Companion February 2014 Low Res

The essential publication for BSAVA membersThe essential publication for BSAVA members

companionFEBRUARY 2014

Top TipsFor rabbit surgery

P12

Free microchippingWhat will you do?

P4

Clinical ConundrumHaematochezia in a Bichon FriseP8

Avian anaesthesia

01 OFC February.indd 1 20/01/2014 08:46

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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 bene t. Veterinary schools interested in receiving companion should email [email protected]. We welcome all comments and ideas for future articles.

Tel: 01452 726700Email: [email protected]

Web: www.bsava.comISSN (print): 2041-2487ISSN (online): 2041-2495

Editorial BoardEditor Mark Goodfellow MA VetMB DPhil CertVR DSAM DipECVIM-CA MRCVSCPD Editor Simon Tappin MA VetMB CertSAM DipECVIM-CA MRCVSPast President Mark Johnston BVetMed MRCVS

CPD Editorial TeamPatricia Ibarrola DVM DSAM DipECVIM-CA MRCVSTony Ryan MVB CertSAS DipECVS MRCVSLucy McMahon BVetMed (Hons) DipACVIM MRCVSDan Batchelor BVSc PhD DSAM DipECVIM-CA MRCVSEleanor Raffan BVM&S CertSAM DipECVIM-CA MRCVS

Features Editorial TeamAndrew Fullerton BVSc (Hons) MRCVS

Design and ProductionBSAVA Headquarters, Woodrow House

No part of this publication may be reproduced in any form without written permission of the publisher. Views expressed within this publication do not necessarily represent those of the Editor or the British Small Animal Veterinary Association.For future issues, unsolicited features, particularly Clinical Conundrums, are welcomed and guidelines for authors are available on request; while the publishers will take every care of material received no responsibility can be accepted for any loss or damage incurred.BSAVA is committed to reducing the environmental impact of its publications wherever possible and companion is printed on paper made from sustainable resources and can be recycled. When you have finished with this edition please recycle it in your kerbside collection or local recycling point. Members can access the online archive of companion at www.bsava.com .

3 BSAVA NewsLatest from your Association

46 Microchip updateLatest on compulsory michrochipping

811 Clinical ConundrumPolyuria/polydipsia in a young Bichon Frise

1213 Top tips for rabbitsImaging and surgery

1419 How ToAnaesthetize a bird

2021 Pyothorax expertiseVanessa Barrs at Congress

2225 Specialist meetingsAffiliated Groups at Congress

26 Countdown to CongressLast minute tips

27 To split or not to splitA PetSavers-funded study into immune-mediated haemolytic anaemia

2829 WSAVA NewsWorld Small Animal Veterinary Association

3031 The companion interviewKirstie Shield

33 Regional CPDLocal knowledge close to home

3435 CPD DiaryWhats on in your area

Additional stock photography:www.dreamstime.com Alexey Poprotskiy; Andres Rodriguez; Auris; Byelikova; Deniskelly; Erik Lam; Frenc; Iqoncept; Isselee; Jocic; Khmel08; Michael Pettigrew

Feline injection site sarcomas are therapeutically challenging because of their locally invasive nature. Several protocols recommend that the two perceived high-risk adjuvanted vaccines should be administered into distinct anatomical sites (left hind leg leukaemia, right hind leg rabies), which should aid surgical resection. This has resulted in a change in tumour distribution with an increased proportion situated caudal to the diaphragm when such a policy is adopted.

The aim of this study was to determine UK cat owners attitudes towards surgical treatments of different anatomical regions. A cross-sectional study of an anonymous convenience sample of UK cat owners was conducted from September to December 2012 using an internet-based survey.

208 owners responded. Of these, 39% said they would pursue surgery regardless of tumour site, and 1% said they would not pursue surgery. Of the remainder, respondents would not allow

OTHER PAPERS IN THIS MONTHS JSAP

Review Paper: Advances in soft ti ssue minimally invasive surgery

Computed tomography in surgical treatment of recurrent draining tracts

Iron status and C-reacti ve protein in canine leishmaniasis

Phenotypic characterizati on of canine epileptoid cramping syndrome in the Border Terrier

Bromide serum levels following an oral loading dose in epilepti c dogs

Log on to www.bsava.com to access the JSAP archive online.

amputation of the forelimb (20%), hindlimb (15%) or tail (15%); 26%, 32% and 27% would not have surgical treatment of the inter-scapular region, chest or abdomen, respectively. The majority of respondents were willing to travel up to 100 miles for radiotherapy or chemotherapy (66% and 69%, respectively).

The authors conclude that the current feline vaccine site recommendations may not be appropriate for UK cat owners.Adapted from Carwardine, D., et al. JSAP 2014; 55, 8488

Whats in JSAP this month?Owner preferences for treatment of feline injection site sarcomas

EJCAP ONLINE

New issue of EJCAP now available visit www.fecava.org/ejcap.

Find FECAVA on Facebook!

02 Page 02 February.indd 2 20/01/2014 14:22

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Collect your new Formularyat Congress

Dont forget to pick up your 2014 member benefit and loyalty benefit publications from the membership service team on the BSAVA stand on the balcony. Vet members can collect the new edition of the BSAVA Small Animal Formulary. The loyalty benefit for paying vet members who have renewed their membership for 2014 is a new edition of the BSAVA Guide to Small Animal Procedures. Vet Nurse members who have renewed their membership for 2014 will receive a new loyalty benefit, the BSAVA Casebook for Veterinary Nurses.

CLINICAL CONUNDRUM

Readers are encouraged to re-read the Clinical Conundrum from Januarys companion online at www.bsava.com, where a few minor inconsistencies have been recti ed.

Membership renewals

If you havent done so already, now is the time to renew your BSAVA membership. If you have any questions regarding your membership please contact our Membership Services Team on 01452 726700 or email [email protected] who will be happy to help.

In November BSAVA wrote to Public Health England to ask if they would be prepared to review their risk assessment for front line staff in veterinary practices (i.e. veterinary surgeons, veterinary nurses and receptionists) regarding pre-exposure rabies vaccination. On 24 December BSAVA received a response which explained that risk categories for inclusion in the free rabies pre-exposure vaccine list are determined by the Joint Committee on Vaccination and Immunisation (JCVI) which is an advisory committee of the Department of Health.

It is this committee that is responsible for any change in policy and PHE issues the vaccines in line with this advice. However, the letter indicated that as there had not been a review for some years. It was their view that there was merit in JCVI revisiting the issue, and so they plan to submit a discussion paper to propose a clearer definition of the groups at occupational risk and to update the description of those groups. Public Health England went on to suggest that BSAVA may wish to make a direct approach to JCVI to stress the particular concerns of frontline veterinary staff and request a review of the current rabies pre-exposure vaccination policy, which we have now done. Members can read both the letters online at www.bsava.com/consultations and we will update you about the progress of this matter as soon as we hear from the Joint Committee on Vaccination and Immunisation.

PHE response on rabies vaccines for vet staff Your views please

This is a busy time for consultations and we encourage you to get involved with BSAVAs various contributions. The RCVS is currently consulting on the proposed new Royal Charter as well as putting out a call for evidence on meeting the expectations on the provision of 24-hour emergency veterinary care.

Just after Christmas the Scottish Government announced a consultation promoting responsible dog ownership in Scotland (Microchipping and other measures).

Following the report of the Advisory Council on the Misuse of Drugs there is also likely to be a consultation on the classification of Ketamine.

To contribute to BSAVA responses on consultations please visit the website www.bsava.com/consultations or email Dr Sally Everitt directly [email protected] . Your involvement in these consultations is invaluable.

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Microchip updateBSAVAs Head of Scientific Policy, Dr Sally Everitt, outlines the current situation regarding compulsory microchipping and the role of Dogs Trust in the free supply of microchips

As you will be aware, the Government announced that it would be introducing compulsory microchipping for all dogs in England from 6 April 2016 (1 March 2015 in Wales). The announcement also included the information that Dogs Trust would make available a free microchip for all unchipped dogs in England and Wales.

The Dogs Trust offer of free microchips extended to providing free microchips to local authorities, housing associations and veterinary surgeries. A letter sent to veterinary practices shortly after the announcement in February stated that they would like to work with as many practices as possible to offer free microchips to dog owners. In this letter it stated that Dogs Trust would provide the free microchips to every practice that wishes to participate, with the proviso that no charge is made when using them. The campaign is expected to last for 12 months and participation will be entirely voluntary.

Mixed reactionThe initial announcement received what can best be described as a mixed reaction from the veterinary profession, as while the

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microchip itself was to be provided free of charge by Dogs Trust the other costs associated with implantation and administration would be borne by the participating veterinary practice. There was concern that providing microchipping free of charge was not only devaluing the role and expertise of the veterinary practice team but also sending out the wrong message over responsible dog ownership.

