The essential publication for BSAVA members

Nursing TrainingProposed changes in VN work-place trainingP4

Clinical ConundrumInvestigation of a poor growth in a young kittenP8

The essential publication for BSAVA members

companionNOVEMBER 2009

GrapeVINeDiscussion of treatment strategies for hypercalcaemiaP17

How to approach rabbit anaesthesia with confi dence

companion

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3 Association NewsRegion In Focus: East Anglia

47 VN Training Changes AgainJohn Bonner reports on proposed changes to the workplace training of veterinary nurses

811 Clinical ConundrumConsider a case of poor growth in a young kitten

1216 How ToApproach rabbit anaesthesia with confidence

1719 GrapeVINeFrom the Veterinary Information Network

2021 Practicing Behavioural MedicineThe new BSAVA Manual prepared to assist, inspire and encourage

22 Touch The Void With Congress SpeakerIntroducing Congress 2010s speaker

23 Veterinary Masterclasses at Congress 2010An overview of the specialist sessions at Congress

24 PetsaversLatest fundraising news

25 2010 Modular ProgrammesHelping you manage your veterinary CPD

2628 WSAVA NewsThe World Small Animal Veterinary Association

29 VMD Proposals & JSAP EditorAssociation news

30 The companion InterviewSteve Leonard

31 CPD DiaryWhats on in your area

WHATS NEW FOR YOU AT www.bsava.com

Additional stock photography Dreamstime.com Miszmasz | Dreamstime.com; Serendigital | Dreamstime.com; Stefan Hermans | Dreamstime.com; Unopix | Dreamstime.com

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

Tel: 01452 726700Email: companion@bsava.com

Web: www.bsava.com

ISSN: 2041-2487

Editorial Board

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

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

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

Design and Production BSAVA Headquarters, Woodrow House

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

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

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

The BSAVA website gives members access to a wide variety of cutting edge veterinary information, clinical abstracts, the latest CPD and the ability to manage your BSAVA account online. Our easy-to-read web pages and downloadable documents mean that you will have the latest practice and clinical knowledge at your fingertips. Our site is constantly evolving; the three newest features are:

1. Latest PollsUpdated on a weekly basis, these polls allow you to comment on a series of questions and debates. Share your thoughts on membership, CPD and the latest veterinary news. You will find these polls around the site, some of which are in member-only areas, so make sure you register/login to the site and get involved.

2. Find a MemberLost contact with friends, professionals and university contacts from years gone by? With this new feature, you can search for fellow members online and send them a message. An email will be sent to the person to let them know they have been contacted through BSAVA find a member. (Please note the sender does not have access to any personal information, including email address).

3. BSAVA ForumsLearn, develop, belong, interact and network with BSAVAs new forums area. Comment on the latest articles in companion, share experiences, case notes and advice with fellow veterinary professionals. This area of the site will allow both non-members and members to share information on topics that are on your mind and are at the forefront of the profession. There is also a dedicated member-only section on the forums.

These features are designed to keep you up to date, all the time. Theres also added information about regional and nationally run courses, and the latest news online, to help you expand on your veterinary knowledge. We know that your career is a journey and the BSAVA are here for wherever the journey takes you. Come on, lets go. Visit www.bsava.com and register and login today to access the above, update your account details and book your CPD.

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ASSOCIATION NEWS

REGION IN FOCUS

EAST ANGLIAGraham Bilbrough champions his BSAVA region

The East Anglia region has a great track record of getting world-class, quality speakers to come and teach on its doorstep meaning local members dont have to travel far to be challenged (and encouraged!) by the very best expertise. Our day meetings are typically held at the Belfry Hotel in Cambourne, as this offers easy access, parking and a great lunch.

The regional committee worked hard to bookend this year with two of the best we began with Sorrel Langley-Hobbs in January, continued to have superb speakers

throughout 2009 and our last event sees Jonathan Bray of Davies Veterinary Specialists helping us all to improve our abdominal surgical skills.

On 15 November at The Cambridge Belfry in Cambourne, Jonathan will take us through everything we need to know to get us through the abdominal crisis (the ones that always seem to come in the middle of the night when there isnt time to phone a friend!).

He will begin with instrumentation, equipment and general approaches, moving onto to the pitfalls and complications of enterotomy, then surgery of the liver, spleen and pancreas, and finishing with case discussions around gastric dilatation volvulus and management of peritonitis. Jonathan is a great presenter

and we are sure well all feel much more confident after his session.

The committee is busy finalizing the CPD calendar for 2010 and as ever we will be aiming to provide meetings that are both interesting and useful to the general practitioner. We will have our first ever weekend meeting combining the best in education on all aspects of the ear with relaxation in a fabulous spa. Other topics vary from the so-called imported diseases to FLUTD. You can find out more online under the CPD section at www.bsava.com or do please get in touch we are always happy to hear from our BSAVA colleagues in the region, simply email eastanglia.region@bsava.com

Chair: Farah MalikElizabeth Smith Veterinary Surgery, Biggleswade

Treasurer: Sheldon MiddletonAcorn House Veterinary Practice, Brickhill, Bedford

Secretary: Graham BilbroughEuropean Medical Affairs Manager for IDEXX Laboratories

Petsavers Representative: Lucy DavisonUniversity of Cambridge

Whos who on the CommitteeCommittee members:

Nick BexfieldWellcome Trust Research Training Fellow, Department of Veterinary Medicine, University of Cambridge

Jane CoatesworthAnimal Health Trust (Sabbatical)

Pascale CollinsEdgewood Veterinary Group, Chelmsford

Francisco Llabres-DiazSpecialist in Diagnostic Imaging, Davies Veterinary Specialists, Higham Gobion, Herts

Eleanor RaffanWellcome Trust Research Training Fellow, Department of Veterinary Medicine, University of Cambridge

Irene RochlitzAnimal Welfare and Anthrozoology Group, Department of Veterinary Medicine, University of Cambridge

CORRIGENDUM: In the article featured in August 2009 companion Keeping Britain Safe discussing PETS derogation, the stated incubation period of Leishmania was incorrect. Readers should note that whilst the majority of cases present within the first 18 months, the incubation period in canine Leishmaniosis may be very prolonged and clinical signs have been reported to first occur up to 7 years after infection. The Editor apologises for the error and thanks Charlie Walker both for his involvement and for the provision of some of the photos which accompany the piece.

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VN TRAINING

VN TRAINING CHANGES AGAIN

Wide-ranging changes are being proposed in the workplace training of veterinary nurses. The plans aim to satisfy the demands of veterinary employers for a simpler, cheaper and less time-consuming process for assessing trainee VNs, while maintaining the high standard of practical and theoretical skills achieved under the existing framework. John Bonner reports

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VN TRAINING

Dealing with masses of paperwork is a headache that we can all do without. So it is not surprising that many senior practitioners have decided that the administrative burden of being a VN training practice is simply not worth the effort. Such a step may bring temporary relief but it is likely that it will only postpone the discomfort until there is a need to recruit new staff and those employers find that there is a dire shortage of suitably qualified applicants.

Government callingHowever, the same bureaucratic forces that created the current problems may also provide their solution. Officials in the government department responsible for skills training, the BIS, want the Royal College, in its role as the body responsible for overseeing VN education, to complete three tasks by the end of next year. These are: the re-accreditation of the RCVS awards in veterinary nursing; responding to the introduction of a new national system for awarding vocational qualifications known as the QCF (Qualifications and Credit Framework); and carrying out a scheduled review of the national occupational standards for VN training.

Together, this trio of fairly arcane chores provides a golden opportunity for a thorough overhaul of the system for veterinary nurse training, which should boost the number of training places available in practices and remedy that chronic shortage of qualified staff. A working party comprising veterinary surgeons, VNs and representatives of training institutions was set up in May under chairwoman Jacqui Molyneux, a practitioner from County Durham and a member of both the RCVS

and VN councils. By the end of September, the group had already produced its interim recommendations after taking written and oral evidence from a range of interested parties.

Race against timeThat is pretty rapid progress but if the VN training colleges are to have sufficient time to reorganise their teaching arrangements in time for the beginning of the 20102011

academic year, that pace has to be maintained. President Richard Dixon was one of two BSAVA representatives giving oral evidence to the Molyneux working party. That puts some unwanted pressure on us all because there is not a great deal of time in which to come up with a robust system. Whatever happens, we must make sure that in the final plans, we keep the good stuff that we see in the current version; there must be no dumbing down in the calibre of the nurses qualifying.

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VN TRAINING

Current system failureDr Dixon insists that there are plenty of bright and caring young people interested in a career as a VN and so the shortage is entirely due to there being insufficient places available in training practices. That is because the system is painfully bureaucratic the nurses work has to be checked by an assessor and then the assessors are checked by assessors and so on. Its a complete nonsense.

So the most significant recommendation in the working groups preliminary report is a proposal to scrap the student portfolios, which were the focus for the in-practice assessment process. Instead, staff at the colleges where the students undertake day or block release training will take full responsibility for assessing the students progress.

