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  • The essential publication for BSAVA members

    MRSAProtecting yourself and your patientsP4

    Clinical ConundrumA case of coughing in a young LabradorP8

    The essential publication for BSAVA members

    companionDECEMBER 2009

    BSAVA CongressThe entire Scientific Programme for 2010P17

    How to investigate and treat feather plucking

  • companion

    2 | companion

    3 Association NewsNew RCVS Trust Library benefit

    47 MRSAMike Jessop on protecting yourself and your patients

    811 Clinical ConundrumConsider a case of coughing in a young adult Labrador

    1216 How ToInvestigate and treat a feather plucking parrot

    1720 Congress ScienceThe 2010 Scientific Programme

    2122 Congress SocialThe comedy and music acts for Party Night

    2325 GrapeVINeFrom the Veterinary Information Network

    2627 Christmas QuizTest your knowledge for the chance to win manuals

    28 PetsaversThree new exciting awards

    29 CPDSurgical mini-modules and Dispensing

    3032 WSAVA NewsThe World Small Animal Veterinary Association

    3334 The companion InterviewJohn Hird

    35 CPD DiaryWhats on in your area

    TO DO END OF YEAR CHECKLIST

    Additional stock photography Dreamstime.com Barbara Helgason | Dreamstime.com; Ernst Daniel Scheffler | Dreamstime.com; Milous | Dreamstime.com; Picsfive | Dreamstime.com; Rafal Glebowski | Dreamstime.com; Robyn Mackenzie | Dreamstime.com; Tasnadi Erika | Dreamstime.com; Vertes Edmond Mihai | Dreamstime.com; Vlntn | Dreamstime.com

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

    Tel: 01452 726700Email: [email protected]

    Web: www.bsava.com

    ISSN: 2041-2487

    Editorial Board

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

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

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

    Design and Production BSAVA Headquarters, Woodrow House

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

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

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

    Checked and updated my pro le at www.bsava.comWith plenty of exclusive member content online, including the four-year archive of Congress MP3s, it really is worth being registered with the

    website and keeping your details up to date.

    Make sure you are ready for the year ahead

    Paid my BSAVA subscription or set up my Direct DebitMembership runs from January to December and subscriptions are due on 1st January. Check the website for payment options, or call 01452 726700 or email: [email protected] if you have any questions.

    Booked my time off to attend BSAVA Congress 811 AprilVisit the Congress section at www.bsava.com for full details.

    Completed the registration form for Congress or booked onlineMembers who register for Congress before 31 January will get a 25 voucher to spend on courses or manuals on the BSAVA Balcony in the NIA.

    Sent my RCVS Trust Library postcard backSee page three for details about this new benefit for Full Members who have had concurrent membership in 2009 and 2010.

    Reviewed my CPD plans for 2010 and booked my courses with BSAVACheck the CPD pages at www.bsava.com to find out about our modular programmes, day courses and regional CPD.

    Paid my BSAVA subscription

    Membership runs from January to December and subscriptions are due on 1st January. Check the

    726700 or email: [email protected] if

    Booked my time off to attend Booked my time off to attend BSAVA Congress 811 AprilBooked my time off to attend

  • companion | 3

    MEMBER BENEFITS

    BSAVA is working with the RCVS Trust to reward Full Members, who renew their membership early in 2010, by offering complimentary access to RCVS Trust Library membership and the wide range of reference resources available

    The RCVS Trust Library brings together a wealth of print and electronic resources. The services they offer have developed significantly in recent years to include a growing range of electronic resources such as an online catalogue, online casebooks and electronic journals. The Library holds some 25,000 books, conference proceedings and reports specialising in veterinary medicine and science, plus access to a wide range of journals both in print and electronically.

    All members of the RCVS, veterinary students, and even the public can visit the Library. However, fee-paying members of the Library receive a greater range of additional benefits.

    BSAVA member benefitAlthough anyone registered with the RCVS is welcome to visit the impressive range of resources in central London, this obviously isnt always practical, and so, for an annual subscription, many find that joining the

    Library gives them a convenient way to access all the services online. Now, thanks to a joint venture between the BSAVA and the RCVS Trust, BSAVA members who feel this would be valuable can add this to their benefits entirely free of charge. This is a loyalty reward and only available to 2009 Full Members who renew their BSAVA membership for 2010.

    electronic journals, thousands of full text journal articles and millions of abstracts. Furthermore with the electronic journals, you can set up alerts and updates in the area of your specific interest. There is also access to the VetMed Resource (containing the Veterinary Science Database which is the worlds largest bibliographic database on veterinary medicine), to review articles, to news, and to the Animal Health & Production Compendium (AHPC). Members would also receive discounts on document delivery, book loan, literature search and update services representing a saving of 30% on their normal charges.

    Supporting the libraryThe RCVS Trust Library is a registered charity and receives no statutory grants. The Library is operating in an increasingly commercial environment and they rely on generous donations and bequests to maintain and develop the collections. BSAVA is pleased that through this partnership well be supporting the Library. For more information about the Library visit www.rcvs.org.uk

    NEW MEMBER NEW MEMBER NEW MEMBER LOYALTY BENEFIT LOYALTY BENEFIT LOYALTY BENEFIT RCVS TRUST RCVS TRUST RCVS TRUST LIBRARY ACCESSLIBRARY ACCESSLIBRARY ACCESSLIBRARY ACCESSLIBRARY ACCESSLIBRARY ACCESS

    The RCVS Trust Library brings together a wealth of print and electronic resources. The services they offer have developed signifi cantly in recent years to include a growing range of electronic resources such as an online catalogue, online casebooks and electronic journals.

    NEW BENEFITNow, thanks to a joint venture between the BSAVA and the RCVS Trust, Full BSAVA members who feel this would be valuable can add this to their benefi ts package, entirely free of charge. This is a loyalty reward and only available to 2009 Full Members who renew their BSAVA membership for 2010.

    RCVS Trust Libraryexclusive

    newmembership benefi

    t

    The Library benefi t will be particularly useful to members undertaking a specifi c form of further study, particularly those pursuing a certifi cate.

    BSAVA is offering to fully subsidise membership of RCVS Trust Library membership as an additional member benefi t. (There is normally an annual fee of around 70 if applying as an individual). So this really is a superb addition to your existing BSAVA benefi ts.

    WHAT TO DOIf you think you would value Librarys services and want this to be added to your list of benefi ts, then return this card to the RCVS Trust before 31 January 2010. Applications after this date can not be considered. The RCVS will then use the details on the card to set up your complimentary RCVS Trust Library membership and we will attach that to your BSAVA benefi ts package.

    * This is only available to Full BSAVA members who have continuous membership in 2009 and 2010 and return this postcard to the RCVS Trust before 31 January 2010.

    The British Small Animal Veterinary Association exists to promote excellence in small animal practice through education and science.

    This is a loyalty reward and only available to 2009

    Full Members who renew their BSAVA

    membership for 2010

    All Full Members have been sent a postcard in their membership/Congress mailing. If you feel this would be a useful resource for you please return the postcard to the RCVS by the 31st January. If you have not received your postcard and want to apply for RCVS Trust Library membership as an addition to your BSAVA benefits then please email [email protected] or call 01452 726700.

    Services and benefitsThe Library offers a range of services to help you access the information you need. They can supply photocopies of journal articles, they can also post books and journals to you and they offer quarterly subject alerts on a range of topics as well as tailormade searches on your specific area of interest. Those members taking up this benefit would get access to a wide range of

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    MRSA

    MRSA

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    MRSA

    Emerging strains of antibiotic-resistant bacteria are a growing threat to the health of humans and animals. Veterinary staff are playing a key role in these developments both as part of the cause and the solution to the problem. BSAVA Past President, Mike Jessop, attended a conference in London which examined the actions that practitioners should be taking to protect their patients and themselves

    consequence of microbial evolution. This can only be addressed through joint action by all those involved in developing, licensing, prescribing and using these drugs, creating scapegoats of any particular link in that chain will not solve the problem, the report said.

    The challenge is formidable. At the present time, resistance essentially is uncontrollable. The reasons behind the establishment and spread of resistance are complex, mostly multi-factorial and mostly unknown. The consensus was that efforts must target both bacterial transmission and antimicrobial use, said Jacques Acar, chair of the AAM working group.

    The antibiotic issueVeterinary surgeons are responsible for prescribing significant quantities of antibiotics and their veterinary premises are a focal point for the transmission of resistant strains between humans and animals. So vets must take some responsibility for any loss of antibiotic sensitivity and play a big part in dealing with the consequences. Specific actions were discussed at a meeting organised by the Bella Moss Foundation, with sponsorship from Defra.

    The charity (www.thebellamossfoundation.com) was established by Jill Moss after her dog died in 2004 as a result of developing an MRSA

    infection in a postoperative wound. She has earned respect from many members of the profession as a result of her tireless efforts to raise awareness of the issue and educate both the profession and the public.

    One of the main priorities for the profession must be to get a better handle on the scale of the problem in veterinary practices, says Jill Moss. The problem here is that there is nobody collecting and collating reliable information on the number of pets that get infected with these bacteria. We have reports sent to us by members of the public and we cant say whether these are necessarily confirmed cases. But what is clear is that the number of incidents appear to be growing a year ago we were getting told of 10 to 15 cases a week, now it is more like 20 to 30, not just in the UK but from all over the world.

