Companion May 2014 Low Res

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The essential publication for BSAVA members

companionMAY 2014

Who is whoMeet your regionalcommitteeP24

Congress storiesHighlights from arecord breakerP4

How To...Utilize radiotherapy fororal tumoursP16

Causesof dysuria


2/362 | companion

Log on to www.bsava.comto access

the JSAP archive online.

EJCAP ONLINE

To access the latestissue of EJCAP visitwww.fecava.org/EJCAP.

Find FECAVAon Facebook!

3 BSAVA NewsLatest from your Association

45 A quality CongressMain stories from the event

69 Congress in picturesFour days in the frame

1013 Clinical ConundrumDysuria in a poodle

1415 Rehab for the whole practiceValuable new manual

1621 How toUtilize radiotherapy for dogs withoral tumours

2224 Who is WhoGet to know your region

2627 PetSaversDermatology funding

2829 WSAVA NewsWorld Small Animal VeterinaryAssociation

3031 The companioninterviewJames Anderson

3233 Regional CPDLocal knowledge close to home

3435 CPD DiaryWhats on in your area

companionis published monthly by the BritishSmall Animal Veterinary Association, WoodrowHouse, 1 Telford Way, Waterwells Business Park,Quedgeley, Gloucester GL2 2AB. This magazineis a member-only benefit. Veterinary schoolsinterested in receivingcompanionshouldemail [email protected]. We welcomeall comments and ideasfor future articles.

Tel: 01452 726700Email: companion@

bsava.com

Web: www.bsava.com

ISSN (print): 2041-2487ISSN (online): 2041-2495

Editorial Board

Editor Mark Goodfellow MA VetMB DPhil CertVR DSAMDipECVIM-CA MRCVSCPD Editor Simon Tappin MA VetMB CertSAMDipECVIM-CA MRCVSPast President Mark Johnston BVetMed MRCVS

CPD Editorial Team

Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVSTony Ryan MVB CertSAS DipECVS MRCVSLucy McMahon BVetMed (Hons) DipACVIM MRCVSDan Batchelor BVSc PhD DSAM DipECVIM-CA MRCVS

Eleanor Raffan BVM&S CertSAM DipECVIM-CA MRCVS Features Editorial Team

Andrew Fullerton BVSc (Hons) MRCVS

Design and Production

BSAVA Headquarters, Woodrow House

No part of this publication may be reproducedin any form without written permission of thepublisher. Views expressed within thispublication do not necessarily represent thoseof the Editor or the British Small AnimalVeterinary Association.

For future issues, unsolicited features,particularly Clinical Conundrums, arewelcomed and guidelines for authors areavailable on request; while the publishers willtake every care of material received noresponsibility can be accepted for any loss ordamage incurred.

BSAVA is committed to reducing theenvironmental impact of its publications

wherever possible and companionis printedon paper made from sustainable resourcesand can be recycled. When you have finishedwith this edition please recycle it in yourkerbside collection or local recycling point.Members can access the online archive ofcompanionat www.bsava.com.

Additional stock photography:

www.dreamstime.com

Annemario; Dkcphotography; Herman Lumanog;

Imagery Majestic; Isselee; Oleksandr Marynchenko; Scott Griessel; Silkenphotography; Teemu Tretjakov

Whats inJSAPthis month?

Prevalence and demographics of

the MYBPC3-mutations inRagdolls and Maine coons

The objective of this study from

Casamian-Sorrosal et alfrom the

University of Bristol was to

determine the prevalence and

demographics of two myosin-binding

protein C (MYBPC3) mutations that affect

Ragdolls (R820W) and Maine Coons

(A31P) in the British Isles.

Using a database of genetic testinglaboratory samples from 2018 Ragdolls

and 742 Maine Coons, data were analyzed

with respect to mutation status, age, sex

and county of origin. The actual

prevalence was compared to the

expected HardyWeinberg prevalence.

The prevalence of the R820W mutation

in Ragdolls was found to be 27% (25.6%

heterozygous, 1.4% homozygous), and

that of the A31P mutation in Maine Coons

was 39.4% (36.4% homozygous, 3%

heterozygous). There were more female

cats and the median age was 6.4 months

(Ragdolls) and 5.9 months (Maine Coons).

This is the first report of prevalence

and demographics of the R820W and

A31P mutations in Ragdolls and Maine

Coons, respectively, in the British Isles.

The prevalence is high, which is of

relevance for breeding and screening

programmes. The significant difference ingenetic distribution may suggest early

death of homozygous Maine Coons.

Adapted from Casamian-Sorrosal D., et al. JSAP 2014; 55:269273

ALSO IN THIS MONTHS ISSUE

Whole blood manganese concentraonsin dogs with primary hepas

Fish oil supplementaon increasesconcentraon of adiponecn inhealthy dogs

Doxorubicin-based chemotherapyfor dogs with right atrial masses and

pericardial effusion Manual vs laboratory PCV and total

protein using EDTA and LiH caninesamples

Cloacal prolapses in reples


3/36companion | 3

Your views count

BSAVA regularly participates in a variety of

consultations. Occasionally the short timescales

(sometimes just a few days) can make it difficult

to fully involve all members. So we now

undertake our own internal consultations on subjects

that are considered to be important to veterinary

professionals in small animal practice just the kind of

issues that we may be asked to consult on in the future.

Last year we undertook successful member

consultations on the role of veterinary nurses in monitoring

and maintaining anaesthesia, and on the advantages and

disadvantages of a new veterinary school. More recently

we have been consulting on the development of

appropriate clinical standards for small animal practice,

24 hour cover, and the use of ketamine in practice.

These consultations take place online at

www.bsava.com/consultations and we wouldencourage you to visit these pages regularly to

participate and comment on the subjects that matter

most to you. We will remind you of them in our monthly

emails, and where time allows here in companion. Wewant to represent our members where it counts please

help us to do that. n

Editorial hand-over forcompanion

Mycobacterium bovis in cats

PetSavers Mucky Pups

Ateam of four from North Yorkshire are

aiming to take on the worlds biggest

obstacle course for PetSavers. The team

of PetSavers Mucky Pups are hoping to

raise as much as possible for PetSavers by taking

part in the new stamina-sapping Rat Race Dirty

Weekend, held at the Burghley Estate in

Lincolnshire on Saturday 10 May.

Tiff OKelly, the Captain of the Mucky Pups

said: When we originally decided to take up a

challenge to raise fund for PetSavers it was

decided that we needed to do something big. Aftera little research, it became clear that it doesnt get

much bigger than the Rat Race Dirty weekend

20 miles and 200 obstacles including mud pits and

lake swims, this challenge seemed appropriate for

what we want to achieve. PetSavers is a fantastic

charity that does great work but needs more

people to know about them! After a little cajoling I

had my squad, and the PetSavers Mucky Pups

team was born.

To donate to the PetSavers Mucky Pups

challenge visit www.justgiving.com/PetSavers-

MuckyPupsn

In April companioncelebrated its sixth birthday.

It was launched in 2008 with

Mark Goodfellow as Editor.

His vision and leadership have

seen companionbecome oneof BSAVAs most valued

member benefits and an

essential part of members

regular continued professional

development as well as avehicle for the association to

engage with members. The

success of companionis a

result of his commitment and

enthusiasm.

Dr Goodfellow will now hand

over the editorial reins to

Simon Tappin. Simon, who

works in practice at Dick White

Referrals, has been involved

with companionfor severalyears, commissioning and

editing the Clinical Conundrum

and How Toarticles.In taking over the Editor

role, Simon said: It has been a

privilege to work with Mark on

companionand I look forwardto building on the excellent

foundations he has created. His

commitment to excellence and

providing genuinely useful,

accessible content for his

fellow BSAVA members has

been inspiring, and in taking on

this role I am aware that we

have a lot to live up to. I know

that the entire Association

appreciates his invaluable

contribution to companion. n

Arecent article in the Veterinary Record, with

information from Public Health England

(PHE), raised concerns about the

prevalence and zoonotic potential of

Mycobacterium bovis in cats.

The Chief Veterinary Officer, Nigel Gibbens,

followed this up with a letter in Veterinary Record

which summarizes current information on M. bovis

infection in cats.

BSAVA has published its own summary online,

based on current information, and at the time of

writing BSAVA Scientific Committee is preparing a

more complete, evidence-based information and

advice document for veterinary surgeons and this will

be made available on the website in May. n

Tiff OKelly

Lucy Horsman

Ian Henderson


4/364 | companion

Congress 36 APRIL 2014

A qualityCongress

Once again the numbers stacked up to make

BSAVA Congress a record breaker. Theofficial total was 6311.Yet President

Professor Michael Day was keen to talk

about the event in terms of quality not just quantity.

