The essential publication for BSAVA members

Clinical ConundrumA cat with an intraocular massP8

How ToPerform a cystotomyP12

The essential publication for BSAVA members

companionOCTOBER 2009

Flash, BangManaging noise fearsP22

In the company of wolves

companion

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3 Association News Introducing the Petsavers Grants Awarding Committee

47 In The Company Of Wolves John Bonner talks to the UK Wolf Conservation Trust

811 Clinical Conundrum Consider a case of a middle-aged cat which was presented with an intraocular mass

1216 How To Perform a cystotomy

17 Orthopaedic Road Show A look at the series of 1-day CPD courses in November

1820 GrapeVINe From the Veterinary Information Network

21 Nominate For The BSAVA Awards Members are invited to nominate colleagues

2224 Flash, Bang, What? Professor Daniel Mills offers advice on noise fears

25 Petsavers Latest fundraising news

2628 WSAVA News The World Small Animal Veterinary Association

2930 The companion Interview Noel Fitzpatrick

31 CPD Diary Whats on in your area

RENEW MEMBERSHIP THE EASY WAY

Additional stock photography Dreamstime.com Alterfalter | Dreamstime.com Braendan Yong | Dreamstime.com Dmitrij | Dreamstime.com Eriklam | Dreamstime.com Vivek Ahuja | 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 BoardEditor Mark Goodfellow MA VetMB CertVR DSAM DipECVIM-CA MRCVSSenior Vice-President Ed Hall MA VetMB PhD DipECVIM-CA MRCVS

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

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

Design and ProductionBSAVA Headquarters, Woodrow House

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

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

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

All BSAVA memberships run from January to December, so it will soon be time to renew your membership for 2010. If youve not already set up a Direct Debit for your membership, this is a great time to sort that out and save yourself some money at the same time.

Set up a Direct Debit todayAnnual Direct Debit (DD) payments receive a 10 discount from the annual subscription fee so not only is this the easiest way to make sure your membership is renewed promptly it is also the most cost-effective.

As well as the annual DD option, there is also another Direct Debit payment plan being offered for the first time in 2010 you can pay monthly to spread the cost throughout the year. Conditions do apply, so see the website for more details.

We recently sent out Direct Debit forms to all members not currently using this easy option to renew their membership. As it isnt possible to submit a DD application online, you should return these forms immediately. If you have not received them you can download them from www.bsava.com, or request them from administration@bsava.com. If you have any questions our membership team will be happy to help call 01452 726700, 95 Monday to Friday.

IMPORTANT DEADLINE: You only have until 20 October to change your membership payment to one of these Direct Debit plans.

More More MoreBSAVA is adding to your list of benefits all the time with increasing discounts and special deals around Congress, plus more exclusive resources online the growing library of Congress MP3s is one of the most popular web-based benefits and now includes our Scottish Congress lectures too. So, to avoid missing out on the full years worth of benefits make sure you set up your Direct Debit now or watch out for further renewal notices in the post or visit the website.

You will soon need to renew your membership and BSAVA has ways of making this even easier than ever if you set up an annual Direct Debit before 20 October

companion | 3

ASSOCIATION NEWS

INTRODUCING THEPETSAVERS GRANTS AWARDING COMMITTEEPetsavers Grants Awarding Committee (GAC) funds Clinical Training Programmes (CTPs) and Clinical Research Projects (CRPs) for the study of naturally occurring disease in small animals

Petsavers studies must not involve the use of experimental animals or the artificial induction of disease, and should result in a beneficial change in the diagnosis or management of naturally occurring animal disease.

The committee is made up of the Chair (who must be in general practice, not in academia), the Secretary, the Chair of Petsavers Management Committee, an officer (usually the President) and six other vets chosen to represent a variety of disciplines both in academia and private practice.

There are two GAC meetings each year; CRP applications are discussed and voted on at the February/March meeting and CTP (residency) applications are discussed and voted on in August. Prior to each meeting all committee members read through and assess the applications; then at the meeting the members present an application in turn prior to voting.Petsavers Management determines the funds available. Most years, one or two CTPs are awarded; the CRPs have a limit of 8000 each, so the number awarded is variable, depending on the funds available and the amount each CRP applicant is requesting. If the applications are not considered to meet Petsavers criteria or to be of an adequate standard, not all the available funds will be awarded however such a situation is rare; usually the competition is fierce, and only the very best get funded.

At the moment Petsavers is funding four CTPs; one to Anne Seawright in Behavioural Medicine and Epidemiology at University of Bristol, one in Evidence Based Small Animal Medicine at Glasgow to Emily Courcier; one in Animal Welfare and Law at University of Bristol with James Yeates, and one to Matthew McMillan working in Anaesthesia and Pain Management at Cambridge.

Present and recent CRP awards include studies in internal medicine, soft tissue surgery, orthopaedics, neurology, ophthalmology, diagnostic imaging, oncology, cardiology and population genetics. Some of the projects come from private practice, and the committee would welcome more applications from practitioners. If you are interested, you can download a copy of the Guide to Applicants from www.petsavers.org.uk or contact Gene Waterhouse, Petsavers Fundraising Manager at g.waterhouse@bsava.com. Or for more information about working with BSAVA as a volunteer email c.haile@bsava.com n

Sarah CaneySarah brings her expertise in feline medicine plus experience of working both in academia and in private practice.

Gerry PoltonGerry provides an independent point of view in the evaluation of applications for Petsavers grants from his viewpoint as a general practitioner, in keeping with the vast majority of BSAVA members. He also advises specifically on his area of expertise, oncology.

Eric MorganEric qualified from Cambridge in 97 and after a short time in practice undertook a PhD in parasite epidemiology in Kazakhstan. Since 2003 he has worked at the University of Bristol and is currently Senior Lecturer in Veterinary Parasitology.

Lucy DavisonLucy holds the RCVS and European Diplomas in Small Animal Medicine and has a PhD in canine diabetes mellitus. She is currently a Wellcome Trust Intermediate Clinical Fellow at the University of Cambridge and divides her time between research in human diabetes genetics and veterinary work.

Pamela JohnstonPamela, the newest member of the committee, is Senior Lecturer in Veterinary Pathological Sciences at Glasgow.

Jo Arthur (Chair)Jos role is to provide information about how the GAC has awarded the funds raised by Management Committee. Jo has raised a lot of money for Petsavers by participating in six London 10K runs since 2004.

Maggie Fisher (Secretary)Maggie Fisher is a vet and a parasitologist, with a consultancy based in Malvern, Worcestershire. She brings to the committee a wide experience of research, of The Animal (Scientific Procedures) Act (ASPA) (1986) and of medicines legislation.

Richard Dixon (President)Richard brings an Officers viewpoint and experience to the committee.

Mark PertweeMark sits on the committee as Chair of Petsavers Management Committee. He works in general practice in Sussex.

Richard WhitelockRichard has been on the Grants Awarding Committee for two years and brings surgical expertise and a practical viewpoint to the consideration of applications.

Committee members

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WOLVES

IN THE COMPANY OF WOLVESOF WOLVES

The patients that Julian Slater and Nick Thompson see are nearly identical genetically to the domestic dog. But most practitioners would think twice before inviting one of these creatures into their consult room. John Bonner talks to the vets in charge at the UK Wolf Conservation Trust, near Reading

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WOLVES

It may be closely related to a dog, but everything about a wolf is just a little more spectacular than its domesticated cousin.Dogs will often need veterinary

treatment for injuries to the mouth and throat sustained when they run on to a stick thrown by their owner. But when a fast-moving wolf collides with a tree stake it can result in an even more dramatic medical emergency as happened to Alba. He is a six-year-old male European wolf who suffered an accident in his enclosure at the UK Wolf Conservation Trust in June 2006. The animal was found in a collapsed state, which was later diagnosed to be the result of a fractured C2 vertebra.

Euthanasia was an obvious topic for discussions between Trust staff and the duty vet but it was decided to wait a few days to assess the degree of damage to the spinal cord. This proved to be less extensive than originally feared and, with prolonged and careful treatment, the animals physical function has been almost fully restored.

Collaborative treatment approachThat process has been supervised by Julian Slater, a partner at the Donnington Grove practice in Newbury, who became the main provider of veterinary services at the centre shortly after the accident. In addition other complementary techniques are also used to treat Alba and the other seven wolves currently living there.

Senior wolf handler Toni Shelbourne is an enthusiastic supporter of complementary medicine and a qualified practitioner of the

T Touch training method which formed part of the injured wolfs physiotherapy regime. Over the past three years, Nick Thompson of the Holisticvet practice in Bath has also given advice on acupuncture, homeopathy, herbal and nutritional medicine.

Whatever clinical method is being used, it is likely to involve some level of hands-on contact with the patient. The Trusts wolves were made accustomed to the touch and smell of humans in the first few days after they were born and so have lost their species innate fear of its only natural enemy. But even so, neither vet is prepared to take unnecessary risks with an animal as powerful as a fully grown specimen of Canis lupus.

