The essential publication for BSAVA membersThe essential publication for BSAVA members

companionMAY 2013

Case of a Collie cross with pyrexia and multiple joint effusions

Fundamentally felineAuthors share expertise P24

Congress in picturesA magni cent meeting P4

How ToApproach Horners syndromeP16

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A web-based questi onnaire to measure dog health-related quality of lifeThis paper reports a companion animal HRQL instrument, the contemporary approach to animal welfare measurement, which is presented in a web-based format with automated producti on of a HRQL pro le. The authors conclude that it o ers major advantages to dog owners, practi ti oners and researchers.

Left ventricular geometrical di erences in dogs with myxomatous mitral valve diseaseThis arti cle nds that sphericity index and RWT are simple methods for assessing LV geometry using 2D echocardiography that may be useful in MMVD dogs as part of risk strati cati on.

Investi gati ng the TATE canine elbow arthroplasty on kinemati cs of the elbowThe authors conclude that the rst generati on TATE canine elbow arthroplasty cartridge and its instrumentati on accurately reconstructed the anatomic centre of rotati on in eight of the 10 elbows assessed in this ex vivo model.

Comparing xati on methods of femoral diaphyseal fractures in catsThis study found no stati sti cally signi cant di erence in the ti me to achieve bone healing, but there was a signi cant di erence

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 companion@bsava.com. We welcome all comments and ideas for future articles.

Tel: 01452 726700Email: companion@bsava.com

Web: www.bsava.com

ISSN: 2041-2487

Editorial BoardEditor Mark Goodfellow MA VetMB CertVR DSAM DipECVIM-CA MRCVSCPD Editor Simon Tappin MA VetMB CertSAM DipECVIM-CA MRCVSPast President Andrew Ash BVetMed CertSAM MBA 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) MRCVSMathew Hennessey BVSc 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

45 Congress in picturesA look at the 2013 event

67 At CongressKey stories from Birmingham

810 International vetsThe experience of foreign vets in the UK

1215 Clinical ConundrumA Collie with pyrexia and multiple joint effusions abnormalities

1621 How ToApproach Horners syndrome

2223 Great livesWoody Woodrow in profile

2425 Fundamentally felineEditors of new manual share their expertise

2627 PetSaversPhotography competition winners

2829 WSAVA NewsThe World Small Animal Veterinary Association

3031 The companion InterviewMark Hedberg

33 Postcards from the RegionsNews from your local groups

3435 CPD DiaryWhats on in your area

Additional stock photography:www.dreamstime.com Alistair Scott; Gpgroup; Tatyana Chernyak; Thomas Lammeyer; Zentilia

Whats in JSAP this month?

Here are just a few of the topics that will feature in your May issue:

in categorised complicati on rates between the groups.

The vacuum phenomenon in intervertebral disc disease of dogs based on CT imagesIn dogs with intervertebral disc disease, vacuum phenomenon is a frequent but inconsistent nding. Although helpful to identi fy degenerated discs, the authors conclude it is not suitable to identi fy currently herniated disc with su cient accuracy.

Correlati on of bronchoalveolar eosinophilic percentage with airway responsiveness in cats with chronic bronchial diseaseThis study provides supporti ve evidence of a correlati on between airway eosinophilic in ammati on and plethysmographic measures of bronchoconstricti on and airway responsiveness.

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

SPECIAL ISSUE OF EJCAP NOW AVAILABLE

Dont forget that as a BSAVA member you are enti tled to free online access to EJCAP register at www.fecava.org/EJCAP to access the latest issue.

Find FECAVA on Facebook!

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The government published the draft Dangerous Dogs (Amendment) Bill on April 9th. This will make it an offence for a dog to be dangerously out of control in any place, including on private property, although there is an explicit exemption in relation to trespassers. Attacks on guide dogs and other assistance dogs will also be explicitly covered.

In regard to banned breeds, the legislative changes will make clear that the court must consider the character of the person in charge of the dog, as well the temperament and past behaviour of the dog, in deciding whether a dog needs to be destroyed or can be placed on the Index of exempted dogs. The changes to attacks on private property and to attacks on assistance dogs apply to England

and Wales. The banned breed amendment will apply to the whole of Great Britain.

The BSAVA supports these extensions and is particularly pleased to see attacks on assistance dogs included as well as recognition that the danger that a dog poses is dependent on the owner. However, we are concerned that these changes do nothing to prevent attacks and we recognise the need for coordinated engagement, relevant education programmes, and the introduction of Dog Control Notices.

The BSAVA is currently consulting with members to establish your concerns and opinions on compulsory microchipping. To have your say contact the BSAVAs Scientific Policy Officer Sally Everitt via email s.everitt@bsava.com.

Dangerous Dog Laws

National VN awareness month

On Saturday 22 June at the World of James Herriot Visitor Centre, Thirsk, the BSAVA North East Region is holding a special Meet the President event so members can get to know Michael Day.

The event starts at 5pm with a welcome address from Jim Wight, followed by a presidential address from Michael. There will then be a buffet and drinks and Jim will also be signing copies of his new book The Real James Herriot. You will have the opportunity to take a self-guided tour and step back in time to see what has made James Herriot into a global phenomenon. There will also be an educational workshop for children. Places are free for the first 50members who register and the cost thereafter will be 6 per head (children under five are free). Tobook your place visit www.bsava.com or email administration@bsava.com.

Meet new PresidentMichael Day

Over the following pages you can see the highlights from Congress 2013. Thank you to the thousands of delegates and exhibitors who contributed to this being a superb year. Now its time to put the 2014 dates in your diary: 36 April.

It was a very good year

At BSAVA Congress in Birmingham, the newest manual titles proved amongst the most popular. Thetop five were: Feline Practice A Foundation Manual; Neurology, 4th edition (includes a DVD); Pocketbook for Veterinary Nurses; Pocketbook for Vets; and Small Animal Practice Management and Development.

Congress also saw the launch of the first five e-Books: Cardiorespiratory Medicine, Endoscopy and Endosurgery, Reproduction and Neonatology, Rodents and Ferrets, and Wound Management and Reconstruction. For those members who missed out on purchasing these e-Books at Congress, they are now available in the BSAVA bookshop visit www.bsava.com for more details.

and awayThe BSAVA stand at the WSAVA Conference in Auckland, New Zealand, held in March, was packed to the rafters with delegates eager to browse the BSAVA Manuals and find out about overseas e-membership. Although the meeting attracted only a small number compared with BSAVA Congress (approximately 1700 delegates), over the 4-day event we signed up over 100 new members and sold nearly 300 manuals. It goes to show that BSAVA science is just as popular on the other side of the world as it is here at home.

Success at home

Cardiorespiratory Medicine, Endoscopy and Endosurgery, Reproduction

May is National VN Awareness Month, which aims to highlight the importance of the veterinary nursing profession. Veterinary Nurses, including many BSAVA VN members, will be organising events to help promote the role of the VNs to the general public, as well as raising awareness of the professions contribution to the welfare of animals. We wish all those getting involved all the very best with their activities. Formore information visit www.bvna.org.uk.

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Professor Richard Dawkins gave an inspiring talk on Thursday, in which he demonstrated his vast knowledge of evolutionary biology and pondered a future without pets.

Delegates got plenty of opportunities to access the industry expertise and new launches in the impressive exhibition.

The BSAVA Balcony Publications and Education stands were kept busy, with delegates keen to know what the Association had to offer.

The exhibition was frequently packed with delegates making the most of the special offers and free gifts.

Ian Battersby was one of the winners in the prestigious BSAVA Awards ceremony on Thursday.

An esteemed Question Time panel chaired by

Chris Laurence discussed Genetic

and Inherited Diseases and

Alfie the King Charlies Spaniel

came along with his owner Nick.

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in picturesVets and VNs were able to get closer to the experts in the expanded practical programme at this Congress.

BSAVA Banquet was a stylish evening of great food and brilliant entertainment from the band E2.

BSAVA was delighted to support Luke Gambles World Veterinary Service and their launch of the ambitious Mission Rabies initiative.

Belly laughs and plenty of dancing were features of Party

Night on Saturday thanks to Alan Davies and the Noisettes.

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At

has lived in the UK for well over two decades said; BSAVA has made huge contributions to veterinary practice in the UK, and already has a global reputation for Congress and publications I believe we have such a wealth of resources and so I am convinced we have so much more to offer the world.

Exhibition of excellenceNearly 300 exhibitors, including new and familiar names, filled the National Indoor Arena, with many choosing to launch new products, services or research findings. The veterinary industry provides an important contribution to Congress and it was clear that many see the event as their key opportunity to demonstrate their products to the profession.