ConsultationThe consensus among respondents to the consultation exercise was that the new nurse training system must attract the widest range of potential students by offering both full- and part-time training. There was no enthusiasm for a system like that which has developed in some other European states, in which entry to the nurse register is only available with a degree. Any system based solely on full-time study would deter many potential students, including many of those with families, suggests BSAVAs other representative, Membership Development Committee chair Tricia Colville.

However, the working group is proposing to adopt a major element of the Irish VN training system, in its emphasis on multi-species training. In their first year students will spend 2 days a

week at college and a minimum of 25 days in work; at least 5 days will be spent at an equine centre and another 5 in a farm animal environment. The idea is to broaden the horizons of VN students and address the particular shortage of qualified nurses working in fields outside small animal practice.

During the first year of their training, there is no requirement for the student to be employed by a particular training practice. But for the clinical phase they will be working for the host practice while

VN TRAINING CHANGES AGAIN

normally spending one day a week at college, where they will learn the more challenging theoretical elements of the curriculum (professional responsibilities, welfare, ethics, etc.).

Defining a TPOne way that the working party plans to increase the supply of available placements is to change the criteria under which a clinic qualifies as a training practice. Currently, the practice must be able to provide training in all aspects of the curriculum,

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VN TRAINING

which debars those practices that do not have full surgical facilities, such as many equine practice and small animal branch surgeries. These will be reclassified as auxiliary training practices (ATPs), where nurses will spend the bulk of their time, moving to a main clinic or a neighbouring practice to complete those aspects of their training which the ATP cannot provide.

It is important that we explore ways for branch surgeries to contribute to the training process as we are losing a potential resource. They may not be able to offer surgical training but a student would still gain valuable experience in areas such as dealing with clients, notes Mrs Colville.

Assessing skillsTo replace the current system for assessing the students practical skills, the working group offers a solution modelled closely on

the professional development phase introduced for newly qualified veterinary surgeons. VN students will record online the numbers of times they have carried out key procedures, such as taking blood samples, and can compare their results with that of their peer group.

This database will be maintained by the RCVS and is password protected. It will be accessible to the students, training centres and the person appointed as their mentor within the practice and will highlight those areas where the student needs to be given more experience, said Mrs Molyneux.

Under the proposed new system, the MRCVS or qualified VN appointed as mentor will be responsible for countersigning the students records. They will offer support and guidance during the training period but will have no responsibilities as an assessor. Mrs

Molyneux says that the mentors will be given training in their role, and that this is unlikely to require more than a single day.

Syllabus contentOne thing that is likely to remain largely unchanged is the syllabus, which was judged to be satisfactory by respondents to the consultation exercise. But there is still room for tweaking the content to include skills in operating new technologies like digital radiography and those disciplines which are a growing part of a VNs responsibilities, such as physiotherapy, says Mrs Colville. To avoid overfilling the syllabus, it may be necessary to reduce the emphasis on other areas and she has been examining this issue for the BSAVA. There is the suggestion that the emphasis and depth of coverage in areas such as pharmacology, law and ethics could be reconsidered and become a greater part of post-registration training.

Developing a system allowing VNs greater opportunities for post-registration education is part of the remit for the working group. They envisage a structure in which a VN could take modules in particular clinical disciplines, leading ultimately to the award of a degree level qualification. This is seen as an essential element in efforts to improve retention of VNs in the sector and create a more satisfying career structure.

However, working with interested bodies like the BSAVA, BVNA and BVA, the working group needs to flesh out these plans over the coming months. It will be collecting responses to its interim report during the autumn and aims to have a completed plan ready for a final consultation in May 2010. n I

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CLINICAL CONUNDRUM

CLINICALCONUNDRUMAngie Hibbert, Clinical Fellow at Langford Veterinary Services, University of Bristol invites companion readers to consider investigation of poor growth in a young kitten

cardio n Vascular (e.g. hypo or hypertension)

I n nfectious (e.g. FIP, toxoplasmosis, FeLV)

T n oxicT n raumaticA n nomalous (e.g. congenital

hydrocephalus, lysosomal storage disease)

M n etabolic (e.g. hypoglycaemia, hepatic encephalopathy, hypo/hypernatraemia, anaemia, uraemia)

I n nflammatoryN n utritionalN n eoplastic.

Blindness can be due to peripheral (intraocular) or central (optic nerves, pathways and visual cortex) disease. Central causes are similar to the differentials listed above. Peripheral causes include congenital cataracts, retinal dysplasia, retinal degeneration, uveitis and glaucoma.

Growth is influenced by genetic, hormonal, nutritional and metabolic factors.

Failure of growth could arise due to:

Deficient nutrient intake, digestion or nabsorption Dietary

Inadequate quantity available Inadequate calorific content

Gastrointestinal parasites Oral, oesophageal or gastro-

intestinal disease (e.g. parasitism) Hepatic disease (e.g. portosystemic

shunt, cholangitis, lysosomal storage disease)

EPI, pancreatitis Anorexia secondary to systemic

disease (e.g. congenital cardiac disease, inflammatory process)

Case PresentationA 14-week-old female entire Birman cat presented for evaluation of poor growth and altered behaviour as an out of hours emergency. The owner described episodes of dullness and incoordination. The owner reported that the cat was considerably smaller than her littermates. The cat was fed a proprietary kitten diet but had a picky appetite. She had received her primary vaccinations (FCV, FHV, panleucopenia and FeLV) and had been treated with fenbendazole. The remainder of the history was unremarkable.

Physical examination revealed that the cat was small, although proportionately grown, with a thin body condition (score 2/5, weight 1.3 kg). She was subdued, did not respond to visual stimulation and had hindlimb ataxia.

Create a problem list based on the cats history and physical examination

Poor body condition and reduced ngrowth rateAbnormal mentation nHindlimb ataxia (causing nincoordination)Blindness nInappetence n

What differential diagnoses should be considered at this stage?The kitten has three problems that relate to the nervous system: altered mentation, blindness and hindlimb ataxia. Altered mentation is a marker of forebrain disease, whilst ataxia can be due to abnormalities affecting the proprioceptive reflex pathway, vestibular system and/or cerebellum.

Differential diagnoses for these findings can broadly be considered by mechanism:

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CLINICAL CONUNDRUM

Calorie or nutrient loss n Fever Protein-losing nephropathy or

enteropathy Diabetes mellitusAbnormal metabolism n Hypothyroidism Diabetes mellitus

Inappetence is considered likely to be secondary to an underlying pathology and therefore does not warrant more specific consideration at this stage.

What initial investigations would you consider?Neurological and ophthalmic examinations should be performed to attempt to localise the region(s) of the central nervous system that are affected and determine whether the kitten has central or peripheral blindness. Fundic examination will allow assessment of the retina for signs of infectious disease (e.g. chorioretinitis), hypertension and/or dysplasia/degeneration.

What is your interpretation of the neurological abnormalities (see Table 1)?The reduced mentation is suggestive of forebrain disease as discussed above. The menace response is a learnt response, and may be absent in normal kittens up to around 12 weeks; however, this kitten is of an age where the response should be present. The menace response involves cranial nerves II (optic) and VII (facial) and the forebrain. Given that the palpebral response was normal and tests cranial nerves V (trigeminal) and VII, the absence of a menace cannot be attributed to a facial nerve deficit. An intraocular

examination was normal and the pupillary light reflex (PLR) was present, indicating the optic nerve was normal; therefore the blindness was considered to be due to forebrain disease. Indeed, all documented neurological deficits (Table 1) could be potentially explained by diffuse or multifocal forebrain disease.

What investigations would you consider next?Serum biochemistry and urinalysis are indicated to evaluate for metabolic causes of the neurological signs and poor growth. Haematology enables evaluation for anaemia and leucocyte changes that could indicate an inflammatory or infectious process. Systolic blood pressure was measured and allowed hypo- and hypertension to be excluded.

