodyweight (kg) + 70

To convert kcal (Cal) to kilojoules (kJ) multiply by 4.185

Box 2

estimated protein requirements for hospitalized dogs and cats are:

Dogs: 5–7.5 g protein per 100 kcal fed■■

Cats: 6–9 g protein per 100 kcal fed.■■

Feeding scheduleNote that calculated food intake should not be given immediately on the first day but introduced gradually over 2–3 days to allow the animal’s metabolism and gastrointestinal tract the time to adapt. This is particularly important if using feeding tubes. The stomach’s capacity may reduce by up to 50% after as little as 48 hours of anorexia. In addition, reduced gastric tone and emptying are features of anorexia, along with changes in gastrointestinal flora and metabolic changes, all of which need time to adapt to the new diet.

Feeding can commence as soon as the patient ■■

has recovered from general anaesthesia.The daily requirement should be divided into ■■

multiple (5 or 6) feeds per 24-hour day.Before and after feeding each time■■ , the tube should be flushed with small amounts (5–10 ml) of lukewarm tap water.

An anorexic cat being fed through an oesophagostomy tube(Courtesy of Rachel Lumbis)

The RER can then be divided by the caloric density of the diet to calculate the amount to be fed. It is worth noting that EU petfood labelling regulations prohibit the inclusion of the caloric density of diets on the tin or bag, but the information can be obtained from product guides or by contacting the manufacturer.

The RER should be viewed as a starting point and the amount fed adjusted upwards (if continued weight loss is apparent) or downwards (if the patient cannot tolerate this amount, e.g. it vomits).

Meeting protein requirementsIf using a balanced dog or cat diet, protein requirements are typically met when the calculated calories are fed. However, as a general guideline,

12-16 How To.indd 15 19/1/10 08:41:03

16 | companion

HOW TO…

➦

Place an oesophagostomy tube

BSAVA GUIDE TO PROCEDURES IN SMALL ANIMAL PRACTICEEditors: Nick Bexfield and Karla Lee

This completely NEW publication features common diagnostic, medical, surgical and emergency procedures in an easy-to-use A to Z listing. Indications, contraindications, equipment, patient positioning and preparation, and potential complications are noted for each procedure. The techniques themselves are presented in a step-by-step format, augmented by photographs and specially commissioned drawings (examples of which accompany this article). Lay-flat binding allows use in the clinic or lab setting.

Every paying member of BSAVA will receive one complimentary copy as part of their membership. Members attending Congress will be able to collect them from the BSAVA Balcony, the rest will be sent out in May.

BSAVA MANUAL OF CANINE AND FELINE REHABILITATION, SUPPORTIVE AND PALLIATIVE CARE: Case studies in patient managementEditors: Penny Watson and Samantha Lindley

This unique publication shows how a team-based approach can be used to improve patient outcomes. Part 1 presents the latest strategies for pain management, clinical nutrition, and physical therapy and rehabilitation. The evidence base for therapies is discussed, with reference to published studies. Part 2 uses a range of case scenarios to illustrate how medical and surgical treatment, dietary advice, physiotherapy, hydrotherapy, acupuncture, nursing care and homecare recommendations can form an integrated approach to the management of individual patients.

Available Summer 2010.

The food should be warmed to body temperature ■■

and injected over several minutes.If the animal shows regurgitation, vomiting or ■■

diarrhoea after feeding, reduce the amount fed in each meal and check that the food fed is warm and iso-osmolar.

Tube care and removalOnce a day, the neck wrap and sterile dressing should be removed and the stoma cleaned using cotton wool or gauze swabs soaked in 4% chlorhexidine gluconate or 10% povidone–iodine.

If oozing of purulent liquid suggests infection, an antibiotic ointment can be applied. A new sterile dressing is then applied and the neck wrap replaced.

The oesophagostomy tube can be removed when it is no longer required; unlike a gastrotomy tube there is no minimum length of time an oesophagostomy tube must have been in place prior to removal. To remove the tube, take off the dressing, remove the suture and pull the tube gently out. The stoma site will close rapidly once the tube is removed, but skin sutures can be placed if preferred. ■

Procedures in Small Animal Practice

Procedures in Small Animal Practice

BSAVA Guide to

BSAVA Guide to

Nick Bexfieldand Karla Lee

BS

AVA

Guide to P

rocedures in Sm

all Anim

al Practice

ContentsAbdominocentesis; ACTH response test; Anaphylaxis – emergency treatment; Arthrocentesis; Aseptic preparation; Barium contrast media; Barium studies of the gastrointestinal tract; Blood pressure measurement; Bblood sampling; Blood smear preparation; Blood transfusion; Bone biopsy – needle; Bone marrow aspiration; Bronchoalveloar lavage; Bronchoscopy; Buccal mucosal bleeding time; Cardiopulmonary–cerebral resuscitation; Cardiorespiratory examination; Cast application; Cerebrospinal fluid sampling; Cranial draw test; Cystocentesis; Dexamethasone suppression tests; Diagnostic peritoneal lavage; Ehmer sling; Elbow luxation – closed reduction; Electrocardiography; Endoscopy of the gastrointestinal tract; Endotracheal wash; Fine needle aspiration; Fluorescein test; Gastric decompression; Gastrostomy tube placement; Haemagglutination test; Hip luxation – closed reduction; Intraosseous cannula placement; Intravenous catheter placement; Intravenous urography; Iodinated contrast media; Myringotomy; Nasal oxygen administration; Naso-oesophageal tube placement; Neurological examination; Oesophagostomy tube placement; Ophthalmic examination; Orthopaedic examination; Ortolani test; Otoscopy; Pericardiocentesis; Platelet count; Prostatic wash; Resting energy requirement; Retrograde urethrography/vaginourethrography; Rhinoscopy; Schirmer tear test; Seizures – emergency protocol; Semen collection; Skin biopsy – punch biopsy; Skin and hair sampling; Soft padded bandage; Spica splint; Thoracocentesis – needle; Thoracostomy tube placement; Tibial compression test; Tissue biopsy – needle core; Tracheostomy; Transtracheal wash; Urethral catheterization; Urethral retrograde urohydropulsion; Urinalysis; Velpeau sling; Water deprivation test; Whole blood clotting time

Edited by Nick Bexfield and Karla Lee

The BSAVA Guide to Procedures in Small Animal Practice provides practical, step-by-step guidance on how to perform the diagnostic and therapeutic procedures commonly performed in small animal veterinary practice. In addition, routine clinical examination of the major body systems, and protocols for the management of selected emergencies are described.In addition to the actual technique, each procedure has information on indications and contraindications, equipment required, and potential complications, together with the editors’ own hints and tips. Details of BSAVA Manuals where wider information, such as interpretation of results, are given throughout.

Special features:A to Z format to aid information retrieval

■■

Extensive cross-referencing in highlighted text■■

Specially commissioned drawings■■

Lay-flat binding■■

This is a truly useful guide, which will provide a valuable and lasting reference for veterinary surgeons, veterinary nurses and students alike.

ISBN 978 1 905319 17 6

12-16 How To.indd 16 19/1/10 08:41:04

companion | 17

CONGRESS

Satellite meetings at BSAVA CongressBSAVA supports its Affiliated Groups with funding and promotion, as well as presenting them with the opportunity to hold a Satellite Meeting on the Wednesday before Congress (this year 7 April)

ABVAAssociation of British Veterinary AcupuncturistsVenue: Executive Room 1, ICCBooking contact: Julie CummingsEmail: bmasgeneralmgr@aol.comWebsite: www.abva.co.ukTel: +44 (0) 1606 786782

AVCPTAssociation of Veterinary Clinical Pharmacology and TherapeuticsVenue: Hall 7a, ICCBooking contact: Maria Gregory-CarltonEmail: secretary@avcpt.orgWebsite: www.avcpt.org

The neurobiology of pain with ■■

Dr Sue Fleetwood-WalkerChallenges facing new approaches to pain ■■

management in animal species with Dr Adrian FosterPK/PD modelling and its relevance to ■■

pharmacological pain intervention with Ludovic PelligandPain control in osteoarthritis with ■■

Dr Dylan ClementsAcute Pain management in animals with ■■

Dr Jo MurrellThe language of Pain: A human perspective with ■■

Dr Mark RockettPanel discussion – all speakers■■

£100 for non-members; £70 for members; £70 for students and residents. Lunch is included

AVSTSAssociation for Veterinary Soft Tissue SurgeryVenue: Hall 6, ICCBooking contact: Alison YoungEmail: avstsadmin@fsmail.netWebsite: www.avsts.org.ukTel: +44 (0) 1707 666366 ex 2432

A Smörgåsbord of topics awaits you at our Spring meeting for 2010.

With a dazzling array of UK and international speakers it’s sure to be a stimulating session.

BrAVOBritish Association of Veterinary OphthalmologistsVenue: Hall 8a, ICCBooking contact: Claudia HartleyEmail: claudia.hartley@aht.org.ukWebsite: www.bravo.org.ukTel: +44 (0) 1638 552700

The British Association of Veterinary Ophthalmologists (BrAVO) is an internationally recognised society of veterinary ophthalmologists and vets with an interest in ophthalmology. We have members not only from the United Kingdom but also Hong Kong, Australia, France, Belgium, Sweden, Italy and South Africa. We are also honoured to have consultant ophthalmologists from the human medical field as members. We are a very sociable group, with over 250 members, and newcomers are welcomed.

BrAVO organises two meetings each year, with state-of-the-art lectures on all aspects of veterinary and human ophthalmology. Our Spring meeting is a one-day pre-BSAVA satellite meeting and includes both local and international speakers. The winter ➥

BAVECBritish Association of Veterinary Emergency CareVenue: Crompton Room, Austin CourtBooking contact: Jan MacDonaldEmail: jan.macdonald@vets-now.comWebsite: www.bavec.co.ukTel: +44 (0) 7785 741033

17-20 Satellite Groups.indd 17 19/1/10 08:52:39

16 | companion

HOW TO…

➦

Place an oesophagostomy tube

BSAVA GUIDE TO PROCEDURES IN SMALL ANIMAL PRACTICEEditors: Nick Bexfield and Karla Lee

This completely NEW publication features common diagnostic, medical, surgical and emergency procedures in an easy-to-use A to Z listing. Indications, contraindications, equipment, patient positioning and preparation, and potential complications are noted for each procedure. The techniques themselves are presented in a step-by-step format, augmented by photographs and specially commissioned drawings (examples of which accompany this article). Lay-flat binding allows use in the clinic or lab setting.

Every paying member of BSAVA will receive one complimentary copy as part of their membership. Members attending Congress will be able to collect them from the BSAVA Balcony, the rest will be sent out in May.

BSAVA MANUAL OF CANINE AND FELINE REHABILITATION, SUPPORTIVE AND PALLIATIVE CARE: Case studies in patient managementEditors: Penny Watson and Samantha Lindley

This unique publication shows how a team-based approach can be used to improve patient outcomes. Part 1 presents the latest strategies for pain management, clinical nutrition, and physical therapy and rehabilitation. The evidence base for therapies is discussed, with reference to published studies. Part 2 uses a range of case scenarios to illustrate how medical and surgical treatment, dietary advice, physiotherapy, hydrotherapy, acupuncture, nursing care and homecare recommendations can form an integrated approach to the management of individual patients.

Available Summer 2010.

The food should be warmed to body temperature ■■

and injected over several minutes.If the animal shows regurgitation, vomiting or ■■

diarrhoea after feeding, reduce the amount fed in each meal and check that the food fed is warm and iso-osmolar.

Tube care and removalOnce a day, the neck wrap and sterile dressing should be removed and the stoma cleaned using cotton wool or gauze swabs soaked in 4% chlorhexidine gluconate or 10% povidone–iodine.

If oozing of purulent liquid suggests infection, an antibiotic ointment can be applied. A new sterile dressing is then applied and the neck wrap replaced.

The oesophagostomy tube can be removed when it is no longer required; unlike a gastrotomy tube there is no minimum length of time an oesophagostomy tube must have been in place prior to removal. To remove the tube, take off the dressing, remove the suture and pull the tube gently out. The stoma site will close rapidly once the tube is removed, but skin sutures can be placed if preferred. ■

Procedures in Small Animal Practice

Procedures in Small Animal Practice

BSAVA Guide to

BSAVA Guide to

Nick Bexfieldand Karla Lee

BS

AVA

Guide to P

rocedures in Sm

all Anim

al Practice

ContentsAbdominocentesis; ACTH response test; Anaphylaxis – emergency treatment; Arthrocentesis; Aseptic preparation; Barium contrast media; Barium studies of the gastrointestinal tract; Blood pressure measurement; Bblood sampling; Blood smear preparation; Blood transfusion; Bone biopsy – needle; Bone marrow aspiration; Bronchoalveloar lavage; Bronchoscopy; Buccal mucosal bleeding time; Cardiopulmonary–cerebral resuscitation; Cardiorespiratory examination; Cast application; Cerebrospinal fluid sampling; Cranial draw test; Cystocentesis; Dexamethasone suppression tests; Diagnostic peritoneal lavage; Ehmer sling; Elbow luxation – closed reduction; Electrocardiography; Endoscopy of the gastrointestinal tract; Endotracheal wash; Fine needle aspiration; Fluorescein test; Gastric decompression; Gastrostomy tube placement; Haemagglutination test; Hip luxation – closed reduction; Intraosseous cannula placement; Intravenous catheter placement; Intravenous urography; Iodinated contrast media; Myringotomy; Nasal oxygen administration; Naso-oesophageal tube placement; Neurological examination; Oesophagostomy tube placement; Ophthalmic examination; Orthopaedic examination; Ortolani test; Otoscopy; Pericardiocentesis; Platelet count; Prostatic wash; Resting energy requirement; Retrograde urethrography/vaginourethrography; Rhinoscopy; Schirmer tear test; Seizures – emergency protocol; Semen collection; Skin biopsy – punch biopsy; Skin and hair sampling; Soft padded bandage; Spica splint; Thoracocentesis – needle; Thoracostomy tube placement; Tibial compression test; Tissue biopsy – needle core; Tracheostomy; Transtracheal wash; Urethral catheterization; Urethral retrograde urohydropulsion; Urinalysis; Velpeau sling; Water deprivation test; Whole blood clotting time

Edited by Nick Bexfield and Karla Lee

The BSAVA Guide to Procedures in Small Animal Practice provides practical, step-by-step guidance on how to perform the diagnostic and therapeutic procedures commonly performed in small animal veterinary practice. In addition, routine clinical examination of the major body systems, and protocols for the management of selected emergencies are described.In addition to the actual technique, each procedure has information on indications and contraindications, equipment required, and potential complications, together with the editors’ own hints and tips. Details of BSAVA Manuals where wider information, such as interpretation of results, are given throughout.

Special features:A to Z format to aid information retrieval

■■

Extensive cross-referencing in highlighted text■■

Specially commissioned drawings■■

Lay-flat binding■■

This is a truly useful guide, which will provide a valuable and lasting reference for veterinary surgeons, veterinary nurses and students alike.

