The essential publication for BSAVA members

companion
APRIL 2011
Asiatic bears
First laparoscopic
cholecystecomy
P4
New Formulary
Even more of a
benet
P8
Clinical Conundrum
Progressive
lameness in a
Spaniel P10
How to utilise
blood products
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3 Congress
News from Congress 2011
46 Publications
Worlds first laparoscopic cholecystecomy in Asiatic black
bears, and Manual donation to international charities
7 CPD
Old age doesnt come alone: an insight into dealing with
the feline and canine geriatric patient
89 Formulary
Ian Ramsey describes the new edition
1013 Clinical Conundrum
Consider a case of progressive lameness in a
Cavalier King Charles Spaniel
1419 How To
Utilise blood products in small animals
20 Petsavers
The winners of the 2011 Petsavers photography
competition
2123 WSAVA News
The World Small Animal Veterinary Association
24 The companion Interview
Sue Shaw
25 BSAVA Northern Ireland Congress
An update on the forthcoming Congress in May
26 Meet Your Region
Spotlight on Northern Ireland Region
27 CPD Diary
Whats on in your area
Additional stock photography Dreamstime.com
Margouillat; Ravl; Stanislav Perov
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 726700
Email: companion@bsava.com
Web: www.bsava.com
ISSN: 2041-2487
Editorial Board
Editor Mark Goodfellow MA VetMB CertVR DSAM DipECVIM-CA MRCVS
Senior Vice-President Richard Dixon BVMS PhD CertVR MRCVS FRSE
CPD Editorial Team
Ian Battersby BVSc DSAM DipECVIM-CA MRCVS
Esther Barrett MA VetMB DVDI DipECVDI MRCVS
Simon Tappin MA VetMB CertSAM DipECVIM-CA MRCVS
Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVS
Features Editorial Team
Caroline Bower BVM&S MRCVS
Andrew 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 .
NEW! EJCAP SPECIAL ISSUE
ON DENTISTRY
The European Journal of Companion Animal Practice (EJCAP)
has published a special issue on Dentistry. All the articles can
now be downloaded from www.fecava.org. This includes; The
Importance of Dental Radiology by B.A. Niemiec; The
evaluation of dentition and occlusion in dogs by P. Roux,
J. Howard; Management of tooth fractures by J. Schreyer;
Periodontal disease from the whole body perspective by
Z. Pavlica, A. Nemec; Oral proliferative lesions in the dog and
cat by L. Verhaert; and Myths and ethics in small animal
dentistry by J. Gawor.
Win M&S
vouchers
In our continued ambition to
communicate with you effectively and
relevantly, BSAVA is inviting you to once
again check and update your profile to
make sure we have your details correct
E
veryone who completed the questionnaire at Congress,
and members who update their online profile by 1st June
this year, will be entered into a draw to win 100 worth of
M&S vouchers.
Making sure your details are up to date and complete
means we can refine the information we send you. This also
helps us to be less wasteful with print resources and save
money on our mailings. We might not get it right all the time,
but wed appreciate your help moving towards a more effective
communications approach. You can update your profile online
at www.bsava.com as long as you are logged in as a
member. If you have any questions then please do not hesitate
to get in touch email administration@bsava.com or call
01452 726700.
JSAP online
Make the most of your access
to the JSAP archive online
W
e all know how frustrating it can be, knowing you think
you have seen a paper in JSAP that might relate to a
tricky current case you are facing but cant remember its
full title or the issue it was in. Equally, not all of us have the space
to save all our printed editions. Which is why is it such a valuable
asset to have the rich archive of past papers online. Blackwell, who
both print JSAP and host the online archive for us, have greatly
improved their website, making it easier to navigate and search for
papers. So make the most of your benefit and use the online JSAP
archive, which you can access easily once you are logged in at
www.bsava.com/jsap.
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Congress
Patricia Colville moves
from chairing Membership
Development into the role of
Honorary Secretary and will
work with Continuing
Education Committee. After
working with the PDSA for
many years, she is now Manager of the
Vets Now hospital in Glasgow.
Andrew Ash, owner of the
five-site Grove Lodge
veterinary group in Sussex,
is now President of the
Association and will sit as
Officer on International
Affairs and Publications
Committees.