Neurological exam

Mentation Depressed

Gait Hindlimb ataxia

Cranial nerve tests Negative menace response bilaterallyNormal palpebral responseNormal PLRNegative following response

Proprioceptive tests

Reduced hopping and placing responses in all four limbs

Segmental reflexes Normal

Ophthalmic exam

Cornea, uveal tract, lens, anterior chamber, posterior chamber and retina

Normal appearance

Table 1: Neurological and ophthalmic examinations pertinent findings

Table 2: Biochemistry results

Parameter Result Reference interval

Urea 5.0 6.510.5 mmol/l

Creatinine 61 133175 mol/l

Albumin 27.6 2435 g/l

Globulin 35.8 2151 g/l

Albumin: globulin ratio

0.77 0.41.3

ALT 49 1545 IU/l

ALKP 118 1560 IU/l

Total bilirubin 5.9 010 mol/l

Sodium 150.5 149157 mmol/l

Potassium 4.99 4.05.0 mmol/l

Chloride 115 115130 mmol/l

Phosphate 2.07 0.951.55 mmol/l

Calcium 2.48 2.32.5 mmol/l

Glucose 3.8 3.55.5 mmol/l

Cholesterol 2.7 3.06.9 mmol/l

Table 3: Haematology results

Parameter Result Reference Interval

Hb 11.50 815 g/dl

HCT 34.2 2545

RBC 8.27 5.510 x1012/l

MCV 41.4 4055 fl

MCH 13.9 12.517.0 pg

MCHC 33.7 3035 g/dl

Plt 252 200700x109/l

WBC 13.0 4.919.0x109/l

Neutrophils 10.4 2.412.5x109/l

Lymphocytes 2.34 1.46.0x109/l

Monocytes 0.26 0.10.7x109/l

Eosinophils 0.1 0.11.60x109/l

Basophils 0 00.1x109/l

Table 4: Urinalysis

Parameter Result

pH 6.0

Blood Negative

Glucose Negative

Ketones Negative

Protein 11.0 mg/dl

Specific gravity 1.027

Protein/creatinine ratio 0.13

Sediment: scant squamous epithelial cells

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CLINICAL CONUNDRUM

CLINICAL CONUNDRUM

What is your interpretation of the laboratory results (see Tables 2, 3 and 4)?Reduced levels of urea and hypocholesterolaemia (Table 2) could suggest hepatic dysfunction. Reduced urea could also be due to malnutrition or diuresis. Reduced levels of creatinine can be attributed to the cats poor body condition and reduced muscle mass. Hyperphosphataemia (and raised ALKP) can be explained by skeletal immaturity. The degree of elevation in ALT is not clinically significant. The haematology results are all within normal limits (Table 3). The only abnormality identified on urinalysis (Table 4) is submaximally concentrated urine, and is most likely to be explained by the kittens immaturity. Alternative explanations or factors include low urea levels and/or hepatic disease.

What would be the next logical diagnostic tests? What aspects of this case make this problematic?Given the age, diffuse neurolocalisation, consistent with metabolic forebrain disease, and abnormalities on the biochemical profile it was elected to evaluate hepatic function.

A bile acid stimulation test would be a logical choice; however, if encephalopathy is responsible for the clinical signs, feeding could exacerbate the neurological signs.

Therefore, in this case options would include: the measurement of blood ammonia levels (test of choice in this case if available); measurement of pre-prandial bile acid only; or initiate treatment for suspected hepatic encephalopathy and perform a bile acid stimulation test if the clinical signs improve.

Accurate laboratory assessment of ammonia requires special sample handling and measurement at a reference laboratory; unfortunately, in-house tests are currently considered unreliable (and newer patient side tests require further validation).

Normal ammonia levels do not exclude hepatic disease, but ammonia is the only toxin associated with hepatic encephalopathy that can routinely be measured.

Pre-prandial bile acids levels can be normal in patients with significant liver disease and therefore cannot exclude hepatic dysfunction. The sensitivity of the bile acid test is greatly increased by assessing both pre- and post-prandial levels.

It was elected to measure fasting bile acids and ammonia initially. Had these tests not been immediately available, treatment for hepatic encephalopathy would have been initiated and the patient observed for improvement. Pre-prandial bile acids measured 82.0 mol/l (ref. range 015.0 mol/l) and ammonia 466.0 mol/l (ref. range 050.0 mol/l).

Have the laboratory results enabled you to explain the kittens presenting signs?The laboratory results are consistent with hepatic dysfunction. Hepatic dysfunction can cause a variety of clinical signs including anorexia and poor growth (in an immature animal) as in this patient, along with vomiting, diarrhoea, polyuria and polydipsia. Furthermore, hepatic encephalopathy (HE) could explain the kittens neurological findings. Other signs seen with hepatic encephalopathy include ptyalism (a feature that is common in cats), aggression and seizures.

What is the most likely cause of the kittens disease and how would you confirm this?Hepatic disease may be divided into parenchymal, biliary and vascular processes. The most common hepatic disease seen in paediatric patients is a congenital portosystemic shunt (PSS). This is a form of vascular anomaly in which an abnormal blood vessel allows blood draining the gastrointestinal tract to bypass the hepatic parenchyma and enter the systemic

circulation directly. Alternative differential diagnoses include biliary disease, which would typically be associated with cholestasis but the biochemistry results have excluded this. Parenchymal causes including inflammatory, toxic, metabolic (hepatic lipidosis) and degenerative hepatopathies (e.g. lysosomal storage diseases) were considered less likely.

What immediate treatment is indicated?The priority is to treat the kittens HE to prevent the development of more serious complications such as seizures. HE arises due to increased circulating levels of metabolites or toxins usually processed by the liver. These include ammonia, mercaptans (metabolites of methionine) and endogenous benzodiazepines.

HE is managed by decreasing the levels of these mediators using antibiotics (ampicillin, amoxicillin, neomycin, metronidazole) to reduce the colonic urease-producing bacterial population and hence the potential for fermentation of ingesta and production of ammonia. Lactulose, an osmotic laxative, is used in conjunction with antibiotics. Lactulose reduces circulating ammonia levels by trapping ammonium ions within the colonic lumen and increasing the rate of transit of faeces through the intestinal tract, thereby reducing the time available for fermentation.

Due to the severity of the kittens signs amoxicillin/clavulanate was administered intravenously and lactulose was given as a retention enema (30 ml/kg using 3 parts lactulose to 7 parts warm water). The enema was repeated every 4 hours for a 12-hour period. By the following morning the kittens mentation was significantly brighter, she was responsive, and all the neurological abnormalities had resolved. Electrolytes, blood gases and glucose levels were monitored as hypokalaemia and metabolic alkalosis exacerbate HE.

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CLINICAL CONUNDRUM

Further evaluationThe next step is to perform abdominal ultrasonography to evaluate the hepatic parenchyma and search for a shunting vessel. Microhepatica and an anomalous blood vessel leaving the portal vein close to the right kidney were identified, supporting the diagnosis of an extra-hepatic portosystemic shunt . The remainder of the abdominal organs appeared normal, including the bladder, which was checked for the presence of uroliths, as ammonium biurate uroliths may form in association with portosystemic shunts. In cases where ultrasonography does not identify a shunting vessel, portovenography may be required for definitive diagnosis.

What are the options for long-term management of this kitten?The kitten could be managed either medically or surgically. Medical management comprises feeding a restricted protein diet, alongside oral lactulose therapy antibiotics for control of HE. Suitable dietary options include prescription hepatic or renal diets, which contain protein with a high biological value. Albumin levels should be monitored to ensure that the protein restriction is not too excessive; if necessary, protein can be supplemented using unsalted cottage cheese (a protein

source of high biological value).Surgical correction of PSS is a specialist

procedure. At exploratory coeliotomy mesenteric portovenography is performed to localise the shunting blood vessel. Once identified the vessel is ligated or partially occluded using an ameroid constrictor, suture or cellophane band. Portovenography is usually then repeated to evaluate the hepatic blood flow (see Figure 1a and b). Potential postoperative complications include the development of seizures, portal hypertension, abdominal haemorrhage and thrombosis.

In this case the kitten responded well to medical therapy, with resolution of all the presenting signs. Surgery was recommended

Current research into feline PSSWe have recently reviewed the case files of cats diagnosed at the Feline Centre, University of Bristol, with PSS. This work revealed that a number of the cats in this referral population were Birmans, suggesting that the breed may be over-represented. This is something that the UK breeders have also recognised, along with vets in New Zealand and Australia. We are currently working with Professor Lesley Lyons, a geneticist at University of California, Davis, to investigate this further. We are searching for any affected Birmans and their siblings, to obtain DNA samples. A simple buccal swab is all that is required, along with the kittens pedigree, if the owner consents. All of the pedigree data will remain confidential.If you think you would be able to help with this project please contact me at the Feline Centre on 01179289420 or via email angie.hibbert@bristol.ac.uk for further information.

following a period of medical stabilisation, but was declined.

Does surgery or medical management offer the best prognosis?Currently there is no firm evidence base to say that surgery is associated with a more favourable outcome than medical therapy in the cat. One of the advantages of surgical correction is that it is often possible to discontinue long-term dietary therapy and treatment with medications. For many owners the commitment of having to medicate their cat two or three times daily and prevent dietary indiscretion is particularly onerous. n

Figure 1a and b: Mesenteric portovenography before and after portocaval shunt ligation in another feline patientCourtesy of Dr Frances Barr

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HOW TO

APPROACH RABBIT ANAESTHESIA WITH CONFIDENCE

HOW TO

Nicki Grint of the University of Bristol outlines the key points to success in rabbit anaesthesia

anaesthesia for a routine operation such as ovariohysterectomy may be complicated by the presence of unexpected findings such as a uterine adenocarcinoma. These tumours can place pressure on the great vessels and the thorax, affecting ventilation and blood pressure, especially when the rabbit is turned into dorsal recumbency.

Lack of expertise. Although rabbits are the third most commonly anaesthetised pet, there are still veterinary staff who are unfamiliar or not confident with the anaesthesia of this species. The dissimilarities in anatomy and physiology between rabbits and other small animal species also make extrapolation of techniques and dosages inappropriate. When presented with an unfamiliar species to anaesthetise, many veterinarians will look to textbooks for anaesthetic protocols. Until recently, doses of drugs referenced in many textbooks were taken from studies

based on experimental animals which were specific pathogen free and of a higher health status than pet rabbits. The drug requirements for rabbits being anaesthetised in day-to-day veterinary practice will often be much lower than those used in experimental studies. In recent years, more and more studies have been published based on data from pet rabbits of a similar health status to those seen in general practice, and several of these papers are referenced in Table 1.

