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The essential publication for BSAVA members

companion
MARCH 2014
How To...
Perform a
transconjunctival
enucleation P18
Mission Rabies
Update from the
crew
P4
Clinical Standards
Results of
consultation
P12
Investigating
abdominal
distension
01 OFC March.indd 1 20/02/2014 10:06
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companion
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 benet. Veterinary schools
interested in receiving
companion should
email companion@
bsava.com. We welcome
all comments and ideas
for future articles.
Tel: 01452 726700
Email: companion@
bsava.com
Web: www.bsava.com
ISSN (print): 2041-2487
ISSN (online): 2041-2495
Editorial Board
Editor Mark Goodfellow MA VetMB DPhil CertVR DSAM
DipECVIM-CA MRCVS
CPD Editor Simon Tappin MA VetMB CertSAM
DipECVIM-CA MRCVS
Past President Mark Johnston BVetMed MRCVS
CPD Editorial Team
Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVS
Tony Ryan MVB CertSAS DipECVS MRCVS
Lucy McMahon BVetMed (Hons) DipACVIM MRCVS
Dan Batchelor BVSc PhD DSAM DipECVIM-CA MRCVS
Eleanor Raffan BVM&S CertSAM DipECVIM-CA MRCVS
Features Editorial Team
Andrew 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
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BSAVA is committed to reducing the
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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 .
3 BSAVA News
Latest from your Association
47 Mission Rabies
An update on this ambitious project
811 Clinical Conundrum
Investigating abdominal distension
1214 Clinical Standards
What members said in consultation
1517 New from Publications
What to see at Congress
1825 How To
Perform a transconjunctival
enucleation
27 Northern Ireland Congress
Visit Armagh this May
2829 Harnessing GP power
Solving immune-mediated
haemolytic anaemia
30 Radiotherapy for brain tumours
Michael Kent at Congress
31 Big issues
Get involved at Congress
3233 Trip of a lifetime
What happens when you take a year
out of practice
3435 PetSavers 40th anniversary
Launch of 200 Project
3637 WSAVA News
World Small Animal Veterinary
Association
3839 The companion interview
Neil Smith
41 Regional CPD
Local knowledge close to home
4243 CPD Diary
Whats on in your area
Additional stock photography:
www.dreamstime.com
Andrey Yakovlev; Jmci; Jocic; Petr Jilek;
Pshonka
I
n recent years, JSAP has organized
popular seminars at BSAVA Congress
focusing on the process of bringing
clinical research to publication, and this
year is no exception. The journal has seen
an increased number of questionnaire-
based papers and, in response to this,
Rachel Dean will provide guidance on the
role of questionnaires in clinical research
and practice.
The seminar will be of interest to first
opinion practitioners as well as residents
and interns. If you are attending Congress,
please come along to Hall 7 in the ICC on
Saturday 5 April at 1405 to find out more.
PAPERS IN THIS MONTHS JSAP
Review paper: Therapeutc optons for
the treatment of chronic pain in dogs
Correlaton between NA, LFO and SFO in
canine hip joint radiographs
Comparison of the EPOC and i-STAT
analysers for canine blood gas and
electrolyte analysis
Characteristcs of canine nasal discharge
related to intranasal diseases
Measurement of thyroxine and cortsol in
canine and feline blood samples
Periodontal disease associated with red
complex bacteria in dogs
Log on to www.bsava.com to access
the JSAP archive online.
Whats in JSAP this month?
Congress seminar:
The practicalities and delivery of
questionnaire-based research
EJCAP ONLINE
To access the latest
issue of EJCAP visit
www.fecava.org/EJCAP.
Find FECAVA on Facebook!
The app is available to download from
the App Store. Please note that you will
need to register for a Wiley Online Library
account (if you do not already have one).
BSAVA Members can find their activation
code and further information on the My
Apps page in the myBSAVA section of
the website. The app is provided by
Wiley, the publishers of JSAP, and is
currently available for Apple devices
only an Android-compatible version is
under development.
Download the new JSAP app
BSAVA Members can now stay in touch
with the latest research on their iPad

and
iPhone

and iPod

touch devices via the


new Journal of Small Animal Practice app.
The app delivers an optimized browsing
and reading experience, including
bookmarking and article-sharing features.
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3
M
y first volunteer role with BSAVA was as
a member of what was then the Clinical
Studies Trust Fund Grant Awarding
Committee, which is now known as
PetSavers. As a former recipient of research
funding, I was only too pleased to be able to give
back by helping with the selection process for
grant funding. After six years on this committee,
I moved to spend a further six years on Scientific
Committee, two more on Education Committee and
then two years on Board before becoming
President in 2013. In all of these roles I have had a
great sense of belonging to a wonderful
organization that achieves a great deal in
advancing standards and knowledge in small
animal practice. It has been a privilege to work with
our dedicated volunteers and my work with BSAVA
has provided a different perspective and outlook to
that of an academic. It has been particularly
interesting to be able to maintain a link to my roots
in small animal practice and increasingly to
consider the business and management elements
of the Officer roles.
PetSavers
Charity Dog Walk
What in the world are your benefits?
Get to know
your BSAVA
colleagues
Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know
Volunteer
voice
Professor
Michael
Day
BSAVA President
20132014
Find out how you can get involved as a
BSAVA volunteer, email Carole Haile
c.haile@bsava.com.
D
id you know that you are also a member of the World Small Animal
Veterinary Association? Many BSAVA members dont realise their
membership presents a number of fantastic benefits from the
WSAVA for no additional fee says Grant Petrie, BSAVA
Representative to WSAVA.
Grant is keen to encourage BSAVA members to make the most of their
WSAVA benefits, which include access to the global edition of Clinicians
Brief, the WSAVA Nutrition Toolkit, and their standardization guidelines.
To access Clinicians Brief go to www.wsava.org and click on Publications
to follow the subscription links. You will need to select BSAVA from the list of
WSAVA member association codes. You can find a full list of your BSAVA
benefits online at www.bsava.com or if you have any questions do not hesitate
to email administration@bsava.com and a member of our team will be very
happy to help.
A
dog walk in aid of
PetSavers was organised
by the Perton Branch of St
Georges vet group on
Sunday 20 October 2013. The
weather was on their side, with hazy
sunshine highlighting the puddles
left by the previous days rain. The
event was well supported by local
clients, and also the local radio
station, who took photos of all
participating dogs for their website.
The walk covered a 90-minute route
around the village and was enjoyed
by those on two legs and those with
four, although the Bassett Hounds
were particularly soggy and muddy
on their return.
Delicious homemade cakes
were provided by several staff
members on return to the practice;
while tucking in, walkers also
bought Christmas cards and trolley
tokens. A generous donation of
120 was made to PetSavers, for
which we are extremely grateful. If
your practice would like to organize
an event like this for PetSavers
please email Emma Sansom
info@petsavers.org.uk.
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The big ambition
You certainly stand out wearing the bright yellow
Mission Rabies shirt. A sudden blitz of colour is
followed by the sound and fury of capturing strays in
the teams blue butterfly nets. Vet Mike Greenberg
recalls a flurry of impressions from Nagpur in central
India. There was a lot of movement and noise, just
what people promise you about India, he says.
Extreme wealth next to extreme poverty, the sacred
with the profane, and the dogs were really wary,
quick, wired. They were dangerous because they
were terrified.
New Yorker Mike, 33, graduated from Cornell
University in 2009. Time served on setting up wellness
clinics and vaccination drives on Native American
reservations preceded a years internship in an animal
shelter. He worked dairy farms and small animal
medicine in a mixed practice. Its all herd health, he
says. We want more milk from cows, better health
from cats.
Mission Rabies was Mikes perfect volunteering
opportunity. City by city, ward by ward, volunteers
would vaccinate enough animals to achieve herd
immunity. The idea of having 70 per cent of the
population vaccinated is a good mantra, he says. If
you get it out of the dog population then you can get it
out of the human population.
Twelve regional hotspots were identified, wards
numbered and allocated to each team. Mission Rabies
volunteers travelled in the projects all-terrain mobile
veterinary hospital and blitzed each area. In the end
more than 60,000 dogs were protected. The next
target is keeping immunity above the magic 70 per
cent. If we maintain it then you can look at eradicating
rabies, says Mike.
Mission Rabies
seeks enlightenment
for Indias problems
Robin Fearon catches up with some of the
Mission Rabies team who chose India as
the starting point for a unique vaccination
campaign last year
I
n September 2013 Mission Rabies, organised by the
Worldwide Veterinary Service (WVS), set an
ambitious target to inoculate 50,000 dogs across
India to combat canine and human deaths from the
disease. Rabies is fatal if not treated quickly and more
than 90 per cent of human cases, most of them
children, are caused by dog bites. One child dies in
India every hour from the disease and a third of all
rabies deaths worldwide occur in India each year.
Shockingly, despite soaring infection rates, there had
been no previous mass programme for canine
vaccination.
For the 68 international volunteers aiming to chase
down strays in the narrow slum alleys or go from door
to door to inject pets in Kolkata, Nagpur or Goa, it was
an eye-opening experience. Leading teams of often
newly trained dog catchers into communities where
potentially infected dogs are seen as an inevitable
hazard meant winning the PR war quickly.
Naomi Kenton Photography
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Kick starting a new culture
Vital equipment and medicines for the mission were
supplied by donation. Charity supporter Medimark
Scientific was among them. UK Managing Director
Rick Hayman volunteered for two weeks in Kolkata
after attending the launch at Dogs Trust Harefield. Our
company has worked with animal welfare charities for
more than 20 years and I wanted to do something
more positive than simply making a donation, he says.
Mission Rabies visited areas that are not
traditionally served by the WHO because they are
not perceived to be in crisis. At the same time they
are not business areas connected with the west like
Delhi or Mumbai. Some of the areas involved may
not be as exposed to international charitable work
and it was interesting to see how it was received as
aid that combined animal health with human health,
says Rick.
By raising a flag to the problems caused by rabies,
the WVS had re-opened the debate on better human
health through better animal health. The whole
purpose of Mission Rabies is to kick start a culture on
dealing with zoonotic diseases, to try and wipe them
out, says Rick.
In India the fear of rabies means thousands of
dogs are killed indiscriminately each year. A WHO
report on the way rabies is tackled acknowledges
the increase in post-exposure prophylaxis to reduce
the human death toll. What it also recognizes is the
high cost of treatment and huge under-investment in
dog vaccination.
Total numbers of deaths from rabies in India are
uncertain. Most cases are reported in rural
communities where there is no canine vaccination,
there are higher disease rates and people are less
likely to seek out medical care. Too many people die
because they do not know about treatment, cannot
access it or cannot afford it.
Once infected the options are slim. The first
recorded case of surviving the disease without a
preventive vaccine was American schoolgirl Jeanna
Giese who was bitten by an infected bat four years
ago. She was treated by inducing a medical coma
that protected her brain from the virus and allowed
her bodys immune system time to rally its defences.
Named the Milwaukee protocol as she was
treated at a childrens hospital in Milwaukee, Jeanna,
now 19, is seen as a potential beacon to guide future
treatment. What the case shows is that without
access to advanced medical care recovery would
have been impossible.
In developing countries resources are limited and
the numbers infected can be overwhelming. As dog
and human populations grow together, the health and
economic costs will only escalate without investment in
canine control programmes.
Mission Rabies offers something unique. Using an
all-terrain vehicle as a veterinary hospital allowed the
WVS to set up clinics anywhere, reaching
communities where people need to know more about
the risks and holding on-the-spot training courses for
local veterinary staff.
The truck itself was built in Britain and shipped
out with financial support from the Animal Welfare
Board of India. Used throughout the 30-day
vaccination drive, the truck is working its way back
through the 12 vaccination checkpoints, where it
stays for one month to help train government officials,
veterinary students, animal welfare workers and
international volunteers.
Getting the message across
Presence is half the battle in these communities.
Driving a bright yellow 7.2 litre Mercedes-Benz truck
with a fully equipped theatre, plus on-board LED
screen for training and presentations, is a powerful
statement of intent.
Mission Rabies flagship has already proved a hit in
places where disease was fearfully accepted. Each Mike Greenberg
Rick Hayman
if you get it out
of the dog
population then
you can get it
out of the human
population
I wanted to do
something more
positive than simply
making a donation
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Mission Rabies seeks enlightenment
for Indias problems
day in September a vaccination team
would work its way as systematically as
possible through the suburban lanes and
chaotic thoroughfares of Indian cities,
catching strays and going from house to
house looking for pet dogs.
Logistically this was a trial. Having a
fixed location for the clinic was better in
some ways but it did not always work in
attracting locals and their dogs. It wasnt
very successful, admits Kate Shervell,
international director for Mission Rabies.
Few people actually brought dogs
despite publicity about the vaccination
site. We found that going door to door
was the best way.
Dog-owning households were obvious.
Barking would start as soon as they
caught wind of the team approaching,
says Kate. We always needed the full
dog-catching team, even when vaccinating
owned dogs, as most of them were even
more ferocious than the roaming dogs and
often needed to be caught in a net.
For volunteers the physical targets
were a challenge, but equally important
was changing the way people think about
rabies. By pushing human and animal
health messages and talking to locals, who
often bombarded them with questions
anyway, workers taught people about
disease transmission.
In places like Vagator Beach in Goa the
work progressed rapidly. People were
interested in the teams activities from the
outset and word of mouth about the clinic
spread quickly. To attract interest the truck
drove around telling villagers about
vaccination over a loudspeaker.
Our team would inject literally every
dog we could find, says veterinary nurse
Eva Petersen. Later a team would go out
and count how many dogs had been
tagged, spray-painted and collared, to get
an idea of coverage.
Good tools, great team
Teams used a smartphone app called
Epicollect to record each animals GPS
location, vaccine dose, ward number,
ownership status, sex, approximate age
and whether the dog was neutered or
spayed. Homed animals were collared.
Each time we had done way over our
target, says Eva. We were reaching in the
nineties percentage-wise. In that respect it
had a massive impact because it is
protecting all of those people.
Eva, 28, first volunteered for WVS
when travelling to Paxos, Greece, to take
part in a neutering programme. Bitten by
the travel bug, she saw the Mission
Rabies truck at BSAVA Congress and
talked to Kate about volunteering.
Vagator Beach was a far cry from the
one vet practice in Hampshires verdant
New Forest where she works. India was a
definite culture shock, she admits.
Everything is so vibrant there, the colours,
the smells. Its an assault on the senses.
Adapting swiftly to conditions and the
ability to switch job roles smoothly were
two vital attributes for the international
volunteers. We worked on a rota system,
says Eva. One day I might be injecting, on
another recording. One person would be
doing the Epicollect, someone would be in
charge of needles and drawing up the
vaccine ready to hand over, another
person injecting and another spaying.
Demanding targets and soaring
midday temperatures generated a
hothouse work ethic. Teams rose well
before sunrise to start before the heat
became unbearable and finished at
sundown each day. Among them was
Bangladeshi veterinary student Jay
Prakash Ray.
Working in the Assamese city of
Guwahati was an education in itself.
Despite its proximity to Bangladesh, the
mix of cultures from nearby Nepal,
Myanmar and China made it an intriguing
prospect. It is considered the centre of
education for northern India, says Jay. It
has great scenic beauty. The weather is
hot and humid, but the people were so
cool and friendly and really helpful.
Although there primarily to inject
vaccines, Jay, 22, relished the opportunity
to join the trucks surgical training
programme. Bangladeshi vet students get
little chance to use the latest technology,
he says. It was a great chance for me to
learn how to eradicate rabies from a
locality and how to run a vaccination team.
The surgeons taught me aseptic surgery
and, most importantly, surgical ethics. Now
I am able to handle an animal humanely on
the operating table.
Always the motivation was improving
health status in both the canine and human
populations. My single step can save a
life, says Jay. This fact helped me to work
long hours each and every day. If this
project can run for the next three years we
can declare these localities rabies-free.
Power to the people
For WVS this is the long-term goal. Training
will give local veterinary staff the skills to
manage street dog populations and
continue vaccination, targeting two million
dogs across India over three years.
Permanent teams are now stationed all
over the country.
Throughout 2014 the truck will continue
its travels, teaching vets how to run
neutering and vaccine campaigns.
Sustainability is a large part of the WVS
agenda and a national network is being set
up to distribute subsidized vaccines and
record their use. September 2014 will see
another mass vaccination to coincide with
World Rabies Day.
Jay Prakash Ray
It was a great chance for
me to learn how to eradicate
rabies from a locality and how
to run a vaccination team
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Changing how people think about
rabies also means looking at the attitudes
ingrained by Indias rigid caste system.
Vet student Alice Hardy, 21, worked in the
city of waterfalls, Ranchi in eastern India.
People from different castes dont really
come into contact with each other, she
says. There is a huge richpoor divide.
Small details make all the difference,
like asking local vets to change the way
they work in communities stricken by
poverty. There is just rubbish piling up
everywhere, says Alice. We had to
encourage the vets to put used needles in
a box that we took with us instead of
throwing them on the floor.
Dedicated dog catchers
Essential to achieving these cultural
targets are the dog-catching teams. All of
the volunteers speak about their
invaluable net skills, local knowledge and
enthusiasm. At the start you could see it
was just a job for them, but by the end of it
they could see how passionate we were
and wed managed to convey that to
them, says Alice.
Vet Mike Greenberg agrees, and picks
out working with the dog catchers as a
highlight of his time in India. It was fun to
see them coalesce as a team, he says.
We would tell them to be gentle, all done
through signing and hand gestures. We
would watch them tell each other the same
thing and organize themselves into a unit.
By sharing values and driving change
on how people think about and treat dogs,
Mission Rabies hopes to change ingrained
behaviour. We can teach people,
especially kids, how to behave around
BRING A BOOK TO CONGRESS
The Worldwide Veterinary Service will be at
BSAVA Congress in April talking about the
impact of Mission Rabies. Anyone interested
in hearing about the project or volunteering
should visit the stand.
WVS would also like any unwanted textbooks
or old BSAVA manuals to send to charites
around the world, where they are really
needed. Last year the charity collected more
than 100 at BSAVA Congress. If you have any,
please take them with you to the WVS stand.
dogs, says Mike. Seemingly simple stuff
but it allows kids to be safe and for dogs
and humans to co-exist.
A holiday for the soul
After a tour that took in the WVS
International Training Centre in southern
India, central Nagpur and Guwahati in
the north east, Mike is ready for the
challenge ahead. Now we are working
on protocols with the aim of making
ongoing vaccination drives run as
smoothly as possible, he says. I went
from catching dogs and vaccinating
them on the streets to writing about how
to do that better.
Volunteers often speak of their
intentions to return to the project and offer
advice to anyone considering charity work.
You learn so much because it is so
different from everyday practice, says Eva
Petersen. You have to be quick on your
feet and improvise. The problem is you get
the bug for it.
Anyone expecting a holiday may have
their illusions shattered. You have to be
prepared for the fact that when you get
there the conditions are a lot more basic
than at home, says Medimarks Rick
Hayman. It is hard work. A holiday for the
soul, not the body.
Mission Rabies retains the energy of
its volunteers at its beating heart. You
need to be fit to run through alleys, vault
walls and catch animals in stifling heat.
Still the project takes volunteers of all ages
vet and non-vet alike. Everyone can
help, says Kate Shervell. As long as you
are willing to work hard, you can really
make a difference.
Alice Hardy
at the start you could see it
was just a job for them, but by
the end of it they could see
how passionate we were and
wed managed to convey that
to them
In 2014 the mission expands to other
territories. Establishing networks to animal
welfare and veterinary organizations
around the globe is full-time work. Every
detail from supplying enough needles to
signing deals with national governments
must be finalized.
Prioritization is difficult. If you look at
the WHO map of high-risk areas for rabies,
it is basically most of Africa, Asia and parts
of central America, says Kate. It is hard to
get accurate data on rabies incidence.
Gambia is in Kates plans, potentially South
Africa, then Thailand and Guatemala.
Really the list is endless and it is almost
like putting a pin in a map, she admits.
Rabies is such a massive problem it is
hard to choose.
Challenges and opportunities await.
Id travelled all over the world and never
seen a rabid dog until working in India this
September, says Kate. We picked up six
in one month and when you do that you
think it is one less to bite another dog or a
child. It brings home what you are doing
and how deadly this disease is. It really
makes you want to work harder on the
project to make it a success.