Michael Day takes on the
Junior Vice-President role.
Michael is Professor of
Veterinary Pathology and
Director of Diagnostic
Pathology at the University
of Bristol. He will be the
Officer on Scientific
Committee.
Grant Petrie, who offers an
internal medicine referral
service in London at the
Portman and Bayswater
Referral Clinics, is now
Senior Vice-President and
will sit on the Journals
Management Committee.
Mark Johnston, who
heads a practice in
Crowborough, East Sussex,
is our Vice-President and
will work closely with the
Regions and Petsavers.
Initially Mark planned to
serve on a Regional Committee for a
couple of years and then stop, but he
insists that once you start as a volunteer
with BSAVA you just dont want to stop.
Our Honorary Treasurer,
Katie Dunn, will work with
Membership Development.
Katie has a long history as
a BSAVA volunteer and was
also JSAP Editor. She now
works as a freelance
medical writer and copy editor.
All on Board
CONGRESS REPORT
COMING SOON
At the time of going to press, the BSAVA and
companion team are still at Congress! So a full
report on the event will feature in the May
edition. However, visit the website where more
and more news, reports and pictures will feature
during the month. If you were there we hope you
had a really great time, if you didnt make it,
remember that as a member you can access the
talks online as MP3 downloads making
Congress last all year long.
F
or the first time BSAVA has filmed some of the behind-the-
scenes developments that turn an athletic and music
venue into the largest companion animal exhibition in the
world. From the end of April you can go online to see a
fascinating time-lapse recording of the creation and dismantling
of the vast NIA space that is home to over 240 exhibitors during
the event. Everything from rigging banners to laying carpets
and dressing the stands it all might take hundreds of people
and hundreds of man-hours but you can watch it unfold in
seconds. Visit the Congress area at www.bsava.com.
G
rant Petries final act as President
on 3 April was to hand the mantel
over to Andrew Ash and welcome
Michael Day and Patricia Colville onto the
Board. This team leads the direction of the
Association, working hand-in-hand with
committee chairmen and the Regions.
Without this committed team of volunteers
there would be no BSAVA.
The Board now says goodbye and
thank you to Richard Dixon. Before coming
onto the Board Richard had been a
committee member and secretary for the
Scottish Region, Regions Co-ordinator,
and Chair of Publications Committee. His
long service to BSAVA is impressive,
greatly appreciated and we know that
whilst no longer serving as an Officer his
support is ongoing.
Congress on film
At the AGM on the
Sunday of Congress the
BSAVA Board saw a
new President and
a refreshed team
of Officers
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PUBLICATIONS
Romain Pizzi, contributor to
the BSAVA Manual of Exotic
Pets, 5th edition, was part of
the veterinary team
responsible for the first
minimally invasive surgical
removal of gallbladders in
Asiatic black bears at a
rescue centre in Vietnam
A
siatic black bears (Ursus thibetanus) are
classified as a vulnerable species by the
International Union for Conservation of Nature
(IUCN). They are kept illegally in Vietnam for bile
farming, and are milked by repeated needle
puncture of the gallbladder, use of an indwelling
catheter or creation of a fistula. Bears rescued from
bile farms have a high incidence of gallbladder and
Worlds first
laparoscopic
cholecystecomy
in Asiatic black
bears
Romain Pizzi and Jonathan Cracknell perform the
worlds first laparoscopic gallbladder removal in
the Asiatic black bear
PUBLICATIONS
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PUBLICATIONS
PIONEERING
OPERATION BENEFITS
FROM BSAVA MANUAL
DONATION
Romain Pizzi (right) and Jonathan Cracknell
(centre) presented a copy of the BSAVA Manual of
Canine and Feline Endoscopy and Endosurgery to
Duong Duy Cuong, veterinary surgeon at the
Mekong Delta Bear Sanctuary.
Advances in equipment technology coupled with
reduction in costs mean that both flexible and
rigid endoscopy are now realistic prospects in
first-opinion practice. This Manual provides a
practical guide for those wishing to use minimally
invasive techniques, with detailed information on
instrumentation, and practical tips and advice on
its care. The principles and basic techniques of
diagnostic endoscopy and endosurgery are
explained and fully illustrated.