That is the biggest difference between the work I do here and my normal duties back in mixed practice. With some of the individuals here, you cant conduct a proper examination because the animal will only tolerate being touched by its usual handler, Julian explains. Even with the others that may be more approachable, often it is only possible to carry out a limited examination with the handlers help. So we will usually see the animal in its cage and observe it as closely as possible.

Nick agrees that it is best to take the advice of the people who are dealing with the wolves every day. I am completely guided by what Toni and the other handlers say. If they tell me that a particular wolf is

Main image: Duma and DakotaBottom left: High security fencing at the Wolf Conservation Trust

Alba (left) with his sisters

Lunca and Latea

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WOLVES

in season or it is just having a bad week, then I do what I can from a distance. On those occasions when it is essential to have a closer look, then Julian will give the animal a sedative or, if necessary, a general anaesthetic.

Not the big bad wolfYet, despite the respect they both show for the wolfs fearsome reputation, neither vet has any personal experience of any aggressive behaviour by their patients. Quite the contrary; the thing that is most noticeable about being near them is how calm and quiet these animals are. You will get none of the posing that you can often see with a rottie or a German shepherd, Julian points out.

But there is quite likely to be aggression between individual wolves when the social hierarchy is forming or undergoing change.

This was the reason for an unusual event last year when three of the inmates required a general anaesthetic. Alba lives in a family group with his sisters Latea and Lunca, and they are the only wolves born and bred at the Trust.

As with other adult males at the site, Alba has been vasectomised to prevent unwanted litters while avoiding the social disruption that may result from having a mixed group of entire and neutered wolves. However, when the previously subordinate female Latea usurped her sisters position as top dog there was a significance increase in tension, particularly in the breeding season. After some soul searching, the Trust welfare team decided to put an end to the squabbles by having all three neutered.

For less serious interventions such as blood sampling or the X-rays needed on Albas spine, Julian has used sedation. This

Toni alonsgide the trailer used for transporting the wolves

involves the same products he uses on his canine patients, at a dose scaled up to suit the wolfs 50 kg frame. In his experience the wolves response to medication is identical to that of a dog. Indeed the only significant medical difference between these two canids is that the ancestral animal tends to be more robust than the in-bred, domesticated version.

Accessing the animalsCertainly, neither vet has sufficient contact with the majority of the Trusts animals to develop the close relationship that the wolf handlers enjoy with their charges. Each wolf has received an introductory course of standard vaccinations but, on the basis of a risk assessment, it was decided that they would not need annual boosters. Nor are the wolves given regular worming treatments, although quarterly stool samples

IN THE COMPANY OF WOLVES

Alba in his pen soon after the accident. Note the pressure sores on his forelimb

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WOLVES

The UK Wolf Conservation Trust www.ukwolf.org was established by the late Roger Palmer in 1995. The Trust currently has three European and five North American wolves maintained in separate packs in three enclosures, each around two acres in size. These animals are socialised ambassador wolves, whose role is to challenge some of the negative views that humans have historically held towards their species. Adults and children visiting the centre learn about the biology and behaviour of the wolf at an education centre which is open on regular dates throughout the year. The organisation also helps to support wolf research and conservation projects across the globe.

are collected and sent to a commercial laboratory where they are checked for any signs of parasitic infection.

The only two wolves that require regular close inspections are Alba who still needs analgesia and physiotherapy to cope with his spinal damage and an elderly female wolf called Dakota. With her sister Duma, she is one of two surviving members of a group of North American wolves that came to the Trust from the Woburn safari park.

Success storiesAt nine years old, Dakota was diagnosed with lymphoma which was confirmed on biopsy. Remarkably, she is still in good health a full two years later. Julian and Nick share responsibility for her treatment and they are comfortable with the others very different approach to practising veterinary medicine. Both accept their clients concern that the animals should be maintained under conditions that are as natural as possible for a wolf living in the Home Counties of England. So there is as little reliance on conventional pharmacological approaches as possible.

Both vets will check with their colleague before administering any treatment that might possibly interfere with the colleagues choice of therapy. In Albas case, the pain caused by the arthritic changes in the wolfs spine are controlled by a combination of standard non-steroidal anti-inflammatory drugs and a herbal mixture (containing frankincense, devils claw, turmeric, jasmine and liquorice) which Nick believes is effective in blocking different pain mediating pathways to standard COX1 and COX2 inhibitors.

The combination of orthodox and complementary treatments may be unusual but it certainly appears to have been effective in at least two cases. The wolf that survived a life-threatening traumatic injury and another living with a normally aggressive form of cancer are good advertisements for the quality of care provided at the Trust. But as Nick points out, success may bring its own problems. In the wild, a wolf is unlikely to live much beyond, say, seven years old but the last wolf to die here was 15 years old. So I think that some of the conditions we may have to deal with are those that will never actually occur in the wild.

The MacKenzie pack of three Canadian wolves Mai, Mosi and Torak.

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CLINICAL CONUNDRUM

CLINICALCONUNDRUM

Rob Lowe of Optivet Referrals, Hampshire challenges companion readers to consider a case of a middle-aged cat which was presented with an intraocular mass

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Figure 1: Left eye of patient on presentation

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CLINICAL CONUNDRUM

Case PresentationAn 11-year-old neutered male Domestic Short-hair cat presented for an assessment of a pink structure in the left eye that had developed over the previous week. The cat had been diagnosed with a sublingual immunocytoma (lymphoplasmacytoid lymphoma) 6 years previously that had responded well to chemotherapy (chlorambucil and prednisolone). The cat was currently receiving 2.5 mg of prednisolone every third day, having had its last dose of chlorambucil 10 months previously due to repeated episodes of myelosuppression. Tests for FeLV at the time of the original diagnosis were negative and the cat had been receiving annual vaccinations for FeLV since then.

Clinical and ophthalmological examinationOphthalmic examination revealed a fleshy pink vascularised protrusion in the ciliary zone of the iris, between 10 and 2 oclock, with a fibrin clot overlying this area and an aqueous flare of +2(/5). The rest of the iris was also mildly inflamed and the pupil was flattened dorsally (see Figure 1). The intraocular pressure was 6 mmHg (as measured with a Tonopen XL, Mentor USA) compared with a pressure of 14 mmHg in the right eye (normal range 1226). After pupil dilation (tropicamide 1%, Minims France) there were no abnormalities detected in the lens, vitreous or fundus. There were no abnormalities detected in the right eye.

A general clinical examination showed no other significant abnormalities, although it was not possible to palpate the abdomen effectively as the abdominal wall was very tense due to the nervous nature of the patient.

What are the differential diagnoses for this case?Fibrin in the anterior chamber, aqueous flare, iris rubeosis and low intraocular

pressure are all clinical signs associated with uveitis. However, the fleshy protrusion within the iris also needs to be considered. The differential diagnosis for this would include iris bomb, intrastromal haemorrhage, a cyst, neoplasia, or iris atrophy leading to displacement anteriorly. Both haemorrhage and neoplasia can be associated with uveitis due to a breakdown of the blood aqueous barrier, and iris bomb is a possible sequel to uveitis; so these three conditions should be suspected.

Can your differentials for the iris mass be prioritized based on the history and physical examination findings?In order to eliminate haemorrhage as a cause it is necessary to consider the causes of haemorrhage that might present as an iris bleed. Systemic hypertension is the commonest cause of iris haemorrhage due to blood vessel wall breakdown in the arterial circle. Away from the site of the haemorrhage it may be possible to see microaneurysms in the arterial circle, while examination of the fundus may reveal retinal bullae,

haemorrhage or detachment. Other causes of haemorrhage include coagulopathies, so other sites of haemorrhage throughout the body in the form of petechiation, ecchymoses, or large volume blood loss may be expected to be present.

Iris bomb can occur as a consequence of posterior synechiae formation in chronic uveitis but can also present in acute disease due to intense fibrin exudation from the iris adhering to the anterior lens capsule. However, it tends to occur circumferentially and not in an isolated area of the iris and any colour change as a result of uveitis would occur throughout the iris structure.

Neoplasia may present as a primary or secondary disease within the eye. The feline eye has a multitude of tissue types and the list of recorded types of neoplasia is very long. However, common causes of intraocular neoplasia include adenoma, adenocarcinoma, melanoma (including amelanotic types), lymphoma and sarcoma. The clinical appearance of all of these types of tumour, apart from pigmented melanomas, is similar, and further differentiation cannot be made on gross physical appearance alone.

Based on the lack of other signs of haemorrhage and the physical appearance of the eye, it was felt that neoplastic disease was the most likely cause of the clinical signs.

Construct a diagnostic planInvestigation of suspected intraocular disease must include an assessment of other body systems for primary or secondary neoplasia. In addition, some fairly simple tests can be employed to help rule out the other two differential diagnoses (haemorrhage and iris bomb).