    Growing problemMRSA is a much more recent problem for veterinary surgeonss than for human medics, who identified the first incidents in 1961. David Lloyd, professor of veterinary dermatology at the RVC, told the meeting that the first cases in animals were not reported until 1999. MRSA in animals is now recognised as a worldwide problem and our understanding of the epidemiology of these strains is growing rapidly. The

    Now wash your hands is the familiar warning in toilet facilities of public buildings across the country. Perhaps it is time for the owners of

    veterinary premises to put up a few more of those signs, not just in the smallest room but throughout the building.

    Improving hygiene standards is a fundamental step in reversing the spread of methicillin-resistant

    Staphylococcus aureus (MRSA),

    the main threat to the effective-ness of essential

    antibiotic agents. However,

    it is only one of many actions that veterinary

    surgeons and VNs will need to take to tackle

    this serious animal and public health risk.

    A report by the influential American Academy of Microbiology

    (AAM), published in October, highlighted the complex reasons for the development of antibiotic resistance which, to a large extent, is an inevitable

  • 6 | companion

    MRSA

    commonly identified risk factors include contact with a human carrier of the MRSA organism, three or more recent courses of antibiotics, surgical implants and a stay of two or more days as an in-patient at a veterinary clinic, he said.

    Vets also appear to be important as carriers of the MRSA organism, with positive swabs taken from 3.9 per cent of vets in contrast to 0.7 per cent of the general population. Moreover, studies have shown a direct link between increased veterinary surgeon colonisation and increased patient infection rates. Perhaps unsurprising as MRSA is a ubiquitous organism which transfers easily between humans, animals and fomites.

    However, it would be unwise to become fixated on a single bacterial strain. The profession has to be vigilant in keeping track of emerging bacterial threats. Most animal MRSA cases occur in a hospital setting, but a community-acquired form of MRSA has become a significant challenge in human medicine and this problem may spill over to the veterinary field. Moreover, there is growing evidence of methicillin resistance in other staphylococcal species and even then in some non-related pathogens. So it is essential for the veterinary profession to carry out regular reappraisals of its infection management procedures.

    The numbers of MRSA infections

    reported in animals is still relatively low compared to the frequency of human cases, noted Tom Maddox, from the National Centre for Zoonosis Research at the University of Liverpool. However, university centres like the Liverpool Small Animal Hospital are reporting a year-on-year increase in cases and it is likely that most general practitioners will encounter a case at some point.

    Mr Maddox advised submitting samples for microbiological analysis from any cases of persistent infection which have failed to respond to empirical antibiotic treatment, especially if fluoroquinolone or beta-lactam antibiotics have been used. Practitioners should be particularly suspicious of infection in cases of animals that have received long-term antibiotics, are immunosuppressed as a result of disease or treatment, have postoperative or traumatic wounds, or have been in contact with a known human or animal carrier of MRSA.

    Diagnosis and treatmentLaboratory diagnosis of MRSA resistance is straightforward and it may be worthwhile for the practitioner to call the lab to discuss the results and their implications for future treatment. When MRSA is confirmed, the bacterium should be considered resistant to all penicillins, beta-lactams, cephalosporins

    and related antibiotics, irrespective of any reported sensitivity. Other familiar agents such as tetracyclines, potentiated sulphonamides and often gentamicin are usually effective in treating small animal isolates. For superficial or localised infections, practitioners should consider topical therapies such as fusidic acid. They may also consider antibiotic-impregnated implants, and standard wound management procedures such as irrigation and debridement may be of value.

    The prognosis in most cases is likely to be good although some may need prolonged treatment. Mr Maddox emphasised the importance of good communication with owners, to ensure that effective hygiene procedures are carried out and to identify any potential zoonotic risks, such as an immunocompromised family member or one about to undergo surgery themselves.

    Using fluoroquinolone and some cephalosporin antibiotics in veterinary practice is particularly controversial following the UK Chief Medical Officer Liam Donaldsons warning that these products should be restricted for treatment of humans. However a blanket ban on veterinary use should not be necessary, argues Mark Dosher, from the Bella Moss Foundation. The foundation would certainly like veterinary surgeons to reduce their use of antibiotics generally, but these particular products should still have a role in small animal practice provided they are used responsibly. They should not be used in any animal unless there is a clear indication that they will be effective, he suggests.

    Antimicrobial productsHowever the veterinary profession is on the back foot in its attempts to defend access to these groups of antibiotics. There is simply insufficient data to prove that current usage is safe and responsible, warned Dr Susan Dawson, also from the University of Liverpool. The only figures available are those from the Veterinary Medicines Directorate, whose last annual report in 2008 showed that while the overall therapeutic use of antibiotics in animals is declining, sales of

    MRSA

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    MRSA

    Top tips1 Good hand hygiene is the simplest and most

    important step to reducing bacterial transmission

    2 Thorough cleaning of the practice premises is also essential. Identify key transmission areas, e.g. keyboards, door handles, otoscopes

    3 Effective protective clothing, e.g. theatre scrubs, masks, gloves

    4 In cases of chronic infection, ensure that samples are taken for bacterial typing and sensitivity testing

    5 Rely on good surgical asepsis and only give prophylactic antibiotics in the rare, high-risk cases

    6 Use long established, low-tech antibiotics such as potentiated sulphonamides wherever possible

    7 Use the minimum possible dose to achieve the stated therapeutic goals (i.e. RUMAs Use as little as possible but as much as needed)8 Ensure as far as possible that the client complies with

    the dosing instructions

    9 Check that there are no potentially vulnerable family members if a dog or cat develops MRSA

    10 Use topical antibiotics and non-antibiotic approaches (e.g. debridement and wound irrigation) wherever possible11 Be aware of, and test for, the risk of resistance developing in other bacterial species

    12 Be open, honest and realistic should MRSA be identified

    fluoroquinolones and cephalosporins are still going up. Most of these products are being used in livestock animal species but in 2007 a significant amount (33,621 kg) was used in non-food species.

    There is a limited range of antimicrobial products available for use by veterinary surgeons; most of those are broad spectrum products and all the licensed preparations are also used in human medicine. So vets must be mindful of the impact of veterinary antibiotic use on the normal gut flora in patients, Dr Dawson warned. Antimicrobial resistance in non-pathogenic bacteria could act as reservoirs of genetic materials for later transfer to pathogenic species.

    Prudent use of antibiotics is essential to avoid further restrictions on their availability for veterinary surgeons, an issue that has been taken on board in the livestock sector through the work of RUMA (the Responsible Use of Medicines in Agriculture Alliance). Its director, Dr Tony Andrews, described the changing attitudes towards antimicrobials in farm species over the past 10 years and the growing pressure from organisations like the World Health Organization for ever stricter controls.

    The issues surrounding antibiotics use were essentially the same for every branch of the veterinary profession and the advice offered by RUMA was the same, irrespective of where the practitioner was working. Take full responsibility for prescribing antimicrobials, he warned. Always be able to justify your choice antibiotic use is no longer a right for a veterinary surgeon, it must be responsibly used. So please remember the RUMA mantra on antimicrobials use as little as possible but as much as needed.

    SA vet viewpointFrom my perspective as a purely small animal practitioner, I made a few observations of my own at the meeting. My feeling is that we are not entirely blameless on some issues which may have relevance to the rise of multi-resistant bacteria. Are there occasions, for example, when we are lured into trying out exciting new antibiotic

    regimes and ignore those stalwarts of yesteryear which remain an effective part of our armamentarium? It is easy to be seduced by pharmaceutical advertising with its emphasis on products like the fluoroquinolones and cephalosporins.

    Just as important, we must guard against financial considerations clouding our clinical judgement. We must ensure that we are never tempted to choose a new exciting high value drug ahead of a familiar old product that may be equally effective. Another potential sin which we must strive to avoid is laziness; the temptation to use a broad spectrum, catch-all therapy rather than opting for a specific treatment for the particular bacterium identified or strongly suspected.

    Removing that particular hair shirt, there are others involved in the supply and use of veterinary medicines who should also consider whether the policies that they have adopted are always the most sensible ones under the circumstances. My feeling is that the regulators (chiefly Practice Standards Committee) also have a lot to answer for. There are issues we cannot ignore practice inspections are aggressively enforcing the 28 day rule on using a vial of antibiotic once it has been broached. Add to this the increasing difficulty in obtaining injectable antibiotics in single-patient doses and that adds up to produce an insidious pressure to overuse rather than waste a valuable product.

    I would argue that these problems provide further evidence, if that were needed, of the dangers of our profession becoming overreliant on the sales of products rather than our hard won knowledge. We are bombarded with advice and literature trying to force us to adopt a retail mentality when we should be focussing our efforts on earning professional fees from the advice that we are able to offer.

    For full access to the BSAVAs MRSA Guidelines and Frequently Asked Questions, visit the Advice section at www.bsava.com n

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    CLINICAL CONUNDRUM

    CLINICALCONUNDRUMFelipe de Vicente and Kathryn Pratschke of the Faculty of Veterinary Medicine at Glasgow University invite companion readers to consider a case of coughing in a young adult Labrador

    Based on the information so far, create a problem list and consider differential diagnoses. Which single diagnostic step is likely in this case to be most useful in narrowing the list of possibilities?The only problem noted was a chronic non-productive cough.

    The differential diagnoses to be considered for a non-productive cough include:

    V n ascular early cardiac disease without pulmonary oedemaI n nfectious (viral, parasitic or bacterial)T n raumatic tracheal foreign bodies.A n natomical bronchial compression (including left atrial enlargement), tracheal collapseI n nflammatory pulmonary infiltrates (such as eosinophilic bronchopneumopathy), tracheobronchitis,N n eoplasia primary or metastatic disease.

    A radiographic study of the thorax is likely to allow rapid narrowing of this list of differential diagnoses and allow decision making regarding further investigation.

