Companion September2008

The essential publication for BSAVA members

Aggressive PetsPotential dangers faced by those working in practiceP7

DACTARIThe dangers of importing animals with serious pathogensP4

DACTARI Aggressive Pets

The essential publication for BSAVA members

companionSEPTEMBER 2008

Rabbit Medicine

Advances in knowledge

and science

Clinical ConundrumInvestigation of coughing in a young Labrador RetrieverP 10

companion

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3 Congress Art Ed Hall visits the creator of the 2009 design

4–6 DACtAri John Bonner examines The Dog And Cat Travel And Risk Information scheme

7–9 Aggressive Pets Pete Wedderburn on the dangers faced in practice

10–13 Clinical Conundrum Investigation of coughing in a young Labrador

14–17 How to… Collect a diagnostic bone marrow sample

18–19 Letters from America Selected discussion from the Veterinary Information Network

20–21 the Age of the rabbit Advances in rabbit medicine by Michelle Ward

22 Petsavers Latest fundraising news

23–25 WSAVA News World Small Animal Veterinary Association

26 the companion interview Claire Bessant of FAB

27 CPD Diary What’s on in your area

companion is produced by BSAVA exclusively for its members.BSAVA, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB.Telephone 01452 726700 or email [email protected] to contribute and comment.

Call for Congress 2009 abstraCts

Additional stock photography Dreamstime.com© Denise McQuillen | Dreamstime.com© Douglas Stevens | Dreamstime.com© Dwphotos | Dreamstime.com© Oleksandr Kalyna | Dreamstime.com© Peksi Cahyo | Dreamstime.com© Rod Lawson | Dreamstime.com© Ruta Saulyte | Dreamstime.com© Ryan Pike | Dreamstime.com

The Clinical Research Abstracts provide a fantastic forum for clinicians in every sort of

employment to present a short talk to fellow veterinarian surgeons.

Abstracts cover a huge range of surgical and medical disciplines, and all Congress delegates are encouraged to attend. The presenters range from undergraduate students, nurses, residents, practitioners and scientists, to learned professors and company directors.

The audience for the CRAs is also varied, but all who come along are definitely

interested in the talks they attend. “There is no snoozing in these intimate gatherings,” says Laura Blackwood of the Congress Scientific Programme committee. “The atmosphere is friendly and helpful, rather than daunting and confrontational, and debate is often lively. Many of the abstracts presented result in publication months or years later, but the CRAs allow everyone to find out what’s new and can be the start of new projects and collaborations.”

The BSAVA is particularly keen for general practitioners to submit abstracts, and if in doubt about the suitability or otherwise of the topic for presentation they can contact Sorrel Langley-Hobbs – [email protected] – of the Congress Scientific Programme committee for advice.

To submit an abstract visit www.bsava.com during the month-long

submission window – 1 October to 1 November 2008. This deadline will be strictly adhered to. n

Clinical Research Abstracts are an essential and important element of the scientific programme at the BSAVA Congress. Online submission of Clinical Research Abstracts takes place 1 October to 1 November

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CONGRESS

CREATING CONGRESS

Each year the current President finds or designs an image to be used to promote their Congress. Finding

something to follow Carmel Mooney’s ‘Warhol-esque’ dog, Mike Jessop’s golden Govinder print and Frances Barr’s startling thermal dog & cat images was a real challenge – especially when my own artistic talent is so limited. As I like and collect art deco pottery, and knew that the angular representation of the Scottie dog was an iconic symbol of the era, I searched Google Images for an ‘art deco Scottie’, which led me to Russell Akerman, Echo of Deco and a trip to his pottery.

Pottery passionRussell was completely untrained in ceramics when he first found work in a ‘ceramics café’ in the Lake District, teaching tourists to make pottery. His natural talent was obvious and developed rapidly. Today he is a well known studio potter, with works exhibited in galleries and private collections worldwide. He produces exquisite vases in terracotta and porcelain, with elegant pinched necks and sumptuous glazes.

As well as being very talented, Russell is exceptionally modest. He actually took the time to tidy his studio before our visit, although the thin veneer of clay dust suggested that he spends most of his time working. The potter is also very patient, perhaps because 10–15% of his output has to be discarded because of breakages or flaws. He even took time to tutor my wife Marie, resulting in her successful ‘throwing’ of her first ever pot. His passion for his work shines through all he does, and his interest in the Art Deco style was obvious.

Echo of DecoIn addition to his art pottery, Russell owns Echo of Deco, a specialist contemporary studio creating individual pieces of ceramic art for pottery collectors and Art Deco enthusiasts. The company was founded in

2004 with his father, Malcolm. Ark Deco is their collection of ceramic animal figures inspired by the well known Noah’s Ark story. The design of the Ark Deco ornaments aims to capture the unique personality and character of each animal interpreted in its simplest form, using distinctive geometric and angular lines characteristic of the Art Deco style.

Congress creationsRussell’s Scottie dog will be the main symbol of Congress 2009, but other animals (dove, cat and rabbit) will also feature. Finally, Russell has agreed to produce a unique piece to be raffled at the Congress Banquet in aid of Petsavers.

Russell hopes to have a studio with an adjacent salesroom to market his art soon but for more information about him and his work now, visit his website – www.echo-of-deco.co.uk ■

Russell Akerman has produced the Art Deco themed ceramics that will feature on all Congress material and at the event itself in 2009. Ed Hall and his wife visited the artist in July to see the creative process and talk to Russell about using the images for Congress

BSAVA Congress2–5 April 2009

Some of the finished Art Deco pieces await dispatch

Artist Russell Akerman with BSAVA President Ed Hall

Russell begins with the raw materials

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WELFARE

DACTARI – A C LEAR VIEWThe Dog And Cat Travel And Risk Information scheme provides a view of the dangers of importing animals with serious pathogens. John Bonner reports on how the profession views the scheme

WELFARE

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WELFARE

DACTARI – A C LEAR VIEWUnlike Clarence, the lion who

struggled with strabismus in the 1960s television show Daktari,

veterinary bodies could see clearly what was going to happen when the DACTARI scheme was launched in 2003. The BVA and BSAVA both urged DEFRA against establishing the scheme as an entirely voluntary reporting system, believing that there should be compulsory notification of significant new diseases in the pet animal population.

Impact, effort and practicalitiesCurrent BSAVA President Professor Ed Hall notes that other voluntary reporting schemes, such as that covering adverse drug reactions, are widely believed to underestimate the numbers of cases involved. Practitioners have little incentive during a busy working day to spend time on non-routine and apparently non-essential tasks.

His Bristol University colleague, Dr Sue Shaw, estimates that it would take up to 15 minutes for a practitioner to log on to the Defra site, navigate their way to the appropriate page and fill in the relevant DACTARI form. She says the Department offers very little ‘added value’ in terms of advice and publicity material to encourage reporting and it downplays the risks of the diseases covered by the scheme – notably babesiosis, ehrlichiosis, dirofilariasis and leishmaniosis. Moreover, the Department insists that disease reports can only be submitted by private practices, not by the commercial laboratories normally responsible for confirming the diagnosis. However, laboratories would provide a more logical channel for reports given their greater experience of both the scientific and administrative procedures involved.

Budget barriersDr Shaw is not alone within the veterinary profession in suspecting that Defra’s reluctance to become more heavily involved in the control of companion animal diseases is a pragmatic decision resulting from tight budgetary restrictions. Certainly, three of the main DACTARI diseases are mainly confined to dogs and so have none of the economic and strategic importance of those diseases in livestock, such as foot-and-mouth and bluetongue, requiring compulsory notification. Yet leishmaniosis is also a significant zoonotic disease, affecting the human population in countries like Italy and Spain, which have the sandfly vector, and are favourite destinations for Britons taking their pets abroad under the Pet Travel Scheme.

Public healthConcerns over the potential risk to public health, prompted Liberal Democrat MP Andrew Stunell (Stockport, Hazel Grove) to ask a Parliamentary Question about the results of DACTARI monitoring of leishmaniosis in July. Junior minister at Defra Mr Jonathan Shaw told him that between 1 January 2003 and 30 September 2006 there were 19 confirmed and 5 suspected cases of canine leishmaniosis reported to the scheme.

These cases are a small fraction of the number of cases recorded by Dr Shaw’s Acarus laboratory at Bristol. She has confirmed more than 700 cases and has no statistics of cases seen at other veterinary laboratories around the country. The CICADA scheme run by Intervet is an attempt to get a handle on the frequency of different diseases seen at small animal practices. Its market survey-based methods are very different from those of the

DACTARI scheme and so are not directly comparable. However, the 150 or so practices that have participated in the three surveys to date have already recorded eight cases of leishmaniosis. If those practices are representative of the country as a whole, then “these reports would tend to indicate that these diseases are more prevalent than might be evident from the passive reporting which occurs,” said John Helps, veterinary manager with Intervet UK.