BSAVA Congress is produced by the profession for the profession which means everything from the science programme to the social events and exhibition is planned by vets and VNs. This is why it goes from strength to strength and has become an important part of the professional landscape. Here are just a few of the stories coming out of Congress this year

A remarkable achievementThis years BSAVA Congress was described as a remarkable achievement by Mark Johnston, the Associations outgoing President, as the event secured its highest ever attendance. A total of 6199vets, vet nurses, practice managers and students came to Birmingham, around six per cent higher than in 2011 the last time the BSAVA hosted its own Congress. In 2012 it was jointly hosted with WSAVA and FECAVA.

A significant number of international delegates attended this year with almost 60countries represented notably Scandinavia (186 delegates), Germany (56), the Netherlands (40) and the USA (31).

Vets and vet nurses jointly acquired more than 100,000 CPD hours in the scientific programme, and were pleased to see an increase in practical and hands-on lectures, which allowed them to get even closer to the expertise on offer.

The Management Stream was also expandedacross three days and this was well-received, offering a series of lectures on practical business advice including public relations, accountancy and humanresources.

Newly inducted BSAVA President Michael Day said he was looking forward to extending the international aspect of BSAVA. The Australian-born Professor who

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Listen up

Members can now download the Congress lecture MP3s online at www.bsava.com so you can catch up on talks you missed or reinforce your notes from those talks you found particularly helpful. You must be registered with the website and logged in to access this member-only content. For more information email administration@bsava.com or call 01452 726700 in office hours.

No more petsIn a hundred years time, will the idea of owning a pet be regarded as an anachronism in much the same way that slavery is viewed now? Evolutionary biologist and best selling author Richard Dawkins posed that question in an interview before his opening day lecture of the 2013 BSAVA Congress.

He said, If changes in public opinion mean that our behaviour today will be seen as backward then our treatment of non-human animals will surely be high on the list. I can see foresee a time that keeping a pet will be viewed as wrong, however well that animal is treated.

However, that isnt an attitude that the emeritus Professor of the Public Understanding of Science at the University of Oxford would wish to encourage. Iam a child of my time and I love my dog. His choice of breed might surprise those who know him for his Rottweiler-like tenacity in defending Darwins legacy. He has a Coton de Tulear, the fluffy white national dog of Madagascar.

SAVSNET is goBSAVA held a press conference at Congress with their colleagues from the University of Liverpool to talk about how the surveillance project SAVSNET is all set to improve understanding of small animal disease.

A new website, www.savsnet.co.uk, went live at Congress on 5 April, and after three years of pilot projects, the impressive

SAVSNET team has ironed out any early teething problems and are ready to launch the project nationwide.

Mark Johnstons Sussex practice has been involved in the development stages, and he says that colleagues will find the process of inputting data very straightforward. It only adds about 30 seconds to the length of a consultation. That is important if you want to guarantee the quality of the data provided.

New Emergency PG Cert from BSAVA & Vets NowCongress saw incoming President Michael Day and Vets Now Clinical Director Amanda Boag sign the agreement signalling the start of their partnership to develop a new postgraduate certificate in

(ifyou didnt collect it you will be sent your copy in May), finding out how they can make the most of the new BSAVA CPD offerings, and talking to the PetSavers team about the vital work that the charity is doing. Many were keen to sign up for the London 10k on 14 July there are still a few places available, so email info@petsavers.org.uk for information. It was a really great Congress for PetSavers who were grateful for donations raised by Petplan, the banquet raffle, Vetoquinol, JCA and Willows totalling 7,471.74. n

emergency and critical care (ECC). The programme, which will follow the same broad structure as BSAVAs existing Postgraduate Certificate, will take the first group of students in May 2014.

Michael said: This is an exciting development to develop a qualification which will be relevant and accessible to vets in practice. Amanda Boag added: The combined expertise of both organisations will result in an engaging and high quality qualification in this field.

Getting involved with PetSaversThe BSAVA Balcony was packed with members collecting their How To books

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More than 40 per cent of the vets that register each year with the RCVS were educated abroad. Britain is clearly an attractive place for foreign-trained colleagues to work but it isnt a land of milk and honey and many of these will return home disillusioned. John Bonner asked four overseas vets what brought them to the UK and what makes them want to stay

International vets working in the UK

Did we have a summer last year? asks Rocio Chicon, a 2011 graduate of Madrid University in sunny Spain, who arrived in the UK at the beginning of 2012 and is now adjusting to the cooler and wetter conditions commonly encountered in South Wales.

Whatever draws foreign-trained vets to Britain, it certainly isnt the climate. But there were few jobs available for an inexperienced clinician back in Spain and, as with the other three vets that companion spoke to, she was keen to practice and develop her professional skills. Some, like Essex-based practitioner Nick Wojciechowski who graduated from Warsaw University in 2003, have found the conditions to their liking and put down permanent roots.

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It is very valuable seeing how veterinary medicine is carried out in other countries and UK practice is highly regarded in Europe. It also helped that I had studied English as my second language and so the UK was the obvious place to come to. I originally wanted to stay for a year or two but I have now been here for seven years, he says.

However, around 30 per cent of foreign graduates decide against renewing their RCVS registration after the first or second year and for many it is because theyfind it difficult to adjust to living in the UK. Even getting that first job can be a struggle: Rocio had spent over six months in Britain looking for work and was on the point of going home when she was offered her job in Newport.

You have to be persistent because it can be difficult to prove that you can be trusted; there have been a few times in the past when European-trained vets have made mistakes, Rocio notes. She was referring to the numbers of EU-trained vets becomingthe subject of a formal complaint to the Royal College. The increasing proportion of EU graduates having to appear before the RCVS disciplinary committee is a cause for concern, said itspresident Jacqui Molyneaux.

Mind your languageAn analysis of those complaints shows that around 80per cent were due to some form of communication failure. That doesnt surprise Stefano Susanna, a 1996 graduate from the Perugia veterinary school in Italy, who now owns the practice in Cowbridge in the Vale ofGlamorgan which he joined as an assistant in 1998.He says that developing excellent English is absolutely fundamental to success for any foreign-trained vet, along with an understanding of the nuances of the language.

So if the animal is overweight, you should learn to call it plump never call it fat. Also when you are new to the UK you have to be aware of the cultural differences. It is quite normal in Europe to give an intracardiac injection when you are euthanasing an animal. But that would horrify an owner if you did that to their animal; it is something that is just not done here except in very unusual circumstances.

Most EU vets that apply to register with the Royal

College will already have a good command of English, and indeed many European veterinary schools do at least some of their teaching in that language. But there is a big difference between official and idiomatic English. There are big variations in accent and the slang terms used in Britain, even for places only 30 or 40 miles apart, notes Nick Wojciechowski.

My first job was in Coventry and it took a little while to get used to the way that clients spoke. But that was nothing compared with the difficulties I had at first talking to my own colleagues. I am with Vets Now, which is based in Scotland, and I found the Scottish accent was a real challenge, he said.

Rocio found that the concentration needed to alternate between communicating professionally with colleagues and comprehensively but clearly with clients was much more difficult than the actual clinical

it is very valuable seeing how veterinary medicine is carried out

in other countries

work. In the first few weeks I found it exhausting and I had a headache most evenings when I finished work. But I am finding it much easier now, she says. Having a nurse nearby who I could call on was very important. They can help you when you are trying to deal with one of the more difficult clients.

The way that you say itThose vets that receive their training outside the EU, like Liron Hirsch, a 2007 graduate from the veterinary school in Rehovet, Israel, cannot automatically apply for RCVS registration on arrival in the UK. So he worked for a year as a hotel receptionist in London before taking his membership examination. That experience fine-tuned his English language skills but did not necessarily prepare him for every eventuality.

As a non-native speaker, one has to be very

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International vets working in the UK

careful with terms that may seem to be very similar. Aclient who says Will you put him to sleep? could be asking about a general anaesthetic or euthanasia. Youhave to be really careful that you understand their meaning if there is any doubt, always check with the client or a colleague.

Land of learningSurviving the first weeks in the job is a challenge for any new graduate, but particularly so for one having to cope while working in a second language. But there is a bright future for those that do have the necessary skills. The RCVS has counted the numbers of members holding specialist qualifications and found that 30 per cent had obtained their first degree at an overseas university.

Nick Wojciechowski believes that the biggest difference between small animal practice in the UK

the greater opportunities here to provide instruction for clients on preventive medicine issues.

In Spain we love our pets just as much but the attitude of clients is different. Often their dogs will be working animals. The pet isnt seen as a member of the owners family in the way that it is here.

Client-led learningNick agrees that UK pet owners are more likely to want to discuss the treatment options with their vet but there is a downside to this greater involvement in the case. English people are more demanding and they do like to complain. It is usually about the costs of treatment and it can happen very quickly before you realise it, they will bring out the big guns. That is, they will get quite cross.