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Clinical conundrum
Laura Heaps, a former intern at the
Royal Veterinary College, invites
companion readers to consider a
Samoyed with abdominal distension
Case presentation
A 10-year-old male entire Samoyed was presented for investigation of
abdominal distension of 5 days duration. The dog had been otherwise
clinically well. Previous medical history of note included complete surgical
ligation of an extrahepatic portosystemic shunt (EHPSS) 9 years previously. No
other significant medical history was reported and the dog was not receiving
any medication.
At presentation the dog was bright, alert and responsive. He weighed 32 kg
and had a body condition score of 6/9. Heart rate was 144 beats per minute with
normokinetic pulses. There was moderate distension of the abdomen with an
appreciable fluid thrill. The remainder of the physical examination, including
fundic and rectal examination, was unremarkable.
What initial investigations would
you perform?
The initial diagnostics were directed
towards identifying the underlying cause of
ascites. Abdominocentesis was performed
and a clear fluid was obtained, consistent
with a pure transudate (total protein 5.6 g/l,
total nucleated cell count 0.2 x10
9
/l).
What are the differential
diagnoses for ascites due the
presence of a transudate?
Pure transudate (hypoalbuminaemia)
Protein-losing enteropathy (PLE)
Protein-losing nephropathy (PLN)
Hepatic disease
Portal hypertension (may result in
formation of transudate or modified
transudate depending on cause)
Pre-hepatic obstruction: e.g. portal
vein obstruction by a thrombus,
neoplastic lesion or stenosis
Hepatic disease: e.g. primary
hypoplasia of the portal vein,
chronic hepatitis, cirrhosis,
veno-occlusive disease, chronic
cholangiohepatitis
Post-hepatic obstruction:
e.g. right-sided heart failure
(e.g. cardiac tamponade,
congestive heart failure), caudal
vena cava or hepatic vein
obstruction (e.g. thrombus, kinking,
neoplasia), BuddChiari syndrome.
A complete blood count and serum
biochemical analysis were performed to
look specifically for hypoalbuminaemia and
evidence of hepatic disease. The results
are shown in Tables 2 and 3.
How do the initial results in
Tables 2 and 3 help refine your
differential diagnoses?
Pure transudates are most commonly a
result of hypoalbuminaemia and the
resulting reduced colloid oncotic pressure.
In this case, the low albumin is most likely
related to either a PLN, a PLE or liver
disease. PLE was considered less likely, as
globulin concentrations are usually also
What are the differential
diagnoses for abdominal
distension?
Ascites
Organomegaly (e.g. hepatomegaly,
splenomegaly)
Weakness of abdominal musculature
(e.g. hyperadrenocorticism, pre-pubic
tendon rupture)
Gastrointestinal dilatation/distension
+/ volvulus
Abdominal neoplasia
Obesity
Obstipation
Pneumoperitoneum
Given the fluid thrill, the likely cause of
the abdominal distension was ascites.
A large volume of free peritoneal fluid
was confirmed ultrasonographically.
Classification of peritoneal fluid
is described in Table 1.
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9
Type of uid Total protein
(g/litre)
Total nucleated cell
count (x10
9
/litre)
Cytological Analysis
Pure
transudate
<25 <1 Macrophages, mesothelial cells, small
lymphocytes, non-degenerate neutrophils
Modied
transudate
2560 <7 As above, with increasing numbers of
neutrophils and lymphocytes
Exudate >25 >7 Predominantly neutrophils; intra- (and
extra-) cellular bacteria if septc
Useful identfying features
Urine
Blood
Bile
Chyle
Fluid creatnine >2x serum; uid potassium >1.4x serum
Fluid PCV equivalent to circulatng blood
Fluid bilirubin > serum bilirubin
Fluid triglyceride >3x serum; uid cholesterol < uid triglyceride
Table 1: Classification of peritoneal fluid
Test Result Reference range Unit
WBC 15.7 617.1 x10
9
/l
Neutrophils 12.25 311.5 x10
9
/l
Lymphocytes 2.98 14.8 x10
9
/l
Monocytes 0.31 0.51.5 x10
9
/l
Eosinophils 0.16 01.3 x10
9
/l
Basophils 0 00 x10
9
/l
RBC 6.37 5.58.5 x10
12
/l
HGB 13.8 1218 g/dl
HCT 42.3 3755 %
MCV 66.4 6077 fL
MCHC 32.5 3137 g/dl
RDW 18.1 12.918.3 %
Platelets 172 150900 x10
9
/l
Table 2: Complete blood count (abnormal results in bold)
Test Result Reference range Unit
Total protein 52.3 4971 g/l
Albumin 16.1 2839 g/l
Globulin 36.2 2141 g/l
Sodium 145 146155 mmol/l
Potassium 4.9 4.15.3 mmol/l
Chloride 118 107115 mmol/l
Calcium 2.27 2.132.7 mmol/l
Inorganic phosphorus 1.59 0.82 mmol/l
Urea 5.4 39.1 mmol/l
Creatnine 99 59138 mol/l
Cholesterol 11.1 3.38.9 mmol/l
Total bilirubin 1.5 02.4 mmol/l
Lipase 133 721115 mmol/l
ALT 35 1388 IU/l
CK 206 61394 IU/l
ALP 17 19285 IU/l
Glucose 5.1 36 mmol/l
Table 3: Serum biochemical analysis (abnormal results in bold)
decreased. Considering that the albumin
concentration was only moderately low, it
would be difficult to implicate
hypoalbuminaemia fully as the sole cause
of the marked ascites. Albumin
concentrations of <15 g/l have been
associated with the development of ascites
due to low oncotic pressure. Considering
that the albumin concentration in this case
was only moderately low, it was difficult to
implicate hypoalbuminaemia fully as the
sole cause of the marked ascites.
Complete blood count showed only
mild, non-specific changes. Serum
biochemistry did not show convincing
evidence of hepatic disease, as liver
enzyme values were not elevated, bilirubin
and urea were within reference range and
cholesterol was not decreased. However,
hepatobiliary disease could not be ruled
out based on these blood results,
particularly in view of the raised cholesterol
and the hypoalbuminaemia.
What further tests would you
perform?
Urinalysis was performed to investigate the
possibility of a PLN (Table 4). A bile acid
stimulation test was performed to further
assess liver function. Pre- and post-
prandial bile acid concentrations were
elevated, indicative of reduced hepatic
function (Table 5).
Thoracic radiographs to identify any
potential cardiac or metastatic neoplastic
disease were unremarkable. Non-invasive
blood pressure (NIBP) (Doppler
sphygmomanometry) was elevated
(measurements ranged 175210 mmHg)
(Risk category III/IV; moderate to severe
risk for target organ damage according to
the ACVIM blood pressure consensus
staement).
See the artcle How to approach the
hypertensive patent by Rosanne E.
Jepson from the March 2012 issue of
companion members can access it
online at www.bsava.com.
MORE ONLINE
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Clinical conundrum
Figure 1: Transverse (A) and longitudinal (B) ultrasonographic images of the liver, portal vein (PV)
and caudal vena cava (CdVC).
A B
What further imaging would you
perform and what is your
interpretation of the images in
Figure 1?
Abdominal ultrasonography was performed
to try to identify a cause of portal
hypertension. Echogenic material was
present within the hepatic portal vein at the
level of the porta hepatis and extending
into the liver. This is consistent with the
diagnosis of a portal vein thrombosis
(PVT). Doppler flow illustrated a small
amount of lumen allowing residual portal
venous flow. The presence of a portal vein
thrombus could explain portal hypertension
and ascites. The gross appearance of the
liver was normal and multiple acquired
shunts were not identified.
There was also mild hyperechogenicity
of both kidneys, with irregular margins
suggestive of a bilateral nephropathy. The
remainder of the abdominal
ultrasonography was normal.
What are the common
presenting signs and risk
factors for PVTs?
Clinical signs can vary from asymptomatic
to acute hypovolaemic shock. The
commonest presenting signs are collapse,
vomiting, abdominal pain, diarrhoea and
ascites. Acute PVTs are associated with
more severe clinical signs, whereas
chronic PVTs are more insidious, with
ascites as the only clinical finding.
Risk factors for PVTs include
inflammatory disorders (e.g. pancreatitis,
peritonitis, cholecystitis), neoplasia, hepatic
disease, vascular injury (e.g. surgery,
trauma, portal hypertension) and conditions
predisposing to hypercoagulability (e.g.
PLN, immune-mediated haemolytic
anaemia, sepsis, hyperadrenocorticism). In
a recent study in dogs, 87% of cases with
PVTs had at least one predisposing factor
and 63% of cases had at least two
(Respess and others 2012).
This case was considered consistent
with a chronic PVT. The patient had several
risk factors including mild PLN, systemic
hypertension and previous abdominal
surgery for ligation of the EHPSS. Without
liver biopsy the presence or absence of
underlying primary hepatic disease was
undetermined.
What further diagnostic tests
may be useful?
Thromboelastography (TEG) was used to
assess coagulation. TEG provides data
about the entire coagulation profile from
the onset of coagulation to fibrinolysis.
The TEG revealed an increased alpha
angle, consistent with a hypercoagulable
state (Figure 3). The alpha angle relates
to the rate of clot formation and is the
angle between the midline and a tangent
to the curve at the 1 mm wide point (solid
blue line).
An anti-thrombin (AT) assay may have
also been useful to consider in this
Diagnostc test Result
Urine specic
gravity
1.022
Dipstck pH 8, protein 3+, blood
4+, bilirubin 1+
Sediment
examinaton
Red blood cells 2550
per HPF, white blood cells
01 per HPF, rare triple
phosphate crystal
Urine protein:
creatnine
0.89 (Reference interval
00.5)
Table 4: Urinalysis results
Bile acid
concentraton
Result Reference
interval
Unit
Pre-prandial 22.9 0.15.0 mol/l
Post-prandial 72 0.110.0 mol/l
Table 5: Bile acid stimulation test
How would you interpret these
results?
The urinalysis raised concern of a PLN,
particularly in view of the elevated urine
protein creatinine ratio (UPC). In addition,
the documented hypertension could have
contributed to the proteinuria. Proteinuria
can also be present with urinary tract
infection; therefore elevated UPCs must be
interpreted with caution when there is an
active urine sediment. The microscopic
haematuria in the current sample was
deemed unlikely to interfere with UPC.
Urine culture was not available for this
sample; however, repeat urinalysis of a
voided urine sample 10 days later
documented a consistently elevated UPC
(1.36) following a negative bacterial culture.
Significantly elevated bile acid
concentrations, with normal ALT and ALP,
indicate some degree of chronic
hepatopathy, possibly related to the
congenital portovenous vascular
abnormalities. Several studies have shown
persistent serum bile acid concentrations
elevations following portosystemic shunt
ligation. It has been speculated that this is
due to irreversible liver pathology or
continued venous shunting.
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Acknowledgements
The author would like to thank Dr Rosanne E.
Jepson for her assistance with this artcle.
Time
Alpha angle
K
R
Figure 2: The thromboelastogram from a normal dog. This is divided into three phases:
precoagulation (the initial linear segment from test initiation to the development of the first fibrin
strands where the lines diverge), coagulation (from line divergence to the maximal separation of the
two branches) and fibrinolysis (from maximal separation until the end of the test). Reaction time (R),
from the start of the trace to the point where the divergent arms reach an amplitude of 1 mm (solid
red line), represents the intrinsic pathway. Coagulation time (K), measured from the point where the
amplitude between divergent arms is 1 mm (solid red line) to the point where the amplitude is
20 mm (solid green line), represents the speed of clot development. Alpha angle, measured angle
between the midline of the trace and the tangent to the curve drawn at the 1mm wide point (solid
blue line), indicates the rate of clot development
Time
Figure 3: The thromboelastogram from the current case revealing an increased alpha angle
(solid blue line) indicating a hypercoagulable state
patient, as low AT titres are often identified
in hypercoagulable patients. This is
usually a result of one of three
mechanisms: reduced AT production by
the liver, as seen in patients with liver
disease; increased AT consumption, for
example in disseminated intravascular
coagulation; and AT losses associated
with PLNs and PLEs. AT has a similar
molecular weight to albumin and therefore
can be lost in the urine in cases of PLN;
this may have been a contributing factor to
the hypercoagulablity seen in this case.
Platelet aggregometry was also
performed for this patient. This is a
technology that provides a dynamic
assessment of platelet clumping after
addition of various platelet activators.
Platelet aggregometry is currently in its
infancy in veterinary medicine.
Nevertheless, results of platelet
aggregometry in the current patient did
not support the requirement for
antiplatelet therapy.
Treatment
The current evidence for the use of
antiplatelet drugs and anticoagulants in
hypercoagulable veterinary patients is
limited. Antiplatelet drugs, such as aspirin
and clopidogrel, inhibit platelet aggregation
and adhesion to the pre-existing thrombus,
whereas anticoagulants, such as low
molecular weight heparin, help inhibit
propagation and recurrence of thrombi. In
humans with chronic PVTs with concurrent
portal hypertension there is a risk of serious
complications, such as recurrent bleeding
from oesophageal varices and
hypersplenism with pancytopenia. Dogs on
the other hand do not seem to develop
these specific complications, although risk
of gastroduodenal ulceration is known to be
higher in dogs with hepatobiliary disease
and portal hypertension. It is therefore
difficult to be certain whether the risks of
anticoagulant therapy outweigh the
benefits, or play any role in the survival of
these patients, and it was decided not to
implement such therapy in this case.
Therapy for PLN and systemic
hypertension was commenced with an
angiotensin converting enzyme inhibitor
(benazepril) and the introduction of a
low-protein diet supplemented with omega
3 fatty acids to help slow potential renal
damage secondary to proteinuria.
Outcome
At re-examination 10 days later the ascites
had improved markedly but the thrombus
was still present on abdominal
ultrasonography with no clear evidence of
recanalization. A repeat TEG profile was
consistent with a normocoagulable state,
although NIBP remained high (170 mmHg).
No changes to the therapy were
implemented as the hypertension was only
mild and there was a possible white coat
effect due to the patients nervous nature.
It was recommended that NIBP, serum
biochemistry and UPC be reassessed at
2-weekly intervals.
Prognosis
There is limited literature regarding the
outcome of these cases; however, poorer
prognoses are associated with acute PVTs,
multiple thrombi, extension of the thrombus
into portal vein tributaries, and systemic
inflammatory response syndrome.
Continued hypercoagulable states
predispose to further thrombosis, such as
cerebral or pulmonary, with potentially
life-threatening consequences.
Recanalization of the thrombus or
formation of secondary venous shunts to
reduce the portal hypertension is possible.
Generally the prognosis for cases of
chronic PVTs is poor to guarded; however
at telephone follow-up 8 months later the
patient is reportedly doing very well and
the ascites has resolved. In this case the
development of collateral circulation
(secondary shunts) was likely, given the
resolution of the ascites.
Reference available online
MORE ONLINE
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Clinical standards
consultation
to patients and service to clients. However, there were
also concerns expressed about the difficulties of
defining and measuring standards and the level at
which standards should be set. Here are a sample of
the comments we received:
I would support the introduction of clinical standards
into the PSS; on the assumption these relate to clinical
audit and are not dictatorial. This would be such as %
of wound issues, frequency of wound culture, etc.
If the scheme was dictatorial this would decrease
the uptake by the profession apart from by the very
large practices and groups. The clinical standards
should be flexible and set realistic targets for vets of
all sizes, and should take into account fit [with] the
business objectives.
Dr Sally Everitt, BSAVAs Head of Scientific
Policy, reveals what members had to say
when we asked you for your thoughts
L
ast August we ran an article titled Are we ready
for clinical standards?, which we followed up
with a member consultation. The majority of
respondents to our consultation were supportive
of the idea of introducing clinical standards into the
Practice Standards Scheme (PSS) suggesting that
these have the potential to raise the standards of care
12-14 Clinical Standards.indd 12 20/02/2014 10:14
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13
What is more important is to choose the most important
areas that can help to achieve more effectiveness in
delivery of clinical services rather than trying to do too
much at once. For any practice, it is probably best to
work on no more than 3 new clinical standards at any
one time, and slowly build them up over time.
Practice Standards Scheme
Since our last article the RCVS has made more details
available on its plans to update the Practice Standards
Scheme; and the Practice Standards Group, along
with representatives of member organizations, have
been working on the contents of the specific modules.
The Council of the RCVS has agreed that the PSS
should develop a modular structure which focuses
more on behaviours and outcomes rather than facilities
and equipment. There are currently 19 proposed
modules as well as separate modules relating to
Hospital Standards and government work. It also
agreed to the Scheme encouraging greater
differentiation between practices, particularly at
general practice level, where bronze, silver and gold
categories were approved. The scheme will remain
voluntary but all participating practices will have to
complete the core requirements of each module.
Core practices
All practices, whether in the Scheme or not, should
meet these standards. Those in the scheme will be
inspected to the legal and RCVS Code requirements.
General practice
Bronze standard will be equivalent to the current
standards for GP practices, but there will be additional
requirements within each module for those wishing to
demonstrate that they achieve a higher level. While
these requirements will be optional, practices will have
to achieve a certain proportion in each module in order
to achieve silver or gold status. There has also been
discussion as to whether practices can achieve and
display accreditation for some modules at a higher
level e.g. an RCVS Accredited Bronze General
Practice but achieving Gold in surgery; anaesthesia
and pain control, and if so how this information would
be conveyed to the public.
Veterinary hospitals
There is still some discussion about the standards
expected of veterinary hospitals but it is likely that they
will have to meet GP gold standard as well as the
requirements of the specific hospital module, which
will include enhanced requirements concerning the
training of staff and clinical audit. There has also been
discussion as to whether veterinary hospitals should
be required, after an appropriate transition period, to
provide their own out-of-hours service and, if so, the
level of staffing that would be expected.
The stated intentions of the new proposals are to
encourage practices to strive for, and achieve
recognition for, higher standards as well as to enable
the public to differentiate between different practices.
At the same time the RCVS Council has stated that it is
important that raising standards should not mean that
veterinary care becomes unaffordable for average
animal owners. Although it is not clear what they
mean by this term, it is clear that in veterinary practice
we provide services to a wide range of people who