Quality is what continues to set BSAVA Congress

apart, he said. The quality of the faultless

organization, the quality of the scientific content, and

the quality of our exhibition and incomparable social

programme.

All the CPD you needVets and vet nurses jointly acquired more than

100,000 CPD hours in a packed and varied scientific

programme across the four days. Thanks to exclusiveaccess to lectures within the online podcast library, not

only can BSAVA members make Congress last all year

long, but they can also achieve their entire 35 hour

quota of CPD from this one event.

It wasnt just the science that topped up delegates

skills either. The increasingly popular Management

Stream provided lectures on business topics that

included public relations, accountancy and human

resources. This addition to the programme draws a

diverse audience of vets, VNs and practice managers

making Congress an event for the entire team.

Alice in Congress landRespected commentator, author and broadcasterProfessor Alice Roberts gave an engaging keynote

speech to a packed ICC hall on the role of evolutionary

science in demonstrating how the human and animal

worlds are intertwined. Her talk had the audience

riveted and she proved a popular choice to follow in

the footsteps of distinguished scientists at BSAVA

Congress in recent years, such as Richard Dawkins,

Lord Robert Winston, and Baroness Susan Greenfield.

A time to celebrateThe BSAVAs charitable arm PetSavers celebrated its

40th anniversary in style at Congress, with a bubbles

and cupcake birthday party on its Balcony stand.PetSavers used the occasion to announce 40,000 of

funding to be split between the seven veterinary

colleges, with the remaining 5,000 available to

veterinary nurses who apply for funding.

PetSavers also launched its 200 Project an

appeal to every veterinary practice to raise 200 each

this year, a figure which would secure future funding

and reduce PetSavers reliance on unpredictable

income sources such as legacies.

Enticing ExhibitionWell over 1800 veterinary books were snapped up on

the BSAVA Balcony, including Congress debutants

the BSAVA Manual of Canine and Feline Radiography

and Radiology; the BSAVA Manual of Rabbit

Medicine, and the BSAVA Manual of Rabbit Surgery,

Dentistry and Imaging. Eligible BSAVA members also

collected their complimentary copies of the new

BSAVA Small Animal Formulary, and the BSAVA

Guide to Procedures in Small Animal Practice from the

Membership Stand on the Balcony.

Nearly 300 exhibitors, including new and familiar

names, filled the National Indoor Arena, with many

choosing to launch new products and offer exclusive

deals. Delegates took advantage of the numerous

offers available and of course walked away with bags

of free gifts and samples. The competition prizes werealso particularly impressive this year including the

chance to win a Range Rover, and a conservation

safari holiday.

The Stand Awards were hotly contested this year

4 | companion


5/36companion | 5


because so many of the exhibitors had been

remarkably creative. Pharmaceutical manufacturerBayer won the best space-only stand award for its art

gallery-themed display. The large shell scheme award

went to Forum Animal Health and the small shell

scheme award was won by Chunk Training.

Big IssuesFriday was Big Issues day and the stream

culminated in a session where Chief Veterinary

Officers from each of the four UK administrations were

invited to the first ever question and answer session

with BSAVA delegates.

They may have been expecting to discuss the

issues that have dominated debates betweengovernment veterinary staff and their colleagues in

private practice in recent months, such as

antimicrobial resistance, compulsory microchip

identification and illegally imported puppies. But the

discussion was dominated by an issue that had flared

up in the national press only a few days before.

The government vets were admonished for failing

to keep their colleagues in companion animal practice

properly informed of the possibility of zoonotic human

infection from cats suffering from bovine tuberculosis.

A Basingstoke practitioner in the audience

complained that government colleagues had not

alerted staff in local practices to a cluster of cases of

Mycobacterium bovisinfection in nine cats around theNewbury area, which had also resulted in two human

cases. I understand that the last of the cases

occurred in March 2013 but the first I knew was when

I read about it last week in the Daily Mail, she said.

It isnt all workThe social programme included comedy by popular

stand-up Marcus Brigstocke, compred by Rhodri

Rhys who returned following his success at last years

party night. Boy band Lawson provided musical

entertainment on Saturday night and ensured that

revellers were already in the dancing mood by the time

the late night disco got started.

By the profession for the professionOutgoing BSAVA President Michael Day was keen to

remind us that this event was truly created by theprofession for the profession when he said two years

of planning comes together for this extraordinary event

during these four days, and I have seen at first hand

the level of detail and preparation that occurs.

Most of that preparation is done by vets and VNs

who volunteer their time and expertize to the two

Congress Committees responsible for putting the

entire event together. They are supported by staff from

Woodrow House HQ who head to Birmingham from

Gloucester each year. This year the Head of Business

Operations pedometer revealed that he had covered

309.70 miles during his week at Congress. That might

be another record breaking figure for 2014.

A new era beginsWhen Katie McConnell was inducted as the new

BSAVA President on the Sunday of Congress she said

it was an honour to have been asked to lead such a

fantastic organization; Like so many previous

Presidents, I look back on my early volunteering days

with deep affection but it would have been a great

surprise to my earlier self to be told that one day I

would be the BSAVA President.

During my presidential year I would like to meet as

many BSAVA members as I can, hopefully in their own

regions. I plan to travel to regional BSAVA continuing

education meetings, not to stand up and lecture but tolisten to individual members and find out what the

BSAVA means to them. The BSAVA is run by members

for members and the only way to shape its work is to

become engaged with it. n


6/366 | companion


DUNKIN AWARDRobyn Jarrett

Congress in picturesCongress is the perfect time for us to celebrate and honourcolleagues who do outstanding work in the veterinaryprofession. The prestigious BSAVA Awards were presentedduring the event and recognized the achievements of theprofessions unsung heroes

THE SIMON AWARDMichael Guilliard

THE WOODROW AWARDTimothy Nuttall

THE AMOROSO AWARDSusan Haywood

THE MELTON AWARDPam Mosedale

THE J.A. WIGHTMEMORIAL AWARDSarah Cleaveland

PETSAVERS AWARDZachary Goodrich

THE BOURGELAT AWARDClaudia E. Reusch

THE BLAINE AWARDJacques Penderis

CLINICAL RESEARCH ABSTRACT(Top to bottom): PractitionerAward (sponsored by companion):Anna Tauro; Intern/Graduate

Award: Joana Gonalves Aguiar;Surgical Award: Mickey Tivers;Medical Award: Nele Van denSteen; Nurse Award: WendyBarnett; Poster Award: XavierNavarro


7/36companion | 7


With another record breaking year for delegate numbers, theexhibitors at BSAVA Congress had to make sure they camewith plenty to impress and they did just that. This was acolourful, lively exhibition, packed with innovation, specialoffers, exclusive launches and engaging stories

Who says there is no timeto relax in the Exhibition?

The Merial sweet shop gave delegates an energy rush and their feline friend helped them to talk about their newparasite control for cats

Congress is a chance for delegates(and presidents) to get close toindustry experts and test out theirlatest offerings

There were lots of new releases atCongress. Safe Solutions choseCongress to launch three newproducts and discuss new EUregulations

As well as hosting their awardsduring Congress week, Petplanhad lots of fun on their stand

Exhibitors got creative andcompetition prizes were evenmore generous than ever

Bayer won the best stand awardand gave away hundreds of funkyframes

Weight management was the focus

for Royal Canin as it sought tocapitalise on the PDSAs recently-announced pet obesity findings

The NIA played host to almost300 exhibitors this year


8/368 | companion


Congress in pictures

From the glittering gala that is theBSAVA Banquet on Friday Night, throughthe daily treats and events in theExhibition and culminating with theever-popular Party Night on Saturday,BSAVA Congress has a reputation forputting on memorable social events

Everyone enjoyed the talk givenby Professor Alice Roberts including Alice!