Like Nick, Liron Hirsch also works for Vets Now and is currently the district vet responsible for the companys four clinics in the Greater London area. Surprisingly perhaps, he says he doesnt mind receiving complaints from clients visiting their practices. You can learn a lot about how the practice is performing from what your clients say. I think it is very useful information to show how you can improve the service that you offer.

When he arrived here, Liron had planned to train as an internal medicine specialist but has now decided that he wants to stay in the emergency and critical care field. Nearly every case that you see is clinically challenging. The big difference between working in a UK hospital and back home in Israel is that the pet insurance industry has developed here much more in Britain. That means that you can do some amazing things to save an animals life or to improve its quality of life and that is what is so satisfying about the job.

you can learn a lot about how the practice is

performing from what your

clients say

and in his native Poland is that here he is working as part of a team, whereas most continental practices have only one or two veterinary surgeons and no qualified support staff. There are some VNs or technicians at the larger practices in his home country but they dont have the quality of training available in Britain. The diagnostic and surgical equipment available in UK practices also tends to be of a much higher standard, he suggests.

There are some key differences in the clients too. Very few dog owners in Spain will agree to having their pet neutered and so the only opportunities to practice ovariohysterectomy procedures back home were in bitches that were also being treated for mammary tumours, notes Rocio. She says the greater numbers of surgery cases at her practice have helped her build confidence in her surgical skills and she appreciates

in Spain we love our pets just as much but the attitude of clients

is different

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

Learn@Lunch webinarsThese regular monthly lunchtime (12 pm) webinars are FREE to BSAVA members just book your place through the website in order to attend. The topics will be clinically relevant, and are particularly aimed at vets or nurses in first-opinion practice.

This is a valuable MEMBER BENEFIT

Coming soon 22 May MRI/CT Which one, when?

with Fraser McConnell 29 May Blood transfusion for nurses

with Jenny Watson 12 June Anaesthesia update for vets

with Liz LeeceBook online at www.bsava.com

All prices are inclusive of VAT. Stock photography: Dreamstime.com. Isselee; Kristina Stasiuliene; Vriesela

Crusty canines and festering felines23 MayThis practical and interactive course for GPs will cover investigation and treatment of common dermatological conditions in dogs and cats and will also include a practical cytology workshop.

SPEAKER

Natalie BarnardVENUE

Crabwall Manor, Chester CH1 6NEFEES

BSAVA Member: 227.00Non BSAVA Member: 340.00

Imaging the abdomen20 JuneThis course is designed to include points of interest for both general practitioners and nurses with an interest in diagnostic imaging.

SPEAKERS

Andrew Parry and Lizza BainesVENUE

Willows Veterinary Centre and Referral Service, Solihull B90 4NHFEES

BSAVA VN Member: 167.00Non BSAVA VN Member: 250.00BSAVA Member: 233.00Non BSAVA Member: 350

Managing birds in practice for vets and vet nurses17 SeptemberThis course is designed for vets and nurses who are interested in avian medicine but who have limited experience (perhaps dealing with less than five birds a week).SPEAKERS

Neil Forbes and Matthew RendleVENUE

Lismoyne Hotel, Fleet, Hampshire GU51 4NEFEES

BSAVA Member: 233.00BSAVA VN Member: 167.00Non BSAVA Member: 350.00Non-Member Nurse: 250.00

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Clinical conundrum

James Swann, a Junior Clinical Training Scholar at the Royal Veterinary College, invites companion readers to consider a Collie with pyrexia and multiple joint effusions

Case presentationA 6-year-old female neutered Collie cross was presented for investigation of pyrexia of unknown origin. She had become acutely lethargic 4 days previously and her food intake had declined progressively over this period. She was lethargic a week previously and had developed a low head carriage. When examined 5 days ago she was found to be pyrexic, but there had been no response to administration of a 5-day course of broad-spectrum antibiotics.

On examination she was quiet and lethargic, but her mentation was appropriate. Rectal temperature was 40.9C and she had a low body condition score (3/9). Her neck was ventroflexed, and she showed signs of discomfort when her head and neck were manipulated dorsally. There were marked effusions of both carpi and tarsi, and she was reluctant to walk. There was palpable enlargement of the popliteal, prescapular and submandibular lymph nodes bilaterally.

n Chronic degenerative arthropathies, including osteoarthritis. Such conditions would not usually present acutely or account for the other problems observed in this dog.

n Infection of joints by pyogenic bacteria (infective arthritis), which may also cause pyrexia and lameness. This disease rarely affects multiple joints simultaneously in a symmetrical pattern and it would be expected to cause severe pain on manipulation of affected joints. Infective arthritis does cause local reactive lymphadenomegaly but is less likely to cause generalised enlargement unless it leads to the development of bacteraemia and septicaemia.

n Immune-mediated arthropathies, which may also cause severe pyrexia, generalised lymphadenomegaly, pain, and reluctance to ambulate.

Which investigations would you perform, and why?Prior to sedation, a complete blood count and serum biochemical profile were obtained to screen for major organ abnormalities. The results are shown in Tables 1 and 2.

Create a problem list for this patient

n Symmetrical effusions of multiple joints n Neck pain n Peripheral lymphadenomegaly n Pyrexia n Lethargy, reluctance to ambulate, and

inappetence

Consideration of which problem is most likely to lead to a diagnosis? What are your differential diagnoses for this problem?There are fewer differential diagnoses for dogs presenting with effusion of multiple joints and investigation of this problem is likely to lead to a diagnosis with greater expediency than consideration of non-specific problems such as pyrexia and inappetence. Differentials for effusions of multiple joints include:

Parameter Result Reference interval

wbC 32.5 617.1 x 109/l

neutrophils 28.9 311.5 x 109/l

band neutrophils 1.95 00.3 x 109/l

Lymphocytes 0.98 14.8 x 109/l

Monocytes 0.65 0.151.5 x 109/l

Eosinophils 0 01.3 x 109/l

RBC 5.61 5.58.5 x 1012/l

HCT 0.38 0.370.55 l/l

Platelets 450 150900 x 109/lTable 1: Results of the complete blood count (abnormal results in bold)

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Parameter Result Reference interval

Total protein 53.7 4971 g/l

Albumin 24.4 2839 g/l

Globulin 29.3 2141 g/l

Urea 5.9 39.1 mmol/l

Creatinine 97 59138 mol/l

Cholesterol 9.5 3.38.9 mmol/l

Total bilirubin 6 02.4 mol/l

Amylase 777 1761245 IU/l

Lipase 49 72115 IU/l

ALT 27 1388 IU/l

CK 348 61394 IU/l

ALP 260 19285 IU/lTable 2: Results of the serum biochemical profile (abnormal results in bold)

Parameter Result

Description Straw-coloured fluid with reduced viscosity

Total nucleated cell count 3.2 x109/l

Culture Negative

Cell types >80% neutrophilsTable 3: Results of synovial fluid analysis from a typical joint, in this case the left tarsus

Parameter Normal synovial fluid Degenerative disease Infectious arthritis Immune-mediated arthritis

Colour Colourless or light yellowClear

Colourless or light yellowClear

Yellow, yellow/green, or serosanguineousOften turbid

Yellow, yellow/green, or serosanguineousOften turbid

Viscosity High High or slightly reduced Reduced Reduced

Total nucleated cell count (x109/l)

3 (up to 150)

Major cell types 10% neutrophils90% mononuclear

10% neutrophils90% mononuclear

>25% neutrophils (usually >90%)20% neutrophils (usually >80%)

14 | companion

Clinical conundrum

Revise your problem list to account for these findings

n Immune-mediated polyarthritis n Reactive peripheral

lymphadenomegaly n Presence of an inflammatory

leucogram n Pyrexia, lethargy and inappetence

How are immune-mediated arthritides classified? Why is this important in this case?Immune-mediated arthritides may be associated with erosive or non-erosive lesions. Rheumatoid arthritis is the only form of erosive polyarthritis reported to occur in dogs in the UK, though erosive polyarthritis associated with Mycoplasma spp. infection has been reported in dogs in Australia and theUSA.

Non-erosive immune-mediated polyarthritis (IMPA) may occur with immune-mediated disease of other organ systems, such as with systemic lupus erythematosus (SLE) or steroid-responsive meningitis/arteritis (SRMA). In most cases, however, other organs are not apparently involved and such cases of IMPA may be further classified into four types:

n Type 1: Idiopathic IMPA with no underlying cause detected.

n Type 2: Reactive IMPA associated with remote infections, including pyometra, pyoderma, pyelonephritis, and bacterial endocarditis. Infection with Borrelia burgdorferi sensu lato, Anaplasma phagocytophilum, Ehrlichia canis or Leishmania spp. has also been associated with the development of polyarthritides, and these are thought to have an immune-mediated component.

n Type 3: Enteropathic IMPA associated with severe forms of gastrointestinal disease, including acute pancreatitis and severe forms of inflammatory bowel disease.

n Type 4: Paraneoplastic IMPA associated with the presence of neoplasia at remote sites.