ISBN 978 1 905319 17 6

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CONGRESS

Satellite meetings at BSAVA CongressBSAVA supports its Affiliated Groups with funding and promotion, as well as presenting them with the opportunity to hold a Satellite Meeting on the Wednesday before Congress (this year 7 April)

ABVAAssociation of British Veterinary AcupuncturistsVenue: Executive Room 1, ICCBooking contact: Julie CummingsEmail: bmasgeneralmgr@aol.comWebsite: www.abva.co.ukTel: +44 (0) 1606 786782

AVCPTAssociation of Veterinary Clinical Pharmacology and TherapeuticsVenue: Hall 7a, ICCBooking contact: Maria Gregory-CarltonEmail: secretary@avcpt.orgWebsite: www.avcpt.org

The neurobiology of pain with ■■

Dr Sue Fleetwood-WalkerChallenges facing new approaches to pain ■■

management in animal species with Dr Adrian FosterPK/PD modelling and its relevance to ■■

pharmacological pain intervention with Ludovic PelligandPain control in osteoarthritis with ■■

Dr Dylan ClementsAcute Pain management in animals with ■■

Dr Jo MurrellThe language of Pain: A human perspective with ■■

Dr Mark RockettPanel discussion – all speakers■■

£100 for non-members; £70 for members; £70 for students and residents. Lunch is included

AVSTSAssociation for Veterinary Soft Tissue SurgeryVenue: Hall 6, ICCBooking contact: Alison YoungEmail: avstsadmin@fsmail.netWebsite: www.avsts.org.ukTel: +44 (0) 1707 666366 ex 2432

A Smörgåsbord of topics awaits you at our Spring meeting for 2010.

With a dazzling array of UK and international speakers it’s sure to be a stimulating session.

BrAVOBritish Association of Veterinary OphthalmologistsVenue: Hall 8a, ICCBooking contact: Claudia HartleyEmail: claudia.hartley@aht.org.ukWebsite: www.bravo.org.ukTel: +44 (0) 1638 552700

The British Association of Veterinary Ophthalmologists (BrAVO) is an internationally recognised society of veterinary ophthalmologists and vets with an interest in ophthalmology. We have members not only from the United Kingdom but also Hong Kong, Australia, France, Belgium, Sweden, Italy and South Africa. We are also honoured to have consultant ophthalmologists from the human medical field as members. We are a very sociable group, with over 250 members, and newcomers are welcomed.

BrAVO organises two meetings each year, with state-of-the-art lectures on all aspects of veterinary and human ophthalmology. Our Spring meeting is a one-day pre-BSAVA satellite meeting and includes both local and international speakers. The winter ➥

BAVECBritish Association of Veterinary Emergency CareVenue: Crompton Room, Austin CourtBooking contact: Jan MacDonaldEmail: jan.macdonald@vets-now.comWebsite: www.bavec.co.ukTel: +44 (0) 7785 741033

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18 | companion

CONGRESS

meeting is a two-day weekend meeting that is held in easy to reach locations around the country, usually in November. Again we include international speakers, and usually a medical speaker for a comparative view in humans.

Members are invited to all meetings and enjoy discounts on textbooks and journal subscriptions, as well as eligibility to apply for one of two travel scholarships (up to the value of £1000 per scholarship each year) every year.

BVZSBritish Veterinary Zoological SocietyVenue: Hall 7b, ICCBooking contact: Victoria RobertsEmail: victoriaroberts06@tiscali.co.ukWebsite: www.bvzs.orgTel: +44 (0) 7971 482292

EXOTICS FOR GP VETSClinical management of ferrets, sugar gliders and ■■

degus – Aidan RafteryDiagnostic approach to the sick bird – Kevin Eatwell■■

Common lizard presentations and their ■■

management – Kevin EatwellCommon chelonian presentations and their ■■

management – Stuart McArthurSafe anaestheisa in rabbits and small mammals – ■■

Ian Sayers

The fourth BVZS satellite meeting provides BSAVA delegates and small animal practitioners in general practice the opportunity to undertake world class continuing professional development in non-domestic species medicine. The programme for the day complements and expands the exotic pet content in the main Congress, allowing further development of your skills and understanding.

➦

Satellite meetings at BSAVA Congress

BVOABritish Veterinary Orthopaedic AssociationVenue: Kingston Room/Faraday Room, Austin CourtBooking contact: Kamila GuilliardEmail: bvoa@btinternet.comWebsite: www.bsava.com/bvoaTel: +44 (0) 1270 662265

The British Veterinary Orthopaedic Association’s objectives include providing CPD for its members, funding clinical research, and providing a forum for discussion and dissemination of orthopaedic knowledge. Membership of the BVOA is open to anybody with an interest in veterinary orthopaedic surgery; general and specialist veterinary surgeons are welcome.

The association holds two meetings per year – the first is the one day Spring meeting that is held in Austin Court at the ICC in Birmingham on the Wednesday immediately before BSAVA Congress. The second runs over three days, from 12–14 November 2010 in Dublin, Ireland. The Dublin meeting is entitled “New horizons in thoracic limb surgery” and will focus on the management of shoulder injuries. There will be an exciting mix of international speakers and state of the art lectures, and a comparative perspective provided by human orthopaedic surgeons. The social programme promises to be excellent and includes a tour and dinner at the Guinness Storehouse on the Saturday night.

Another very important function of the Association is the provision of funding for orthopaedic research projects. This is available for members in general practice as well as those in academia, and is subject to approval by the Chairman of the Scientific Committee. For further information, visit www.bsava.com/bvoa.

BVDABritish Veterinary Dental AssociationVenue: Lodge Rooms 1 & 2, Austin CourtBooking contact: Helen HydeEmail: helen.hyde@ntlworld.comWebsite: www.bvda.co.ukTel: +44 (0) 1954 204474

Scientific meeting and AGM with international speakers, including Bill Gengler (President of the AVDC), and Julius Liptak

BVDSGBritish Veterinary Dermatology Study GroupVenue: Hall 8b, ICCBooking contact: Filippo De BellisEmail: filippovet@hotmail.comWebsite: pcwww.liv.ac.ukTel: +44 (0) 1707 666366

17-20 Satellite Groups.indd 18 19/1/10 08:52:39

companion | 19

CONGRESS

CABTSGCompanion Animal Behaviour Therapy Study GroupVenue: Hall 11a, ICCBooking contact: Claire CorridanEmail: clairecorridan@yahoo.co.ukWebsite: www.cabtsg.orgTel: +44 (0) 1606 352091

The two themes for this year’s Study Day are ‘repetitive behaviours in companion animals’ and ‘regulation of dog trainers and behaviourists’.

There will be 3 sessions, the first on repetitive behaviours in companion animals, the second, a short paper session on emerging science in the companion animal behavioural field, and the final session will address the issues surrounding regulation of dog trainers and behaviours.

Repetitive behaviours in companion animals are commonly seen but not particularly well understood. Identification of the motivation for these behaviours can be difficult but their management and counselling of the client can be equally challenging. CABTSG have two guest speakers presenting on this subject, Professor Daniel Mills and Dr David Abrahamson, covering aspects of differential diagnoses, behavioural and medical management protocols.

Scientific papers are an essential part of CABTSG’s Study Day programme. The ‘new science’ sessions will be divided in two, one on the theme of repetitive behaviours and an open session for papers on any subject relating to companion animal behaviour. ➥

Our ‘Back to Basics’ lectures, which have proved so popular at BVZS meetings, will be presented by experienced and specialist veterinarians. The programme will deliver a comprehensive grounding for the part-time enthusiast whilst the more advanced exotic and zoological practitioner will be informed of the latest developments in both understanding and practical techniques. Each lecture will be 1–1¼ hours in length, followed by time for questions and discussion.

The ‘Back to Basics’ presentations will address the approach to cases seen in small zoo contract work or whilst developing an exotic pet caseload and so will be directly relevant to BSAVA and BVZS members.

BVZS’s satellite event lunch is sponsored by Genitrix.

In 2008 CAWC (The Companion Animal Welfare Council) launched a report outlining the need for regulation of individuals working in the field of animal training and behaviour. We will be joined by Dr Anne McBride, Kendal Shepherd and James Yeates, who will present on the implications of the CAWC initiative for the veterinary profession, for those working in the dog training and behaviour field, and for dog owners and their dogs. This session will be chaired by Professor Sir Colin Spedding, who is also currently chairing the CAWC meetings on this subject.

Conference Dinner: Optional conference dinner 6pm in Hall 11A of the ICC (book with registration) cost £30 per person.

EAVDI (BID)European Association of Veterinary Diagnostic Imaging (British and Irish Division)Venue: Telford Room, Austin CourtBooking contact: Andrew DenningEmail: andrew@new-priory.comWebsite: cheval.vet.gla.ac.uk/EVDI/ea-bed.htmTel: +44 (0) 1638 555668

The British and Irish Division of the European Association of Veterinary Diagnostic Imaging (EAVDI-BID) is open to any veterinary surgeon, student, radiographer or nurse with an interest in veterinary diagnostic imaging. The division organizes two regular meetings each year – a satellite day meeting in Birmingham on the Wednesday before BSAVA Congress, and a two-day autumn meeting (usually October/November) which in recent years has been held in Cambridge, Dublin and Glasgow. Speakers at the meetings are drawn from a wide range of internationally recognised specialists, and cover a wide range of imaging topics, in both small and large animal practice. This offers you a fantastic opportunity for continuous professional development (CPD) in diagnostic imaging and at an unbeatable price. In addition, at each meeting there is an informal film-reading session, with more unusual cases presented for interpretation (although only imaging residents are required to present cases to the meeting). Lectures at the pre-BSAVA meeting in 2010 are hoped to include MRI of the limbs in small animals and correlating imaging and arthroscopic findings. For further information and contact details for the committee, see the EAVDI website (currently cheval.vet.gla.ac.uk/EVDI/eavdi.htm although a new website is currently under construction).

17-20 Satellite Groups.indd 19 19/1/10 08:52:39

18 | companion

CONGRESS

meeting is a two-day weekend meeting that is held in easy to reach locations around the country, usually in November. Again we include international speakers, and usually a medical speaker for a comparative view in humans.

Members are invited to all meetings and enjoy discounts on textbooks and journal subscriptions, as well as eligibility to apply for one of two travel scholarships (up to the value of £1000 per scholarship each year) every year.

BVZSBritish Veterinary Zoological SocietyVenue: Hall 7b, ICCBooking contact: Victoria RobertsEmail: victoriaroberts06@tiscali.co.ukWebsite: www.bvzs.orgTel: +44 (0) 7971 482292

EXOTICS FOR GP VETSClinical management of ferrets, sugar gliders and ■■

degus – Aidan RafteryDiagnostic approach to the sick bird – Kevin Eatwell■■

Common lizard presentations and their ■■

management – Kevin EatwellCommon chelonian presentations and their ■■

management – Stuart McArthurSafe anaestheisa in rabbits and small mammals – ■■

Ian Sayers

The fourth BVZS satellite meeting provides BSAVA delegates and small animal practitioners in general practice the opportunity to undertake world class continuing professional development in non-domestic species medicine. The programme for the day complements and expands the exotic pet content in the main Congress, allowing further development of your skills and understanding.

➦

Satellite meetings at BSAVA Congress

BVOABritish Veterinary Orthopaedic AssociationVenue: Kingston Room/Faraday Room, Austin CourtBooking contact: Kamila GuilliardEmail: bvoa@btinternet.comWebsite: www.bsava.com/bvoaTel: +44 (0) 1270 662265

The British Veterinary Orthopaedic Association’s objectives include providing CPD for its members, funding clinical research, and providing a forum for discussion and dissemination of orthopaedic knowledge. Membership of the BVOA is open to anybody with an interest in veterinary orthopaedic surgery; general and specialist veterinary surgeons are welcome.

The association holds two meetings per year – the first is the one day Spring meeting that is held in Austin Court at the ICC in Birmingham on the Wednesday immediately before BSAVA Congress. The second runs over three days, from 12–14 November 2010 in Dublin, Ireland. The Dublin meeting is entitled “New horizons in thoracic limb surgery” and will focus on the management of shoulder injuries. There will be an exciting mix of international speakers and state of the art lectures, and a comparative perspective provided by human orthopaedic surgeons. The social programme promises to be excellent and includes a tour and dinner at the Guinness Storehouse on the Saturday night.

Another very important function of the Association is the provision of funding for orthopaedic research projects. This is available for members in general practice as well as those in academia, and is subject to approval by the Chairman of the Scientific Committee. For further information, visit www.bsava.com/bvoa.

BVDABritish Veterinary Dental AssociationVenue: Lodge Rooms 1 & 2, Austin CourtBooking contact: Helen HydeEmail: helen.hyde@ntlworld.comWebsite: www.bvda.co.ukTel: +44 (0) 1954 204474

Scientific meeting and AGM with international speakers, including Bill Gengler (President of the AVDC), and Julius Liptak

BVDSGBritish Veterinary Dermatology Study GroupVenue: Hall 8b, ICCBooking contact: Filippo De BellisEmail: filippovet@hotmail.comWebsite: pcwww.liv.ac.ukTel: +44 (0) 1707 666366

17-20 Satellite Groups.indd 18 19/1/10 08:52:39

companion | 19

CONGRESS

CABTSGCompanion Animal Behaviour Therapy Study GroupVenue: Hall 11a, ICCBooking contact: Claire CorridanEmail: clairecorridan@yahoo.co.ukWebsite: www.cabtsg.orgTel: +44 (0) 1606 352091

The two themes for this year’s Study Day are ‘repetitive behaviours in companion animals’ and ‘regulation of dog trainers and behaviourists’.

There will be 3 sessions, the first on repetitive behaviours in companion animals, the second, a short paper session on emerging science in the companion animal behavioural field, and the final session will address the issues surrounding regulation of dog trainers and behaviours.

Repetitive behaviours in companion animals are commonly seen but not particularly well understood. Identification of the motivation for these behaviours can be difficult but their management and counselling of the client can be equally challenging. CABTSG have two guest speakers presenting on this subject, Professor Daniel Mills and Dr David Abrahamson, covering aspects of differential diagnoses, behavioural and medical management protocols.

Scientific papers are an essential part of CABTSG’s Study Day programme. The ‘new science’ sessions will be divided in two, one on the theme of repetitive behaviours and an open session for papers on any subject relating to companion animal behaviour. ➥

Our ‘Back to Basics’ lectures, which have proved so popular at BVZS meetings, will be presented by experienced and specialist veterinarians. The programme will deliver a comprehensive grounding for the part-time enthusiast whilst the more advanced exotic and zoological practitioner will be informed of the latest developments in both understanding and practical techniques. Each lecture will be 1–1¼ hours in length, followed by time for questions and discussion.

The ‘Back to Basics’ presentations will address the approach to cases seen in small zoo contract work or whilst developing an exotic pet caseload and so will be directly relevant to BSAVA and BVZS members.

BVZS’s satellite event lunch is sponsored by Genitrix.

In 2008 CAWC (The Companion Animal Welfare Council) launched a report outlining the need for regulation of individuals working in the field of animal training and behaviour. We will be joined by Dr Anne McBride, Kendal Shepherd and James Yeates, who will present on the implications of the CAWC initiative for the veterinary profession, for those working in the dog training and behaviour field, and for dog owners and their dogs. This session will be chaired by Professor Sir Colin Spedding, who is also currently chairing the CAWC meetings on this subject.

Conference Dinner: Optional conference dinner 6pm in Hall 11A of the ICC (book with registration) cost £30 per person.