Appropriate approachesWith practitioners becoming increasingly experienced in recognizing and treating canine leishmaniosis cases, it will become ever more difficult for private diagnostic laboratories to keep tabs on the numbers of cases in the UK. “It is now being managed as an endemic disease of dogs in the UK and there is no reason to report it as being unusual anymore,” Dr Shaw suggests.

Of course, leishmaniosis is not yet a true endemic disease, as the insect responsible for transmitting the protozoan parasite

Chronic ehrlichiosis in a Labrador Retriever. The dog was from Sardinia but had lived in the UK for 2 years before presentationReproduced from BSAVA Manual of Canine and Feline Infectious Diseases

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WELFARE

concerned – the sand fly (Phlebotomus spp.) – is not present in the UK. However, as with bluetongue there is evidence of a northward shift in the distribution of the disease and its vector. Defra’s confidence that even if sand flies are accidentally introduced they would not survive under UK conditions is hardly justified, as the insect has already been recorded in the Channel Islands, Dr Shaw points out.

So, would a viable population of Mediterranean sand flies even be a prerequisite for the disease to establish in the British Isles? A practitioner in west Wales has now identified a case, confirmed at the Bristol lab, of leishmaniosis in a dog that has never travelled abroad to a disease-endemic area. This raises the possibility of the disease having found an alternative transmission route, but whether this is dog-to-dog or via a different arthropod vector is not yet clear. The only way to find out would be to conduct the sort of monitoring of wildlife as well as domestic species that Andrew Stunell suggested in his Parliamentary question.

Defra collaborationStunell was told there is no targeted surveillance for leishmaniosis in wildlife and no cases have been identified via the existing wildlife scanning surveillance system to date. Nevertheless, a Defra spokesman denied that the department is ignoring the risks posed by new zoonotic diseases. He pointed to collaboration between the department and the Health Protection Agency whose joint Human Animal

Infections and Risk Surveillance (HAIRS) group regularly reviews the situation with leishmaniosis and other zoonoses.

Through its Veterinary Laboratories Agency, the department is also participating in the world’s first interdisciplinary centre dedicated to the study of zoonotic diseases. The centre will be based at the Liverpool veterinary school’s Leahurst campus and is supported by a £1.7 million grant from the Northwest Development Agency.

One way of finding out the size of the problem to be addressed at the new centre would be to gather reliable data on the numbers of dogs with leishmaniosis living in the UK, as the available treatments do not eradicate the parasite and these dogs may remain a source of future infections. But Defra’s spokesman said “making a disease such as leishmaniosis notifiable could place an unnecessary burden on pet owners as effective control measures could be difficult to implement and enforce.”

Financial implicationsBVA president Mr Nick Blayney suggests that making a disease notifiable does not automatically create a financial burden, as the costs depend on what further measures are then needed to eradicate the disease. There would be financial implications in Defra staff time when investigating an outbreak – “but that doesn’t necessarily carry huge costs and if Defra can’t manage even that, then is there any point in having the department?” he asks.

Chris Laurence, veterinary director of the Dogs Trust, believes that the concept of

DACTARI was flawed from the beginning because it only set out to record numbers of positive cases. To be of any value as a risk assessment system, it would also be necessary to record negatives, the total numbers of dogs travelling with pet passports, in order to assess the prevalence of disease accurately.

So as far as he is concerned, there is no point in arguing for changes in the DACTARI recording methods – “It is a lost cause,” he said. But there is a very good reason for getting hold of good epidemiological data, not only for dealing with leishmaniosis. It would also help control other diseases relevant to the EU derogation granted to the UK and four other member states on its rules for the import of non-commercial animals (see companion June issue, ‘The Quarantine Question’).

Gathering dataThrough their membership of the umbrella body Pets in Europe, the Dogs Trust and other UK welfare organisations are trying to gather reliable data on the incidence of leishmaniosis and other companion animal diseases across the whole European Community. By emphasising the resulting human health implications, the group wants to persuade the European Commission to give pet animals a much higher political priority.

Only legislation introduced by Brussels is likely to have any significant impact on controlling companion diseases when there is so much movement of animals throughout the 27 member states. If the Commission began to take companion animal diseases as seriously as the major economic diseases of livestock, Britain would be able to take action against exotic diseases like leishmaniosis without running the risk of being accused of protectionism. But the benefits of measures to stop the northwards spread of this disease would also be felt in those countries where it is endemic. “If you talk to vets in Greece and Italy, they would love to be able to do something about these conditions but at the moment their governments are just not interested,” Mr Laurence said. ■

Clinical manifestations of leishmaniosis: lingual granuloma formationReproduced from BSAVA Manual of Canine and Feline Infectious Diseases

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THROUGH GRITTED TEETHAggressive dogs present a serious challenge to vets in practice. Pete Wedderburn considers the potential dangers faced by those working in practice

Despite the ban on ‘dangerous breeds’, there seems to be a continuing trend for keeping large,

strong dogs that can present a serious threat to humans. Apart from the physical danger to vets, staff and other clients, there are potential legal issues if a client is bitten by their own pet while the vet is ‘in charge’.

To review the issues involved, imagine a fictitious series of events that could happen in any clinic.

This first point of contact is a good time to make initial enquiries. Is the dog easy to handle? Does he get on well with other animals? If there are any issues like these, it makes sense for the receptionist to suggest that the dog could be left outside in the car until the vet is ready to call the client in for the consultation. If there is a history of difficulties handling the animal, a plan of action can be made in advance. Does the owner have a muzzle? Is it possible to put a

muzzle on the dog? The practice should have a protocol advising receptionists on the right questions to ask, and suggesting the appropriate course of action to take when an apparently aggressive dog is expected to arrive at the clinic. This may include booking an extra-long appointment, and informing the vet on duty in advance.

As before, queries about muzzling need to be made. Fear aggression is common, and it may be easier for an owner to place a muzzle than for the vet to approach a fearful animal. Some owners, who know that the dog “does not like vets” or is likely to be aggressive in the consulting room can be asked to muzzle the dog in the waiting room prior to the consultation or contact with surgery staff. At this point, the question about who would be responsible if an owner were bitten needs to be addressed. A legal position could be taken that the veterinary surgeon is the professional person in charge of a situation when there is risk involved, and therefore may have a liability if somebody is injured. If a veterinary surgeon judges at any time that it is not safe to proceed, then they should not do so. Each owner’s ability to handle his or her animal should be carefully assessed. If an owner offers to apply a muzzle provided by the practice, the vet should ensure that the owner is competent to carry out the task without the risk of injury.

Vets have a legal obligation to ensure that the workplace is safe. As the RCVS Practice Standards checklist states, “Employers must have a Health and Safety policy setting out how they ensure risks to Health and Safety of employees, contractors and customers are kept as low as reasonably practicable”. The hazards involved in restraining animals need to be assessed, and a set of Local Rules needs to be formulated to advise staff on the appropriate way to deal with aggressive animals. These need to be seen to be regularly reviewed and updated as needed. Appropriate equipment and protective clothing (such as gauntlets, muzzles, and a dog-catching pole) needs to be provided, and training must be given to all staff members in their correct use. Any incident where a staff member is injured needs to be carefully recorded in the Accident Book. The practice must have employer’s liability insurance, as well as public liability insurance, to give the practice financial protection if a claim for damages is made either by a staff member or a member of the public.

Veterinary surgeons who are assistants should talk to their own financial advisors about permanent health insurance, to cover the eventuality of being unable to work for a sustained period in circumstances where the practice insurance may not cover them because they may be deemed to be the responsible professional person.

AGGRESSIVE ANIMALS

A new client telephones to make an appointment for their large male Rottweiler

A client arrives in the waiting room with a large and boisterous German Shepherd Dog, telling the receptionist that “he does not like vets”

During the consultation process, a veterinary nurse who is helping to restrain a growling terrier is badly bitten on her arm

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Again, vets need to remember that they may be held legally responsible for activities that take place inside the consulting room. If a vet is not comfortable with the safety of a situation involving the restraint of an aggressive animal, they should state their opinion, and refuse to continue.

Behaviourist Jon Bowen stresses the importance of reading the body language of dogs, so that a tendency for aggression can be identified before any damage has been done.

“If you ask many experienced vets, you will discover that they suffer more dog bites in the first few years of practice. With time and a few painful incidents, vets learn to recognise the signs that a dog may bite, and they take fewer risks.” Jon recommends that all vet clinic staff should be reminded about the key aspects of canine body language that offer early warning signs of aggression. “If a dog’s tendency to aggression is identified early during an interaction, a muzzle can often be applied. Once the dog has been aroused to the point of an

aggressive incident, it can be too late to intervene with a muzzle. A higher level of intervention, such as sedation, may become necessary, with all of the extra complications that are involved”.