Size. Although rabbit breeds can range in size from dwarfs to giant French lops, many rabbits presented for anaesthesia will be of a small size. This can make anaesthetic techniques such as intravenous catheterisation and endotracheal intubation difficult. Small rabbits will also not be able to tolerate high levels of resistance and dead spaces in the anaesthetic breathing systems used to deliver volatile agent and oxygen.

Rabbits are famed for being high-risk candidates for anaesthesia. This infamy is partially deserved; a recent study (Brodbelt et al. 2008) identified that 1 in 72 rabbits dies due to anaesthesia, compared with 1 in 601 dogs and 1 in 419 cats. These statistics have improved over the past 18 years however, as the previous UK study suggested a 1 in 28 death rate in rabbits (Clarke and Hall, 1990). This improvement may be due, amongst other things, to an increasing familiarity of vets and nurses with this species and also the release into the market of anaesthetic and sedative drugs with a wider safety profile.

Why are rabbits at a higher risk of peri-anaesthetic morbidity compared to other species?

Underlying disease. Many rabbits that are presented for anaesthesia are not in full health. Malnourishment and dehydration (common in rabbits requiring dental treatment) should be identifiable on clinical examination. However, subclinical respiratory disease, such as pasteurellosis, may be present. Although signs may not be apparent on clinical examination, this disease can affect the rabbits oxygenation during anaesthesia, and may also progress to a clinical infection postoperatively. Even

Preanaesthetic medication

Induction of anaesthesia Reference

Ketamine 15 mg/kg + midazolam 3 mg/kg IM

Grint and Murison (2008)

Ketamine 15 mg/kg +medetomidine 0.25 mg/kg IM or SC

Grint and Murison (2008)Orr et al. (2005)

Ketamine 15 mg/kg + medetomidine 0.5 mg/kg SC

Orr et al. (2005)

Fentanyl/fluanisone0.1 ml/kg IM

Propofol IV to effect(mean dose 2.2 mg/kg)

Martinez et al. (2009)

Fentanyl/fluanisone0.1 ml/kg IM

Midazolam IV to effect(mean dose 0.7 mg/kg)

Martinez et al. (2009)

Buprenorphine 0.03 mg/kg IM

Alfaxalone 23 mg/kg IV Grint et al. (2009)

Table 1: Pre-anaesthetic medication and induction doses taken from studies on pet rabbit populations

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In general terms, smaller animals have a higher metabolic rate. Metabolism requires several driving forces, e.g. glucose and oxygen, and rabbits thus have higher demands for these substrates. A smaller animal will have a higher surface area to volume ratio compared to larger animals. Having a larger surface area tends to make the animals more susceptible to heat loss under anaesthesia. Hypothermia is common in small animal anaesthesia but may be more pronounced in small species such as the rabbit.

Endotracheal intubation. Apart from their small size, endotracheal intubation in the rabbit is challenging due to a variety of factors. They have a narrow gape, which makes visualisation of the larynx difficult, a view also obscured by long incisors and a fleshy tongue. Laryngospasm is relatively common when endotracheal intubation is attempted, and may be influenced by the choice of anaesthetic protocol. The glottis of the rabbit is relatively small compared to other species of a similar weight. Iatrogenic respiratory mucosal damage is a potential sequel to endotracheal intubation.

Pain. Rabbits are a prey species and so will be unwilling to show signs of pain, especially when housed with cats and dogs, which they may see as predators. Therefore, pain assessment in this species is in its infancy, a potential underlying cause for the low percentage of vets providing analgesia to this species for surgical procedures.

Gastrointestinal system. Rabbits are classed as hindgut fermenters, where they use microbes for digestion of food in

their large caecum and proximal colon. Rabbits can develop ileus postoperatively, and factors which may increase the likelihood of this include pain, starvation, stress and alteration of diet. Gut tympany due to gut stasis can have deleterious affects during anaesthesia, increasing pressure on the diaphragm and the abdominal great vessels.

So how can we try and improve our rabbit anaesthesia?

Pre-anaesthetic preparation. All animals should be stabilised as fully as possible before being anaesthetised. Examples include feeding up a rabbit needing a dental procedure, on a slurry diet; or correcting dehydration with fluid therapy. Rabbits can be fed up to the point of premedication; this will maintain glucose levels, sustain body heat production, and help prevent gut stasis.

Pre-anaesthetic medication. Rabbits can be easily stressed, and struggling before anaesthesia can result in: rabbits fracturing vertebrae or dislocating hips; catecholamine-induced arrhythmias; or difficulty placing intravenous catheters. Stress is also a contributing factor to gut stasis.

The provision of pre-anaesthetic medication will have all the same benefits as with other species, i.e. facilitating catheter placement, sedation, anxiolysis, and reduction of drug dosages required for induction and maintenance of anaesthesia. Drugs which have been used as premedicants in rabbits include acepromazine, benzodiazepines, alpha-2 adrenergic agonists, and opioids. A

neuroleptanalgesic combination of fentanyl and fluanisone, marketed under the trade name Hypnorm, is a licensed drug for use in the rabbit in the UK. Fluanisone is a butyrophenone and produces sedation and similar cardiovascular effects to the phenothiazine drugs. Fentanyl, an opioid, produces sedation and analgesia, but also some respiratory depression. The administration of buprenorphine after this neurolept combination produces sequential analgesia where the partial antagonism of the fentanyl reduces respiratory depression, but does not completely discontinue analgesia.

Intravenous access facilitates accurate and to effect dosing of intravenous induction agents and administration of fluid therapy and emergency drugs. Intravenous catheters (usually 22 or 24 G) are usually placed in the marginal ear vein in the rabbit (Figure 1), but can also be placed in the cephalic vein. Catheterisation is facilitated by the use of a local anaesthetic cream (such as EMLA) applied to a clipped area over the insertion site, and covered with an occlusive dressing, 3040 minutes before catheter placement.

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HOW TO

APPROACH RABBIT ANAESTHESIA WITH CONFIDENCE

its low blood gas solubility produces a fast induction, it has a more pleasant odour and produces less respiratory mucosal irritation than isoflurane. If the rabbit does become stressed with this technique, in contrast to halothane, sevoflurane will not sensitise the myocardium to catecholamine-induced arrythmias. With both chamber and mask techniques, acclimatising the rabbit to fresh gas flows with just oxygen initially is recommended, as is slowly increasing the dialled percentage of agent, rather than suddenly administering a high dose, which may cause breath holding.

Endotracheal intubation is recommended for all rabbit anaesthesia, except for the shortest procedures where a mask may be sufficient. Working around the endotracheal tube during dental work can be problematic, but airway protection is important in these cases. The larynx of the rabbit can be visualised with the aid of an endoscope, an otoscope or a paediatric laryngoscope. Often, with direct visualisation, a stylet is introduced into the

Figure 2: A mask can be used to pre-oxygenate a rabbit before endotracheal intubation is attempted

Figure 1: A 24 G catheter is introduced into the marginal ear vein of a rabbit

Pre-oxygenation. As pet rabbits often have subclinical respiratory infections which may affect their gas exchange, and endotracheal intubation may not be as swift in this species as in others, pre-oxygenation before induction of anaesthesia is a useful technique. An effective and practical method would be via face mask (Figure 2). Alternatives, such as flow-by oxygen, provide lower levels of inspired oxygen and any pre-oxygenation achieved by placing a rabbit in an oxygen tent is soon lost when the rabbit is lifted out of the chamber for induction.

Induction of anaesthesia can be achieved by intravenous, intramuscular or inhalational drugs. Various injectable agents have been used in pet rabbits (see Table 1). Inhalational induction can be carried out using a face mask or a chamber. With both

techniques, it is recommended that the rabbit is adequately sedated before volatile agent is administered. Of all the agents available currently, sevoflurane is the authors inhalation induction drug of choice;

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HOW TO

trachea initially and then the endotracheal tube can be railroaded over this. An alternative technique of endotracheal intubation is the blind method, where the anaesthetist relies on hearing breath sounds coming through the endotracheal tube as the tube is advanced (Figure 3). If the breath sounds disappear, then endo-oesophageal intubation is suspected and the tube should be withdrawn and redirected. When endotracheal intubation

is successful, usually breath sounds will become louder, and the rabbit may cough. Some authors advocate the use of topical lidocaine in the larynx to prevent the laryngospasm which may result from endotracheal intubation attempts.