This classification scheme identifies those tests that are now required to investigate for an underlying cause and to establish a definitive diagnosis.

On the basis of this information, how would you investigate the arthritis further?Diagnostic imaging was required to differentiate erosive from non-erosive arthritis. In this case, orthogonal radiographs were made of the left tarsus, and these images are shown in Figure 2. The images confirm that the polyarthritis was non-erosive.

Further investigations were required to detect possible underlying disease or inciting factors that could be associated

with the development of IMPA. In this case, the following tests were performed.

n Computed tomographic (CT) scans were made of the thorax and abdomen to screen for the presence of neoplastic masses and these revealed no abnormality. Although CTwas used in this case, thoracic radiography and abdominal ultrasonography could also be used todetect macroscopic changes consistent with neoplasia.

n A brief echocardiogram was obtained and this did not detect any changes suggestive of bacterial endocarditis.

n Three blood cultures were collected from different peripheral venepuncture sites and no bacterial growth was observed after these had been incubated for 7 days.

n A urine sample was obtained by cystocentesis and culture was performed because bacterial urinary tract infections may be an inciting cause for type 2 IMPA. Culture of the urine revealed no bacterial growth and the results of urinalysis with a semi-quantitative chromatographic dipstick are shown in Table 5.

n Quantification of the serum anti-nuclear antibody (ANA) titre yielded a negative result at a dilution of 1:40. This result indicated that the dog was unlikely to have SLE.

n A sample of synovial fluid was submitted for polymerase chain reaction to detect genetic material originating from Borrelia spp., the causative agent of Lyme disease. Nosuch material was detected.

n A blood sample was not submitted in this case for measurement of the serum titre of anti-Anaplasma phagocytophilum antibodies, although this is another organism endemic to the UK that may cause polyarthritis.

A

b

Figure 2 A & b: mediolateral and caudocranial radiographs of the left tarsus

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ConTRIbUTe A CLInICAL ConUndRUm

If you have an unusual or interesting case that you would like to share with your colleagues, please submit photographs and brief history, with relevant questions and a short but comprehensive explanation, in no more than 1500 words to companion@bsava.comAll submissions will be peer-reviewed.

ACknowLedgemenTS

The author is very grateful to Dr Oliver Garden for clinical discussion of this case, and to Patricia Crosse for kindly providing the image shown in Figure 1 and for interpretation of clinical data.

Parameter Result

Colour Yellow, slightly cloudy

Specific gravity

1.045

pH 6.5

Protein 3+

Glucose Negative

Ketones Negative

Blood 3+

Sediment RBC: 110 per high power fieldWBC: 15 per high power field

Culture No bacterial growth detected after incubation for 48 hours

Table 5: Results of urinalysis

If this dog had a history of foreign travel, would further diagnostic tests be advisable?Exotic tick-borne parasites such as Ehrlichia canis and Leishmania spp. have the potential to cause the signs described in this dog and to act as stimuli for the development of secondary IMPA. Tests to rule out these infections would therefore be advisable if the dog had a consistent travel history. An immunochromatographic SNAP test is available to test for exposure to E.canis, B. burgdorferi and A.phagocytophilum by providing evidence of specific antibodies. PCR-based tests are also available for these organisms and Leishmania spp.

What is the final diagnosis in this case?Type 1 idiopathic IMPA, although concurrent SRMA could not be ruled out without CSF analysis.

What are the possible causes of neck pain in this dog?It is thought that many dogs with IMPA suffer concurrent cervical or spinal pain due to involvement of the intervertebral

articulations. A recent retrospective study indicated that up to 48% of dogs with IMPA and concurrent signs of cervical pain had cerebrospinal fluid (CSF) changes consistent with inflammatory disease (Webb and others, 2002), suggesting that polyarthritis may occur commonly with SRMA. Collection and analysis of CSF would have been required in this case to rule out the possibility of concurrent SRMA.

What are the possible explanations for the proteinuria and haematuria observed on the urine sample?The dog may have had an occult urinary tract infection that was not cultured because antibiotics had been administered for several days before the urine sample was obtained. IMPA has also been associated with concurrent glomerulonephritis and immunohistochemical studies have indicated that this may be related to immune complex and complement deposition in the glomeruli of some animals (Bennett, 1987). Glomerulonephritis may cause renal proteinuria and, in severe cases, haematuria.

How would you treat this dog? Which clinical, haematological, and biochemical parameters should be monitored?Cases with idiopathic IMPA require immunosuppressive treatment and the agents used most commonly are corticosteroids. In this case, dexamethasone was administered perenterally until the dog began to eat reliably, when prednisolone was administered orally at 3 mg/kg/day. Treatment was also initiated with azathioprine (at 2 mg/kg/day) so that the dose of prednisolone could be reduced in the future once the disease was in

remission. Once in remission azathioprine was reduced to a maintenance dose (0.52 mg/kg q48h) and the dose of prednisolone in increments every 3 weeks thereafter.

A course of antibiotics was also prescribed in view of the possible occult urinary tract infection. Proteinuria and haematuria resolved within a week of commencing immunosuppressive and antibiotic therapy.

Azathioprine may cause bone marrow suppression, hepatotoxicity, and pancreatitis. Periodic blood samples were therefore obtained to monitor blood cell counts, liver enzyme activities, and the serum concentrations of indicators of liver function. With high doses of corticosteroids, it may also be advisable to submit periodic urine samples for cytological review and, culture and sensitivity testing, in case of occult urinary tract infection. n

References and further reading are available at www.bsava.com.

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How to approach Horners syndrome

Horners syndrome is a common neurological disorder affecting the eyes, which is present in both the canine and felinepopulations.Clinical manifestationsHorners syndrome occurs because of damage to the sympathetic nervous supply to the eye. This results in typical ocular changes (Figure 1) including the following.

Miosis (pupil constriction) In unilateral cases, the anisocoria will be more

pronounced in a darkened room, as the affected pupil will be unable to dilate appropriately.

Enophthalmos Is caused by sinking of the globe into the orbit

due to loss of tone in the orbital smooth muscle Viewing the patient from above can make this

easier to appreciate. Protrusion of the third eyelid (nictitating membrane)

In dogs, this occurs passively because of the enophthalmos.

In cats, it is both an active process, as there is a small amount of smooth muscle within the third eyelid, innervated by the sympathetic supply, as well as a passive process due to enophthalmos.

Ptosis of the upper eyelid (drooping) and decreased tone in the lower lid Due to loss of tone to Mllers muscle

(smoothmuscle).

Other ocular changes can include ipsilateral congestion of the scleral vessels and nasal mucosa, and on a fundic exam the retinal blood vessels may appear congested. Damage to the sympathetic supply can also cause ipsilateral peripheral vasodilatation, which will manifest as increased warmth and hyperaemia of the pinna.

In cases with a partial Horners syndrome only ipsilateral miosis will be present. This most commonly occurs with acute severe lateralised cervical lesions in dogs. A partial brachial plexus avulsion resulting in damage to the T1 nerve root may also result in an ipsilateral partial Horners syndrome.

Horners syndrome can be bilateral and this may cause visual impairment if the protrusion of the nictitating membrane causes obstruction of the pupils (Figure 2). In general, however, Horners syndrome does not cause visual impairment per se.

Victoria Doyle, European and RCVS Specialist in Veterinary Neurology, helps us approach this tricky problem

Figure 1: Right Horners syndrome in a dog showing miosis, ptosis and protrusion of the third eyelid. enophthalmos is the fourth feature associated wth Horners syndrome but cannot be appreciated in this image Jacques Penderis. Reproduced from BSAVA Manual of Canine and Feline Neurology, 4th edition.

Figure 2: Bilateral Horners syndrome in a Golden Retriever. Third eyelid protrusion may interfere with vision in cases of bilateral Horners syndrome, whereas in unilateral cases it can be considered mainly cosmetic Jacques Penderis. Reproduced from BSAVA Manual of Canine and Feline Neurology, 4th edition.

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AnatomyThe pathway of the sympathetic supply is very long and damage anywhere along its route can result in Horners syndrome. The pathway remains ipsilateral along its entire length. There are three orders of neuron in the sympathetic pathway to the eye (Figure 3).

First-order neuron cell bodies are located in the hypothalamus and rostral midbrain. The axons of these neurons run caudally

through the brainstem into the lateral part of the cervical spinal cord to reach the first three thoracic spinal cord segments (T1T3) within the tectotegmental spinal tract.

The first-order neurons synapse with the cell bodies of the second-order neurons (pre-ganglionic neurons) located in the intermediolateral grey column of the spinalcord.

The second-order neurons exit the vertebral canal through the intervertebral foramina alongside the ventral nerve root arising from the first three thoracic spinal cord segments (T1T3). The axons of the second-order neurons leave

the T13 nerve roots as the ramus communicans and join the thoracic sympathetic trunk.