    What is your interpretation of the radiographs provided?On both the dorsoventral and lateral views the cardiac silhouette is enlarged and globoid (Figure 1a and Figure 1b). The ventral area of the diaphragm cannot be delineated and the gastric axis is displaced cranially. On the lateral view, ventrally and caudally there is an area which contains

    Case PresentationA 20-month-old male entire Labrador Retriever presented with a 2-month history of intermittent coughing, usually dry and non-productive. He had failed to improve during treatment with antibiotics and antitussives by the referring veterinary surgeon. Otherwise he was clinically well. The patient presented in good general condition, being of normal body size for his age and breed.

    The only previous problem was an umbilical hernia, which had been surgically corrected when he was 10 weeks old.

    Physical examination was unremarkable; the dog was bright, alert and responsive. The respiratory rate was 28 breaths per minute, with pink mucous membranes and capillary refill time less than 2 seconds. The heart rate was 96 beats per minute with femoral pulses strong, symmetrical and rhythmic. Thoracic auscultation was difficult to evaluate as he was quite restless during the examination.

    Vn ascular early cardiac disease without pulmonary oedemaIn nfectious (viral, parasitic or bacterial)Tn raumatic tracheal foreign bodies.An natomical bronchial compression (including left atrial enlargement), tracheal collapseIn nflammatory pulmonary infiltrates (such as eosinophilic bronchopneumopathy), tracheobronchitis,Nn eoplasia primary or metastatic disease.

    A radiographic study of the thorax is likely to allow rapid narrowing of this list of differential diagnoses and allow decision making regarding further investigation.

    What is your interpretation of the radiographs provided?On both the dorsoventral and lateral views the cardiac silhouette is enlarged and globoid (Figure 1a and Figure 1b). The ventral area of the diaphragm cannot be delineated and the gastric axis is displaced cranially. On the lateral view, ventrally and caudally there is an area which contains

    failed to improve during treatment with antibiotics and antitussives by the referring veterinary surgeon. Otherwise he was clinically well. The patient presented in good general condition, being of normal body size for his age and breed.

    The only previous problem was an umbilical hernia, which had been surgically corrected when he was 10 weeks old.

    Physical examination was unremarkable; the dog was bright, alert and responsive. The respiratory rate was 28 breaths per minute, with pink mucous membranes and capillary refill time less than 2 seconds. The heart rate was 96 beats per minute with femoral

    rhythmic. Thoracic

    difficult to evaluate

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    CLINICAL CONUNDRUM

    several radiodense structures and overlies the cardiac silhouette. The appearance is suggestive of pyloric gravel sign and perhaps other foreign material. On the dorsoventral view, the area consistent with the gravel sign is located in the midline, and the diaphragmatic outline at this level again cannot be completely visualised. No abnormalities are evident in the observed lung fields.

    What is your provisional diagnosis and what would be your next diagnostic steps?Given the thoracic radiographic findings, which show the presence of abdominal viscera in the thoracic cavity, a pericardioperitoneal diaphragmatic hernia (PPDH) was considered likely. Although a traumatic diaphragmatic rupture could have been a possible diagnosis, the globoid nature of the cardiac silhouette made a congenital PPDH more likely. Therefore, abdominal imaging was indicated to evaluate the extent and nature of the diaphragmatic deficit and to determine which abdominal organs had herniated.

    Abdominal radiographs demonstrated cranial displacement of the abdominal structures (Figure 2). An ultrasound examination revealed a large amount of mineralized material in the pyloric outflow tract, which extended cranioventrally to the liver and into the pericardial sac. It was possible to trace the duodenum from adjacent to the heart, running caudally through the diaphragmatic defect into the right abdomen. Also present within the pericardial sac were liver lobes and the gall bladder.

    Figure 1a

    Figure 1b

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    CLINICAL CONUNDRUM

    CLINICAL CONUNDRUM

    What does the mineralized material seen on both radiography and ultrasound suggest?The mineralized material in the pyloric outflow tract and the radiographic gravel sign indicate a chronic partial pyloric obstruction.

    What is the likely final diagnosis?These findings were suggestive of a pericardioperitoneal diaphragmatic hernia (PPDH) with chronic partial obstruction to gastric outflow.

    How would you manage this case and what are the potential perioperative concerns?Surgery is indicated with two aims, first to repair the PPDH and secondly to manage the pyloric obstruction.

    Ventilation under anaesthesia is usually required for PPDH surgery, as lung expansion can be compromised. Atelectic lungs should be slowly re-inflated avoiding airway pressures above 15 cm H2O during

    ventilation. This is to reduce the risk of re-expansion pulmonary oedema developing, although this may not be evident until several hours after the surgery.

    There is also a risk of reperfusion injury to incarcerated viscera (especially the liver) and possible abdominal compartment syndrome (in which the abdominal cavity is insufficiently capacious for the returned organs). Although the surgical plan does not include entering the pleural cavity, provisions for chest drain placement should be made preoperatively in case this becomes necessary. Intrathoracic adhesions are uncommon but can hinder retraction of the organs back through the defect. In some cases, particularly in cases with sternal defects, the diaphragmatic defect can be difficult to close and appropriate implant materials to aid closure may be required.

    Surgical findings in this caseDuring the procedure analgesia was provided with epidural morphine and a constant rate infusion of fentanyl. The patient was artificially ventilated throughout anaesthesia. Methadone was

    given as part of the premedication, and a dose of meloxicam was also administered intravenously. Amoxicillin/clavulanate (600 mg) was given intravenously every 90 minutes during the surgery.

    A ventral midline exploratory coeliotomy was performed, extending from the xiphoid process to the cranial preputial level. A large congenital diaphragmatic hernia (pericardioperitoneal diaphragmatic hernia) was confirmed and a concurrent gastric foreign body identified. The pylorus, duodenum, pancreas and quadrate and left medial liver lobes were retracted from the pericardial sac. There were no adhesions present in this case. Examination of the herniated liver lobes showed some anatomical variation in the shape of the lobes when compared with the expected normal appearance, and turbulence was visible in the portal vein adjacent to the porta hepatica.

    These changes were presumably due to hepatic development in an extra-abdominal location as a result of the congenital hernia. There was evidence of widespread intestinal and mesenteric oedema plus lymphatic congestion, again most likely related to the hernia and periodic organ displacement.

    A standard gastrotomy was performed, and a foreign body was retrieved (a medium-sized ball, collapsed) (Figure 3). The gastrotomy site was closed routinely in two layers. Surgical gloves and contaminated instruments were changed prior to continuing with the rest of the surgery.

    The dorsal portion of the diaphragmatic defect was sutured in a continuous pattern using polydioxanone; however the ventral defect was too large for straightforward suture closure. A sheet of Vet-Biosist was soaked in sterile saline then sutured in place

    Figure 2

  • companion | 11

    CLINICAL CONUNDRUM

    with interrupted sutures of polydioxanone to fill the defect. This was then overlaid with a layer of omentum, sutured in place with interrupted sutures.

    Copious peritoneal lavage was performed with warmed sterile saline prior to a final swab count and routine abdominal closure. In this case no chest drain was required as the pleural cavity was not entered.

    What are the key postoperative concerns?In some cases re-expansion pulmonary oedema can develop following repair; therefore close postoperative monitoring of respiration is required. Fluids were continued at maintenance levels (2 ml/kg/h) until the next day. No oxygen supplementation was needed. Methadone was given every 4 hours to provide analgesia. No antibiotics were used during the postoperative period.

    The dog made an uneventful recovery and was discharged the day after surgery. Carprofen was prescribed and it was recommended to feed the dog three or four small meals a day for a week, as well as exercise restriction.

    What is a pericardioperitoneal diaphragmatic hernia?A PPDH is an abnormal communication between the pericardium and the abdomen. PPD rupture may occur as a result of trauma in humans (in whom the diaphragm forms one wall of the pericardial sac); however, true PPDHs are always congenital in dogs and cats, in which no direct communication should exist between the pericardial and peritoneal cavities after birth. The most widely accepted theory regarding the embryogenesis of this defect is that the hernia occurs due to incomplete development of the septum transversum of the diaphragm. This could be a result of a teratogen, a genetic anomaly, or prenatal injury.

    This condition can be asymptomatic, with the PPDH being an incidental finding during investigation of another unrelated problem, or found at post-mortem examination. The severity of any symptoms present depends on which structures are involved in the hernia, the size of the hernia itself, and the degree of movement that is allowed forwards and back through the hernia.

    Clinical signs are usually related to the herniated organs compressing the intrathoracic structures leading to respiratory signs including coughing. Gastrointestinal signs may occur when structures of the digestive system are herniated (especially the intestines). Most

    affected animals are diagnosed before 4 years of age and males appear to be predisposed.

    What other conditions have been associated with pericardioperitoneal diaphragmatic hernia?PPDH has been associated with other anomalies of closure of the embryonic midline, such as cranial abdominal hernias, umbilical hernia and sternal deformities, as well as congenital cardiac abnormalities. It is worth noting that in the case presented here the history included repair of an umbilical hernia at 10 weeks of age.

    PPDH has been implicated as the cause of intrapericardial cyst formation in both dogs and cats, and has been associated with pulmonary vascular disease.

    Portal hypertension, incarceration and strangulation of abdominal viscera may develop as a result of organ herniation. Reperfusion injury can rapidly develop once herniated organs are replaced, leading to profound systemic signs. The occurrence of chronic gastric outflow obstruction in this case is not a typical finding with PPDH and seems more likely to have resulted from the concurrent gastric foreign body.