To purchase your copy of this BSAVA Manual,
contact our Membership and Customer Services
on 01452 726700, or order your copy online at
www.bsava.com.
Member price: 49.00
Price to non-members: 75.00
liver disease, with studies showing that >40% of
fistulated bears later die from liver and/or
gallbladder tumours, believed to result from the
chronic inflammation and infections associated
with bile collection.
Open surgery
Many bears rescued from bile farms undergo
open abdominal surgery to remove the diseased
gallbladder and limit the development of malignant
liver and gallbladder tumours. An open approach
to cholecystectomy is associated with large,
painful wounds and a prolonged recovery time it
is often necessary to confine the bears for 6 or
more weeks to allow the wounds to heal
completely.
In humans this approach to gallbladder
removal is associated with high levels of
postoperative pain, prolonged hospitalisation,
slow recovery, and an increased risk of
dehiscence, infection and hernia development.
Thus, in most developed countries, this type of
surgery has been largely replaced by
laparoscopic cholecystecomy.
Minimally invasive surgery
In December 2010, a team from the Royal
Zoological Society of Scotland (RZSS) and Free
the Bears (FTB) performed the worlds first
laparoscopic removal of gallbladders from Asiatic
black bears at the Mekong Delta Bear Sanctuary in
Vietnam. Romain Pizzi (veterinary surgeon) and
Jonathan Cracknell (anaesthetist) were amongst
the team undertaking this pioneering surgery.
The team carried out comprehensive health
checks (haematology, serum biochemistry and
abdominal ultrasonography) on all the rescued
Asiatic black bears at the centre. Laparoscopic
abdominal examinations were carried out in nine of
the bears, and liver biopsy samples obtained. Of
these nine bears, three were found to have
significantly diseased and fibrotic gallbladders.
The three Asiatic black bears had their
gallbladders removed via minimally invasive
(keyhole) surgery. This is the first time that
laparoscopic cholecystectomy has been
performed in these animals. There are significant
welfare benefits to this approach compared with
open abdominal surgery, including a more rapid
recovery from the procedure. Within a week of
surgery the bears were engaging in normal
activities, including swimming, climbing and
social interaction. n
PUBLICATIONS
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PUBLICATIONS
I
n June 2010, with the agreement of the
BSAVA Officers, the International Affairs
Committee donated previous editions of
BSAVA Manuals in English, Japanese and
Spanish, to Worldwide Veterinary Services
(WVS) for distribution to animal welfare
charities worldwide. WVS was founded in
2002 by Luke Gamble, a veterinary surgeon,
and registered as a charity in 2003. WVS
aims to provide aid and assistance to animal
charities and non-profit organisations
around the world, with an emphasis on
working with local communities.
India
The WVS International Training Centre
(ITC) in southern India was opened in
September 2010 in association with the
India Project for Animals and Nature.
The ITC is organising a series of modular
training courses for veterinary surgeons,
paraprofessionals, kennel hands and
shelter workers, in a wide range of animal
health and welfare topics. The aim of these
courses is to provide advice and support
to animal charities and sanctuaries, and to
encourage them to work together to ensure
best practice techniques.
Several BSAVA Manuals have been
donated to the WVS International Training
Centre in India (above).
Thailand
Saving one dog wont change the world,
but surely the world will change for that one
dog is the motto of the Care for Dogs
Foundation in Chiang Mai, Thailand. The
charity helps to improve the health of
homeless dogs by vaccinating them,
providing them with veterinary care, and
running a feeding project. It also provides a
rescue centre, and aims to decrease the
number of street and temple dogs by
neutering them and promoting responsible
adoption. In addition, the charity facilitates
the treatment and neutering of cats, and
works with nuns at the temples to find new
homes for the animals they foster. Last
June, an international delegation of three
vets from WVS spent 2 weeks at the charity,
neutering dogs and cats, and performing
emergency surgical procedures. The Care
for Dogs Foundation is now looking for a
vet to spend 2 years working at their centre.