EAVDI (BID)European Association of Veterinary Diagnostic Imaging (British and Irish Division)Venue: Telford Room, Austin CourtBooking contact: Andrew DenningEmail: andrew@new-priory.comWebsite: cheval.vet.gla.ac.uk/EVDI/ea-bed.htmTel: +44 (0) 1638 555668

The British and Irish Division of the European Association of Veterinary Diagnostic Imaging (EAVDI-BID) is open to any veterinary surgeon, student, radiographer or nurse with an interest in veterinary diagnostic imaging. The division organizes two regular meetings each year – a satellite day meeting in Birmingham on the Wednesday before BSAVA Congress, and a two-day autumn meeting (usually October/November) which in recent years has been held in Cambridge, Dublin and Glasgow. Speakers at the meetings are drawn from a wide range of internationally recognised specialists, and cover a wide range of imaging topics, in both small and large animal practice. This offers you a fantastic opportunity for continuous professional development (CPD) in diagnostic imaging and at an unbeatable price. In addition, at each meeting there is an informal film-reading session, with more unusual cases presented for interpretation (although only imaging residents are required to present cases to the meeting). Lectures at the pre-BSAVA meeting in 2010 are hoped to include MRI of the limbs in small animals and correlating imaging and arthroscopic findings. For further information and contact details for the committee, see the EAVDI website (currently cheval.vet.gla.ac.uk/EVDI/eavdi.htm although a new website is currently under construction).

17-20 Satellite Groups.indd 19 19/1/10 08:52:39

20 | companion

CONGRESS

ESFMEuropean Society of Feline MedicineVenue: Hall 10, ICCBooking contact: Amanda DennantEmail: conferences@fabcats.orgWebsite: fabcats.org/conferencesTel: +44 (0) 1747 871872

Who could argue that cats can be difficult! But then they can also be fascinating because they don’t follow the rules. However you think of them, they are now a large part of companion animal practice.

At the European Society of Feline Medicine (ESFM) pre-Congress day we aim to cover current feline issues and to provide as much as possible to take back to practice. This year we are also introducing four practice tip sessions – all cover ‘ins and outs’ with cats – blocked cats, using catheters, feeding the anorexic cat, and getting medicines in. Other international speakers will follow last year’s very popular approach of 30 minute update talks on food allergies, atopy, asthma, ureteroliths and thyroidectomy technique.

Through its monthly international peer-reviewed Journal of Feline Medicine and Surgery (JFMS) ESFM provides both basic science and practical clinical reviews from world leaders for the advancement of understanding of disease and the treatment of cats in daily veterinary practice.

Visit www.fabcats.org/conferences/bsava/2010 to find out more and to book your place – don’t leave it too late; we were sold out last year!

consultant in medicine and critical care and a member of the guideline development group for venous thromboembolism prevention for the National Institute of Clinical Excellence (NICE). For those attendees that are in the processing of writing their CertSAM casebook there will be a lunchtime session offering advice. The day will include the following sessions:

Epilepsy: when the (usual) drugs don’t work with ■■

Dr Holger VolkAntimicrobial usage in companion animal practice: ■■

facts and moral dilemmas with Dr Susan DawsonCase Reports competition presentations – ■■

sponsored by VétoquinolVenous thromboembolism: learning from a human ■■

perspective with Dr Nandan GautamHow to write a successful CertSAM casebook ■■

with Jon WrayControversies surrounding treatment of aortic ■■

thromboembolism with Dr Matt BealFeline acromegaly: separating facts from ■■

assumptions with Stijn Niessen

Fees: Members £65, Non-members £95 (lunch included if you register before 15 March 2010). Annual membership: £25.

SAMSoc’s satellite event is sponsored by Hill’s Pet Nutrition and Vétoquinol.

For details or to book any

Satellite Meeting please

contact the organiser directly.

VCSVeterinary Cardiovascular SocietyVenue: Hall 9, ICCBooking contact: Yolanda Martinez PereiraEmail: yolanda@zoologicalmedicine.comWebsite: www.bsava.org.uk/vcsTel: +44 (0) 7743 947802

➦

Satellite meetings at BSAVA Congress

SAMSocSmall Animal Medicine SocietyVenue: Hall 8a, ICCBooking contact: Yvonne McGrottyEmail: medicinereferrals@hotmail.comTel: +44 (0) 1412 377676

Members of SAMSoc include specialist internists and general practitioners from the UK and abroad who share a passion and enthusiasm for small animal medicine. The society hosts a meeting every year at BSAVA Congress.

This year SAMSoc are delighted to announce our speaker from human medicine is Dr Nandan Gautam, a

17-20 Satellite Groups.indd 20 19/1/10 08:52:41

companion | 21

CONGRESS

➥

Americans are well known in this country for the high quality of their dental work and so perhaps it is not surprising that even their pets can

receive cutting edge orthodontic care. A leading exponent of veterinary dentistry from the US has been invited to pass on his skills to his British and European colleagues at BSAVA Congress in Birmingham in April. Among a series of presentations on different aspects of oral surgery, Professor Bill Gengler of the University of Wisconsin will outline the principles of orthodontics to correct conditions resulting from malocclusions.

From man to beastAppliances similar to those originally developed in human dentistry are used with increasing frequency in dogs on both sides of the Atlantic to create a more regular bite. But in contrast with human orthodontics these methods are never used simply for cosmetic reasons. “The orthodontic procedures that we do

perform are only for the health and comfort of the animal,” he explains.

As a member of the American Veterinary Dental College, he uses these techniques to prevent or to treat the painful consequences of malocclusions, not to give the dog’s owners hope of success in shows. “As a group, we are very ethical and try not to change the appearance so it will have an advantage in the ring. We also encourage owners to neuter animals that have orthodontic treatment resulting from

hereditary defects.”

Problems and solutionsTwo defects which these methods are often used to

treat are linguoversion of the mandibular canine teeth (or base narrow canines)

and rostroversion of the maxillary canine tooth. The former can be a very painful condition and occurs mainly in long-nosed dogs such as Labradors, German Shepherd Dogs and Standard Poodles. Affected animals have very narrow mandibles and lower canine teeth that erupt vertically, with the result that over time

Bit between the teeth at Congress

Dentistry lectures are always especially popular at Congress – and even more so when a leading expert shares their skills

21-22 Congress.indd 21 19/1/10 08:53:09

20 | companion

CONGRESS

ESFMEuropean Society of Feline MedicineVenue: Hall 10, ICCBooking contact: Amanda DennantEmail: conferences@fabcats.orgWebsite: fabcats.org/conferencesTel: +44 (0) 1747 871872

Who could argue that cats can be difficult! But then they can also be fascinating because they don’t follow the rules. However you think of them, they are now a large part of companion animal practice.

At the European Society of Feline Medicine (ESFM) pre-Congress day we aim to cover current feline issues and to provide as much as possible to take back to practice. This year we are also introducing four practice tip sessions – all cover ‘ins and outs’ with cats – blocked cats, using catheters, feeding the anorexic cat, and getting medicines in. Other international speakers will follow last year’s very popular approach of 30 minute update talks on food allergies, atopy, asthma, ureteroliths and thyroidectomy technique.

Through its monthly international peer-reviewed Journal of Feline Medicine and Surgery (JFMS) ESFM provides both basic science and practical clinical reviews from world leaders for the advancement of understanding of disease and the treatment of cats in daily veterinary practice.

Visit www.fabcats.org/conferences/bsava/2010 to find out more and to book your place – don’t leave it too late; we were sold out last year!

consultant in medicine and critical care and a member of the guideline development group for venous thromboembolism prevention for the National Institute of Clinical Excellence (NICE). For those attendees that are in the processing of writing their CertSAM casebook there will be a lunchtime session offering advice. The day will include the following sessions:

Epilepsy: when the (usual) drugs don’t work with ■■

Dr Holger VolkAntimicrobial usage in companion animal practice: ■■

facts and moral dilemmas with Dr Susan DawsonCase Reports competition presentations – ■■

sponsored by VétoquinolVenous thromboembolism: learning from a human ■■

perspective with Dr Nandan GautamHow to write a successful CertSAM casebook ■■

with Jon WrayControversies surrounding treatment of aortic ■■

thromboembolism with Dr Matt BealFeline acromegaly: separating facts from ■■

assumptions with Stijn Niessen

Fees: Members £65, Non-members £95 (lunch included if you register before 15 March 2010). Annual membership: £25.

SAMSoc’s satellite event is sponsored by Hill’s Pet Nutrition and Vétoquinol.

For details or to book any

Satellite Meeting please

contact the organiser directly.

VCSVeterinary Cardiovascular SocietyVenue: Hall 9, ICCBooking contact: Yolanda Martinez PereiraEmail: yolanda@zoologicalmedicine.comWebsite: www.bsava.org.uk/vcsTel: +44 (0) 7743 947802

➦

Satellite meetings at BSAVA Congress

SAMSocSmall Animal Medicine SocietyVenue: Hall 8a, ICCBooking contact: Yvonne McGrottyEmail: medicinereferrals@hotmail.comTel: +44 (0) 1412 377676

Members of SAMSoc include specialist internists and general practitioners from the UK and abroad who share a passion and enthusiasm for small animal medicine. The society hosts a meeting every year at BSAVA Congress.

This year SAMSoc are delighted to announce our speaker from human medicine is Dr Nandan Gautam, a

17-20 Satellite Groups.indd 20 19/1/10 08:52:41

companion | 21

CONGRESS

➥

Americans are well known in this country for the high quality of their dental work and so perhaps it is not surprising that even their pets can

receive cutting edge orthodontic care. A leading exponent of veterinary dentistry from the US has been invited to pass on his skills to his British and European colleagues at BSAVA Congress in Birmingham in April. Among a series of presentations on different aspects of oral surgery, Professor Bill Gengler of the University of Wisconsin will outline the principles of orthodontics to correct conditions resulting from malocclusions.

From man to beastAppliances similar to those originally developed in human dentistry are used with increasing frequency in dogs on both sides of the Atlantic to create a more regular bite. But in contrast with human orthodontics these methods are never used simply for cosmetic reasons. “The orthodontic procedures that we do

perform are only for the health and comfort of the animal,” he explains.

As a member of the American Veterinary Dental College, he uses these techniques to prevent or to treat the painful consequences of malocclusions, not to give the dog’s owners hope of success in shows. “As a group, we are very ethical and try not to change the appearance so it will have an advantage in the ring. We also encourage owners to neuter animals that have orthodontic treatment resulting from

hereditary defects.”

Problems and solutionsTwo defects which these methods are often used to

treat are linguoversion of the mandibular canine teeth (or base narrow canines)

and rostroversion of the maxillary canine tooth. The former can be a very painful condition and occurs mainly in long-nosed dogs such as Labradors, German Shepherd Dogs and Standard Poodles. Affected animals have very narrow mandibles and lower canine teeth that erupt vertically, with the result that over time

Bit between the teeth at Congress

Dentistry lectures are always especially popular at Congress – and even more so when a leading expert shares their skills

21-22 Congress.indd 21 19/1/10 08:53:09

22 | companion

CONGRESS

➦

Bit between the teeth at Congress

the lower canine teeth drill holes through the roof of the mouth into the nasal compartment, allowing food and debris to cause a septic rhinitis.

The latter condition occurs frequently in Shetland Sheepdogs but can also occur in a wide range of other breeds including Italian Greyhounds, poodles, and many types of terrier. It is also seen frequently in cats, and in both species causes lip trauma, periodontal disease and temporomandibular joint pain.

The underlying principles of orthodontics are to induce movement in the malpositioned tooth by applying gentle force on the periodontal ligament. This will result in migration of monocytes to the immediate area and their differentiation into bone-resorbing osteoclasts in the direction of the tooth movement and into new bone-forming osteoblasts on the opposite side. To avoid damaging these structures, the required force should not exceed the capillary blood pressure of the ligament. While they can be applied constantly or intermittently, pressure for at least six hours a day will be necessary to reposition the affected teeth, he explains.

Basic skills to future trendsWhile describing the novel technologies and surgical methods needed to achieve these changes, Prof. Gengler will emphasise the importance of more fundamental veterinary skills in achieving a good visual appearance and functional result. “The key messages that I want to get across are the importance of knowing your oral and dental anatomy and carrying out a thorough oral examination.”

REGISTER NOWBSAVA Congress, 8–11 April 2010■■

www.bsava.co■■ m – Save 5% on online registrations or download the registration formcongress@bsava.co■■ m – to request a registration pack01452 726700 – for enquiries ■■

Radiography and conventional photographs are essential in planning appropriate treatment, he says. “As in many situations, the inexperienced ‘newby’ will encounter problems through underestimating the problem at hand or failing to think through the treatment plan. With orthodontics it is important to be able to think in three dimensions. It is essential to be able to understand what effects the appliance you are using will have on the other oral structures.”

As well as bringing colleagues up to date on current methods, Prof. Gengler will also be able to highlight future trends. “What is over the horizon? Well dental implants are already here but not widely used and they will likely be used increasingly with time. Jaw lengthening or shortening for the correction of malocclusion through distraction osteogenesis may become more prominent in the future. And the use of allografts or xenografts for reconstructive surgery following surgery for oral cancers is another new frontier.” ■

21-22 Congress.indd 22 19/1/10 08:53:10

companion | 23

CPD

Several advances have recently been made in the areas of diagnosis, staging and therapy of common veterinary cancers. Dr David Vail of

North America and Dr Jane Dobson of the UK both have active clinical research programmes investigating novel diagnostic and therapeutic strategies involving companion animals, and both will be sharing their expertise at four locations in May.

Applications of novel immunohistochemical, flow-cytometric and imaging modalities have been applied to early diagnosis and staging of common tumour histologies, including lymphoma, mast cell tumours, osteosarcomas and soft tissue sarcomas among others. These technologies can lead to early diagnosis and more thorough therapeutic response evaluations, and provide additional prognostic information important to caregivers.

The addition of novel chemotherapeutic strategies, including the availability of more targeted therapies such as growth-factor receptor targeting and anti-tumour vaccines, as well as more accurate radiation therapy techniques are beginning to have an impact upon the standard of care in veterinary oncology and will be discussed at length.

This roadshow will explore all these advances and techniques and in addition, Dr Vail will illustrate currently applied clinical trial approaches used to investigate these new modalities, and Dr Dobson will discuss her work with photodynamic therapy (PDT) techniques. ■

Veterinary oncology roadshowDr David Vail and Dr Jane Dobson are taking a tour of the UK to explore what is new in veterinary oncology

Veterinary surgeons have been pioneering minimally invasive techniques since the early 1970s. However uptake was initially slow, partly

due to the prohibitive cost of endoscopy equipment and partly because of the same scepticism that had also faced the early pioneers in human practice. Flexible endoscopy was the first technique to gain acceptance in the veterinary profession because of the benefits these instruments give in the exploration of the tubular structures of the body, in particular the respiratory and gastrointestinal tracts.

In March Professor Ed Hall of Bristol Vet School will offer his expertise to vets thinking of purchasing

Introduction to flexible GI endoscopy

endoscopy equipment, and those who feel they are not getting full value from their equipment. He will explore how to perform upper and lower GI endoscopy, how to get through the pylorus and how to obtain optimal biopsies, using videos and sharing his practical experience with endoscopy models. ■

DATES19 May 2010 – Bellhouse Hotel, Beaconsfield, Metropolitan Region21 May 2010 – Redwood Hotel & Country Club, Bristol, South West Region23 May 2010 – Queensferry Hotel, Fife, Scottish Region25 May 2010 – Mottram Hall, Cheshire, North West Region

Member Fee – £203.28 inc. VATNon-Member Fee – £304.91 inc. VAT

Visit www.bsava.com to register or call 01452 726700.

DATE18 March 2010 – Woodrow House, GloucesterMember Fee – £203.28 inc. VATNon-Member Fee – £304.91 inc. VAT

CPD

The addition of novel chemotherapeutic strategies, including the availability of more targeted therapies such as growth-factor receptor targeting and anti-

Veterinary

roadshowDobson are taking a tour of the

23 CE.indd 23 19/1/10 08:49:18

22 | companion

CONGRESS

➦

Bit between the teeth at Congress

the lower canine teeth drill holes through the roof of the mouth into the nasal compartment, allowing food and debris to cause a septic rhinitis.