Can a vet refuse to treat a patient in such circumstances? Veterinary surgeons have a responsibility to ensure the welfare of the animals under his or her care, but human welfare still comes before animal welfare. A vet can make a decision on the basis of protecting the people involved in a situation like this. The RCVS agrees that the welfare of people must come first. The RCVS adds that the aggressive nature of the animal should be made clear on the clinical notes, so that another vet taking over treatment of the animal is made aware of the risk involved.

Sedation is sometimes the only answer. Oral medication (such as acepromazine) has traditionally been given prior to visits to vet

clinics, with limited effectiveness. The ideal answer would be a low-volume, safe, highly effective ‘knock-down’ sedative, which is reversible, but as anaesthetist Lynne Hughes from University College Dublin Veterinary School explains, the perfect sedation method does not exist. “A combination of drugs is more effective than any one drug on its own,” Lynne says. “Every case needs to be looked at individually – one combination of drugs may suit one dog, whereas a different cocktail will be more effective for another”. Examples of sedation protocols are listed in the table opposite. Lynne stresses that a sedated animal is not necessarily a ‘safe’ animal. Some sedatives can have the effect of depressing a dog’s

AGGRESSIVE ANIMALS

THROUGH GRITTED TEETH

Signs of fear, progressing into aggression1. Fearful avoidant behaviour:

■ Cowering■ Flattened ears, tail down■ Shaking, trembling■ Attempts to escape

2. Passive fearful defensive behaviour:The above, plus...■ Hackles raised■ Baring of teeth■ Avoiding direct staring eye

contact■ Growling

3. Confrontational fearful defensive behaviour:■ Hackles raised■ More erect body posture■ Barking/loud growling■ Direct eye contact■ Lunging/snapping/biting

1 & 2 are attempts to avoid conflict; the dog is trying to warn the person away.

Dogs will move between these stages, but may go straight to confrontational behaviour if previous attempts to avoid conflict have failed.

The owner tells the vet that the dog does not need a muzzle, and that he can hold the dog securely, but then either he or the vet/nurse gets bitten

A 12 stone Bull Mastiff is clearly unmanageable due to aggression. After a number of incidents, the vet has recommended euthanasia of the dog on safety grounds. The owner refuses to agree to this and wants to continue to bring the dog back to the clinic

A stocky, muscular, “Labrador cross” is brought into the consult room. The dog growls when the vet tries to take his temperature

A 40 kg Border Collie snarls and snaps whenever a muzzle is brought close to his head

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A crossbred terrier is brought in for treatment following a dog fight. On checking the records, the vet discovers that this is the third incident in a space of a year

natural inhibition to bite. More than one vet has suffered a severe bite after an apparently sedated dog has suddenly made an unexpected aggressive lunge.

When a dog is being euthanased due to aggression, at which point is a gun needed rather than a vet with a needle and syringe? These occasions are rare, and decisions may involve liaison between police officers, the RSPCA, and local veterinary surgeons. Sometimes, deft use of a dog-catching pole, a muzzle and chemical sedation (including potent oral medication in a bait) can be adequate. Safety of humans must always be paramount.

AGGRESSIVE ANIMALS

Sedation protocols for aggressive dogs. Lynne Hughes, UCD

Drug combinations Notes

Acepromazine (ACP) 0.02–0–0.05 mg/kg (to max of 2 mg) + morphine 0.5 mg/kg i.m.

High doses of ACP should be reserved for healthy dogs and avoided in Boxers or giant breeds. Morphine will cause vomition unless the dog is in pain (remove the muzzle until vomition occurs and warn the owner in advance). Dogs are sensitive to noise when sedated. Deep sedation lasts 20–30 minutes. Glycopyrrolate 0.01 mg/kg (or atropine 0.04 mg/kg) may be administered i.m. if bradycardia occurs

Medetomidine 10–20 µg/kg + butorphanol 0.3–0.5 mg/kg (or morphine 0.3–0.5 mg/kg) i.m.

High doses of medetomidine should be reserved for healthy dogs. Sudden arousal may occur. Reliability of sedation is improved by addition of an opioid but can also potentiate respiratory depression. Additional ketamine (5 mg/kg i.m.) may be required in very aggressive dogs. Wait at least 40 minutes after ketamine before reversing with atipamezole (or convulsions may occur). Owner should be present for reversal

A call comes in from the local police station. A Golden Retriever has attacked three people, causing serious injuries. Euthanasia is clearly indicated, but the police officer is not sure if anyone will be able to get close enough to the animal to give an injection

Vets need to be aware of the fact that illegal dog fighting seems to be increasing in popularity. There is an ethical dilemma about the correct course of action to be taken if a dog is suspected to be involved in this activity. The RSPCA are happy for all such suspicions to be reported directly to them. The 24 hour Cruelty and Advice Line is 0300 1234999, and a message can be left for the Special Operations Unit. Such reports can be made anonymously, but personal involvement may be needed to find out further information or if legal action ensues. The RCVS advice on breaching client confidentiality can be found in the Guide to Professional Conduct and is also amplified in an Advice Note – “Client confidentiality – reporting alleged criminal activity” (www.rcvs.org.uk/advicenotes). Essentially, a veterinary surgeon may breach client confidentiality if choosing to report suspected criminal offences. ■

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A crossbred terrier is brought in for treatment following a dog fight. On checking the records, the vet discovers that this is the third incident in a space of a year

High doses of ACP should be reserved for healthy dogs and avoided in Boxers or giant breeds. Morphine will cause vomition unless the dog is in pain (remove the muzzle until vomition occurs and warn the owner in advance). Dogs are sensitive to noise when sedated. Deep sedation lasts 20–30 minutes. Glycopyrrolate 0.01 mg/kg (or atropine 0.04 mg/kg) may be administered i.m. if bradycardia occurs

High doses of medetomidine should be reserved for healthy dogs. Sudden arousal may occur. Reliability of sedation is improved by addition of an opioid but can also potentiate respiratory depression. Additional ketamine (5 mg/kg i.m.) may be required in very aggressive dogs. Wait at least 40 minutes after ketamine before reversing with atipamezole (or convulsions may occur). Owner should be present for reversal

Vets need to be aware of the fact that illegal dog fighting seems

dog is suspected to be involved in this activity. The RSPCA are happy for all such suspicions to be reported directly to them. The 24 hour Cruelty and Advice Line is 0300 1234999, and a message can be left for the Special Operations Unit. Such reports can be made anonymously, but personal involvement may be needed to find out further information or if legal action ensues. The RCVS advice on breaching client confidentiality can be

Guide to Professional Conductand is also amplified in an Advice Note – “Client confidentiality – reporting alleged criminal activity” (www.rcvs.

). Essentially, a veterinary surgeon may breach client confidentiality if choosing to report suspected criminal offences. ■

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Details of drug dosages and methods of application of drugs mentioned in this article must be verified by individual users.Also see BSAVA Small Animal Formulary.

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CLINICAL CONUNDRUM

CLINICALCONUNDRUM

Case PresentationA 2-year-old female neutered Labrador was reported to have been retching and coughing for several months. Initially signs occurred chiefly after eating but they had now increased in frequency and could occur when excited or when resting. The cough had mostly been non-productive but on occasions yellow or green mucus had been expectorated. The dog panted more after exertion than she used to but her overall exercise tolerance was good. There had been no ocular or nasal discharge. Sneezing had been absent. Her weight had not altered.

Mike Stafford Johnson of Martin Referrals describes the investigation of coughing in a young Labrador Retriever

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CLINICAL CONUNDRUM

ExaminationOn physical examination, heart rate was 100 beats per minute and no murmur was audible. Pulse amplitude was normal and mucosae were pink. Respiratory sounds were normal. Increased tracheal sensitivity was present, with tracheal pinching inducing coughing.

RadiographyUnder anaesthesia, lateral and dorsoventral thoracic radiographs were obtained. A close up of the lateral and a dorsoventral view are shown here.

What changes are evident? What is the lung pattern demonstrated?Skeletal and extrathoracic structures appear normal. Cardiac shape and size appear normal, as does the pulmonary vasculature.

A generalised marked bronchial pattern is present. The thickened bronchi resemble tramlines when seen longitudinally and doughnuts when seen end-on.

What are the differentials for such a lung pattern?A bronchial pattern is caused by bronchial wall thickening or mineralisation. The differentials include:

Inflammatory/Infectious■■ – Peribronchial cuffing and mucosal inflammation in chronic bronchitis, with or without accompanying evidence of bronchopneumonia. Causes of chronic bronchitis include bacterial, viral, fungal, protozoal and parasitic infections, and pulmonary infiltration with eosinophils (± parasitic infection). Clinical signs associated with chronic bronchitis

include cough (variably productive), exercise intolerance and, in some cases, an exaggerated sinus arrhythmia due to increased vagal toneAnomalous■■ – Mineralisation is seen in older dogs and in chondrodystrophic breeds of all agesMetabolic – ■■ Mineralisation is observed in hyperadrenocorticismNeoplastic■■ – e.g. bronchial carcinoma or diffuse bronchial lymphoma.