While there is sympathy for those owners who were genuinely unable to afford the costs of microchipping, the extension to all dog owners not only imposes a cost on veterinary practices but also removes a source of revenue. There was also concern that participating in the scheme could create an expectation amongst clients that microchipping is a free service which would continue after the Dogs Trust scheme ends.

Getting it rightWhile BSAVA has always supported compulsory microchipping, we expressed concern that the announcement from Defra to the effect that All dogs in England to get free microchips had been made prematurely without full

consideration of the implications and consequences, and that in order for compulsory microchipping to be successful it is important that all stages in the chain from supply of microchips through to registration and maintenance of the databases are properly funded.

Although it has been suggested that taking part in the Dogs Trust scheme to provide free microchips through veterinary practices has the potential to bring in people who would not normally attend the practice, it is not clear that these people will necessarily be willing or able to pay for other veterinary services.

Northern Ireland experienceWhen compulsory microchipping was introduced in Northern Ireland, Dogs Trust ran a similar scheme. While this had reasonably wide uptake, the feedback from our members involved in the campaign received mixed reviews. When asked in a BSAVA consultation in 2013 if they considered that providing free microchipping as part of the Dogs Trust scheme had been a positive or negative experience for the practice, only a quarter of respondents

considered it to have been a negative experience while equal numbers considered it to have been a positive experience or neutral experience.

Probing this a little more deeply the majority of respondents noticed an increase in footfall as a result of the scheme but few reported any increase in turnover. In general, practices were happy to be able to provide this service for their own clients but did not feel either the practice or animals benefitted from additional veterinary services to nonclients. Most did not feel that they gained longterm clients from this initiative. Here are some of the comments about this experience:Lots of new people came into the practice, quite a few just had the free microchip but others bought worm/flea treatments and some have become on-going clients of the practice.

The footfall increased but there was no increase in turnover. We had no issue with our own clients receiving free microchips which they often did at booster vaccination time. The vast majority of non-clients purchased nothing else from the practice.


6 | companion

Microchip update

I think it was a positive thing as an aid to reinforce our already-bonded clients and new puppy owners, but the new clients with adult dogs for chip were (with some nice exceptions) almost always with dogs that had never seen a vet before, just wanted chip n go and discussions about routine healthcare, feeding, behaviour etc. just bounced off them. Although some of them would buy a pink diamante collar on the way out a much bigger priority than a worming tablet it would seem.

Dealing with the falloutThere were some concerns expressed in Northern Ireland about the administration of the scheme, where the Dogs Trust actually provided the microchips, with some practices reporting problems with delivery of the microchips. However, at the time of going to press, we understand that in England and Wales practices will be able to use microchips from their normal supplier and claim back a fee from the Dogs Trust for every chip implanted. There was also some uncertainty about how long the scheme would run for and again we understand that this has been clarified on this occasion with the Scheme due to run for one year from 1 April 2014.

Here is a comment received via the consultation about administrative problems:Support staff were under considerable strain with the admin side of microchipping. At the start, Dogs Trust wanted lists of owners and numbers for verification of their chips. Politely told to do their own audit. Support staff were relieved and happy when the free period of microchipping came to an end. The public thought that this was a government sponsored scheme and therefore the vets were being reimbursed by government.

Respondents also mentioned more serious problems that arose and the expectation that it would be the veterinary surgeon who would sort these out, free of

charge, even if they had not carried out the original implantation:Lots of problems with the microchipping done at free events. Not completing paperwork, not chipping them properly or checking that the chip is in following implantation. We had lots of people in the practice expecting us to fix the problems as we are their vet.

A lot of the people coming in were only interested in the free microchip and had no interest in other services. One owner brought in an Akita with a broken leg for a free microchip (despite the fact it was already microchipped!), as an attempt to get a free consultation!

Dogs Trust Free Microchipping through Vets campaignDogs Trust is launching their Free Microchipping through Vets campaign and we understand that letters have now been sent out to practices. The BSAVA consider that the decision whether to participate in the scheme should be a matter for individual practices. Here are some questions that have been raised by veterinary surgeons during the last year some of these will be answered by the Dogs Trust list of Frequently Asked Questions; some will be questions for individual practices to consider.

1. How does the cost of our microchips compare with the amount Dogs Trust will reimburse?

2. What additional paperwork will be required in claiming back money for microchips implanted under the scheme?

3. Do we have the resources in terms of staff and consulting room space to provide this service?

4. Can the practice run free microchip clinics at a certain time and offer normally priced microchips at other times?

5. Who in the practice will carry out the free microchipping (vets, nurses, other members of staff trained to implant microchips)?

6. Do we want to offer health checks or advice at the time of microchipping to benefit the animal or to encourage owners to purchase other products or services from the practice?

7. Will the scheme allow us to implant microchips free of charge at the time of another chargeable service e.g. vaccination, neutering?

8. Can free microchips be used in dogs that require microchipping for other reasons, e.g. tail docking/pet passports?

9. Will a person coming for free microchipping who has not previously been to the practice become a client?

10. Will we ask for proof of identity from nonclients who wish to participate in order to ensure registration details are correct? (There is no requirement to do this as the responsibility for ensuring that the owner and animals details are correct will rest with the owner/registered keeper)

11. How will we deal with animals presented for microchipping which have significant health problems of which the owner is unaware and may not be willing or able to address?

12. If the person offers to make a donation how will this be handled does it have to go to Dogs Trust or could it go to another charity which the practice supports? n

At the time of writing BSAVA had not received the FAQs from Dogs Trust, as soon as we do this will be made available online at www.bsava.com and we will inform members as and when we have any new information.


For more information or to book your coursewww.bsava.com/cpd

Learn@Lunch webinarsThese 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 26 February Hospitalizing rabbits (nurses) 19 March Acute airway investigation (vets) 26 March ECGs (nurses)

Book online at www.bsava.com/cpd

Stock photography: Dreamstime.com. Countrymama; Viorel Sima; Winterling

These regular monthly lunchtime (12 pm) webinars are FREE to BSAVA Members just book your place through

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BSAVA Member: 240.00 inc. VATNon-member: 360.00 inc. VAT

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 cytology7 MayThe course will provide practical tips on setting up and using a microscope, staining methods and sample collection techniques.SPEAKER

Emma DewhurstVENUE

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Whats new in allergies in dogs and cats1 MayThis course will describe the current advances in immunology, microbiology and cutaneous physiology, which direct the practicing clinician in the diagnosis and treatment of allergies.

SPEAKER

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allergies in dogs Advanced

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07 CE Advert February.indd 7 20/01/2014 09:38

8 | companion

Clinical conundrum

Silvia De Cecco and Massimo Orioles, interns at Vets Now Referrals-Kent, invite companion readers to consider a case of intermittent haematochezia and polyuria/polydipsia in a young Bichon Frise

Case presentationA 5-year-old female entire Bichon Frise presented with a history of mild intermittent haematochezia and recent polyuria and polydipsia (PU/PD). The patient had no history of travel outside of the United Kingdom and was regularly vaccinated and wormed.

Despite the occasional presence of fresh blood, the faeces were normal in shape and texture. The owner did not report abnormalities in defecation

frequency, tenesmus or dyschezia. No progression of the condition was noticed over time. An initial trial with

antibiotic therapy (amoxicillin/clavulanate at 20 mg/kg BID for 10 days) did not lead to

improvement in clinical signs; no other medications were given and the dog was

not currently on any treatment. A marked increase in water intake was noted 3

weeks prior to presentation, with an increased frequency of urination; no signs of dysuria were reported.

On physical examination the dog was bright, alert and responsive. Body condition

score was 4/9. Mucous membranes were hyperaemic and moist, with a capillary refill time of 50 ml/kg/day and water consumption is >100 ml/kg/day. Although in our case the daily intake was not measured, the owner reported a sudden and obvious increase in water consumption.

Polyuria is often the primary condition with compensatory polydipsia, although primary polydipsia is possible. Taking into account the clinical information gained to date the differential diagnoses for the PU/PD include:

frequency, tenesmus or dyschezia. No progression of the condition was noticed over time. An initial trial with

antibiotic therapy (amoxicillin/clavulanate at 20 mg/kg BID for 10 days) did not lead to

improvement in clinical signs; no other

bright, alert and responsive. Body condition score was 4/9. Mucous membranes were hyperaemic and moist, with a capillary refill time of

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Secondary to gastrointestinal disease Endocrine disease

Hyperadrenocorticism Diabetes mellitus Central diabetes insipidus Acromegaly

Renal disorders (chronic renal failure, pyelonephritis, renal glycosuria)

Neoplasia (often as a result of paraneoplastic hypercalcaemia)

Liver disease Electrolyte disorders (hypercalcemia,

hypokalaemia) Miscellaneous (hypothalamic disease,

hyperviscosity syndrome) Primary polydipsia

Some differential diagnoses are less likely without a supportive clinical history or physical examination findings (hyperadrenocorticism, liver disease) but cannot be excluded without further investigation.