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CLINICAL CONUNDRUM

How does your interpretation of the test results refine your differential diagnosis?The differential diagnoses for renomegaly are hydronephrosis, polycystic kidney disease, perinephric and renal cysts, renal neoplasia, acute renal failure, pyelonephritis and FIP. At this point FIP was reconsidered as a possibility for the ocular signs but this does not normally present with a mass within the iris.

The commonest form of renal neoplasia in the cat is lymphoma. Based on the history of a sublingual immunocytoma (lymphoplasmacytoid lymphoma, a low grade B cell lymphoma) a provisional diagnosis of lymphoma of the kidneys and left eye was made.

Further investigations at this point could include renal biopsy, enucleation of the left eye, iris mass biopsy or aqueocentesis. Enucleation of the eye would provide an

excellent diagnostic specimen but should be reserved for non-visual eyes or, if neoplasia is suspected, where other clinical disease is absent.

Renal biopsy is the recognised method of diagnosing renal lymphoma but, based on the clinical skill set of the attending clinician, a fine needle aspirate biopsy of the iris mass was chosen as the next diagnostic step. This was performed using a 21 gauge needle through the limbus adjacent to the mass and aspirating the centre of the mass. Smears of the aspirated tissue were submitted for cytology.

This confirmed the presence of a monomorphic population of lymphocytes. There were also some neutrophils and macrophages present.

Based on these findings a diagnosis of disseminated lymphoma was made and the owner elected for no further intervention. n

Contribute a Clinical ConundrumIf 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.

CLINICAL CONUNDRUM

Figure 3: Cat with simple closed urinary collection system

Initial investigation included systemic blood pressure, full haematology and serum biochemistry. These revealed a systolic blood pressure of 165 mmHg (Doppler, Thames-Park UK) (reference range

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CLINICAL CONUNDRUM

BSAVA Manual of Small Animal Ophthalmology, 2nd editionThis Manual builds on the success of the first edition and provides a practical, consulting room guide to small animal ophthalmology, but with sufficient detail to satisfy those who wish to study this fascinating specialty in greater depth.

The latest edition of a classic worldwide bestseller nThoroughly updated nExpanded to include surgical principles nChapters dedicated to exotic pets nInternational authors nHigh quality full-colour photographs throughout n

Member price: 55.00Non-member price: 85.00Buy online at www.bsava.com or call 01452 726700

a working tool able to be read quickly in the consulting roompractical illustrations

(drawings and photos) are of good qualitya very complete work

European Journal of Companion Animal Practice

High quality full-colour photographs throughout

or call 01452 726700

PRACTICAL FILM READING: YOUR WAYYour very own cases studied on an imaging course where you dictate the content

Who better to decide what you cover on a course than you? So BSAVA is giving you the opportunity to work with two of the UKs most respected veterinary radiologists to create the content for this 3 November course.

There will be the opportunity to examine X-ray images and try to reach a diagnosis or list of differentials, then discuss the findings with the lecturers and

your fellow delegates. The innovative aspect is that each delegate is invited to choose their preferred subject area in advance of the course. The lecturers guarantee to include at least two cases for interpretation and discussion from each selected area. If you book on this course with a group of friends or colleagues, you could end up tailoring the course precisely to your collective design!

You can ask, when booking, which other subject areas have already been nominated so you can either choose something different, or repeat a nomination to gain extra coverage of this area during the day. For more information visit www.bsava.com, email administration@bsava.com or call 01452 726700 today and a member of our team will be happy to help. n

Course detailsDate: 3 NovemberSpeakers: Frances Barr & Fraser

McConnellVenue: Woodrow House,

GloucesterCourse Fees:BSAVA Members: 261.10 inc VATNon-members: 391.65 inc VAT

Edward Bock | Dreamstime.com

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HOW TO

PERFORM A CYSTOTOMY

HOW TO

Chris Shales of Willows Referral Service, Solihull reviews the optimal surgical approach when entering the urinary bladder

The dominant blood supply to the bladder is the caudal vesicular artery which branches from the urogenital artery, itself originating from the internal pudendal artery. Approximately half of animals are reported to have an additional and therefore likely superfluous supply from a cranial vesicular artery. Drainage occurs into the internal pudendal veins and drainage lymph nodes are the sublumbar group as one might expect.

IndicationsIndications for cystotomy include:

Cystic calculi removalCystic mass removal / biopsyBladder wall biopsyUreteral catheterisationNeoureterostomy, neoureterocystostomy

Adventitia

TransitionalepitheliumLamina propria

Submucosa

Detrusor muscle

Mucosa

Figure 1: Diagram representing the layers of the bladder wall. The submucosa is the key suture-holding layer

Some of these procedures can also be performed by minimally invasive techniques using rigid endoscopy where this equipment is available.

ApproachThe patient is positioned in dorsal recumbency, clipped and aseptically prepared for a caudal midline laparotomy. Prior to starting the procedure, the surgeon should check that all the equipment likely to be required is at hand and carry out a careful swab count.

An incision extending from just caudal to the umbilicus to just in front of the pubis is made through the skin with a scalpel blade and continued through the fat to the level of the body wall. Many surgeons find that elevating the fat a little either side of the linea alba helps in identification of layers during closure.

Cystotomy can be indicated as part of a diagnostic investigation or to offer either temporary or permanent therapeutic benefit for several relatively common diseases affecting the urinary tract. The prevalence of disease processes that affect the bladder and frequent lack of access to cystoscopy requires that the general practitioner interested in surgery is able to offer cystotomy to their patients. Whilst a straightforward cystotomy should not present a significant obstacle to either the surgeon or patient, complications have the potential to be serious and are often avoidable. Good surgical technique should reduce the complication rate associated with cystotomy to an acceptably low level.

AnatomyThe urinary bladder is suspended by two lateral umbilical ligaments (continuous with the uterine broad ligaments in the female) and further stabilised by a ventral umbilical ligament. The lining consists of a transitional epithelium supported by a lamina propria and then a submucosal layer. The submucosa is surrounded by a detrusor muscular layer, with the outermost layer consisting of adventitia (Figure 1).

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HOW TO

Figure 2: Ventral midline laparotomy incision. The fascia of the rectus sheath can clearly be seen superficial to the rectus abdominis muscle. Neither rectus abdominis muscle belly has been incised

Figure 3: The avascular ventral ligament of the bladder has been identified

The linea alba is identified, and rat-toothed forceps used to elevate the cranial end of the surgical site prior to careful incision with an inverted scalpel blade. A finger can then be introduced into the abdominal cavity and passed caudally along the midline to ensure there are no adhesions, prior to careful incision of the midline fascia using a straight pair of Mayo scissors. Continued elevation of the midline and only using the distal third of the scissor blades should significantly reduce the risk of inadvertent visceral organ damage during the remainder of the linea alba incision. There should be no requirement to damage either rectus abdominis muscle belly during the midline incision. Confining the incision to the fascia should improve patient comfort postoperatively and reduce bleeding from

small vessels (Figure 2). Many surgeons do not place retractors in the abdominal wall, but blunt-ended self-retaining retractors (e.g. Gelpi) can be useful in improving visibility and access.

The bladder can then be identified and the ventral ligament broken down if necessary (Figure 3). A 2 or 3 metric (3/0 or 2/0) monofilament stay suture with a tapercut, taperpoint or round-bodied swaged-on needle is placed at the cranial pole of the bladder. Passing the suture through the full thickness of the bladder wall twice and securing the long ends of the suture with haemostatic forceps provides a secure method of retracting the bladder cranially and stabilising it for the remainder of the procedure (Figure 4). If an assistant is not present, the suture can be fastened to the drapes to provide

the required retraction.Prior to retraction of the bladder, it is

often worthwhile to ventroflex the bladder through the abdominal incision and carry out a logical assessment of the remaining organs (Figure 5). A full exploratory laparotomy may not be necessary or possible through this sized approach but the caudal abdominal viscera, ureters and dorsal surface of the bladder should be inspected. Moistened laparotomy or standard swabs can then be placed dorsal and lateral to the bladder prior to re-orientation back into the original position to give access to the ventral bladder wall.

The cranial pole stay suture can now be used to stabilise the bladder as described, and the surgeon should check that it has not become twisted at all prior to performing the cystotomy.

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HOW TO

PERFORM A CYSTOTOMY

A key principle to any surgical procedure, but of particular relevance to bladder surgery, is the requirement for gentle and sympathetic tissue handling. The bladder wall incision will initially bleed relatively copiously but the surgeon must resist the temptation to swab or use diathermy on any but the largest vessels. Excessive use of swabs or diathermy has the potential to increase

Figure 5: The stay suture in the cranial pole has been used to ventroflex the bladder through the abdominal wound and facilitate exploration of the caudal abdomen. The camera is pointing caudally and the uterine bifurcation can clearly be seen lying dorsal to the bladder

Figure 4: This hypoplastic bladder has been retracted cranially using a 2 metric polypropylene stay suture placed in the cranial pole. This dog had bilateral ectopic ureters

CystotomyA clean number 11 scalpel blade is used to perform a stab incision into the ventral midline towards the cranial pole of the bladder, and a Poole or other suction tip is inserted to drain the urine and minimise spillage (Figure 6). A sharp pair of

Metzenbaum scissors is then used to extend the incision caudally to the length required to perform the desired procedure. One or two stay sutures can be placed full thickness through the bladder wall either side of the cystotomy incision to allow the bladder to be held open (Figure 7).