Most likely cause in this case?In a young mesocephalic dog, eosinophilic bronchitis is the most likely differential diagnosis resulting in such a pronounced bronchial pattern. Infectious causes such as bordetellosis do not typically seem to be associated with such a marked pattern,

whilst bronchial neoplasia would be unusual at this young age and is unlikely in a dog which appears otherwise to be well.

What are the typical bronchoscopic findings?Most commonly there will be abundant mucus present in multiple bronchi. Recently, cases have been described where mucus is not apparent but there is moderate to marked erythema of the airways. Chronic untreated cases may show localised or multiple areas of bronchiectasis.

Additional diagnostic testsTracheobronchoscopy was performed. The trachea appeared normal. There was widespread mucus present in all of the major mainstem bronchi.

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CLINICAL CONUNDRUM

CLINICAL CONUNDRUM

Bronchoalveolar lavage (BAL) was performed and samples sent for cytology and bacterial /fungal culture.

Cytology revealed vast numbers of eosinophils and low numbers of macrophages; respiratory epithelial cells and neutrophils were also evident. Bacteria were not apparent cytologically.

Bacterial and fungal culture was negative.These findings are typical of

eosinophilic bronchitis.

What are the causes of this syndrome?Eosinophilic bronchitis can be associated with Angiostrongylus vasorum infection, and exotic diseases such as heartworm (Dirofilaria), or even fungal infection, are also rare causes. However, the majority of cases in the UK are classed as eosinophilic bronchopneumopathy (EBP) (previous referred to as pulmonary infiltrate with eosinophils (PIE)), having excluded these other differential diagnoses. EBP is a disease in which the definitive cause is not known but is suspected to be a hypersensitivity reaction to inhaled allergens. Certain breeds, especially Huskies or Husky crosses, appear to be predisposed. In addition, we document more cases in Labradors and Jack Russell Terriers than in other breeds. Affected dogs are usually under 4 years of age.

Additional tests that can be considered?Whilst EBP may be suspected based on clinical signs and signalment, diagnosis

requires exclusion of other differentials in addition to demonstration of consistent radiographic, bronchoscopic and BAL cytology findings.

To exclude other differential diagnoses, faecal examination for Angiostrongylus vasorum lungworm larvae, using the Baermann technique, and/or examination of BAL samples for larvae should be undertaken. If there has been a history of travel abroad it is appropriate to test for Dirofilaria.

Is treatment advised?Yes. Bronchiectasis may occur in a proportion of chronically affected dogs if untreated. Such a lesion will not resolve and will likely predispose to secondary bacterial infection. Some affected dogs will show lethargy and inappetence. Untreated dogs can develop marked dyspnoea. Nasal discharge due to spread of the inflammatory reaction to the nose may occur early or late in the course in some dogs.

Therapy

Even if no evidence of lungworm is ■■

apparent, fenbendazole is advised at 50 mg/kg daily for 10–14 days.In the majority of cases the condition is ■■

suspected to be due to pulmonary hypersensitivity to an inhaled allergen. These dogs will require corticosteroids. Avoidance of any known irritants such as smoke or household sprays is advised in all cases.

– Oral prednisolone at immunosuppressive doses initially is advised. The usual starting dose is 1 mg/kg twice daily for 14 days, then re-evaluate. The dose is halved/tapered every 2 weeks according to progress. Aim for a maintenance dose of 0.5 mg/kg every second day. A total course of 3–5 months is necessary for most dogs.

– Many dogs will not relapse after a single course. Others will relapse after months and may require a further 3–5-month course(s). Other dogs may relapse immediately once steroids are ceased, and these dogs likely require long-term treatment.

– Inhaled steroids may be useful in some dogs where chronic treatment is necessary or steroid side effects are unacceptable. Either beclomethasone or fluticasone may be provided via metered dose inhalers into spacers. The usual dose is 125–250 µg per metered inhalation, 1–2 puffs twice daily. These may be sufficient to control signs alone or in combination with oral steroids.

It is likely that severely affected dogs will require oral steroids to control signs initially, followed by inhalant therapy with or without oral steroid therapy once stabilised. In some dogs following tapering to a withdrawal of the steroid dose, clinical signs do not recur, in other therapy is required long term.

Contribute a Clinical ConundrumIf you have an unusual or interesting case that you would like to share with your colleagues, please submit photographs and brief history, with relevant questions and a short but comprehensive explanation in no more than 1500 words to [email protected] submissions will be peer-reviewed.

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CLINICAL CONUNDRUM

Eosinophilic bronchopneumopathyInfiltration of the airways or pulmonary parenchyma by eosinophils has previously been described in the dog as pulmonary infiltration with eosinophils (PIE), pulmonary eosinophilia or eosinophilic pneumonia. The present convention is to use the term ‘eosinophilic bronchopneumopathy’ in recognition that eosinophilic infiltration involves both airways and parenchyma in the majority of cases.

The cause of EBP remains unclear, and most cases are classed as idiopathic but, as mentioned above, a hypersensitivity to aeroallergens is suspected. However, the supporting evidence is scant and on occasion contradictory, as whilst some dogs have positive intradermal skin tests to a variety of aeroallergens, the majority do not. Furthermore, there is little doubt that the pathophysiology of lung allergy is different to that manifested in the skin and that assessing these dogs by intradermal skin testing is less than ideal.

Cytological examination and bacterial culture of mucus collected by tracheal lavage or at bronchoscopy is necessary to confirm the diagnosis of EBP. Bronchoscopy also allows visual inspection of the airways and the presence of a moderate to large amount of greenish/yellow mucus is typical, as well as evidence of bronchial inflammation and even wall irregularities. It is the cytological examination of this greenish material, and its relative eosinophil count, which confirms the diagnosis of this disease.

Healthy dogs usually have <5% eosinophils found in fluid collected by BAL whereas in those affected with EBP, eosinophils may constitute >50% of the cells harvested. Examination of the BAL also enables diagnosis of Angiostrongylus vasorum infection and neoplasia, which are important differential diagnoses. Similarly, bacterial pneumonia can be excluded on the basis of bacterial culture, although it should be remembered that the large bronchi of dogs are not completely sterile and a positive culture result must be interpreted in the context of the case in question and the sampling technique employed. ■

Bronchoalveolar lavage cytology from a dog with EBP (Wright-Giemsa stain, original magnification x800). Courtesy of K. Papasouliotis

Endoscopic views of the bronchi of a dog with EBP. Note the tenacious greenish material, mucosal thickening (and, although not typical, compression of the bronchial lumen by associated bronchial lymphadenopathy). Courtesy of K. Murphy

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HOW TO…

COLLECT A DIAGNOSTIC BONE MARROW SAMPLE

HOW TO…

It has been said that with practice, collecting bone marrow becomes as easy as placing an intravenous catheter. That

may be a slight exaggeration but once a clinician gets over the ‘fear factor’, collecting bone marrow is not difficult. Making good smears from the bone marrow sample can be more challenging! If the practitioner does not perfect the art of making good smears then the interpretation of the bone marrow sample may be rendered meaningless.

BenefitThe first step in collecting a diagnostic bone marrow sample is selecting a patient that will benefit from the technique.

There are many indications for performing bone marrow aspiration (Table 1). Some are immediately obvious (e.g. non-regenerative anaemia after excluding extra-marrow suppression); others are less clear (e.g. in patients with fever of unknown origin but without obvious haemopoietic disease).

In most patients it is preferable to collect both an aspirate and a core biopsy sample. Suitable sites include the iliac wing, proximal humerus and proximal femur.

AnaesthesiaThe author’s preference is to use general anaesthesia and to sample from the proximal humerus (Figure 1), although

aspirates from a number of sites including the iliac crest (Figures 2 and 3) can be taken under sedation with local anaesthetic. The author prefers performing bone marrow aspiration under general anaesthesia for a number of reasons:

The procedure can be performed ■■

quickly and without pain during the techniqueIf a ‘dry tap’ is obtained, aspiration can ■■

be attempted from the other humerus or another of the sites listed above.

Premedication and anaesthetic agents/protocol may be influenced by the patient’s

Kate Murphy from the Small Animal Hospital, University of Bristol, offers a useful guide to collecting bone marrow

Table 1: Indications for performing bone marrow sampling

Pancytopenia

Non-regenerative or poorly regenerative anaemia

Neutropenia or thrombocytopenia where the cause is not obvious (not usually performed in suspected immune-mediated thrombocytopenia)

Suspected haemopoietic neoplasia, myelodysplasia, or marrow dysfunction as indicated by ineffective cytopoiesis or erythropoiesis

To evaluate iron stores when other information is inadequate

Fever of unknown origin

Evaluation of lytic bone lesions

Staging of neoplasia, e.g. lymphoma, mast cell tumours, histiocytic disease

Investigation of hyperglobulinaemia

Investigation of hypercalcaemia

Evaluation of unexplained leucocytosis or thrombocytosis

Figure 1: Site for bone marrow sampling from the proximal humerus

primary disease and the reader is referred to more specialised texts such as the BSAVA Manual of Anesthesia and Analgesia for advice on this aspect.