Hyperaemic mucous membranesCauses of hyperaemic mucous membranes may be physiological or pathological. The former can be stress or exercise related, whereas the latter may be observed in vasodilatory shock and in cases of erythrocytosis. At this point the cause was unknown; however, shock was unlikely as the dog was bright and alert with a normal heart rate, pulse quality and capillary refill time, similarly the dog did not seem particularly stressed or excited.

Outline a diagnostic plan for this patientHaematology, biochemistry and urine analysis are suggested first-line tests to evaluate the presence of the systemic and endocrine diseases listed above. The evaluation of coagulation times (PT, aPTT) are also indicated to detect disorders of secondary haemostasis, although, as discussed, these would be an unusual cause of intermittent haematochezia without evidence of bleeding elsewhere.

Haematology results are shown in Table 1 and urinalysis in Table 2. Serum biochemistry and a coagulation profile revealed no abnormal findings.

Parameter Result Reference interval

RBC 13.3 5.58.5 x1012/l

HCT 0.86 0.370.55 l/l

Hb 23.0 12.018.0 g/dl

MCV 64.4 60.077.0 fl

MCH 17.3 18.530.0 pg

MCHC 26.8 30.037.5 g/dl

WBC 13.91 5.5016.90 x109/l

Neutrophils 9.24 2.0012.00 x109/l

Lymphocytes 1.93 0.504.90 x109/l

Monocytes 1.50 0.302.00 x109/l

Eosinophils 1.24 0.101.49 x109/l

Basophils 0.01 0.000.10 x109/l

Platelets 221 175500 x109/lTable 1: Haematology results from Day 1 (abnormal results in bold)

Parameter Result

Specific gravity 1.015

Glucose Negative

Bilirubin Negative

Ketones Negative

Blood Negative

pH 6.5

Protein 2+

Leucocytes Negative

Sediment analysis Occasional granular cast and white blood cell

UPC ratio 2.1 (reference interval

10 | companion

Clinical conundrum

as non-renal (i.e. lower urinary tract inflammation or haemorrhage) or renal, commonly seen in glomerular lesions, but also in renal parenchymal inflammation and haemorrhage.

Given that no other significant abnormal findings were detected on urine analysis or on abdominal imaging, the definitive origin of the proteinuria was still considered unknown. A second UPC ratio repeated 2 days after the patient was discharged revealed a normal value suggesting stress due to hospitalization as a possible cause.

At this stage, the PU/PD, and possibly the haematochezia, were thought likely to be secondary to the hyperviscosity resulting from the increased RBC mass, and evaluations focused on the underlying cause for the erythrocytosis. Other reported signs of erythrocytosis due to increased viscosity include seizure activity, abnormal behaviour, ataxia, blindness and tremor, but were not reported in this case.

What are the main differentials to consider at this stage? Absolute primary erythrocytosis Absolute secondary erythrocytosis (appropriate or

inappropriate)

Which diagnostic procedures may help to further narrow the differentials?The next step is to determine whether the increase in RBC mass is physiologically appropriate or inappropriate. After hypoxic causes have been

Parameter Result Reference Interval

PaO2 85 85100 mmHg

PaCO2 37.6 3440 mmHg

pH 7.35 7.357.45

HCO3 21 2024 mmol/l

Base excess -5 -50 mmol/l

HCT >75 3550 l/lTable 3: Arterial blood gas results

Erythrocytosis

Absolute

Primary

Primaryerythrocytosis(polycythemia

vera)

Secondary

Appropriate

Cardiac disorderRespiratory disorder

Haemoglobin disorder

Kidney neoplasiaMiscellaneous neoplasiaNon-neoplastic kidney

disorders

Inappropriate

HyperadrenocorticismHyperthyroidism

Acromegaly

Relative

DehydrationSplenic

contraction

Endocrinopathy

Figure 1: Flow chart showing the differential diagnoses for erythrocytosis

excluded, causes of secondary inappropriate erythrocytosis should be investigated. The following tests were performed:

Arterial blood gas analysis (Table 3):Decreased arterial partial pressure of oxygen (PaO2) may suggest secondary appropriate erythrocytosis due to EPO release and red cell production in response to hypoxia; this is most commonly seen with cardiopulmonary disease. Hypoxia is defined as a PaO2 of >70 mmHg when an animal is breathing room air. As increased blood viscosity may interfere with arterial blood sampling, phlebotomy to lower the PCV can be considered before blood gas analysis is performed. Pulse oximetry can be used if arterial blood gas analysis is unavailable. Usually a saturation lower than 92%, determined by repeated measurements, confirms hypoxia. In this dog, arterial blood gas analysis was within normal limits, which provided no evidence for hypoxaemia as the cause of the erythrocytosis.

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Table 4: Erythropoietin serum concentration

Parameter Result Reference interval

Erythropoietin 10.1 8.228 MIU/ml

80%

75%

70%65%

60%55%50%

45%

40%1

DAY

PCV

3 11 15 23 33 40 46 51 65 86 136 149 208117

Figure 2: Change in red cell numbers over time, measured as packed cell volume (PCV). The yellow dots indicate occasions when phlebotomy was also performed

Thoracic and abdominal imaging: Thorough examination of the cardiopulmonary system by physical examination and imaging can help to advance the diagnostic process when investigating for causes of secondary absolute erythrocytosis. This is particularly important if hypoxaemia is detected on blood gas analysis. It should be noted that animals with erythrocytosis and hypoxaemia are usually cyanotic. Dogs with a right-to-left shunting patent ductus arteriosus classically have differential cyanosis (caudal mucous membranes such as the prepuce and vulva are cyanotic, whereas oral mucous membranes are not) and do not usually have a heart murmur. After hypoxaemic causes have been excluded, abdominal imaging can help to identify pathological processes involving the kidneys or other abdominal organs.In this dog thoracic radiographs, echocardiography and abdominal ultrasonography were unremarkable.

Erythropoietin: Serum EPO concentration was found to be normal (Table 4). This result is supportive of primary erythrocytosis as it does not provide evidence of an underlying over production of erythropoietin (either appropriate or inappropriate) to increase red cell numbers.

viscosity by lowering the RBC mass. The goal is to maintain the PCV around 6065%, therefore phlebotomy should be perfomed regularly until RBC numbers are controlled. Phlebotomy (removing 1520 ml of blood per kg bodyweight) should be accompanied by replacement fluid therapy (usually an equal volume of a balanced crystalloid solution is administered over 3060 minutes) to restore circulating volume. If aggressive phlebotomy is performed, a plasma transfusion may be considered to avoid depletion of plasma protiens and coagulation factors.

Several therapies including chemotherapy and the administration of radioactive phosphorus have been suggested to suppress red cell production. The chemotherapy agent of choice is hydroxyurea (loading dose 3050 mg/kg orally once a day, after one week reduce to 15 mg/kg orally once daily, then titrate to effect), although other alkylating agents have also been used with mixed results. Hydroxyurea acts by inhibiting DNA synthesis, causing reversible myelosuppression without affecting RNA or protein synthesis. Usually the effect of hydroxyurea is enhanced by reducing the PCV with phlebotomy.

Outcome and follow-upPhlebotomy was performed on three occasions in the 6 weeks following diagnosis (Figure 2), until the PCV was consistently lower than 60%. The clinical signs improved rapidly as the red cell numbers fell and were controlled completely as red cell numbers normalized. Hydroxyurea was introduced as long term therapy and was well tolerated by the patient. Nine months later there has been no recurrence of the clinical signs or appreciable side effects to the medication. The haematochezia also resolved and the owners report the dog has a good quality of life. Although the prognosis for primary erythrocytosis is guarded, most cases have a good response to treatment and the long term outcome is often reasonable if the PCV can be well controlled.

What is the most likely cause of erythrocytosis at this stage?Primary erythrocytosis (polycythemia vera) is the most likely diagnosis and this diagnosis has been made by excluding all other potential causes of erythrocytosis. Primary erythrocytosis is defined as an abnormal proliferation of erythroid precursors in the bone marrow that follow a normal pattern of maturation. Therefore, despite being considered a myeloproliferative disorder, the erythroid precursor mature into normal RBCs; this occurs independently of EPO. Primary erythrocytosis, caused by a mutation in the JAK2 gene leading to defective EPO receptors has been reported in humans and dogs. JAK2 genetic testing was not performed in our patient.