Maintenance of anaesthesia. Some of the induction protocols may produce anaesthesia for a sufficient time for short procedures to be carried out, although

Figure 3: During blind endotracheal intubation, the anaesthetist listens for breath sounds whilst advancing the tube

oxygen should always be supplemented. If volatile agents are to be used to maintain anaesthesia, an ideal agent in the rabbit would be of low blood solubility (e.g. isoflurane or sevoflurane), leading to a faster recovery from anaesthesia. Anaesthetic gases should be delivered via non-rebreathing systems in all but the largest rabbits. As small mammals, they will struggle with breathing systems with large amounts of resistance and dead space, so a valveless breathing system such as an Ayres T-piece with Jackson Rees modification would be ideal. Fresh gas flow calculations should be based on a higher minute ventilation rate compared with dogs and cats, of approximately 250 ml/kg/min. Nitrous oxide may be used as an additional carrier gas to oxygen. Using this analgesic gas will limit the fraction of inspired oxygen, and so monitoring of SpO2 is mandatory. Some authors are concerned about nitrous oxide accumulation in the gas-filled guts of the rabbit. Theoretically, as the gas in these guts is not air, accumulation should not be an issue, but monitoring for tympany during the anaesthetic is advised.

Fluid therapy is most effective given intravenously. Alternative routes include subcutaneous or intraperitoneal injections, although the author avoids giving glucose-containing fluids via these alternative routes. As with all fluid therapy, the rate of infusion and type of fluids given depends on the fluid balance of the patient and what type and amount of fluid is lost.

Monitoring anaesthesia. The same monitors as used in other small animals can be used in rabbits, for example pulse oximetry, capnography and electrocardiography. However, monitors

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HOW TO

ReferencesBrodbelt DC, Blissitt KJ, Hammond RA et al.

(2008) The risk of death: the Confidential Enquiry into Perioperative Small Animal Fatalities. Veterinary Anaesthesia and Analgesia 35, 36573

Clarke KW and Hall LW (1990) A survey of anaesthesia in small animal practice. AVA/BSAVA report. Journal of Veterinary Anaesthesia 17, 410

Grint NJ and Murison PJ (2008) A comparison of ketamine-midazolam and ketamine-medetomidine combinations for induction of anaesthesia in rabbits. Veterinary Anaesthesia and Analgesia 35, 11321

Grint NJ, Smith HE and Senior JM (2009) Clinical evaluation of alfaxalone in cyclodextrin for the induction of anaesthesia in rabbits. Veterinary Record 163, 3956

Martinez MA, Murison PJ and Love E (2009) Induction of anaesthesia with either midazolam or propofol in rabbits premedicated with fentanyl/fluanisone. Veterinary Record 164, 8036

Orr HE, Roughan JV and Flecknell PA (2005) Assessment of ketamine and medetomidine anaesthesia in the domestic rabbit. Veterinary Anaesthesia and Analgesia 32, 2719

that have been originally designed for human use may be set to monitor different numerical ranges of physiological parameters. Pulse palpation is easily achieved using the auricular artery that runs down the middle of the ear, and this is also the vessel that can be cannulated for direct blood pressure measurement. Due to the small size of some rabbits, oscillometric blood pressure measurement may be difficult, but blood pressure can be measured using the Doppler technique.

Analgesia. As with all other species, multimodal analgesia should be employed if the rabbit is undergoing a painful procedure. This is especially important as pain assessment in this species is still in its infancy. Medetomidine, ketamine and fentanyl/fluanisone are all commonly used in premedication/induction protocols, and are inherently analgesic. Buprenorphine is a popular choice of opioid in general practice

Figure 4: Warm water filled gloves and bubble wrap are used to prevent hypothermia during anaesthesia

due to its relatively long duration of action. Non-steroidal anti-inflammatory drugs such as meloxicam and carprofen will also provide longer term analgesia. Local anaesthetic blocks, such as epidurals and brachial plexus blocks can be used, although accurate calculation of doses is critical to avoid overdose. One local technique which is relatively contraindicated in the rabbit is the retrobulbar block, as the rabbit has a large venous plexus behind the globe which is easily penetrated.

Temperature should be regularly monitored during anaesthesia. An endo-oesophageal thermistor probe will provide a continuous temperature reading; alternatively, intermittent readings from a rectal thermometer can be used. Active warming using a warm air blower device or hot water bottles/heat mats (with a layer of insulation between the device and the surface of the rabbit) can be used.

Additionally, insulation using bubble wrap or blankets will slow heat loss (Figure 4).

Recovery from anaesthesia. Rabbits should recover from anaesthesia in a warm, calm environment away from predators. They should be well monitored, as most perioperative deaths occur in this period. Short-acting anaesthetic drugs should be employed wherever possible, as the sooner rabbits are moving around after anaesthesia, the sooner they will be able to maintain their own body temperature. Food should be offered as soon as the rabbit is sufficiently recovered, to prevent ileus, and provide a source of glucose. Analgesia should also be continued into the postoperative period. n

APPROACH RABBIT ANAESTHESIA WITH CONFIDENCE

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VIN

Katherine Poole BVSc, Medivet Ickenham, Uxbridge, UK

I have a 5yr old MN boxer who presented last night with a 3 day history of lethargy, inappetance, vomiting and PUDP. On clinical examination TPR wnl, CVS OK no rhythm disturbances, chest clear, abdo palpation normal, submand LN slightly enlarged but other LN wnl, CRT 4 mmol/L. I started him on Hartmanns IV and repeated the bloods this morning confirming the hypercalcaemia is repeatable and now he appears to also have mildly elevated creatinine and BUN. Unfortunately I was unable to get a urine sample for dipstick and SG before starting IVFT but I am presuming it is pre-renal azotaemia?

Xrays were taken for tumour search and there is a possible abdo mass which I am planning to do an ultrasound scan tomorrow with fna/biopsy if indicated. Rads of chest were clear. After reading about hypercalcaemia in Associate, I checked his BP which was normal and switched him to 2x maintenance NaCl 0.9%. Im going to send a full biochem and haematology to an external lab to try and quantify the hypercalcaemia as our in-house analyser doesnt read above 4 mmol/L.

Apart from the scan and repeating the bloods I am planning to send a blood sample to a specialist for ionised calcium, PTH and PTHrp but unfortunately the bloods are only run every week and I just missed the boat so the sample wont be run until Wednesday with results Thursday which worried me in the meantime especially if tumour search is negative.... what do I do in the meantime?

At the moment all I can do is give IVFT to get rid of the calcium through the kidneys or should I start a low dose diuretic despite the azotaemia? Is there anything else I can do to help, given that I have no diagnosis as yet? Am I missing anything? Incidentally phosph is wnl and no other abnorms with biochem or haem apart from calcium, BUN and creat.

Any help would be great!

Cheers

Tina Wismer DVM, DABVT, DABT, ASPCA Animal Poison Control Center, University of Illinois, Urbana, IL

If no response to fluid diuresis, I would then look at using pred to help decrease the calcium. Furosemide can also be used.

If no response to those, then you can give calcitonin or pamidronate (used to treat hypercalcemia of malignancy in humans).

Looking at the breed, I would be concerned about neoplasia.... :(

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

Discussion: Hypercalcaemia treatment strategy

Editors note: Associate is VINs online book, featuring chapters on canine, feline, public health, and foreign animal/bioterrorism diseases.

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VIN

GrapeVINe

Samantha Berge Dewitt Veterinary Medical Center, Syracuse, NY

Did you perform a very careful rectal exam looking for a mass? Unfortunately, unless the owners are feeding supplements with really high Vitamin D, or he chewed up medication with this in it, he has cancer somewhere. The first 12 rule outs for Hypercalcemia are Lymphoma, Lymphoma.....etc, then anal adenocarcinoma, then other neoplasia.

Susan Curci, DVM, Veterinary Specialists of Northern Colorado, Ft. Collins, CO

Sure the dog didnt get into anything?

Katherine Poole

Well today I checked him over again and his submandibular LN are massive and so are the popliteals. Also on abdo scan mesenteric LN enlarged. No other masses. I know I thoroughly checked his LN yesterday and day before and they definitely werent enlarged. Now his calcium is 3.99 mmol/L, ALP and ALP are twice norm and BUN/creat rising slowly. I plan to do LN biopsies tomorrow but wont get results until Tuesday as it is now the weekend. Likely to be lymphoma so should I start COP anyway as he is slowly deteriorating? Or should I hold out with just IVFT. Xrays of chest taken yesterday showed no obvious mets so which protocol would be best if I do start before I get confirmation?

Samantha Berge

I am sorry Kate. If the dog is decompensating, is it the CHOP protocol? You can do L-spar and prednisone for 20 days before starting the big gun chemo? Sorry, definitely not an oncologist.

Katherine Poole

Does anyone know how to cross ref with oncology dept please?

Therese Grover DVM, VIN representative; VNN reporter Seattle, WA

>>> Does anyone know how to cross ref with oncology dept please? > If no response to fluid diuresis, I would then look at using pred to help decrease the calcium.

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VIN

All content published courtesy of VIN with permission granted by each quoted VIN Member. For more details about the Veterinary Information Network visit vin.com. As VIN is a global veterinary discussion forum not all diets, drugs or equipment referred to in this feature will be available in the UK, nor do all drug choices necessarily conform to the prescribing rules of the Cascade. Discussions may appear in an edited form.