have different relationships with their animals and
different resources, practical as well as financial,
available to care for their animals.
It is important to acknowledge that some owners
will have to make decisions based on financial
considerations and that if achieving gold status costs
the practice money in terms of providing better
facilities and improved staff training, these costs will
have to be passed on to the client. However, if we
make an analogy with the rating of hotels, it is clear
that people may be looking for very different things
compared to the people who design the rating system.
The practice standards scheme is a bit like the hotel
rating scheme, many brilliant small hotels are only 3*
because they do not have wifi and broadband and
swimming pools and spas and 24 hour room service
but instead they have antiques and seashores and
honesty bars.
PROPOSED MODULES
1. Staf and management
2. Client experience
3. Clinical governance
4. Outpatent care
5. Premises
6. Medical records
7. Inpatent care
8. Nursing
9. Surgery
10. Anaesthesia
11. Dentstry
12. Diagnostc imaging
13. Laboratory and post-mortem
14. Business
15. Medicines
16. Pain control
17. Emergency and critcal care
18. Out of hours
19. Infecton control
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Clinical standards consultation
Assessing clinical care
It has been pointed out that clinical care is
as much about the staff as the facilities.
This leads on to questions about how
inspectors will assess practices. Whilst it
is easy to carry out tick box inspections
checking for the presence of certain
pieces of equipment or paperwork,
assessing the quality of care given is
much more difficult.
Even in the medical profession, where
they are far more used to the idea of
inspections, there is uncertainty about how
to assess care in general practice. The
Care Quality Commission, which inspects
medical healthcare services, has recently
released the results of its first inspections
of NHS general practices, which it inspects
under five headings:
1. Are they safe?
This includes checking whether
practices are clean and safe,
including whether medicines are
managed properly and whether
practices learn from safety
incidents, such as prescribing
errors or missed diagnoses.
2. Are they effective? This will include
checking that:
Patients are given the right
diagnosis and treatment
The care of patients with long-term
conditions is managed well
Patients are referred properly to
specialist services
Patients and those who care for
them are involved in decisions
about their care.
3. Are they caring?
This will include checking that patients
are treated with compassion, dignity
and respect.
4. Are they responsive?
This will include checking how the
practice responds to feedback from
people. It will also include how medical
records are stored and shared with the
patient and other services
5. Are they well led?
This will include checking that the
practice supports its staff, provides
training and supervision to make sure
they are able to do a good job, and has
good quality governance.
While veterinary practices differ
significantly from GPs surgeries in the
way that services are provided and paid
for, as well as the fact that we have to
consider the needs of both the animal
patient and human client, all of these
questions seem relevant to veterinary
practice although the way that they are
answered may be different.
Inspection
It will almost certainly be necessary for
the inspectors to use a range of different
methods to assess the clinical care given
in the practice, including talking to staff
and clients as well as checking
paperwork such as rotas and client
leaflets and, perhaps most important of
all, observing what goes on during the
normal working day.
However, the inspectors will only be
present in the practice for a short period of
time, so they will also need to rely on the
practice providing evidence of how they
meet some of the standards. If we look at
how this is achieved in other settings,
possible options include self-certification
and providing a portfolio of evidence. One
of the methods often used to demonstrate
(as well as improve) the standards of care
delivered is clinical audit.
At its simplest, clinical audit is the
collecting and recording of clinical
information with the aim of monitoring the
quality of care. Clinical audits can look at
either process or outcome. However it is
neither possible nor desirable to audit
everything, so it is important to decide
what is sensible and achievable. Some
suggestions for clinical audits that may
be relevant to the Practice Standards
Scheme are post-op infection rates,
antibacterial usage (particularly if paired
with a practice policy on responsible
antibacterial prescribing), and pain
assessment and analgesia.
One area that has does not yet
appear to be included in the Standards is
assessment of the consultation itself. As
the consultation is such an important part
of the communication process between
the veterinary surgeon (or veterinary
nurse) and the client, and is where many
of the decisions regarding the clinical
care of the animal is made, this is
perhaps surprising.
The medical profession has used
assessment of the general practice
consultation for some time as part of the
revalidation process. However, part of
the problem in veterinary medicine is
that although we have models of the
consultation process, such as the
CalgaryCambridge model now taught
in veterinary schools, my own research
(published in JSAP last year) indicates
that the veterinary consultation is a
complex iterative and interactive process
and we do not yet have any validated
methods of assessment.
Congress workshop
There is still a long way to go before the
details of the new scheme are agreed,
so there is time to influence the
decisions that are made. We will be
holding a discussion forum/workshop at
BSAVA Congress on Saturday 5 April
from 11am to 1pm, at which Pam
Mosedale (BSAVA representative on the
RCVS Practice Standards Group), Jacqui
Molyneux (Past President of the RCVS
and Chair of the RCVS Practice
Standards Group) and I will update you
on the process and give you an
opportunity not only to ask questions but
to tell us your views.
In the meantime please take a few
minutes to complete our questionnaire
online at www.bsava.com/
consultations. n
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15
Congress 36 APRIL 2014
Browsing the
Balcony
bookshop
I
f you are coming to Congress in April
then make sure you visit the bookshop
on the BSAVA Balcony. BSAVA
Members get an extra 5 off all titles at
Congress on production of a valid
membership card (excludes e-Books).
Remember to show the sales team your
card to receive this discount.
BSAVA Manuals of Rabbit
Medicine and Rabbit Surgery,
Dentistry and Imaging
Rabbit Medicine edited by
Anna Meredith and Brigite Lord
Rabbit Surgery, Dentstry and Imaging
edited by Frances Harcourt-Brown
and John Chity
Rabbits make up a considerable and
growing proportion of the caseload in
small animal practice, and both interest
and knowledge in rabbit medicine and
surgery has grown rapidly. In recognition
of this, the BSAVA Manual of Rabbit
Medicine and Surgery has been
superseded by two separate volumes
the BSAVA Manual of Rabbit Medicine
and the BSAVA Manual of Rabbit
Surgery, Dentistry and Imaging. These
two manuals provide the most
comprehensive and up-to-date coverage
of all aspects of rabbit veterinary care
currently available, in an easy-to-use,
well illustrated format following the tried
and tested BSAVA Manual template.
Rabbit Medicine
General Congress price: 49.00
Member Congress price: 44.00
Rabbit Surgery, Dentstry and Imaging
General Congress price: 55.00
Member Congress price: 50.00
BSAVA Manual of Canine and
Feline Radiography and
Radiology: A Foundation Manual
Edited by Andrew Holloway and
Fraser McConnell
Confident radiographic interpretation
presents a considerable challenge and this
BSAVA Manual provides a comprehensive
review of the approach to radiological
interpretation, the range of variants and the
key fundamental principles and their
application to common diseases. Replacing
the classic BSAVA Manual of Small Animal
Diagnostic Imaging as an introduction for
veterinary students, nurses and new
graduates, this Manual features high-quality
radiographic reproductions demonstrating
normal anatomy and key aspects of
interpretation of abnormal features, as well
as illustrations showing patient positioning
and the practical approach that is the
hallmark of the BSAVA Manuals. The
Manual is accompanied by a CD which
contains all the radiographic images from
the book.
General Congress price: 49.00
Member Congress price: 44.00
AVAILABLE SOON
BSAVA Manual of Canine
and Feline Ophthalmology,
3rd edition
Edited by David Gould and
Gillian McLellan
Visit the Balcony for a sneak preview of the
forthcoming new edition of the BSAVA
Manual of Canine and Feline
Ophthalmology, which has been
extensively revised and updated to take
account of developments in this rapidly
expanding field. The first section of the
manual covers examination and clinical
techniques and includes chapters on
ocular examination, diagnostic imaging
and laboratory investigations. The second
section of the manual focuses on the
diagnosis and treatment of common ocular
diseases. Each chapter in this section
follows a similar format covering anatomy
and physiology, the investigation of
disease and details of canine and feline
conditions. The final section provides a
problem-oriented approach to common
presentations, including anisocoria,
blindness and the red and painful eye,
using flowcharts and algorithms.
e-Books
Following on from the successful launch
of the first five e-Books at Congress last
year, the latest titles available in this
format are:
BSAVA Manual of Canine and Feline
Abdominal Imaging
BSAVA Manual of Canine and Feline
Advanced Veterinary Nursing, 2nd editon
BSAVA Manual of Canine and Feline
Haematology and Transfusion Medicine,
2nd editon
BSAVA Manual of Canine and Feline
Oncology, 3rd editon
BSAVA Manual of Canine and Feline Surgical
Principles: A Foundaton Manual
Available exclusively to BSAVA
Members, this new format has proved
increasingly popular over the last twelve
months. Visit the stand to browse these
e-Books on our new iPad viewing
station.
Congress sees the
arrival of more new
BSAVA Manuals
and e-Books
15 Congress Publications.indd 15 19/02/2014 14:12
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companion
Twenty years
in the making
BSAVA Congress this year sees the launch
of the eighth edition of the indispensable
BSAVA Small Animal Formulary
F
irst published in 1994, the
BSAVA Small Animal Formulary has
been a mainstay for small animal
practitioners for over 20 years. With
a new edition released, on average, every
three years, this popular member benefit
continues to support the profession with
details on the drugs available for use in
veterinary patients, as well as
supplementary information on prescribing,
the responsible use of antibacterials and
safety and handling of medicines.
PROTECT bookmark
New for this edition is the inclusion of
a bookmark adapted from the
PROTECT poster produced jointly by
the Small Animal Medicine Society
(SAMSoc) and BSAVA. Antibacterial
resistance is a politically
important topic and
there are those who
wish to restrict
veterinary use of
certain antibacterial
products, which
could have
significant
implications for
animal health and
welfare. It is
therefore essential
that veterinary
surgeons are seen
to be using
antibacterials
responsibly; the
PROTECT poster
and accompanying
literature (available
on the BSAVA
website) helps
practitioners in this
objective.
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17
CONGRESS COLLECTION
Eligible BSAVA Members will be able
to collect their copy of the new BSAVA
Small Animal Formulary, 8th editon,
from the BSAVA Balcony in the NIA
during Congress in April. For those
members not atending Congress, your
copy will be posted out to you.
Additonal copies will also be
available to purchase from the BSAVA
Publicatons stand at a cost of 45.
BSAVA Members remember to bring
your membership card to receive a
5 discount o this price.
Protocols in the Appendix
The chemotherapy and sedation
protocols have been separated
from the general information in the
Appendix for this new edition,
making them easier to locate. In
addition, a series of new
immunosuppression protocols has
been included. Each of the relevant
drug monographs contains a
cross-reference in the doses
section to the relevant protocol in
the Appendix.
Drugs removed
A number of drug monographs have been
deleted from this new edition of the
Formulary as older drugs become
unavailable and newer drugs make them
obsolete. The monographs removed include:
Alpha-casozepine
Buspirone
Chlortetracycline
Cisplatin
Cyclopentolate
Estradiol
Felbamate
Interferon alfa
Ketoconazole
Medium chain triglycerides
Milrinone
Nalbuphine
Natamycin
Nitropruside
Oxazepam
P07P
Phentolamine
Primidone
Procainamide
Resocortol butyrate
Sodium valproate
Thyrotropin releasing hormone
Client information leaflets
Veterinary surgeons should provide
information to their clients about the safe
use of drugs that they prescribe and
dispense for patients under their care. For
drugs authorized for use in dogs and/or
cats this information is usually supplied to
veterinary surgeons by the pharmaceutical
company and this should then be passed
on to clients.
For drugs that are not authorized for
the particular use in the particular species
there is still a responsibility to provide
information, but the leaflets provided with
these drugs may not be adequate. Thus,
the BSAVA has provided, as a service to
its members, a series of Client Information
Leaflet (CILs) that can be used to help
practitioners fulfil their obligations. Where
a CIL for a particular drug is available for
BSAVA members to download from the
BSAVA website, this is noted in the
Formulary in both the individual drug
monograph and in the index.
The information provided in these
leaflets is not intended to be exhaustive
nor to cover every possible use of a
particular drug, and practitioners should
exercise care to check that the
information provided in the leaflets is
suitable for their patient. These
information leaflets do not absolve
veterinary surgeons from providing
information specific to the individual
patient or client but will help provide
generic information on the safe use of a
drug. The responsibility for the safe and
appropriate use of drugs remains with
prescribing veterinary surgeons. Leaflets
for additional drugs are planned.
Drugs added
The new drug monographs that have
been added to this edition of the
Formulary include:
Cetirizine
Cimicoxib
Cisapride
Dibotermin alfa
Imepitoin
Indoxacarb
Moxifloxacin
Oclacitinib
Pradofloxacin
Spinosad
Telmisartan
Torasemide
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How to perform a
transconjunctival
enucleation
E
nucleation is indicated for eyes which harbour
malignant neoplasia, or which are irreversibly
blind and painful. The loss of an eye is,
however, a highly upsetting procedure for the
patients owner and it is therefore of particular
importance that the procedure is carried out in a way
that the best possible aesthetic postoperative
appearance is achieved. This includes the need for
careful haemostasis to minimize postoperative
bruising and swelling, avoidance of skin sutures or the
need for removal of facial sutures, and minimal orbital
tissue loss to prevent sinking of the skin overlying the
orbit. Older methods of packing the orbit with gauze
that was removed over several days postoperatively,
leaving a granulating wound healing by second
intention, are now obsolete.
Methods
Methods for enucleation in the dog and the cat are
divided into transconjunctival and transpalpebral. In
the transconjunctival approach, the ocular surface is
exposed throughout the procedure and access to the
orbit is achieved via the incised conjunctival sac. With
this approach, the lids are generally removed after the
globe has been extirpated. In the transpalpebral
approach, access to the orbit is gained via the incised
eyelid skin and the eyelids are removed together with
the globe; the conjunctival sac is not breached.
In the authors opinion, the transconjunctival
approach allows the best overview of the surgical
site and thus allows optimal haemostasis. The
improved visibility also results in a lesser tendency
to pull excessively on the optic nerve during
removal of the globe, which should be avoided as it
has been associated with blindness in the
contralateral eye in cats.
Furthermore, the author proposes that the
transconjunctival approach results in minimal loss of
orbital tissue and may therefore lead to less sinking of
the skin at the surgical site postoperatively.
Contraindications to a transconjunctival approach are
limited; but the presence of malignant neoplasms of
the conjunctiva or ocular surface would certainly be an
indication for a transpalpebral approach. In addition, a
transconjunctival approach would potentially not be
the ideal method in cases of infectious ocular surface
disease; here, the more sterile method would be the
transpalpebral approach.
Equipment required
n Surgical forceps (such as St Martins thumb forceps
with a 0.3 mm tooth)
n Metzenbaum scissors (small, curved and blunt
tipped)
n Mosquito forceps (fine)
n Needle holders
n Towel clamps
n Sterile drapes
n Sterile gauze swabs (ideally X-ray detectable)
n 3 metric (2/0) polydioxanone
n 1.5 metric (4/0) poliglecaprone 25
n 0.7 metric (6/0) Polyglactin 910
n Skin glue
Anaesthetic requirements
Premedication with acepromazine and a full opioid
agonist (such as methadone or morphine) is preferred
unless contraindicated in a specific patient. Additional
analgesia is provided with a systemic non-steroidal
anti-inflammatory (NSAID) injection authorized for
perioperative use and a retrobulbar local anaesthetic
block (see below). Induction is carried out with
propofol or alfaxalone and the patient is maintained
with inhalational anaesthesia. The need for intravenous
fluid therapy is decided on an individual basis.
Perioperative antibiosis
The conjunctival sac of the healthy canine and feline
eye has to be considered a cleancontaminated site,
justifying the use of a single dose of a potentiated
amoxicillin at 20 mg/kg given slowly intravenously
following induction. If the transconjunctival approach is
chosen for eyes with surface infection or perforating
injuries, the site has to be considered as contaminated
or dirty and, whilst the antibiotic may have to be
Christine Heinrich from Willows
Veterinary Centre and Referral
Service guides readers through
this tricky procedure
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19
chosen empirically initially, a swab for antimicrobial
culture should first be obtained and submitted so that
antimicrobial therapy can be continued appropriately.
Clip and positioning
The periocular area is carefully clipped in a circular
shape, extending approximately 35 cm away from the
eyelids (Figure 1). It is generally preferable to avoid
damage to the skin associated with an over-zealous
clip. A small amount of lubricant or artificial tear eye
ointment/gel is applied to the conjunctival sac, as this
enables hair that may lodge here following clipping to
be flushed out easily later. The patient is positioned in
lateral recumbency and the head is elevated with the
help of a deflatable pillow so that the palpebral fissure
is level and parallel with the surgeon (Figure 1).
Local anaesthetic block
To augment perioperative analgesia, a retrobulbar
local anaesthetic block with 12 ml of a suitable local
anaesthetic (e.g. lidocaine, bupivacaine, mepivacaine
or ropivicaine) is indicated. (Table 1) Care must be
taken not to exceed the toxic dose of the anaesthetic
agent, as systemic absorption from the retrobulbar
space is significant.
The author uses bupivacaine (Marcain