International delegatesenjoying the underwaterdelights of the SeaLife Centreat a special reception

Chart makers Lawson provided therock element, making suredelegates were in the mood tokeep dancing into the early hours

Marcus Brigstocke was the latesttop name comic to entertain at theComedy Club

Party Night has earned an unrivalled reputation for bringing theprofession together for an informal night of laughter and dancing

BSAVA Banquet provided delegates with an opportunity to dress up andenjoy a glamorous evening with superb food and great company

PetSavers Patron Gyles Brandreth with Wolfgang Dohne andPedro Martn Bartolom at the Petplan awards


9/36companion | 9


From students to founding members of BSAVA, all ages andlevels of experience need to be taken care of and provided forat BSAVA Congress. This is possible because it is anorganization run by the profession for the profession

The first Veterinary Nurse Merit Awards were collectedat Congress

Barbara Weaver and Sheila Crispin were given HonoraryLife Membership at the AGM

The 201415 Officer team is led by President Katie McConnell and is joined bySusan Dawson (far right)

Clinical Research Abstract award winners. CRAs are animportant part of Congress that nurture new science andtalent within the profession

The two new rabbit Manualslaunched at Congress werebest sellers. Marion Jowett,BSAVA Publishing Manager,celebrated the launch withJohn Chitty and RichardSaunders at her last Congress

after working with BSAVA for17 years

Quality science sits at the heart of Congress and each year the vets and VNs on Congresscommittee aim to creative an innovative programme that maintains standards

More lectures at Congress now have a practical orinteractive element, allowing delegates to meet theexperts and get involved


10/36

Louise Bird, Resident in SmallAnimal Medicine at AndersonMoores Veterinary Specialists,invites companionreadersto consider the causes ofdysuria in a 3-year-old maleneutered Standard Poodle

10 | companion

Clinicalconundrum

Case presentationA 3-year-old male neutered Standard Poodle

presented with a 2-year history of intermittent

stranguria and pollakiuria. The episodes

occurred at irregular intervals during periods

of stress. His bladder was usually easy to

express during an episode; however, at times

bladder expression was difficult and urethral

catheterization was necessary to relieve the

obstruction. On each occasion the catheter

was reported to have passed easily. Urine

culture had infrequently been found to be

positive for bacterial growth on free-catch or

catheterised urine samples and on theseoccasions antimicrobial therapy had been

commenced. Most episodes of stranguria had

resolved without antibiotic therapy over a

23 day period.

The owners reported the dog to have

developed stranguria following a period of

hospitalization for symptomatic treatment of

acute-onset gastrointestinal tract disease.

Physical examination revealed him to be

bright and in good body condition. The general

physical examination was within normal limits.

On gentle bladder palpation, a small stream of

urine was produced without signs of dysuria

and the stream continued when bladder

palpation was stopped. The bladder remained

palpably moderately full following this.

Neurological examination was unremarkable.


11/36companion | 11

Create a problem list based on the dogs

history and physical examination findings

Stranguria

Pollakiuria

Urinary retention

What differential diagnoses should beconsidered at this stage?Several disorders may result in stranguria and

pollakiuria with a full bladder in the dog:

Urolithiasis

Neoplasia of the bladder/urethra

Urethritis

Urethral stricture/trauma

Bladder displacement/entrapment

Prostatic disease

Neurogenic dysuria

Clinical signs of stranguria and pollakiuria in this

case were chronic (2-year history) and intermittent,

which made conditions such as urolithiasis, lower

urinary tract neoplasia, bladder displacement/

entrapment and prostatic disease unlikely. However,

some of the potential conditions may cause intermittent

signs and could not be fully excluded based on history

and physical examination alone. Uncomplicated

urinary tract infection was felt unlikely as the patienthad repeatedly presented with a full bladder.

This dog appeared to have urinary retention; the

differential diagnoses can be divided into neurogenic

and non-neurogenic causes:

Neurogenic causes of urinary retention

Upper motor neuron bladder dysfunction (occurs

with a lesion of the suprasacral spinal cord

segments; pons of the brainstem to L7)

Lower motor neuron bladder dysfunction (occurs

with a lesion in the sacral spinal cord segments)

Detrusorurethral dyssynergia (reflex dyssynergia)

Primary detrusor atony

Non-neurogenic causes of urinary retention

Anatomic urethral obstruction (secondary to such

processes as infection, inflammation, calculi,

neoplasia, blood clots) Functional urinary obstruction (urethral spasm,

urethral stricture, idiopathic)

Medications (opioids, anticholinergics, tricyclic

antidepressants, calcium channel blockers)

Considering the neurogenic causes of urinary

retention: lesions of the suprasacral spinal cord

typically result in dysfunction of ascending

proprioceptive and descending motor tracts,

manifesting clinically as tetra- or paraparesis and

ataxia, which were not present in this case. Lesions of

the brainstem and spinal cord cranial to S1 were

considered very unlikely based on a combination of

history (intermittent and chronic clinical signs) and

physical examination findings (normal neurological

examination).

Occasionally very dorsal spinal cord lesions such

as subarachnoid diverticuli can result in urinary or

faecal incontinence in the absence of other

neurological signs), so upper motor neuron bladder

dysfunction could not be entirely excluded at this

stage. Patients with lower motor neuron bladder

The patient posturing to urinate unproductively


12/3612 | companion

Clinical conundrum

dysfunction usually have concurrent neurological

abnormalities, such as flaccid paraparesis anddepressed genitoanal reflexes, which were also

not present.

A normal stream of urine was produced on

abdominal palpation and was continued when

abdominal palpation was stopped; this would make

primary detrusor atony less likely, as this condition

commonly results in a weak or absent urine stream.

There was no history of prior medications resulting in

non-neurogenic urinary retention.

Therefore, at this stage, detrusorurethral

dyssynergia, partial anatomical or functional urinary

obstruction, or a dorsal spinal cord lesion such as a

subarachnoid diverticulum remained the most likelydifferential diagnoses.

What initial investigations would youconsider?The diagnostic work-up in this case was directed

towards differentiating between neurogenic and

non-neurogenic causes of urinary retention.

Abdominal ultrasonography was performed to

exclude mechanical obstructions of the urinary outflow

tract (such as prostatic disease and bladder

entrapment) as best as possible. This revealed the

bladder wall to be mildly, but diffusely, thickened. This

change was felt likely to have been the result of

previous cystitis or fibrosis. As there were no discrete

lesions, neoplasia was considered to be unlikely. The

remainder of the urinary tract, which could be

assessed with ultrasound, was considered normal.

Urinalysis and urine culture were performed on a

sample obtained by cystocentesis, as urinary tract

infections had infrequently been diagnosed during

episodes of stranguria. Urine culture revealed a

heavy growth of Enterococcus sp. This was thought

to be secondary to urine retention rather than the

underlying cause of clinical signs, as urinary tract

infections had only occasionally been diagnosed

during previous periods of stranguria and most

episodes of stranguria and historically had resolvedwithout antimicrobial treatment. A 10-day course of

potentiated amoxicillin was prescribed; culture of a

mid-stream urine sample collected at the end of the

antibiotic course was negative.

How do the results of these initial

investigations help refine the differentialdiagnoses?Idiopathic detrusorurethral dyssynergia remained a

differential, as diagnosis of this condition is based on

the exclusion of detectable pathological conditions

that could also cause urine outflow obstruction.

The distal and prostatic components of the urethra

could not be examined with ultrasound due to

overlying bone, so a partial intraluminal or extraluminal

urethral obstruction could not be fully excluded at

this stage.

A neurogenic cause secondary to a spinal cord

lesion also remained possible. However, the majority of

patients with spinal cord disease severe enough tocause urinary tract signs are neurologically abnormal

on examination.

What further investigations may behelpful at this stage?Urethroscopy was performed to assess the distal and

prostatic urethra. The only abnormality detected was

an area of mild mucosal inflammation approximately

10 cm from the prepuce. This lesion was not causing

intraluminal obstruction of the urethra and was

thought unlikely to be the cause of the clinical signs.

It was presumed to be secondary to urethral

catheterization prior to urethroscopy. The mucosalsurface of the bladder appeared normal.

Contrast urethrography (in combination with

double-contrast cystography) would have been an

alternative method of imaging these areas if

endoscopy had not been available or were limited due

to patient anatomy (urethroscopy is generally limited to

female and larger male dogs).

Although a subarachnoid diverticulum was

thought to be an unlikely differential in this case,

magnetic resonance imaging of the spine was

performed to exclude this and other structural

neurological disease definitely; the MRI revealed no

obvious abnormalities.

Final diagnosisThese findings exclude a partial intraluminal or

extraluminal urethral obstruction or a spinal cord lesion


13/36companion | 13

as an underlying cause of the stranguria, pollakiuria

and urinary retention.The history and exclusion of other causes indicated

idiopathic detrusorurethral dyssynergia, with likely

secondary urinary tract infection.

Idiopathic detrusorurethral dyssynergiaIdiopathic detrusorurethral dyssynergia is a

functional disorder of the voiding phase of micturition.

This phase requires a coordinated contraction of the

detrusor muscle of the bladder, with simultaneous

relaxation of the internal and external urethral

sphincters. In patients with idiopathic detrusor

urethral dyssynergia there is contraction of the

bladder without relaxation of the urethral sphincters.Affected patients have a normal initiation of voiding

but urination is then interrupted by contraction of the

urethral sphincter, resulting in a urine stream which

may be narrowed, occur in spurts or dribbles; or

patients can sometimes have complete obstruction of

urine flow.

Stranguria and dysuria, the same signs as seen

with mechanical obstruction of the urine outflow tract

(e.g. by urethral mass or calculi) can be present.

Affected patients usually retain urine, evident as

increased residual volume of urine in the bladder. The

bladder is often hard, turgid, and can sometimes be

difficult to express manually because of the increased

tone to the urethral muscles, but a urethral catheter

can be easily passed into the bladder.