Figure 6: A Poole suction tip has been inserted through a stab incision in the cranioventral bladder wall. The incision is slightly off midline due to the presence of a bladder wall transitional cell carcinoma that was subsequently resected. There are a number of moist swabs dorsal to the bladder, of which one can be seen in the picture. Additional swabs to protect the abdominal musculature were placed before the procedure continued

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HOW TO

Figure 7: The cystotomy in this hypoplastic bladder has been completed to expose bilateral intramural ectopic ureters (indicated by the instrument). The bladder wall has been retracted using 2 metric polypropylene stay sutures. Two caudally positioned sets of Gelpi self-retaining retractors are being used to aid exposure

Figure 8: This Labradors bladder wall has suffered chronic irritation from large numbers of cystic calculi. The bladder wall was approximately 12 mm thick. Closure was carried out in two layers and recovery was without incident

inflammation and can result in wall oedema that can significantly hamper the remainder of the procedure and potentially affect healing adversely. The author does not use either swabs or diathermy and maintains visualisation using gentle saline lavage and suction to remove blood and clots. The haemorrhage is self-limiting and does not present a significant problem to either patient or surgeon in the vast majority of cases.

The position of the cystotomy incision may vary slightly depending on the procedure performed, but for most cases will be positioned in the ventral midline of the bladder in a craniocaudal direction.

ClosureAs in other visceral organs, the submucosa represents the suture-holding layer of the bladder and must therefore be included in any bladder closure. There are a number of methods used by surgeons, including inverting suture patterns. The author uses a one or two layer simple continuous

appositional suture layer with a synthetic, absorbable, monofilament material on a swaged-on round-bodied, taperpoint or tapercut needle. The start and end of the suture is positioned just beyond the ends of the bladder incision. Sutures are placed approximately 3 mm from the wound edge

and approximately 5 mm apart in a medium-sized dog (smaller bladders may need smaller sutures).

Normal or relatively thin bladder walls are closed in one layer taking care to include the submucosa, which will often result in full thickness passage of the needle. Two layer closure is usually not practical unless the bladder wall is very thickened (Figure 8) but should include the mucosa and submucosa in the first layer followed by the adventitia and muscle layers in the second.

Some surgeons place an appositional pattern (continuous or interrupted) followed by an inverting layer (using a rapidly absorbed, monofilament suture on a similar needle) in order to ensure a leak-proof closure. A well performed continuous appositional layer suture does not usually require this additional support, and often the size of the bladder can make this a little challenging, but there are no strong arguments that it is inappropriate.

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HOW TO

PERFORM A CYSTOTOMY

Non-absorbable suture material should be avoided in the bladder wall due to its potential for acting as a nidus for calculi formation. Multifilament suture is usually not considered a good choice where wicking of fluid or bacteria can be considered a potential problem (such as during bladder closure). In addition, urease-producing bacterial infections such as Proteus, Staphylococcus and Klebsiella can reduce the effective strength of materials such as polyglycolic acid to as little as 48 hours.

The closure should be inspected for areas of possible leakage, particularly at either end. Placement of the ends of the suture beyond either end, and limiting the distal (or caudal) limit of the cystotomy to an area easily accessible for suturing should minimise this risk. Additional simple interrupted sutures can be placed if the surgeon is concerned, but one must avoid excessive use of suture material.

The bladder wall is considered to be capable of healing in as little as 23 weeks. One might consider that a particularly inflamed bladder wall would have the potential to take a little longer but selection of absorbable suture can be based on the capacity for rapid healing. The author usually selects a material with an effective tensile strength of 35 weeks depending on the expected ability to heal (e.g. glycomer 631, polyglecaprone 25, polyglyconate, or polydioxanone).

A pressure test is probably of limited use to the experienced surgeon but can serve as a crude test for leaks. A patient on intraoperative fluids is likely to be producing urine at a rate that will allow a small amount of pressure to be applied to the bladder with a little urine inside and the urethra gently occluded. Alternatively,

additional intraluminal fluid can be supplied using a syringe filled with saline and an orange (25 gauge) needle. One must remember that any suture closure will leak if enough pressure is applied.

The suture line and surface of the bladder can then be gently lavaged with a small quantity of warm saline; unless leakage has been copious there is usually no requirement for abdominal lavage. The final stay suture can be removed from the cranial pole of the bladder and the swabs used for packing off the bladder can be removed. The omentum is draped over the suture line in order to support healing. Tacking it in position is not usually required. It is essential at this point to complete a swab count prior to abdominal closure.

The potential for seeding of transitional cell carcinoma to other tissue indicates that additional precautions are taken when dealing with lesions of this kind, including changing gloves and surgical instruments before handling any tissue other than the bladder.

Routine closureThe abdominal wall is closed using the fascia of the rectus sheath as the suture-holding layer. A simple interrupted or continuous appositional pattern is ideal, using a permanent or absorbable suture material that will provide effective support for at least 56 weeks (e.g. polycloconate or polydioxanone). The subcutaneous fat layer should be apposed to eliminate dead space and the skin closed in a method favoured by the surgeon. The author typically closes the fat in a simple continuous appositional pattern using a monofilament absorbable material (e.g polyglecaprone 25 or glycomer 631) and the subdermal layer in a simple continuous pattern using the same material.

Skin staples or monofilament nylon skin sutures can be placed as required.

AftercareThe patient must receive multimodal analgesia whenever possible and the nursing staff warned that urinary incontinence may occur during the initial postoperative period. Blood-tinged urine and occasional blood clots in the urine are also not uncommon following cystotomy and should not be a cause for concern. Cystotomy cases should not require a transurethral or cystostomy tube to be placed unless the bladder is atonic or there is a separate defined requirement for postoperative deflation of the bladder.

The performance of a cystotomy should not in itself indicate a requirement for anything more than routine perioperative antibiotic therapy. There may be an indication for an extended postoperative course associated with certain disease processes.

During the first 1224 hours postoperatively, the clinician must ensure that accurate records are available of any urine passed in terms of quantity passed, nature of the urine and behaviour during urination. Those cases where urine is not produced in the volumes expected should be examined carefully and may require ultrasonographic assessment of residual bladder volume or free abdominal fluid that might indicate a uroabdomen. Transurethral catheterisation to empty the bladder is usually not necessary and has the potential to compromise the bladder closure unless carried out sympathetically.

The majority of cystotomy cases should recover without incident. Any case that is not recovering in the way expected by the clinician should be assessed for possible uroabdomen.

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CPD

ORTHOPAEDIC ROAD SHOWIn November BSAVA will take to the road with international orthopaedic experts. A series of 1-day courses will deliver the very best CPD, at a convenient location and at a price that is great value for money

explained. This disease accounts for billions of pounds of canine healthcare costs in the developed world. Newer radiographic methods will be discussed and the evidence base around case management will be discussed and debated, and you will have plenty of opportunity to ask questions.

SpeakersDr Mike Conzemius DVM Diplomate ACVSMike received his DVM and PhD in Biochemical Engineering from Iowa State University. He completed his surgical residency at the University of Pennsylvania. He has served as a faculty member at the University of Pennsylvania and Iowa State University and is currently a Professor of Surgery at the University of Minnesota. His research and clinical interests are joint replacement, stem cell therapy and genetic testing for orthopaedic diseases.

Prof John Innes BVSc PhD CertVR DSAS(orth) MRCVSJohn qualified from the University of Liverpool in 1991. He was at the University of Bristol for 10 years and whilst there completed a PhD on canine osteoarthritis and the RCVS diploma in small animal surgery (orthopaedics). He was appointed professor of small animal surgery at Liverpool in 2001 and he is currently Associate Dean for Knowledge Exchange. He is a recognized RCVS specialist in small animal orthopaedics. His current research projects are focussed around joint diseases and his clinical interests include all areas of small animal orthopaedics. In 2005 he was awarded the BSAVA Simon Award. John is a co-editor of the BSAVA Manual of Canine and Feline Musculoskeletal Disorders.

Mike Guilliard MA VetMB CertSAO MRCVSMike graduated from Cambridge University Veterinary School in 1972 and has spent his entire professional career in general practice with what is now Nantwich Veterinary Group. He gained the Certificate of Small Animal Orthopaedics in 1995 and has twice gained the BSAVA Dunkin Award. His publications have been mainly on distal limb lameness and he has lectured in both Europe and the USA.

This is a great opportunity to develop your diagnostic abilities and expand your surgical skills in the types of orthopaedic procedures that are presented most in practice with speakers who are both experienced and approachable.