0.5%)
which has a slower onset of action than lidocaine but a
longer duration of action. For this reason, the author
gives the block prior to the surgical eye preparation
with disinfectant, so that the drug is effective by the
time the first surgical incision is made. Prior to
application of the block, the skin of the lower lid is
wiped repeatedly with a sterile cotton swab soaked in
1:50 diluted povidoneiodine solution. (Figure 2).
The surgeon has washed hands carefully but is not
gloved for this part of the procedure. To apply the
block, the inferotemporal palpebral technique (ITP) is
chosen. If a specific curved retrobulbar needle is not
available, a 2 G, 1.5-inch spinal needle is used, bent at
an approximate 20-degree angle at its mid-point. The
needle is then positioned at the ventral orbital rim and
inserted through the lower lid at the junction of its
middle and lateral thirds (Figure 3).
Local
anaesthetc
Dose
(mg/kg)
Toxic dose
(mg/kg)
Onset tme
(minutes)
Duraton of
acton (hours)
Mepivacaine 2 29 510 22.5
Lidocaine 24 1120 1015 12
Bupivacaine 2 3.54.5 1020 2.56
Ropivacaine 1.5 1020 1020 2.54
Table 1: Drugs for local anaesthetic use in dogs
Figure 1: The patients head is positioned with the palpebral
fissure on an even level and parallel to the surgeon. Note the
circular clip, which is approximately 3 cm wide
Figure 2: The lower lid
is prepared
aseptically with a
povidoneiodine-
soaked swab prior to
application of the
inferotemporal
palpebral nerve block
Figure 3:
The inferotemporal
palpebral nerve block
is placed 5 mm below
the lower eyelid
margin at the junction
between the lateral
and central thirds of
the lower eyelid.
Note the curved
retrobulbar needle
used
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How to perform a
transconjunctival enucleation
The needle is advanced until a slight popping
sensation is detected, indicating that the orbital fascia
has been pierced. The needle is then directed slightly
dorsally and medially towards the apex of the orbit and
advanced approximately 12 cm. The local
anaesthetic is injected after gentle aspiration to check
for blood to avoid intravascular injection.
Increased resistance encountered on injection of
the local anesthetic agent might indicate that the
needle has been placed into the optic nerve sheath. In
this case, the needle must be redirected to avoid
intrathecal injection, which can cause respiratory
arrest by infiltration of the subarachnoid space and the
central nervous system.
Surgical preparation
Following application of the retrobulbar block, the
conjunctival sac and skin are prepared using a 1:50
dilution of povidoneiodine solution. Initially, sterile
cotton buds dipped into the povidoneiodine can be
used to remove hair and debris from the depths of the
conjunctival sac and from the posterior aspect of the
third eyelid (Figure 4a). This is followed by repeat
flushing of the conjunctival sacs and ocular surface
with the diluted povidoneiodine through a 5 ml
syringe, which has the plastic part of an intravenous
catheter or a plastic nasolacrimal cannula attached
(Figure 4b). The surface is flushed until no further
debris or hair emerges. Finally, the periocular skin is
repeatedly gently wiped using sterile swabs soaked in
the povidoneiodine solution.
The surgical site is then covered with
appropriate surgical drapes. A four-step draping
procedure can be employed, although the author
prefers the use of a drape with a round hole of
approximately 7 cm together with a sterile adhesive
drape, which is incised to the required shape
(Figure 5). At the end of the surgical preparation and
draping, a sterile drop of local anaesthetic (e.g.
proxymetacaine) and a drop of 2.5% phenylephrine
are applied to provide additional local anaesthesia
and aid haemostasis (Figure 6).
Figure 5: The surgical field has been aseptically prepared and
draped. Note the use of a re-usable drape with a round
opening and an adhesive plastic drape
Figure 6: Both proxymetacaine and 2.5% phenylephrine are
applied to the conjunctival sac to provide local anaesthesia
to the conjunctiva and minimize conjunctival haemorrhage
Figure 4: (A) A sterile cotton bud soaked in 1:50 diluted
povidoneiodine is used to wipe the conjunctival fornices
clean. (B) The conjunctival fornices and space posterior to
the third eyelid are flushed repeatedly with a 1:50
povidoneiodine solution. A soft nasolacrimal cannula or an
intravenous catheter can be used
A
B
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Surgical procedure
As a first step, a lateral canthotomy is carried out to
increase access to the orbital tissues. To minimize
bleeding, a straight pair of mosquito forceps can be
placed on to the skin where the lateral canthus is to
be incised (Figure 7a) and left in place for
approximately 30 seconds. The canthus is then
elevated with appropriate surgical forceps and
incised to about 1 cm (Figure 7b), exposing the
lateral edges of the upper and lower conjunctival
sacs (Figure 7c).
The exposed conjunctiva is now lifted with the
forceps and blunt dissection between conjunctiva and
episcleral tissue is started (Figures 8a and b). To
increase access to the orbit and the globe, the
conjunctiva is gradually cut along the limbus, leaving
at least 57 mm of conjunctiva attached to the limbus
(Figure 8c). This is essential as the tissue attached at
the limbus acts as a handle, allowing the surgeon to
manipulate the globe into any direction required to
facilitate dissection. Smaller amounts of conjunctiva
left at the limbus have a tendency to tear, meaning that
the surgeon does not have enough tissue to hold and
manipulate the globe, which results in an uncontrolled
and swivelling eye.
Dissection then continues towards the posterior
aspect of the globe, first dorsally (Figure 8d) and then
along the ventral aspect of the globe. Dissection along
the ventral globe is carried out in front of the third
eyelid (i.e. on the bulbar aspect of this structure)
(Figure 8e) as the third eyelid is only excised once the
globe has already been removed.
C A
Figure 8: (A) Initially, blunt dissection is employed
to reach the dorsal sclera. (B) Next, blunt
dissection towards the ventral sclera is carried out
via the small incision at the canthus. (C) To
improve scleral exposure and allow dissection
further towards the posterior aspect of the globe,
the dorsal conjunctiva is incised at a distance of at
least 5 mm away from the limbus. It is of utmost
importance to retain adequate conjunctival tissue
at the limbus as this will be used to manipulate
the globe with the surgical forceps. (D) The dorsal
sclera and its extraocular muscle insertions are
gradually exposed. (E) Dissection continues along
the ventral sclera. Fibrous tendons of extraocular
muscles are severed sharply
B
D E
A B C
Figure 7: (A) To minimize bleeding from the canthotomy, mosquito forceps are applied to the skin at the lateral canthus for
approximately 30 seconds. (B) Subsequently, the canthus is incised to a length of approximately 1 cm. (C) The lateral
conjunctival edges are identified (arrows), facilitating dissection between conjunctiva and globe
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Whilst most subconjunctival and episcleral tissue
can be dissected bluntly adhering along the curvature
of the globe, insertions of the extraocular muscles
have to be cut by sharp dissection. The surgeon must
be prepared to identify these muscle insertions in most
cases as tough and tendinous strands with few muscle
fibres rather than as the solid, well defined muscle
drawings known from the anatomical textbook.
Altogether, there are four rectus muscles, a dorsal
and a ventral oblique muscle and the retractor bulbi
muscle. The tendons of the extraocular muscles insert
into the fibrous scleral coat, from which they are
difficult to distinguish visually intraoperatively. The
rectus muscles insert 59 mm posterior to the limbus
dorsally, laterally, medially and ventrally. The dorsal
oblique muscle passes through a cartilaginous trochlea
in the medial orbit (which can sometimes be
encountered during enucleation) and its tendon inserts
below and lateral to the tendon of the dorsal rectus
whilst the ventral oblique muscle inserts in close
association with the lateral rectus tendon. The retractor
bulbi muscle is closely associated with the optic nerve,
surrounding it in a cone-like fashion and its fibres
insert in a fan-like manner into the posterior sclera
How to perform a
transconjunctival enucleation
posterior to the rectus muscle attachments. It is not
always possible to remove all retractor bulbi
attachments prior to sectioning of the optic nerve, and
often fibres of this muscle are cut together with optic
nerve and vessels. The muscle insertions are dissected
sharply, which produces a crunchy feel during
dissection compared with the softer episcleral tissue.
Specific care must be taken when dissecting along
the dorsomedial aspect of the globe, as a large vein
(angularis oculi vein) winds here along the dorsomedial
orbital bone. Extensive haemorrhage will occur if this
vessel is incised by mistake (which happens much
more readily during a transpalpebral approach) and
haemostasis must be carried out before further
dissection can continue.
Once the globe has been freed from conjunctival
and rectus/oblique muscle attachments, remaining
retractor bulbi muscle fibres, optic nerve and optic
vein and artery are sectioned. It is usually not possible
to identify these structures one by one, as they are in
close proximity and it suffices to place a small, straight
or curved pair of artery forceps posterior to the globe
(Figure 9a) and to cut between globe and forceps with
the dissection scissors (Figure 9b). Care must be
A
C
B
Figure 9: (A) Once all extraocular muscles and conjunctival adhesions have been removed, artery forceps are placed across the
optic nerve and its associated blood vessels. Care is taken to avoid excessive traction on the globe during placement of the
clamp or the subsequent sectioning of the tissues. (B) The excised globe is removed. A small part of the optic nerve is usually
visible at the posterior pole (arrow). (C) With the trans-conjunctival method, minimal tissue will remain attached to the globe.
The globe is kept safe until the end of surgery when it is submitted in formalin for histopathological examination.
(D) Haemostasis of the retrobulbar blood vessels is achieved by cauterizing along the clamp placed on to the tissues
D
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taken not to exert excessive traction on the optic nerve
by pulling on the globe. In the cat, it may be necessary
to section the nerve/vessel attachment without prior
clamp placement to avoid excessive traction on the
globe. In this case, placement of a clamp on to the
vessels is attempted subsequently but primary
haemostasis might not be possible (see below).
The excised globe, which has minimal remaining
conjunctival and muscular attachments (Figure 9c) is
stored safely, to be sent later for histopathological
examination. It is not usually necessary to ligate the cut
tissues, as both the artery and vein associated with the
optic nerve are relatively small vessels in the dog and
cat; it is usually sufficient to carry out cautery along the
mosquito forceps (Figure 9d). In addition, the forceps
are left in situ until the eyelids have been removed and
until closure of the wound is to begin.
In the next step, the eyelid margins are removed
with the help of the dissection scissors. Prior to
removal of the eyelid margins, it is important to identify
conjunctiva that remains adherent to the eyelid margin
(Figure 10a). This must be removed with the eyelid
margin as failure to do so may result in wound healing
complications postoperatively.
It is not usually necessary to prepare the skin
aspect of the incision with a scalpel blade, as lid skin
and underlying tissue are usually soft and thin enough
to be easily cut with scissors (Figure 10b). The medial
canthus can present something of a challenge to
removal of the eyelid margins, as tight fibrous
adhesions to the orbital fascia exist here. These must
be removed by sharp dissection close to the orbital
bone. Electrocautery is employed to control any
haemorrhage from the cut lid margins.
The lower eyelid margin is removed next but the
cut here does not breach the lower conjunctival sac
(Figure 10c), so that the removed lower lid margin
remains attached to the third eyelid (Figure 10d).
Finally, the lid margin and attached third eyelid
are pulled up and mosquito forceps are clamped
across the base of the third eyelid (below the third
eyelid gland) (Figure 11a) to provide haemostasis
following cutting of the tissues above the forceps
(Figure 11b). Again, cautery is carried out along the
mosquito forceps (Figure 11c) to ensure that the
relatively good vascular supply to the base of the
third eyelid and its gland is sealed following
forceps removal.
A
D
Figure 10: (A) Conjunctiva that remains adherent to the eyelids (arrow) must be identified and excised during lid margin
removal. (B) The upper lid with its adherent conjunctival lining is removed with sharp dissection scissors. (C) During removal
of the lower lid, the conjunctival connection to the third eylid is not cut both lower lid margin and third eyelid will be
removed together. (D) The excised lower lid, which remains attached to the third eyelid, is gently pulled out to aid removal of
the third eyelid and third eyelid gland
B
C
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How to perform a
transconjunctival enucleation
A C B
Figure 11: (A) A clamp is placed across the base of the third eyelid, below the third eyelid gland. (B) Lower lid margin and third eyelid are excised together
above the previously placed clamp. (C) The edge of the third eyelid is cauterized along the mosquito clamp to prevent haemorrhage from the significant
vascular supply to the third eyelid
Figure 12: Orbit following removal of the globe, third eyelid
and eyelid margins. The surgeon must ensure that
haemorrhage is controlled and that no unwanted tissues
(globe, conjunctiva) or swabs are left behind
Following removal of the globe, eyelid margins and
third eyelid, the mosquito forceps holding the cut optic
nerve and its associated vessels are released. The
exposed orbit with its remaining tissues (consisting of
fat, fascias, muscles and vessels) is inspected to
ensure that no unwanted ocular tissue or swab material
has been left behind (Figure 12). The entrances to the
nasolacrimal ducts can be identified and cauterized in
an attempt to prevent the rare complications of
postoperative nasal bleeding via the nasolacrimal canal
or orbital air cyst formation. Should haemorrhage occur
at this stage, then a sterile, ideally radiographically
detectable, swab is placed into the orbit and held in
place by manual pressure for 5 minutes. After this time,
clotting should have occurred (unless the patient has a
clotting problem) and the swab is removed prior to
wound closure. At this stage of the procedure, an
orbital splash block can be carried out if the surgeon
had chosen not to apply a retrobulbar block
preoperatively. For this purpose, a similar amount of
local anaesthetic as described above is applied to the
open orbit prior to closure.
Closure of the orbit is carried out with two
continuous layers of 3 metric (2/0) absorbable suture
material such as polydioxanone (2/0 PDS