Equipment required

Jamshidi bone marrow needle, e.g. Bone ■■

marrow aspiration/ biopsy needle (11G x 4”) (Kendall Monoject, Tyco Healthcare UK Ltd)

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HOW TO…

Figure 2: Site for bone marrow sampling from the iliac wing

Figure 3: Site for bone marrow sampling from the proximal femur

20 ml syringe■■

Local anaesthetic (without adrenaline)■■

No. 11 scalpel blade■■

Anticoagulant (sterile) – CPDA/ACD ■■

(collect from transfusion bag) or EDTA (prepared from a standard EDTA blood tube; see below)Microscope slides (> 10)■■

EDTA pot & formalin pot■■

Surgical drape & sterile gloves■■

Strong assistant■■

PreparationBone marrow interpretation is a challenge but this can be reduced if a blood sample is taken into an EDTA tube on the day of the bone marrow collection. This allows the bone marrow to be interpreted in the light of ‘current’ peripheral haematological status.

Before starting the bone marrow collection it is important to treat the aspiration needle with anticoagulant to avoid clotting during sample collection.

1Remove the stylet and attach the 20 ml syringe to the needle.

2Aspirate the ACD/CPDA/EDTA anticoagulant in a sterile fashion and

roll anticoagulant around the syringe before squirting the excess out – this should leave the syringe and needle ‘coated’ (Figure 4).

3Remove the syringe and carefully replace the stylet, ensuring it is

properly sited and fully locked.

If you do not have blood transfusion bags in the practice it is possible to pre-treat the syringe by adding sterile saline or water which is injected into an EDTA blood tube and then aspirated.

COLLECT A DIAGNOSTICBONE MARROW SAMPLE

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HOW TO…


Since bone marrow aspiration is rarely an emergency procedure, the practitioner is advised to order in some commercial anticoagulated blood bags to improve the success of their bone marrow aspiration as, in the author’s experience, using EDTA for this purpose is not as effective at preventing clotting of the marrow sample.

Procedure using a Jamshidi biopsy needleThis needle is designed to take both aspirates and core samples. General anaesthesia is induced and once the patient is stable:

1Position the patient in lateral recumbency.

2Widely clip the area around the scapulohumeral joint.

3Surgically prepare the biopsy site.

4Position the leg with the humerus flexed (parallel to the patient’s

thorax) (Figure 5). Ensure a strong colleague is holding the leg for you and

the humeral shaft) using a drilling/firm ‘forward rotating’ action and steady pressure (Figure 7).

Counterpressure from an assistant holding the limb can be helpful (they push with all their might against you pushing from the other end!). Initially it can be hard to get the bone marrow needle to get a purchase into the bone, and occasionally it slips off. If this is happens, start again and recheck your anatomical landmarks. Once you are happy the needle is in the correct position, retry going very slowly and with controlled forward pressure.

Figure 5: Position of the limb for obtaining a bone marrow aspirate from the proximal humerus

Figure 6: Make a small stab incision with the scalpel blade

Figure 7: Use a firm forward drilling pressure to advance through the cortex and into the marrow cavity

prepare them for the pressure you will be applying to the leg – they will need to apply counterpressure.

5Instil local anaesthetic to the level of the periosteum over the greater

tubercle of the humerus.

6Re-scrub the area.

7Make a small stab skin incision with the No. 11 scalpel blade (Figure 6).

Figure 4: Coating the needle and syringe with anticoagulant

8Insert the Jamshidi needle with the stylet firmly in place (check the stylet

has been firmly replaced after the aspiration of anticoagulant described earlier).

9Humeral samples are taken by palpating the most proximal facet of

the humeral head (greater tubercle). Gradually advance into the marrow cavity (heading towards the elbow and parallel to

Reduced resistance is usually felt as the needle enters the medullary cavity. If correctly placed, the needle should feel solidly ‘fixed’ in place, and moving the needle should result in moving the bone itself. If the needle is placed too medially over the humeral head, it is easy to penetrate the joint capsule. This does not pose a significant danger to the patient but can render the bone marrow sample non-diagnostic if contaminated by joint fluid and may cause mild joint inflammation.

10Once the needle is believed to be correctly sited, remove the stylet.

Attach the 20 ml syringe (previously coated with anticoagulant) and aspirate firmly (Figure 8). As soon as bone marrow (which looks like thick blood) is noted in the hub of the syringe, stop aspirating – you do not need more than 0.2 ml of bone marrow (Figure 9). Excessive suction will result in haemodilution of the sample. There are no prizes in the technique for the biggest sample collected – just for a diagnostic one!

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HOW TO…


Figure 10: Transfer the marrow sample on to glass slides

Figure 11: Technique for spreading bone marrow on the slide

Figure 12: Core sample pushed out of the needle

Figure 13: Preparing an impression smear from the bone marrow core sample

Figure 8: Apply pressure to obtain a small quantity of marrow

Figure 9: A small marrow sample has been collected

of each. There are a number of alternative techniques. It may be helpful for practitioners to discuss the technique of preparing the slides with the clinical pathologist who will evaluate the bone marrow sample.

a. Excess blood is allowed to run down the slide on to absorbent paper, leaving flecks of marrow attached to the glass.

b. A clean slide is then backed on to the remaining marrow and the marrow is allowed to spread along the edge of the spreader slide, which is then swiftly pushed forward to provide a thin smear with a feathered edge (Figure 11).

11Detach the syringe but leave the needle in place and replace the stylet

whilst smears are prepared.

12Smears are prepared by angling multiple slides at 45 degrees (Figure

10) and placing a drop of marrow at the top

It is essential that smears are prepared and air-dried immediately. It is important to assess whether a diagnostic marrow sample has been obtained grossly by looking at the slides as they dry. If the slides look like blood smears – they probably are. Marrow smears should look like blood but with fatty bits and refractile spicules.

13Obtain a core biopsy sample by removing the stylet and advancing

the needle approximately 2–3 cm further into the bone. Move the needle swiftly sideways a few times to break off the distal part of the sample and then retract the needle. Use the blunt probe supplied with the needle to push the core sample out (from tip through the handle) (Figure 12). The core sample can be gently rolled along a slide to produce an impression

smear (Figure 13) which can be helpful to provide more rapid results if the bone marrow aspirate is non- diagnostic. The core is then placed in a pot of formalin.

14Submit samples for cytology and histopathology. A concurrent blood

sample should be submitted to aid interpretation, as discussed above.

Additional investigations may be performed on bone marrow samples, e.g. infectious disease tests, iron profile, Coombs’ test.

ProblemsCommon problems in obtaining diagnostic bone marrow aspirates and core biopsy samples are:

Haemodilution of the sample■■

Poor smear preparation – too thick or ■■

inadequately spread material. ■

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VIN FORUMS

The 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 who have specialized knowledge and skills. In this regular feature, VIN shares with companion readers a small animal discussion that has recently taken place in their forums.

LETTERS FROM AMERICAfrom 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 who have specialized knowledge and skills.

companion readers a small animal discussion that has recently taken place in their forums.

The Veterinary Information Network brings together veterinary professionals

LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM LETTERS FROM AMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAAMERICAThe Veterinary Information Network brings together veterinary professionals

LETTERS FROM LETTERS FROM LETTERS FROM

“Discussion Creator”

This is a dog referred to me because the owner wanted to see if the eye could be saved. What do you think?

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VIN FORUMS

All content published courtesy of vin.com. The names of participants have been removed from this feature. 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.


One of the other long-term problems is dry eye due to decreased corneal sensitivity: lagophthalmos re-proptosis

corneal ulcer/rupture

In fact most of the strabismus is due to the tear of the medial and ventral rectus muscles.

“Reply 1”Ewww!I put one back in that looked a lot like that... acute trauma that happened in a boarding incident on a Sunday morning. As they say, ‘Not too good.’

It went well initially, but has had complications since.

However, with this one I’m curious about a couple of things – the appearance of the lens, for instance. Also, is there a foreign body? What is the white-ish object or tissue at the lateral aspect of the globe?

“Reply 2”What complications do we see with proptosis?

“Reply 3”Potential infection, lateral strabismus due to occulomotor nerve damage or an avulsed medial rectus (often leads to corneal ulceration). Also rarely lens lux, nerve avulsion, rupture of eye muscles, blindness and chronic pain.


That is the optic nerve. Since the optic nerve is torn then ciliary arteries that supply blood to the eye are also torn.

There is no blood supply to eye. This eye is literally dead. If this eye were placed back in the orbit, it would start to rot in the dog’s head.

This eye should be enucleated and it’s already 95% enucleated.