An underlying anatomical or neurological lesion

has not been described in dogs with idiopathic

detrusorurethral dyssynergia. Most cases have a

normal neurological examination. Affected patients

usually have an acute onset of clinical signs, and

for this reason, trauma or a small vascular accident

in the lower lumbar spine have been suggested

aetiologies.

In a study of 22 dogs with idiopathic detrusor

urethral dyssynergia (Daz Espieira et al; 1998),

affected patients were middle-aged male dogs (13 of

22 were entire), of large and giants breeds. Nine ofthe 22 dogs had periodic clinical signs of dysuria/

stranguria, with or without complete obstruction, for

longer than one year. Therefore, this presentation was

fairly typical of those reported in the literature.

How would you manage and treat this

case?Treatment is directed towards coordination of

detrusorurethral activity during urination, by relaxing

the urethral sphincter. Both a sympathetic (affecting

the striated muscle of the external urethral sphincter)

and a somatic (affecting the smooth muscle of the

internal urethral sphincter) form of idiopathic

detrusorurethral dyssynergia are recognized. For

this reason, both phenoxybenzamine and diazepam

were prescribed.

Phenoxybenzamine is an alpha adrenergic

antagonist and reduces urethral smooth muscle tone

in small animals. Side effects of alpha antagonists

include gastrointestinal upset, hypotension andincontinence.

Diazepam is a skeletal muscle relaxant and can be

used to reduce striated muscle tone within the external

urethral sphincter. The major side effect of diazepam is

sedation, although paradoxic excitement and

hepatotoxicity are also possible.

An alternative alpha antagonist is prazosin, which

is a selective alpha1receptor blocker. Adverse effects

are similar to those of other alpha antagonists,

particularly hypotension. Sedation, behavioural

changes and seizures have been recognized with the

intravenous administration of prazosin, but have not

been observed with oral preparations.

OutcomeTwo weeks after phenoxybenzamine and diazepam

were commenced the clinical signs were significantly

improved, although some sedation secondary to

diazepam was reported after several days. The plan

for ongoing management was to introduce both

medications for short course as soon as signs of

stranguria and dysuria were noted. Due to the

reported side effects of diazepam, and as chronic

dosing of this medication can lead to upregulation of

the hepatic microsomal enzyme system and,

therefore, tolerance to the drug in dogs, diazepam

was not prescribed to be given continuously. Inaddition, clinical signs were intermittent and urination

was normal between episodes, so continual dosing of

both diazepam and phenoxybenzamine was deemed

unnecessary in this case.

References

available online

MORE

ONLINE


14/3614 | companion

Rehabilitationfor the wholepractice

Companion animals are undergoing previously

uncontemplated treatments and surviving what

would once have been rapidly fatal conditions.

The BSAVA Manual of Canine and Feline

Rehabilitation, Supportive and Palliative Careis aimed at

the whole veterinary team, drawing on all their skills to help

patients achieve as full a function and quality of life as

possible after surgery, trauma or disease, and to manage

chronic conditions effectively for the benefit of the animal,

owner and the practice team.

From principles

The principles of rehabilitation, supportive and palliativecare are detailed in the introductory chapters of the Manual.

The science behind pain and its management, clinical

nutrition and physical therapies is explored, and the clinical

applications are reviewed with reference to published

evidence of efficacy and/or effectiveness.

In any clinical case, the aims of rehabilitation should be:

To limit pain

To return the animal to normal function where possible

To reduce recovery times.

Rehabilitation requires patience and time. Realistic

timelines need to be set, so that the veterinary practice and

the owner can assess progress and identify when this is tooslow or inadequate. Realistic outcome measures need to be

set with, ideally, input as appropriate from physical

therapists, nurses and nutritionists, as well as veterinary

surgeons and owners.

to practical applicationsA unique feature of this remarkable Manual are the

case-based scenarios that demonstrate how the

principles of rehabilitation can be put into practice.

The cases cover diverse topics: from elbow arthritis in

an elderly cat, to inflammatory bowel disease in a

dog; and from glaucoma in dogs, to leg amputation in

cats. Each case is presented in a similar manner and

details the following areas, as appropriate to the

individual patient:

Patient history, clinical signs on presentation and

diagnostics Agreed medical/surgical management

Acute/chronic pain management

Fear, stress, conflict concerns

Nutritional requirements

Physiotherapy

Hydrotherapy

Acupuncture

Other nursing and supportive care

Owner advice and homecare recommendations.

To purchase your copy of theBSAVA Manual of Canine and FelineRehabilitaon, Supporve and

Palliave Care: Case Studies in PaentManagement, visit the website atwww.bsava.com or call ourMembership and Customer ServicesTeam on 01452 726700.

The BSAVA Manual ofCanine and FelineRehabilitation, Supportiveand Palliative Careprovidesvaluable information forevery member of the team

Main imagereproduced fromBSAVA Manual ofCanine and FelineRehabilitation,Supportive andPalliative.Courtesy ofDavid Prydie


15/36companion | 15

Exclusive to VN Members

Launched at BSAVA Congressin April, the BSAVA Casebookfor Veterinary Nurses,edited by Rachel Lumbisand Stuart Ford-Fennah,is the latest loyalty benefitfor VNs renewing theirBSAVA membership

Veterinary nursing has developed considerably over the

past decade, with the role of the Veterinary Nurse

continually expanding and advancing. Registered

Veterinary Nurses (RVNs) now demonstrate an

acceptance for autonomy, accountability and

responsibility for their actions, and adherence to the

RCVS Code of Professional Conduct.

In defining a professional role for veterinary

nurses, one of the first steps has been to introduce the

nursing process and models of nursing into the

veterinary nursing syllabus. This has led to the

creation of care plans through which the nursing care

of veterinary patients can be systematically assessed,

planned and delivered by VNs. The introduction in this

casebook, adapted from the relevant chapter in theBSAVA Textbook of Veterinary Nursing, 5th edition,

provides information on the principles of nursing

models, whilst two of the case studies are linked with

care plans that demonstrate how these principles can

be applied in practice.

The BSAVA Casebook for Veterinary Nurses

showcases a selected number of cases originally

published in the BSAVA Manual of Canine and Feline

Rehabilitation, Supportive and Palliative Care.

These range from acute severe pancreatitis in a dog

to chronic gingivostomatitis in a cat and from triaditis in

a cat to osteosarcoma in a dog. To make these studies

even more valuable to VNs, additional information on

nursing considerations has been added to each case.

Eligible BSAVA VN Members who did not collect

their complimentary copy at BSAVA Congress will be

sent their Casebook by the end of May.

BSAVA VN Merit Award

Rehabilitationand physiotherapyLowri Davies and Tamsin OBrien

Attendance courses:Friday 12 September, Saturday 13 September

and Saturday 25 October

at SMART Clinic, Cardiff

Evening webinars:Tuesday 14 October and Tuesday 18 November

This Award will place nurses

in the framework of the

rehabilitation team and

cover the processes

involved with the different

types of therapies available

and how they can be

applied, assessed and

monitored.

Therapies covered will

include hot and cold

therapy, acupuncture and

electrotherapy. Practicalsessions will support the

theory learnt. To further your

learning, the Award will finish

with an online assessment

and case study.

Book your place now at www.bsava.com or by calling our

Membership and Customer Services Team on 01452 726700.


16/3616 | companion

How toutilize radiotherapyfor dogs with oral tumours

Introduction to radiation therapyRadiotherapy is an important and increasingly

available treatment modality for the treatment of

neoplastic conditions in veterinary patients, and oral

tumours make up a significant part of the caseload of

the veterinary radiation oncologist. Radiation is most

commonly and most ideally used in the adjunctive

setting that is postoperatively in the presence of

microscopic disease but this treatment modality can

also be used in the gross disease setting in

appropriate cases.

There are currently six centres in the UK with the

ability to treat patients with radiotherapy: theUniversities of Liverpool, Edinburgh, Glasgow and

Cambridge, VRCC Veterinary Referrals in Essex and

the Animal Health Trust in Suffolk.

Radiation works by killing tumour cells. Photon

beams are generated by a linear accelerator (Figure 1)

and directed through tissue. This results in the release

of electrons and free radicals, which cause damage to

DNA, RNA and cellular proteins via both direct and

indirect effects. Tumour cells (Table 1) and surrounding

normal tissues vary in their sensitivity and hence

response to radiation.

Definitive radiation protocols consist of numerous

treatments of a small dose of radiation; most

commonly 2.74.2 Gy administered daily or onalternate days and the objective of therapy is to

maximize tumour control.