) followed by
either a subcuticular layer of 1.5 metric (4/0) absorbable
sutures such as poliglecaprone 25 (4/0 Monocryl

) or
absorbable 0.7 metric (6/0) polyglactin 910 sutures (6/0
Vicryl

). The author does not recommend the use of


non-absorbable skin sutures as removal of small facial
sutures may be difficult in non-cooperative patients.
Furthermore, ophthalmologists find that absorbable
skin sutures are usually well tolerated when used
following eyelid procedures.
The first layer of absorbable sutures aims to pull the
remaining orbital fascia as close together as possible,
to reduce later sinking of the skin into the orbit as much
as possible. To this effect, a cutting needle is chosen
and the sutures are placed as close as possible to the
periosteum, almost into the fibrous tissue (Figure 13a
and b). The second layer aims to seal the orbital
opening completely by pulling the subcutaneous
tissues of the eyelids together (Figure 13c). The orbital
closure must be complete to prevent haemorrhage
from a possible orbital haematoma, which may form
postoperatively. All suture ends must be buried. The
subcuticular layer brings together the skin edges, and
the final knot is buried using an Aberdeen knot. Tissue
glue can be applied to the wound margins for an
additional sealant effect (Figure 14).
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C
A
Figure 13: (A) The first layer of the orbital closure aims to
approximate the remainders of the orbital septum as much
as possible. (B) The theory is that the tighter the orbital
septum is closed, the less skin sinking will be visible
postoperatively. This recommendation has however never
been proven. (C) The second suture layer must provide
orbital sealing to prevent postoperative haemorrhage. All
suture ends must be buried
B
Figure 14: The application of tissue glue (Vetbond)
provides additional wound support and together with
the subconjunctival layer avoids the need for unsightly
skin sutures
Figure 15: A satisfactory wound at the end of surgery
Figure 16: The patient shown in the above pictures just a few
hours after the operation, re-united with her owner
Following removal of the drapes, the surgeon
must remember to carefully wipe off all blood, which
may have stuck to the periocular hair, to prevent a
suboptimal postoperative appearance. It is far
easier to clean blood from the patients face under
anaesthesia than in the conscious patient
(Figure 15).
Most patients recover quickly from an enucleation
and can be discharged the same day (Figure 16).
Postoperatively, the use of systemic NSAIDs is usually
recommended for 57 days. The need for
postoperative antibiotic use is based on the
considerations described above. An Elizabethan collar
should be provided for the client, although its use is
rarely required following an enucleation. It should not
be forgotten to submit the globe for histopathological
examination to confirm the clinical diagnosis which
has justified removal of the globe and to ensure that
the condition which has led to loss of the eye will not
ultimately have implications for the fellow eye (as, for
example, in primary lens luxation) or with regards to
systemic conditions. n
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For more information or to book your course
www.bsava.com/cpd
Learn@Lunch
webinars
These regular monthly lunchtime (12 pm) webinars are
FREE to BSAVA Members just book your place through
the website in order to access the event. The topics will
be clinically relevant, and particularly aimed at those in
first opinion practice. There will be separate webinar
programmes for vets and for nurses.
This is a valuable MEMBER BENEFIT
Coming soon
23 April Advances in MCT (vets)
30 April Oxygen supplements (nurses)
14 May SAVSNET (vets)
Book online at
www.bsava.com/cpd
Stock photography: Dreamstime.com. Dmitry Naumov; Elena Schweitzer
F
o
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v
e
t
s

a
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v
e
t

n
u
r
s
e
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Companion
animal diabetes
mellitus management
in practice
A 21st century view
21 May
This course will include insulin types, how
to achieve diabetic remission, how to
prescribe a diabetic diet, the role of home
blood glucose monitoring, and more.
SPEAKERS
Stijn Niessen and Yaiza Forcada
VENUE
Hatfield Oak Hotel, Hatfield
FEES
BSAVA Member: 240.00 inc. VAT
Non-member: 360.00 inc. VAT
A
d
v
a
n
c
e
d