The lens looks cloudy because there isn’t a blood supply to the eye and an aqueous circulation in the globe. Since there is no oxygen supply to the lens, the lens develops a cataract. (Just as all dead animals develop cataracts after death.)

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PUBLICATIONS

THE AGE OF THE RABBIT

The domestic rabbit has undergone a dramatic social transformation in the past decade or so. The humble

backyard children’s pet of yesteryear has evolved in more recent times into a popular part, along with dogs and cats, of the companion animal aristocracy.

Part of the familyFor some time it has been recognised on the grounds of popularity that this small herbivore is well deserving of its third place

on the podium of UK mammalian pet ownership. However, not only have the sheer numbers of rabbits increased, so too has the general public acceptance of this animal as a valued family member.

Rabbit ownersClient expectation is at an all-time high in many veterinary disciplines. The rabbit-owning fraternity are no exception to this. With improvements in the availability of health information and the formation and promotion of rabbit welfare organisations, rabbit owners are becoming increasingly knowledgeable. Their enthusiasm for quality clinical care is abundant and the general consensus is that the level of veterinary services available at the local practice for Mrs Smith’s French Lop, should be no

different from that available for Mr Brown’s Labrador cross. And why should it be?

Professional responseAs a result of this rapid social promotion, the veterinary profession has been forced to respond by developing a branch of science devoted to the medical care of this unique creature. Far from being little dogs and cats, and also differing in many ways from large domestic herbivores like horses, rabbits have unique behavioural, anatomical and physiological characteristics that are essential considerations in the prevention, diagnosis and treatment of disease.

In the past rabbits had a reputation for being: next to impossible to anaesthetise safely; highly prone to all manner of postoperative complications: difficult to treat medically with available therapeutics: and too prone to stress to hospitalise.

Advances in knowledgeThankfully, with advances in knowledge and skill these concerns have been allayed. Yes, it is certainly true that rabbits are susceptible to a number of problems that may not be such an issue in dog and cat medicine, but with an improved understanding of their particular needs it is now entirely possible to resuscitate critically ill rabbits effectively, to perform lengthy surgical procedures safely and to provide long-term medical care for chronic disease conditions.

Michelle Ward discusses the changes and advances in rabbit medicine

A hospitalised rabbit with a severe head tilt due to suspected infection with Encephalitozoon cuniculi. A catheter has been placed in the right marginal ear vein and secured with a bandage for administration of intravenous medication and fluids

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PUBLICATIONS

Rabbit ManualThe BSAVA Manual of Rabbit Medicine and Surgery, 2nd edition, edited by Anna Meredith and Paul Flecknell, reflects the increase in interest and understanding of rabbit health and disease. Filled with colour illustrations, it includes chapters on: general nursing care; cardiovascular disorders; dentistry; diagnostic imaging; euthanasia; respiratory disorders; digestive system disorders; urogenital system and disorders; nervous and musculoskeletal disorders; ophthalmology; dermatoses; behaviour problems; therapeutics; anaesthesia and perioperative care; and common surgical procedures. For more information or to order visit www.bsava.com or call 01452 726700. Member price: £49.

musculoskeletal disorders; ophthalmology; dermatoses;

Rabbit undergoing a routine dental examination. Due to the anatomy of the oral cavity, accurate assessment of cheek tooth crown height and shape requires sedation and the use of appropriate equipment (gags and cheek dilators)

About the authorMichelle WardBSc BVSc(Hons I) DZooMed(Mammalian) MRCVSRCVS Recognised Specialist in Zoo and Wildlife Medicine

Michelle Ward studied at the University of Sydney, Australia, gaining degrees in both zoology and veterinary science and developing interests in animal nutrition and exotic/wildlife medicine. Following graduation and a short-term post as a research assistant, she moved to the UK to begin work as a veterinary surgeon in private mixed practice. For over three years Michelle worked at practices in Worcestershire, Lincolnshire and Yorkshire and during this time developed a keen interest in rabbit and rodent medicine and surgery. In August 2004 she was appointed the Petsavers Senior Clinical Training Scholar in Rabbit and Exotic Medicine at the University of Edinburgh’s Royal (Dick) School of Veterinary Studies. Michelle is now Lecturer and Manager of the Exotic Animal and Wildlife Clinic at the Royal (Dick) School of Veterinary Studies. Michelle also contributed to the BSAVA Manual of Rabbit Medicine and Surgery, 2nd edition. For more information about Petsavers and the work it supports visit www.petsaversorg.uk .

Rabbit medicine and rabbit surgery are emerging as disciplines in their own right. Recent advances include: improved understanding of the relevance of the protozoan parasite Encephalitozoon cuniculi to rabbit health; surgical methods for the treatment of abscesses; long-term management of acquired dental disorders; diagnosis and treatment of renal failure and various forms of neoplasia; recognition and treatment of behavioural disorders; and the application of advanced imaging techniques such as CT and MRI to the diagnosis of disease.

Preventive medicineWhilst our ability to diagnose and treat complex conditions is improving, it is important not to lose focus on the one area of practice that is likely to have the greatest impact on rabbit welfare – preventive medicine. Through effective client education and the promotion of lifelong health management plans, including vaccination, biannual health checks, regular dental assessment and parasite control, it is hoped that the disease entities related to suboptimal husbandry (which are still all too common) will become less prevalent.

This is an exciting time to be involved in the veterinary care of rabbits as new disease entities are being diagnosed and novel solutions to old problems are being discovered all the time. Who knows, the next discovery could well be in your consultation room. ■

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Improving the health of the nation’s pets

Leaving a legacy to Petsavers can mean making a lasting difference to the way your profession diagnoses and treats small animals in the future

PETSAVERS

WHERE THERE’S A WILL

CHRISTMAS CARDS

Petsavers has received valuable income from donations left by vets and animal lovers in their wills. Legacies provide

more than 80% of its income and there are few other financial sources to help fund the many investigations needed to make a difference to the way we treat the animals in our care. So the veterinary charity has produced a ‘Remembering Petsavers in Your Will’ leaflet to help advise on ways to make a difference to animal welfare.

How it worksOnce you have identified the value of your personal assets, investments and property, decide on the amount you wish to donate to Petsavers. This is called a pecuniary legacy.

A second option is to leave a residual legacy. That is, donating to Petsavers what is left after all specific gifts have been made to family, friends and relations. A third way is to leave certain assets for Petsavers such as stocks and shares or other items that we can turn into cash: valuable stamp collections, items of jewellery, or property – all can provide essential funds to help us help pets.

What next?Petsavers always recommends involving a solicitor in drawing up your will. Whatever you leave to Petsavers will make an enormous difference. For more information or to request the leaflets for your practice email [email protected] or call 01452 726700. ■

Petsavers’ aim is to fund work into helping diagnose and treat the illnesses that affect small animals so

that the profession can further improve the health and longevity

of our nation’s pets. We do this by funding clinical studies and clinical training programmes. In the last 30 years Petsavers has given nearly £2 million

towards these goals. We rely on the support of veterinarians, nurses and pet owners.

By buying our Christmas cards this year you will help to fund even more studies to improve the treatment and care of pets. You can buy them as cards from

your practice to your clients, or even buy them to sell on to those visiting your practice. A range of designs and styles will be available. For more information about the cards this year visit www.petsavers.org.uk or call 01452 726700 to request an order form. ■

CHRISTMAS

produced a ‘Remembering Petsavers in Your Will’ leaflet to help advise on ways to make a difference to animal welfare.

How it worksOnce you have identified the value of your personal assets, investments and property, decide on the amount you wish to donate to Petsavers. This is called a

etsavers’ aim is to fund work into helping diagnose and treat the illnesses that affect small animals so





animals in the futureproduced a ‘Remembering Petsavers in Your

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CHRISTMAS

produced a ‘Remembering Petsavers in Your Will’ leaflet to help advise on ways to make a difference to animal welfare.

How it worksOnce you have identified the value of your personal assets, investments and property, decide on the amount you wish to donate to Petsavers. This is called a

Petsavers’ aim is to fund work into helping diagnose and treat the illnesses that affect small animals so





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WSAVA NEWS

WSAVA WORLD CONGRESS DUBLIN 2008

The WSAVA board has been very active over the last year. Besides a voluminous amount of e-mail

correspondence, we also participated in a number of teleconferences and held a full board meeting in Tampa, USA, in May at the time of the AAHA conference. I would like to express my appreciation to the AAHA Board of Directors for the hospitality afforded to us. A significant amount of time was spent debating strategic planning under the guidance of David Wadsworth. We concluded by redefining both the goals and mission statement of the WSAVA. We also met with the directors of AAHA to discuss the possibility of their hosting a WSAVA congress in the near future.

I had the pleasure of representing your Association at the inaugural South European Veterinary Conference in Barcelona in October 2007 as well as at the South African Veterinary Association Congress

which was held at Sun City last month. I received a number of other invitations to attend member association meetings but due to time constraints I was not able to accept. I apologize for this.