Hypofractionated radiation protocols are

administered less frequently, often once weekly, and

Sarah Mason was the recipient of the 2013 BSAVA Frank Beattietravel scholarship, which allowed her to travel to the University ofCalifornia Davis to spend two weeks learning more aboutradiotherapy for the treatment of neoplasia in companion animals.Here Sarah presents an introduction to the use of radiotherapy inthe management of canine oral tumours, illustrated with casesshowing the practical knowledge gained on her trip

Figure 1: The linear accelerator at the University of Liverpool


17/36companion | 17

Late side effects develop many months following

treatment. These can include permanent alopecia,fibrosis and leucotrichia (growth of white hair) in the

treatment field and ocular side effects can include

KCS, uveitis, bone necrosis and lens fibrosis.

Intensity-modulated radiotherapy (IMRT) is an

advanced form of radiation therapy which allows

superior conformation of the radiation dose to the

three-dimensional shape of the tumour. This modality

is available in the USA and I was able to learn how to

plan and treat IMRT patients during my trip to UC

Davis. IMRT allows more sparing of the normal tissues

and consequentially fewer side effects should occur.

This capability is not yet available in UK veterinary

centres but hopefully should become so over the nextfew years.

Canine oral tumoursThe most common malignant oral tumours in dogs are

melanoma, squamous cell carcinoma (SCC) and

fibrosarcoma (FSA). Melanomas are highly metastatic

tumours and the tumour has often already

metastasized by the time of diagnosis. Metastases are

less common in SCC and FSA.

Surgery (maxillectomy or mandibulectomy) is

usually the best treatment option for small, rostrally

located tumours, and sometimes for more caudally

located tumours. Dogs tolerate these surgical

procedures well and in some cases of low-grade

tumours this will be curative. Preoperative CT assists in

determining the extent of tumour margins and

consequently surgical planning and in some cases

may help to determine whether a patient is a surgical

candidate. In cases where surgery is not possible but

the tumour is sensitive to radiation, this can be used as

a sole treatment modality (malignant melanoma and

round cell tumours within the oral cavity; non-surgical

candidates). If complete surgical margins are not likely

to be achievable then radiotherapy can be used

pre- or postoperatively.

In order to assess whether radiation therapy is

appropriate for the patient, a biopsy is required todetermine the tumour type. Cytology of an oral mass

may not be diagnostic, as many oral tumours are

significantly inflamed at presentation. Staging can be

performed following discussion with the client

Tumour type (canine) Sensivity

Round cell (plasmacytoma/hisocycsarcoma/lymphoma)

Very sensive

Squamous cell carcinoma Sensive

Malignant melanoma Sensive

Acanthomatous ameloblastoma(previously epulis/basal cellcarcinoma)

Sensive

Sarcoma (high grade) Medium sensive

Fibrosarcoma (low grade/biologicallyhigh grade)

Least sensive

Table 1: Radiation sensitivity of canine oral tumours

higher doses of radiation are used per treatment

fraction. Hypofractionated regimes are more

appropriate in the palliative setting or for patients

with comorbidities where slowing tumour progression

or improvement of clinical signs is the objective

of treatment.

The dose of radiation that can be delivered to a

tumour is limited by the damage caused to

surrounding normal tissue and the consequential risk

of acute or chronic treatment associated side effects.

Radiation side effects

As radiation also causes damage to normal tissues,side effects will result from treatment. Appropriate

radiation planning avoids as much normal tissue as

possible. However, the anatomical location of oral

tumours and closely associated normal structures

means that a balance has to be struck between

maximizing the dose to the tumour and minimizing the

normal tissue dose.

Acute radiation side effects occur between weeks

2 and 4 after starting therapy, can worsen in the week

or two after treatment, and have normally resolved

within a few weeks of treatment completion. Skin

within the treatment field is likely to become alopecic,

erythematous and moist desquamation can develop.

Inflammation of mucous membranes similarly occursand mucositis and conjunctivitis are common.

Corneal ulceration or keratitis are also possible acute

sequelae to radiation therapy if the eye receives a

significant dose.


18/3618 | companion

How to utilize radiotherapyfor dogs with oral tumours

regarding tumour type and likelihood of local and

systemic metastasis. This usually includes fine needleaspiration of the local lymph nodes and abdominal

and thoracic imaging, although this will depend on the

tumour type.

Case selectionAppropriate selection of cases for radiotherapy and

management of client expectations is important in

order to prepare clients for their pets treatment. It is

unlikely that radiation therapy will be curative for

canine oral tumours, and clients need to work with the

oncologist to understand and commit to the treatment

objectives for their pet. This can range from attempting

to achieve control of local disease in the medium tolong term (definitive protocols) to palliation of large/

painful tumours in order to reduce pain and improve

quality of life (palliative protocols).

Tumour size is an important factor in local tumour

control: tumour recurrence following surgery

radiotherapy is more likely in larger tumours. Prompt

diagnosis and treatment of canine oral tumours is

paramount in order to achieve the best possible

outcome for the patient. Unfortunately, many oral

tumours, particularly those located caudally, are not

evident to the owner until they have reached a

significant size, and treatment in these cases can

be challenging.

Patients should be in good enough clinical

condition to proceed with treatment. Neither age nor

the presence of comorbidities should preclude

treatment as long as the oncologist feels that the

benefit of treatment outweighs any risk to the patient.

However, comorbidities are likely to impact on the

oncologists recommendation regarding palliative

versusdefinitive radiation protocols and whether or not

surgery should be attempted. The benefit of radiation

in cases where distant metastatic disease is present

should be assessed on a case-by-case basis.

While radiation does not cause systemic side

effects, general anaesthesia is required and severely

debilitated patients or pets with expected lifespans ofless than 23 months are not likely to benefit from

treatment. Radiation oncologists are always willing to

provide advice on case selection and management

prior to referral.

Role of the referring veterinarianPrior to referral for radiation therapy, clients should beadvised of the approximate cost of treatment and that

therapy will require multiple visits (between five and

twenty depending on the protocol) to the referral

centre. Boarding of pets is an option at some centres

but this will add to costs. Radiotherapy treatment has

to be administered under general anaesthesia and the

client should be prepared for this.

The patient will most likely require a CT scan to be

performed for radiation planning at the centre

administering the treatment. This is because radiation

planning software is calibrated to the specific CT

scanner and treatment machine. It is usually not

possible to plan treatment from MRI or CT scansperformed at other veterinary practices and the owner

should be advised of this prior to referral. However, if

these have been done it is important to provide the

radiation oncologist with a copy. This is particularly

relevant if the patient has had surgery since the

original imaging was done, as the entire tumour

volume should be included in the radiation field.

An appropriate work-up prior to referral includes

measurement and biopsy of the oral mass and

palpation and fine needle aspiration of both

submandibular lymph nodes. If thoracic radiographs

are performed, these should be three inflated views

(right and left lateral and dorsoventral views).

Treatment planning ( any further appropriate staging)can then be performed as appropriate for the tumour

type at the referral centre, following discussion with the

client regarding likelihood of metastatic disease and

prognosis with various treatment modalities. Good-

quality digital photographs of the lesion prior to biopsy

can be very useful to the radiation oncologist.

At referral the referring veterinary surgeon should

provide:

A summary of the patients medical history/referral

letter, including measurements and location of the

mass

A copy of the histopathology report from the

tumour biopsy (if not immediately available thisshould be forwarded as soon as possible)

A digital copy of any previous radiographs/CT/MRI

scans in DICOM format (or radiographic film) and

photographs of the lesion


19/36companion | 19

Copies of cytology and other clinical pathology

reports when performed Details of any current medication

This should minimize treatment delays and also

avoid repeat testing for the patient.

Once options have been discussed and the

client and oncologist have agreed on the

treatment, planning can begin. A specific radiation

plan has to be made for each patient and

specialized computer radiation planning software

is required (e.g. Pinnacle/Eclipse). The objective of

treatment is to administer 100% of the planned

dose to the entire planned treatment volume (PTV).

This is easier said than done in some cases andcompromise has to be made in avoiding dose to

the normal tissues: an individual plan can take

several hours to generate.

Some case examples of patients with oral tumours

treated with radiotherapy are presented below.

In summary, dogs with oral tumours are candidates

for radiation therapy if:

Surgery has not achieved tumour-free margins or

tumour-free margins are considered minimal

Surgery (maxillectomy/mandibulectomy) can be

used to downstage the disease and radiotherapy

planned postoperatively

The tumour is too extensive for surgery

The tumour is causing pain/discomfort/mass effect

The dog has oral melanoma

The client is committed to treatment and

associated costs (currently palliative protocols cost

around 16002500 and definitive around

36004500; not including the cost of CT/other

staging which would be estimated at 8001500).

AcknowledgementsThe author is very grateful to BSAVA for the award of

the Frank Beattie scholarship 2013 which supported

travel to UC Davis.