This thread appears in an edited form.To read the full thread and access the links mentioned visit http://www.vin.com/Link.plx?ID=85426

Last night I gave him vincristine and dexamethasone. Hes continuing on preds today. I increased fluids 0.9% NaCl to 3x maint for the renal failure and to try and rid of the calcium. Today he is much brighter!!!! He is still inappetant but took a little yoghurt for his owner. Hes obviously not out of the woods but I am going to repeat his bloods later and see whats going on.

Cheers for all advice

Katherine Poole

Oh and he is now on metoclopramide to counter any nausea/vomiting!

Katherine Poole

Ive just repeated bloods on Bud:

Haematology mild lymphopenia and mild granulocytosis. WBC count and other haematology values are wnl. How long after vincristine would I expect to see changes in the haematology.

Biochemistry mild hypoalbuminaema. Calcium now 3.4 mmol/L (as >4 mmol/L yesterday) but BUN 28 mmol/L and creatinine 290 umol/L so no changes from yesterday.

Ive started him on Fortekor today and he is continuing with 3x maintenance NaCl 0.9% to help flush out the calcium and kidney toxins. Still, much brighter today but not wanting to eat. Fingers crossed! Anything else I can do in the meantime?

Douglas H. Thamm

Can you get salmon calcitonin? That would get the calcium down in a hurry and give the other meds time to work

Katherine Poole

Bud went home yesterday! In the end his calcium levels normalised :)

My main concern is the kidney BUN and creatinine have stayed the same despite the IVFT and additional fortekor. The protocol that we are using is L-VCA-short as recommended by the VRCC. The protocol is 19 wks in total consisting of prednisolone and cycling between vincristine 0.7 mg/m2, cyclophosphamide 250 mg/m2 and doxorubicin 30 mg/m2.

This is my first chemo patient. One vet has recommending using doxorubicin at 25 mg/m2 and also that the chemo agents could make his kidneys worse but Im not sure which poses most risk to his kidneys and is there an alternative that may be better as the protocol suggests chlorambucil instead of cyclophosphamide if severe side effects are seen. Im going to give oral endoxana instead of IV as suggested by another vet in my practice.

Any advice for managing this case in terms of chemotherapy or if the protocol Im using is not recommended etc would be hugely helpful.

Douglas Thamm

It is doubtful that any of these agents will adversely affect renal function. Your protocol is a very good choice.

Katherine Poole

Thanks Doug. Well Bud had his cyclophosphamide on Friday and hes doing well at home so fingers crossed and hopefully I can get him into remission!

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PUBLICATIONS

PRACTICING BEHAVIOURAL ME DICINEThe Editors of the BSAVA Manual of Canine and Feline Behavioural Medicine, Debra Horwitz and Daniel Mills, explain how the new edition with extra useful CD has been prepared to assist, inspire and encourage all who work with behaviour in practice

their behaviour, especially their communicative abilities, in order to lay the foundations of husbandry practices which maximize their quality of life.

Rehoming issuesA new chapter recognizes an important aspect of behavioural medicine that has not received the attention it deserves: the measures which can be applied to the population of pets within and from animal shelters and rehoming centres. This chapter is devoted to providing information on how veterinary surgeons can help both the organizations and the owners of rehomed animals to adopt practices that encourage successful adaptation to a new home. Taken with the other chapters on health and welfare, we hope that the numbers of animals relinquished or euthanased for behavioural problems can be reduced.

CD extrasBecause we have so much to deal with in daily practice, this new edition has several special features to simplify behavioural

As the discipline of behavioural medicine has evolved, it has become increasingly evident that it permeates all areas of veterinary medicine and should not be considered solely the domain of specialists. In this new edition advice is given on best practice in the home and the clinic, to prevent problems arising in the first place. Importantly, a whole chapter is devoted to the interplay of medical disease and behaviour, to help the veterinary surgeon understand how these are intertwined.

Treating problem behaviourThe new manual deals with various behavioural problems and brings new information not only on behavioural biology but also on diagnosis and treatment regimes. Nowhere is the importance of this more evident than in an understanding of canine and feline aggression. Canine aggression in particular continues to be misrepresented as some sort of hierarchical drive within the animal, and this popular misunderstanding promotes practices that are to the detriment of the animals, their owners and the bond between them. Aggression most often occurs due to underlying anxiety, fear-related issues and a lack of appropriate recognition and understanding of cross-species communication. Armed with clear descriptions of canine communication and how to interpret it, the veterinary surgeon will be poised to help owners recognize, treat and avoid aggressive encounters with their dogs, without compromising their welfare.

Our feline companions, too, are often misunderstood, and several chapters from the manual offer a better understanding of

Canine Ladder of Agression: how a dog reacts to stress or threat

Biting

Snapping

Growling

Stiffening up, staring

Lying down, leg up

Standing crouched,tail tucked under

Turning body away,sitting, pawing

Yawning, blinking,nose licking

Creeping, ears back

Walking away

Turning head away

Allorubbing among cats probably serves to strengthen bonds within a group (Courtesy of T de Keuster)

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PUBLICATIONSPUBLICATIONS

PRACTICING BEHAVIOURAL ME DICINE

medicine and treatment. Easy-reference tables and treatment regimes make the chapters highly practical. Full-colour photographs and informative diagrams illustrate and explain behaviours and concepts. In addition, a range of questionnaires helps you to identify problem areas and reach a diagnosis. A major innovation are the client handouts, featuring high-quality advice from our international expert authors, on topics such as:

Pet selection Handling exercises for puppies and kittensWhat your dog needs Avoiding house soiling by cats Treating a fear of car journeys using desensitization and counter-conditioningCognitive dysfunction syndrome.

The questionnaires and client handouts are supplied on a CD so that you can print them off and use them right away to guide your clients.*

Member benefitsAs a member of BSAVA you will be able to download the questionnaires and client handouts online at www.bsava.com for added ease of use in your practice. *Terms and conditions of use apply.

Member price: 49Non-member price: 74ISBN: 978 1 905319 15 2

CD ENCLOSED

BSAVA is pleased to support the Blue Dog project. This aims to educate parents and children about interacting with their pet at home, and represents a multidisciplinary team effort involving veterinary behaviouralists, child psychologists, teachers and artists. The result is an excellent teaching tool for pet-owning families. Buy online at www.bsava.com

The Blue Dog Parent Guide & CD ROM

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This cat is communicating by touch as well as depositing scent

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CONGRESS

TOUCH THE VOID WITH CONGRESS SPEAKER

Joe Simpsons attempt at the first ascent of the West Face of a peak in the Peruvian Andes has become one of the all time classic tales of mountaineering, and the subsequent book and BAFTA award winning film, Touching the Void, is hailed as an account of psychological, even philosophical witness of the rarest compulsion.

Highs and lowsJoe and his climbing partner, Simon Yates, successfully climbed the peak in Siula Grande. But on the ridge down, they encountered difficult terrain, Joe fell and broke his leg, the calf bone splitting his knee.

Simon took it upon himself to lower Joe down the vast majority of the mountain. However, despite Simons single-handed

rescue attempt, a turn of events left Joe hanging over a steep overhanging ice face in the middle of a building blizzard. Simon was trying to support Joe from a desperate bucket belay hollowed from the snow, uncertain what exactly had happened. After hanging on for over an hour, Simon reached a point where he had to make a choice: be pulled from the mountain into the abyss and certain death, or cut the rope. He cut the rope holding his partner and Joe fell into a gaping crevasse below, landing unexpectedly on a snow bridge. After cutting the rope Simon proceeded down the mountain, passing the crevasse and assessing that Joe must have died from the fall.

Through adversityDespite his significant injuries, Joe lowered himself further into the crevasse and managed to find a way out. Suffering from hypothermia and dehydration, he then faced the enormous task of crossing a glacier with a broken leg and no support. He crawled down the glacier and the moraines over a period of three days, all the way back to base camp, finding Simon and their traveling friend Richard Hawking just hours before they were due to leave base camp.

It is a tale of two men thrown into a nightmare of terrifying life and death choices

and heartbreaking decisions. It is about agony and terror, courage and weakness. It tells of trust and friendship tested to the very limits of human endurance.

Fascinating speakerYou need no special knowledge of mountain climbing to understand the many inspirational messages to be found in the telling of this powerful human drama. It is about the triumph of the human spirit, the immense instinct to survive and the innate strength we have within us to succeed.

The appeal of Joe as a speaker is that he tells his story in an unassuming, articulate and often humorous style. He refrains from giving patronising analogies between his exploits and the jobs of the people in the audience, preferring that they draw their own conclusions from the multitude of key messages that are wrapped up in his story. The overriding feeling is one of total amazement and that no matter how tough things may get, there is a way to not only come through it, but to achieve even greater goals.

All delegates are welcome to attend the lecture free of charge. It takes place on the Thursday afternoon of Congress. See www.bsava.com for details about Congress registration and the social programme.

Weve all felt like were on the edge of a precipice sometimes, but our Congress speaker for 2010 will tell us what it is actually like to be dangled by a thread and left for dead

CONGRESS

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CONGRESS

VETERINARY MASTERCLASSES AT CONGRESS 2010Blood gas evaluation: how to use the numbers to help the patientsThursday 8 April 9.00AMSpeakers: Matt Beal and Amanda BoagThis session is aimed at both general and emergency practitioners. It will be case-based and fully interactive. Both presenters have extensive experience of using both venous and arterial blood gas analysis in clinical practice and will present and discuss a variety of cases.