Japan
The SALA (Save Animals Love Animals)
Network in Tokyo (right) is a non-profit
organisation, involved with rescuing
abandoned dogs and cats that are victims
of the pet boom in Japan. The SALA
Network estimates that upwards of
BSAVA Manual donation
to international charities
Jo Arthur, a member of the BSAVA International
Affairs Committee, has been instrumental in the
recent donation of BSAVA Manuals to veterinary
charities around the world. Here, she tells us more
Several BSAVA Manuals have been
donated to the WVS International Training
Centre in India
The SALA Network benefits from BSAVA
Manual donation
PUBLICATIONS
800,000 animals have been admitted to
public shelters, with little prospect of being
reunited with their owners or finding new
homes, many are euthanased. After a
health check and basic training (for dogs),
SALA facilitates finding new homes for
abandoned animals, and promotes
neutering, name tags and microchipping.
In addition, SALA lobbies for improvement
in the management of public animal
shelters, the provision of dog parks and
dog training courses.
Around the world
In addition to the three animal charities
above, BSAVA Manuals have also been
donated to:
n Maun Animal Welfare Society in
Botswana
n Animal Care Samos and Greek Animal
Rescue in Greece
n Animal Refuge Kansai in Japan
n Dog Star Foundation in Sri Lanka
n Animal Aid Unlimited in India n
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CPD
Old age
doesnt come alone
In May and June, BSAVA will present courses
offering new insight into dealing with the feline and
canine geriatric patient
With the benefits of preventive
programmes, in concert with changing
capabilities and expectations, geriatric
medicine is an increasing part of the
caseload for small animal practitioners.
With age comes degeneration and
disease; things just dont work so well as
they used to. Multiple problems and
co-morbidity make the art of managing
the geriatric patient akin to spinning
plates; when one problem is sorted,
another one appears.
Clive Elwood works in a large referral
practice that sees over 4000 new cases
per year, many of whom have multiple
clinical problems. Rory Bell is in charge
of one of the busiest internal medicine
referral services in the UK. Between
The number of geriatric cats in the UK is
increasing and cat owners want and
expect excellent health care, tailored to
meet the specific requirements of their
aged cat. Recently a number of
advancements have been made in feline
geriatric medicine, including new
strategies to improve recognition and
treatment of chronic pain and measures
to optimise renal care that are tailored to
the individual animal. These updates will
be discussed in detail during the course.
The themes of the other lectures
concentrate on the most commonly seen
problems in geriatric cats, including an
update on hyperthyroidism,
hypertension, renal disease and the
diagnostic approach to the cat
presenting with weight loss.
While anaesthesia and sedation
are commonly required for geriatric
them Clive and Rory have over 20 years of
clinical experience in canine referral
medicine.
This 1-day course will use a
combination of lecture material and
interactive case management scenarios to
deliver practical and useful advice on how
to approach this expanding branch of
canine medicine. Covering such diverse
yet inter-related topics as GI, renal, urinary,
endocrine, cardiac and CNS disease,
Clive and Rory will guide the delegates
through the difficulties and conflicts
encountered when trying to manage these
cases optimally.
Given the risks of destabilising what
can be a very delicately balanced
management, the emphasis will be on
animals, they undergo unique
physiological changes that can make safe
and effective analgesia and anaesthesia
challenging. A lecture on geriatric cat
anaesthesia will increase understanding
of the physiological changes of aging
and promote confidence in anaesthetising
this patient population safely. Medical
lectures about hyperthyroidism and
chronic renal failure will be linked with
information about appropriate anaesthetic
management of these cases. Tips about
how to carry out nerve blocks for dental
procedures will be given.
The course speakers, Angie Hibbert
and Jo Murrell, are specialists in feline
medicine and in anaesthesia and
analgesia, respectively, and therefore
together can provide a unique practical
guide to the management of both healthy
and diseased geriatric cats.