Figure 2: (A) Side effects at the end of radiation treatment: mild mucositis. (B) Resolution of the mucositis 4 weeks aftercompletion of therapy

A B

A 7-year-old male neutered Golden Retriever

presented following incomplete excision of an

amelanotic melanoma from the right buccal and

mandibular gingiva. Staging was negative for localand distant metastasis and the dog received

4 weekly fractions of 8 Gy to treat residual

microscopic disease. Side effects were minimal

(desquamation of the skin of the lip and mucositis;

Figure 2) and the dog remained disease-free for9 months following treatment.

Case 1


20/3620 | companion

Case 2

Figure 5: 3Dreconstructionshowingextensive bonylysis associatedwith the tumourin this case

Figure 6: The dog at the end of treatment. There isgeneralized alopecia of the treated area. The left-sidedfacial swelling has improved

How to utilize radiotherapyfor dogs with oral tumours

A 9-year-old female neutered cross-breed dog

presented with an extensive oral tumour involving

the left maxilla and nasal cavity and extending into

the brain (Figures 3, 4 and 5). The dog had

moderate left-sided nasal discharge and evidence

of nasal obstruction, and the left submandibular

lymph node was mildly enlarged and firm. Staging

included a biopsy of the primary tumour, which wasdiagnosed as squamous cell carcinoma, and fine

needle aspirates of both submandibular lymph

nodes which confirmed carcinoma metastasis to the

left submandibular lymph node.

The dog received a hypofractionated radiation

protocol in order to palliate the clinical signs;

unfortunately the eye was in the treatment field and

received a similar dose of radiation to the tumour.

Minimal side effects (mild mucositis, alopecia (Figure

6)), periocular dermatitis and conjunctivitis occurred.

Two months following the end of her treatment, she

had significantly improved clinical signs and

continued to enjoy an excellent quality of life.

Figure 3: Positioned for treatment. The tumour is evidentas an extensive left-sided facial mass

Figure 4: CT images:(A) Transverse sectionand (B) sagittal section.The tumour involvesmuch of the leftmaxillary region andnasal cavity, andextensive left-sidedbony lysis and facialdistortion can beappreciated

A

B


21/36companion | 21

A 10-year-old female neutered Greyhound

presented for treatment of a maxillary squamous cell

carcinoma (Figure 7). Maxillectomy was performed

to downstage the disease, however, tumour cells

remained at the surgical margins. Radiotherapy was

planned to treat the residual microscopic disease.

The patient underwent postoperative CT and

radiation planning. A thermoplastic mask wasmoulded and a custom pillow (Mouldcare)

made to fit the exact shape of the patients head

(Figure 8).

Figure 8: Positioned for treatment. The head is positionedon a customized pillow and supported by a mouldedplastic mask

Figure 9: Two weeks after treatment. Alopecia,desquamation and crusting of the skin and nasal planumcan be appreciated

Figure 7: At presentation. The SCC presented as anexophytic maxillary gingival mass

Figure 10: Four weeks after treatment, with resolving sideeffects. Alopecia is more extensive but the previousdesquamation has resolved

She then received 12 fractions of 4 Gy radiation

delivered on a Monday/Wednesday/Friday basis.

Side effects during treatment were mild and

consisted of some moderate mucositis.

Side effects worsened in the 2 weeks following

treatment and desquamation of the skin in the

treatment field developed (Figure 9). One month

following radiation treatment the patient remaineddisease-free and her side effects were resolving

(Figure 10). Three-monthly monitoring for

recurrence was planned for the next 12 months.

Case 3

AVAILABLE FROM BSAVA

BSAVA Manual of Canine and Feline

Oncology, 3rd editon

Edited by: Jane Dobson and Duncan Lascelles

Member price: 55.00Price to non-members: 89.00

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JOURNAL OF SMALL ANIMAL PRACTICE


22/3622 | companion

Getting to knowyour regionThe hard work of our regional volunteersunderpins the BSAVA. These vets and VNsorganize courses and social events throughout

the year to make sure their fellow members get accessto quality, affordable CPD and local peer support.Heres a whos who of our invaluable regional family

3

6

4

9

5

21

7

10

11

12

8

1: Cymru/Wales

Chair:Esther Barrett

Treasurer:Branwen Davis

Secretary:Roberta Eley

Regional Rep:Marina

Crockford

Hamish Cormie

Craig Connolly Sian Howley

Emily Ward-Smith

Rhian Williams

Emma Gerrard

Sian Evans

Emma Owen

Alongside the expansion of the region at the

beginning of 2013, we also introduced free

registration at our regional evening CPD meetings

for all BSAVA members. Our aim is to provide free,

high quality CPD at a venue near you so please

watch out for meeting updates in companionand

on the BSAVA website. Have you ever thought ofbecoming a BSAVA Regional Volunteer? If youd

like to find out more about joining the BSAVA

Cymru/Wales committee wed love to hear from you

simply email [email protected].

Esther Barrett

2: East Anglia

Chair: Pascale Collins

Treasurer: Melanie Fleming

Secretary:Hannah

Brinsmead

Farah Malik

Fiona Smith

James Warland

Kerry Hall

Simone Knudsen

Lizzie Murch

If you have never come along to one of our

regional events please do try. Our courses are an

affordable way to learn with great speakers in a

friendly atmosphere. If youd like to find out more

about joining the BSAVA East Anglia Committee

and have the opportunity to get involved withregional events, wed love to hear from you. You

can get in touch with us by sending an email to

[email protected] Collins

3: Southern

Chair: Krista Arnold

Treasurer: Lucy Chadwick

Secretary: Carl Gorman

PetSavers Rep:Jayne Fisher

Sam Le Vallee

Scot Crae

We aim to run informative and topical meetings for

the benefit of the Southern regions vets and

nurses close to home throughout 2014, with talks

from specialists in their fields from around the UK.

If youd like to find out more about joining the

BSAVA Southern committee and the opportunity to

get involved with regional events, wed love to hear

from you. You can get in touch with us by sending

an email to [email protected].


23/36companion | 23

4: Metropolitan

Chair: Tim Williams

Treasurer: Anna Marshall-Brown

Secretary: Rebecca Geddes

PetSavers Rep:Karen Humm

Regional Rep:Allison van Gelderen

Jelena Catchpole

Heather Covey

Esther Bijsmans

Matthew Swaffield

We are here to organize the kind of CPD events that

you are interested in, so if you have any requests

for future topics you would like to see, please let us

know. Suggestions from veterinary nurses are

extremely welcome we are hoping to organize a

meeting for nurses in 2014. Similarly, if you have

any feedback youd like to share with us, please get

in touch. You can get in touch with us by sending

an email to [email protected]. 7: North East

Chair:Tim Shearman

Treasurer:Maurice Kelly

Secretary:Helen OKelly

PetSavers Rep:Julia Thomson

Lucy Nicholson

Sally Whitehead

Victoria Lee

Paul Spellman

Chris Robinson

Victoria Roberts

Hannah Langley

North East Committee meetings are friendly and

fun, and we always have sticky toffee pudding!

One of the main benefits of being on the

committee is that you get to go to regional CPD

events for free. Wed welcome any suggestions

you may have for new venues to hold our meetings

in perhaps you feel we should bring a CPD event

to your town please get in touch. Wed also be

interested to know what topics youd like us to

cover and which speakers youd like to hear from.

You can get in touch with us by sending an email

to [email protected].

5: Scottish Region Chair: Graeme Eckford

Treasurer: Gerard McLauchlan

Secretary: Yvonne McGrotty

PetSavers Rep:Sharon Sharp

Madonna Livingstone

Lyndsay Kennedy

Sam Woods

Julien Guevar

Barbara-Ann Innes

We are working hard to put the finishing touches to

the Scottish Congress for the end of August and we

are looking forward to another successful year.

Were also excited to announce that weve just

finalized our CPD plans for 2015! If youd like to find

out more about joining the BSAVA Scottish

committee and the opportunity to get involved withregional events, wed love to hear from you.

You can get in touch with us by sending an email

to: [email protected].

6: South West

Chair: Nic Hayward

Treasurer: Jim Hughes

Secretary: Ellen Harmer

PetSavers Rep:Caz Haywood

Jo Aplin

Rachel Mason

Jennie Babington

Gabi Habacher

Sam McGuinness

Emily Parr

Guy Poland

Kate Esler

Ruth Pearson

Louise Longstaff

Jennifer Beard

Jenny Ross

Fiona Peffers

Whilst we have a healthy 17 members on our committee,

we are still seeking at least one volunteer from Cornwall

to enable us to provide more courses in the far South

West. If youd like to know more about what volunteering

entails, please get in touch! Also, please do let us know

what courses youd like to see and well do our best to

organize them. You can get in touch with us by sending

an email to [email protected].