Pelvic limb lameness is really common in dogs with hip dysplasia and along with cruciate disease these cases will be the most common orthopaedic conditions a practitioner will be faced with. Accurate diagnosis, disease staging and appropriate decision-making are critical for successful case management. This road show will deal with common conditions of the canine pelvic limb and is designed for primary care practitioners who want to build their confidence.

Understanding hip dysplasia (HD) and the methods used to diagnose the condition is a key core skill for first-opinion practitioners, because advising clients appropriately is essential. Newer radiographic methods will be discussed and the role they play in understanding HD

Who, Where, WhenMike Conzemius & John Innes4 November Radisson Hotel, Belfast11 November Bellhouse Hotel, Beaconsfield

Mike Conzemius & Michael Guillard6 November Thistle Hotel, Brands Hatch9 November Novotel Hotel, Newcastle

Fees:Members: 191.83 inc VATNon Member: 287.74 inc VATFor further information please contact the Membership and Customer Services Team on 01452 726700 or email administration@bsava.com

18 | companion

VIN

Ken Thorley BVSc MVS (SA Med. & Surg.), Victoria 24-Hour Hospital & Clinics, Hong Kong

Hi Bernie,

Others can give you are more informed opinion than me, but heres my 5 cents worth:

>>> I am wondering whether we should be increasing his pred dose to 25 mg daily which would take it up to 4 mg/kg > I realise he may also have the other two arms of triaditis, as intestines and pancreas were not biopsied

companion | 19

VIN

>>> He is not an easy cat to pill so I would prefer stick to the important anti-inflammatory meds rather than using urso or same as I dont think there is a lot of evidence based medicine as to their usefulness in this disease please let me know if there is.

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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/Linkiplx?ID=74908

GrapeVINe

Ken Thorley

Hi Bernie,Lymphocytic cholangitis cases often have normal to increased appetite and continuing weight loss just as you have described so either the cat is not going as well as the normalised ALT suggests, or there is a concurrent problem. I suspect the former, and would be hesitant to taper the treatment. You could run a cobalamine/folate/fPLI/TLI to check for other GI disease, as well as the other tests you have mentioned above.

Brad Reiser DVM, VIN Rep, Northwest Veterinary Hospital, Inc., Wauseon, OH

Hi Bernie, Heres a link that might be helpful: http://www.vin.com/Link.plx?ID=40866. As Ken suggests, there might be other issues here the GI panel would be a logical next step.

Michele Gaspar

Bernie, I would definitely concur with Kens and Brads thoughts on the GI panel. I would bet this kitty is hypocobalaminemic. Please keep us posted.

Bernie Bredhauer

Hi Michele. We did B12/Folate on Moet who has actually gained 100g on the last visit. He has not had any B12 injection yet.

B12 374 pmol/L (2501200)Folate 7.1 mmol/L (10.445.4)

also a T4 31 nmol/L (1075)

I have see a lot of US data on the boards in cats that seems to have a much higher range for B12 (6001800), the range I have is the one published by the Aussie Lab that ran the assay. There is also a paper out on B12 levels in cats in this months Australian Vet Journal that I have yet to read but would like to know whose normal range I should consider. Any comments from the Aussies who are running B12 also appreciated.

Thanks

Michele Gaspar

The range for the B12 isnt much different from the one we have in the States and at that posted level, I would supplement (250 mcg sub-q once-weekly for six weeks, then every other week for six weeks and then once-monthly long-term). Although the cobalamin in Moet is still within the normal range, it is at the lower end of normal. As you know, cobalamin levels in serum are higher than they are in tissue.

The folate is compatible with longstanding intestinal disease, as cats hang on to folate for a long time.

Editors note: link = Feline

Inflammatory Liver Disease David C.

Twedt, Colorado State University Fort

Collins, CO, USAProceeding of 18th

ECVIM-CA Congress, 2008

Editors note: PM Barron, JT

Mackie, NA Evans and N Langer: Serum

cobalamin concentrations in

healthy cats and cats with non-alimentary

tract illness in Australia. Australian

Veterinary Journal July 2009 Vol 87 (7),

280283

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BSAVA AWARDS

Ways to save at Congress 2010

Book Online to save 5% on your registration available from 1 December 2009 Members registering for whole Congress by 31 January 2010 get a 25 voucher to be used on courses or manuals on the BSAVA Balcony at Congress *Early Bird Deadline 10 February 2010Practice Badge Deadline 16 March 2010Avoid the late booking surcharge, this will commence 1 April 2010

For more details visit www.bsava.com, email congress@bsava.com or call 01452 726700

* Must be a 2010 member. Only available to fee-paying members, not applicable to student members. Conditions apply.

NOMINATE FOR THE BSAVA AWARDS

The BSAVA invites members to nominate colleagues for the BSAVA Awards

The BSAVA Awards are a prestigious recognition of the contributions individuals make to our profession. Our Awards Committee meets every December to consider your nominations, and the awards are presented at a ceremony during Congress in April. The Committee cannot make nominations itself and therefore relies on members putting forward names for consideration.

You do not have to make suggestions for every Award. Take a few minutes to talk to your friends or colleagues in your practice or place of work. Whatever you do PLEASE NOMINATE!

How to nominateThis is your opportunity to recognise the hard work of your professional colleagues. You can download the nomination forms online at www.bsava.com or contact the Honorary Secretary, Alison Speakman, email: secretary@bsava.com, for more information. Deadline for nominations is 16 November 2009. Full details and information on past winners can be found on the website.

Award categoriesFrank Beattie Travel Scholarship

This travel scholarship, worth 2000, is to help a member of the BSAVA undertake a trip abroad to study a particular aspect of veterinary practice. This is the only award where applications are invited from the intended recipient.

Amoroso Award This is presented for outstanding contributions to small animal studies by a non-clinical member of university staff.

Blaine Award This award is presented for outstanding contributions to the advancement of small animal veterinary medicine or surgery. Veterinarians and non-veterinarians are eligible as recipients of this award.

Bourgelat Award This award is presented as the primary international recognition for really outstanding contributions to the field of small animal practice.

Simon Award This award is presented for outstanding contributions in the field of veterinary surgery.

Melton Award This award is presented for meritorious contributions by veterinary surgeons to small animal veterinary practice. The award is open only to veterinary surgeons in general practice.

Woodrow Award This award is presented to a BSAVA member for outstanding contributions in the field of small animal veterinary medicine.

J.A. Wight Memorial This award is presented to recognise outstanding contributions to the welfare of companion animals.

Countdown to Congress 811 April 2010With so many ways for members to save at BSAVA Congress from subsidised registration to discount vouchers and a huge range of offers from exhibitors, now is the time to mark the date in your diary and look at how much you can get from your CPD budget during these four days in April. Visit www.bsava.com to download the Scientific Programme and find details for the social programme.

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PUBLICATIONS

FLASH, BANG, WHAT?

As the evenings draw in, so the firework season begins and veterinary surgeons can expect to be asked what can be done to help frightened pets. Professor Daniel Mills of the University of Lincoln offers some advice

1. Ignore any fearful behaviour or pretend to be particularly happy as you go about your normal routine. The idea is to create an atmosphere that indicates there is nothing to be concerned about. This is perhaps the single most important thing an owner can do at this time.a. Dont punish or be annoyed with

your pet for being scared; it only confirms that there is something to be afraid of.

b. Dont fuss or try to reassure the pet, as this can encourage the behaviour.

2. Make sure your pet is kept in a safe and secure environment at all times. The use of dog appeasing pheromone can help provide an emotionally secure environment for dogs. Cats should be kept indoors at this time of year and rabbits brought in if possible.

3. Provide a safe and secure retreat for your pet, as this will help it cope and so reduce the intensity of the fear response. The area should be associated with pleasant experiences when there are no fireworks going off; it should not simply be a bolthole that the pet goes to when it is scared. It may help to black out one of the quietest rooms in the house and place toys, etc. for your pet to play with, preferably with you, so the room is associated with positive experiences. Blacking out the room removes the potential additional problem of flashing lights in the case of firework or thunderstorm fears. In addition, some animals have also learned an association with the smell of bonfires and if you think this is the case, do not have a fire going in the home.

Although veterinary behavioural medicine has emerged in recent years as its own specialism within the profession, it is important to realise that the vast majority of behaviour work is still done in first-opinion practice, and managing noise fears is a good example of this.

Sound sensitivities are generally quite straightforward to recognise and reported as some sort of fear or phobia in the patient to noise, but there are two important diagnostic considerations when presented with this complaint:

1. Identify that the animal is genuinely scared and is not simply showing a learned attention-seeking behaviour. This can be done by exposing the pet to a recording of the noise in the owners absence and monitoring its physiological and behavioural response.

2. Establish that the animal does not also have some other behaviour problem that is compromising its welfare, which might require its own treatment.