World representationJolle Kirpensteijn, Anne Sorenson and Luis Tello (the latter two in their personal capacity) attended the North American Veterinary Conference (NAVC) in January 2008. At this conference one stream of lectures was dedicated to the WSAVA and was chaired by Jolle. I would like to thank the NAVC directors and Colin Burrows in particular for this means of promoting the WSAVA. This will be ongoing at future NAVC conferences.

David Wadsworth and Jolle Kirpensteijn attended the British Small Animal Veterinary Association (BSAVA) congress in April.

At these venues the opportunities were used to meet with our sponsors, representatives from industry, and members of the various boards of directors. I thank all these member associations for the hospitality afforded to our executive board members.

David Wadsworth carried out two site visits to Brazil, in preparation for the 2009 São Paulo WSAVA World Congress, where he held meetings with the congress organizing committee, the PCO, and sponsors.

TreasurersJolle Kirpensteijn and Di Sheehan worked very hard to get our financial books in order. Jolle kindly offered to continue as caretaker treasurer until the end of 2007 and finally handed the reigns over to Di in May of this year. As you can understand, the changing of bank accounts and the transfer of information between Canada, the Netherlands and Australia did not make it that easy to get all the paperwork in place in time for this meeting.

CommunicationWalt Ingwersen has worked tirelessly on the website, updating information, and improving the layout of the homepage. Luis Tello has been as busy as ever producing the news bulletin and WSAVA flyers. He has also been responsible for the new-look logos. We thank them for the amazing PR job they did. I would also like to thank Bayer Healthcare and Hill’s Pet Nutrition for their sponsorship of the website and news bulletin. As always I appeal to all assembly representatives to supply Walt with updated information on the activities of your association for posting to the website and for this section of WSAVA News.

SponsorshipI am pleased to report that the Hill’s Pet Nutrition sponsorship contract has finally

Dr Brian Romberg’s President’s Report to the WSAVA Assembly delegates in August

24 | companion

WSAVA WORLD CONGRESS DUBLIN 2008

WSAVA NEWSWSAVA NEWS

been signed. This contract encompasses the sponsorship of our congress as the sole Prime Partner and the co-sponsorship of our CE program, website and news bulletin and the renal standardization project.

We also concluded contracts for co-sponsorship of our website and news bulletin, renal standardization project, and CE project with Bayer Healthcare and for co-sponsorship of our CE program with Intervet/Schering Plough Animal Health.

AppreciationI would like to thank the committee chairs and members for their contribution during the year. In particular I would like to thank Anjop Venker van Haagen for her years of commitment as chairperson of the Scientific Advisory Committee. Anjop’s term of office has now been completed and her position will be filled by Prof Michael Day.

MicrochippingAt the strategic planning meeting in Tampa it was agreed that, thanks to the past leadership and work on standardizing microchip technology by members of the WSAVA microchip committee, issues related to microchipping no longer required a stand-alone committee. Microchips will now fall under the umbrella of the animal welfare committee. I would like to thank Fred Nind for chairing the microchip committee and for representing the WSAVA at ISO WG3 meetings. Fred has informed us that he would still be available to represent the WSAVA at these meeting should we require him to do so.

CPDThe Continuing Education project under the leadership of David Wadsworth continues to be one of our main goals. David was ably assisted by Roger Clarke, Luis Tello and

Lawson Cairns. Without the support of our sponsors Bayer Healthcare, Hill’s Pet Nutrition, and Intervet/Schering Plough Animal Health we would not have been able to take CE to as many locations as we did. However, further expansion of this project is being curtailed by a lack of finance and we are actively involved in seeking a fourth sponsor. I thank all our member associations who contribute in some way or another to this venture – without your assistance our task would be that more difficult.

WelfareThe Animal Welfare Committee co-chaired by Ray Butcher and Roger Clarke was mainly involved in organizing the welfare seminars for this congress and the forthcoming congress in Brazil as well as the drawing up of the programme for the WSAVA welfare stream for the FASAVA congress.

Special projectsThe Standardization Projects are still attracting an enormous amount of attention. At this meeting the Gastrointestinal Group will be highlighting their significant achievements; the Atlas of Canine and Feline Gastrointestinal Endoscopy and Related Pathology is expected for release towards the end of 2009. This project was jointly sponsored by Hill’s Pet Nutrition and the WSAVA. Our sincere thanks to Robert Washabau and his team members for a task well done.

After the successful publication of the International Guidelines for the Vaccination of Dogs and Cats in September 2007 by the Vaccine Guideline Group, Intervet/Schering Plough Animal Health have once again agreed to sponsor this group so that they can continue their work for another year. The group has set itself three distinct goals: the active consultation on the existing

guidelines with national leaders from member countries of the WSAVA; the further consideration of the scientific evidence base for minority vaccines not considered in the initial report; and the production of information on vaccination for pet owners and breeders.

With the purchase of the Scan Scope system and its installation at the Texas A&M University at the beginning of this year, the Renal Standardization Group has proceeded with its study. Our appreciation to Bayer Healthcare and Hill’s Pet Nutrition for their sponsorship of this study.

To all the project leaders and group members our sincere gratitude for your involvement in these studies which are of immense importance to academics, specialists, and practitioners. Claudio Brovida remains our special projects co-ordinator and we really appreciate his enthusiasm for these projects and the time and effort he devotes to them.

The Hereditary Diseases Committee under the leadership of Urs Giger met recently in France to finalize the development of their website, the production of an informational booklet, and to approve the database. Åke Hedhammar, Peter Markwell and Urs presented lectures on hereditary diseases during this year’s Congress.

PartnershipsWe have maintained a cordial relationship with FECAVA, FASAVA, FIAVAC and FAFVAC and today we welcome The Federation of Small Animal Practitioners Association of India (FSAPAI) into our fold. We must thank Umesh Karkare for his tireless efforts in bringing this to fruition.

I would like to congratulate Larry Dee and Roger Clarke for being acknowledged

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WSAVA NEWS

by AAHA for their contributions to the profession. They were presented with their awards at the AAHA congress. I apologize if I have left out any other committee or assembly members who may have received similar recognition.

HandoversI have now completed my two-year term of office and I would like to extend my sincere gratitude to all my fellow board members who have given me unbelievable support over the last two years and to you the assembly members for allowing me the privilege of leading this great association. I must also thank my wife Isabel for her support and for allowing me ‘time off’ to accomplish my WSAVA commitments. I will be handing over the presidency to David Wadsworth who I know is more than capable of looking after the affairs of the WSAVA.

Larry Dee has completed his term as Past President and will be leaving the Board. Larry in his diplomatic way could always be relied upon for valued advice. Larry is not lost to veterinary politics and will once again focus his attention on the American arena. I wish him well and I know that he will always be available to the WSAVA should we require his input.

Anne Sorenson has unfortunately decided to vacate the post of honorary secretary, which she has held for four years.

This post is an enormously taxing position – not only did she have to contend with the daily needs of the board and assembly members but she also had to answer letters from the public seeking advice on veterinary matters. Mom, as Anne is affectionately known, will be really missed at Board meetings, especially for how well she looked after us. I am sure Poul however will be happy to have his wife back.

Pernille Blok Rissom has acted as our secretarial assistant, a position she occupied with much enthusiasm. Pernille will be vacating this position as of this meeting and I thank her for her diligence.

Luis Tello has been nominated unopposed to the position of vice president, as has Walt Ingwersen to the position of honorary secretary. We are very fortunate that these two highly efficient and hard working gentlemen have made themselves available to serve your executive.

New awardYour executive committee has decided to institute a President’s Award as from this year. This award will be presented on a time-to-time basis by the President of the WSAVA in recognition of the recipient’s outstanding contribution to the association. The recipient will be selected by the executive board and the award consists of a plaque, to be presented at the assembly meeting, together with complimentary

congress registration and two tickets to the formal congress social event. The first presentation took place during the meeting in Dublin and the first recipient is Dr Hans Klaus Dreier from Austria.

To Nicola Neumann and the members of her committee, our grateful thanks for all your hard work in organizing the Dublin congress. It takes endless hours of planning and meetings to arrange and manage a congress such as this and we express our sincere appreciation to everybody concerned. I must also thank VICAS for taking on this venture – a small association in numbers but not in effort. ■

WSAVA Vision: WSAVA is dedicated to the continuing development of global companion animal care

WSAVA Mission: To foster the exchange of scientific information between individual veterinarians and veterinary organisations

News from the Morocco Veterinary Medical AssociationThe main aims of AMVAC (Association Marocaine des Vétérinaires pour Animaux de Compagnie) are:

To organize continuous education on ■

small animal medicine, surgery, nursing and nutrition for the Moroccan VeterinariansTo keep our members informed on ■

the recent scientific and technique news concerning small animalsNational and international ■

representation of the profession within government and other veterinary organizationsParticipation in veterinary congresses ■

and meetings.