The thoracic sympathetic trunk travels inside the thorax ventrolateral to the vertebral bodies before coursing cranially along the neck in association with the vagus nerve.

The sympathetic supply and the vagus nerve form the vagosympathetic trunk, which lies within the carotid sheath.

The axons of the second-order neurons course rostrally to the cranial cervical ganglion located ventromedially to the tympanic bulla. At this level the axons of the second-order neurons synapse with the cell bodies of the third-order neurons (post-ganglionic neurons).

The third-order neurons pass through the ventral part of the tympanic bulla and enter the cranial cavity through the tympano-occipital fissure, together with the carotid artery and glossopharyngeal nerve (CN IX).

Within the cranial cavity the axons travel rostrally, passing in close proximity to the cavernous sinus before exiting the cranial cavity through the orbital fissure with the ophthalmic branch of the trigeminal nerve.

The sympathetic supply innervates the smooth muscle of the eyelids (including third eyelid), orbit and iris dilator muscle, as well as the smooth muscles within the blood vessels to thehead.

Clinical approachDamage anywhere along the length of the pathway from a vast array of conditions can result in clinical signs of Horners syndrome. Therefore, Horners syndrome should, in general, be viewed as a clinical sign rather than a diagnosis, except in cases that are ultimately diagnosed with idiopathic Horners syndrome.

Animals presenting with clinical signs of Horners syndrome should have a full history taken. Each patient should also have a full clinical, ophthalmological and neurological examination performed. This information is amalgamated to identify a location where the damage is likely to have taken place.

Figure 3: The pathway of the sympathetic innervation to the eye and adjacent structures of the head Jacques Penderis. Reproduced from BSAVA Manual of Canine and Feline Neurology, 4th edition.

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How to approach Horners syndrome

Horners syndrome is classified as follows:

First order when the damage has occurred to the first-order neurons Which run between the hypothalamus and the

T1T3 spinal cord segments. Secord order when the damage has occurred to

the second-order neurons Which run from the intermediate grey column of

the spinal cord at the T1T3 spinal cord segments to the cranial cervical ganglion adjacent to the tympanic bulla.

This may also be referred to as a preganglionic lesion in some texts as the lesion occurs before the pathway reaches the cranial cervical ganglion.

Third order when the damage occurs to the third-order neurons Which run from the tympanic bulla through the

cranial cavity to the eye. This may also be referred to as a postganglionic

lesion in some texts as the lesion occurs after the cranial cervical ganglion.

Possible neurological signs associated with Horners syndrome First-order Horners syndrome caused by a lesion

in the brain from the hypothalamus and rostral midbrain to the brainstem: Altered mentation (i.e. obtundation, stupor,

coma) Change in behaviour (i.e. vocalisation, pacing,

circling towards or away from the lesion, hemineglect/hemi-inattention if the lesion is lateralised)

Seizures Endocrine changes if the lesion is within the

hypothalamus (e.g. polyuria, polydipsia, adipsia, abnormal eating habits, abnormal temperature regulation, hyperglycaemia)

Altered cardiac function including bradycardia Altered posture (e.g. head tilt towards/away

from the lesion, decerebrate/decerebellate rigidity)

Altered gait (e.g. tetraparesis/plegia, or hemiparesis, ataxia)

Postural reaction deficits of variable severity Cranial nerve deficits (e.g. CN IIXII) Spinal reflexes are likely to be normal but may

be increased in affected limbs Cervical spinal hyperaesthesia is possible

depending upon the lesion If the lesion involves the thalamus patients can

show non-specific pain which is referred to as thalamic syndrome

First-order Horners syndrome caused by a lesion within the cervical spinal cord C1C5 spinal cord segments. Normal mentation Recumbent if the lesion is severe enough Tetraparesis/tetraplegia or hemiparesis/

hemiplegia, ataxia of the affected limbs Generally the gait is more severely affected

in the pelvic limbs Upper motor neuron (UMN) signs of the

affected limbs (normal to increased spinal reflexes with good tone)

Postural reaction deficits in affected limbs which are usually more marked in the affected pelvic limb(s)

Respiratory compromise is possible if lesion involves the C5C7 spinal cord segments as they form the origin of the phrenic nerve

Spinal hyperaesthesia is possible depending upon the lesion

First-order Horners syndrome caused by a lesion within the spinal cord from C6T2 spinal cord segments Normal mentation Recumbent if the lesion is severe enough Tetraparesis/tetraplegia or hemiparesis/

hemiplegia, ataxia of the affected limbs Lower motor neuron (LMN) signs of the

thoracic limbs (reduced/absent spinal reflexes and reduced muscle tone) and UMN signs of the pelvic limbs (normal to increased spinal reflexes with good muscle tone)

Postural reaction deficits in affected limbs Respiratory compromise possible if lesion

involves the C5C7 spinal cord segments as they form the phrenic nerve

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Reduced/absent cutaneous trunci (panniculus) reflex if the lesion involves the C8T1 spinal cord segments

Spinal hyperaesthesia is possible depending upon the lesion

Second-order Horners syndrome caused by a lesion involving the T1T3 nerve roots Normal mentation LMN monoparesis/plegia (reduced/absent

spinal reflexes and reduced muscle tone) and to the affected thoracic limb

Postural deficits in the affected limb Possibly reduced to absent sensation of the

affected limb depending upon the severity of the lesion

Second-order Horners syndrome caused by alesion involving the cranial thoracic sympathetictrunk May have no neurological deficits apart from

the Horners syndrome Second-order Horners syndrome caused by a

lesion involving the cervical sympathetic trunk May have no neurological deficits apart from

the Horners syndrome If the lesion is bilateral there will be significant

involvement of the vagus nerve and so laryngeal and oesophageal dysfunction may be present

Third-order Horners syndrome caused by a lesion affecting the tympanic bulla Vestibular signs (i.e. ipsilateral head tilt,

nystagmus (horizontal/rotatory), ataxia) Possible facial paresis/paralysis

Third-order Horners syndrome involving the intracranial portion of the neuron (from the tympano-occipital fissure to the orbital fissure) Cavernous sinus syndrome, which can cause

dysfunction of cranial nerves III, IV, VI as well as the ophthalmic and maxillary (possibly also the mandibular) branches of CN V. External ophthalmoplegia (inability to move

the eyeball) due to paralysis of the extraocular muscles

Internal ophthalmoplegia (fixed pupil) due to loss of function of the iris and ciliary muscles

The pupil may be fixed either mydriatic or mid-range as potentially the parasympathic (via CN III) and the sympathetic innervation to the pupil can be affected

Absent pupillary light reflex if parasympathetic component of CN III involved

Both internal and external ophthalmoplegia can occur (referred to as total ophthalmoplegia or panopthalmoplegia)

Ipsilateral sensory deficits in the regions innervated by the ophthalmic and maxillary branches of CN V (Figure 4)

Reduced/absent palpebral reflex Reduced/absent corneal reflex

Possible ipsilateral atrophy of the masticatory muscles if the mandibular branch of CN V is involved

The optic nerve is not affected. However, due to the loss of accommodation by the lens and reduction/loss of eyeball movement this can impair the patients vision

Third-order Horners syndrome involving the retrobulbar region Deficits involving CN II, III, IV, VI, ophthalmic

and maxillary branches of CN V Possible pain on opening the mouth as it will

cause the ramus of the mandible to push against a retrobulbar mass

Figure 4: (A) Sensory innervation fields of the three branches of the trigeminal nerve. (B) Motor innervation of the mandibular branch of the trigeminal nerve to the muscles of mastication Jacques Penderis. Reproduced from BSAVA Manual of Canine and Feline Neurology, 4th edition.