Baseline measures are important as change often takes time and in the absence of complete (or early) cessation, owners may be inclined to report that the problem is not better and abandon treatment when progress has actually been made. For this reason a score sheet is recommended (for an example see the companion section under Publications at www.bsava.com). Owners can complete this at regular intervals and the total score (frequency x severity for all signs) calculated. Where possible this should be supplemented with a video of the animals behaviour.

InterventionIt is important to recognise that intervention occurs at two levels, and clients must be encouraged to engage in both to safeguard the wellbeing of their pet:

Managing the immediate crisis (often meets the primary desire of the client).Long-term resolution of the problem (to prevent reoccurrence).

Managing the immediate crisisGeneric advice that can be offered to clients includes:

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PUBLICATIONS

Chemotherapeutic intervention may be justified on welfare grounds. Benzodiazepines, such as alprazolam (0.010.1 mg/kg as needed, but

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PUBLICATIONS

BSAVA POLICY ON FIREWORKS

producing sedation, ataxia or hyper-excitability that might make the animal more difficult to manage. The emotional impact of a fearful/phobic event may be reduced either by reducing the dogs emotional response to that event, or by altering its memory of it. Given that all short-term medications used for phobia management are liable to produce adverse effects, some of which might be highly undesirable or even dangerous during a phobic event, it is essential that any drug used must be tested with an individual patient and the dose titrated to effect.

Acepromazine (ACP)ACP does not have anxiolytic properties and will therefore not alter the impact of an event unless the animal is rendered unconscious throughout. For several reasons ACP is not considered suitable for the management of canine noise phobias.

BenzodiazepinesDiazepam produces short-term anxiolytic effects, and impairs the consolidation of short-term memory so that events experienced immediately after a dose of the drug will be remembered less clearly. At low doses diazepam retains its amnesic effects, whilst at higher doses anxiolysis and sedation are achieved. Diazepam is a Schedule 4 Controlled Drug and there is no authorized oral veterinary preparation.

TriazolobenzodiazepinesAlprazolam (Xanax) produces broadly similar anxiolytic and anterograde amnesic effects to the benzodiazepine

drug diazepam. It is also a platelet activating factor antagonist, leading to retrograde amnesic effects (Saraf et al., 2003). It may be used in advance of an expected fearful or phobic event in the same way as diazepam. However, alprazolam may also be given after a phobic event in order to impair the dogs memory of it (Crowell-Davies, 2003). Alprazolam is a Schedule 4 Controlled Drug and there is no authorized veterinary preparation.

3. Pheromones DAP (dog appeasing pheromone) has anxiolytic properties in a number of situations and has been shown to reduce the signs of fearfulness during firework events. DAP has no known adverse effects and is not a licensed preparation. It may be safely combined with other treatments. DAP is available in the form of a diffuser or a collar.

Long-term therapyFears and phobias may be managed on a short-term basis, but once the firework season, or other period of phobic exposure, comes to an end it is important to treat the problem so that it is less severe in the future. Behavioural therapy, sometimes combined with medication or pheromones, can achieve this.

1. Behavioural Desensitisation and counter-conditioning have been shown to be safe and effective methods for the treatment of fears and phobias of fireworks. Desensitisation must be followed by counter-conditioning in order to consolidate any behavioural improvement.

2. Drugs Selegiline (Selgian, CEVA Animal Health) is licensed for the treatment

This is an extract from the full policy statement, which can be found online in the Advice section at www.bsava.com

of behavioural disorders with an emotional origin, which includes fears and phobias. It is the only authorized preparation for the treatment of sound phobia problems. Benzodiazepines, such as diazepam, and triazolobenzodiazepines, such as alprazolam, may also be used in long-term therapy.

3. Pheromones DAP has been shown to be effective in assisting the response to behavioural therapy. By reducing the dogs general level of anxiety, the pheromone provides a reassuring environment within which the animal is more likely to respond to behavioural therapy.

4. Herbal and homeopathic drugs, and food supplements Currently, there is no peer-reviewed evidence for the efficacy of herbal or homeopathic agents, nor food supplements, in the management or treatment of noise phobias.

ReferencesCrowell-Davis, S.L., Seibert, L.M., W, Parthasarathy,

V, T.M. (2003) Use of clomipramine, alprazolam, and behavior modification for treatment of storm phobia in dogs. J Am Vet Med Assoc. 222(6): 7448.

Saraf, M.K., Kishore, K., Thomas, K.M., Sharma, A., Singh, M. (2003) Role of platelet activating factor in triazolobenzodiazepines-induced retrograde amnesia. Behav Brain Res. 142(12): 3140.

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PETSAVERS

Improving the health of the nations pets

PETSAVERS CHRISTMAS CARDS

FOCUS ON PETSAVERS PROJECTS

Petsavers cards are great for personal and practice use. A pack of ten Petsavers cards costs 3.99. Amongst the designs there is a great picture taken by Richard Smart of his 4-month-old kitten Poppy hiding in the tinsel, whichwas submitted as part of last years Petsavers photography competition. Visit www.petsavers.org.uk or call 01452 726700.

Chest tubes are commonly used in postoperative management following thoracotomy. Complications, such as iatrogenic infection, pleural irritation and tube-induced effusion, may be seen, although the incidence of these complications is unknown and bacteria-related complications are rarely investigated. The incidence of infection associated with closed-chest placement of chest drains in human medicine is 912%.

Matthieu Cariou explains his project entitled Bacteria-related complications associated with thoracostomy tube use in dogs and cats analysis of incidence and risk factors, one of the many funded by Petsavers In the last 35 years

Our aims are to investigate the incidence of bacterial contamination and infection following elective thoracotomy and to relate this to clinical, clinicopathological and laboratory measures of infection and inflammation.

160 dogs will be recruited in which a chest drain will be placed after thoracotomy as a standard clinical procedure. Samples for bacteriology and cytology will be taken daily from the day of the surgery until removal of the chest drain. An ELISA for C-reactive protein will be performed on all serum and pleural fluid samples collected in those patients. Descriptive statistics will be used to report the incidence of bacterial contamination and infection, and the bacterial species identified. Differences in measured variables between animals with and without bacterial growth will be investigated.

The study will provide baseline data on the incidence of infectious complications related to the use of chest drains. In

addition, the diagnostic utility of cytological evaluation of the pleural fluid and evaluation of fluid and serum biomarkers in the diagnosis of bacterial contamination and infection will be investigated.

The study aims to provide practitioners with guidelines for the length of time a chest drain should be kept in and, more specifically, advice for when a chest drain should be removed in terms of the surgery performed, the amount of intrapleural fluid production and the appearance of the fluid.

The study should also allow us to give practitioners tools they can use (like cytology or fluid markers) to suspect/diagnose a significant bacterial contamination or even an infection before general signs are visible in the patient, hence allowing them to initiate an appropriate treatment very early in the course of the potential disease. Finally, the study will enable practitioners to better inform their clients on the likelihood of a chest drain causing a problem.

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WORLD CONGRESS HIGHLIGHTS

The 34th WSAVA World Congress proved to be one of the largest WSAVA World Congresses ever held, with close to 3,500 attendees coming to the bustling and cosmopolitan city of So Paulo, Brazil. The scientific programme featured over 80 world-renowned veterinary lecturers covering over 30 disciplines in 9 simultaneous session streams, including 5 State-of-the-Art Lectures. There was also a WSAVA Animal Welfare stream, a WSAVA Hereditary Diseases stream, a North American Veterinary Conference stream, and 3 Pre-Congress Forums (one focusing on ophthalmology, one covering tibial tuberosity advancement using XGen plates featuring Professor Cassio Auada Ferrigno, and the third on advanced topics in acupuncture by Dr Huisheng Xie).

The international appeal of the WSAVA World Congress was demonstrated by the fact that people attended from 55 countries, representing every continent but Antarctica. There was tremendous support from within Brazil, with attendees from 26 of the 27 States of the Brazilian Federation.

Evenings were spent meeting old friends and making new ones at a variety of lively

social events. The Opening Ceremonies took place on Tuesday, July 21 at the Alfa Theatre. Following presentation of the prestigious WSAVA Awards (see below), spirited demonstrations of samba, bossa nova, and football (soccer, of course) took place. The evening closed with cocktails served in the theatre reception area. The following night saw the elegant Gala dinner that was held at the luxurious Hotel Grande Hyatt, with diners serenaded by Brazils Band Jazz Trio. The tempo picked up on Thursday night for the Brazilian Party. Held at the HSBC Brazil Hall, the evening featured cultural dances and music from a variety of performers that included the San Marco Band, Mocidade Alegre, and a samba school and even the Congress Organizers and WSAVA Assembly members, who were invited to the stage to show their newly learned Brazilian dance techniques!

As the saying goes, all good things must come to an end, as Friday saw the Closing Ceremonies where the hard work of the many volunteers was recognized and a presentation by next years Congress host Geneva, Switzerland ensured that many of those present would be sure to join their colleagues again for the 35th WSAVA Congress to be held from June 25, 2010 in Geneva, Switzerland.