Nic Hayward


24/3624 | companion

Getting to know your region

8: Northern Ireland Chair:Lynsey Hamilton

Treasurer:Barbara McConnell

Lesley Moore

Paul Crawford

Katrina Cusack

The BSAVA Northern Ireland Congress will take

place on 2324 May at the Armagh City Hotel. With

Internationally renowned speakers in both the

Veterinary and Nursing streams, the theme for NI

Congress this year is the abdominal patient, with

the main emphasis on the management of surgical

cases. If youd like to find out more about joining

the BSAVA Northern Ireland committee pleaseemail [email protected].

11: East Midlands Chair: Joanne Douglas

Treasurer: Mark Dunning

Secretary:Helen Ozleton

Savannah Williams

Mike Davies

Anneli Beese

Tirzah Woodthorpe

Douglas Dick

Jennifer Irving

We recently introduced our Pub Clinical Club meetings

and they have already proved to be a huge success.

These meetings offer you the chance to discuss hot

topics, get top tips and clinical updates with colleaguesfrom practice/referral centres/universities in an

interactive, friendly environment with a FREE meal.

Attendees also have the opportunity to win prizes in our

Clinical Pub Quiz. If youd like to find out more about

joining the committee wed love to hear from you

please email [email protected].

Mike Davies

10: North West

Chair:Andrew Iveson

Treasurer:Neale Roach

Secretary:Peter Graham

Rebecca Littler

Turlough ONeil

Simone Der Weduwen

Weve recently finalized our

courses not only for the rest of

2014 but for 2015, so we hope

that youll be able to come along and join us

we would really like to meet you. We are currently

quite a small committee and extra members are

always welcome if youd like to find out more

about joining the BSAVA North West committee

and the opportunity to get involved with regional

events, wed love to hear from you.You can get

in touch with us by sending an email to

[email protected].

Andrew Iveson

12: West Midlands

Chair: David Godfrey

Treasurer: Hannah Gritti

Secretary: Jo Godsall

Secretary:Simon Godsall Regional Rep:Will Walker

Dave Fisher

Isuru Gajanayake

Vicky Pheysey

Stephanie Jayson

Laura Jordan

Tom OReilly

Apart from our practical day on caged birds, reptiles

and small mammals, all of our CPD in 2014 and 2015 is

free to BSAVA members (vets and nurses). This is our

Committees initiative to increase delegate numbers

and to provide another benefit to you being a BSAVA

member every year. We will always welcome new

committee members, so please contact us and well

explain what you can gain by getting involved email

to [email protected].

9: South East

Chair: Louise Smith

Treasurer: Cathy Thomson

Secretary: Roger Holden

PetSavers Rep: Alison Livesey

Regional Rep:Muna Roberts

Julian Hoad

Whilmari Worrow

Jane Pomeroy

Wolfgang Dohne

This year weve decided to focus on providing CPD

courses with a practical element. If youd like to find

out more about joining the BSAVA South East

committee and the opportunity to get involved with

regional events, were particularly keen to hear from

vet nurses as well as anyone living in Kent or East

Sussex. You can get in touch with us by sending an

email to [email protected].

Louise Smith

GET INVOLVED

To fnd out more about geng involved with your region youcan contact Jennie Bartholomew [email protected]

or get in touch with your region directly.


25/36

For more information or to order

www.bsava.com/publicationsBSAVA reserves the right to alter prices where necessary without prior notice.

BSAVA PublicationsCOMMUNICATINGVETERINARY KNOWLEDGE

e-BOOKS AVAILABLE FROM BSAVA

BSAVA Members have been asking to have the Associations

highly-respected series of Manuals as e-Books; to read on PCs,

tablet computers and e-readers. The BSAVA is pleased toannounce the launch of five more e-Books, bringing the total

number of Manuals available in this format to ten.

How to order

Members can order e-Books from www.bsava.com. Once your

order is processed, you should be able to access your files from the

My orders/downloads area of MyBSAVA (login required). You will

be able to select the file types that suit your particular e-readers,

and load the e-Book on to multiple devices.

See www.bsava.com/ebooksor email [email protected]

for further information.

Exclusive to BSAVA Members

Prices from 25

ePUB and Kindle formatsavailable


26/3626 | companion

Celebrang 40 YEARS of improving the health of pets

Dermatologyand dermato-endocrinology funding

Professor Keith Thoday tells

companionreaders about theresearch funded in support ofveterinary dermatology and dermato-endocrinology over the past 40 years

The BSAVA charity PetSavers

(initially called the Clinical Studies

Trust Fund) has been in existence

for all but the first three years of my

professional career. In that time, I and

many others who have worked in the areas

of dermatology and dermato-

endocrinology have received significant

financial support in our research

endeavours and in the training of the next

generation of specialists.

Over the years, I have had eight

awards from PetSavers. I received my first

in 1980. I was just about to register with the

University of Edinburgh to carry out my

part-time PhD research into an alopecic

condition in cats, then called feline

endocrine alopecia as it was suspected to

have a hormonal basis, possibly

hypothyroidism. As a full-time lecturer,I needed money for research

consumables: I applied for and was

awarded 2000. Looking back now, it is

hard to imagine that we didnt even know

what the main feline thyroid hormones were

and certainly had no reference intervals for

them. This grant allowed me to confirm not

only that they were thyroxine (T4) and

triiodothyronine (T3), but also the effects

on their plasma concentrations of age,

gender, breed, heredity and environment.

Uncovering felinehyperthyroidismShortly after I had begun my PhD, the first

cases of what appeared to be truly a new

disease (rather than a newly-recognized

disease) were seen in the USA and, very

quickly, subsequently in the UK and the

Netherlands. This condition, feline

hyperthyroidism, was to demand a large

amount of my clinical and research time

over the next 20 or so years.

With further sequential financial supportfrom PetSavers in five tranches between

1983 and 1993, together with my MSc

student Carmel Mooney and subsequently

my PhD student Darren Foster, we were

able to define further the historical, physical

and diagnostic features of the disease,

various aspects of its medical management

and some features of its aetiopathogenesis,

a total of 15 peer-reviewed publications and

five invited book chapters, all directly or

indirectly supported by PetSavers awards.

As befits such an important disease,

research into other aspects of feline

hyperthyroidism has received subsequent

support, with Jonathan Elliot (2000), Tim

Williams (2010) and Natalie Finch (2012)

all looking at different aspects of a major

problem, the development of

compromised kidney function after

treatment for the disease.

Canine endocrinedermatopathiesThe diagnosis of two important canine

endocrine dermatopathies has also been

supported by PetSavers. In 1996, Carmel

Mooney investigated various aspects of

canine hypothyroidism and in 1997, Ian

Ramsey looked at the thyrotropin response

to thyrotropin releasing hormone in dogs.

Switching to hyperadrenocorticism, in

1999, Carmel then studied the value of

17-hydroxyprogesterone measurements in

the diagnosis of the condition and in 2001,Ian carried out further studies in dogs

being treated for Cushings-like syndrome

in determining changes in their parathyroid

hormone concentrations.

Nowadays, skin biopsy in dermatology

is a tool used on a daily basis in practice. It

is easy to forget that the science (and art)

of dermatopathology had to be learned so

that we can rely on its diagnostic value as

we now do. In 1985, Pauline McNeil at the

Glasgow Veterinary School was awarded a

grant that laid some of the foundations of

this specialty.

Commitment to dermatologySkin disease associated with micro-

organisms is one of the most important


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aetiological areas in canine dermatology

and, as such, has been well financed by

PetSavers. When I began working in

dermatology, Malassezia pachydermatis

was not recognized as a canine pathogen.

Now, few dermatologists (and many

general practitioners) would go a working

day without identifying its involvement in

some dog with skin disease. Leading the

way in investigations into this yeast has

been Ross Bond who was initially

supported by the CSTF/Ella Dora Renison

Studentship (1992) at the Royal Veterinary

College (RVC), with subsequent PetSavers

funding (1996) in this area.

It is probably correct to say that any

canine skin disease may becomesecondarily infected with bacteria, usually

the animals own bacterial flora.

Recognizing the importance of bacterial

skin disease, PetSavers has strongly

supported research in this area.

Richard Harvey (1991) investigated the

population dynamics of Staphylococcus

pseudintermediuson canine skin during

his residency at the RVCand Pauline

McNeil looked at in vivoculture of canine

hair follicles (1998). As the first stage of

cutaneous bacterial infection is adherence,

we became very interested in this process

at Edinburgh and PetSavers (1999)

financed Peter Forsythes investigations

into the effects of breed and anatomical

site on adherence of pathogenic

staphylococci to corneocytes from healthy

dogs during his residency with us.