The latter condition occurs frequently in Shetland Sheepdogs but can also occur in a wide range of other breeds including Italian Greyhounds, poodles, and many types of terrier. It is also seen frequently in cats, and in both species causes lip trauma, periodontal disease and temporomandibular joint pain.

The underlying principles of orthodontics are to induce movement in the malpositioned tooth by applying gentle force on the periodontal ligament. This will result in migration of monocytes to the immediate area and their differentiation into bone-resorbing osteoclasts in the direction of the tooth movement and into new bone-forming osteoblasts on the opposite side. To avoid damaging these structures, the required force should not exceed the capillary blood pressure of the ligament. While they can be applied constantly or intermittently, pressure for at least six hours a day will be necessary to reposition the affected teeth, he explains.

Basic skills to future trendsWhile describing the novel technologies and surgical methods needed to achieve these changes, Prof. Gengler will emphasise the importance of more fundamental veterinary skills in achieving a good visual appearance and functional result. “The key messages that I want to get across are the importance of knowing your oral and dental anatomy and carrying out a thorough oral examination.”

REGISTER NOWBSAVA Congress, 8–11 April 2010■■

www.bsava.co■■ m – Save 5% on online registrations or download the registration formcongress@bsava.co■■ m – to request a registration pack01452 726700 – for enquiries ■■

Radiography and conventional photographs are essential in planning appropriate treatment, he says. “As in many situations, the inexperienced ‘newby’ will encounter problems through underestimating the problem at hand or failing to think through the treatment plan. With orthodontics it is important to be able to think in three dimensions. It is essential to be able to understand what effects the appliance you are using will have on the other oral structures.”

As well as bringing colleagues up to date on current methods, Prof. Gengler will also be able to highlight future trends. “What is over the horizon? Well dental implants are already here but not widely used and they will likely be used increasingly with time. Jaw lengthening or shortening for the correction of malocclusion through distraction osteogenesis may become more prominent in the future. And the use of allografts or xenografts for reconstructive surgery following surgery for oral cancers is another new frontier.” ■

21-22 Congress.indd 22 19/1/10 08:53:10

companion | 23

CPD

Several advances have recently been made in the areas of diagnosis, staging and therapy of common veterinary cancers. Dr David Vail of

North America and Dr Jane Dobson of the UK both have active clinical research programmes investigating novel diagnostic and therapeutic strategies involving companion animals, and both will be sharing their expertise at four locations in May.

Applications of novel immunohistochemical, flow-cytometric and imaging modalities have been applied to early diagnosis and staging of common tumour histologies, including lymphoma, mast cell tumours, osteosarcomas and soft tissue sarcomas among others. These technologies can lead to early diagnosis and more thorough therapeutic response evaluations, and provide additional prognostic information important to caregivers.

The addition of novel chemotherapeutic strategies, including the availability of more targeted therapies such as growth-factor receptor targeting and anti-tumour vaccines, as well as more accurate radiation therapy techniques are beginning to have an impact upon the standard of care in veterinary oncology and will be discussed at length.

This roadshow will explore all these advances and techniques and in addition, Dr Vail will illustrate currently applied clinical trial approaches used to investigate these new modalities, and Dr Dobson will discuss her work with photodynamic therapy (PDT) techniques. ■

Veterinary oncology roadshowDr David Vail and Dr Jane Dobson are taking a tour of the UK to explore what is new in veterinary oncology

Veterinary surgeons have been pioneering minimally invasive techniques since the early 1970s. However uptake was initially slow, partly

due to the prohibitive cost of endoscopy equipment and partly because of the same scepticism that had also faced the early pioneers in human practice. Flexible endoscopy was the first technique to gain acceptance in the veterinary profession because of the benefits these instruments give in the exploration of the tubular structures of the body, in particular the respiratory and gastrointestinal tracts.

In March Professor Ed Hall of Bristol Vet School will offer his expertise to vets thinking of purchasing

Introduction to flexible GI endoscopy

endoscopy equipment, and those who feel they are not getting full value from their equipment. He will explore how to perform upper and lower GI endoscopy, how to get through the pylorus and how to obtain optimal biopsies, using videos and sharing his practical experience with endoscopy models. ■

DATES19 May 2010 – Bellhouse Hotel, Beaconsfield, Metropolitan Region21 May 2010 – Redwood Hotel & Country Club, Bristol, South West Region23 May 2010 – Queensferry Hotel, Fife, Scottish Region25 May 2010 – Mottram Hall, Cheshire, North West Region

Member Fee – £203.28 inc. VATNon-Member Fee – £304.91 inc. VAT

Visit www.bsava.com to register or call 01452 726700.

DATE18 March 2010 – Woodrow House, GloucesterMember Fee – £203.28 inc. VATNon-Member Fee – £304.91 inc. VAT

CPD

The addition of novel chemotherapeutic strategies, including the availability of more targeted therapies such as growth-factor receptor targeting and anti-

Veterinary

roadshowDobson are taking a tour of the

23 CE.indd 23 19/1/10 08:49:18

24 | companion

VIN

Susan Bertram, DVM Horse Guard, Redmond, OR

Patient is a 9 yr old F/s wheaten terrier, second opinion on rising urine pro:creatinine ratios.Clinically normal, no wt loss. B wt. 38 lb (17 kg*), BCS= 5/10 (ideal)

Urine specific gravity and protein trends from referring clinic:

Date USG Urinalysis Haematology/Biochemisty* Notes

11/2007 1.030 protein 3+, neg blood

BUN = 4.6 mmol/l (ref 2.5–9.6)Crea = 114 mmol/l (ref 44–160)phos = 1.4 mmol/l

8/2008 1.040 pro: 3+, trace blood

BUN = 7.5 mmol/lCreat = 106 mmol/lphos = 1.4 mmol/l

+ Clavamox

2/2009 1.039 Protein: 4+, negative blood. UPC = 2.8 (ref 0–1)

3/2009 1.040 pro: 4+, trace blood UPC = 3.9 BUN = 6 mmol/lCreat = 88 mmol/lALT = 105 IU/l (ref 10–100)TP = 54 g/l (ref 52–82)Alb = 25 g/l (ref 22–39)Chol = 8.2 mmol/l ref (2.8–8.3)Amyl = 1736 IU/l (ref 500–1500)

Benazapril started 5 mg q 24 hrs, 1/2 baby aspirin and omega 3 supplement, NF diet+ Clavamox

5/6/09 1.018 protein 500 mg/dL, blood neg, UPC = 7.5 !!!!, by cysto, culture not indicated per lab.

HCT = 42.8%, all else WNLs

GrapeVINeThe Veterinary Information Network brings together veterinary professionals from across the globe to share their experience and expertise. At vin.com users get instant access to vast amounts of up-to-date veterinary information from colleagues, many of whom have specialised knowledge and skills. In this regular feature, VIN shares with companion readers a small animal discussion that has recently taken place in their forums

Discussion: Wheaten Terrier with rising urine protein:creatinine ratios

So, several things stand out:

1) first, pet is not hypoproteinemic or azotemic, but yes, losing protein, which got WORSE after starting the Benazapril. The other clinic rec’d increasing Benazapril to BID, and this is when O. sought my opinion.

2) Since the once daily treatment made the values worsen (or, at least didn’t stem the progression at all) is it warranted/safe to increase? The urine specific gravity also decreased and I do not know why they didn’t repeat renal values, only ran a cbc post Tx. I realize this should be done.

Also, I have searched the archives and while I see time and again a low protein diet being recommended, I have not seen a good explanation. If patient is not azotemic, and is losing protein thru urine, won’t protein catabolism of muscle tissue ensue? How will this help this patient?

I know we should check a blood pressure, too, but the owner was told by her other vet it won’t be accurate because the dog is too spazzy and exciteable.

Appreciate advice on diet question and Rx question.

*Editor’s note: Values have been converted to SI units for ease of interpretation.

5/6/09 1.018

So, several things stand out:

1) first, pet is not hypoproteinemic or azotemic, but yes, losing protein, which got WORSE after starting the

2) Since the once daily treatment made the values worsen (or, at least didn’t stem the progression at all) is

Also, I have searched the archives and while I see time and again a low protein diet being recommended, I have not seen a good explanation. If patient is not azotemic, and is losing protein thru urine, won’t protein catabolism of muscle tissue ensue? How will this help this patient?

I know we should check a blood pressure, too, but the owner was told by her other vet it won’t be accurate because the dog is too spazzy and exciteable.

Appreciate advice on diet question and Rx question.

24-26 GrapeVINe.indd 24 19/1/10 08:50:53

companion | 25

VIN

➥

Robert Vasilopulos DVM,MS, DACVIMVeterinary Specialty Center of Tucson, VIN Internal Medicine Consultant

>>> culture not indicated per lab <<< culture is always indicated in these cases… needed to do c/s and not c/s IF

>>> which got WORSE after starting the Benazapril. <<< it did get worse but not likely related to ACI – worsening of disease? the benazepril dose is very low dose… most use 0.5 mg/kg which would be 9.5 mg and then escalate till desired effect ie a normal UPC. >>> safe to increase? <<< yes.

>>> urine specific gravity <<< This is only one value and can change minute by minute… don’t think you can take much more from 1 value. Recommended to check renal and UA/UPC after each change.

>>> good explanation <<< Decreases protein loss.

>>> won’t protein catabolism of muscle tissue ensue? <<< Can lead to problem when alb is low.

>>> blood pressure won’t be accurate because the dog is too spazzy and exciteable. <<< If normal then normal… if high then need to decide if real or not.

Susan Bertram

OK, maybe I am being dense, but if ingested protein is going to be lost through the kidneys anyway, are we just trying to make urine protein lab values look better? Does the protein actually accelerate DAMAGE to the kidneys? Again, I am talking about non-azotemic patient, such as this dog.

I have heard that low protein diets even in CRF patients, especially cats, may only make the lab values look better, not actually help, and maybe harm the patient (as in, it won’t eat the yukky tasting low protein foods, so it loses weight, catabalizes its muscle tissue, etc.) and to clarify, do you mean the low protein diet is only a problem when the albumin is also low?

So, what if now the patient is azotemic after the benazapril? I assume we would NOT increase the dose.

Thanks.

Robert Vasilopulos

>>> Does the protein actually accelerate DAMAGE to the kidneys? <<< Absolutely yes… that is one reason we want to control. Leads to tubular damage and renal failure.

>>> not actually help <<< If you look at the literature… some from Hills on k/d compared to other diets the quality and quantity of life of patient was prolonged/improved.

>>> maybe harm the patient <<< If they refuse to eat then better to have them eat something, use phos binders to control phos etc.

>>> do you mean the low protein diet is only a problem when the albumin is also low? <<< Some nephrologists think that giving a very protein restricted diet to a severely hypoproteinemic patient leading to more wt loss etc. is actually harmful… don’t think all believe this and no proof in literature

>>> azotemic after the benazapril? I assume we would NOT increase the dose <<< Depends on the degree… if mild then would not worry… how do we know the ACEI is causing the azotemia? and not progression of disease… would have to stop the ACEI and recheck values… could also try other ACEI

Susan Bertram

I would be interested in literature re: protein damage to renal tubules in carnivores. I knew it was theorized, didn’t know solidly proven. can you refer be to some articles, thanks. Thank you for your input on this case.Sincerely, Dr. Bertram

Robert Vasilopulos

Not certain of any literature but CVT 13 has a great review article.

Julie Fischer DVM, DACVIM, Veterinary Specialty Hospital-San DiegoSan Diego, CA, VIN Consultant – Nephrology/Urology

There are lots of references for the nephrotoxicity of proteinuria, most of the primary research comes from human literature, but the physiology of this particular process is the same. Basically, the proximal tubular epithelial cells try hard to reclaim protein from the filtrate, and when they get “maxed out,” transport errors occur, lysosomes spill in the interstitium, and inflammation with resulting tubulointerstitial fibrosis results. Here is an excerpt on the pathophys from the notes from one of my glomerular disease lectures:

“The major job of the proximal tubular epithelial cells is the reclamation of needed solutes from the ultrafiltrate by endocytosis, regardless of whether the solutes are there under physiological (normally filtered) or pathological (leaky glomeruli) conditions. Once reabsorbed from the lumen, the cells secrete the solutes into the renal interstitium for transport back into nearby vessels. When an increased amount of protein is present in the ultrafiltrate, the tubular epithelial cells continue to perform this function to maximum transport capacity, packaging proteins into lysosomes where they are degraded into amino acids. (Despite best tubular efforts, however, transport capacity is usually exceeded, resulting in protein loss in the urine.) Increased protein endocytosis necessitates increased lysosomal processing, with increased frequency of lysosomal swelling and rupture, resulting in enzymatic damage to the cytoplasm.

24-26 GrapeVINe.indd 25 19/1/10 08:50:53

24 | companion

VIN

Susan Bertram, DVM Horse Guard, Redmond, OR

Patient is a 9 yr old F/s wheaten terrier, second opinion on rising urine pro:creatinine ratios.Clinically normal, no wt loss. B wt. 38 lb (17 kg*), BCS= 5/10 (ideal)

Urine specific gravity and protein trends from referring clinic:

Date USG Urinalysis Haematology/Biochemisty* Notes

11/2007 1.030 protein 3+, neg blood

BUN = 4.6 mmol/l (ref 2.5–9.6)Crea = 114 mmol/l (ref 44–160)phos = 1.4 mmol/l

8/2008 1.040 pro: 3+, trace blood

BUN = 7.5 mmol/lCreat = 106 mmol/lphos = 1.4 mmol/l

+ Clavamox

2/2009 1.039 Protein: 4+, negative blood. UPC = 2.8 (ref 0–1)

3/2009 1.040 pro: 4+, trace blood UPC = 3.9 BUN = 6 mmol/lCreat = 88 mmol/lALT = 105 IU/l (ref 10–100)TP = 54 g/l (ref 52–82)Alb = 25 g/l (ref 22–39)Chol = 8.2 mmol/l ref (2.8–8.3)Amyl = 1736 IU/l (ref 500–1500)

Benazapril started 5 mg q 24 hrs, 1/2 baby aspirin and omega 3 supplement, NF diet+ Clavamox

5/6/09 1.018 protein 500 mg/dL, blood neg, UPC = 7.5 !!!!, by cysto, culture not indicated per lab.

HCT = 42.8%, all else WNLs

GrapeVINeThe Veterinary Information Network brings together veterinary professionals from across the globe to share their experience and expertise. At vin.com users get instant access to vast amounts of up-to-date veterinary information from colleagues, many of whom have specialised knowledge and skills. In this regular feature, VIN shares with companion readers a small animal discussion that has recently taken place in their forums

Discussion: Wheaten Terrier with rising urine protein:creatinine ratios

So, several things stand out:

1) first, pet is not hypoproteinemic or azotemic, but yes, losing protein, which got WORSE after starting the Benazapril. The other clinic rec’d increasing Benazapril to BID, and this is when O. sought my opinion.

2) Since the once daily treatment made the values worsen (or, at least didn’t stem the progression at all) is it warranted/safe to increase? The urine specific gravity also decreased and I do not know why they didn’t repeat renal values, only ran a cbc post Tx. I realize this should be done.

Also, I have searched the archives and while I see time and again a low protein diet being recommended, I have not seen a good explanation. If patient is not azotemic, and is losing protein thru urine, won’t protein catabolism of muscle tissue ensue? How will this help this patient?

I know we should check a blood pressure, too, but the owner was told by her other vet it won’t be accurate because the dog is too spazzy and exciteable.

Appreciate advice on diet question and Rx question.

*Editor’s note: Values have been converted to SI units for ease of interpretation.