OLD DOGS AND NEW TRICKS: CANINE GERIATRICS
OPTIMISING VETERINARY CARE: THE GERIATRIC CAT
The course will be designed to
promote interaction between the
speakers and delegates in order to
maximise information transfer during
the day. A number of case-based
scenarios will be used to ensure
clinical applicability and give the
delegates a number of top tips that they
can immediately apply to their geriatric
cat caseload. n
Date: Tuesday 24 May
Venue: Kettering Park Hotel
& Spa
Speakers: Angie Hibbert
and Jo Murrell
Fees:
BSAVA Member: 213.83
Non-member: 320.74
Date: Tuesday 21 June
Venue: Kettering Park Hotel
& Spa
Speakers: Rory Bell
and Clive Elwood
Fees:
BSAVA Member: 213.83
Non-member: 320.74
taking a holistic approach, and the
guiding principle throughout will be
First do no harm. Delegates should
come away from the course enthused
and empowered to improve their
practice in this challenging yet
rewarding area. n
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FORMULARY
New Formulary
for 2011
I
t seems like only yesterday that I was
handed my copy of the 6th edition of the
BSAVA Small Animal Formulary (forever
to be known as the bright pink one) at
BSAVA Congress. It was my first edition at
the helm of the publication and I was
looking forward to a long rest. Yet here we
are again with another new edition (the red
one). The cover might not be as shocking
as its predecessor, but its colour will still
make it immediately identifiable on the
practice pharmacy shelf.
Like its predecessor, this edition is a
source of considerable pride to the BSAVA
and is one of the most highly valued
benefits of BSAVA membership. Editing this
piece of BSAVAs family silver has been a
privilege. Yes, it is hard work but I also
learn a lot in the process. In particular I
spend a lot of time reviewing the evidence
base behind many drugs. In some cases it
is very good, but all too frequently the
doses of drugs turn out to have been
empirically derived (that means guessed
in plain English) and simply never
challenged or checked. Rather worryingly
(or at least you should be worried), the
situation in human medicine is not much
better. Many doses are based only on
experimental animal studies. However, this
is often quite helpful for those vets faced
with certain exotic species!
Editorial board
Work on this latest edition of the BSAVA
Small Animal Formulary involved more than
20 people. The scientific editors were
recruited from academic, private referral
and first opinion practices. All are experts in
their various fields, with a wide range of
experience and knowledge. Work started in
earnest after BSAVA Congress 2010 and
most of the monographs were reviewed and
rewritten where necessary by October of
last year. The hardest decisions are those
that involve a drug that is still available
being omitted from the book. Some drugs in
the Formulary seem to persist without
actually being used. How many vets have
used acarbose in the last 10 years?
Additions to the Formulary
Over 20 new drugs have been added to
this edition of the BSAVA Small Animal
Formulary. Many of these drugs, such as
robenacoxib, chitosan and masitinib, have
become available for veterinary use since
the publication of the last edition. Others,
such as several antiepileptics, have been
included on the basis of new evidence of
efficacy in cases for which authorised
Ian Ramsey, Editor-in-Chief of the BSAVA Small
Animal Formulary, describes the new edition and
outlines the ongoing online developments for this
indispensible drug guide
medications are not available, have not
worked or are contraindicated. The
handling of cytotoxic drugs by veterinary
practices is likely to come under increasing
scrutiny in the coming years. For this
reason our new oncology editor, Jenny
Helm, has rewritten the guidelines in line
with current European College
recommendations. The sedative protocols
have been overhauled as well. Innovation
comes in the form of a table of emergency
drugs inside the front cover.
Removed from the Formulary
Each edition brings its fair share of
goodbyes as well as hellos. This edition
is no exception. So it was a sad goodbye
to more than a dozen drugs, most of which,
in truth, will not be missed. However, the
loss of thiopental (thiopentone) sodium, the
anaesthetic induction agent that anyone
over the age of 35 would have learnt as
the standard, should surely not pass
without comment. Intraval Sodium (as it
was always known) was the Rapinovet of
its day. It was a drug that each small
animal practitioner could expect to use
every working day. Safe and effective, it
has simply been surpassed by newer
alternatives and is no longer commercially
available in the UK.