    What is the prognosis with PPDH?Surgical correction carries a good prognosis provided the animal survives the immediate perioperative period. Concomitant intracardiac defects or pulmonary vascular disease could be detected preoperatively with more advanced diagnostic imaging techniques, such as an echocardiogram, and are associated with a poorer prognosis. However, sternal and abdominal wall defects have no adverse effect on survival. n

    Figure 3

  • 12 | companion

    HOW TO

    Figure 1: This Patagonian conure has been selectively plucking feathers on the legs. This can indicate underlying reproductive disease and inappropriate pair bonding of a parrot to its owner

    INVESTIGATE AND TREAT A FEATHER PLUCKING PARROT

    HOW TO

    Kevin Eatwell, lecturer in Exotic Animal and Wildlife Medicine at the Royal (Dick) School of Veterinary Science, discusses the most common condition affecting pet parrots

    What clinical signs may be seen?The external appearance of a pet parrot is usually of importance to the owner, but despite this some owners fail to present a bird until the clinical signs are severe. The pattern of feather change or damage may lead the clinician to suspect particular conditions and it is important to identify the exact nature of the feather damage. Feather plucking can be seen when the bird is physically removing feathers, preventing re-growth of an area and leading to alopecia (Figure 1). In contrast, feather pickers or chewers traumatise feathers; these can be clearly evident on examination but are not plucked. A third group can self-traumatise areas leading to intense pain, blood loss, alopecia and scarring. In these cases urgent intervention is required.Feather plucking, feather picking or self-trauma are commonly presented in clinical practice. Many owners will

    present a bird looking for a quick resolution to a problem that has existed for many years. Yet unless these cases are investigated thoroughly to identify any underlying factors leading to the plucking, presumptive treatment is likely to fail.

    The causes for feather plucking broadly fall into two categories: either a psychological problem that has resulted from captivity; or a specific illness leading to the damage. What the clinician must do first is identify any problems by reviewing the clinical history, physical examination and diagnostic testing. These findings should be evaluated in context of the feather plucking to associate them directly with the problem. At this stage therapy can begin, depending on the diagnosis. In urgent cases remedial therapy may be required whilst achieving a diagnosis. Common causes associated with feather plucking are listed in Table 1.

    After wing clippingAir sacculitisAllergic disease (inhaled or food)Behavioural problemsChlamydophilosisCloacal diseaseExcessive allopreeening from another birdFolliculitis (bacterial or fungal)Heavy metal toxicityHepatic diseaseHypocalcaemiaNeoplasiaNutritional disordersPainful focusParasitic diseasePoor socialisationProventricular dilatation diseaseReproductive activity

    Table 1: Differential list for causes of feather plucking (most common in bold)

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    HOW TO

    behaviour such as excessive grooming, plucking or even pain responses from the bird. If so, this may associate the damage with the presence of the owner and it may be that the bird is seeking attention from its owners, which they probably will be giving and hence rewarding the behaviour. Conversely, other birds may damage themselves when the owners are absent.

    You also need to identify if any previous treatment has been administered by the owner or other veterinary surgeons prior to visiting you. Some of these treatments may have been inappropriate. There may have been some diagnostic tests performed previously as well, whose results may be useful.

    What are the important questions to ask during a consultation?It is critically important to evaluate the birds history as a whole. Many factors, ranging from skin irritation or desiccation through to inadequate nutrition, can predispose to feather damage. Thus a thorough husbandry review is indicated and all predisposing factors should be eliminated. General husbandry advice should be given (and followed) in all cases of birds with feather damage (Table 2).

    It is important to discuss the birds socialisation with the owners in detail. Parrots generally perceive their owners as parental figures when young, siblings when adolescent, and as mates and competitors

    when adult. Inappropriate pair bonding may be seen, with the bird becoming fixated on one individual and aggressive to other people. Signs seen may include mating postures or regurgitation, for example.

    The anatomical site where the bird has damaged the feathers is important. The distribution of feather damage may suggest a painful focus in the area and may be centred over a wing clip (Figure 2), the proventriculus, the ovary, the air sacs, the liver or vent, for example. It is important to identify where the feather damage started, as it can spread over a wider area over time as clinical signs progress.

    Having worked out the site of the damage, you then need to find out if the owner is witnessing any inappropriate

    Improve the diet and avoid fatty foods. A complete pelleted diet should be offered, along with some fresh fruits and vegetables.Provide the bird with access to either natural or artificial UV-b light. Birds can see into the UV spectrum and this facilitates natural behaviour and helps prevent hypocalcaemia (which is a particular problem in grey parrots).Ensure the bird is not exposed to an excessive photoperiod; 12 hours of light a day is sufficient for most equatorial species.Avoid any inhaled toxins such as tobacco smoke, PTFE (from non-stick frying pans) or deodorants.Spray or mist the bird daily with warm water.Improve the birds socialisation with multiple owners and consider training the bird to stimulate it.Never get the wing clipped.

    Table 2: General husbandry advice for owners

    Figure 2: This grey parrot has started traumatising the feathers at a site of a previous wing clip. This can progress to self-trauma of the skin of the wing tip, requiring amputation

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    HOW TO

    INVESTIGATE AND TREAT A FEATHER PLUCKING PARROT

    essentially rules out or diagnoses many of the potential underlying factors leading to feather plucking. At this point, if a number of common medical conditions have been eliminated, remedial hormonal therapy may be indicated, if an active gonad (and hence likely excessive pair bonding) was identified on laparoscopy.Should these tests fail to lead to a diagnosis then investigation of primary skin disease should follow. Detailed examination of the skin and feathers is important and should be undertaken while the bird is anaesthetised. If any areas are of concern, then diagnostic

    How can I investigate the causes of feather plucking?Every clinician you speak to will have a different list of diagnostic procedures they perform and each plan is, of course, tailored to each individual case. The important factor is to prioritise diagnostics and aim to get as much information as possible to rule out as many of the underlying factors quickly and economically.

    Whilst screening for infectious disease is important (there are PCR tests for psittacine beak and feather disease (PBFD), polyoma virus and Chlamydophila), the importance of such results has to be taken in context. What is the real likelihood of an adult grey parrot, housed in isolation for a number of years, with perfect head feathers, having been exposed to PBFD? Although a Chlamydophila PCR may be positive, is there significant pathology (liver or air sac disease) leading to plucking over the keel? Instead of rushing in with specific testing, looking at the birds health status as a whole may yield more useful results.

    Authors suggested investigatory procedure

    The bird should be anaesthetised and a full blood profile taken. This is useful to rule out hypocalcaemia, liver disease, renal disease, low proteins and also to check for signs of systemic infection such as a monocytosis or toxic activity within the white cell lines. For example, if the bird had PBFD then a low white cell count may be seen. In contrast, significant Chlamydophila infection will elevate the white cell count and there may be signs of liver damage on the profile.

    Radiography is important and two views should be taken, a lateral and a ventrodorsal. These can be useful to look for signs of proventricular enlargement or for radiodense foreign bodies such as heavy metals. Chronic joint disease causing a painful focus may also be seen in older birds.The next step to consider is laparoscopy (Figure 3). This, although invasive, provides far more information about the birds health status. The clinician can evaluate the air sacs, liver, heart, proventriculus, lungs, kidneys, gonads (and hence reproductive status), spleen, intestines and cloaca. This

    Figure 3: This blue and gold macaw is undergoing laparoscopic biopsy as it has hepatomegaly which may be related to its poor feather quality

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    HOW TO

    samples can be taken. Fret marks can be seen where feather growth has been disrupted due to a poor diet or PBFD. Changes in pigmentation of feathers, which can become black or pink plumage depending on species, can occur with liver disease.

    Skin scrapes can be examined for ectoparasites in areas of hyperkeratosis. Abnormally thickened blood feathers can be removed and the pulp examined cytologically for pulpitis. Diff Quik staining can reveal bacteria or heterophillic inflammation. Alternatively a skin biopsy sample can be taken (including a quill feather) and sent for histopathology. This is of particular importance where ulceration, nodules

    or signs of chronic disease are seen. Neoplastic conditions are also on the differential list in these cases (Figure 4). Culture of skin lesions can also be performed. The techniques used mirror that used for mammalian skin disease.

    Caution is to be advised when interpreting skin tests, as many cases of pulpitis or inflammation can be due to secondary opportunistic infections as a consequence of the feather plucking. Treatment of theses conditions with antibiotics and analgesics may help to control feather plucking, but the underlying cause should always be thoroughly evaluated.Specific diagnostics may be indicated for an individual case: e.g. PBFD or

    Chlamydophila PCR; crop biopsy if proventricular dilatation disease is suspected; or blood lead or zinc levels if heavy metal toxicity is suspected. A full faecal analysis may also be required if endoparasitic disease is suspected.If all medical conditions have been excluded it suggests that there is a behavioural element to the problem and remedial behavioural therapy can be undertaken.

    How should a severe case be managed?If the bird is at risk of causing significant self-trauma then remedial action may need to be undertaken urgently for humane reasons. This may necessitate: a collar to be placed to prevent self-trauma; analgesia for pain control; debriding, cleaning and dressing wounds; and antibiotics if the wounds are infected. However these are not stand-alone solutions, and a thorough review of husbandry and clinical history are indicated alongside a diagnostic plan. There is little point in collaring a bird and providing psychotropic drug therapy without confirming this is 100% necessary.

    Other birds may start performing self-trauma as a result of a painful focus. This can be seen in birds that have been wing clipped and that have subsequently damaged the end of their wing, impairing feather regrowth. In severe cases amputation of the wing tip is required. Another common site of self-trauma is the keel. Birds incapable of flight can jump off high perches or the top of the cage when scared. The landing is rough, leading to a split keel as the bird hits the ground. Osteomyelitis is possible in these lesions and surgical treatment is generally indicated.