Canine bacterial otitis externa is very

common in veterinary practice so it is no

surprise that this multifactorial condition

has received support from PetSavers. In

2011, Neil McEwan at the Liverpool School

was awarded funds to study the efficacy of

topical antibacterial agents with and

without the addition of the sensitizing andbactericidal agent ethylene-diamine

tetra-acetic acid-tris (EDTA-tris) on

Pseudomona aeruginosaisolated from

canine ear infections.

In 2012, Carly Bell was supported in her

investigations into the in vivoantimicrobial

action of two ear cleaning solutions on

canine otitis externa. In another bacterial

study, Susan Dawson (1998) at the

Liverpool School was awarded funds for an

investigation into the effect of antibacterial

treatment for bacterial skin disease on the

antibacterial resistance of faecal

Escherichia coliisolates from dogs, a study

which, as we continue to contemplate

emerging bacterial resistance, is of great

current relevance.

The microclimate of the canine skin

and coat has potential effects on many

conditions, not least on bacterial

pyoderma. In 1991, from referral practice,Chris Chesney was given an award to

investigate the moisture content within the

dogs haircoat.

Funding all areasViruses and parasites were not neglected

by PetSavers. Elizabeth Pegg of the RVC

received one of the very earliest grants

(1980) to study the biology of the common

ear mite of the dog and cat, Otodectes

cynotis, while in 1983, Derrick Baxby and

Rosalind Gaskell of Liverpool University

received funds to investigate the incidence,source and clinical features of feline

cowpox. Feline cowpox was rarely

recognized until this work and the disease

is, of course, a potential zoonosis.

My colleague at Edinburgh, Adri van

den Broek, was interested in the effects of

gut fat absorption on a number of canine

skin conditions. In 1990, he received two

awards, one to investigate gut fat

absorption and clearance in atopic dogs

before and after subcutaneous allergen

immunotherapy and the second to study

zinc and fat absorption in dogs with

zinc-responsive dermatosis. One of thereasons why this latter condition is far less

common nowadays stems from the results

of the studies carried out by Adri and the

Edinburgh group at this time.

Eosinophilic granuloma is a feline

reaction pattern with which all small animal

clinicians will be familiar. In 2010, Anja

Kipar received an award to elucidate the

pathogenesis of this troublesome

diagnostic and therapeutic problem.

Supporting specializationPetSavers has not confined itself solely to

funding research projects. As well as Ross

Bonds studentship noted above, Sue

Paterson received financial support during

her studies for the RCVSs Diploma in

Veterinary Dermatology. She told me

recently that it would have been very

difficult for her to have undertaken and

completed her studies from generalpractice without this award. I also was

delighted that PetSavers funded a

Residency in Dermatology at Edinburgh in

2000. Our appointee, Silvia Colombo,

carried out some excellent research on

canine atopic dermatitis, studied for the

Diploma of the European College of

Veterinary Dermatology and passed the

examination at her first attempt. Both Sue

and Silvia are now European Veterinary

Specialists in Dermatology.

In looking back over the awards that

PetSavers has made in my specialist areasin its 40 years of existence, I find myself

constantly impressed at the foresight and

excellent judgement that the Awards

Panels have consistently shown. They have

invariably given grants in areas important

to clinical practice and made them to

people who subsequently did what was

hoped of them. PetSavers has a long and

successful history and a fantastic future:

heres to the next 40 years. n


28/3628 | companion

The stage is almost set for the 39th WSAVA

World Congress which takes place in Cape

Town from 1619 September 2014. Itpromises to be amazing, so if you havent yet

thought about attending, plan now to take advantage

of the Early Bird Rates for registration which are on

offer until 1st June.

When making your preparations, make sure you

check out the Pre-Congress Programme on Monday

15 September. The theme is Vets in the Wild a Peek

Behind the Scenes with speakers including South

Africas leading wildlife veterinarians who will discuss

topics ranging from rhino and lion conservation to

experiences of wildlife ophthalmology and dentistry.

South African veterinarians are at the forefront of

wildlife medicine their experiences make this a

unique session that is not to be missed!

Destination South AfricaEvery country in the world displays some diversity, but

South Africa, stretching from the hippos in the

Get ready forCape Town

Early bird rates for the 39th WSAVA WorldCongress end on 1st June 2014

Limpopo River to the penguins waddling on the Cape,

takes some beating. It befits its position at the

southern end of the worlds most epic continent, with

more types of terrain than photographers can shake

their zoom lens at.

Theres the deserted Kalahari, Namakwas

springtime symphony of wildflowers, iconic Table

Mountain and Cape Point, Kruger National Parkswildlife-stalked savannah and, running through the

east of the country and into Lesotho, the

Drakensberg. KwaZulu-Natals iSimangaliso

Wetland Park alone has five distinct ecosystems,

attracting both zebras and dolphins.

If youre interested in another kind of wildlife, hit the

nightclubs on Cape Towns jumping Long St or sample

African homebrew in a township shebeen. When its

time to reflect on it all, do it over seafood on the

Garden Route, curry in Durbans Indian Area, a

sizzling Cape Malay dish, or a braai (barbecue) in the

wilderness accompanied by a bottle of pinotage

produced by the oldest wine industry outside Europe.

South Africans are some of the most upbeat,welcoming and humorous folk youll encounter

anywhere, from farmers in the rural north who tell you

to drive safely on those dirt roads, to Khayelitsha kids

who wish you molo (good morning in Xhosa).


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Following the devastation in the Philippines

caused by Typhoon Haiyan last November, the

Philippine Animal Hospital Association (PAHA)

appealed to the veterinary community in Asia

and around the world for help. A tremendous response

was received we received inquiries and offers of help

from veterinarians as far afield as Israel, Japan,

A global communitypulling together forthe PhilippinesDr Amie Babasa, PAHA Past

President, reflects on the supportgiven by the internationalveterinary community followingTyphoon Haiyan

Singapore, South Korea and Canada. We also

received financial assistance from Dr Alane

Cahalanes fundraising work in Hong Kong withdonations from the Hong Kong Veterinary Association,

veterinary clinics, individual vets and pet owners. It

was a wonderful surprise to know that there were

colleagues out there in the world who truly cared and

went out of their way to communicate their intent to

help us.

Haiyan made us realize how unprepared we were

for disasters. We had no support system or protocol in

place so it was a learning experience and we had

great support from International Fund for Animal

Welfare (IFAW), World Society for the Protection of

Animals (WSPA) and Humane Society International

(HSI). A positive development is that we have now

formed a coalition with international, national and local

organizations to address animal relief and rescue.

With the experience and insights we gained from

Haiyan, we are now working to put in place an

information campaign to educate our clients about

disaster preparedness. We aim to help build localities

resilient to disasters while we look into training we can

undertake to help us prepare for any future disasters.

We would like to thank everyone who helped and

continues to help us. It is what being a global

community is all about!

Suspect a hereditary disorder?Use the WSAVAs search toolfor DNA testing

Thanks to Dr Urs Giger and his team on the WSAVA Hereditary Disease

Committee, the WSAVAs work in the area of DNA testing for hereditary

diseases in dogs and cats worldwide has grown rapidly over the past year.

There are now 53 labs and a list of 175 different mutations and diseases.

The WSAVA lab search tool has also been developed and is currently

being updated by the Committee, which was in part supported by

Waltham and Wisdom Panel. You can access the tool from the PennGenLaboratories website. If you have a puppy or kitten of a particular breed

and you suspect a hereditary disorder, do check this valuable web tool for

available DNA tests and laboratories based on breed or disease.

Dr Urs Giger


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QWhat can you tell us about your

chosen veterinary career?

AIm a bit of a child of James Herriot.

Louth is a market town in a rural

area and I envisaged a life as a

member of a rural community with an

active outdoors life, related to agriculture. I

consider myself to be an academic vet. I

think it is important that the profession

embraces and recognizes the full range of

opportunities available to vets that draw on

their training, experience and motivation. Ithink the profession needs members who

are academics and who focus on

developing the evidence that underpins

the professions activities.

My current role is about engaging

with colleagues to manage and develop

the BVMS programme, which is

undergoing a period of change as we

introduce a fundamentally redesigned

programme. I am meetings man. I have

meetings with everybody

to keep them informed and work through

any problems. Engagement is at arange of levels: school, college,

university and RCVS. Other meetings

involve contributing to the research

projects I am involved with.

Professor

JamesAndersonBVM&S MVM PhDDSAO DipECVNILTM MRCVS

thecompanioninterview

James Anderson was born in Redruth, Cornwall in1960 and grew up in Louth, Lincolnshire. Hegraduated as a vet from the Royal (Dick) VeterinarySchool at the University of Edinburgh in 1984. Hespent four years in mixed practice in Lancashire andLeicestershire before moving to the University ofGlasgow Veterinary School to trai

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Companion May 2014 Low Res