The Congress was supported by WSAVA Prime Partner, Hills Pet Nutrition; Gold Sponsors Nutriara, Vetnil, and Royal Canin; and Bronze sponsors Pfizer, Merial, and Biovet. The Exhibition Hall featuring some 300 exhibitors was combined with the 9th EDICAO Pet South America Fair a first for a WSAVA World Congress which attracted over 20,000 visitors.

For more information on the 2009 WSAVA Congress, including a photo gallery, visit the website at www.wsava.org

Some 3,500 people from around the world came to So Paulo to learn and celebrate the collegiality of veterinary medicine

Entertainment at the opening ceremony

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WSAVA NEWS

WSAVA Hills Mobility AwardThis award is presented to recognize the outstanding work of a clinical researcher in the field of canine and feline orthopaedic medicine and surgery, whose research has contributed significantly to the well-being of pets lives and to the humananimal bond worldwide through improvements in the mobility and quality of life of pets.

Duncan X Lascelles BVSc PhD DipACVS DipECVS RCVS CertVA (Anaesthesiology and Small Animal Surgery), Associate Professor in Small Animal Surgery, Director of the Comparative Pain Research Laboratory, and Director of the Integrated Pain Management Service at North Carolina State University College.

WSAVA Hills Excellence in Veterinary Healthcare AwardThis award recognizes the outstanding work of veterinarians in promoting companion animal healthcare and the family pet/veterinary bond through a special sensitivity to both clients and patients, using leading edge clinical nutrition and advanced medical and surgery techniques.

Professor Peter J Ihrke VMD DipACVD DipECVD, Professor of Dermatology and Chief of Dermatology at the University of California, School of Veterinary Medicine. Prof Ihrke is also an Adjunct Clinical Associate Professor of Dermatology at Stanford University School of Medicine.

WSAVA Presidents AwardThis award is made only periodically by the President of the WSAVA to a member of

AND THE WINNERS ARE...!

WSAVA Waltham International Award for Scientific AchievementThis award is based on outstanding contributions by a veterinarian who has had a significant impact on the advancement of knowledge concerning the cause, detection, cure and/or control of disorders of companion animals.

Professor Robert Washabau VMD PhD DipACVIM (Internal Medicine), Professor of Medicine and Department Chair of Veterinary Clinical Sciences at the University of Minnesota, and Chair of the WSAVA Gastrointestinal Standardization (GI) Group which creates standards for the clinical and histological diagnosis and treatment of GI disease.

WSAVA Intervet/Schering-Plough International Award for Service to the ProfessionThe award is presented to a person who has given exemplary service in fostering and enhancing the exchange of scientific and cultural ideas throughout the veterinary small animal world.

Dr Larry G Dee DVM DipABVP (Canine and Feline), Hollywood Animal Hospital, Hollywood, Florida. The award honours his nine years service to the WSAVA Executive Committee, including two years as President between 2004 and 2006.

Congratulations to the 2009 WSAVA Award Winners

the WSAVA who is judged to have made an outstanding contribution to the association. This year, the award was made to Didier-Noel Carlotti, Doct-Vet DipECVD. Dr Carlotti is a dermatologist based in Bordeaux, France, who has contributed scientifically internationally in his chosen discipline. He has also been a hugely effective force in the wider small animal veterinary field in both France (AFVAC), where he has just concluded his Presidency, and Europe where he was the Foundation President during the formation of FECAVA.

Future CongressesGeneva, Switzerland25 June 2010Jeju, South Korea1417 October 2011Birmingham, UK1215 April 2012Christchurch, New ZealandMarch 2013

Congress Proceedings now available onlineProceedings from the WSAVA 2009 World Congress are now available online via www.wsava.org (the link is on the right-hand column of the Homepage). They are also available online in a partnership with IVIS (International Veterinary Information Service, www.ivis.org), a New York based, not-for-profit organization dedicated to the improvement of animal care by providing up-to-date, clinical information to veterinarians, veterinary students, and animal health professionals.

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WSAVA NEWS

WSAVA NEWSWSAVA NEWS

MARKING A MILESTONE YEAR

Board and various committees, which he highlighted in his Congress Presidents Message (see WSAVA News in the July issue of companion).

This Assembly meeting marked a milestone year as a number of critical and key initiatives were discussed and adopted. These included:

A motion to formalize the WSAVA as an incorporated and not-for-profit entity in Canada. While simply formalizing how the WSAVA has historically operated, this move will also provide the association with legal status, volunteer/member liability protection, and greater transparency and professionalism of activity.A motion to modify how the WSAVA World Congress is administered. This was adopted and will see the WSAVA take on a more active role in the areas of Congress finances and scientific programme. The host association will continue to play a key role in overseeing the social programmes, highlighting the cultural uniqueness of their region, a very popular feature of WSAVA Congresses.

The WSAVA Assembly Meeting covered a number of key initiatives taking the Association forward

The establishment of a charitable Foundation that will provide greater opportunities for members of the international small animal community to show their support of WSAVA global activities through financial donations.

A report from the WSAVAs new Treasurer, Dr Diane Sheehan, that confirmed the association finances to be in good stead, especially considering the current trying economic times, and thanks in large part to the generous support of our sponsors, particularly our Prime Sponsor Hills Pet Nutrition, as well as our growing membership and the high rate of 2008 dues payment.

Dr Veronica Leong from Hong Kong was elected as a 7th Executive Board member.

The past and ongoing contributions of Dr Didier-Noel Carlotti to the WSAVA and international veterinary community were recognized through his receipt of the 2009 WSAVA Presidents Award (see page 27). Assembly members also voted to accept one new full member association Venezuela; two associate member associations Cuba and Nepal; and three affiliate member associations International Veterinary Association of Pain Management (IVAPM), the European Society of Veterinary Cardiology (ESVC), and the Latin American Veterinary Emergency and Critical Care Society (LAVECCS). And finally, New Zealand was voted as the host of the 2013 WSAVA Congress to take place in Christchurch. More details are available in the Assembly Minutes at www.wsava.org

WSAVA President Dr David Wadsworth

WSAVA President Dr David Wadsworth launched the WSAVAs 50th birthday year at the Assembly Meeting, which will culminate with several celebratory events in Geneva during next years Congress. He then provided updates from a very active WSAVA leadership, including the Executive

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THE companion INTERVIEW

NOEL FITZPATRICKNoel Fitzpatrick grew up with his four sisters and one brother in the Republic of Ireland in Portlaoise, where his father was a farmer. He graduated from University College Dublin in 1990, and spent time in the USA on scholarships, where he got the research bug. After some time in large animal work in Ireland he worked in mixed practice in London and America, before setting up Fitzpatrick Referrals in Surrey. He received The Simon Award at the 2009 BSAVA Congress for the development of innovative surgical techniques and treatments in the field of small animal orthopaedics.

It is unusual for a practitioner to be working at the cutting edge of comparative medicine. How did you develop your interest in this area?As a child I was fascinated by what seemed to be an innate connection between anything that happened to

a sheep or a dog and the same thing happening to a human. It seemed strange to me that my Uncle Paul, who only had one leg, surely had the same bones and tissues as a dog, and why could we not apply similar technology to treat all creatures? I was fascinated how biology worked and got a great exposure to biology as a child seeing operations on the farm and delivering lambs. My earliest childhood memory was failing to save a lamb that subsequently died and promised myself that that would not happen again if I had enough knowledge. So, my aspiration has been to build a place which could allow the exchange of ideas between human medicine and animal medicine. This is the philosophy of one medicine, one surgery, one creation. Where I work now is a far cry from the kitchen table in West Cork where I performed my

first ever bone operation on a dog with a broken leg, but you know what, all the MRI scanners in the world could not imbue the clinical acumen that my boss at that time had in his one hand he could look at a sheep at fifty paces and know intuitively what was wrong. Now I teach my interns and residents look at the patient, use your hands, your eyes and your ears first. What we know now as fact isnt truth. Fact is transient, truth eternal. My job is to discover truth about things and use what I believe to be that truth to make an implant or a procedure into a fact of life for surgeons to help patients.

What do you consider to be your most important professional achievement so far?I think creating an environment where three things can happen: (1) where we can truly marry compassionate care and excellence in veterinary medicine; (2) where we can truly create an environment where the philosophy of one medicine can flourish for the betterment of humans and animals; and (3) where we can foster a new breed of surgeon and clinician who gain access to our

system because of their attitude, rather than their intrinsic aptitude. In other words, I believe that if your heart is in the right place and you have a basic modicum of knowledge then veterinary medicine or any other career that you choose to put your heart and soul into should give back to you the ability to fulfil your dreams. And so the most important achievement that I have had to date was allowing several young individuals who are more intelligent and more talented than I will ever be to have the first step on their ladder to success, whether it be internship or residency, and that is why I sponsor cooperative residencies with universities.