What treatment would you suggest?Therapy for primary erythrocytosis is based on the reduction of the RBC mass by phlebotomy and suppression of erythroid production in the bone marrow. Phlebotomy has been advocated as initial therapy in any symptomatic patient to reduce

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12 | companion

Top tips for rabbits:imaging and surgery

Continuing our occasional series highlighting practical tips from authors featured in the BSAVA Manual of Rabbit Surgery, Dentistry and Imaging and the BSAVA Manual of Rabbit Medicine

Epiphora in rabbits and dacryocystographyBy Vladimir JeklNasolacrimal duct obstruction due to the apical elongation or other tooth apex pathology is the most common cause of epiphora in rabbits. The optimal way in which to reach the diagnosis is dacryocystography.

The patient is placed in lateral recumbency on the X-ray cassette, with the affected side uppermost to facilitate contrast medium administration.

Using CT to detect a prolapsed gland of the third eyelidBy Michael FehrAn 8-year-old female, spayed, vaccinated rabbit was presented with a large lump under her eye that had developed over the last few days. She had a history of dental problems and had had conjunctivitis 15 weeks prior. She had also had a runny nose for a few days.

Clinical appearance

Post-contrast right lateral radiograph of the normal nasolacrimal duct in a rabbit. The arrows indicate the tortuous route of the contrast medium. A small amount of the contrast medium (iomeprol) can be seen in the nasal cavity

Obvious distension of the nasolacrimal duct due to apical incisor elongation

After administration of a topical analgesic, 0.51 ml of iodine-based contrast medium (e.g. iohexol, iomeprol: 300400 mg iodine/ml) is instilled into the nasolacrimal punctum, which is situated on the lower eyelid close to the medial canthus of the eye.

TIP: Initial administration of a small amount of contrast medium (0.30.5 ml) is recommended to prevent inhalation and superimposition over the nasolacrimal duct.

Right lateral and dorsoventral radiographs should be taken immediately.

Following the procedure, application of a protective eye gel containing retinol and anti-inflammatory drugs is recommended to protect the superficial eye structures.

The differential diagnoses were: prolapse of the deep gland of the third eyelid; lymphoma of the Harderian gland; retrobulbar abscess. Radiography might or might not be diagnostic. A coronal CT scan showed a prolapsed enlarged,

Coronal CT scan showing a prolapsed, enlarged, hypodense lacrimal gland at the lateroventral aspect of the left globe

hypodense dilated lacrimal gland. The diagnosis was prolapse of the deep gland of the third eyelid. Treatment options are surgical removal of the prolapsed gland or replacement using a pocket technique. Both options are described in the BSAVA Manual of Rabbit Surgery, Dentistry and Imaging.

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Flushing the tear ductBy Richard SaundersWhilst general anaesthesia is required to enter the bony foramen and apply sufficient pressure to unblock and flush the nasolacrimal duct, most conscious rabbits will tolerate a catheter being placed into the single lower lid punctum and gentle flushing into the soft tissue portion of the duct. Topical ocular local anaesthetic drops are applied to the area, and a 2420 G intravenous cannula (without metal stylet) is placed into the punctum.

The key to successful cannulation of the duct is in gentle eversion of the

The punctum is identified in the ventral eyelid

lower eyelid with the thumb and forefinger, pulling it laterally and ventrally with a slightly rolling action, to position and partially open the punctum.

Various suggestions have been made as to the exact nature of flushing solutions, with the addition of antibiotics or products to break down purulent material. However, the most important requirement is the physical removal of purulent material and establishing the patency of the duct, as this will allow drainage of tears through the duct, preventing their overflow on to the skin of the face. Sterile isotonic saline or Hartmanns solution are ideal; they should be warmed to body temperature before use to avoid discomfort to the rabbit. Flushing should be carried out regularly (e.g. daily) until patency is restored, if possible.

Skin incisions for rabbit spaysBy William LewisWhen spaying rabbits it is helpful to make the skin and abdominal incision in the optimal position.

If the incision is too cranial, the surgeon will encounter the caecum or small intestines. These may get in the way of the surgical procedure; or they will require handling or manipulating, with a risk of inducing ileus or, in the worst case scenario, accidentally lacerating these organs.

If the incision is too caudal, the bladder is likely to exteriorize and get in the surgeons way. Because of the short ovarian attachments , it may also be difficult to manipulate the ovaries out of the abdomen if the incision has not been made far enough forward.

Texts give the landmarks for the skin incision as midway between the umbilicus and the pubic symphysis. Depending on the size and age of the rabbit, as well as the amount of fat in the abdomen, it may be difficult to localize the cranial brim of the pubic symphysis.

This may result in the incision being made in a less than optimal area.

A useful alternative landmark is to use the last (i.e. most caudal) pair of nipples as a guide to making the incision. If a line is drawn between the last pair of nipples, the incision should be roughly 1 cm cranial and 1 cm caudal to this line, along the midline of the rabbit. In a sexually mature rabbit the cervix with its associated fat will lie immediately under the incision and can be lifted out of the wound without any searching. Incising in this area also prevents the caecum coming out through the wound.

Many rabbits have asymmetrically placed nipples. In these cases, a line should be drawn from each of them, laterally across the abdomen. A third line drawn along the rabbits midline and between these first two lines will then mark the correct site to make the incision.

If the surgeon follows these easy landmarks the incision will always be made in exactly the correct position to allow the cervix and uterus to be exteriorized from the abdomen easily, with no searching and without the caecum getting in the way.

The midline incision is made perpendicular to the line drawn between the last nipple pair. The arrow is pointing to the umbilicus

The cervix is visible immediately under the incision site

Various suggestions have been

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How to anaesthetize a bird

Joanna Hedley, Clinician in Rabbit, Exotic Animal and Wildlife Medicine at the Royal (Dick) School of Veterinary Studies, talks us through avian anaesthesia

Figure 1: Subcutaneous fluids may be easily administered in the inguinal region

Anaesthesia of birds has often been viewed as a high-risk procedure, to be avoided if possible. Birds have minimal functional residual capacity, so even a brief period of apnoea may rapidly lead to hypoxia and cardiac arrest. Having a higher metabolic rate than mammals of a similar size also leads to rapid drug metabolism, heat loss and, potentially, hypoglycaemia. However, by understanding the relevant differences between birds and mammals, it should be possible to minimize these risks and provide the same standard of anaesthetic care for birds as for our traditional companion animal patients.

Preparing your patient for general anaesthesiaMost birds undergo general anaesthesia for investigations or treatment of underlying disease. Birds have adapted to hide signs of disease; this means that they may often have been sick for some time, but just present to the veterinary surgeon once the disease is advanced and the problem can no longer be hidden. It is therefore important to perform at least a basic clinical examination and stabilize the avian patient before proceeding to general anaesthesia.

A full clinical examination may require sedation or anaesthesia, especially in the stressed patient, and handling should be limited in these cases. Stress can result in the release of catecholamines, causing hypertension, reduced renal perfusion and even predisposition to cardiac arrhythmias and sudden death. This is unlikely in a well socialized parrot or raptor, but is a higher risk in small birds less accustomed to handling, such as canaries or finches. Observations from a distance are generally more useful than a prolonged physical examination in these cases.

After initial assessment, the avian patient should be stabilized in a warm (2530C), quiet enclosure, ideally away from the sights and sounds of predator species such as cats and dogs. Hydration deficits should be corrected, although assessment of hydration status can be difficult in the avian patient. Severely dehydrated patients may have skin turgor and sunken eyes, but any bird which has undergone a period of anorexia should be assumed to be 510% dehydrated even if this is not obvious on clinical examination.

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Drug Dose Route of administration

Meloxicam 0.20.5 mg/kg q24h or half dose q12h

s.c., i.m., orally

Lidocaine

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Figure 3: Induction via the medial metatarsal vein may be easily performed in swans

Figure 4: Intubation may be performed in small birds using an intravenous catheter

these has been advocated in recent years to reduce both stress at induction and the anaesthetic gas concentration required for maintenance. Disadvantages include the stress of increased handling to premedicate the bird and the potential for a longer recovery, so premedication will not be appropriate in every case but should definitely be considered.

Some birds, such as waterfowl, have developed a considerable capacity for breath-holding and will almost always require premedication or injectable induction agents for a smooth induction. An intravenous catheter may be placed in the medial metatarsal vein for administration of the induction agent (Figure 3). Various protocols may be used, including induction with alpha-2 agonist/ketamine combinations, alfaxalone or propofol.