5/6/09 1.018

So, several things stand out:

1) first, pet is not hypoproteinemic or azotemic, but yes, losing protein, which got WORSE after starting the

2) Since the once daily treatment made the values worsen (or, at least didn’t stem the progression at all) is

Also, I have searched the archives and while I see time and again a low protein diet being recommended, I have not seen a good explanation. If patient is not azotemic, and is losing protein thru urine, won’t protein catabolism of muscle tissue ensue? How will this help this patient?

I know we should check a blood pressure, too, but the owner was told by her other vet it won’t be accurate because the dog is too spazzy and exciteable.

Appreciate advice on diet question and Rx question.

24-26 GrapeVINe.indd 24 19/1/10 08:50:53

companion | 25

VIN

➥

Robert Vasilopulos DVM,MS, DACVIMVeterinary Specialty Center of Tucson, VIN Internal Medicine Consultant

>>> culture not indicated per lab <<< culture is always indicated in these cases… needed to do c/s and not c/s IF

>>> which got WORSE after starting the Benazapril. <<< it did get worse but not likely related to ACI – worsening of disease? the benazepril dose is very low dose… most use 0.5 mg/kg which would be 9.5 mg and then escalate till desired effect ie a normal UPC. >>> safe to increase? <<< yes.

>>> urine specific gravity <<< This is only one value and can change minute by minute… don’t think you can take much more from 1 value. Recommended to check renal and UA/UPC after each change.

>>> good explanation <<< Decreases protein loss.

>>> won’t protein catabolism of muscle tissue ensue? <<< Can lead to problem when alb is low.

>>> blood pressure won’t be accurate because the dog is too spazzy and exciteable. <<< If normal then normal… if high then need to decide if real or not.

Susan Bertram

OK, maybe I am being dense, but if ingested protein is going to be lost through the kidneys anyway, are we just trying to make urine protein lab values look better? Does the protein actually accelerate DAMAGE to the kidneys? Again, I am talking about non-azotemic patient, such as this dog.

I have heard that low protein diets even in CRF patients, especially cats, may only make the lab values look better, not actually help, and maybe harm the patient (as in, it won’t eat the yukky tasting low protein foods, so it loses weight, catabalizes its muscle tissue, etc.) and to clarify, do you mean the low protein diet is only a problem when the albumin is also low?

So, what if now the patient is azotemic after the benazapril? I assume we would NOT increase the dose.

Thanks.

Robert Vasilopulos

>>> Does the protein actually accelerate DAMAGE to the kidneys? <<< Absolutely yes… that is one reason we want to control. Leads to tubular damage and renal failure.

>>> not actually help <<< If you look at the literature… some from Hills on k/d compared to other diets the quality and quantity of life of patient was prolonged/improved.

>>> maybe harm the patient <<< If they refuse to eat then better to have them eat something, use phos binders to control phos etc.

>>> do you mean the low protein diet is only a problem when the albumin is also low? <<< Some nephrologists think that giving a very protein restricted diet to a severely hypoproteinemic patient leading to more wt loss etc. is actually harmful… don’t think all believe this and no proof in literature

>>> azotemic after the benazapril? I assume we would NOT increase the dose <<< Depends on the degree… if mild then would not worry… how do we know the ACEI is causing the azotemia? and not progression of disease… would have to stop the ACEI and recheck values… could also try other ACEI

Susan Bertram

I would be interested in literature re: protein damage to renal tubules in carnivores. I knew it was theorized, didn’t know solidly proven. can you refer be to some articles, thanks. Thank you for your input on this case.Sincerely, Dr. Bertram

Robert Vasilopulos

Not certain of any literature but CVT 13 has a great review article.

Julie Fischer DVM, DACVIM, Veterinary Specialty Hospital-San DiegoSan Diego, CA, VIN Consultant – Nephrology/Urology

There are lots of references for the nephrotoxicity of proteinuria, most of the primary research comes from human literature, but the physiology of this particular process is the same. Basically, the proximal tubular epithelial cells try hard to reclaim protein from the filtrate, and when they get “maxed out,” transport errors occur, lysosomes spill in the interstitium, and inflammation with resulting tubulointerstitial fibrosis results. Here is an excerpt on the pathophys from the notes from one of my glomerular disease lectures:

“The major job of the proximal tubular epithelial cells is the reclamation of needed solutes from the ultrafiltrate by endocytosis, regardless of whether the solutes are there under physiological (normally filtered) or pathological (leaky glomeruli) conditions. Once reabsorbed from the lumen, the cells secrete the solutes into the renal interstitium for transport back into nearby vessels. When an increased amount of protein is present in the ultrafiltrate, the tubular epithelial cells continue to perform this function to maximum transport capacity, packaging proteins into lysosomes where they are degraded into amino acids. (Despite best tubular efforts, however, transport capacity is usually exceeded, resulting in protein loss in the urine.) Increased protein endocytosis necessitates increased lysosomal processing, with increased frequency of lysosomal swelling and rupture, resulting in enzymatic damage to the cytoplasm.

24-26 GrapeVINe.indd 25 19/1/10 08:50:53

26 | companion

VIN

➦

GrapeVINe

Initial renal injury directly stimulates generation of angiotensin II (ANG II), and both decreased GFR and decreased plasma oncotic pressure can lead to renin-angiotensin-aldosterone system (RAAS) upregulation. ANG II, and aldosterone are both pro-inflammatory, and ANG II directly induces upregulation of transforming growth factor-β (TGF-β). TGF-β causes both tubular cell hypertrophy and increased synthesis of Type IV collagen. Excessive protein reabsorption activates inflammatory genes, and causes upregulation of tubular-derived endothelin-1 (ET-1, a very potent vasoconstrictor), monocyte chemoattractant protein-1 (CCL2, formerly known as MCP-1), and an immunoregulatory cytokine called CCL5 (formerly known as RANTES). The presence of increased ET-1 in the interstitium leads to ischemic damage, and induces the interstitial fibroblasts to proliferate and secrete increased amounts of matrix. True to its (former) name, CCL2 attracts monocytes and other inflammatory mononuclear cells, and CCL5 is chemotactic for T cells, eosinophils and basophils.

Increased interstitial amino acid transport is itself pro-inflammatory, and (combined with the cellular injury described above, and the results of ANG-II and chemoattractant factor upregulation) eventually results in tubulointerstitial nephritis with fibrosis and progressive loss of renal function. Magnitude of proteinuria usually determines severity of inflammatory response, and fulminant, heavy proteinuria can cause inflammation severe enough to result in acute tubular necrosis and uremia. If proteinuria can be slowed or halted, and the patient can be sustained (e.g., with standard care or with dialysis), recovery from acute tubular necrosis and recovery from renal failure will often occur.”

So no, it’s not just cosmetic or making the numbers look better – proteinuria is pathological in and of itself, and pathogenicity is proportional to magnitude.

Hope that helps.

Michael Riegger, DVMNorthwest Animal Clinic and Hospital, Albuquerque, NM

Good afternoon all,

Are there any double blinded comparisons of these situations?

Julie Fischer

Hi Michael –

Double blinded comparisons of what (though most likely the answer is “no”)? The following study WAS blinded/controlled (and had the participation of some folks who truly know their way around the kidney!), and looked at enalapril use in dogs with GN, evaluating proteiniuria and progression in response to tx, but most of our data come from (fairly copious) human and lab animal studies.

J Vet Intern Med. 2000 Sep-Oct;14(5):526-33Effects of enalapril versus placebo as a treatment for canine idiopathic glomerulonephritis. Grauer GF, Greco DS, Getzy DM, Cowgill LD, Vaden SL, Chew DJ, Polzin DJ, Barsanti JA

Michael Riegger

Thanx! =)

Julie Fischer

You bet. Glad you’re looking for the evidence behind the rhetoric!

All content published courtesy of VIN with permission granted by each quoted VIN Member.For more details about the Veterinary Information Network visit vin.com. As VIN is a global veterinary discussion forum not all diets, drugs or equipment referred to in this feature will be available in the UK, nor do all drug choices necessarily conform to the prescribing rules of the Cascade. Discussions may appear in an edited form.

This thread appears in an edited form. To read the full thread and access the links mentioned visit http://www.vin.com/Link.plx?ID=4331686

Editor’s note:Two familial renal diseases are recognised in the Soft-coated Wheaten Terrier.

1) A juvenile renal disease with pathologic changes suggestive of renal dysplasia. 2) An adult onset protein-losing nephropathy (PLN) either alone or in combination with a protein-losing enteropathy. Increased gut

permeability is suggested to lead to immune complex glomerulonephritis (membranoproliferative glomerulonephritis) that then progresses to glomerular sclerosis and chronic interstitial nephritis (end-stage renal disease). Clinical findings are those expected in PLN (wt loss, proteinuria, hypoalbuminaemia, hypercholesterolaemia progressing to PU/PD, azotaemia, hyperphosphataemia and non-regenerative anaemia ) Hypertension and thromboembolism occasionally develop. The disease is progressive and associated with a poor prognosis. Treatment is palliative.

24-26 GrapeVINe.indd 26 19/1/10 08:50:53

companion | 27

PETSAVERS

Improving the health of the nation’s pets

PETSAVERS

Petsavers is currently funding a study on ‘Establishing potential CSF markers of degenerative myelopathy in the dog’. The study

is headed by Professor T. James Anderson at the University of Glasgow.

Professor Anderson describes his project: Degenerative myelopathy (DM) (or chronic degenerative radicuolomyelopathy, CDRM) is a condition of the nervous system that affects mostly older German Shepherd Dogs. A number of other specific breeds may also be affected, in particular the Chesapeake Bay Retriever and the Pembroke Corgi.

This slow degenerative condition of the central nervous system leads to deterioration in hindlimb action, with affected dogs becoming increasingly unsteady and eventually unable to walk. Though, fortunately, this condition appears not to be painful, it is distressing for both patient and owner; and as there is no cure, progression leads ultimately to euthanasia. The frustration of the lack of an ‘in life’ diagnostic test is well recognised in veterinary

Petsavers is looking for runners to take part in the British 10K London Run. The run is a huge event and 27,000 runners took part last year for many different charities. The route takes in many of London’s

landmarks including the London Eye and the Houses of Parliament. The run is taking place on Sunday 11 July 2010, so there is plenty of time to train and raise sponsorship. If you are interested in taking part please

contact Gene Waterhouse on g.waterhouse@bsava.com. Petsavers has a limited number of places for the run, so if you are keen to take part please

get in touch soon to avoid disappointment. ■

Degenerative myelopathy projectProfessor T. James Anderson describes his Petsavers-funded project on degenerative myelopathy

practice, particularly as some other conditions may have a similar clinical appearance.

A major step forward in the understanding of DM has been made recently in the USA where it has been revealed that affected dogs share a mutation of a common gene. The affected gene is Superoxidase 1 (SOD1). SOD1 is involved in protecting cells from free radicals, which are important in many destructive pathways underlying disease. The contribution of SOD1 to DM is now being actively investigated around the world.

The current understanding is that the presence of the mutation indicates that a dog has the potential to develop the disease, but is not specifically diagnostic. Other diseases, most importantly degenerative disc disease, can cause similar clinical signs and/or occur concurrently, but have a potentially better outcome. Making the correct diagnosis in an individual dog is important so the best advice can be given.

This project will examine protein markers that studies in a disease in man related to the SOD1 mutation – amyotrophic lateral sclerosis (ALS) – suggest may be related to the presence of disease. These disease markers comprise changes in a group of serum and CSF proteins in ALS. The aim is developing a test that will allow a diagnosis of DM to be made with greater confidence. ■

Calling all runners

27 Petsavers.indd 27 19/1/10 08:35:19

26 | companion

VIN

➦

GrapeVINe

Initial renal injury directly stimulates generation of angiotensin II (ANG II), and both decreased GFR and decreased plasma oncotic pressure can lead to renin-angiotensin-aldosterone system (RAAS) upregulation. ANG II, and aldosterone are both pro-inflammatory, and ANG II directly induces upregulation of transforming growth factor-β (TGF-β). TGF-β causes both tubular cell hypertrophy and increased synthesis of Type IV collagen. Excessive protein reabsorption activates inflammatory genes, and causes upregulation of tubular-derived endothelin-1 (ET-1, a very potent vasoconstrictor), monocyte chemoattractant protein-1 (CCL2, formerly known as MCP-1), and an immunoregulatory cytokine called CCL5 (formerly known as RANTES). The presence of increased ET-1 in the interstitium leads to ischemic damage, and induces the interstitial fibroblasts to proliferate and secrete increased amounts of matrix. True to its (former) name, CCL2 attracts monocytes and other inflammatory mononuclear cells, and CCL5 is chemotactic for T cells, eosinophils and basophils.

Increased interstitial amino acid transport is itself pro-inflammatory, and (combined with the cellular injury described above, and the results of ANG-II and chemoattractant factor upregulation) eventually results in tubulointerstitial nephritis with fibrosis and progressive loss of renal function. Magnitude of proteinuria usually determines severity of inflammatory response, and fulminant, heavy proteinuria can cause inflammation severe enough to result in acute tubular necrosis and uremia. If proteinuria can be slowed or halted, and the patient can be sustained (e.g., with standard care or with dialysis), recovery from acute tubular necrosis and recovery from renal failure will often occur.”

So no, it’s not just cosmetic or making the numbers look better – proteinuria is pathological in and of itself, and pathogenicity is proportional to magnitude.

Hope that helps.

Michael Riegger, DVMNorthwest Animal Clinic and Hospital, Albuquerque, NM

Good afternoon all,

Are there any double blinded comparisons of these situations?

Julie Fischer

Hi Michael –

Double blinded comparisons of what (though most likely the answer is “no”)? The following study WAS blinded/controlled (and had the participation of some folks who truly know their way around the kidney!), and looked at enalapril use in dogs with GN, evaluating proteiniuria and progression in response to tx, but most of our data come from (fairly copious) human and lab animal studies.

J Vet Intern Med. 2000 Sep-Oct;14(5):526-33Effects of enalapril versus placebo as a treatment for canine idiopathic glomerulonephritis. Grauer GF, Greco DS, Getzy DM, Cowgill LD, Vaden SL, Chew DJ, Polzin DJ, Barsanti JA

Michael Riegger

Thanx! =)

Julie Fischer

You bet. Glad you’re looking for the evidence behind the rhetoric!

All content published courtesy of VIN with permission granted by each quoted VIN Member.For more details about the Veterinary Information Network visit vin.com. As VIN is a global veterinary discussion forum not all diets, drugs or equipment referred to in this feature will be available in the UK, nor do all drug choices necessarily conform to the prescribing rules of the Cascade. Discussions may appear in an edited form.

This thread appears in an edited form. To read the full thread and access the links mentioned visit http://www.vin.com/Link.plx?ID=4331686

Editor’s note:Two familial renal diseases are recognised in the Soft-coated Wheaten Terrier.

1) A juvenile renal disease with pathologic changes suggestive of renal dysplasia. 2) An adult onset protein-losing nephropathy (PLN) either alone or in combination with a protein-losing enteropathy. Increased gut

permeability is suggested to lead to immune complex glomerulonephritis (membranoproliferative glomerulonephritis) that then progresses to glomerular sclerosis and chronic interstitial nephritis (end-stage renal disease). Clinical findings are those expected in PLN (wt loss, proteinuria, hypoalbuminaemia, hypercholesterolaemia progressing to PU/PD, azotaemia, hyperphosphataemia and non-regenerative anaemia ) Hypertension and thromboembolism occasionally develop. The disease is progressive and associated with a poor prognosis. Treatment is palliative.