If we are talking about professional achievements that are truly scientific, there are three things that I am particularly proud of. But its a team effort and Id like to emphasize that. One is limb amputee prostheses; another is spinal inter-vertebral disc replacement; and another is joint resurfacing and joint prostheses. My objective over the next twenty years will be to become involved with the greatest minds in the world to develop a neuro-integrated external prosthesis whereby in the case of

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limbs that are lost for whatever reason in animals or humans we would be able to develop not only what we have done to date, which is an implant which integrates with bone and skin, but also an implant which will integrate with nerves and muscles and truly become part of the body. And in this way we can move forward with the development of treatments for nerve disorders as well, through the use of stem cells and other newer technologies which may help treatment of severe spinal cord injuries, and these goals remain close to my heart as I move forward over the next couple of decades.

What is the most significant lesson you have learned so far in life?It was taught to me by my mother. I was about eight and wed walked a very long way on the south coast of Ireland, climbing to the top of a hill where we knew there was a church and shop nearby. I was thinking in my head of the shop and the sweets that lay within it. My mum was thinking of the church and climbing the hill to her was climbing to a higher level so she could speak to God. Climbing the hill for me was getting to the shop. And when we got there I saw the doughnuts in the window, rotating around with sugar sparkling on top of them, and I was not allowed to go into the shop until after wed been into the church. And I accepted that, but when we came out my mum and I had not enough money for a drink and a doughnut. My mum was very thirsty and I said to her to get the drink. She went into the shop and she brought out a doughnut. We sat on a bench overlooking the sea and she split the doughnut in half. And as she handed me one half, the jam spilled out of it and she said to me, Look,

theres eating and drinking in this. The moral of the story is, make the best of what you have, do not be selfish, and sometimes even the simplest things yield the greatest rewards, if only you choose to see them.

If you could change one thing about yourself, what would it be?Actually I dont like myself very much, in spite of what people would think. I think you do need to have an ego to succeed in business or in a profession but I think that a surgeon who cant recognize that he or she will constantly be humbled by biology is not the kind of surgeon I want to be. So I dont think Im ever good enough at any level, either physically or professionally or personally. I think Ive failed often and I guess if there was one thing I could change it would be how I accept failure or rejection, because I dont accept that well. I have a tendency only to remember my failures and not my successes, so I would like to be a little more calm, a little more accepting and a little more resigned to the failure that is inevitable in my life.

What is your most important possession?The rosary beads that my dad left when he died are my most important possession, and

its not because Im particularly religious but because they represent faith in something bigger than ourselves, a faith that somehow truth will win through, a faith that we are not it and never will be it. There is something greater than us, and Im not sure what that is. I dont think Dad was sure what it was either but when I look at the rosary beads it reminds me that power, money, fame, possessions and achievement dont really matter and the only thing that really matters is the respect of those you respect, and Dad respected God. I respect Creation, and I will do whatever I can to protect and preserve it.

What would you have done if you hadnt chosen to be a vet?Well, my second choice was a doctor and my third choice was an actor. As a vet, every day I feel the enormity of the challenges that lie ahead so I can only imagine what it would have been as an actor to feel rejection many times worse than that of biology rejecting a surgeon, because if we do our job well as biological gardeners then usually Creation smiles on us, whereas Im sure that if I had been an actor I would have got a lot more frowns than smiles. So I think I made the right decision, and Im happy.

THE companion INTERVIEW

make the best of what you have, do not be selfish, and sometimes even the simplest things yield the greatest rewards

CPD DIARY

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CPDDIARY12 OctoberMondayThoracic radiologySpeaker Nic HaywardThe University of Exeter, Queens Margaret Rooms 2 & 3, Streatham Campus, Northcote House, Exeter EX4 4QJ. South West RegionDetails from Kate Rew, kate@linhayvet.co.uk

EVENINGMEEtING

14 OctoberWednesdayOncology: local practitioner viewsSpeakers Andrew Bodey and Ron LoweThe IDEXX Laboratories, Grange House, Sandbeck Way, Wetherby, West Yorkshire LS22 7DN. North East RegionDetails from Chris Dale, northeastregion@bsava.com

EVENINGMEEtING

20 OctoberTuesdaySurgical options for ear diseaseSpeaker Davina AndersonThe Potters Heron Hotel, Ampfield, Romsey, Hampshire S051 9ZF. Southern RegionDetails from Michelle Stead, 01722 321185, mmstead@btinternet.com

EVENINGMEEtING

21 OctoberWednesdayPractical ultrasoundSpeaker Fraser McConnellDavid Lloyd Leisure, Moss Lane, Whittle-le-Woods, Chorley, Lancashire PR6 8AB. North West RegionDetails from Simone der Weduwen, 01254 885248, beestenhof@ntlworld.com

DAYMEEtING

22 OctoberThursdayGIT II (BSAVA Modular Course)Speaker Alex GermanThe Thorpe Park Hotel and Spa, 1150 Century Way, Thorpe Park, Leeds LS15 8ZBDetails from BSAVA, 01452 726700, administration@bsava.com

DAYMEEtING

3 NovemberTuesdayPractical film reading: your waySpeakers Frances Barr & Fraser McConnellBSAVA, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, GL2 2ABDetails from BSAVA, 01452 726700, administration@bsava.com

DAYMEEtING

14 OctoberWednesdayDispensing lawSpeaker John HirdThe Holiday Inn Haydock, Lodge Lane, Newton Le Willows WA12 0JG. North West RegionDetails from Simone der Weduwen, 01254 885248, beestenhof@ntlworld.com

EVENINGMEEtING 20 OctoberTuesday

Clinical nutrition: Let food be your first medicineSpeaker Penny Watson BSAVA, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley GL2 2AB. Details from BSAVA, 01452 726700, administration@bsava.com

DAYMEEtING

21 OctoberWednesdayClient compliance and practice managementSpeaker Clayton McKayThe Ramada Hotel, Shaws Bridge, Belfast BT8 7XP. Northern Irish RegionDetails from Shane Murray, shane@braemarvetclinic.co.uk, or VetNI, 028 25898543, info@vetni.co.uk

DAYMEEtING

22 OctoberThursdayConsequences of infections with exotic diseasesSpeaker Maggie FisherThe Leatherhead Golf Club, Kingston Road, Leatherhead, Surrey KT22 0EE. Surrey and Sussex RegionDetails from Jo Arthur, 01243 841111, joarthur85@btinternet.com, or Jackie Casey, 01483 797707, jackie.casey@greendale.co.uk

EVENINGMEEtING

28 OctoberWednesdayFLUTD All bunged up and nowhere to goSpeaker Angie HibbertThe Park Inn Hotel, Llanedeyrn, Cardiff CF23 9XF. South Wales RegionDetails from the Chairman or secretary,southwalesregion@bsava.com

EVENINGMEEtING

16 OctoberFridayFeline Infectious Disease Road ShowSpeakers Prof Michael Lappin & Prof Danille Gunn-MooreDay meeting at Chilworth Manor, Southampton SO16 7PT. Details from BSAVA, 01452 726700, administration@bsava.com

19 OctoberMondayFeline Infectious Disease Road ShowSpeakers Prof Michael Lappin & Prof Danille Gunn-MooreDay meeting at Mottram Hall, Wilmslow Road, Mottram St Andrew, Cheshire SK10 4QT.Details from BSAVA, 01452 726700, administration@bsava.com

21 OctoberWednesdayFeline Infectious Disease Road ShowSpeakers Prof Michael Lappin & Prof Danille Gunn-MooreDay meeting at The Miskin Manor Country Hotel and Health Club, Miskin, Nr Cardiff CF72 8ND.Details from BSAVA, 01452 726700, administration@bsava.com

18 OctoberSundayFeline Infectious Disease Road Show (with Parallel Nurse Session)Speakers Prof Michael Lappin & Prof Danille Gunn-Moore (Kerry Simpson)Day meeting at The Hilton Dunkeld Hotel, Dunkeld, Scotland PH8 0HX. Details from BSAVA, 01452 726700, administration@bsava.com

4 NovemberWednesdayOrthopaedics Road ShowSpeakers Mike Conzemius & John InnesDay meeting at The Radisson SAS Hotel, Belfast, The Gasworks, 3 Cromac Place, Ormeau Road, Belfast, BT7 2JBDetails from BSAVA, 01452 726700, administration@bsava.com

21 OctoberWednesdayVaccination, reactions and feline infectious diseaseSpeaker Michael DayThe Russell Hotel, 136 Boxley Road, Maidstone, Kent ME14 2AE. Kent RegionDetails from Hannah Perrin,hannah@burnhamhousevets.com

EVENINGMEEtING

British Small Animal Veterinary AssociationWoodrow House, 1 Telford Way, Waterwells Business Park,

Quedgeley, Gloucester GL2 2ABTel: 01452 726700 Fax: 01452 726701

Email: administration@bsava.comWeb: www.bsava.com

Any questions?If you need more information see page 2 inside or www.bsava.com for full details or have any questions then please contact us right away. You can email administration@bsava.com or call 01452 726700 and a member of our team will be happy to help.

Stick with us in 2010

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