    Figure 4: This Princess of Wales parakeet has a uropygial gland tumour that requires surgical removal. A collar will need to be placed to prevent damage to the granulating surgical wound created

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    HOW TO

    INVESTIGATE AND TREAT A FEATHER PLUCKING PARROT

    Figure 5: This grey parrot is having severely traumatised feathers removed under anaesthesia to facilitate new growth

    How should treatment be tailored?Improving husbandry and treating any specific condition identified is important. Damaged feathers may require removal under anaesthesia (Figure 5) or imping (grafting of donor feathers onto damaged feather shafts). Analgesia is important during the regrowth phase as the bird may become overly pruritic as a large number of follicles all grow at once. Topical treatments may be used but should be limited to products specifically marketed for birds. Topical steroids are generally contraindicated.

    What prognosis should I give?In many chronic cases resolution is difficult and at best the condition is managed. The owner requires total commitment to the case. It can take many months to improve a birds condition and these cases require a primary clinician to be in charge of case progression. Consideration should be given to refer to an RCVS specialist for a complete evaluation of the case, diagnostic evaluation and subsequent management. The BSAVA Manual of Psittacine Birds provides more details on the diagnosis and treatment of psychological problems and skin disease in parrots.

    BSAVA Manual of Psittacine BirdsTo treat a sick bird properly it is essential to understand aspects of normal biology and this is what you will find in the BSAVA Manual of Psittacine Birds, along with the many advances in psittacine medicine.Clinical examination is presented in a logical, highly practical way, with integrated photographs of key features. Colour images of haematology and cytology, and a step-by-step post-mortem examination procedure illustrate the role of clinical pathology.Imaging views of normal and abnormal presentations are included. The systemic illness chapters are designed to be read in their entirety or to be referred to as needed. For general practitioners the most commonly seen psittacine patients are small parrots, cockatiels and budgerigars, and a chapter is devoted to their common problems. This practical approach to the sick bird is extended in an appendix of diagnostic algorithms for common presentations such as fluffing up, fitting and feather damage.A pictorial guide to droppings illustrates normal and abnormal appearances and their significance.For more information or to buy the manual visit www.bsava.com or call 01452 726700.

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    CONGRESS SCIENTIFIC PROGRAMME 2010

    Thursday 8 AprilTime Hall 1 Hall 3 Hall 5 Hall 8 Austin CourtKingston Room Hall 10

    DERMATOLOGY ENDOCRINE SOFT TISSUE SURGERY IMAGING I SPINAL SURGERYEXOTICS

    A practitioners guide to

    VETERINARY MASTERCLASS

    0830 Cutaneous drug reactions in dogs and cats

    Ed Rosser (USA)

    Recent advances in the understanding of canine diabetes mellitus

    Lucy Davison (UK)

    A surgical approach to the oncological patient

    Julius Liptak (USA)

    Abdominal radiology: the pitfalls

    Wilfried Mai (USA)

    Lumbosacral stenosis: presentation and diagnosis

    Thomas Gdde (Ger)

    Dealing with venomous species and dangerous wild animals

    Mark Amey (UK)09001230Executive 2

    Blood gas evaluation: how to use the numbers to help the patients

    Matt Beal (USA) &Amanda Boag (UK)

    0915

    0925 Feline symmetrical alopecia: diagnosis and management

    Ed Rosser (USA)

    Intensifi ed insulin therapy in cats with diabetes mellitus

    Claudia Reusch (Sui)

    Reconstruction after oral oncological surgery

    Julius Liptak (USA)

    Diagnostic imaging in the diagnosis of abdominal sepsis

    Wilfried Mai (USA)

    Lumbosacral stenosis: surgical management

    Thomas Gdde (Ger)

    Post mortem examination of exotics

    Mark Stidworthy (UK)

    1010 1000 EXHIBITION OPENS & COFFEE BREAK NATIONAL INDOOR ARENA

    1105 Diagnostic tools to identify skin infections

    Claudia Nett (Sui)

    Approach to the uncontrolled diabetic dog

    Ian Battersby (UK)

    Thoracic wall tumours: surgery and reconstruction

    Julius Liptak (USA)

    Thoracic radiography: interpretive principles

    Tobias Schwarz (UK)

    Management of congenital spinal disorders

    Jacques Penderis (UK)

    Respiratory diseases in rabbits, rats and degus

    Anna Meredith (UK)

    1150

    1200 Dermatophytes: diagnosis and therapy

    Claudia Nett (Sui)

    Update on IGF-1 as a diagnostic tool for acromegaly

    Claudia Reusch (Sui)

    Perineal masses: surgery and reconstruction

    Jane Ladlow (UK)

    Thoracic radiology: the pitfalls

    Wilfried Mai (USA)

    Spinal trauma

    Malcolm McKee (UK)

    Anorexia and weight loss in parrots

    John Chitty (UK)

    1245

    EXHIBITION & LUNCH NATIONAL INDOOR ARENA

    m

    Time Hall 1 Hall 3 Hall 5 Hall 8 Austin CourtKingston Room Hall 10

    DERMATOLOGY ENDOCRINE SOFT TISSUE SURGERYIMAGINGHow to SPINAL SURGERY

    EXOTICSA practitioners

    guide to

    1405 Updates on the diagnosis and treatment of sebaceous adenitis and seasonal fl ank alopecia in dogs

    Ed Rosser (USA)

    Endocrinopathies and hypertension

    Claudia Reusch (Sui)

    Perineal hernia (rupture)

    Peter Holt (UK)

    take good hip and elbow radiographsTobias Schwarz (UK)

    Appropriate use of advanced imaging in spinal disease

    Erik Wisner (USA)

    Emergencies in birds of prey

    Nigel Harcourt-Brown (UK)

    take optimal thoracic radiographsFraser McConnell (UK)

    1450

    1500 Secondary infections in allergic patients: Malassezia, bacterial folliculitis

    Claudia Nett (Sui)

    Obesity: an endocrine disorder?

    Alex German (UK)

    Surgical treatment of rectal neoplasia

    Peter Holt (UK)

    decide which imaging modality to use for the urogenital tractTobias Schwarz (UK)

    Wobbler syndrome

    Laurent Garosi (UK)

    Oh no, I have a sick fi shcoming in!

    Ray Butcher (UK)

    take diagnostic samples with ultrasound guidanceMichael Herrtage (UK)

    1545

    CLOSE FOR BSAVA LECTURE HALL 1

    1630

    BSAVA LECTURE HALL 1JOE SIMPSON TOUCHING THE VOID

    1700

    WELCOME RECEPTION NATIONAL INDOOR ARENACome and enjoy a free drink with the exhibitors

    1900

    EXHIBITION CLOSES IN NATIONAL INDOOR ARENA

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    CONGRESS SCIENTIFIC PROGRAMME 2010

    Friday 9 AprilTime Hall 1 Hall 3 Hall 5 Hall 8 Hall 9 Hall 10

    INTERACTIVE ONCOLOGY SEIZURES FELINE ORTHOPAEDICSTRANSFUSION

    MEDICINE BEHAVIOURVETERINARY

    MASTERCLASSES

    0830 Managing persistent vomiting

    Kenny Simpson (USA)

    Feline lymphoma

    Dave Ruslander (USA)

    Epileptic seizures: classifi cation and diagnostic approach

    Holger Volk (UK)

    Equipping the practice for feline orthopaedic surgery

    John Lapish (UK)

    Does my patient need a transfusion?

    Amanda Boag (UK)

    Mental stimulation for dogs to prevent behaviour problems: what makes a good toy or game?

    Helen Zulch (UK)09001230Executive 1

    Challenging cardiopulmonary diseases

    Lynelle Johnson (USA) & Virginia Luis Fuentes (UK)

    Executive 2

    Diagnostic challenges, clinical presentations, and long-term management of food allergy in dogs and cats

    Ed Rosser (USA)

    0915

    0925 Canine mammary tumours

    Jo Morris (UK)

    Metabolic and toxic causes of epileptic seizures

    Laurent Garosi (UK)

    Fracture planning in cats

    Rico Vannini (Sui)

    Canine blood donation: the practicalities

    Gill Gibson (UK)

    Taking care of dog behaviour in everyday veterinary practice: make your life easier!

    Kendal Shepherd (UK)

    1010 EXHIBITION & COFFEE BREAK NATIONAL INDOOR ARENA

    1105 Feline medicine

    Mike Lappin (USA)

    Multimodality care: when to cut, irradiate or use chemotherapy for cancer

    Dave Ruslander (USA)

    STATE OF THE ARTGenetic testing in canine and feline epilepsy

    Cathryn Mellersh (UK)

    Forelimb fracture repair in cats

    Katja Voss (Australia)

    Blood banking: an alternative to DIY?

    Amanda Boag (UK)

    Life skills for puppies; practical tips for new owners

    Helen Zulch (UK)

    1150

    1200 Is it cancer? How to read your pathology report

    Sue Murphy (UK)

    MRI imaging changes in epilepsy: cause and effect

    Fraser McConnell (UK)

    Practical and economical methods for mandibular fracture repair in cats

    Harry Scott (UK)

    Safe transfusion medicine practices

    Matt Beal (USA)

    Help, my dog has bitten someone; what should I do?