Diagnostic challenges, long-term management of food allergy in dogs and catsFriday 9 April 9.00AM Speaker: Ed RosserThis masterclass is for those with a special interest in dealing with more complex forms of food allergy. It will discuss changes in understanding over the last 20 years, common and uncommon clinical features and the need for diet trials of 90 days in dogs and cats for the diagnosis of food allergy.

Challenging cardiopulmonary diseasesFriday 9 April 9.00AMSpeakers: Lynelle Johnson and Virginia Luis FuentesPractitioners, residents, and specialists will get a greater confidence in diagnostic decision making for animals presenting with cough, laboured breathing or tachypnoea from this masterclass. Classic and challenging cardiopulmonary cases will be presented.

Corneal surgeryFriday 9 April 14.15PMSpeaker: Ingrid AllgoewerThis Masterclass will cover the basic principles as well as details of techniques currently applied in small animal corneal surgery. Information on indications, surgical techniques and materials, adjunctive medical treatment, follow-up, prognosis and complications will be presented.

Diagnosis and management of chronic intestinal diseaseFriday 9 April 14.15PMSpeakers: Ed Hall and Kenny SimpsonThis interactive session will focus on contemporary approaches to the diagnosis and management of chronic intestinal diseases such as inflammatory bowel disease, alimentary lymphoma and lymphangiectasia, illustrated by real case examples.

In-house blood smearsSaturday 10 April 08.45AM Speaker: Harold W. TvedtenThis wet-lab will be a computer-based, small group study of blood smears with a powerpoint format. Participants will receive two CD-roms to take away: one without diagnoses or interpretations and one with.

Soft tissue sarcoma in the cat and dogSaturday 10 April 9.00AMSpeakers: Julius Liptak and David RuslanderThis Masterclass offers GPs and specialists a greater understanding about new surgical techniques as well as the rationale for radiotherapy and/or chemotherapy. Case examples will be used to reinforce the critical steps in this multimodality approach.

Imaging in the diagnosis of vascular liver diseases in dogs and catsSaturday 10 April 14.15PMSpeakers: Wilfried Mai and Victoria JohnsonDelegates will review the classification of hepatic vascular abnormalities, describe the imaging methods used for anatomically resolved vascular imaging, and describe the findings that can be expected with each of them, as well as the pros and cons of various modalities.

Locking implants in orthopaedicsSaturday 10 April 14.15PMSpeakers: Katja Voss and Malcolm NessAlthough the widest definition of locking implants would include external fixators and interlocking nails, this Masterclass will concentrate on Locking Plate Systems specifically those which are currently commercially available for small animal surgery.

Lameness of unknown origin? Foraminal lesions along the spinal vertebral columnSunday 11 April 9.00AM Speaker: Thomas GddeConsider the clinical presentation of foraminal lesions, typical imaging findings, the suitability of different MRI protocols, and offer an understanding of surgical foraminotomy procedures and physiotherapeutic strategies for the postoperative period.

Feline bug transfusions: important blood-borne infectionsSunday 11 April 9.00AMSpeakers: Michael Lappin and Sverine TaskerDiscuss current controversies about blood-borne infectious agents in cats, of importance for all cats but, specifically, for blood donors. Emphasis will be place on haemoplasmas, retroviruses, and Bartonella spp.

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PETSAVERS

Improving the health of the nations pets

PETSAVERS AWARDS NEW ONCOLOGY GRANT

A Residency in Small Animal Clinical Oncology has recently been awarded to the University of Liverpool and interviews for the position will take place in the coming months. Over three years the resident will be provided with post-graduate clinical training, sitting an ECVIM-CA general examination in internal medicine at the end of their second year and the ECVIM-CA certifying examination in oncology on completion of their residency.

Exciting undertakingThe resident will be encouraged to undertake projects to broaden the education they receive and the support

from Petsavers will include funding for a project entitled; Nausea and Vomiting after Vincristine and Cyclophosphamide Chemotherapy, and Effects of Maropitant (Cerenia) on Incidence and Severity. Currently, the true frequency and severity of gastrointestinal side effects in dogs that have received standard doses of vincristine and cyclophosphamide are unknown. It is hoped that this study will give a better understanding of this area, allowing veterinarians and clients more information with which to make a decision when looking at treatment options.

Supervisor is past recipientThe residency will be supervised by Dr Laura Blackwood, who herself had a residency in clinical oncology at the University of Cambridge funded by Petsavers in 1993, when Petsavers was known as the Clinical Studies Trust Fund. When finding out about the grant award Laura said that We are really delighted to have received these awards from Petsavers,

A Residency in Small Animal Clinical Oncology has been awarded to the University of Liverpool

Dr Laura Blackwood

for both the resident and the project: it is a great boost for the oncology team at Liverpool. My Petsavers residency was the foundation of my career, and I am very pleased that we have been given this opportunity to train another person to contribute to the oncology community. A very big thank you to Petsavers.

Petsavers Grants Awards Committee Chair Jo Arthur commented that: It is very rewarding for the Grants Awarding Committee to be able to award a Clinical Training Program (CTP) to Dr Laura Blackwood, not only because she was the second Petsavers Oncology CTP scholar, but also because the associated Clinical Research Project (CRP) has direct relevance to, and will therefore benefit, pets in general practice. Petsavers is also appreciative of Laura helping on the Petsavers stand at BSAVA Congress, promoting Petsavers to vets in practice.

The clinical training programme award to Liverpool is just one example of the important funding provided by Petsavers to help veterinary training. Petsavers also funds numerous research projects to help improve diagnosis and treatment of the nations pets. To find out more and to pledge your support please visit www.petsavers.org.uk

SUPPORT THE PETSAVERS PHOTOGRAPHY COMPETITION

Enclosed in this months companion is a poster which we hope you will be able to display in your practice, to encourage your clients and staff to enter

our competition.

ORDER YOUR CHRISTMAS CARDS NOW

In order to guarantee UK deliveries before Christmas, you need to place your Yuletide order before noon on

15 December.

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CPD

2010 MODULAR PROGRAMMES

Taking a modular approach to your veterinary CPD throughout the year can help you manage your career progression and build an impressive skills base

Unlike many other modular courses available, the BSAVA Modular programmes dont focus your entire efforts on a single issue, but rather offer you a range of modules to broaden your expertise and expand your skills in general practice.

For 2010 there will be two Modular Programmes on offer each with a good range of subjects to keep you interested throughout the year, brought to you by the most impressive experts in the relevant field. However, if you do not feel you have the time or resources to complete the whole modular series, we will consider, based on place numbers available, making single modules available to you anything to encourage and support you.

For full details about the entire content of the modules for the two programmes running next year see enclosed booklet or visit the CPD section at www.bsava.com heres a brief outline about what you can expect

BSAVA Member (inc VAT)

Non Member (inc VAT)

FEES:Early Bird Price: 5% discount offered on all bookings received by 31 December 2009Full modular 1294.85 1942.28Individual module 193.11 289.674 Modules booked at the same time 734.45 1101.67Clinical Pathology (25 May) Individual module 215.32 322.98Prices from 1 January 2010Full modular 1363.00 2044.50Individual module 203.28 304.914 Modules booked at the same time 773.10 1159.65Clinical Pathology (25 May) Individual module 226.65 339.98

Modular series A 2010

Critical Care 26 January with Amanda BoagEndocrinology I 23 February with Ian RamseyEndocrinology II 27 April with Mike HerrtageClinical Pathology 25 May with Elizabeth VillersGIT I 22 June with Penny WatsonGIT II 28 September with Alex GermanHaematology 19 October with Clare KnottenbeltClinical Nutrition 23 November with Penny Watson

Modular series B 2010

Urinary Tract I 28 January with Hattie SymeUrinary Tract II 25 February with Hattie SymeRespiratory Medicine 29 April with Brendan CorcoranTreating the Cardiac Patient 27 May with Jo Dukes McEwanEmerging and Infectious Parasitic Diseases 24 June with Sue ShawOncology I 30 September with Rob FoaleOncology II 21 October with Rob FoaleNeurology 25 November with Jacques Penderis

Venue: BSAVA Headquarters, Woodrow House, GloucesterTimetable: Registration 09:30, Lectures: 10:00, Finish: 18:00

Venue: Thorpe Park Hotel & Spa, LeedsTimetable: Registration 09:30, Lectures: 10:00, Finish: 18:00

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The 2010 WSAVA Congress offers four days of cutting-edge science in a relaxing and multicultural environment

as engagement. The city is home to the head quarters of numerous international organisations such as the World Health Organization and the Red Cross.

Capital city of a Swiss canton, Geneva has always valued democracy and the respect of the individual, their culture and language. Genevas multicultural population offers a platform for frank and constructive commu nication, and exchange of experiences with a vision to facilitate dialogue around the world.