A B

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Possible exophthalmos and resistance to eyeball retropulsion if there is a retrobulbar mass

Exposure keratitis due to inability to close the eyelids over the exophthalmic globe

Mild increase in intraocular pressure

Differential diagnosis First-order Horners syndrome

Localising to the brain cervical spinal cord Encephalitis/encephalomyelitis

Infectious, e.g. Toxoplasma gondii, Neospora caninum, fungal (Cryptococcus), feline infectious peritonitis (FIP)

Inflammatory, e.g. meningoencephalitis of unknown aetiology (MUA)

Intracranial neoplasia Localising to the cervical spinal cord

Ischaemic myelopathy/fibrocartilaginous embolism (FCE)

Intervertebral disc extrusion Infectious/Inflammatory myelitis Neoplasia

Second-order Horners syndrome Iatrogenic

Post dorsal laminectomy (T1T3 vertebrae) Epidural ropivacaine Venopuncture Surgery in the ventral neck region

Idiopathic (more commonly third-order) Infectious/inflammatory

Secondary to bite wound to ventral neck Metabolic

Diabetes mellitus Neoplasia arising from or infiltrating the nerves

of the brachial plexus Thyroid tumours (e.g. adenocarcinoma) Mediastinal tumours (e.g. lymphosarcoma

and malignant peripheral nerve sheath tumours)

Traumatic Brachial plexus avulsion Bite wound to ventral neck Intervertebral disc extrusion affecting T1T3

spinal cord segments

Ischaemic myelopathy/fibrocartilaginous embolism (FCE) affecting T1T3 spinal cord segments

Third-order Horners syndrome Iatrogenic

Bulla osteotomy Idiopathic (most commonly, but can be second

order) Infectious/Inflammatory

Otitis media/interna In association with trigeminal neuritis Retrobular abscess

Metabolic Diabetes mellitus

Neoplasia Involving the trigeminal nerve and ganglion Retrobular mass i.e. carcinoma, sarcoma,

lymphoma, meningioma, mast cell tumour

Pharmacological testingPharmacological testing can be used to support your clinical suspicion of the location if the lesion has been present for >2weeks. The test relies upon denervation hypersensitivity, which occurs as the smooth muscles within the eye increase their sensitivity to neurotransmitters (i.e. noradrenaline) after denervation.

The test is not 100% sensitive or specific and so must be interpreted in light of the clinical and neurological findings. The degree of denervation hypersensitivity is also related to the extent of the denervation, which in some cases may not be complete.

Topical 1% phenylephrine is applied to both eyes simultaneously. The time taken for mydriasis (pupil dilatation) to occur is recorded. The general principle is: the closer the lesion is to the iris, the shorter the time it will take for the pupil to dilate.

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Additional diagnostic testsIn general, haematology and comprehensive biochemistry are recommended to assess for any systemic component of the disease process, which may be occurring (e.g. increased leucocyte count or metabolic changes).

Patients with suspected first-order Horners syndrome are likely to require advanced imaging of the head and/or neck to the T3 vertebral body depending upon the results of the neurological examination. MRI will allow identification of structural lesions which may be responsible for the Horners syndrome.

Routine cerebrospinal fluid (CSF) analysis can assist in identifying the nature of any pathology seen (e.g. inflammatory cells, rarely infectious organisms or atypical cells indicative of certain types of neoplasia, most commonly with lymphoma).

The CSF can also be submitted for PCR testing for infections including Toxoplasma gondii and Neospora caninum. If protozoal disease is suspected, paired serology for T.gondii and N.caninum, taken 2weeks apart to look for a rising titre, is recommended.

Patients with suspected second-order Horners syndrome should have thoracic radiography performed, as thoracic masses can damage the sympathetic pathway as it passes through the thoracic cavity.

MRI of the cervicothoracic spine may also be indicated to identify structural lesions which may be responsible for the Horners syndrome. If the lesion communicates with the subarachnoid space, then CSF analysis may also be indicated to assist in further identification of the pathological process. Surgical biopsy of the lesion would be recommended if feasible.

Patients with suspected third-order Horners syndrome should have an otoscopic examination performed to assess for the possibility of middle ear disease. Further imaging including radiography, computed tomography (CT) or MRI of the bullae may be indicated. Myringotomy to obtain samples for cytology and culture may also be required if material is found within the bullae. Part of the route of the third-order neurons is intracranial and so MRI of the brain may be indicated, depending on the presence of additional neurological signs. If the lesion contacts the subarachnoid space then CSF analysis can also yield useful diagnostic information.

The specific diagnostic approach and diagnostic tests that are indicated must be interpreted in light of the details of each specific case. For example, a trauma case with an avulsed brachial plexus causingHorners syndrome may also have additional injuries requiring more extensive stabilisation as wellas investigation.

Treatment and prognosisThe treatment and prognosis is entirely dependent upon the underlying cause and its severity. The exact treatment and prognosis for all of the differential diagnoses listed above is beyond the scope of this article and the reader is referred to the BSAVA Manual of Canine and Feline Neurology for further information.

For idiopathic Horners syndrome, the prognosis is excellent, with recovery within weeks to months with no treatment in most cases. Cases with bilateral idiopathic Horners syndrome where the protrusion of the third eyelids is affecting vision may benefit from the topical application of 1% phenylephrine.

ConclusionThe sympathetic supply to the eye follows a very long course and lesions anywhere along its length can cause Horners syndrome. Interpreting the results of the clinical, neurological and ophthalmological findings in each patient will help to localise the lesion.

Once the lesion has been localised a differential diagnosis list should be created to tailor specific tests that are applicable to reach a final diagnosis. Treatment and prognosis is dependent upon the underlying cause but is excellent for cases of idiopathic Horners syndrome.

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Great lives

Cecil Erskine Woodrow MRCVS was born in Ormskirk, Lancashire, the son of the local vicar, who was also the Canon of Liverpool Cathedral. His mother died in his early childhood and his father when he was a boy. Consequently he was educated at St Edmunds School, Canterbury, a Church of England School for orphans. He showed a particular aptitude for mathematics at school and his first job in 1920 was at a bank.

This however was not to his liking and he took a post teaching mathematics at a school in Cornwall before entering the Royal

Veterinary College in 1924. He qualified MRCVS in 1928, being the Fitzwygram Scholar that year, and then worked as an assistant before purchasing a declining equine practice in Chiswick, West London. He developed this successfully as a small animal practice up to the outbreak of the Second World War.

While in Chiswick, before the war, he had developed an interest in both boats and navigation and owned a steam yacht, the SY Vicuna, in which he regularly sailed on the Thames. On the outbreak of war he joined the Thames Patrol piloting and navigating cargo vessels along the Channel and the Thames to get them to their destination. Later he wrote a book on astronavigation, and was the first person to write a series of articles, for a yachting magazine, on the use of the pocket calculator as an aid to navigation.

Bruce Vivash Jones of the Veterinary History Society and a founding member of BSAVA has written a book about the lives of 119 inspirational vets who have had an impact on our profession. Here he remembers his good friend Woody Woodrow a small animal practitioner who became first BSAVA President, noted for his sound judgements and leadership qualities

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After the war Woodrow resumed practice and moved into a bomb-damaged building at 14 Pont Street, SW1. From these rather cramped premises he began to build a most successful West End practice. In 1958 he negotiated a new lease and was able to occupy the whole building, with an expansion of both facilities and personnel. As one of the very first practices to use an appointment system he was able to exert a control over his work and also create an environment which suited the society-oriented clientele that he cultivated.

Living outside London, at Haxted Mill near Edenbridge, Kent, he built quarantine and boarding kennels which became a valuable adjunct to the practice. Woodrow had foresight, he had the personality that attracted his clients, was a good diagnostician and spoke with conviction. His early Pont Street practice days coincided with the, still only partially explained, hard pad epidemic.

His advice was sought by Burroughs Wellcome, then the only vaccine manufacturer, as he ran a vaccination programme for a nearby department store. As a result he wrote several clinical papers on the topic. He was not a natural surgeon and passed this work to Gordon Knight at the RVC.

After the enlargement of the premises he was joined in partnership by W Brian Singleton in 1959. Singleton also moved to Kent and built an additional surgical facility; this enabled a significant expansiongrowing to become the leading London West End practice.

Apart from his work as a competent practitioner, Woodrow made a major contribution to the profession as the first President of the BSAVA: it was coincidental that he was President of the Central Veterinary Society when the meeting was called by Singleton, in 1956, to discuss the formation of a small animal specialist group. As almost all those present belonged to the Central it naturally followed that he was elected adhoc chairman of the meeting: it was a good choice he had presence and commanded respect. Out of that meeting grew the BSAVA, and Woodrow was unanimously elected the first president and then (uniquely for the Association) was elected for a second term. It was a good decision: he not only gave the infant a sense of direction and purpose but he also controlled the hotheads who wanted a political movement (and were anti-BVA inclined).

One obituarist wrote that he, gave the new association prestige and standing due to his commanding personality, his charm and tact. His

experience and wise advice was crucial in guiding the council, which at times tended to be over-enthusiastic and impatient, through its formative period.

For several years after his presidency he continued to advise the Association on constitutional matters. He also authored the first BSAVA Handbook, The Export and Import of Dogs and Cats, published in 1962. Iremember working with him on this and was amazed by his grasp of the multitude of regulations that he had compiled into an easy-to-understand reference book. He was presented with the Blaine Award by BSAVA in 1963.

In his leisure time and in retirement he, with his wife Mary and family, restored Haxted Mill, both the house and the watermill to working order. Later he established it as a fascinating museum and one of hissons and wife also opened a teashop. Woodrow was knowledgeable not just in veterinary medicine, but in astronavigation, beekeeping, electronics andwatermills.

Woody, as he was universally known (he did not care for either of his given names), was always good company, he was a stimulating conversationalist, was considerate in his behaviour and modest in his manner.