How to maintain anaesthesiaFor a short procedure, such as blood sampling, intubation may not be necessary but in most cases once a suitable plane of anaesthesia is achieved, intubation should be performed (Figure 4). Birds have no epiglottis so the glottis is easily visualized by pulling the tongue forwards with atraumatic forceps. The avian trachea has complete cartilaginous rings and the mucosa is easily damaged, so the use of a non-cuffed tube is recommended to avoid pressure necrosis. The tube should be carefully secured in place using a tie or tape to minimize movement, that could lead to the formation of tracheal strictures following the anaesthetic. Some species such as Blue and Gold Macaws seem particularly prone to tracheal strictures following intubation. It may be preferable to maintain these birds on a mask for shorter procedures or place an air sac tube for longer procedures to avoid potential tracheal trauma. Small birds (

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Figure 5: An intravenous catheter may be placed in the basilic vein

Figure 6: Fluids may be given via an intraosseous cannula placed in the ulna

Care should be taken to maintain the temperature of the bird during anaesthesia. Due to their high surface area-to-volume ratio and rapid metabolism, hypothermia can be a significant problem. The background room temperature should be kept warm and supplementary heating aids such as circulating water blankets, warm towels and microwaveable heat pads may help to maintain the animals temperature. Warm scrub solutions should be used to prepare surgical sites, and plucking should be minimized if possible. Intravenous or intraosseous fluids should also be warmed prior to administration.

How to monitor anaesthesiaAnaesthetic monitoring is critical in birds, as changes in the depth of anaesthesia, breathing and heart rate can happen quickly. Respiratory rate and rhythm should be monitored constantly and IPPV provided as necessary, as even a brief period of apnoea may rapidly lead to cardiac arrest. Even if the bird is breathing, it may not be ventilating adequately due to body position under anaesthesia, tube position or reduced respiratory rate.

Respiratory rates may be set at 1015 breaths/minute. The appropriate pressure will depend on the size of the individual patient, but it is best to start with a low pressure and then to increase this slowly until small breathing movements are seen, resembling those of the conscious bird. Apnoea is such a common and significant complication of avian anaesthesia, that many practitioners prefer to mechanically ventilate their patients throughout the procedure to prevent problems.

Fluid therapy should be continued throughout anaesthesia and intravenous or intraosseous access should be established for longer procedures. Intravenous catheters may be placed in the basilic (Figure 5), right jugular or medial metatarsal veins. The choice of location may depend on the species of bird and procedure being performed.

Catheters can be sutured in place for the duration of the anaesthesia but may be difficult to maintain in recovery, so are often removed at this point to avoid self-removal by the bird and potential haemorrhage. Intraosseous cannulas may be placed in the distal ulna (Figure 6) or proximal tibiotarsus. Spinal needles may be used or, for smaller patients, hypodermic needles may be of more appropriate size. Needles should be placed aseptically and will need to be taped or sutured in place.

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Figure 8: The corneal reflex may be checked with a damp cotton bud and should remain present throughout anaesthesia

Capnography is therefore very useful to assess the effectiveness of ventilation. End-tidal carbon dioxide should be monitored throughout anaesthesia and ideally maintained between 35 and 45 mmHg. Pulse oximetry may also be used but readings are not consistently accurate in avian patients and so generally just provide a guide to whether levels of oxygenation are increasing, decreasing or constant.

The heart may be auscultated using a paediatric stethoscope and a pulse may be palpated over the brachial artery (Figure 7). A Doppler probe can also be secured in this location to provide a constant audible monitor of heart rate and potentially to allow indirect blood pressure monitoring. Indirect monitoring may underestimate blood pressure, especially if the cuff size is too big, but can be used to reflect trends in pressure. Systolic blood pressure should ideally be

Figure 7: The brachial pulse may be easily palpated in the axillary region

maintained at >90 mmHg; if levels fall below this, fluid therapy should be tailored accordingly.

Reflexes which can be assessed include jaw tone, toe pinch and the cloacal reflex. However, care should be taken when checking the toe pinch of a raptor or jaw tone of a large parrot. Eye position generally stays central during anaesthesia, but the corneal reflex can be checked with a damp cotton bud and should remain as indicated by the nictitating membrane moving across the eye (Figure 8). The speed of this response will indicate the depth of anaesthesia although the reflex may be abolished if checked too frequently.

In the event of an avian anaesthetic emergency, the speed of response is critical. Emergency drugs should be easily accessible and for critical patients, appropriate dosages should be drawn up in syringes ready for use prior to the induction of anesthesia (Table 2).

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Figure 9: Birds should be monitored closely throughout recovery and held in an upright position

Drug Dose Indication

Adrenaline 0.11 mg/kg i.v., i.o., intratracheal

Cardiac arrest

Atropine 0.010.5 mg/kg i.v., i.o., intratracheal

Suspected supraventricular bradycardia

Diazepam 0.11 mg/kg i.v., i.m.

Seizures

Doxapram 520 mg/kg i.v., i.o., intratracheal

Respiratory arrest

Table 2: Examples of emergency drugs used in birds. Lower doses are suggested initially, with incremental increases if no response is seen

RecoveryRecovery following anaesthesia is generally thought to be the time of highest risk for avian patients, so careful monitoring is required throughout this period. If IPPV has been given, this should be continued during recovery until the bird is self-ventilating normally. The endotracheal tube should remain in place until jaw movements increase and voluntary breathing occurrs. The bird should be held upright, with the head supported and the body only gently restrained (Figure 9) to prevent any restriction of breathing, until the bird is able to perch. At this point it can be placed in a pre-prepared warm incubator and should be closely monitored until movement is coordinated.

Analgesia should be continued in the post-anaesthetic period for any painful procedure, even if the bird is not showing any obvious signs of

pain. In addition to NSAIDs and opioids, the use of tramadol may also be considered for those animals likely to need longer term analgesia. Food should be offered as soon as the bird is no longer ataxic, and if not eating within 2 hours, tube feeding should be carried out to prevent hypoglycaemia. n

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20 | companion

Congress 36 APRIL 2014

Pyothorax expertiseat Congress

QOne would assume that a penetrating injury would be the major cause of this condition; is that so?ANo, it is surprising to most people that fighting and biting is not the most common cause of pyothorax in cats. In older case series this was more common and probably reflected a higher proportion of entire male cats more likely to engage in territorial aggression. A bite wound to the chest of a cat can certainly result in direct inoculation of bacteria from the oral cavity into the thoracic cavity, and bite wounds have been identified in some affected cats. However, recent case series do not support fighting and biting as the most common cause of pyothorax. This is also supported by the evidence showing that free-roaming cats with outdoor access are not more likely to get pyothorax than indoor cats. Furthermore, male cats, more likely to engage in territorial aggression, are not over-represented, and other diseases transmitted by biting, such as feline immunodeficiency virus are not common in cats diagnosed with pyothorax.

So what does happen to cause this condition?What is clear, in all studies, is that the bacteria isolated from the thoracic cavity of cats with pyothorax are the same species as those found in the mouth and throat of

comorbidities reflecting age-related susceptibility, such as feline leukemia virus infection, may be present.

Being from a multi-cat household also increases the risk. For what reason?In one study, cats with pyothorax were nearly four times as likely to have come from a multi-cat household compared to cats without pyothorax. The authors of that study suggested that fighting and biting would be more likely in a multi-cat household, and that this would be the cause of the pyothorax. However, behavioural studies do not support this concept of aggression in stable multi-cat households as explained earlier, and FIV, which is primarily spread by intercat aggression, was only present in 3% of cats tested.

The increased risk of pyothorax in multi-cat households more likely reflects the increased risk of exposure to upper respiratory pathogens due to direct contact with other cats harboring these pathogens (nasal discharge, grooming) and indirect contact (food, water bowls, contact with human carers), with subsequent development of URTIs.

How frequently would you expect a typical small animal practitioner to encounter such a case?Pyothorax is not common, but certainly not rare. A busy small animal practice might encounter one or more cases of pyothorax per year. Presentations are more common in emergency centres, since cats often do not present until late in the disease process when their respiratory reserve is exhausted.

What are the typical clinical signs?The most common respiratory signs are increased respiratory rate and a restrictive pattern of respiration (rapid, shallow respiration with inspiratory dyspnoea). Heart sounds may be muffled due to the accumulation of thick purulent exudate in the thoracic cavity. Similarly, lung sounds

healthy cats. The question is: how did these so called normal flora get from the mouth into the chest cavity?

The single biggest risk factor for pyothorax is pre-existing upper respiratory tract infection. URTIs are common in cats and are often mixed viral (e.g. feline herpesvirus 1 and feline calicivirus) and bacterial (Mycoplasma species, Bordetella bronchiseptica) infections. A URTI can cause damage to the mechanism that prevents upper respiratory secretions from reaching the lower respiratory tract. This mechanism of mucociliary clearance is an important host defence mechanism against bacterial colonization of the lower respiratory tract. Failure of this mucociliary escalator is thought to be the mechanism by which these bacteria gain access to the lower respiratory tract, initially causing pneumonia, with infection then spreading into the pleural space, so-called parapneumonic spread.