The city offers many leisure activities and cultural entertainment which guarantee a pleasant and relaxing stay (in the European style) during the congress. Geneva is a great city with a perfect setting, exquisite food and magnificent facilities. The central location will permit attendees to enjoy pre- or post-congress visits to the surrounding countryside, the lake, or the Alps and will offer easy access to most capitals of Europe.

The WSAVA committee invites all of those who are dedicated to the study and

treatment of all aspects of small animal practice to come and share their knowledge and experi ence in Geneva. The scientific programme features four days of cutting-edge veterinary science with six simultaneous streams providing lectures in English at both the advanced and general level. Trademark features of the WSAVA World Congress, including State-of-the-Art Lectures, Animal Welfare Stream, Hereditary Defects

Stream, and member association streams (e.g. NAVC), as well as a Veterinary Nursing and Management Programme, add diversity to the strong scientific programme featuring renowned veterinary scientists from around the world. These

Geneva is proud to host the 35th WSAVA Congress, the 16th FECAVA Congress, 41st SVK-ASMPA Congress, and the 3rd FAFVAC Congress. An international city par excellence, Geneva has a historical tradition of humanitarian concern as well

WELCOME TO GENEVA

treatment of all aspects of small animal

The scientific programme features four days of cutting-edge veterinary science with six simultaneous streams providing lectures in English at both the advanced and general level. Trademark features of the WSAVA World Congress, including State-of-the-Art Lectures, Animal Welfare Stream, Hereditary Defects

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WSAVA NEWS

Abstract Submission OpenAbstracts for oral or poster presentation at the WSAVA 2010 Geneva World Congress in the following subject categories are now being accepted:

ONE MEDICINEThe theme for WSAVAs 50th Anniversary Year is to encourage closer collaboration between human and veterinary medicine

Recognising the link between animal diseases and public health, the WSAVA has adopted the theme of One Medicine for its 50th anniversary year which will culminate at the next World Congress, taking place in Geneva, 25 June 2010.

In adopting this theme, WSAVA aims to promote closer collaboration between the medical and veterinary professions. It

will encourage, for instance, the establishment of joint ventures in education, clinical care, surveillance and the control of cross-species disease. A similar theme of One World, One Health has recently been adopted by the World Organisation for Animal Health (OIE).

The One Medicine concept is gaining momentum as international veterinary and medical organisations recognise the

benefits of closer collaboration. Throughout this anniversary year we will be highlighting in practical terms the opportunities for improved human and animal health that a closer working relationship between the veterinary and medical professions will bring.

One Medicine will then form the centrepiece of the 2010 WSAVA Congress, with a series of lectures devoted to aspects of comparative medicine and emerging zoonotic infectious diseases, some of which will be delivered by colleagues from the world of human medicine. It will also include an overview lecture WSAVA: One World, One Medicine delivered by Professor Michael J Day, chair of the WSAVA Scientific Advisory Committee.

Abstracts can be submitted online at the Congress website. The deadline for abstract submission is 31 January 2010.

Animal welfare/Pain medicine/Behaviour medicine

Cardiology Respiratory medicine Diagnostic imaging Dermatology Emergency medicine/Critical

care/Anaesthesia Endocrinology Exotic animals Gastroenterology/Hepatology Genetics

Infectious diseases/Laboratory medicine

Practice economy and management

Uro-nephrology Medical and surgical neurology/

Physical therapy Oncology Ophthalmology Orthopaedics Reproduction Soft tissue surgery

lectures are complemented by two pre-congress all-day seminars hosted by the European Society of Veterinary Cardiology (ESVC) and the International Veterinary Ear, Nose and Throat Association (IVENTA) both WSAVA Affiliate Member Associations.

The social programme will also be a highlight, featuring the culture and beauty of Switzerland during the Opening Ceremonies on 2 June, the Gala Dinner on 3 June, the Swiss Night on 4 June and the Closing Ceremony highlighting WSAVA World Congress 2011 in Jeju, Korea, on 5 June. Dont delay as online registration is open, with early bird registration available until 15 February 2010. The WSAVA 2010 Geneva World Congress website can be accessed through the WSAVA website homepage or directly at www.wsava2010.org.

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WSAVA NEWS

WSAVA NEWSWSAVA NEWS

HAPPY ANNIVERSARY!WSAVA President Dr David Wadsworth reflects on 50 years of change

WSAVA President Dr David Wadsworth (second from left) and Past Presidents (left to right) Drs Hans Klaus Dreier, Gabriel Varga, John Holt, Brian Romberg, and Larry Dee at the Presidents Reception

Who would have thought that 50 years could pass so quickly! I think that the WSAVA has met and exceeded all the thoughts and aspirations that the small group of visionaries who met in 1959 could ever have envisaged. Currently over 70,000 veterinary surgeons from more than 70 countries are represented in the WSAVA Assembly. WSAVA reaches out to developing countries with the unique WSAVA CE programme which, working with our long-term partners Bayer Animal Health, Hills Pet Nutrition and Intervet/Schering-Plough, has provided a days lectures to over 5000 veterinarians in 30 countries.

One of the first roles of the founding fathers was to stage a WSAVA Congress in collaboration with one of the national association members. Initially the congress was a biennial event but its popularity soon meant that it was held annually. We have now held 36 Congresses in 19 countries and the next three congresses will be held in Geneva, Korea, and the UK, emphasising the diversity and global nature of the Congress. WSAVA is proud to work closely with our Prime Partner, Hills Pet Nutrition, in the staging of these unique congresses which take cutting edge veterinary science to veterinary surgeons around the world.

The WSAVA Standardization projects are a relatively recent addition to the

portfolio. There are currently three projects dealing with hepatic, gastrointestinal and renal disease, along with a standardization project for vaccination regimes. Groups of experts from all parts of the world meet and discuss regularly the histological symptoms of the various diseases and agree on a standardized terminology which will be the benchmark for all future veterinary diagnosis within these fields.

Hereditary defects have been part of the veterinary world for even more years than WSAVA has existed and in combination with WALTHAM the Hereditary Defects committee is now looking at the genetic base for these problems and is hopeful of providing guidelines for the future. The original WSAVA members were at the forefront of science in developing hip and elbow dysplasia schemes and the genetic

detail now examined shows just how far and how quickly veterinary science is developing.

Animal welfare in the veterinary world goes without saying and often without much thought being given to it. The WSAVA takes this aspect of veterinary science most seriously and currently sponsors programmes at regional congresses and makes it obligatory that any WSAVA Congress includes an animal welfare stream.

There have been many famous veterinary names associated with WSAVA there is no space to include them all here but Wayne Riser, Jean Maynard, Bill Magrane, Brian Singleton, Saki Paatsama, Jan Gajentaan, Carl Osbourne, and John Holt are giants who led the WSAVA and the profession for the first 25 years and founded what surely will be a legacy in the veterinary world forever.

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ASSOCIATION NEWS

VMD PROPOSALS FOR A NEW MEDS CATEGORY

NEW EDITOR SOUGHT FOR BSAVA JOURNALThe BSAVA is looking for a highly motivated individual with excellent organisational and editorial skills for the post of Editor of its scientific journal, the Journal of Small Animal Practice (JSAP)

benefit for five decades. By publishing research in all aspects of small animal clinical practice, this is one of the essential ways that BSAVA fulfils its remit to advance scientific knowledge throughout the profession.

The Editor plays a key role in further developing JSAP as a leading international journal in its field. A thorough knowledge of veterinary medicine is essential for this role, and the successful candidate will have practical experience of publishing in peer reviewed scientific journals, a good

understanding of the publishing process, and superb communication skills. Working alongside a dedicated, professional team of support and publishing staff, this part-time, home-based role needs someone

with the talent to work on a high-impact journal and the vision to take it forward. This position is renewable annually and attracts an honorarium.

The closing date for applications 18 December, if you are interested please email Ian Mellor for full details i.mellor@bsava.com or call 01452 726708.

As a BSAVA member you will appreciate the quality content and prestige of JSAP, the highly regarded monthly peer reviewed journal that has been a much-valued member

FOR BSAVA JOURNALpractice, this is one of the essential ways that BSAVA fulfils its remit to advance

throughout the profession.

understanding of the publishing process, and superb communication skills. Working alongside a dedicated, professional team of support and publishing staff, this part-time, home-based role needs someone

with the talent to work on a high-impact

In October the Veterinary Medicines Directorate (VMD) issued proposals for an additional distribution category for authorised veterinary medicinal products (POM-EA). The BSAVA and BVA have been working closely together, primarily through the BVA Medicines Group (on which BSAVA sits), to communicate an appropriate response to these proposals. In particular the BSAVA has obviously been keen to ensure that any response takes into consideration the potential impact on companion animals.

The proposals centre around the concept that once an initial clinical diagnosis has been determined and medicine prescribed, it can be repeated without any further authorisation for up

to three years by an SQP or pharmacist.This is supposedly aimed at farm

practices to combat the criticisms which led to the Competition Commission enquiry back in 2005. However, there are concerns that this will also result in the push to licence e.g. virtually every flea and worm preparation used in companion animals.

BSAVA President, Dr