While AMVAC is less than 2 years old, our 30 members (including private

MEMBER ASSOCIATION UPDATESpractitioners and faculty from the veterinary school in Rabat), have been very active in hosting small animal continuing education meetings, which have included:

Small Animal Cardiology: organized in ■

collaboration with the WSAVA and AFVAC and held in January 2008 featuring two French guest speakersSmall Animal Dermatology: held in ■

March 2008 in collaboration with the WSAVA and AFVAC, also featuring two guest French lecturers.

Proposed AMVAC future CE activities include a seminar on the most common skin diseases in small animals, scheduled for October 25 of this year, and a CE meeting on Emergency and critical care to be held some time in 2009. ■

26 | companion

companion INTERVIEW

Claire Bessant grew up in Northern Ireland with her teacher mother, chemist father and younger brother and sister. After studying Animal Physiology at Leeds she worked in advertising, before a career with the British Veterinary Association in its editorial department. She is now Chief Executive of the Feline Advisory Bureau

THEcompanionINTERVIEW

You have become known within the profession through your work at the Feline Advisory Bureau but you previously worked in publishing. What prompted that change?I started editing FAB’s Journal back in 1990 when I was working on a freelance basis. When the chief executive job came up it was part time and I thought it would be interesting. Much of what FAB does is presentation of information, whether it is written or at conferences, and I have had to learn (and keep learning) about all the other aspects of running a charity in the constant struggle to raise profile and funds for our work.

Who has been the most inspiring influence on your professional career?I have been very lucky to work with some fantastic people whose enthusiasm and generosity of time and intellect have made work a joy. Andy Sparkes, Ross Tiffin, my feline expert panels, my trustee directors and colleagues across the world with an enthusiasm for cat medicine have made the work feel like it is making a difference.

What do you consider to be your most important achievement during your career?To come up with ideas and then to make them happen, maintaining high quality,

bringing new ideas and making the subject relevant to a particular market gives a great feeling of achievement. Examples would be Easy to Give awards, Cat Friendly Practice, WellCat for Life and our achievements with the European Society of Feline Medicine – there are some very exciting developments in the Journal of Feline Medicine and Surgery to come next year too.

What has been your main interest outside work?As I am a single mum with a full time job, four children, a house with a large garden, a dog, three cats and lots of family and friends to keep in contact with, I have to say that there is not much time for hobbies! I sometimes have a book on cats to write as well. Last year I enjoyed some travel, often with work, but also to Tonga to swim with Humpback whales, which was an amazing experience.

If you could change one thing about your appearance or personality, what would it be?Perhaps on occasion I would be a bit less trusting, and sometimes a bit more courageous doing things I don’t enjoy, like driving, sport, going on rough seas or dealing with conflict.

What is the most significant lesson you have learned so far in life?Work with people you like and trust; integrity and honesty are priceless, friends cannot be valued enough. Have fun and surround yourself with enthusiastic people who think their glass is half full, not half empty. Try to look at things in a different way and not just follow what has been done before.

What is your most important possession?It has to be my relationship with my family and friends. Though if you are talking material things, then the photographs I have taken over the years.

What would you have done if you hadn’t chosen to work in animal welfare?One of my daughters is studying English and I must say if I had my time again I would love to do that and photography – the sciences were pretty dry to study and often pretty difficult to get enthusiastic and passionate about. However, my job now enables me to mix science with creativity, so I can’t complain. ■

FAB is 50 this year. For more information visit www.fabcats.org

CPD DIARY

companion | 27

5 OctoberSunday

Practical dentistry for general practitionersSpeaker Norman JohnstoneDay meeting at the Dunkeld House Hotel, Dunkeld. Scottish Region.Details from Lisa O’Donnell, telephone 07970 546334, email [email protected]

8 OctoberWednesday

An update on feline chronic gingivostomatitisSpeaker Alex SmithsonEvening meeting at IDEXX Laboratories, Wetherby. North East Region.Details from Karen Goff, telephone 01924 275249, email [email protected]

8 OctoberWednesday

GeriatricsSpeaker Stijn NiessonEvening meeting at The Holiday Inn, Haydock. North West Region.Details from Simone der Weduwen, email [email protected]

CPDDIARY

22 OctoberWednesday

Heart murmurs in catsSpeaker Adrian BoswoodEvening meeting at The Potters Heron Hotel, Romsey. Southern Region.Details from Michelle Stead, telephone 01722 321185, email [email protected]

14 OctoberTuesday

Immune-mediated disease of dogs and catsSpeaker Sheena WarmanEvening meeting at The Park Inn, Llanederyn, Cardiff. South Wales Region.Details from the Chairman or Secretary email [email protected]

15 OctoberWednesday

Wildlife and exotic emergenciesSpeakers Anna Meredith and Sharon RedrobeDay meeting at The Hilton, Bromsgrove. Organised by BSAVA.Details from BSAVA Customer Service, telephone 01452 726700, email [email protected]

22 OctoberWednesday

Feline infectious diseasesSpeakers Rachel Dean and Sheila WillsDay meeting at Janssen Laboratories, High Wycombe. Metropolitan Region.Details from Allison van Gelderen, email [email protected]

23 OctoberThursday

What’s sensible and what’s new in canine lymphomaSpeaker Gerry PoltonEvening meeting at Leatherhead Golf Club. Surrey and Sussex Region.Details from Jo Arthur, telephone 01243 841111, email [email protected]

28 OctoberTuesday

Lower urinary tract disease in the dog and catSpeaker Hattie SymeDay meeting at BSAVA HQ, Gloucester. Organised by BSAVA. Details from BSAVA Customer Service, telephone 01452 726700, email [email protected]

23 OctoberThursday

Small animal dispensing courseSpeakers Phil Sketchley, Steve Dean, John Hird, Fred Nind, Peter GripperDay meeting at The Basingstoke Country Hotel. Organised by BSAVA. Details from BSAVA Customer Service, telephone 01452 726700, email [email protected]

6 NovemberThursday

Practical haematology: detective work for nursesSpeaker Kostas PapasouliotisDay meeting at BSAVA HQ, Gloucester. Organised by BSAVA. Details from BSAVA Customer Service, telephone 01452 726700, email [email protected]

6 NovemberThursday

Exploring the true potential of cytologySpeaker Andrew TorranceAfternoon meeting at The Potters Herron Hotel, Romsey. Southern Region.Details from Michelle Stead, telephone 01722 321185, email [email protected]

6 NovemberThursday

Raptor medicineSpeaker Nigel Harcourt-BrownEvening meeting at The Swallow Hotel, Preston. North West Region.Details from Simone der Weduwen, email [email protected]

23 OctoberThursday

Traumatic brain and spinal cord injury: What can I do?Speaker Giunio Bruto CherubiniEvening meeting at The Russell Hotel, Maidstone. Kent Region.Details from Hannah Perrin, email [email protected]

12 NovemberWednesday

Rabbits: it’s not the teeth or gut, what next?Speaker John ChittyEvening meeting at The Park Inn, Llanederyn, Cardiff. South Wales Region.Details from the Chairman or Secretary email [email protected]

12 NovemberWednesday

CPD road show: surgical emergencies Speakers Karen Tobias (USA) and John WilliamsDay meeting at The Stirling Management Centre, University of Stirling Campus. Scottish Region.Details from BSAVA Customer Service, telephone 01452 726700, email [email protected]

13 NovemberThursday

LA calls for SA vetsSpeaker: Graham DuncansonEvening meeting at Russell Hotel, Maidstone. Kent Region.Details from Hannah Perrin, email [email protected]

For more information contact Customer Services on 01452 726700 or email [email protected] visit www.bsava.com

Small Animal Dispensing CourseDate: Thursday 23 OctoberSpeakers: Fred Nind John Hird Peter Gripper Steve Dean Philip SketchleyVenue: Basingstoke Country HotelCourse Fees: BSAVA Members: £176.00 + VAT (£206.80 inc. VAT) Non Members: £236.00 + VAT (£277.30 inc. VAT)

Wildlife and Exotic Emergencies for Vets and Veterinary NursesDate: Wednesday 15 OctoberSpeakers: Anna Meredith & Sharon RedrobeVenue: Hilton, BromsgroveCourse Fees: £140.00 + VAT (£164.50 inc. VAT)

Endocrinology IIDate: Tuesday 25 NovemberSpeaker: Ian RamseyVenue: Woodrow HouseCourse Fees: BSAVA Members: £161.70 + VAT (£190.00 inc. VAT) Non Members: £315.00 + VAT (£370.13 inc. VAT)

Practical Haematology: Detective Work for NursesDate: Thursday 6 NovemberSpeaker: Kostas PapasouliotisVenue: Woodrow HouseCourse Fees: £190.00 + VAT (£223.25 inc. VAT)

BSAVA CPD

Companion September2008

Documents

Transcript of Companion September2008