Young cats are at greater risk of developing a pyothorax. Why is that?Young age is a risk factor due to biological rather than behavioural reasons. It has been shown that young cats less than 12 months of age are more likely to develop atypical infections such as pyothorax with concurrent lungworm or roundworm infections. In these cases the bacterial species may be of gastrointestinal rather than oropharyngeal origin, e.g. Escherichia coli or Salmonella species. Also, other

Vanessa Barrs of the University of Sydney has a longstanding interest in the management of pyothorax, a major medical emergency for feline practitioners. She will

be passing on her knowledge to colleagues at BSAVA Congress in April but in the meantime she gave John Bonner an inkling of what they may expect to hear

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may be decreased ventrally or, in some cases where there is concurrent severe pneumonia, lung sounds may be increased dorsally. Fever is often present, but its absence does not rule out pyothorax, and some cats with severe, advanced infections will be hypothermic.

Those signs described seem fairly non- specific is it a challenging diagnosis?Diagnosis can be challenging, because respiratory signs can be hard to detect. This is illustrated by one study where 40% of owners did not detect any respiratory problem with their cat but sought veterinary attention because of lethargy and loss of appetite. These signs are common to most feline illnesses and are of little help to the investigating practitioner. A thorough clinical examination will usually enable detection of respiratory disease but even then signs can be subtle. Pyothorax should be considered as a differential diagnosis for unexplained fever.

What would be the main differential diagnoses?Major differentials for pyothorax include all other causes of pleural effusion, including transudates, modified transudates, exudates and hemorrhagic effusions, since the diseases that cause these can result in presentation for dsypnoea. Of these, the five most common causes of feline pleural effusion are cardiac disease, feline infectious peritonitis, pyothorax, idiopathic chylothorax and neoplasia. Clinical signs and signalment are helpful to rank these for example if fever is present and the cat is young, the major differentials would be feline infectious peritonitis and pyothorax. The presence of cardiovascular abnormalities such as a gallop, murmur, arrhythmia or jugular distension/pulse results in a higher ranking for cardiac disease. However, some cats with right- or left-sided congestive heart failure may not have obvious localizing signs, and cardiac causes cannot be ruled out. If available,

echocardiography can allow the clinician rapidly to rule out this diagnosis. If not available, obtaining a pleural fluid sample enables the clinician to readily identify the presence of a pleural exudate. Usually this procedure is performed after the presence of pleural effusion has been confirmed on radiography. However, if dyspnoea is life-threatening at presentation and a restrictive pattern of respiration is present, blind thoracocentesis can be performed to drain the thoracic cavity of effusion and obtain a sample for fluid analysis.

Are there any figures on survival rates?Until recently, pyothorax in cats was considered to have a poor prognosis. However, it has become clear that most cats that survive the first 48 hours following presentation can be successfully treated with aggressive medical management. For cats in which thoracostomy tubes are placed to drain the effusion, survival rates of 80 to 95% are reported.

What are the good and bad prognostic indicators?Not many studies have determined prognostic indicators for pyothorax, so it is difficult to place a lot of value on these until further studies become available. In one study of 80 affected cats, hypersalivation and low heart rate at presentation were poor prognostic indicators. Many cats with low heart rates were also hypothermic. Hypothermia and bradycardia can reflect septic shock in cats. Placement of a thoracic drain and survival beyond the first 48 hours after presentation are good prognostic indicators for pyothorax.

Antimicrobial treatment may have to start before the results of bacterial culture are available. So what would you recommend as a reliable combination to begin the treatment?Antimicrobials suitable for initial empirical treatment of typical feline pyothorax include penicillin G (e.g. benzylpenicillin

potassium or benzylpencillin sodium) or an aminopenicillin (e.g. ampicillin or amoxicillin) alone or in combination with metronidazole. Alternatively parenteral monotherapy with a potentiated penicillin, e.g. amoxicillin/clavulanate can be used.

At what stage should the vet recommend surgical treatment?Indications for exploratory surgery at diagnosis include detection of pulmonary or mediastinal abscess, or very loculated effusions on imaging. It is also indicated when medical management fails, as determined by persistence of effusion 37 days after placement of thoracic drains (thoracostomy tubes), or if there is development of a pneumothorax or drain obstructions caused by pleural adhesions.

Do surviving cats recover full lung function and are there any other long-term impacts?Surviving cats generally have excellent respiratory compensation after treatment, even after removal of a lung lobe or pneumonectomy (resection of all lung lobes from one side of the thorax). In a recent case series four cats that had pneumonectomy survived to discharge and an excellent quality of life was reported on long-term follow-up. Careful monitoring, oxygen supplementation, pain relief, blood transfusion and thoracostomy tube management were important factors in the successful postoperative recovery of these cats. Disease recurrence is uncommon (around 5% of cases) and, generally, long-term impacts are rare. n

VANESSA AT CONGRESS

Thursday 3 April

n Dealing with the difficult cat: Alimentary lymphoma, chronic rhinitis, pyothorax

n Small Group Session: Feline medicine cases

n Interactive case-based medicine: Feline pancreatitis

20-21 Congress Science.indd 21 20/01/2014 12:51

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Specialist Groups at CongressOn the Wednesday of Congress, BSAVA helps its Affiliated Groups hold their own meetings, offering even more CPD to those with special interests. For full details and registration please contact the organisations directly

Association of Veterinary Soft Tissue Surgeons (AVSTS)Venue: Hall 7, ICCWebsite: www.avsts.org.ukContact: Alison Young [email protected]

The Association of Veterinary Soft Tissue Surgeons welcomes all vets and nurses involved with canine and feline soft tissue surgery cases, and aims to provide a thought-provoking discussion forum at its two annual meetings. The spring meeting in Birmingham on the Wednesday of BSAVA Congress week traditionally covers Whats new and hot? and in 2014 we have another great line-up, including Professor Gerhard Oechtering from the University of Leipzig, Laurent Findji from the VRCC, Stephen Baines from The Willows, and Nick Bacon from University of Florida. Our autumn meetings, held on a non-half-term Friday/Saturday, allow a theme to be explored with greater depth and breadth, and benefit from inclusion of the comparative aspects from human surgery, as well as fine food, wine, and laughter. See website for further details of our 2014 meetings and to find out how to join our society. www.avsts.org.uk

British Association of Veterinary Emergency and Critical Care (BAVECVenue: Crompton Room, Austin CourtWebsite: www.bavecc.org.ukContact: Toby Birch

[email protected]

BAVECC is a small but enthusiastic group of veterinary nurses, practitioners and ECC specialists who have a special interest in dealing with the emergency or intensive care patient. We meet every year for a dedicated CPD event during the pre-BSAVA Congress day, during which we have lectures dealing with current veterinary ECC topics and also a guest speaker from the human intensive care medical field. This year we will discuss Fluid dilemmas. Please join us. For further information and to register, please contact Toby Birch or register online at www.bavecc.org.uk

British Veterinary Behaviour Association (BVBA)Venue: Hall 10, ICC Website: www.bvba.org.ukContact: Jaqi Bunn [email protected]

The British Veterinary Behaviour Association is a friendly group consisting of UK and international members with a common interest in companion animal behaviour. We are always happy to welcome new members to our meetings, whether they have just an interest, or are working in the field of behaviour. Our membership includes people in veterinary practice, veterinary students, behaviour science students, behaviour professionals, academics, researchers and pet charity workers. Our diverse membership enjoys the exchange of ideas and expertise.

We invite you to attend our annual BSAVA Congress study day in Birmingham on 2 April 2014 and the topic this year is Aggression: medical or mental? Our speakers will explore how we approach the diagnosis and management of aggression in dogs, cats and caged birds, with particular reference to

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establishing the underlying cause. For anyone with an interest in pet behaviour, this is an event you should not miss.

We are delighted to welcome Danille Gunn-Moore and Sarah Heath (cats), John Chitty (caged birds), and Gary Landsberg and Clare Rusbridge (dogs), who will discuss important medical and behavioural differential diagnoses, illustrating their points using case examples and leading us to a greater understanding of aggression in cats, dogs and caged birds. All our speakers are accomplished and experienced in their field, and anyone attending this study day can expect to be well entertained, as well as taking home plenty of useful advice. In addition the programme will include a range of short presentations on other aspects of domestic animal behaviour selected from submitted abstracts.

Refreshments, including lunch, are provided, and there will be the opportunity to visit and talk to our various sponsors during breaks.

British Veterinary Dental Association (BVDA) Venue: Lodges 1 and 2, Austin Court Website: www.bvda.co.ukContact: Rob Pascoe [email protected]

The morning sessions for the BVDA annual scientific meeting in association with the BSAVA Congress will focus on endodontic techniques, including a guest speaker from Birmingham Dental School, Mr Philip Tomson, discussing the emerging subject of Regenerative endodontics.

The highlight of the afternoon sessions will be lectures from Dr Christopher Snyder, Clinical Assistant Professor in Veterinary Dentistry and Oral Surgery at the University of WisconsinMadison. He will be talking on the subject of maxillofacial fractures and injuries in dogs and cats.