l
e
v
e
l
A practical
guide to getting
the most out of
in-house cytology
7 May
The course will provide practical tips on
setting up and using a microscope,
staining methods and advice on
sample collection techniques.
SPEAKER
Emma Dewhurst
VENUE
Woodrow House, Gloucester
FEES
BSAVA Member:
240.00 inc. VAT
Non-member:
360.00 inc. VAT
P
r
a
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t
i
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a
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Practical
haematology
Detective work for nurses
5 June
The aim of this interactive course is to
introduce nurses to microscopy and provide
the basis for identifying haematological
abnormalities using the facilities of the
practice lab. The use of microscopes will
allow a hands-on approach.
SPEAKER
Kostas Papasouliotis
VENUE
Woodrow House, Gloucester
FEES
BSAVA Member:
172.00 inc. VAT
Non-member:
257.50 inc. VAT
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26 CE Advert March.indd 26 19/02/2014 14:27
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27
W
idely accepted as one of the most friendly
and sociable opportunities for CPD, where
you can also guarantee the quality of
lectures, the Northern Ireland Companion
Animal Weekend for vets and nurses has once again
produced an outstanding programme that includes
Dan Brockman, Ian Self and Aiden McAlinden.
Lectures to inspire
The team who put the programme together hope that
by having two surgeon speakers and one
anaesthetist there will be a great balance in the
content and that delegates will leave with more
confidence and knowledge. Over the two days of the
congress there will be plenty of practical tips for the
practitioner, with an integrated approach to the
surgery patient, from diagnosis to prognosis and all
the important bits in between.
In addition there will be an advanced stream on the
Saturday, with lectures in both the surgical and
analgesic fields in addition to the general practitioner
talks. Lectures will include: Decision making in
gastrointestinal cases, Advanced local anaesthetic
techniques, Exploratory coeliotomy: tips and tricks
and Extrahepatic biliary surgery.
We are sure that these lectures delivered by
internationally recognized speakers will be entertaining
as well as educational and will include a significant
element of interaction and discussion while maintaining
a practical edge for those working in the real world.
Nursing programme
In conjunction with our friends from the BVNA, a
comprehensive programme is also in place for nurses,
led by Louise ODwyer. They too will be considering the
anaesthetic and surgical management of the
abdominal patient.
As if all of this wasnt enough, we will also be
holding an extensive trade exhibition within the hotel,
where you will have the chance to speak to a number of
local and national companies who will be showcasing
the latest products, innovations and services to assist
you with the day-to-day challenges you may face as a
busy vet or vet nurse.
Northern Ireland also knows how to put on superb
social events, giving you the chance to let your hair
down after a long day of lectures. Further details will be
available on the website.
So make sure you join us once again in the beautiful
city of Armagh for two days of high-quality CPD, an
extensive trade exhibition and sizzling social events.
The event takes place in the Armagh City Hotel, just an
hour from the two main airports and Belfast.
Prices will be confirmed very shortly, so keep an
eye out on www.vetni.co.uk where you can also find a
full programme and reservation details.
Ian Self
Dan Brockman
Aidan McAlinden
County Armagh is surrounded
by some of Northern Irelands
prettiest countryside
A weekend of abdominal
soft tissue surgery and
anaesthesia CPD awaits
delegates 2324 May 2014
with engaging speakers
and plenty of opportunities
to relax and socialize too
27 NI Congress.indd 27 19/02/2014 14:31
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Congress 36 APRIL 2014
Harnessing
GP power
R
ob Goggs is a British-trained veterinary
surgeon currently working at Cornell
University in New York State who will
deliver a lecture on immune-mediated
haemolytic anaemia (IMHA), the most common
immune-mediated disease seen in dogs on both
sides of the Atlantic.
In his lecture he will explain why major questions
about the aetiology, diagnosis and treatment of the
condition remain unanswered despite it having been
the focus of significant research efforts for many
years. The main reason is that published studies
have generally focussed on the relatively small
numbers of cases seen at universities and other
referral centres, while most IMHA patients are dealt
with in first opinion practices. Some way must be
found to make greater use of the experience of
general practitioners to better understand the causes
of the disease and to identify the better therapeutic
strategies, he says.
Power in numbers
Rob hopes his presentation will be a rallying call for
colleagues to work together in gathering the
information needed to defeat a condition that
causes physical distress to the animal, emotional
pain to its owner and professional frustration for
their veterinary advisors. I think it is one of the most
challenging conditions that we encounter in
practice. You can give the dog the best treatment
that you have to offer but patients can just slip away
before your eyes, he says.
Better treatments have meant that the survival
rate in IMHA has improved over the past few years
and those dogs that do respond to treatment will
usually go on to live a full and healthy life. However,
mortality remains high, at around 20 per cent. The
condition may occur in any breed but is particularly
common in some such as English Springer
Spaniels, Cocker Spaniels and Old English
Sheepdogs. Most cases occur in middle-aged
dogs and there appears to be a greater incidence
of the disease in females.
A key goal of any future collaboration between
academic and general practice clinicians must be to
develop and validate new diagnostic tests, as current
methods are often unsatisfactory, he suggests.
Signs of pallor due to the falling red blood cell
counts may not be obvious in the early stages of
disease, and initially the animal may receive
symptomatic treatment for the more easily recognized
but non-specific signs of lethargy, weakness and
occasional vomiting. Moreover, some cases where
agglutination is not present may not be readily
detectable without additional laboratory tests. There
are particular difficulties in diagnosing the non-
regenerative form of IMHA, as this would usually
involve a bone marrow biopsy and additional tests to
rule out various differential diagnoses.
Small animal practitioners
need to unlock the power of
numbers to solve the enigma
of immune-mediated haemolytic
anaemia, BSAVA Members will
be told at Congress
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Congress 36 APRIL 2014
Exploring treatments
In his presentation, Rob will explore the various
treatment options available for IMHA cases. While
there is consensus on the use of glucocorticoids to
down-regulate the dogs immune response, there is
controversy over the value of other immunosuppressive
drugs such as azathioprine, ciclosporin or
mycophenolate mofetil. Recruiting the large population
of dogs dealt with in first opinion practice will be
essential if we are to collect the number of cases
needed for meaningful comparative studies of these
various secondary agents, he notes.
Mortality in IMHA cases is often the result of
complications such as pulmonary thromboembolism.
A major focus of Robs own research is in developing
methods for improving the chances of detecting clots,
so that appropriate therapy can be instituted. He is
optimistic that computed tomography will become an
increasingly valuable tool for detecting and guiding the
treatment of PTE.
He will also touch on the potential of advances in
genetics to generate new insights into the causes and
treatment of IMHA. The first goal of genomics studies
will be to identify the haplotypes that account for the
greater frequency of disease in particular breeds.
Knowing which genes are involved may then shed light
on the underlying mechanisms of the disease.
A better understanding of the disease aetiology
may also be developed through investigations into a
rare condition in human patients, paroxysmal nocturnal
haemoglobulinuria or PNH, which shows some similar
features. Recently the human condition has been
treated effectively using a monoclonal antibody-based
therapy but that agent is hugely expensive and the
costs involved in producing a canine equivalent may
prove prohibitive.
Is this something we can think about in the
veterinary community? Rob asks. It would be a tall
order but if, as a profession, we dont show any
ambition when tackling a problem like this, we will only
chip away at the edges; we wont make any real
progress. I think it is essential we set ourselves
challenging targets; we have got to think big. n
ROB AT CONGRESS
Sunday 6 April16151700
n Medicine on a Budget: Suspected IMHA
28-29 Congress Science Goggs.indd 29 19/02/2014 14:49
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Congress 36 APRIL 2014
Radiotherapy
for brain tumours
R
adiotherapy is becoming both
more widely available and
increasingly effective, yet
clinicians and even knowledgeable
pet owners will know that any aggressive
treatment for brain tumour patients carries
risks. A decade or more ago it was feared
that damage could be caused to healthy
brain tissue which might change the
animals personality, and that would
undermine the close relationship between
the pet and its owner.
Back then there were not diagnostic
techniques available to identify a tumour
sufficiently early to do much about it,
and indeed the majority of tumours were
likely to have been confirmed only on
postmortem examination. However, there
are now methods to localize and
characterize the lesion and treatments
can be affected that can restore the
pets quality of life and significantly
extend its duration.
Of course, some owners may feel it is
unreasonable to put an elderly animal
through the rigours of oncological
treatment that is a perfectly acceptable
decision for them to make. There are no
fixed rules, the owner has to make the right
choice for their pet in that particular
situation, Professor Michael Kent says,
ahead of his lectures at BSAVA Congress.
GPs and owners
While only a small minority of veterinary
surgeons will have the clinical expertise to
provide those treatments, general
practitioners can make considerable
progress towards reaching a definitive
diagnosis. They will be able to carry out
the investigations needed to rule out
non-cranial causes, such as liver or kidney
disease, that may also explain the typical
clinical signs of a brain tumour notably
changes in mental function, behaviour and
movement. They will also be able to
conduct part of the diagnostic work-up for
confirmed neurological disease; increasing
numbers of practices now have both
access to advanced imaging technology
and the skills to interpret the results.
A combination of magnetic resonance
imaging and computed tomography will
not only identify the presence of a tumour
and indicate its size and position, it can
also give hints as to the cell type involved
(the clinician is unlikely to risk attempting a
biopsy). This in turn may give some
indication of the density of tissue an
essential consideration in planning a
course of radiotherapy.
Treatment and results
Professor Kent says results will obviously
vary according to individual circumstance
but in cases involving canine pituitary
tumours the owner can often expect their
dog to live for up to three years. In
meningioma cases, it is commonplace to
have extensions in life expectancy of
between one and three years, and even in
cases involving more aggressive gliomas,
the patient will often live for another year
following radiotherapy.
Whatever treatment is chosen for that
particular tumour, the pet will probably
receive medical treatment before surgery
or radiotherapy is attempted. Most dogs
or cats with brain tumours will also
have cranial oedema, and steroids will be
given to try and reduce swelling around
the lesion.
Professor Kents group is working on
Professor Kent of the
University of California,
Davis will enlighten
Congress delegates
MICHAEL AT CONGRESS
Thursday 3 April
Brain Tumours
Radiotherapy of brain
tumours: not for my
dog?
Friday 4 April
Nursing Oncology
Update on feline injecton site sarcoma
Saturday 5 April
Small Group Session
The incomplete margin
Sunday 6 April
Top Tips for Treatng Cancer
Getng a diagnosis
Using chemotherapy safely
Referring for radiotherapy
developing two refinements of standard
radiotherapy. The first, definitive
fractionated radiotherapy, involves a series
of perhaps twenty procedures using
relatively low doses of radiation as a means
of sparing the surrounding healthy tissue.
The second method, stereotactic
radiosurgery, takes the opposite approach,
in delivering a highly focussed blast of
intense radiation.
His group has been pioneering the use
of this method since 2009 and has so far
been employed in treating 175 canine and
feline cases. The equipment has got a lot
better and we can deliver the beam with an
accuracy of about one tenth of a millimetre
in any direction. We have been working
with the equipment to position the patients
and to control pitch and roll so
that the dose is targeted very precisely,
Professor Kent explains.
Clients need to know that there are
many different options now for treating this
sort of disease and these can produce
very good results without the need for
highly invasive procedures.
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T
he Big Issues stream will run in Hall 7 all day
on Friday 4 April. The morning will include
sessions from Professor Sarah Cleaveland and
Luke Gamble on rabies control in Africa and
Asia, while the afternoon will look at issues closer to
home with talks on the legislative and welfare
implications of illegal imports, as well as the plans for
the introduction of compulsory microchipping of dogs
in England and Wales. The session will end with the
opportunity for delegates to come and pose questions
to the Chief Veterinary Officers from England, Wales,
Scotland and Northern Ireland relating to current and
proposed legislation.
A changing world
The environment in which we all work is changing
says Dr Sally Everitt, who will be chairing all the Big
Issues talks. We are affected not only by legislation
from Europe but increasingly also dealing with animals
which travel to and from Europe, carrying with them
this risk of disease. There is also an increasing amount
of legislation relating to both veterinary practice and
owning companion animals. We have updated Pet
Travel Regulations coming into force in December
2014, and compulsory microchipping being discussed
and introduced, at different times, in each of the
countries of the United Kingdom.
BSAVA Congress will confront
some of the biggest issues
facing the veterinary
profession this April, with
talks from those in the know
about rabies, pet travel,
microchipping, veterinary
medicines and exotic pets
including the chance to pitch
questions to four of the UKs
Chief Veterinary Officers
As BSAVAs Head of Scientific Policy, Dr Everitt
makes it her business to stay informed on all legislative
changes. Having been a vet in general practice for
many years she understands the impact these can
have on vets and veterinary nurses, and there is plenty
on the horizon for discussion at Congress.
In the pipeline there are also new European