24-26 GrapeVINe.indd 26 19/1/10 08:50:53

companion | 27

PETSAVERS

Improving the health of the nation’s pets

PETSAVERS

Petsavers is currently funding a study on ‘Establishing potential CSF markers of degenerative myelopathy in the dog’. The study

is headed by Professor T. James Anderson at the University of Glasgow.

Professor Anderson describes his project: Degenerative myelopathy (DM) (or chronic degenerative radicuolomyelopathy, CDRM) is a condition of the nervous system that affects mostly older German Shepherd Dogs. A number of other specific breeds may also be affected, in particular the Chesapeake Bay Retriever and the Pembroke Corgi.

This slow degenerative condition of the central nervous system leads to deterioration in hindlimb action, with affected dogs becoming increasingly unsteady and eventually unable to walk. Though, fortunately, this condition appears not to be painful, it is distressing for both patient and owner; and as there is no cure, progression leads ultimately to euthanasia. The frustration of the lack of an ‘in life’ diagnostic test is well recognised in veterinary

Petsavers is looking for runners to take part in the British 10K London Run. The run is a huge event and 27,000 runners took part last year for many different charities. The route takes in many of London’s

landmarks including the London Eye and the Houses of Parliament. The run is taking place on Sunday 11 July 2010, so there is plenty of time to train and raise sponsorship. If you are interested in taking part please

contact Gene Waterhouse on g.waterhouse@bsava.com. Petsavers has a limited number of places for the run, so if you are keen to take part please

get in touch soon to avoid disappointment. ■

Degenerative myelopathy projectProfessor T. James Anderson describes his Petsavers-funded project on degenerative myelopathy

practice, particularly as some other conditions may have a similar clinical appearance.

A major step forward in the understanding of DM has been made recently in the USA where it has been revealed that affected dogs share a mutation of a common gene. The affected gene is Superoxidase 1 (SOD1). SOD1 is involved in protecting cells from free radicals, which are important in many destructive pathways underlying disease. The contribution of SOD1 to DM is now being actively investigated around the world.

The current understanding is that the presence of the mutation indicates that a dog has the potential to develop the disease, but is not specifically diagnostic. Other diseases, most importantly degenerative disc disease, can cause similar clinical signs and/or occur concurrently, but have a potentially better outcome. Making the correct diagnosis in an individual dog is important so the best advice can be given.

This project will examine protein markers that studies in a disease in man related to the SOD1 mutation – amyotrophic lateral sclerosis (ALS) – suggest may be related to the presence of disease. These disease markers comprise changes in a group of serum and CSF proteins in ALS. The aim is developing a test that will allow a diagnosis of DM to be made with greater confidence. ■

Calling all runners

27 Petsavers.indd 27 19/1/10 08:35:19

28 | companion

PUBLICATIONS

Exotic Pets – the classic reborn

In the US, sugar gliders probably reached their peak of popularity as a novelty pet about six years ago. Therefore, most of those clients that are still keeping them are among the knowledgeable and enthusiastic minority who have often made considerable sacrifices to adapt their home and lifestyle to cope with the demands of these unusual pets. Usually, these people are also generous in providing advice and support for other less experienced owners, Cathy says.

Increasing diversityPet marsupials were mentioned briefly in the previous edition of the Manual, published in 2002, but with the expansion in veterinary involvement in their care, they now merit a complete chapter. Another currently fashionable species, the African pygmy hedgehog (a hybrid between the white-bellied hedgehog Atelerix albiventris and the Algerian hedgehog A. algirus) is also given a chapter to itself.

John Bonner speaks to the editors of the new edition of the original veterinary manual on exotic pet care

Too sweet for their own good?They sleep all day, they are noisy at night and they bite. Their dietary needs are difficult to meet, they scent mark around the home and they need huge amounts of space to exercise. So they are certainly far from being an ideal pet – but they have the enormous eyes of a nocturnal mammal, they’re undeniably cute (as shown on our new cover), and there’s the rub…

…They are sugar gliders (Petaurus breviceps), small arboreal marsupials native to Australia and New Guinea. They are also an increasingly popular pet species in Britain, which is why they are included in a chapter on pet marsupials in the updated and expanded new edition of the BSAVA Manual of Exotic Pets. Sugar gliders feature in the new Marsupials chapter, written by Cathy Johnson-Delaney, a specialist in exotic animal medicine based near Seattle, who is a co-editor of the new fifth edition which will be published in February 2010. Given the difficulties that most people face in successfully keeping sugar gliders, Cathy says she would discourage any client contemplating buying one who has not done their homework.

In principle, she is not averse to the notion of keeping a pet marsupial, provided that it is the right sort. She herself has a female Virginia opossum (Didelphis virginiana), a species with a long and relatively successful record of cohabitation with humans. But in a 15-year career caring for sugar gliders she knows that most of the problems that occur in this and most other exotic species are a direct result of ignorance and poor husbandry. As such they are issues that veterinary practitioners are likely to be asked to resolve and, like many of her colleagues, she has personally taken responsibility for a large number of pets discarded when their owners realise that they cannot cope or they have lost interest.

The advent of the recent BSAVA Manual of Rodents and Ferrets has led to some reorganisation of the rodent content, including a new chapter devoted to chinchillas, degus and duprasi. There are also completely new chapters on some groups that will be professionally challenging to all but the most

28-29 Publications.indd 28 19/1/10 08:42:54

companion | 29

PUBLICATIONS

companion | 29

experienced exotics practitioner, such as crocodilians and ratites (ostriches, rheas and emus).

One of the more familiar species, the ferret, is grouped together with two closely related mustelid groups, otters and skunks. As with some of the species already mentioned, otters may not be a regular visitor to the suburban veterinary consult room, and long may that remain the case. But it is important to include them, because species like the Asian short-clawed otter (Aonyx cinerea) are active during the day and are therefore a favourite for small zoological collections. So, practitioners may well be called out to administer preventive healthcare, in the form of distemper vaccinations, and to treat their common ailments, such as urolithiasis.

EXOTIC PETS COVEREDMice, rats, hamsters and gerbils; Guinea pigs, chinchillas, degus and duprasi; Chipmunks and prairie dogs; Rabbits; Marsupials; Ferrets, skunks and otters; African pygmy hedgehogs; Primates – callitrichids, cebids and lemurs; Cage and aviary birds; Racing pigeons; Birds of prey; Ostriches, emus and rheas; Crocodilians; Tortoises and turtles; Lizards; Snakes; Frogs and toads; Salamanders, axolotls and caecilians; Freshwater ornamental fish; Marine fish; Invertebrates

User-friendlyAs with all BSAVA Manuals, the new Exotic Pets is intended to be a book that becomes dog-eared with regular use, rather than something that decorates a shelf for months on end. The editors have spent a considerable amount of time checking and amending the content and format, so that it is possible for the user to have confidence that they will quickly find what they are looking for during a consultation.

“The idea is that each chapter should be presented in a consistent and logical way. We have organised each one so that it begins with a brief explanation of the natural history of the particular species or group, and goes on to deal with their anatomy, physiology, nutrition and husbandry. For the less experienced practitioner, we also include advice on how they should be handling that animal before describing the overall diagnostic approach and the diseases that they are most likely to encounter. We hope that this Manual will give a vet everything they need to know in order to approach an unfamiliar species in a sensible way and for them to be able to give an owner good advice on how to look after it,” Anna explains. ■

Some species included in the manual may no longer be strictly classified as exotics – rabbits, for example, long ago entered the mainstream of veterinary practice. However, co-editor Anna Meredith from the University of Edinburgh veterinary school, says it was decided to maintain a comprehensive list of minor species in the Manual, so that it remains the ‘go-to’ publication in the field.

Such have been the advances in knowledge on rabbits that there is a separate BSAVA Manual devoted to them. But the condensed information presented in Exotic Pets will provide a busy practitioner with pretty well everything they need to know during the course of a consultation. Any further research can be carried out later when the practitioner has time to check in the more specialised volume.

companion | 29

28-29 Publications.indd 29 19/1/10 08:42:58

28 | companion

PUBLICATIONS

Exotic Pets – the classic reborn

In the US, sugar gliders probably reached their peak of popularity as a novelty pet about six years ago. Therefore, most of those clients that are still keeping them are among the knowledgeable and enthusiastic minority who have often made considerable sacrifices to adapt their home and lifestyle to cope with the demands of these unusual pets. Usually, these people are also generous in providing advice and support for other less experienced owners, Cathy says.

Increasing diversityPet marsupials were mentioned briefly in the previous edition of the Manual, published in 2002, but with the expansion in veterinary involvement in their care, they now merit a complete chapter. Another currently fashionable species, the African pygmy hedgehog (a hybrid between the white-bellied hedgehog Atelerix albiventris and the Algerian hedgehog A. algirus) is also given a chapter to itself.

John Bonner speaks to the editors of the new edition of the original veterinary manual on exotic pet care

Too sweet for their own good?They sleep all day, they are noisy at night and they bite. Their dietary needs are difficult to meet, they scent mark around the home and they need huge amounts of space to exercise. So they are certainly far from being an ideal pet – but they have the enormous eyes of a nocturnal mammal, they’re undeniably cute (as shown on our new cover), and there’s the rub…

…They are sugar gliders (Petaurus breviceps), small arboreal marsupials native to Australia and New Guinea. They are also an increasingly popular pet species in Britain, which is why they are included in a chapter on pet marsupials in the updated and expanded new edition of the BSAVA Manual of Exotic Pets. Sugar gliders feature in the new Marsupials chapter, written by Cathy Johnson-Delaney, a specialist in exotic animal medicine based near Seattle, who is a co-editor of the new fifth edition which will be published in February 2010. Given the difficulties that most people face in successfully keeping sugar gliders, Cathy says she would discourage any client contemplating buying one who has not done their homework.

In principle, she is not averse to the notion of keeping a pet marsupial, provided that it is the right sort. She herself has a female Virginia opossum (Didelphis virginiana), a species with a long and relatively successful record of cohabitation with humans. But in a 15-year career caring for sugar gliders she knows that most of the problems that occur in this and most other exotic species are a direct result of ignorance and poor husbandry. As such they are issues that veterinary practitioners are likely to be asked to resolve and, like many of her colleagues, she has personally taken responsibility for a large number of pets discarded when their owners realise that they cannot cope or they have lost interest.

The advent of the recent BSAVA Manual of Rodents and Ferrets has led to some reorganisation of the rodent content, including a new chapter devoted to chinchillas, degus and duprasi. There are also completely new chapters on some groups that will be professionally challenging to all but the most

28-29 Publications.indd 28 19/1/10 08:42:54

companion | 29

PUBLICATIONS

companion | 29

experienced exotics practitioner, such as crocodilians and ratites (ostriches, rheas and emus).

One of the more familiar species, the ferret, is grouped together with two closely related mustelid groups, otters and skunks. As with some of the species already mentioned, otters may not be a regular visitor to the suburban veterinary consult room, and long may that remain the case. But it is important to include them, because species like the Asian short-clawed otter (Aonyx cinerea) are active during the day and are therefore a favourite for small zoological collections. So, practitioners may well be called out to administer preventive healthcare, in the form of distemper vaccinations, and to treat their common ailments, such as urolithiasis.

EXOTIC PETS COVEREDMice, rats, hamsters and gerbils; Guinea pigs, chinchillas, degus and duprasi; Chipmunks and prairie dogs; Rabbits; Marsupials; Ferrets, skunks and otters; African pygmy hedgehogs; Primates – callitrichids, cebids and lemurs; Cage and aviary birds; Racing pigeons; Birds of prey; Ostriches, emus and rheas; Crocodilians; Tortoises and turtles; Lizards; Snakes; Frogs and toads; Salamanders, axolotls and caecilians; Freshwater ornamental fish; Marine fish; Invertebrates

User-friendlyAs with all BSAVA Manuals, the new Exotic Pets is intended to be a book that becomes dog-eared with regular use, rather than something that decorates a shelf for months on end. The editors have spent a considerable amount of time checking and amending the content and format, so that it is possible for the user to have confidence that they will quickly find what they are looking for during a consultation.

“The idea is that each chapter should be presented in a consistent and logical way. We have organised each one so that it begins with a brief explanation of the natural history of the particular species or group, and goes on to deal with their anatomy, physiology, nutrition and husbandry. For the less experienced practitioner, we also include advice on how they should be handling that animal before describing the overall diagnostic approach and the diseases that they are most likely to encounter. We hope that this Manual will give a vet everything they need to know in order to approach an unfamiliar species in a sensible way and for them to be able to give an owner good advice on how to look after it,” Anna explains. ■

Some species included in the manual may no longer be strictly classified as exotics – rabbits, for example, long ago entered the mainstream of veterinary practice. However, co-editor Anna Meredith from the University of Edinburgh veterinary school, says it was decided to maintain a comprehensive list of minor species in the Manual, so that it remains the ‘go-to’ publication in the field.

Such have been the advances in knowledge on rabbits that there is a separate BSAVA Manual devoted to them. But the condensed information presented in Exotic Pets will provide a busy practitioner with pretty well everything they need to know during the course of a consultation. Any further research can be carried out later when the practitioner has time to check in the more specialised volume.

companion | 29

28-29 Publications.indd 29 19/1/10 08:42:58

30 | companion

What an eventful year it has been for WSAVA! The WSAVA Congress held in São Paulo was a great success, with over 3500 delegates

making it the biggest WSAVA World Congress ever staged. It was always going to be a huge party and the Saturday night event had the delegates dancing and partying until the early hours of the morning! The education programme was superb and great credit must go to Drs Wanderson Ferrara, Saliem Sayeed and Marco Gioso and their committees for their work in staging the Congress and setting such a high standard for the future. Talking of which, the Assembly voted to take the 2013 Congress to Christchurch, New Zealand, and we are already working hard with them to ensure our ongoing Congress success. We are immensely grateful to our Prime Congress Sponsor, Hill’s Pet Nutrition, for all the help given to WSAVA as we aim to set the highest standards in veterinary education.

Change and hard work on the BoardThere have been changes to the WSAVA Board. We were saddened that Dr Luis Tello resigned because of time commitment pressures, but I am really pleased that he has been able to continue to look after the WSAVA CE programme in Latin America. His deep knowledge of the area and his many friends and contacts mean that the programme runs very smoothly and I am very grateful for all the help he gives. He was replaced by Professor Peter Ihrke – who I am sure needs no introduction. He is currently Vice President and we will be looking to him for his wisdom and knowledge of international committee work. Dr Veronica Leong also joined the Board to add greater depth to a committee which is struggling under

an expanding workload. Her expertise in marketing will be invaluable in helping us to expand our PR portfolio.

Dr Sheehan has continued to work hard in developing the treasury, and is now faced with the task of working with the new Canadian accountants and instituting another new system that will hopefully be stable for many years to come as the WSAVA settles into its new incorporation as a Canadian Registered not-for-profit company.

Professor Jolle Kirpensteijn – and we must congratulate him on being elected a full Professor in the University of Utrecht – has been working tirelessly on future WSAVA Congresses and developing sponsorship opportunities with our commercial partners. The Assembly voted in São Paulo to form a Congress Steering Committee to look into the current structure and future development of the WSAVA Congress – Drs Kirpensteijn and Sheehan have worked tirelessly to form this committee and one of its first tasks will be to examine bids for the 2014 Congress.

Hon. Secretaries are always spoken of as hard working and Dr Walt Ingwersen is no exception. As well as his normal duties, he has been the lynchpin in the negotiations with the Canadian authorities and we are grateful to him and his wife June for all their hard work. June will also be developing the prototype WSAVA secretariat which will function separately to, but under the jurisdiction of, the Honorary Secretary.