Alongside an exciting range of lectures, there will be range of exhibitors displaying the latest range of veterinary dental instruments and materials. For further details and to register, please visit the BVDA website www.bvda.co.uk

British Veterinary Dermatology Study Group (BVDSG)Venue: The Crowne Plaza Hotel,

Birmingham Website: www.bvdsg.org.uk Contact: [email protected]

The British Veterinary Dermatology Study Group holds two annual meetings a day meeting prior to BSAVA Congress in April, and a weekend meeting usually in November. Both meetings attract eminent speakers from home and abroad, covering all aspects of veterinary and human dermatology.

Members also have an opportunity to present their own work and findings at each meeting in the form of abstracts or short communications. The pre-Congress meeting will be held at The Crowne Plaza Hotel, Birmingham and is entitled: Pyoderma: bog standard or multiresistant? The BVDSG has secured R. Mueller and J.M. Blondeau as the international speakers. The next autumn meeting is to be held on 1516 November at the Radisson Blu Hotel, Manchester Airport, and is entitled: Hairs, hormones and hounds. For further details please email [email protected] or visit www.bvdsg.org.uk or www.bvdsgmeetings.com

British Veterinary Orthopaedic Association (BVOA)Venue: Hilton Metropole Hotel, BirminghamWebsite: www.bsavaportal.com/bvoa Contact: [email protected]

The BVOA is the BSAVAs biggest affiliate organisation, comprised of orthopaedic specialists and general practitioners, and known for its popular and sociable scientific meetings focusing on varied topics. The 2014 Spring Meeting will explore the mysteries of feline orthopaedics with speakers including Harry Scott, Sorrell Langley-Hobbs and Denis Marcellin-Little. Hosted at the Hilton Metropole Hotel, Birmingham, the day will include refreshments and notes. Clinical research abstracts may be


24 | companion


eligible for the Lesley Vaughan Prize. Registration is via the BVOA website

www.bsavaportal.com/bvoa where the benefits of membership are detailed. For 35 per year (or 90 with a subscription to the journal Veterinary Comparative Orthopaedics and Traumatology) members receive discounts on meeting and CPD registration, a biannual newsletter, access to the BVOA forum Google Group for case discussion and online resources. The BVOA funds research projects and information regarding grants is available on the website. The BVOA Facebook page also provides news and updates from the association. Autumn Meeting 2426 October, Brighton.

European Association of Veterinary Diagnostic Imaging (British and Irish Division) (EAVDI-BID) Venue: Hall 9, ICCWebsite: www.eavdi.org/eavdi-bid-home-page Contact: Andrew Parry

[email protected]

The British and Irish Division of the European Association of Veterinary Diagnostic Imaging is open to any veterinary surgeon, student, radiographer or nurse with an interest in veterinary diagnostic imaging. The division organises two regular meetings each year, one meeting in Birmingham, on the Wednesday prior to BSAVA Congress, and a further two-day meeting in the following November. Our Autumn meeting this year will be a joint meeting with the Veterinary Cardiovascular Society on 1415 November.

This year EAVDI-BID will be holding a BSAVA Congress meeting in Hall 9 of the ICC. The meeting is themed on neuroimaging. Lectures will be on a broad range of subjects within this discipline and lecturers include Holger Volk speaking on syringohydromyelia, Sebastien Behr speaking on inflammatory CNS disease and Chris Lamb speaking on meningeal disease. A film-reading quiz will finish the day. Prices are

deliberately kept as low as possible to encourage new membership:

Resident/Intern: 90.00EAVDI member: 107.00Non-EAVDI member: 135.00For further details, registration and programme

please visit: www.eavdi.org/eavdi-bid-home-page or contact the chairman Andrew Parry.

International Cat Care (ICC) Venue: Hall 5, ICCWebsite: www.icatcare.org/vets Contact: Amanda Blencow

[email protected]

This years ISFM feline symposium on the day before BSAVA Congress will be focusing on Practical feline therapeutics: How do I treat ? for those everyday feline problems that are commonly seen in general practice. The aim is to provide a new focus and up-to-date practical advice on these issues.

Lectures will be given by Alberta de Steffano (Animal Health Trust), Vanessa Barrs (University of Sydney), Angie Hibbert (Langford Veterinary Services), Sarah Caney (Vet Professionals), Sheila Wills (University of Bristol) and Daniel Mills (University of Lincoln).

Topics covered will include: inappetent cats and the use of pharmacological stimulants, idiopathic epilepsy in cats, chronic upper respiratory infection in cats, stress and the use of facial pheromone versus when to use drugs, hyperthyroidism, and herpesvirus infection, amongst others. Get 5 off your registration price if you register online via www.icatcare.org/vets

Small Animal Medicine Society (SAMSoc)Venue: Hall 8, ICCWebsite: www.samsoc.org.ukContact: Alison Hall [email protected]

Members of SAMSoc include specialist internists and general practitioners from the UK and abroad who

Specialist Groups at Congress


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share a passion and enthusiasm for small animal medicine. New members are always welcome and membership is only 29.

SAMSoc organises two meetings each year, with lectures aimed at practitioner and specialist level. The Spring meeting is held every year at BSAVA Congress and is suitable for everybody with an interest in small animal medicine. This year the day will include the following exciting sessions:

Guillermo Couto Can we cure lymphoma? Elizabeth Villiers Flow cytometry: how does it

work and how can I use it to help my patients? Lizza Baines The met check: diagnostic imaging

for the cancer patient Dr Caroline Shiach IMHA and ITP in people

The meeting is still only 100 and includes course notes and lunch (if registration completed before 3 March). To book your place at the meeting or to become a SAMSoc member please contact Alison Hall or visit the website. Submissions for the case report competition should be sent to [email protected] by 17 February 2014.

Details of our autumn meeting, held in November, are available on our website. SAMSoc also offers a 500 travel scholarship annually to any SAMSoc member. For more information please contact [email protected]

Veterinary Cardiovascular Society (VCS)Venue: Hall 11, ICCWebsite: www.bsavaportal.com/

vcs/Meetings.aspxContact: Jan Cormie treasurer@vcs vet.co.uk

Membership of the Veterinary Cardiovascular Society is open to any veterinary surgeon or veterinary nurse from the UK and abroad with a special interest in cardiology. Annual VCS membership: 25. The society holds two meetings a year, a one-day pre-BSAVA Congress Spring meeting at the ICC in Birmingham and a two-day Autumn meeting, usually in Loughborough in November (1415 November 2014).

We also offer travel grants annually to VCS members to help them attend the ECVIM or ACVIM Congresses, as well as cardiology small project research grants.

The VCS pre-BSAVA Congress Spring meeting will focus on the clinical effects of heart disease and failure (heart rate, occurrence of coughing), the new IDEXX test for NT-proBNP and Doppler echocardiography, with speaker Professor John Bonagura. There will also be a panel discussion and case reports. The meeting will emphasize a practical approach to common issues encountered in general practice.

Registration costs Before 14 March

Members: 125 Non-members: 150

After 14 March Members: 150 Non-members: 175

Last date for registration is 24 March. Cost includes lunch and proceedings.

Please visit our website for access to the full programme and details of how to register: www.bsava.com/vcs


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Time well spent is money saved

At a time when value for money and wise buying decisions are vital, the extensive commercial exhibition at Congress will once again showcase the latest innovations, services and products. With so much to see and plenty of exclusive discounts, this is your chance to make sure you make the most of special offers, as well as negotiate the best deals for you and your practice and discuss new products with industry experts.

Real savings can be made when taking advantage of the amazing discounts and offers available within the Exhibition Vouchers Booklet. At Congress 2013, there were 28 tablet computers up for grabs, over 600 worth of shopping vouchers, 2 HD TVs and a number of discounts on CPD workshops, products and services, so it really pays to visit the Exhibition.

Theres an App for that

BSAVA Members can register for FREE Exhibition- only passes. Visit the website for details.

Cant come to Congress for the four days but want to check out what is on offer in the NIA?

Party night

Dust off your dancing shoes and get ready to laugh with Congress Party Night on Saturday 5 April, which will have live music provided by rock/pop band Lawson and laughs aplenty from Marcus Brigstocke and Rhodri Rhys.

Countdown to CongressRegistrations for Congress have been flooding in. The team at Woodrow House HQ is busy keeping up with demand, and the volunteers responsible for making Congress happen are checking the finer details to ensure their colleagues from all over the UK and from overseas get the most benefit from. From the Committee Chair Farah Malik to our

registration team we all want this to be a year that provides you with more knowledge, confidence, inspiration, and connections.

If you have not registered yet then there is still plenty of time visit www.bsava.com or if you have any questions email [email protected] or call 01452 726700 and a member of our team will be happy to help.