    Kendal Shepherd (UK)

    1245

    EXHIBITION & LUNCH NATIONAL INDOOR ARENA

    i

    i s

    m

    Time Hall 1 Hall 3 Hall 5 Hall 8 Hall 9 Hall 10

    INTERACTIVE ONCOLOGY SEIZURES FELINE ORTHOPAEDICSTRANSFUSION

    MEDICINE FARM PETSVETERINARY

    MASTERCLASSES

    1415 Not just a string of numbers: how to read a clinical chemistry report

    Harold Tvedten (Swe)

    Skin tumours in the cat

    Dave Ruslander (USA)

    Optimising maintenance management of epileptic seizures

    Jacques Penderis (UK)

    Foot fracture repair in cats

    Katja Voss (Australia)

    Rational use of blood products

    Matt Beal (USA)

    Treating the sick pet chicken

    Victoria Roberts (UK)

    14151745Executive 1

    Diagnosis and management of chronic intestinal disease

    Kenny Simpson (USA) & Ed Hall (UK)

    Executive 2

    Corneal surgery

    Ingrid Allgoewer (Ger)

    1500

    1510 Skin tumours in the dog

    Dave Ruslander (USA)

    Refractory epilepsy

    Holger Volk (UK)

    Common joint problems in cats and how to manage them

    Rico Vannini (Sui)

    Treating the sick pet pig

    Graham Duncanson (UK)

    1555 EXHIBITION & TEA BREAK NATIONAL INDOOR ARENA

    1650 Conundrums in hypertension

    Clarke Atkins (USA)

    PREPARATION FOR BANQUET

    Feline seizures

    Jacques Penderis (UK)

    Pelvic fractures in cats: when and how to repair

    Katja Voss (Australia)

    Feline transfusion medicine: uniquely challenging aspects

    Sophie Adamantos (UK)

    Treating the sick pet goat

    Kat Bazeley (UK)

    1735

    1745 Emergency management of seizures

    Karen Humm (UK)

    Feline femoral fracture repair and how to avoid complications

    Rico Vannini (Sui)

    Blood typing and cross matching: what to do and when

    Gill Gibson (UK)

    Group health for the hobby farmer

    Kat Bazeley (UK)

    1830

    EXHIBITION CLOSES IN NATIONAL INDOOR ARENA

    read a clinical chemistry i

    i

    m

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    CONGRESS SCIENTIFIC PROGRAMME 2010

    Saturday 10 AprilTime Hall 1 Hall 3 Hall 5 Hall 8 Hall 9 Hall 10

    INTERACTIVE FELINE MEDICINE OPHTHALMOLOGY GASTROENTEROLOGY TNAVCReptiles CARDIOLOGYVETERINARY

    MASTERCLASSES

    0830 What are these radiographic bone changes?

    Erik Wisner (USA)

    Feline vaccinology: whats the best approach to preventing infections in cats?

    Mike Lappin (USA)

    Eye testing for hereditary eye diseases

    Sheila Crispin (UK)

    Whats new in feline pancreatitis

    Kenny Simpson (USA)

    Common reptilian emergencies

    Doug Mader (USA)

    Systemic arterial embolism in cats

    Clarke Atkins (USA)

    08451230Hall 6

    In-house blood smears

    Harold Tvedten (Swe)

    09001230Executive 2

    Soft tissue sarcoma in the cat and dog

    Julius Liptak (USA) & Dave Ruslander (USA)

    0915

    0925 Wellness programmes for a healthy practice

    Margie Scherk (Can)

    Genetic testing for hereditary eye diseases

    Cathryn Mellersh (UK)

    Imaging the pancreas

    Michael Herrtage (UK)

    ER/ICU care of reptile patients

    Doug Mader (USA)

    Asymptomatic cats with murmurs

    Kerry Simpson (UK)

    1010 EXHIBITION & COFFEE BREAK NATIONAL INDOOR ARENA

    1105 The polytraumatised cat: how to face the challenge

    Rico Vannini (Sui)

    Feline vaccinology: whats the current thinking on vaccine-associated side-effects?

    Mike Lappin (USA)

    Breed-related eyelid disorders

    Ingrid Allgoewer (Ger)

    Diagnosis and management of acute pancreatitis

    Dan Chan (UK)

    Fracture repair in reptiles

    Doug Mader (USA)

    Differentiating cardiac from respiratory disease

    Clarke Atkins (USA)

    1150

    1200 Unique challenges to manage the neonate and kitten

    Margie Scherk (Can)

    Primary glaucoma: diagnosis, differential diagnosis and treatment options

    Claudia Hartley (UK)

    Chronic pancreatitis in the dog: a new disease entity?

    Penny Watson (UK)

    Reptilian gout

    Doug Mader (USA)

    Why do dogs with murmurs cough?

    Luca Ferasin (UK)

    1245

    EXHIBITION & LUNCH NATIONAL INDOOR ARENA

    i

    i

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    Time Hall 1 Hall 3 Hall 5 Hall 8 Hall 9 Hall 10

    INTERACTIVE FELINE MEDICINE OPHTHALMOLOGY GASTROENTEROLOGY TNAVCDentistry CARDIOLOGYVETERINARY

    MASTERCLASSES

    1415 Why is this rabbit not eating?

    Frances Harcourt-Brown (UK)

    Fever of unknown origin in the cat

    Mike Lappin (USA)

    Inherited conditions of the lens: diagnosis and treatment options

    Ingrid Allgoewer (UK)

    Chronic vomiting: whats the cause?

    Jimmy Simpson (UK)

    Maximising dentistry in your practice

    Bill Gengler (USA)

    ACE inhibitors, azotaemia and NSAIDs

    Clarke Atkins (USA)

    14151745Executive 1

    Imaging in the diagnosis of vascular liver diseases in dogs and cats

    Wilfried Mai (USA) & Victoria Johnson (UK)

    Executive 2

    Locking implants in orthopaedics

    Katja Voss (Australia) & Malcolm Ness (UK)

    1500

    1510 Inherited conditions of the ocular fundus

    Sheila Crispin (UK)

    Chronic gastritis in dogs and cats

    Kenny Simpson (USA)

    Regional anaesthesia and oral pain management

    Bill Gengler (USA)

    Hypertensive heart disease: importance, monitoring and treatment

    Clarke Atkins (USA)

    1555 EXHIBITION & TEA BREAK NATIONAL INDOOR ARENA

    1650 Ophthalmology

    Ingrid Allgoewer (Ger)

    PREPARATION FOR PARTY

    NIGHT

    FELINE MEDICINE STATE OF THE ARTThe emerging importance of bacteria in infl ammatory bowel diseaseKenny Simpson (USA)

    Oral trauma

    Bill Gengler (USA)

    Goals and side-effects of heart failure treatment: what should we monitor?

    Anne French (UK)

    Homecare and end of life issues

    Margie Scherk (Can)

    1735

    1745 Therapeutic implications of renal insuffi ciency: new thoughts

    Margie Scherk (Can)

    Endoscopic evaluation of the GI tract

    Jimmy Simpson (UK)

    Orthodontics

    Bill Gengler (USA)

    Managing tachyarrhythmias: current approaches

    Simon Dennis (UK)

    1830

    EXHIBITION CLOSES IN NATIONAL INDOOR ARENA

    i

    i s

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    CONGRESS SCIENTIFIC PROGRAMME 2010

    Sunday 11 AprilTime Hall 1 Hall 3 Hall 5 Hall 8 Hall 9 Hall 10

    IMAGING II MADE EASY RESPIRATORY UROLOGY GERIATRICS CLINICAL PATHOLOGYVETERINARY

    MASTERCLASSES

    0900 Small animal thoracic imaging I

    Erik Wisner (US)

    Microchipping

    Chris Laurence (UK)

    Managing snotty-nosed cats

    Lynelle Johnson (USA)

    Current trends in canine urolithiasis (including management)

    Jodi Westropp (USA)

    Diet in the ageing animal

    Dan Chan (UK)

    Interpretation of graphic reports from haematology instruments

    Harold Tvedten (Swe)

    09001230Executive 1

    Feline bug transfusions: important blood-borne infections

    Mike Lappin (USA) & Sverine Tasker (UK)

    Executive 2

    Lameness of unknown origin? Evaluation and prevalence of foraminal lesions along the spinal vertebral column

    Thomas Gdde (Ger)

    Microscopy

    Elizabeth Villiers (UK)

    0945

    0955 Small animal thoracic imaging II

    Erik Wisner (US)

    Skin scraping

    Claudia Nett (Sui)

    Managing snotty-nosed dogs

    Jon Wray (UK)

    Current trends in feline urolithiasis (including management)

    Jodi Westropp (USA)

    The ageing heart and lungs

    Geoff Culshaw (UK)

    Cytology I: how to get back something better than non-diagnostic on FNAs

    Balzs Szladovits (UK)

    Getting blood from an aggressive catMargie Scherk (Can)

    1040 EXHIBITION & COFFEE BREAK NATIONAL INDOOR ARENA

    1145 Abdominal imaging

    Fraser McConnell (UK)

    Bone marrow aspirationElizabeth Villiers (UK)

    Tracheal collapse: the tip of the iceberg

    Lynelle Johnson (USA)

    Occult urinary tract infections

    Clive Elwood (UK)

    The ageing musculoskeletal system

    Sorrel Langley-Hobbs (UK)

    Anaemia in the cat

    Harold Tvedten (Swe)

    Placing an oesophagostomy tubeKaren Humm (UK)

    1230

    EXHIBITION & LUNCH NATIONAL INDOOR ARENA

    1400 EXHIBITION CLOSES IN NATIONAL INDOOR ARENA

    m

    Time Hall 1 Hall 3 Hall 5 Hall 8 Hall 9 Hall 10

    IMAGING II MADE EASY RESPIRATORY UROLOGY GERIATRICS CLINICAL PATHOLOGY

    1400 Review of small animal orthopaedic disease

    Erik Wisner (USA)