Dr Brian Romberg has not been relaxing after his tenure as President, he has been working on the formation of the WSAVA Foundation, again as a registered company based in Canada, and he will be submitting his report on this exciting project in Geneva.

What a year!David Wadsworth, WSAVA President, reports on an eventful year for the Association

30-32 WSAVA News.indd 30 19/1/10 08:45:45

companion | 31

WSAVA NEWS

➥

New partnership for animal welfareThe Strategic Planning process identified animal welfare as one of the four pillars that underwrite the raison d’etre of WSAVA. I am extremely pleased to announce that WSAVA is entering into a partnership with WALTHAM, a division of Mars Inc., who will work with the Association in promoting animal welfare during the WSAVA and other large congresses, in promoting animal welfare in member association countries where there is an identified need for an improvement in standards, and in promoting the WSAVA Animal Welfare Convention. We are entering a very exciting phase of development of heightened awareness of the veterinary profession in this subject.

CE successThe WSAVA CE programme last year hosted 5000 delegates in 32 countries and the work of the committee will be reported in detail in a later issue. I am grateful to the help given to me by Drs Julian Wells, Roger Clarke, Lawson Cairns and Luis Tello in overseeing their various regional meetings. Our sponsors, Hill’s Pet Nutrition, Intervet/Schering-Plough Animal Health and Bayer Animal Health, provide invaluable help in the planning stages and work with the Association representatives in setting up the local meetings. Our member associations, ASAVA, BSAVA, VOK, AFVAC and NSAVA have once again been extremely helpful and generous in providing expertise and funding which has continued to help our programme to expand.

Other projectsProfessor Urs Giger and his team have been making excellent progress in the mapping of the canine and

feline genomes and identifying the many hereditary diseases. WALTHAM is to be thanked for their background assistance and funding for this extremely worthwhile project which will hopefully improve standards in breeding for generations to come.

Professor David Polzin organises the Renal Standardization Project which is getting well into its stride and the information produced in two years time should benefit current generations of animals. This is a huge project and we are grateful to both Hill’s Pet Nutrition and Bayer Animal Health for their support.

Professor Michael Day has been chairing the second phase of the vaccination protocol group and will be reporting in Geneva on this first truly global project which will add much needed clarity to a subject which seems to vary from country to country. Intervet/Schering-Plough Animal Health have been our partners in this exciting and challenging subject.

Michael Day and the Scientific Advisory Committee have worked unceasingly to advise on the scientific programmes of the WSAVA congresses and will be overseeing the ‘One Health One Medicine’ initiative which will form part of the programme in Geneva. Renowned international speakers from both the medical and veterinary professions will exchange ideas and look to future developments of mutual interest.

We are looking forward to the next Congress in Geneva next June. Dr Chris Amberger and his team have prepared an excellent programme. CPD with Lac Leman and Mont Blanc as a backdrop – what more can one say! Make a note in your diaries and join us there. ■

IN MEMORIAM – DR LLUÍS POMARDr Lluís Maria Pomar i Pomar, who was WSAVA President from 1980–82, passed away in Palma de Mallorca on 8 November 2009 at the age of 92. Although one does not pass on such news about a valued friend and colleague without a touch of sadness, it is also a time to celebrate Lluís’s many achievements and to be thankful for the opportunity to have known him. He was one of WSAVA’s primary mentors – during the 1980s the WSAVA Presidents achieved a great deal and put WSAVA on the firm footing that it now enjoys. Lluís was also one of the founders of AVEPA (Spanish Small Animal Veterinary Association), and was a driving force of small animal veterinary practice in Mallorca and Spain. ■

30-32 WSAVA News.indd 31 19/1/10 08:45:52

30 | companion

What an eventful year it has been for WSAVA! The WSAVA Congress held in São Paulo was a great success, with over 3500 delegates

making it the biggest WSAVA World Congress ever staged. It was always going to be a huge party and the Saturday night event had the delegates dancing and partying until the early hours of the morning! The education programme was superb and great credit must go to Drs Wanderson Ferrara, Saliem Sayeed and Marco Gioso and their committees for their work in staging the Congress and setting such a high standard for the future. Talking of which, the Assembly voted to take the 2013 Congress to Christchurch, New Zealand, and we are already working hard with them to ensure our ongoing Congress success. We are immensely grateful to our Prime Congress Sponsor, Hill’s Pet Nutrition, for all the help given to WSAVA as we aim to set the highest standards in veterinary education.

Change and hard work on the BoardThere have been changes to the WSAVA Board. We were saddened that Dr Luis Tello resigned because of time commitment pressures, but I am really pleased that he has been able to continue to look after the WSAVA CE programme in Latin America. His deep knowledge of the area and his many friends and contacts mean that the programme runs very smoothly and I am very grateful for all the help he gives. He was replaced by Professor Peter Ihrke – who I am sure needs no introduction. He is currently Vice President and we will be looking to him for his wisdom and knowledge of international committee work. Dr Veronica Leong also joined the Board to add greater depth to a committee which is struggling under

an expanding workload. Her expertise in marketing will be invaluable in helping us to expand our PR portfolio.

Dr Sheehan has continued to work hard in developing the treasury, and is now faced with the task of working with the new Canadian accountants and instituting another new system that will hopefully be stable for many years to come as the WSAVA settles into its new incorporation as a Canadian Registered not-for-profit company.

Professor Jolle Kirpensteijn – and we must congratulate him on being elected a full Professor in the University of Utrecht – has been working tirelessly on future WSAVA Congresses and developing sponsorship opportunities with our commercial partners. The Assembly voted in São Paulo to form a Congress Steering Committee to look into the current structure and future development of the WSAVA Congress – Drs Kirpensteijn and Sheehan have worked tirelessly to form this committee and one of its first tasks will be to examine bids for the 2014 Congress.

Hon. Secretaries are always spoken of as hard working and Dr Walt Ingwersen is no exception. As well as his normal duties, he has been the lynchpin in the negotiations with the Canadian authorities and we are grateful to him and his wife June for all their hard work. June will also be developing the prototype WSAVA secretariat which will function separately to, but under the jurisdiction of, the Honorary Secretary.

Dr Brian Romberg has not been relaxing after his tenure as President, he has been working on the formation of the WSAVA Foundation, again as a registered company based in Canada, and he will be submitting his report on this exciting project in Geneva.

What a year!David Wadsworth, WSAVA President, reports on an eventful year for the Association

30-32 WSAVA News.indd 30 19/1/10 08:45:45

companion | 31

WSAVA NEWS

➥

New partnership for animal welfareThe Strategic Planning process identified animal welfare as one of the four pillars that underwrite the raison d’etre of WSAVA. I am extremely pleased to announce that WSAVA is entering into a partnership with WALTHAM, a division of Mars Inc., who will work with the Association in promoting animal welfare during the WSAVA and other large congresses, in promoting animal welfare in member association countries where there is an identified need for an improvement in standards, and in promoting the WSAVA Animal Welfare Convention. We are entering a very exciting phase of development of heightened awareness of the veterinary profession in this subject.

CE successThe WSAVA CE programme last year hosted 5000 delegates in 32 countries and the work of the committee will be reported in detail in a later issue. I am grateful to the help given to me by Drs Julian Wells, Roger Clarke, Lawson Cairns and Luis Tello in overseeing their various regional meetings. Our sponsors, Hill’s Pet Nutrition, Intervet/Schering-Plough Animal Health and Bayer Animal Health, provide invaluable help in the planning stages and work with the Association representatives in setting up the local meetings. Our member associations, ASAVA, BSAVA, VOK, AFVAC and NSAVA have once again been extremely helpful and generous in providing expertise and funding which has continued to help our programme to expand.

Other projectsProfessor Urs Giger and his team have been making excellent progress in the mapping of the canine and

feline genomes and identifying the many hereditary diseases. WALTHAM is to be thanked for their background assistance and funding for this extremely worthwhile project which will hopefully improve standards in breeding for generations to come.

Professor David Polzin organises the Renal Standardization Project which is getting well into its stride and the information produced in two years time should benefit current generations of animals. This is a huge project and we are grateful to both Hill’s Pet Nutrition and Bayer Animal Health for their support.

Professor Michael Day has been chairing the second phase of the vaccination protocol group and will be reporting in Geneva on this first truly global project which will add much needed clarity to a subject which seems to vary from country to country. Intervet/Schering-Plough Animal Health have been our partners in this exciting and challenging subject.

Michael Day and the Scientific Advisory Committee have worked unceasingly to advise on the scientific programmes of the WSAVA congresses and will be overseeing the ‘One Health One Medicine’ initiative which will form part of the programme in Geneva. Renowned international speakers from both the medical and veterinary professions will exchange ideas and look to future developments of mutual interest.

We are looking forward to the next Congress in Geneva next June. Dr Chris Amberger and his team have prepared an excellent programme. CPD with Lac Leman and Mont Blanc as a backdrop – what more can one say! Make a note in your diaries and join us there. ■

IN MEMORIAM – DR LLUÍS POMARDr Lluís Maria Pomar i Pomar, who was WSAVA President from 1980–82, passed away in Palma de Mallorca on 8 November 2009 at the age of 92. Although one does not pass on such news about a valued friend and colleague without a touch of sadness, it is also a time to celebrate Lluís’s many achievements and to be thankful for the opportunity to have known him. He was one of WSAVA’s primary mentors – during the 1980s the WSAVA Presidents achieved a great deal and put WSAVA on the firm footing that it now enjoys. Lluís was also one of the founders of AVEPA (Spanish Small Animal Veterinary Association), and was a driving force of small animal veterinary practice in Mallorca and Spain. ■

30-32 WSAVA News.indd 31 19/1/10 08:45:52

32 | companion

WSAVA NEWS

➦

The official welcome reception will take place on 2 June at Palexpo and be followed by a Swiss Apero in the exhibition hall.

The world famous Geneva Fountain will form the backdrop for the Gala Dinner on 3 June. Participants will leave from Downtown Geneva on a boat for a relaxing one-hour cruise on Lake Geneva. A welcome drink will be served on board as the last light of the day reflects on the Lake. Following the boat trip the gala dinner will be served with a musical accompaniment.

Geneva 2010: updateTo keep up with the latest progress and learn more about “One Medicine”, please join us at the WSAVA World Congress in Geneva on 2–5 June 2010

The Swiss Evening Party on 4 June will allow delegates to discover a historical location of Geneva: the Bâtiment des Forces Motrices (BFM). A former hydro-electrical facility built on the Rhône River, the BFM will be converted into a giant gala room to make this a unique event.

The Scientific Programme is now available – look for more information and print your own copy at www.wsava2010.org ■

© M

ihai

-bog

dan

Laz

ar |

Dre

amst

ime.

com

30-32 WSAVA News.indd 32 19/1/10 08:46:05

companion | 33

THE companion INTERVIEW

Carmel Mooney

QWhat was your family life like and was there any history of veterinary medicine?

AMy one brother and I share a birthday – he was four and really wanted a Dinky car, but got me instead, so he has never really forgiven me.

My father was a civil servant specialising in pensions and taxes and my mother (not unexpectedly) was a full-time housewife. I grew up in DunLaoghaire, Co Dublin, a small town south of the city and went to both primary and secondary school locally – St Joseph of Cluny. After school I studied veterinary at ➥

Carmel Mooney was born in Dublin in 1964 – the youngest of eight children (four boys and four girls). She spent many years as a BSAVA volunteer in various posts, becoming President of the Association in 2006

Carmel is a 1986 graduate of UCD’s former Faculty of Veterinary Medicine. After spending several years in Scotland where she completed both MPhil (The University of Edinburgh) and PhD (The University of Glasgow) theses, she returned to UCD initially as Lecturer and then Head, Department of Small Animal Clinical Studies. More recently she was appointed as Clinical Director of the University Veterinary Hospital. Carmel obtained the European Diploma in Veterinary Internal Medicine (Companion Animals) in 1998 and is also a RCVS Specialist in Small Animal Medicine (Endocrinology), awarded in recognition of her clinical and research work in the field of small animal endocrinology

UCD – it was bad enough being a girl but being a city girl with no family ties to the profession made my choice somewhat unusual (at least then!).

What was your route into the veterinary profession; was it something you always knew you wanted to do?Veterinary was pretty much what I wanted to do all along – I never really had a second choice. I didn’t advertise the desire to do veterinary very much – it would not been considered an appropriate career by the nuns, so I used to suggest that I was going to do medicine.

33-34 Interview.indd 33 19/1/10 08:41:34

32 | companion

WSAVA NEWS

➦

The official welcome reception will take place on 2 June at Palexpo and be followed by a Swiss Apero in the exhibition hall.

The world famous Geneva Fountain will form the backdrop for the Gala Dinner on 3 June. Participants will leave from Downtown Geneva on a boat for a relaxing one-hour cruise on Lake Geneva. A welcome drink will be served on board as the last light of the day reflects on the Lake. Following the boat trip the gala dinner will be served with a musical accompaniment.

Geneva 2010: updateTo keep up with the latest progress and learn more about “One Medicine”, please join us at the WSAVA World Congress in Geneva on 2–5 June 2010

The Swiss Evening Party on 4 June will allow delegates to discover a historical location of Geneva: the Bâtiment des Forces Motrices (BFM). A former hydro-electrical facility built on the Rhône River, the BFM will be converted into a giant gala room to make this a unique event.

The Scientific Programme is now available – look for more information and print your own copy at www.wsava2010.org ■

© M

ihai

-bog

dan

Laz

ar |

Dre

amst

ime.

com

30-32 WSAVA News.indd 32 19/1/10 08:46:05

companion | 33

THE companion INTERVIEW

Carmel Mooney

QWhat was your family life like and was there any history of veterinary medicine?

AMy one brother and I share a birthday – he was four and really wanted a Dinky car, but got me instead, so he has never really forgiven me.

My father was a civil servant specialising in pensions and taxes and my mother (not unexpectedly) was a full-time housewife. I grew up in DunLaoghaire, Co Dublin, a small town south of the city and went to both primary and secondary school locally – St Joseph of Cluny. After school I studied veterinary at ➥

Carmel Mooney was born in Dublin in 1964 – the youngest of eight children (four boys and four girls). She spent many years as a BSAVA volunteer in various posts, becoming President of the Association in 2006

Carmel is a 1986 graduate of UCD’s former Faculty of Veterinary Medicine. After spending several years in Scotland where she completed both MPhil (The University of Edinburgh) and PhD (The University of Glasgow) theses, she returned to UCD initially as Lecturer and then Head, Department of Small Animal Clinical Studies. More recently she was appointed as Clinical Director of the University Veterinary Hospital. Carmel obtained the European Diploma in Veterinary Internal Medicine (Companion Animals) in 1998 and is also a RCVS Specialist in Small Animal Medicine (Endocrinology), awarded in recognition of her clinical and research work in the field of small animal endocrinology

UCD – it was bad enough being a girl but being a city girl with no family ties to the profession made my choice somewhat unusual (at least then!).

What was your route into the veterinary profession; was it something you always knew you wanted to do?Veterinary was pretty much what I wanted to do all along – I never really had a second choice. I didn’t advertise the desire to do veterinary very much – it would not been considered an appropriate career by the nuns, so I used to suggest that I was going to do medicine.

33-34 Interview.indd 33 19/1/10 08:41:34

34 | companion

THE companion INTERVIEW

…it was good to give something back to a profession that has served me well in my working life…

➦ Did you know you’d have a career in academia and teaching, or did you originally intend to go into practice?Like a lot of new veterinary students, I romanticised about the perfect life as a mixed practitioner. However, a couple of late night farm calls in the middle of winter with the wind and rain whistling around during seeing practice made me realise it wasn’t for me! There was also the realisation that were other career paths in veterinary that were every bit as challenging but perhaps in different ways.