Our IT team has been working hard on a brand new and much-improved App for Congress which will enable you to: See the most up-to-date Scientific programme,

with lecture details and locations Browse the full list of speakers Build your own personal schedule to plan your

time effectively View the full Exhibitor listings and

company details Send us your feedback and comments Find out useful delegate information View Congress-related tweets

The App will be available prior to Congress. Members will be the first to hear when it goes live. To download it for free, just head over to the Apple AppStore (for iPhone/iPad) or Google Play (for Android).

and a number of discounts on CPD workshops, products and services, so it really

for thatur IT team has been working hard on a brand new and much-improved App for Congress which will enable you to:

See the most up-to-date Scientific programme,

Build your own personal schedule to plan your

The App will be available prior to Congress. Members will be the first to hear when it goes live. To download it for free, just head over

Enhance your Congress experience

Get closer to the experts with a number of Small Group Sessions and Practical Workshops; visit www.bsava.com/congress to find out more.

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For more information about PetSavers studies email [email protected].

Immune-mediated haemolytic anaemia (IMHA) remains an important cause of critical illness in dogs, with a case fatality of 3070%. Thromboembolic disease is reported as the most common complication, but a large number of dogs are euthanased due to an inability to control the disease (either in the short or long term) and due to long-term complications such as side effects of treatment.

In the treatment of immune-mediated diseases such as IMHA with glucocorticoids, we often fail to achieve disease remission or cure without unacceptable side effects. In humans, studies have shown that among systemic treatments involving the same total dose of glucocorticoids, split-dose regimens such as twice-daily dosing tend to be more toxic than single daily-dose methods.

A veterinary perspectiveSo far, there are no data available for veterinary patients on whether a single dose regimen would be as effective but less toxic than the conventionally used split regimen, as has been shown in human patients. Therefore, the aim of this study is to look at the efficacy (initial response as well as long-term outcome) and associated side effects of two different treatment protocols a more empirical twice-daily versus a once-daily regimen.

All dogs with a provisional diagnosis of IMHA will be eligible to be enrolled in this study pending further diagnostic testing. After exclusion of underlying disease processes, dogs with primary IMHA will be

Celebrating 40 YEARS of improving the health of pets

randomized to receive prednisolone either as a single daily dose or as a conventional split dose. Concomitant therapy consisting of a second immunosuppressive drug, gastroprotectants and antithrombotic medication will be the same for each group.

Efficacy of the single daily dose will be assessed in comparison to the conventional split-dose regimen regarding initial response, effects on lypmphocyte profile and long-term outcome. Furthermore, common side effects of glucocorticoids will be assessed by performing a serum biochemical profile, routine urinalysis, non-invasive blood pressure measurement (NIBP), thromboelastography (TEG), assessment of muscle mass and body condition scores, dermatological assessment, and by using a standardized questionnaire.

We hypothesize that a single daily dose regimen will be as effective as a split-dose regimen based on the initial response and long-term outcome. Furthermore, we hypothesize that an initial single daily dose regimen followed by an every-other-day maintenance protocol will be associated with fewer side effects and higher owner compliance and satisfaction.

Study potentialThe ability to achieve a quick remission of the disease without owner perception that the side effects of the drug are worse than the disease itself will have a major impact on patient management and outcome.

The results of this study will have the potential to be transferable to other

To split or not to split that is the question

Barbara Glanemann

Barbara Glanemann graduated from the University of Leipzig, Germany, in 2001. After completing a doctoral thesis at the University of Zurich, Switzerland, Barbara accepted a position as Intern in a private referral centre in Switzerland in 2004. On completion of this programme she entered the joined residency programme in small animal Internal medicine at the University of Giessen, Germany, and the Royal Veterinary College of London and gained her Diplomate ECVIM-CA in 2008. Prior to returning to the RVC as a lecturer in small animal medicine in December 2009 Barbara worked as a specialist in a private referral centre in Southern England.

Barbara Glanemann discusses her study into immune-mediated haemolytic anaemia

common conditions requiring long-term glucocorticoid therapy, such as immune-mediated meningitis, immune-mediated polyarthritis, etc.

The proposed study will also be the first to evaluate the effect on lymphocyte populations of glucocorticoids in the treatment of canine IMHA. It will be among the first to examine CD4+ FOXP3+ Tregs in the context of a spontaneous canine autoimmune disease. This is an area of intense research in people, reflecting the immunotherapeutic potential of Tregs in infectious, autoimmune, allergic and neoplastic disorders. n

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I am honoured and humbled by the confidence shown in me in the recent WSAVA election. I was not expecting to assume the WSAVA presidency so soon but I am committed to continue to drive progress towards our goals of improving companion animal care around the world.

I would like to thank Jolle Kirpensteijn for all that he has done for the WSAVA. He has been a wise mentor and his willingness to resume the presidency when Professor Peter Ihrke resigned for reasons of ill health gave me time to better learn and understand the many facets and intricacies of our organization. Jolle has been a fantastic leader and a great ambassador for the WSAVA. I thank him for his years of loyal service.

Meanwhile, I am proud to assume the responsibility of leading this great organization. Both the support we provide to our members globally and our contribution on the world stage in areas such as One Health are growing fast. Our committees and task forces are working productively, plans for World Congress 2014 Congress are virtually complete and registration is going well. I am also pleased to report that the readership of our digital global journal Clinicians Brief continues to grow.

WSAVA is your association and, as your elected leader, I really want to hear from you. What ideas do you have to help us deliver our mission? What can we do to enhance the work of your members? How can we help you? I would welcome your thoughts and contributions.

Thank you again for your support and for the work that you do for our profession. n

Colin Burrows

A message from the new President

Incoming WSAVA President Colin Burrows wants to hear from you

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Introducing a new veterinary oath for the WSAVA

The WSAVAs Animal Welfare and Wellness Committee has been working to develop a simple voluntary oath for the global profession

An oath should be central to everything that vets do, guiding their decisions and ensuring that they act in the best interests of patients at all times. Yet many countries do not have an oath, or other professional affirmation of the role of vets in the community. In countries with an oath, most fail to recognize the concept of animal welfare, focusing purely on the importance of relieving suffering.

The WSAVAs Animal Welfare and Wellness Committee (AWWC) believes this is an important omission and has been

As a global veterinarian, I will use my knowledge and skills for the benefit of our society through the protection of animal welfare and health, the prevention and relief of animal suffering and the promotion of One Health. I will practise my profession with dignity in a correct and ethical manner, which includes lifelong learning to improve my professional competence.

This oath is voluntary but the committee hopes that all members of WSAVA will wish to adopt it. The AWWC will announce the oath formally at the World Congress in 2014, but in the meantime the Committee plans to launch a new award to highlight members who really embody the values the oath stands for. Details of the award criteria and how to enter will be announced shortly. n

working to develop a simple voluntary oath, which reflects all aspects of the vets role. In doing this, Committee members examined the veterinary oaths used around the world and also talked to member associations to understand their expectations of an oath. Having done this, the committee has now developed a new oath that highlights the importance of animal welfare and is relevant to all veterinary practitioners. It can be used on its own, as an adjunct to an existing statement or as a guide to associations or groups looking to develop their own oath:

There will also be the opportunity to visit neighbouring countries, including Botswana, Mozambique, Namibia and Lesotho, with volunteer lecturers to help teach local veterinarians. This will appeal particularly to those with an interest in lecturing and education and this work will serve as an extension of WSAVAs CE programme.

In addition, the organizers are hoping to run an activity based around supporting South Africas endangered rhino population and are also looking for volunteers for a pre-Congress stream to help educate local animal health inspectors. More details on both of these will be available soon.

The social outreach programme will be welcomed by many communities that usually have only limited access to veterinary services, and is an ideal opportunity to give something back to Africa. For more details visit www.wsava2014.com. n

Make a difference by taking advantage of a unique social outreach opportunity

World Congress 2014

World Congress 2014 takes place from 1619 September in Cape Town. It will be an ideal opportunity to be updated with the latest in veterinary science and to exchange ideas with colleagues from around the world. The social programme will ensure you experience the best of South African hospitality, food and wine, while the

opportunity to take a wildlife safari is not to be missed. However, this World Congress will be truly unique. It will also be about reaching out and providing much-needed support to indigent communities in Johannesburg, Cape Town and Durban.

The organizers are partnering with the International Fund for Animal Welfare (IFAW) and the South African Veterinary Association to develop a range of social outreach programmes, including opportunities to participate in clinics involved with the WSAVAs rabies vaccination campaign. This will include basic diagnostics and treatments and may involve neutering clinics. Arrangements are being finalized and work will be carried out in conjunction with local animal welfare institutions.

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Kirstie ShieldDipAVN(Surgical) RVN LCGI MBVNA

QTell us about how you chose your career.A I knew from a young age that I would become a veterinary nurse. Once Id completed work experience in practice, I knew it was the life for me. After A levels, teachers encouraged me to apply for university. However in my heart of hearts I was adamant that veterinary nursing was reall

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Companion February 2014 Low Res