    Placing a PEG tube

    Lucy McMahon (UK)

    Use of bronchoscopy and bronchoalveolar lavage in small animal medicine

    Lynelle Johnson (USA)

    STATE OF THE ARTLaser lithotripsy: its use for canine and feline urolithiasis

    Jodi Westropp (USA)

    The ageing brain

    Holger Volk (UK)

    Anaemia in the dog

    Harold Tvedten (Swe)

    Indirect ophthalmoscopy

    Lorraine Fleming (UK)

    1445

    1455 Interventional radiology: overview and veterinary applications

    Matt Beal (USA)

    Joint taps

    Harry Scott (UK)

    Chronic cough: making the diagnosis

    Lynelle Johnson (USA)

    Advanced diagnostics for lower urinary tract evaluation in small animals

    Jodi Westropp (USA)

    The ageing kidney

    Hattie Syme (UK)

    Cytology II: interpretation of cytological preparations

    Balzs Szladovits (UK)

    Medicating birds

    John Chitty (UK)

    1540

    1550 Role of the tracheal stent for the management of tracheal collapse

    Matt Beal (USA)

    Acidbase interpretation

    Amanda Boag (UK)

    Chronic cough: management

    Brendan Corcoran (UK)

    Managing multidrug-resistant urinary tract infections

    Jane Eastwood (UK)

    The ageing eye

    David Williams (UK)

    Testing for FIP, FeLV and FIV

    Sverine Tasker (UK)

    Emergency echo

    Virginia Luis Fuentes (UK)

    1635TEA & COFFEE ICC HALL 3 FOYER

    CONGRESS CLOSES

    s

    For full details of the Veterinary and Nursing Programme for Congress 2010

    visit www.bsava.com

    Details correct at time of going to press

  • companion | 21

    CONGRESS

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    CONGRESS

    Once youve enjoyed some of the best veterinary science in the lecture halls and discovered the latest industry innovations in the Exhibition, youll be ready to let your hair down

    Youre having a laugh arent you? Well you will be if you make sure youve got your Party Night ticket for the Saturday of Congress. Youll be treated to a double whammy of fun this year, with your cult comedy host Stephen Grant turning on the laughing gas with a short set, before introducing you to one of the most popular names on the comedy circuit

    Jason ManfordIn 1999, at the Buzz Comedy Club in Manchester, fate stepped in to turn Jason Manford from a 17-year-old glass collector into a professional comic. When a performer didnt arrive for their set one evening, Jason stepped in an event which marked the beginning of his comedy career. Just six gigs later he was winning comedy awards and today hes a TV panel show stalwart, providing the laughs as one of the captains on 8 out of 10 Cats. Even if you

    dont recognise his face, youll know what he sounds like, as he can currently be heard as one of the voices in the BBC comedy sketch show, Walk on the Wild Side and for the Churchill Insurance adverts.

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    CONGRESS

    Have a drink on usIn between the comedy and the music youll be able to indulge in some nice nibbles from the Party Night buffet and get yourself some drinks. Dont forget to use your drink tickets earlier in the evening during Happy Hour, when your drink ticket is worth double!

    Jason Manford joke:About tipping when dining out

    You cant give an adult a pound, you

    may as well say there you go mate,

    get yourself some sweets.

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    CONGRESSCONGRESS

    The ProclaimersTwin brothers Craig and Charlie Reid will lead the Party Night musical frivolities. As The Proclaimers, they have enjoyed huge success across the globe with emotional, honest, witty, sing-along raucousness that entertains fans across the generations.

    Sound beginningsAfter building a strong following in Scotland, in January 1987 they made a now seminal appearance on Channel 4s The Tube, performing Letter From America. Singing in regional accents about Scotland they were a far cry from the mid-Eighties playlist staples of Rick Astley and Sinitta. Voted NME Readers Best New Band that year, they toured the UK extensively and Letter From America, produced by Gerry Rafferty, went Top 3.

    TOP TUNES

    Essential reminder to membersRemember, if you register for whole Congress before 31 January we will give you 25 to spend on CPD or manuals on the BSAVA Balcony at Congress. Conditions apply. The regular Early Bird deadline is 10 February.

    Book your Party Night tickets with your Congress registration to avoid disappointment. For full details about all the social acts and events and to register, visit www.bsava.com.

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    ResurgenceIn 2007 they topped the UK singles chart again with a rousing new rendition of their classic anthem Im Going to Be (500 Miles), a collaboration with comedians Peter Kay and Matt Lucas for Comic Relief, raising over a million pounds in the process. EMI re-launched their 2002 Best Of collection, re-entering the Album Charts at number 5.

    Matt Lucas is a huge fan and in the sleeve notes of their Best Of compilation he writes: I find it hard to put into words quite how the music of The Proclaimers makes me feel. It makes me laugh. It makes me cry. It just makes me generally euphoric.

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    VIN

    Marc Silverman, DVMAgoura Animal Clinic, Agoura Hills, CA

    I have a sick patient that could use your input. Alex is a 17 year old M/N DSH with an 8 day history of illness. He first presented to our practice on 7/7/09 with weight loss over 1 month and anorexiav and vomiting for 3 days. He was febrile on presentation (T=103.8F), 78% dehydrated, listless, and had a 2/6 left sternal systolic heart murmur.

    Chest and abdominal radiographs were normal except the kidneys seemed somewhat rounded instead of kidney-shaped. Urinalysis showed SG1.015, pH=6, no protein and unremarkable sediment. Subsequent urine culture was negative. Systolic blood pressure was 125mm Hg.

    In-house blood work showed the following abnormalities: low normal HCT=25% with normal RBC morph. Increased BUN (112, normal 1636), increased Creat (5.3, normal 0.82.4), PO4 (8.6, normal 3.17.5) and low K (2.8, normal 3.55.8).

    Treatment was initiated with IV L/R and K+ supplement, injectable Pepcid, sodium ampicillin, and Zofran. After 2 days, the cats dehydration had resolved, he was normothermic, his heart murmur had not changed, he had not vomited since being hospitalized, he was much more alert, but still had a poor appetite.

    Blood work was repeated and his azotemia and hypokalemia had improved to the point that we felt that they may no longer be contributing to his anorexia. His anemia was more severe but a bit more than we expected from rehydration alone:

    BUN now 60 from 112Creat now 3.6 from 5.3HCT now 19% from 25%

    Mirtazepine was started (1/4 tab of 15mg tab q 72 hours) and he was switched from injectable Zofran to Cerenia. We also started him on sucralfate.

    The following day (day 3 of hospitalization) he appeared more animated but still would not eat so the owner elected to take him home for a day to see if his appetite would be better at home. He was discharged with L/R and 20meq KCl/L and the owner was instructed to give him 100cc SQ daily, plus oral Cerenia, Pepcid, Sucralfate (given separately) and amoxicillin. Two days later (yesterday evening), Alex was returned to us due to persistence of the poor appetite.

    Blood work showed his anemia was worse (HCT=15% still normocytic, normochromic) and his kidney function tests were stable (BUN=50 Creat=3.5). We ultrasounded his abdomen today (I wish we had done this on day 1).

    We found his abdomen unremarkable except for his pancreas (which is hypoechoic with possibly a mild hyperechoic rim) and his kidneys (which dont seem to have as crisp a contrast between the cortices and medullae). So our presumptive diagnoses are now that he has had pancreatitis the entire time and the kidney disease has been more chronic and only of secondary consequence to his illness. We are also considering that he could have IBD or lymphoma, but we did not find any areas of small intestine that were thickened.

    Please evaluate the following images of his kidneys, liver and pancreas. Videos will follow. We are not sure how much change can be present in a normal geriatric feline pancreas, so please tell us if you feel a diagnosis of pancreatitis can be made from this study.

    The images we made with our 12L probe seem washed out (darker and less contrast) even though the detail seems better (smaller pixels?) than with the 8C probe. Any suggestions on tweaking the settings for better images?

    Thanks, Marc

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

    Discussion: Pancreatitis versus old pancreas

    companion | 23

  • 24 | companion

    VIN

    GrapeVINe

    Robert Hylands DVM, VIN Associate EditorDiagnostic Imaging, Westbridge Veterinary Hospital, Mississauga, ON, Canada

    The images demonstrate as you suspected an inflamed pancreas. What is different though is the lack of thickening of the adjoining duodenum. Sometimes I only see the inflammation near the head of the pancreas in the acute stages of the disease. The surrounding fat does seem hyperechoic but no fluid is noted. Perhaps this would be more evident on the videos. In older cats what we often see is nodular hypoechoic zones within the parenchyma of the pancreas. I do not really appreciate this in your cat. To me this looks more like a chronic active pancreatitis but only further testing would confirm.

    The anemia is of obvious concern in this patient. Is there any evidence of a response? What is the platelet count? The kidneys do not seem diseased enough to be the root of this problem. Look for other causes, loss or lack of production

    As for the L12 perhaps you are using the wrong preset, maybe try something like a carotid or thyroid preset or decrease the gain.

    Figure 1: Liver and portal veinFigure 2: Right kidneyFigure 3: Left kidneyFigure 4:Left limb of pancreasFigure 5: Right limb of pancreas with duodenum

    1

    3

    5

    2

    4

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    VIN

    The chronic active pancreatitis makes a lot of sense with the 1 month history of weight loss.

    >>> I do not know if your cat was on fluids during the US scan but there are signs of pyelectasia (see the arrows) on your image. > The anemia is of obvious concern in this patient. Is there any evidence of a response? What is the platelet count? The kidneys do not seem diseased enough to be the root of this problem. Look for other causes, loss or lack of production...