He was a sound advisor; many times when I asked him his opinion on an Association or other matter, he would always return with a reasoned answer. His later years were influenced by major abdominal surgery in 1963, with a slow recovery, but he suffered a terrible blow with the loss of his eldest son in 1989. He had had three sons. It is a fitting and lasting tribute that BSAVA has named their headquarters building after him, with his bronze bust in the lobby. n

TwenTieTh-CenTury VeTerinary LiVes

This book presents the history of the British veterinary profession from 19002000, told through the lives of the people who both experienced it and helped to make it happen. The life stories of 119 men and women are presented, each of whom played a role, often significant and sometimes pivotal, in the twentieth-century British veterinary world. Order forms for Twentieth-Century Veterinary Lives (25.00) can be found on www.veterinaryhistorysociety.org.uk.

Bruce Vivash Jones graduated from the Royal Veterinary College in 1951. He had a varied veterinary career, both in the UK and overseas, that brought him into contact with many leaders of the profession. In fact he was either a friend of, or knew, 51 of the 119 people discussed in his book. A long interest in the history of the profession has seen him take the lead in cataloguing the RCVS Collection of memorabilia as well as being Chairman of the Veterinary History Society for some years.

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The BSAVA Manual of Feline Practice: AFoundation Manual was launched at BSAVA Congress and became one of the best-selling titles on the Publications stand. The editors Andrea Harvey and Sverine Tasker here explain the thinking behind the book and how it will help both students and vets in general practice

passionate that a holistic approach is vital to being able to practise good feline medicine, and this is lost in textbooks that cover both cats and dogs. What we really mean by a holistic approach is that good theoretical knowledge about diseases isnt enough. The good feline vet also needs to have an understanding of cat behaviour, of how to create an environment that minimises stress for cats, of how to handle cats appropriately for different procedures, of what particular equipment to use in cats, and so on.

Who is this Foundation Manual aimed at?It is really aimed at anyone that deals with cats in veterinary practice. We envisage it being particularly useful for new graduates and practitioners who maybe arent as confident in performing certain diagnostic or therapeutic techniques, or do not feel that they are as comfortable as they could be dealing with feline patients. It will also be very relevant to students, and will help to give them an idea of what disorders are common in general practice, as this can be difficult to see from comprehensive student textbooks. The Manual is not designed to be an exhaustive or in-depth text but rather is predominantly aimed at general practice, with the hope that it will provide any vet, whether a new graduate or an experienced practitioner, with the information that they need to know to approach and manage common feline problems to a high standard. Veterinary nurses will also find useful information in the book, particularly with regard to handling and positioning cats for procedures, and to keeping wards cat-friendly.

How did you decide what to include andwhat to leave out?That was very difficult! But we tried really hard to focus on problems that are most commonly encountered in general practice. We started off with our own ideas, based on our experience and on common queries that we get asked by first-opinion vets, and then we also got ideas from many groups of practitioners, including some in different countries, and from vets with a surgical bias (as we are both medics), to try and make sure the topics were as internationally relevant as possible and covered the whole spectrum of feline practice. Finally, we gave the authors scope within

Why do we need a Manual solely for cats?Cats are so different to dogs. In systems-based textbooks the vast majority of a chapter is often on the disease in dogs, with just a short section at the end on cats. In problem-based books, the most common problems in cats can sometimes be lost amongst the canine ones; the most important differential diagnoses are often different in cats and there may be important differences in management. It is also vital to be able to perform practical diagnostic and therapeutic techniques and again there are many differences between cats and dogs that arent usually evident in textbooks covering both species.

Cats have overtaken dogs as the most common pet in the UK and, as a consequence, both the popularity of feline medicine and the need to do it well have risen hugely. But probably our biggest reason for wanting to do this Manual is that we are both so

Fundamentally feline

Sverine Tasker and Andrea Harvey at the launch of their new manual at BSAVA Congress in April

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their individual sections to suggest what they thought was most important to include.

Quick Reference Guides what and why?The QRGs were a key part of our vision for the Manual from the beginning. There are so many practical diagnostic and therapeutic techniques that vets arent necessarily confident in performing (and may be too embarrassed to ask about); even with the guidance of a textbook it can be very daunting performing a procedure for the first time, especially if you havent seen it being done recently. Quite often textbooks dont give quite enough detail for you to be able to confidently perform the technique, just refer to a technique without any guidance on how to perform it, or the technique is described in dogs, omitting subtleties such as restraint and positioning of cats or special equipment required for them. What we wanted to create was a set of practical illustrated step-by-step guides for all the commonly performed diagnostic and therapeutic techniques in feline practice, with a level of detail that meant that anyone could easily carry out the technique, without the need to get information from other sources.

Additionally, when describing methods or techniques, textbooks often give options to the reader, such as different types of equipment or different approaches, but this can sometimes lead to confusion, especially when the book is being used cat-side, as we envisage this Manual will be. Whilst we recognise that there is always more than one way of doing things, we wanted to present the reader, whenever possible, with one clear set of straightforward instructions to reduce confusion and allow them to perform the technique with confidence, even if for the first time. This is particularly important for emergency conditions.

Where appropriate we wanted to have as many illustrated guides as possible, and we have used detailed colour photographs throughout, rather than diagrammatic representations, to make it as easy as possible for the reader to see clearly what they need to do. We put in a lot of effort to really try to get good step-by-step photographs demonstrating techniques and, importantly, all of the photo legends are full and

descriptive so that the reader doesnt have to guess what they are showing.

What do you see as the main take-home message?That anyone seeing feline first-opinion cases has the ability to practise excellent feline veterinary care for many of the common feline problems encountered. Wewant people to appreciate the specific needs of the cat and to adopt a holistic approach to these unique patients.

How can BSAVA members pass on their comments and suggestions for future editions?We would very much welcome feedback on any aspect of the Manual: readers can email publications@bsava.com with their comments. We would particularly like them to suggest areas to expand or omit in future editions, whether there are any additional QRGs that would be useful to have, and whether the level of information in the Manual has been appropriate for their needs.

their individual sections to suggest what they thought

Quick Reference Guides what and why?The QRGs were a key part of our vision for the Manual from the beginning. There are so many

embarrassed to ask about); even with the

daunting performing a procedure for the first time, especially if you havent seen it being done recently. Quite often textbooks dont give quite enough detail for you to be able to confidently perform the technique, just refer to a technique without any guidance on how to

descriptive so that the reader doesnt have to guess what they are showing.

AVAILABLE FROM BSAVA

496 pagesExtensively illustratedISBN: 978 1 905319 39 8Member: 55.00Non-member: 85.00

24-25 Publications.indd 25 18/04/2013 11:28

Please take the opportunity to learn more about PetSavers and the vital research that

is carried out year upon year. If you would like to make a donati on to assist PetSavers in their aim to improve the health of the nati ons pets, please visit the Donati ons secti on of the PetSavers website

www.petsavers.org.uk or call 01452 726 723.

Please take the opportunity to learn more about PetSavers and the vital research that

is carried out year upon year. If you would like to make a donati on to assist PetSavers in their aim to improve the health of the nati ons pets, please visit the Donati ons secti on of the PetSavers website

www.petsavers.org.uk or call 01452 726 723.

26 | companion

The PetSavers Photography Competition awards were presented at Congress in April

The judges were overwhelmed with over 550entries for the PetSavers Photography Competition this year, and the standard was very high. The theme was to celebrate the pets that we love and cherish as part of our family by capturing Priceless Moments and sharing them with the world. The competition was judged in two categories Adult (Aged 16 and over) and Junior

(under 16).We hope you enjoy the pictures as much as

wedid.

Winning pets and theirpriceless moments

Debbie FordPumpkin: Our Halloween PuppyThis is Pumpkin: the singleton puppy of our Sheltie Poppys first litter. Pumpkin arrived several days early and seeing as Poppy had shown no signs of nesting or being ready to deliver, it was a miracle that she survived at all. We had gone to bed and were fast asleep, with Poppy asleep in the kitchen, when our son happened to come home from the pub with his mates. You can imagine his amazement when, as he sat down to give the dogs a cuddle, he noticed one very tiny puppy still attached to her placenta under her mothers tail. She was very cold and tiny and for several days we had to bottle feed her, but then she began to grow in strength and to suckle from her mother and since then, theres been no looking back. This is a picture of her when she was a week old, in Daniels (the midwifes) hands.

1

Adult Category

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companion | 27

Roxi-Lola McCormick-ThompsonTalk to the handThis is my bearded dragon Jasper. This photo was taken when I first got him. Imanaged to capture him waving which is a common characteristic of young bearded dragons. This is a Priceless Moment as he no longer arm waves and this was our first time meeting each other.

Danielle PorterLooking outShadow is looking out in the ocean. Thisis a Priceless Moment as it captures her personality.