Animal Health Regulations which will include
provisions relating to companion animals and their
owners. We are also awaiting a major update to the
Veterinary Medicines Directive which has at times
been rumoured to include regulations relating to
decoupling of the veterinary surgeons right to
prescribe and dispense antimicrobials in an effort to
promote more responsible use of these products.
People in the know
Although there is no specific legislation at EU level
concerned with companion animals, the EU is
concerned about the welfare of dogs and cats in a
commercial environment and is embarking on a study to
establish whether an EU-wide legal framework is
necessary. This study, which is intended to report at the
end of 2014, will cover three major areas: existing legal
framework and the experiences of Member States;
current welfare of dogs and cats in commercial breeding
environments; and perspectives for improvement.
Alongside this there is much discussion about
whether it is appropriate to keep many exotic species
as pets, with some countries already introducing or
proposing positive and negative lists adds Dr Everitt.
This will have significant implications for both pet
keepers and the veterinary profession. In the light of all
this we are delighted to have Deborah Wells and Andy
Patnelli from Defra as well as animal health inspector
Sharon Edwards and RSPCA Senior Parliamentary
Adviser Joe Moran coming to share their knowledge
and experiences with us.
The Association is also delighted to be able to
introduce Alick Simmons (Deputy CVO England),
Christianne Glossop (CVO Wales), Sheil Voas (CVO
Scotland) and Robert Huey (CVO Northern Ireland).
Delegates interested in these Big Issues are
encouraged to attend these talks to take the
opportunity to ask questions and hear what the CVOs
have to say.
Congress confronts
big issues
Dr Sally Everitt
Professor Sarah
Cleaveland
Luke Gamble
30-31 Congress Science Big Issues.indd 31 19/02/2014 14:52
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A
fter five years of vet school and
plunging straight into a full-time
job in Bristol, I started dreaming
of a big trip with Kate (my other
half). With our friends buying houses,
getting married, and becoming practice
partners I worried if this was the right thing
to do. On the other hand, this was the time
to do it for us. So we moved to London to
lodge with Kates parents and locum full
time to save up. On the Monday after my
five-year reunion with vet school chums we
headed off to South Africa, India, Thailand,
Cambodia, Vietnam, Laos, Malaysia,
Singapore, Australia, New Zealand and Fiji.
South Africa
With our lives crammed into a 20 kg
suitcase we were off to South Africa. This is
a country that is constantly changing and it
reminds me of my own country, Northern
Ireland. Regeneration is ongoing and all
the people we met, whatever race or
religion, were so warm and welcoming. Our
gem of a find was a hippy commune in the
Craggs. We arrived not knowing what to
expect but it was a haven in the middle of a
forest. It also had its own pack of baboons
that raided the site every morning.
India
After the easy introduction of South Africa
next stop India. For the first three weeks
we toured Rajasthan and we flew over to
Varanassi to see the Ganges at dawn. We
then headed to Mumbai for a couple of
days and jumped on a train overnight
down to Goa a more chilled affair after
the hustle of northern India. We then
headed further south to meet friends in
Kerala. We started in Kovalam, where we
actually met someone else that we were
not expecting. On a hot sweaty day
carrying our laundry up a rather steep hill,
I heard a familiar voice of Emily Caddick,
a friend of mine from Bristol University.
I had no idea she was there and this
proves it is a very small world indeed.
India was a bit of a culture shock. We
struggled with a male-dominated society,
and found it hard to come to terms
with the lack of animal welfare.
Bangkok
We arrived in Bangkok for a week, seeing
the temples, palaces and some crazy
driving. We decided to head north to
Chiang Mai, where we took a cooking class
and visited the elephant nature park set up
by an amazing Thai lady. These elephants
had been rescued from various situations
and rehabilitated. They are not worked and
allowed to roam the massive reserve. The
park educates people about the plight of
the Asian elephant and I only wish we had
been more organized and volunteered
there as vets. If you are interested please
visit www.elephantnaturepark.org for
more information.
On the animal front we had sworn not
to work during our travels, but having
already seen the poor welfare standards in
India, we picked a small unknown animal
charity outside Chiang Mai called Care for
Dogs. There we worked with an amazing
young vet called Pamela Bayer. She works
so hard to try and give the dogs the best
care possible with their limited budget.
Kate and I ran a neuter clinic for the week.
I would encourage anyone who can help to
contact them www.carefordogs.org. We
stayed in the local village at a home stay
and the volunteer team helped us with the
language barrier and even after just
1 week we felt like one of the family.
Spend your days
fantasizing about sunnier
climes, or taking that
year off you keep
promising yourself?
Andy Fullerton made the
dream a reality and
came back refreshed to
a profession he loves.
This might just inspire
you to pack your bags
The trip
of a
lifetime
32-33 Fullerton Travel.indd 32 19/02/2014 14:58
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Cambodia and Vietnam
Cambodia was not our favourite country
the killing fields in Phnom Penh upset me
terribly but Angkor Wat was breathtaking
at sunrise. The country is currently
recovering and at the same time struggling
with corruption and poverty. After
Christmas on the beach in Siannoukville
we headed to Vietnam. My parents came
out to meet us, which was superb. Vietnam
was our favourite country in Asia, with an
intriguing and turbulent past but with such
friendly people and exceptional cuisine.
Back to Thailand, then Malaysia
After a long train journey and very bumpy
boat trip we landed on Koh Tao. We signed
up for our open water diving course and
discovered an addictive hobby. We then
island hopped all the way down the west
coast, meeting another amazing charity
called Koh Lanta Animal Welfare, and
headed into Malaysia. We only had a short
time in Malaysia but our highlight was
Penang, with such beautiful architecture,
history and food.
Singapore and Austrailia
From Malaysia we headed to Singapore,
where I realized a whole district and
historic hotel is named after me
(The Fullerton Hotel). The porter didnt
appreciate me asking for a free room while
flashing my passport at him! Then it was
time to move on from noodles and cheap
beer and head to Australia, where we had
a blast. We headed up to the stunning
Fraser Island before driving our
campervan all the way to Sydney. We
stayed with my best friend from university,
Jennie Blenkinsop. She works for Pfizer
out there and kindly put us up for two
weeks. We met up with more Oz-based
friends from vet school, enjoying cocktails,
art and culture.
New Zealand and Fiji
We spent three weeks touring New
Zealands South and North Islands.
Highlights included Lake Tekapo,
Queenstown, a helicopter ride up the Franz
Josef glacier, a sky dive in Abel Tasman
and many hot baths coupled with the
sulphuric smells of Rotorua! Fiji was a
stunning place to finish our travels. We
spent two weeks island hopping on the
Yasawa group of islands. We racked up a
fair few dives as well as snorkelling with
Manta Rays. The beaches were pristine
and the water crystal clear.
Homeward bound
After nine amazing months we were
eventually tired of living out of a suitcase
and wearing the same clothes. There was
no worry with finding work back in London.
After only one day of rest, I was back
working for Zasman Vet as a locum,
covering maternity leave.
By travelling, my hope was to have
time to think about where to go with my
career and learn more about myself. Kate,
a seasoned traveller, said to me, Dont
expect any sort of epiphany... it just never
comes!. Yet I think traveling does make
you realize how your life can just zip by in
the whirlwind of work. It gives you time to
think about what is important to you.
I realized how much I missed the
veterinary work challenging my mind on a
daily basis. However I didnt miss the
stress that is associated with our job in
general practice. I wanted to manage
stress better when I came back, but Im
not sure I have mastered that yet. We
need to keep an eye on how stressed
people become in this profession.
Going back to work has been more
difficult than I thought in some ways I had
forgotten so much! I felt like a new
graduate again. It didnt take long to catch
up, but this reinforces the need for us to
keep up with our CPD. BSAVA Congress
here I come!
Kate and I would like to travel again but
probably for shorter periods and in one
country at a time. Kate is considering
going into lab work or research rather than
nursing, and I am considering the option of
an imaging residency.
ANDYS TIPS
If you do go on a trip, try and keep your
optons open rather than follow a set
itnerary. Have a budget but dont scrimp.
We met a lot of people travelling on a
tght budget but they never did anything
fun. I would rather have a shorter, more
adventurous trip than a longer one countng
the pennies. Also, you are never too old to go
back-packing. We met a lot of people older
than us doing the same thing. So dont hold
back, if you are in a positon to take some
tme o and travel, just do it.
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Celebratng 40 YEARS of improving the health of pets
PetSavers 40th anniversary
fundraising campaign
To celebrate its 40th anniversary PetSavers
has launched the 200 Project and is
appealing to the veterinary community to
help mark this milestone in style
The things PetSavers
people do
PetSavers people have run, climbed, sailed,
walked, baked and skied to raise money in recent
years. Each and every one is owed a huge thank
you without these efforts the veterinary
profession would be less well informed and
animal welfare would suffer. What could you and
your practice do this year to get involved in the
200 Project? n
FUNDRAISING EVENTS 2014
n The Bath Half Marathon 2 March
n The Virgin London Marathon 13 April
n Rat Race Dirty Weekend at Burghley 10 May
n The Britsh London 10k 13 July
n The Wiltshire 100 Bike Ride 7 September
P
etSavers is launching a fundraising campaign
to coincide with its 40th anniversary and is
asking the small animal practices within the
UK to pledge to raise 200 throughout 2014.
Pedro Martn Bartolom, PetSavers Chairman,
said: The 200 Project is PetSavers first major
fundraising campaign. It will be one of our biggest
challenges yet but I am confident that with the
enthusiasm, commitment and support of our
colleagues in practice we can succeed.
By joining our 200 Project we are asking
practices to pledge to raise 200 by whatever
Be a PetSavers Practice
means they can. It can be through taking part in an
external fundraising event like local fun-runs,
organising your own fundraiser in practice, or
simply placing an individual donation. If every
small animal practice can raise at least 200 we
will be able to continue to fund clinical research
projects into small animal diseases.
To sign up to the 200 Project, practices are
asked to contact 01452 726723 or email info@
petsavers.org.uk. After registering, a fundraising
pack will be sent out which contains plenty of tips
and ideas on how practices can get involved and
also how to promote and get publicity for your event.
All those practices that participate will be featured in
an online honour wall and receive a certificate
celebrating their fundraising achievement. n
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PetSavers people
in pictures
34-35 PetSavers.indd 35 19/02/2014 15:03
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V
eterinary surgeons in the UK
launched the original impetus to
organize a specialist group for
small animal veterinary care an
initiative which led first to the creation of
the BSAVA and, later, to the WSAVA. In
1956, at a meeting of the World Veterinary
Association, the decision was taken to
grant affiliation to specialist associations
to encourage closer contact between
colleagues working in the same field. A
group of British veterinary surgeons then
decided to form a specialist group in the
UK, similar to the American Animal
Hospital Association (AAHA) which had
been established for some time. They
believed that once a UK association had
been established, other European
countries would follow and the creation of
an international association would then be
possible. The BSAVA held its inaugural
meeting in March 1957.
Weve come
a long way
A recent addition to the
WSAVA website is a
brief history of the
organization and its key
achievements
KEY MILESTONES IN WSAVA HISTORY
1961 The rst World Congress held is in
London, UK
1980 The rst collaboraton joint report
from the WSAVA and World Health
Organizaton
1984 The rst two WSAVA Internatonal
Awards are introduced
World Congresses become annual
events
1992 The WSAVA Contnuing Educaton
(CE) Commitee is formed
1993 The rst WSAVA CE Conference is
held in Prague
2000 The rst of the WSAVAs
Standardizaton Projects is launched
2006 First WSAVA textbook is launched,
produced by the WSAVA Liver
Standardizaton Group
The Vaccinaton Guidelines Group is
formed with support from MSD
The Scientc Advisory Commitee
(SAC) is formed
The Animal Welfare and Wellness
Commitee is re-launched
2008 Hills Pet Nutriton forms a
partnership with WSAVA, becoming
its major sponsor
2009 The WSAVA 50th Anniversary
celebraton is held in So Paulo, Brazil
2010 The One Health Commitee, Global
Pain Council and Global Nutriton
Commitee are formed
2011 A Memorandum of Understanding is
signed between WSAVA and OIE to
promote increased collaboraton in
One Health
The WSAVA Foundaton, the WSAVAs
charitable trust, is created
2012 A Permanent Congress Organizer is
appointed to organize World
Congresses
2013 The rst veterinary nursing
associaton (New Zealand Veterinary
Nursing Associaton) joins the WSAVA
At a meeting in Madrid, Spain, in 1959,
representatives from Denmark, Holland,
Italy, Germany, Mexico, Norway, Portugal,
the UK and the USA created an
organization called the International
Association of Small Animal Specialists
(IASAS). It had an Executive Committee
and a set of Statutes. Its first meeting was
sponsored by the BSAVA and took place in
London in 1961. One of its first decisions
was to rename itself the World Small
Animal Veterinary Association.
Initial progress was slow but, with
each World Congress, more associations
joined, attendance increased, and the
committees became more effective. The
Journal of Small Animal Practice, which
had become the WSAVAs official
publication, helped to share information
between countries.
By the end of 1977, associations in
18 countries had joined. As time went on,
more and more organizations became
involved and, as sponsors also came
onboard, the work of the WSAVA became
more diverse and more far-reaching.
A further boost to its momentum came
with the fall of the Iron Curtain in Europe in
1989. This sparked the formation of
further national small animal associations
and specialist groups which, in turn,
joined the WSAVA.
Today, the WSAVA has 93 member
associations, representing 158,000
veterinarians globally. Further information is
available from www.wsava.org. n
36-37 WSAVA.indd 36 19/02/2014 15:10