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    PUBLICATIONS

    Test your knowledge with our BSAVA Publications Quiz, based on the BSAVA Manuals released in the last 12 months (Abdominal Imaging, Behavioural Medicine, Rodents and Ferrets, and Wound Management). Do it just for fun, or for your chance to win these four new veterinary manuals. Simply email your answers to [email protected] before 31 December 2009, the winner will be drawn from all the correct responses

    CHRISTMAS QUIZCHRISTMAS CHRISTMAS CHRISTMAS CHRISTMAS CHRISTMAS CHRISTMAS

    ImagingWound care

    13

    4

    What N is the initial phase of an excretory urogram?

    What P is another name for these normal duodenal out-pouchings seen with contrast radiography?

    What A could have caused this gaseous dilatation of the stomach?

    What D is the type of lateral view which requires the patient to be placed in lateral recumbency and use of a horizontal X-ray beam?

    What J is a type of silicone drain available in different lengths, with a large flat end that contains multiple fenestrations?

    5

    6What S is a type of muscle flap indicated to close defects of the perianal area and perineal hernias?

    A1:

    A2: A4: A6:

    A5:

    A3:

    What P is another name for these

    2

  • companion | 27

    PUBLICATIONS

    Rodents and ferrets

    Behaviour

    8

    What J are a type of forceps used for microsurgery?

    What H describes this tension-relieving mattress suture?

    What J are a type of forceps 7

    What type of cells, beginning with the letter K, are a unique population of leucocytes found in guinea pigs and recognizable by their oval or round inclusions?

    9

    their oval or round inclusions?

    10

    What type of cells, beginning with the letter K, are a unique with the letter K, are a unique

    11

    12

    14 16

    What E has been caused by scruffing in this hamster?

    What A is a disease of ferrets and mink caused by a parvovirus?

    What F is a type of papilla found on the long, mobile tongue of ferrets, which is missing from this list: filiform, vallate, foliate?

    What S is a possible behavioural problem in dogs with clinical signs of destruction, vocalization, house soiling or self-trauma/licking?

    What P is a type of learning also known as classical or respondent conditioning?

    What E contributes to independent play/activity in a dog?independent play/activity in a dog?

    13 15What A is a type of affiliative behaviour characterized by two cats rubbing their heads, bodies or tails on one another?

    For more information about the latest BSAVA manuals visit www.bsava.com

    A7:

    A8:

    A9:

    A11:

    A10: A12:

    A13:

    A15:

    A14: A16:

    S

    .J. E

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    rst

    (ww

    w.li

    ving

    art.

    org.

    uk)

  • 28 | companion

    PETSAVERS

    Improving the health of the nations pets

    THREE NEW EXCITING AWARDS

    As 2009 draws to a close, so does Petsavers 35th year. Petsavers was formed in 1974 as the Clinical Studies Trust Fund and has been devoted to improving our understanding and treatment of the diseases affecting our pets ever since.

    To celebrate Petsavers 35th year, Petsavers decided to make a special one-off award of up to 25,000. Qualified veterinary surgeons were invited to apply for funds to support a clinical study in pet small animal,

    the objective of which must be to advance the understanding of the cause and/or management of a clinical disorder. The projects, like all Petsavers-funded studies, could not involve experimental animals and the project must also further the knowledge of the small animal practitioner.

    The Petsavers Grants Awarding Committee met this August to discuss the applications received and decide which application would receive the special Petsavers 35th anniversary award.

    The standard of applications was high and eventually the grants awarding committee decided to fund not just one project, but three.

    35th anniversary projects

    To celebrate the their 35th anniversary, Petsavers has funded three new valuable projects

    1 Using molecular genetics to predict more accurately the prognosis for dogs with mast cell tumours, awarded to Mrs Suzanne Murphy of the Animal Health Trust. The aim of this study is to confirm the consistent differential expression of eight genes that putatively display different levels of expression between mast cell tumours that metastasise and mast cell tumours that do not.

    3 Diagnostic value of transverse sectioning in the evaluation of skin biopsy specimens from alopecic dogs, awarded to Dr Ross Bond of the Royal Veterinary College. The aim of the study is to challenge current veterinary pathology practice by providing evidence that transverse sectioning, in conjunction with routine vertical sectioning, is of additional diagnostic value in the histopathological evaluation of biopsies from alopecic dog skin, as noted in human dermatopathology. Samples from cases of canine alopecia generated through the clinical caseload are to be evaluated histopathologically after both vertical and transverse sectioning. In addition to this varied case material, the techniques are to be applied comparatively to characterise the pathological features of an alopecic skin disease of Curly Coated Retrievers.

    2 Computed tomography assessment of efficacy of arthroscopy in the treatment of medial coronoid disease by a prospective clinical study, awarded to Mr Elvin Kulendra of the Royal Veterinary College. The aim of this study is to test the hypothesis that dogs with elbow lameness associated with fragmentation of the medial coronoid process have greater functional improvement after arthroscopy in which articular fragments are completely removed than when fragments are either partially or incompletely removed.

    We hope that all three projects will be a great success and are delighted to be able to fund them all. If you are interested in Petsavers grants and projects please visit our website to find out more: www.petsavers.org.uk

  • companion | 29

    CPD

    SHARPEN YOUR SURGERY SKILLS

    The BSAVA surgical mini-modular programme starts with the basics and builds to develop higher levels of surgical decision making, offering practical tips on how to achieve declared surgical goals

    Surgery of the alimentary tractWednesday 28 AprilThe second module will discuss specific gastrointestinal diseases to reinforce the principles highlighted in the first module. More common diseases, such as intestinal obstruction, gastric dilatation and volvulus and large bowel diseases, will be used to illustrate best surgical practice relevant to any surgical practitioner. Patient evaluation, stabilisation, surgical treatment and postoperative care will all be covered in more detail.

    From large kidney to small bladderTuesday 11 MayOn the third module you will explore surgical diseases of the urinary tract in more

    detail, with the aim of highlighting the special considerations necessary for surgery at different levels within the urinary tract. Surgical management of urinary incontinence, urinary tract neoplasia and urinary tract trauma will be described, along with essential steps in patient assessment and stabilisation.

    Abdominal pot pourri: pancreatic, adrenal, biliary tract and liverTuesday 15 JuneFinally, the fourth module will address surgical diseases of specific organs in more detail, with the aim of highlighting the special considerations necessary for different organs. Diagnosing and treating diseases of the extrahepatic biliary tract, pancreas and adrenal glands all have their own specific challenges and pitfalls; these will be highlighted and discussed.

    FEES Member Non Member

    Booked before 1 Jan 2010

    734.45 1101.67

    After 1 Jan 2010 773.10 1159.65

    All modules for the surgery course will be presented at Woodrow House in Gloucester by Dan Brockman and a second speaker (to be confirmed). Book before 1st January to make an even greater saving on your usual member discount.

    Back to basicsTuesday 16 MarchThe first module will serve as a reminder of basic physiology of the abdominal cavity and organs, and will cover a range of generic and specific recommendations regarding surgery inside the peritoneal cavity, from the provision of perioperative antibiotics and instrument selection to consideration of the redundancy in different organ systems.

    The essential dispensing course from BSAVA helps veterinary practices manage their dispensaries with up-to-date information on the new Medicines Regulations. The content of the course provides you with everything you need to know about dispensing and now includes equine and clinical waste elements too. The next course takes place in Cambridge on 16 March. Places fill quickly, so book early to save money and avoid disappointment. For more details and to book, see the flyer enclosed with this edition or visit the website.

    For more information or to book a place on a BSAVA CPD course, visit www.bsava.com, email [email protected] or call 01452 726700.

    DISPENSING FOR THE WHOLE PRACTICE

    he essential dispensing course from BSAVA helps veterinary practices manage their dispensaries with up-to-date information on the new Medicines Regulations. The content of the course provides you

    elements too. The next course takes place in Cambridge on 16 March. Places fill quickly, so book early to

    For more information or to book a place on a BSAVA CPD course, or call 01452 726700.

    DISPENSING FOR THE

  • 30 | companion

    The annual WSAVA Continuing Education programme was held in a packed Shanghai Science Hall on 17 September. The WSAVA invited Dr Terry King from Australia Veterinary Specialist Services Pty Ltd to deliver a lecture about emergency veterinary medicine and critical care. The lecture was introduced by the President of the Shanghai Small Animal Veterinary Association, Dr Geoffrey Chen, and was translated by Dr Shu Dai from Hills Pet Nutrition China Division.

    Dr King gave lectures on the diagnosis and treatment of sepsis in dogs and cats, and

    transfusion in critical cases. Dr King graduated from the University of Queensland School of Veterinary Science in 1975 and spent the next 19 years in private practice in Brisbane. After a years sojourn in the USA and Brisbanes Animal Emergency Centre, Terry joined the University of Queensland Veterinary Teaching Hospital in late 1995 as a medical resident, becoming Director of the Clinic and Hospital in 1997 and 2002 respectively. Dr King enjoys the emergency aspects of veterinary practice and has a special interest in treating the critically ill. He is highly committed to family veterinary medicine, prolonging the humananimal bond.

    The WSAVA CE programme in Shanghai was sponsored by Bayer Healthcare, Hills Pet Nutrition China Division, and Intervet/Schering-Plough Animal Health.

    CPD IN SHANGHAIGeoffrey Chen reports on the WSAVAs continuing education programme

    Dr Terry King, Dr James Holder and Dr Geoffrey Chen with the Hills team in Shanghai

    We wish all of our WSAVA family and colleagues within the veterinary/animal health

    profession a w