You are known in the field of endocrinology, what made you choose this specialism?It is so straightforward – you know what a hormone does and you can easily work out what happens if there is too much or too little! Actually my first job was based in small animal medicine at the R(D)SVS – Dr Keith Thoday was my mentor and he had just completed a PhD on thyroid function in cats and really engendered my interest in the subject – I had never seen a hyperthyroid cat before then and could not believe how many cases there were.

You’ve been a key BSAVA volunteer for many years, what did you get out of it?I started as a volunteer while still at Edinburgh just helping out the regional committee. Everyone seemed to be doing it and I had attended a couple of CPD events run by BSAVA and had enjoyed them. I don’t think there was anything more altruistic than that – although looking back it was good to give something back to a profession that has served me well in my working life. It is different working with a group of volunteers because you all tend to be like-minded and enthusiastic with similar aims – it gives an additional sense of achievement and I have gained knowledge and skills that would not normally be gained through my day job. The icing on the cake however is the camaraderie and some of my best friends emanate from my ‘volunteer’ jobs.

What have been the biggest challenges of your career so far?Completing a PhD whilst having my first child was pretty challenging – but the PhD got finished eventually.

What do you consider to be your most important achievement during your career so far?To date becoming BSAVA President – hopefully there will be more.

What has been your main interest outside work?It is quite varied – but mostly cooking, walking.

Who has been the most inspiring influence on your professional career?Mark Peterson – one of the top veterinary endocrinologists around – a prolific writer on the subject. Undoubtedly most of our knowledge on hyperthyroidism comes from clinical and research work he has been involved in, and he has always been really helpful to me.

What is the most significant lesson you have learned so far in life?You can always be proved wrong.

If you could change one thing about your appearance or personality, what would it be?Where do I start?

What is your most important possession?I suppose in so far as a dog or cat can be a possession, they are always the most important possession!

What would you have done if you hadn’t chosen to be a vet?Not really sure. I think I am more comfortable with small animals but maybe I could have chosen a different discipline – an anaesthetist or surgeon maybe. ■

THE companion INTERVIEW

33-34 Interview.indd 34 19/1/10 08:41:37

companion | 35

CPDdiary

9 FebruaryTuesday

A practical approach to treating psittacinesSpeaker Neil ForbesPotters Heron Hotel, romsey SO51 9ZF. Southern Regiondetails from southern@bsava.com

EVENINGMEETING

11 FebruaryThursday

Thoracic medicine: the coughing dogSpeaker Simon Swiftdavid Lloyd Leisure, Moss Lane, Whittle-le-Woods, Chorley Pr6 8aB. North West Regiondetails from Vikki Moran, vikki.moran@sky.com

EVENINGMEETING

17 FebruaryWednesday

An update on fish medicine: goldfish & koi carpSpeaker Peter Scottrussell Hotel, 136 Boxley rd, Maidstone, Kent ME14 2aE. Kent Regiondetails from Hannah Perrin,hannah@burnhamhousevets.com

EVENINGMEETING

23 FebruaryTuesday

Endocrinology I: PU/PD & alopeciaSpeaker Ian RamseyBSaVa, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2aBdetails from BSaVa, 01452 726700,administration@bsava.com

DAYMEETING

5 FebruaryFriday

Rehabilitation & acupuncture in companion animals (for vets & nurses)Speaker Siobhan MenziesVSSCo, Lisburn. Northern Irish Regiondetails from Shane Murray, shane@braemarvetclinic.co.uk, or VetNi, 028 25898543, info@vetni.co.uk

EVENINGMEETING

7 FebruarySunday

How to… Step-by-step guides to practical medical & emergency techniquesSpeakers Nick Bexfield and Karen HummCambridge Belfry, Cambourne, Cambridgeshire CB23 6BW. East Anglia Regiondetails from Graham Bilbrough, graham-bilbrough@idexx.com

DAYMEETING

4 MarchThursday

Head and neck surgerySpeaker Don SheahanVSSCo, Lisburn. Northern Irish Regiondetails from Shane Murray, shane@braemarvetclinic.co.uk, or VetNi, 028 25898543, info@vetni.co.uk

EVENINGMEETING

7 MarchSunday

Liver disease in the dog and cat: is diagnosis and treatment a waste of time, or can I really make a difference?Speaker Penny WatsonPavilions of Harrogate, Great yorkshire Showground, railway road, Harrogate HG2 8PW. North East Regiondetails from Chris dale, 01422 833960, 07884 231307, chris.j.dale@btinternet.com

DAYMEETING

24 FebruaryWednesday

Poisonings: things best avoidedSpeaker Kate MurphyPark inn, Llanederyn, Cardiff CF23 9XF. South Wales Regiondetails from southwalesregion@bsava.com

EVENINGMEETING

25 FebruaryThursday

Lower urinary tract disease in the dog & catSpeaker Hattie SymeThorpe Park Hotel & Spa, 1150 Century Way, Thorpe Park, Leeds LS15 8ZBdetails from BSaVa, 01452 726700,administration@bsava.com

DAYMEETING

10 MarchWednesday

How to get the most out of your in-house labSpeaker Christopher BelfordHoliday inn, Barnet By Pass, Elstree, Hertfordshire Wd6 5PU. Metropolitan Regiondetails from Pedro Martín Bartolomé, 020 89504995, pmbartolome@gmail.com

DAYMEETING

14 MarchSunday

Backyard poultry problems and solutionsSpeaker Victoria RobertsThe Glasgow Pond Hotel, Great Western road, West End, Glasgow, G12 0XP. Scottish Regiondetails from ross allan, 07786 653371, r_allan_sco@yahoo.co.uk

EVENINGMEETING

10 MarchWednesday

Pets: what souvenirs to leave behindSpeaker Sue ShawPark inn, Llanederyn, Cardiff CF23 9XF. South Wales Regiondetails from southwalesregion@bsava.com

EVENINGMEETING

11FebruaryThursday

Perineal disease: lavatory tumourdiscussing the surgical and medical oncology of the lower urinary and gastrointestinal tracts and perineumSpeakers Gerry Polton and Nick BaconLeatherhead Golf Club, Kingston road, Leatherhead, Surrey KT22 0EE. Surrey & Sussex Region. Registration for this event must be made in advance.details from Gerry Polton, 01883 741440,gpolton@ndsr.co.uk

HALF DAYMEETING

18 FebruaryThursday

Approach to raised liver enzymesSpeaker Alison RidyardHoliday inn aberdeen West, Westhill drive, aberdeen aB32 6TT. Scottish Regiondetails from Val Pate, 07932 770311,valpate@ntlworld.com

EVENINGMEETING

a broad network of regional branches gives you the potential to meet like-minded colleagues in your area and delivers high-quality CPd on your doorstep. For further details of events in your area, visit www.bsava.com

All dates were correct at time of going to print; we would suggest that you contact the organisers for confirmation.

10 FebruaryWednesday

Murmurs in puppies & kittens also (includes AGM)Speaker Sue RobertsidEXX laboratories, Grange House, Sandbeck Way, Wetherby LS22 7dN. Places must be booked in advance as numbers at this venue are limited. North East Regiondetails from Chris dale, 01422 833960,07884 231307, chris.j.dale@btinternet.com

EVENINGMEETING

35 Diary.indd 35 19/1/10 08:53:25

34 | companion

THE companion INTERVIEW

…it was good to give something back to a profession that has served me well in my working life…

➦ Did you know you’d have a career in academia and teaching, or did you originally intend to go into practice?Like a lot of new veterinary students, I romanticised about the perfect life as a mixed practitioner. However, a couple of late night farm calls in the middle of winter with the wind and rain whistling around during seeing practice made me realise it wasn’t for me! There was also the realisation that were other career paths in veterinary that were every bit as challenging but perhaps in different ways.

You are known in the field of endocrinology, what made you choose this specialism?It is so straightforward – you know what a hormone does and you can easily work out what happens if there is too much or too little! Actually my first job was based in small animal medicine at the R(D)SVS – Dr Keith Thoday was my mentor and he had just completed a PhD on thyroid function in cats and really engendered my interest in the subject – I had never seen a hyperthyroid cat before then and could not believe how many cases there were.

You’ve been a key BSAVA volunteer for many years, what did you get out of it?I started as a volunteer while still at Edinburgh just helping out the regional committee. Everyone seemed to be doing it and I had attended a couple of CPD events run by BSAVA and had enjoyed them. I don’t think there was anything more altruistic than that – although looking back it was good to give something back to a profession that has served me well in my working life. It is different working with a group of volunteers because you all tend to be like-minded and enthusiastic with similar aims – it gives an additional sense of achievement and I have gained knowledge and skills that would not normally be gained through my day job. The icing on the cake however is the camaraderie and some of my best friends emanate from my ‘volunteer’ jobs.

What have been the biggest challenges of your career so far?Completing a PhD whilst having my first child was pretty challenging – but the PhD got finished eventually.

What do you consider to be your most important achievement during your career so far?To date becoming BSAVA President – hopefully there will be more.

What has been your main interest outside work?It is quite varied – but mostly cooking, walking.

Who has been the most inspiring influence on your professional career?Mark Peterson – one of the top veterinary endocrinologists around – a prolific writer on the subject. Undoubtedly most of our knowledge on hyperthyroidism comes from clinical and research work he has been involved in, and he has always been really helpful to me.

What is the most significant lesson you have learned so far in life?You can always be proved wrong.

If you could change one thing about your appearance or personality, what would it be?Where do I start?

What is your most important possession?I suppose in so far as a dog or cat can be a possession, they are always the most important possession!

What would you have done if you hadn’t chosen to be a vet?Not really sure. I think I am more comfortable with small animals but maybe I could have chosen a different discipline – an anaesthetist or surgeon maybe. ■

THE companion INTERVIEW

33-34 Interview.indd 34 19/1/10 08:41:37

companion | 35

CPDdiary

9 FebruaryTuesday

A practical approach to treating psittacinesSpeaker Neil ForbesPotters Heron Hotel, romsey SO51 9ZF. Southern Regiondetails from southern@bsava.com

EVENINGMEETING

11 FebruaryThursday

Thoracic medicine: the coughing dogSpeaker Simon Swiftdavid Lloyd Leisure, Moss Lane, Whittle-le-Woods, Chorley Pr6 8aB. North West Regiondetails from Vikki Moran, vikki.moran@sky.com

EVENINGMEETING

17 FebruaryWednesday

An update on fish medicine: goldfish & koi carpSpeaker Peter Scottrussell Hotel, 136 Boxley rd, Maidstone, Kent ME14 2aE. Kent Regiondetails from Hannah Perrin,hannah@burnhamhousevets.com

EVENINGMEETING

23 FebruaryTuesday

Endocrinology I: PU/PD & alopeciaSpeaker Ian RamseyBSaVa, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2aBdetails from BSaVa, 01452 726700,administration@bsava.com

DAYMEETING

5 FebruaryFriday

Rehabilitation & acupuncture in companion animals (for vets & nurses)Speaker Siobhan MenziesVSSCo, Lisburn. Northern Irish Regiondetails from Shane Murray, shane@braemarvetclinic.co.uk, or VetNi, 028 25898543, info@vetni.co.uk

EVENINGMEETING

7 FebruarySunday

How to… Step-by-step guides to practical medical & emergency techniquesSpeakers Nick Bexfield and Karen HummCambridge Belfry, Cambourne, Cambridgeshire CB23 6BW. East Anglia Regiondetails from Graham Bilbrough, graham-bilbrough@idexx.com

DAYMEETING

4 MarchThursday

Head and neck surgerySpeaker Don SheahanVSSCo, Lisburn. Northern Irish Regiondetails from Shane Murray, shane@braemarvetclinic.co.uk, or VetNi, 028 25898543, info@vetni.co.uk

EVENINGMEETING

7 MarchSunday

Liver disease in the dog and cat: is diagnosis and treatment a waste of time, or can I really make a difference?Speaker Penny WatsonPavilions of Harrogate, Great yorkshire Showground, railway road, Harrogate HG2 8PW. North East Regiondetails from Chris dale, 01422 833960, 07884 231307, chris.j.dale@btinternet.com

DAYMEETING

24 FebruaryWednesday

Poisonings: things best avoidedSpeaker Kate MurphyPark inn, Llanederyn, Cardiff CF23 9XF. South Wales Regiondetails from southwalesregion@bsava.com

EVENINGMEETING

25 FebruaryThursday

Lower urinary tract disease in the dog & catSpeaker Hattie SymeThorpe Park Hotel & Spa, 1150 Century Way, Thorpe Park, Leeds LS15 8ZBdetails from BSaVa, 01452 726700,administration@bsava.com

DAYMEETING

10 MarchWednesday

How to get the most out of your in-house labSpeaker Christopher BelfordHoliday inn, Barnet By Pass, Elstree, Hertfordshire Wd6 5PU. Metropolitan Regiondetails from Pedro Martín Bartolomé, 020 89504995, pmbartolome@gmail.com

DAYMEETING

14 MarchSunday

Backyard poultry problems and solutionsSpeaker Victoria RobertsThe Glasgow Pond Hotel, Great Western road, West End, Glasgow, G12 0XP. Scottish Regiondetails from ross allan, 07786 653371, r_allan_sco@yahoo.co.uk

EVENINGMEETING

10 MarchWednesday

Pets: what souvenirs to leave behindSpeaker Sue ShawPark inn, Llanederyn, Cardiff CF23 9XF. South Wales Regiondetails from southwalesregion@bsava.com

EVENINGMEETING

11FebruaryThursday

Perineal disease: lavatory tumourdiscussing the surgical and medical oncology of the lower urinary and gastrointestinal tracts and perineumSpeakers Gerry Polton and Nick BaconLeatherhead Golf Club, Kingston road, Leatherhead, Surrey KT22 0EE. Surrey & Sussex Region. Registration for this event must be made in advance.details from Gerry Polton, 01883 741440,gpolton@ndsr.co.uk

HALF DAYMEETING

18 FebruaryThursday

Approach to raised liver enzymesSpeaker Alison RidyardHoliday inn aberdeen West, Westhill drive, aberdeen aB32 6TT. Scottish Regiondetails from Val Pate, 07932 770311,valpate@ntlworld.com

EVENINGMEETING

a broad network of regional branches gives you the potential to meet like-minded colleagues in your area and delivers high-quality CPd on your doorstep. For further details of events in your area, visit www.bsava.com

All dates were correct at time of going to print; we would suggest that you contact the organisers for confirmation.

10 FebruaryWednesday

Murmurs in puppies & kittens also (includes AGM)Speaker Sue RobertsidEXX laboratories, Grange House, Sandbeck Way, Wetherby LS22 7dN. Places must be booked in advance as numbers at this venue are limited. North East Regiondetails from Chris dale, 01422 833960,07884 231307, chris.j.dale@btinternet.com

EVENINGMEETING

35 Diary.indd 35 19/1/10 08:53:25

British Small Animal Veterinary AssociationWoodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB

Tel: 01452 726700 Fax: 01452 726701Email: administration@bsava.com Web: www.bsava.com

Visit www.bsava.com to register or call 01452 726700

© Zubair009 | Dreamstime.com

DATES19 May 2010 – Beaconsfi eld

21 May 2010 – Bristol23 May 2010 – Fife

25 May 2010 – Cheshire

Member Fee – £203.28 inc. VATNon-Member Fee – £304.91 inc. VAT

BSAVA Oncology RoadshowExplore advances and techniques in veterinary oncology with Dr David Vail and Dr Jane Dobson

36 OBC.indd 36 19/1/10 08:49:40