D
r Janne Orro-Taruste, President of the
Estonian Small Animal Veterinary Association
(ESAVA), explains that the country has been
free of urban rabies since 1959 but that
sylvatic rabies has been endemic in the country for
many decades, with the main reservoirs being red
foxes and raccoon dogs.
Estonia is declared rabies-free
Following an extensive,
seven-year wildlife vaccination
programme, Estonia has been
declared free of rabies by
the OIE
Dr Janne Orro-Taruste
ASAVA joins WSAVA CE
sponsor a country programme
I
n its 40th anniversary year, the Australian Small
Animal Veterinary Association (ASAVA) has joined
the WSAVAs Sponsor a Country programme,
offering sponsorship to enable the CE Committee to
develop a coordinated five-year programme to meet
the needs of companion animal veterinarians in
Vietnam. CE Committee Chairman Jill Maddison, a
past president of ASAVA, is developing the
programme in collaboration with the Vietnamese Small
Animal Veterinary Association (VSAVA). The
programme will begin this year and will focus on
developing and enhancing the core clinical skills of
Vietnamese veterinarians.
Debbie Osborne, a past president of ASAVA and
Debbie Osborne
She says: The compulsory vaccination of dogs
and cats and vaccination of livestock in outbreak sites
was effective in controlling rabies but not in eradicating
it. As eradication was our goal, we began an oral
rabies wildlife vaccination campaign and, between
20062010, 1.72 million vaccine baits were dropped
from small planes across Estonia twice a year (apart
from in water fields, urban areas and on roads). During
this period sylvatic rabies cases dropped from 266 in
2005 to zero in 2010.
Since 2011 we have restricted the oral rabies
vaccination campaign to a 2050 km buffer zone
bordering neighbouring countries where rabies is still
present. We plan to continue this programme. Were
delighted that there have been no cases of rabies in
Estonia since 2011 in wildlife, pet animals or livestock
and, as a result, the World Organisation for Animal
Health (OIE) has declared us to be rabies-free. We
would be delighted to share our experiences with other
member associations considering this approach. n
current member of the WSAVA Financial Advisory
Committee, comments: Were delighted to offer this
support to Vietnam and will also be looking at other
ways in which we can grow the relationship between
ASAVA and VSAVA in the years ahead.
Jill Maddison adds: Were delighted that ASAVA
has joined several other members in stepping up to
support countries where companion animal practice is
developing. Its particularly helpful that we have a
long-term commitment of funds because it enables us
to plan the CE programme for VSAVA and to select
speakers from around the world, based on their
expertise and their ability as educators for veterinarians
in emerging companion animal markets. n
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Colonel
Neil
Smith
QHVS
Colonel Neil Smith is President of the Royal College of
Veterinary Surgeons. After graduating from the RVC in
1989 he was commissioned into the Royal Army
Veterinary Corps (RAVC). He is now the Director of the
Army Veterinary and Remount Services, Head of the
RAVC, which currently has around 400 personnel
including 35 regular and a dozen reservist veterinary
officers, and holds the appointment of Queens
Honorary Veterinary Surgeon (QHVS). He has held a
mixture of clinical, staff and command positions and
has worked in a number of countries including many
parts of the UK, US and Germany, with short
assignments in many others. This involved small
animal and equine work, as well as research and farm
animal capacity building. Neil has also worked in
private and charity practice, including for the Blue
Cross for which he is now a trustee. He was heavily
involved in the response to foot-and-mouth disease in
2001, working in Cumbria and the Joint Co-ordination
Centre in London. He was a member of RCVS Council
from 2004 to 2008, and rejoined in 2010.
Q
Why did you choose a veterinary
career?
A
It is something that I wanted to do
from a very young age although
I did change my mind in my early
teens after reading James Herriot!
However, I got very involved with horses
where I grew up in West Yorkshire and after
doing my O-Levels I decided I wanted to
become a vet. Unfortunately, I forgot to
work hard enough for my A-Levels the first
time, but managed to get the right grades
the next time.
Why did you decide to join the RAVC?
I became interested in joining the RAVC
before I went to university after visiting the
RAVC Centre in Melton Mowbray whilst a
sixth-former. In my second year at
university I decided to apply to join the
Army after graduation, and although
I didnt intend to do more than 4 years I am
still here nearly 25 years on.
What are the benefits of being a vet in
the Army?
When I first joined the Army I was given
a lot of responsibility, clinical freedom
and a reasonable amount of variety.
As well as caring for the military dogs
and horses, I also ran a clinic for
servicemens pets, so it was a
combination of military veterinary work
while essentially running a small animal
practice at the same time. I also led and
managed soldiers, dealing with career,
welfare and disciplinary issues.
The Army has given me a range of
opportunities in both career
development and travel. As well as
working in a wide range of roles, it has
allowed me to do three Masters degrees:
an MSc in Food Science, an MBA and
an MA in Defence Studies. But no two
officers have identical careers!
Is joining the Army a career opportunity
you would encourage veterinary
students to take?
It is a great opportunity as far as gaining
management experience at an early
stage in your veterinary career is
the companion interview
38-39 Interview.indd 38 19/02/2014 15:13
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concerned, but isnt necessarily suitable
for those vets who want to pursue clinical
specialism, as the work tends to be more
general. However, many vets are very
successful in their careers having done
48 years in the Army. We also have
increasing opportunities for vets who are
interested in being reservists.
What has been the highlight of your
veterinary career in the Army?
There have been lots of highlights and
challenges. Helping to ensure we have
highly skilled and effective military dog
teams is very rewarding, as well as leading
and managing soldiers. However, helping
with the reconstruction of Bosnia following
the terrible civil war was both a high and a
low point. I went to Bosnia in time for
Christmas 1996, and the devastation was
shocking. My main memory is of travelling
around the country, often with an
interpreter, finding the remaining local vets.
Before the war there was a state
veterinary system but that had collapsed.
Part of our role was capacity building,
aiding the surviving veterinary surgeons
to recreate a veterinary service. In much
of the country agriculture was a key part
of the economy, so it was vital to
re-establish veterinary services, including
veterinary public health, for those people
who relied on their animals for their
livelihood. There was also a significant
feral animal problem in some areas, so
we instigated a capture, neuter, rabies
vaccination and release programme.
How and why did you choose to become
involved with the RCVS?
I have always been a joiner I was heavily
involved whilst at the RVC with its Students
Union Society and the University of London
Union. But its not about being political,
but more because I like getting involved.
In terms of the RCVS, my experiences
during the foot-and-mouth outbreak in
2001 highlighted the need for strong
veterinary leadership and a clear
veterinary voice. I also felt that I might
know enough vets to have a chance of
getting elected. I didnt get elected the
first time I first stood for Council in 2003,
but was successful in 2004.
What have been the challenges of being
a member of RCVS Council?
When I first became a member I found it
took time to understand how things
actually worked at the College. Every
department was its own oasis of activity
and expertise but it was difficult to point
to something and say that is what the
Royal College of Veterinary Surgeons
does. But many things have changed,
and Im sure new Council members learn
much faster than I did!
One of the challenges for the College
as a whole is communicating to the
profession and the public what the College
is and does. We are a Royal College that
regulates, but when standing for election to
Council I have found that issues that
potential voters were raising were actually
more appropriate for the BVA rather than
the RCVS. We also have to endure a small
minority of the profession who believe their
role is continually to find fault. I am pleased
to say we have a very positive relationship
with the major representative bodies,
including the BSAVA, who are
very constructive in their comments
and suggestions.
Setting, upholding and advancing
veterinary standards isnt easy, but I think
we are definitely moving in the right
direction. The proposed changes to the
Royal Charter and revising the Practice
Standards Scheme are two initiatives which
fit within these aims.
What are you particularly proud to have
achieved as President of the RCVS?
For me, launching the Queens Medal in
the House of Lords was a particular
highlight. But the best thing about being
President is admitting veterinary surgeons
and veterinary nurses into the College
it is people not
organizations that
make a difference
it is a huge privilege to meet people who
have just started their careers and to tell
them about the College and what it does.
I have also really enjoyed the Veterinary
Defence Societys recent graduate
seminars; they give a fantastic opportunity
to dispel some of the negative myths about
the RCVS and help give young vets
confidence in their professional lives.
Do you think quality of life for
veterinary surgeons has changed in the
past decade?
The veterinary profession unfortunately has
a reputation for working too hard, for too
many hours. I dont think it has changed
much for farm animal and equine
practices, but there has been a shift for
many small animal practitioners because
many practices now use dedicated OOH
providers and therefore work shorter and
more sociable hours. However, this is
probably also a factor in the apparent
reduction in assistants salaries.
Who are your professional heroes?
I think there have been a large number of
very impressive veterinary surgeons
some because they were excellent and
inspiring teachers, such as Leslie
Vaughan. But being a military man, I have
to pick a couple of Army Officers who
were also veterinary surgeons. The first is
Lieutenant-General Sir Frederick
Fitzwygram, who was President of the
RCVS for several years in the 1870s, a
cavalry officer and prolific veterinary
author, especially on equine matters.
My second choice would be Major-
General Sir Frederick Smith who, as a
young officer, fought in the Boer War and
then wrote a history of the war as well as
the history of the RAVC, the history of
veterinary literature and a textbook on
glanders. Copies of all his work are held in
the RCVS Knowledge Library.
What is the most important lesson life
has taught you?
Despite working in large and established
bureaucracies, I have come to realise that
it is people not organizations that make
a difference.
38-39 Interview.indd 39 19/02/2014 15:13
For more information or to order
www.bsava.com/publications
BSAVA reserves the right to alter prices where necessary without prior notice.
BSAVA Publications
COMMUNICATING VETERINARY KNOWLEDGE
GO WILD!
BSAVA Manual of
Wildlife Casualties
Edited by Elizabeth Mullineaux,
Dick Best and John Cooper
BSAVA Manual of
Exotic Pet and
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Edited by Molly Varga,
Rachel Lumbis and Lucy Gott
Wildlife casualties provide the veterinary surgeon with a wide range of
problems. Success depends not only upon the clinical skills of the
practitioner, but also encompasses nursing staff and those involved in the
rehabilitation and release of the casualty. Knowledge of the natural history
of the species directs the choice of suitable handling facilities and
accommodation that are essential to the successful outcome. This Manual
will be of special interest to veterinary surgeons, veterinary nurses and
those dedicated to the care and rehabilitation of wildlife.
The number of exotic and wildlife cases presented at the veterinary
practice has increased significantly, with greater expectations regarding
level of care. This Manual provides veterinary nurses with a greater
understanding of the nursing requirements of these less familiar species,
enabling them to modify and apply their skills to these cases. Written by
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Manual is designed to be practical and user-friendly, enabling the easy and
direct application of theory to practice.
...a must-have text for any practice seeing first-opinion exotic cases, along
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40 Publications Advert March.indd 40 19/02/2014 15:14
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41
Local
News from BSAVA Regions
knowledge
Holiday bugs
With the easing of the legislation involving animals travelling
to Europe under the pet passport scheme, more and more
clients are opting to take their pets on holiday rather than
leaving them behind. Are you giving your clients the most
up-to-date advice prior to their departure? Are you aware of
the potential problems to which pets are susceptible while
abroad? Would you recognize an unusual or exotic condition
in an animal that has travelled into Europe? Would you know
how to diagnose and treat these problems if they presented
at your surgery?
BSAVA West Midland region has organized this evening.
This CPD lecture by Maggie Fisher has been put together to
give you an overview of the current issues and problems you
may encounter, plus advice and guidance on the best
management of animals presenting with a holiday bug. The
evening will be held in Wolverhampton. For more information
or to book a place visit www.bsava.com.
Hairless hounds and mangy mutts
Imagine the scene Friday evening surgery before your weekend off.
The last appointment is waiting and its just a dog booster. Except it isnt.
Its got awful itchy skin. Your heart sinks when you see that early finish
disappearing but the owner thinks you can probably give them
something for the skin while doing the booster. Your heart sinks further
when you realize its on good regular antiparasitic treatment which they
get from you, and havent missed a month for over a year. And scrolling
through the notes, your old ticker bottoms out when you notice someone
has already drawn a blank with the allergy testing and the food trial.
Of course, youre not going to sort its problems by the time the
surgery shuts. In fact, not even by the time the pub shuts, but what
you need is some ideas, some differentials. What can you remember
about all those other skin diseases that they talked about at college?
Come along to this evening meeting on 20 March to be
inspired by our speaker Natalie Barnard at Bridgwater Canalside
Centre just a few minutes from Junction 24 of the M5. The
meeting starts at 7.30pm. Pre-book at www.bsava.com or contact
southwest.region@bsava.com for further information.
Poisons: what they do to
pets and what to do
about them
Join BSAVA North East Region for this day meeting on
Sunday, 23 March with Alexander Campbell from the
National Poisons Information Service (Birmingham Unit)
and RVN Jackie Bell.
Alex will speak on the history of vet toxicology and
on calculations. He will also give an overview of
common poisonings including some common drug
poisonings (paracetamol, NSAIDs, vitamin D
analogues), human foods that are toxic to animals
(Vitis vinifera, chocolate, xylitol, mycotoxins), pesticides
(metaldehyde, rodenticides), plants and chemicals
(ethylene glycol). Hell then introduce whats new in
treatments (lipid rescue).
Jackie will speak on getting the best case history,
decontamination and supportive care in poisons cases,
the poisoned exotic pet, and educating your clients
about poisoning prevention.
This meeting will be held at the Gomersal Park Hotel,
Moor Lane, Bradford. Registration starts at 9.30am and
lectures finish at 5.00pm. For more information and to
book your place visit www.bsava.com.
Veterinary evidence: how do I
nd it and is it any good?
The title of the upcoming PetSavers-linked meeting in the South
West, on Wednesday 18 June, may sound like a topic to
inadvertently induce a narcoleptic state, but actually promises to be
an enlightening evening of discovery into how to perform a credible
literature search.
Dr Rachel Dean (the co-founder of the Centre of Evidence-
Based Medicine at Nottingham University) will help us to access
the best evidence-based medicine for our patients by providing us
with the skills required to navigate search engines efficiently. Once
we have the elusive evidence, Dr Dean will then show us how to
interpret it and decipher the good from the dubious. This skill is a
basic requirement for the plethora of certificate courses out there,
but is also a lifesaver for those tricky cases that time-limited general
practitioners are faced with.
A PetSavers representative will explain their mission to raise
funds for clinical research into illnesses and conditions affecting
pets, without the use of experimental animals. PetSavers provides
grants for scientific and ethical research in the field of veterinary
medicine (either in general or referral practice).
This promises to be a cosy affair at the RSPCA Dogs and Cats
Home, Bristol. Places are limited to 20, so book early. Sponsored by
CABI who introduced the VetMed Resource to BSAVA Members.
41 Regions.indd 41 19/02/2014 15:17
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CPD diary
LUNCHTIME WEBINAR
Wednesday 19 March
13:0014:00
Acute airway investigation
Speaker: Mickey Tivers
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 26 March
13:0014:00
ECGs
Speaker: Pedro Oliverio
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 23 April
13:0014:00
Advances in MCT
Speaker: Susan North
Online
Details from administration@bsava.com
EVENING MEETING
WEST MIDLANDS REGION
Thursday 20 March
From the trenches: top tips to
deal with emergencies efficiently
Speaker: Aofie OSullivan
Three Pears Beefeater Grill, Worcester
Details from westmidlands.region@bsava.com
EVENING MEETING
WEST MIDLANDS REGION
Tuesday 25 March
Radiographic appraisal for nurses
Speaker: Paul Mahoney
Willows Veterinary Centre and Referral
Service, Solihull
Details from westmidlands.region@bsava.com
EVENING MEETING
CYMRU/WALES REGION
Wednesday 26 March
Diagnostic imaging of the
vomiting dog
Speaker: Thomas Maddox
Coleg Cambria Llysfasi
Details from cymru.wales.region@bsava.com
EVENING MEETING
METROPOLITAN REGION
Tuesday 11 March
Top Ten Tips: getting the most out
of haematology at the reference
lab as well as your clinic
Speakers: Graham Bilbrough and
Susan Randell
Riverside House, Berkshire
Details from metropolitan.region@bsava.com
DAY MEETING
NORTHERN IRELAND REGION
Sunday 2 March
How to survive the neurological
consultation
Speaker: Laurent Garosi
Dunadry Hotel, Co. Antrim
Details from nireland.region@bsava.com
EVENING MEETING
CYMRU/WALES REGION
Monday 3 March
Diabetes mellitus: a team
approach
Speaker: Grant Petrie
Welshpool Livestock Market, Powys
Details from Cymru.wales.region@bsava.com
DAY MEETING
Thursday 6 March
Advances in management of
parasitic skin disease
Speaker: Patrick Bordeau
Hilton, Stansted Airport
Details from administration@bsava.com
DAY MEETING
SOUTH WEST REGION
Friday 7 March
Survival guide to neurology in
practice
Speaker: Laurent Garosi
The Gables Hotel, Falfield
Details from southwest.region@bsava.com
DAY MEETING
SOUTHERN REGION
Sunday 9 March
Geriatric cat
Speaker: Martha Cannon
Apollo Hotel, Basingstoke
Details from southern.region@bsava.com
DAY MEETING
Tuesday 4 March
Wound management and infection
control for nurses
Speaker: Louise ODwyer
Woodrow House, Gloucester
Details from administration@bsava.com
DAY MEETING
Thursday 20 March
BSAVA dispensing course
Speakers: Fred Nind, Phil Sketchley,
Sally Everitt, Mike Jessop, Pam Mosedale,
John Millward and Mike Stanford
Aldwark Manor, York
Details from administration@bsava.com
EVENING MEETING
NORTH EAST REGION
Sunday 23 March
Poisons: what they do to pets and
what to do about them
Speakers: Alex Campbell and Jackie Belle
Gomersal Park Hotel, Bradford
Details from northeast.region@bsava.com
EVENING MEETING
SOUTH WEST REGION
Thursday 20 March
Hairless hounds and mangy mutts
Speaker: Natalie Barnard
Bridgewater Canalside Centre, Somerset
Details from southwest.region@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Tuesday 18 March
The PUB Clinical Club
Speaker: TBC
The Royal Oak, Ockbrook
Details from eastmidlands.region@bsava.com
EVENING MEETING
EAST ANGLIA REGION
Wednesday 19 March
Alone and afraid
Speaker: Sue Ketland
Wood Green, The Animal Charity,
Cambridgeshire
Details from eastanglia.region@bsava.com
March
April
DAY MEETING SCOTTISH REGION
Sunday 23 March
An interactive cased-based
medicine and surgery session
Speakers: Clare Knottenbelt
and Kathryn Pratschke
Glasgow Vet School
Details from scottish.region@bsava.com
42-43 CPD Diary March.indd 42 19/02/2014 15:18
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43
EXCLUSIVE FOR MEMBERS
Extra 10% discount on all BSAVA
publicatons for members atending any
BSAVA CPD event.
All dates were correct at tme of going to print; however, we
suggest that you contact the organizers for confrmaton.
LUNCHTIME WEBINAR
Wednesday 30 April
13:0014:00
Oxygen supplements
Speaker: Karen Humm
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 21 May
13:0014:00
Endocrine diagnostics
Speaker: Carmel Mooney
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 14 May
13:0014:00
SAVSNET
Speaker: Alan Radford
Online
Details from administration@bsava.com
DAY MEETING
WEST MIDLANDS REGION
Wednesday 7 May
Holiday bugs
Speaker: Maggie Fisher
Wolverhampton Medical Centre,
Wolverhampton
Details from westmidlands.region@bsava.com
AFTERNOON MEETING
SOUTHERN REGION
Thursday 15 May
Orthopaedic problems of the
forelimb in dogs
Speaker: Andy Moores
Holiday Inn Express, Southampton
Details from southern.region@bsava.com
EVENING MEETING
SOUTHERN REGION
Tuesday 17 June
Recognition of the emergency
patient: including triage and
implementation of nursing plans
Speaker: Kath Howie
TBC, Basingstoke area
Details from southern.region@bsava.com
EVENING MEETING
NORTH EAST REGION
Wednesday 7 May
The inappetent cat
Speaker: Roger Wilkinson
Idexx Laboratories, Wetherby
Details from northeast.region@bsava.com
May
June
OTHER UPCOMING BSAVA CPD COURSES
See www.bsava.com for further details
BSAVA Educaton
Wednesday 18 June
Breed schemes
South West Region
Wednesday 18 June
Veterinary evidence: how do I fnd it and
is it any good?
Metropolitan Region
Wednesday 18 June
Skin and ear disease in dogs and cats
Educaton in conjuncton with AVSTS
Tuesday 24 June
Top tps and tricks for closing and
reconstructng wounds in small animal
practce
BSAVA Educaton
Wednesday 25 June
CT/MRI what is it?
South West Region
Wednesday 25 June
Small animal medicine: top tps
interactve
EVENING WEBINAR
Tuesday 29 April
20:0021:00
Choosing the right way to deal
with a fracture update
Speaker: Gareth Arthurs
Online
Details from administration@bsava.com
DAY MEETING
Thursday 1 May
Whats new in allergies in cats
and dogs
Speaker: Stephen Shaw
Hilton, Stansted Airport
Details from administration@bsava.com
DAY MEETING
Wednesday 7 May
Is it me or are these lenses on this
microscope covered in oil? A very
practical guide to getting the most
out of in-house cytology
Speaker: Emma Dewhurst
Woodrow House, Gloucester
Details from administration@bsava.com
DAY MEETING
METROPOLITAN REGION
Sunday 18 May
Whats new for old cats?
Speakers: Hattie Syme and Roseanne Jepson
Holiday Inn Express, 275 Old Street, London
Details from metropolitan.region@bsava.com
EVENING MEETING
SOUTH WEST REGION
Tuesday 20 May
Cranial cruciate ligament disease:
where are we now?
Speaker: Neil Burton
Cullompton Rugby Club, Devon
Details from southwest.region@bsava.com
DAY MEETING
Wednesday 21 May
Companion animal diabetes
mellitus management in practice:
an up-to-date, holistic,
21st-century view
Speakers: Stijnn Niessen and Yaiza Forcada
Hatfield Oak Hotel, Hatfield
Details from administration@bsava.com
DAY MEETING
Thursday 5 June
Practical haematology: detective
work for nurses
Speaker: Kostas Papasouliotis
Woodrow House, Gloucester
Details from administration@bsava.com
AFTERNOON MEETING
SCOTTISH REGION
Thursday 29 May
Exotic emergencies
Speaker: Livia Benato
Dundee Discovery Centre
Details from scottish.region@bsava.com
EVENING MEETING
NORTH EAST REGION
Tuesday 3 June
Wound management for nurses
Speaker: Louise ODwyer
Chantry Vets, Wakefield
Details from northeast.region@bsava.com
DAY MEETING
NORTH WEST REGION
Wednesday 11 June
The acute abdomen
Speaker: John Williams
Holiday Inn, Haydock
Details from northwest.region@bsava.com
42-43 CPD Diary March.indd 43 19/02/2014 15:18
36 April 2014
The ICC / NIA Birmingham UK
Over 300 clinically and practically
relevant lectures
Plenty of networking opportunities
Extensive trade exhibition
@BSAVACONGRESS Follow us for the latest updates
Practical Science Bustling Exhibition Superb Social
You cant afford
to miss out
R
e
g
iste
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o
n
lin
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N
O
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44 OBC - Congress.indd 44 20/02/2014 10:32