Lucia LanganPeek-a-boo!My dog Lollie wanted some fresh air... eventually she found a space for her little face the old cat flap!

Zoe JervisLettuce BeginHere is one of my lovely guinea pigs Bert, enjoying a juicy piece of lettuce, waiting for the sun toarrive.

Ben HicklingHugs anyone?My picture represents the love that I have with my cats and the happiness in our household. Tinker my cat is is posing as she wants a hug.

1

2

3

Imanaged to capture him waving which is a common

Roxi-Lola McCormick-Thompson

2

Danielle PorterLooking out

3

Junior Category

26-27 PetSavers May.indd 27 18/04/2013 11:36

28 | companion

2013 WSAVA award winners announced

The WSAVA has announced the winners of its annual awards. Highly regarded in global companion animal care, they recognise ground-breaking achievement in clinical care. They were presented to the winners at WSAVA/FASAVA World Congress in Auckland, New Zealand

Wellness and Welfare Committee and is a partner at the Wylie Veterinary Centre, Upminster, UK.

Professor Peter IhrkeUntil his retirement in 2012, Peter Ihrke was Professor of Dermatology and Chief of Dermatology Service at the School of Veterinary Medicine, University of California, Davis. He was also Clinical Associate Professor of Dermatology at the School of Medicine, Stanford University and an Executive Board Member of the World Congress of Veterinary Dermatology Association (WCVDA). During his career, he combined his practice with the teaching of students and the continuing professional development of veterinarians.

Professor Ihrke first became involved with the WSAVA as assembly representative for the American College of Veterinary Dermatology (ACVD). He became President in 2012 but had to step down because of health problems. He was awarded the WSAVA Hills Excellence in Veterinary Healthcare Award in 2009.

WSAVA Hills Excellence in Veterinary Healthcare Award Professor Thierry OlivryThis award recognises outstanding work from veterinarians in promoting companion animal healthcare and the family pet/veterinary bond through a sensitivity to clients and patients, using leading edge clinical nutrition and advanced medical and surgery techniques. It has been awarded to Thierry Olivry, Professor of Immunodermatology at the North Carolina State University (NCSU) College of Veterinary Medicine in Raleigh. He has authored or co-authored more than 180 peer-reviewed articles and was Clinician of the Year at NCSU in 2005. He received the Pfizer Award for Research Excellence at NCSU in 2010.

WSAVA Hills Pet Mobility Award Professor James L. CookThis award recognises the outstanding work of a clinical researcher in the field of canine and feline orthopaedic medicine and surgery. It has been made to Professor James (Jimi) Cook, Director of the Comparative Orthopaedic Laboratory at the University of Missouri, USA, which carries out research into osteoarthritis, tissue engineering and articular cartilage physiology. The author of many peer-reviewed publications in the veterinary and human medical sphere, Professor Cooks interests lie in arthroscopy, minimally invasive fracture repair, orthopaedic tissue engineering and total joint replacement.

WSAVA Global One Health Award Professor Lonnie KingThis recognises an outstanding contribution in promoting One Health. It has been awarded to Professor Lonnie King, Dean of the Ohio State University College

WSAVA Presidents Award Dr Ray Butcher and Professor Peter IhrkeThis award is made periodically by the President of the WSAVA to a member judged to have made an outstanding contribution to the Association. This year, unusually, two members have been recognised Dr Ray Butcher and Professor Peter Ihrke.

Dr Ray ButcherThrough his work with the World Society for the Protection of Animals (WSPA), Ray Butcher has been instrumental in efforts to control dog populations humanely, particularly in Eastern Europe and in Asia. He is a founding member of the Blue Dog Trust, an international programme to reduce the incidence of dog bites in children. He is a founding director of the Alliance for Rabies Control (ARC) and is on the board of the International Companion Animal Management Coalition (ICAM), representing the ARC and WSAVA. He is a past Chair of the WSAVA Animal

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companion | 29

of Veterinary Medicine, USA.During a long career, Professor King

has served many national and international One Health organisations. Before joining Ohio State University he was Director of the Center for Disease Controls (CDCs) new National Center for Zoonotic, Vector-Borne and Enteric Diseases (NCZVED). He is also past Chair of the One Medicine Task force for the American Veterinary Medicine Association (AVMA) and is Point of Contact for One Health activities at the CDC.

WSAVA International Award for Scientific Achievement Professor David TwedtThis award recognises the work of a veterinarian in advancing the professions knowledge of companion animal disorders. It has been made to Professor David C Twedt. A Diplomate of the American College of Veterinary Internal Medicine (ACVIM); David is Professor of Clinical Sciences at Colorado State University and Director of the Veterinary Endoscopy Teaching Center. He is a past President of the ACVIM and the Comparative Gastroenterology Society and is an expert in gastroenterology and hepatic diseases of small animals.

Iranian veterinarians benefit from first WSAVA CE webinar programmeThe first WSAVA CE webinar for the Iran Small Animal Veterinary Association (ISAVA) took place last October with speaker Dr Kersti Seksel. A specialist in animal behaviour, she provided an overview of the diagnosis of behaviour problems in dogs and cats. The system used to broadcast the webinar was provided by the Royal Veterinary Colleges Continuing Professional Development team in London.

Dr Jill Maddison, Chair of the WSAVAs CE Committee, comments: The webinar with ISAVA is just one of a number of new initiatives to help us achieve our mission of bringing practical, relevant and inspiring CE to companion animal veterinarians who have previously had little access to training and development to international standards.

The webinar will be available shortly on the new WSAVA website.

CE in CubaDr Zoe Belshaw from the School of Veterinary Medicine and Science at the University of Nottingham, and WSAVA CE Co-ordinator for Eastern Europe, ran two WSAVA CE meetings in Cuba on Fundamentals of Small Animal Medicine. The topic was selected based on responses to a questionnaire sent to Cuban veterinarians to ascertain their priorities for CE. The sessions took place in Pinar del Rio and Havana and were made possible by a donation from the Norwegian Small Animal Veterinary Association. NSAVA, an organisation with 460 members, has supported WSAVA CE work in Cuba since 2003.

Vaccination Group continues its workThe WSAVA Vaccination Guidelines Group has continued its work on companion animal vaccination requirements in Asia, with a visit to India. The team travelled to Delhi and Mumbai, meeting local practitioners, government representatives, academic microbiologists and vaccine suppliers. They also met Dr Nalinka Obeyesekere, a private practitioner from Colombo and founder of the Blue Paw Trust who updated them on infectious disease and vaccination issues in Sri Lanka.

While in India, VGG members presented CE programmes on vaccinology which were enthusiastically received. Chairman of the VGG, Professor Michael Day from the University of Bristol, UK said: We gained a good understanding of the particular problems faced by the subcontinent in particular the challenge of controlling canine rabies infection. There are an estimated 20,000 human deaths annually from canine rabies virus infection in India and it was encouraging to learn of a new governmental control programme scheduled to start later this year. The VGG will next meet in China and Thailand in July 2013. n

WSAVA global CEOver recent months WSAVA has run CEprogrammes in many parts of the world here are a few highlights

Zoe Belshaw

Michael Day

Jill Maddison

Kersti Seksel

Commenting on the 2013 WSAVA Awards, President Professor Jolle Kirpensteijn, said: The achievements of this years winners confirm the commitment of our profession to constantly push boundaries to ensure we enhance veterinary care for companion animals. Iwould particularly like to acknowledge the contributions made by Ray Butcher and Peter Ihrke. Both are living embodiments of what we stand for but they are also great friends and colleagues. We are proud of all our winners. We congratulate them and hope they will inspire others.

Nominations are now being considered for the 2014 WSAVA Awards, which will be presented at the 2014 WSAVA Congress in Cape Town, South Africa, from 1619 September. For information on the nomination process, please contact wsavasecretariat@gmail.com. n

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30 | companion

Mark was born in Portland, Oregon, though he grew up in Saudi Arabia, and attended vet school in Budapest. His parents are both teachers his father teaches English for the Saudi military. He decided on a veterinary career after volunteering at Jeddah vet clinic in his teens, and gained a DVM from Budapest in 2006. He returned to the clinic he had volunteered for, as sole-charge, before moving to the UK to spend two years in practice in Dover. He is currently the Short Course Manager at The College of Animal Welfare where he runs their CPD programme. He has been married to Vera for 7years and they have two daughters, Suzanna (two years) and Klara (five months). Mark is a much valued pastoral mentor for the BSAVA Postgraduate Certificate in Medicine.

the companion interview

Mark B. Hedberg

QHow did you decide to take the veterinary career path you chose?AEvery job I ever took (which isnt a terribly long list) was because I was looking to move forward in my career; whether that was learning to be a better vet, looking for a new challenge, or even hey, that looks like what I want to do!.

What is your particular area of interest and what is it about that subject/species that fascinates you most? I started as a small animal GP with an interest in cats and exotics. I l