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FORMULARY
25 NEW
ADDITIONS
Alpha-casozepine
Arginine
Chitosan
Domperidone
Felbamate
Glutamine
Immunoglobulins
Lanthanum carbonate octahydrate
Levetiracetam
Masitinib mesylate
Mavacoxib
Miltefosine
Mirtazepine
Mitoxantrone
Pholcodine
Pregabalin
Pyriproxyfen
Robenacoxib
S-Adenosylmethionine
Sevelamer hydrochloride
Silybin
Sodium valproate
Toceranib
Topiramate
Zonisamide
Members who did not collect
their copy of the new edition
of the Formulary at Congress
will be sent it in the post by
the end of May.
Keeping up to date
Over the years new drugs come and old
drugs go, but when it comes to their trade
names and availability, the speed of
change is much faster. Keeping track of
what is available (and what the trade names
are) is a substantial task on its own.
However, the improvements in the
Veterinary Medicines Directorates
website (www.vmd.gov.uk) have made
the process simpler and the NOAH
website (www.noah.co.uk) and the British
National Formulary website (www.bnf.org)
continue to be very useful sources for the
editor and authors.
Future developments
In addition to the PDF
version, all members will
also have access to the new
online searchable version of
the 7th edition of the BSAVA
Small Animal Formulary.
This will have all the
information that is currently
available in the Formulary,
plus sources of information
(references and further
reading), a classification
system based on the
therapeutic action, and
ultimately links to other
useful resources. Watch out
for announcements about
further online
developments.
Acknowledgements
I would like to thank my
fellow editors for their
efforts and all those people
who contacted me. We
continue to strive towards
perfection in the Formulary,
knowing that we can never
achieve it, but learning so
14 REMOVALS
Acarbose
Bromocriptine
Dextrans
Febantel (now covered under pyrantel)
Glibenclamide
Glycerol
Isosorbide dinitrate
Mebendazole
Methyltestosterone
Streptokinase
Thiopental
Thiostrepton
Vedaprofen
Warfarin
much on the journey and hopefully
providing the BSAVA members with a
fantastic resource. If you do think we have
missed out something, or you spot an
error, then please contact us at
formulary@bsava.com.
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CLINICAL CONUNDRUM
Clinical
conundrum
Mark Longley and Kinley Smith of Glasgow
Vet School invite companion readers to
consider a case of progressive lameness in
a Cavalier King Charles Spaniel
Septic arthritis can result in severely painful
swollen joints, often accompanied by non-weight-
bearing lameness. Staphylococcus and Streptococcus
spp. are commonly implicated. Most cases are
associated with a penetrating injury, though
haematogenous spread of bacteria to the joints is
more likely in cases of pre-existing OA. Where
haematogenous spread of infection is involved,
multiple joints may be affected.
Neoplasia (e.g. synovial cell sarcoma), though
capable of causing joint destruction and luxation in
some cases, is again unlikely to cause symmetrical
bilateral disease.
Immune-mediated polyarthritis usually affects
multiple joints, may be shifting in nature, and is often
symmetrical. The joints are usually swollen and the
severity of pain may be variable. In cases of
rheumatoid arthritis, destruction of ligamentous
structures of the joint may occur in end-stage disease,
resulting in luxation of the affected joints.
How would you investigate a bilateral
arthropathy?
Joint radiography and synoviocentesis are essential
diagnostic tools for the investigation of any arthropathy.
In addition, further investigation may include full
haematology and biochemistry, survey radiographs of
thorax and abdomen, and abdominal ultrasonography.
In this case, haematology and biochemistry results
were unremarkable.
What abnormalities are visible on the
radiographs?
Radiographs of the carpi are shown in Figures 1 and 2;
severe bilateral changes are evident. There is marked
soft tissue swelling around both carpi.
Antebrachiocarpal caudal subluxation and collapse
of the middle carpal and carpometacarpal joints is
present bilaterally. Both joints have multiple irregular
radiolucent foci affecting the subchondral bone of the
distal radial and ulnar epiphysis, the carpal bones and
the proximal metacarpals. There is periarticular new
bone formation suggestive of secondary OA.
Synoviocentesis of both carpi was performed.
There was an increased volume of low viscosity
synovial fluid. This fluid contained large numbers of
Case presentation
An 8-year-old male Cavalier King
Charles Spaniel was presented with
a 6-month history of progressive
forelimb lameness. Swelling and
pain were initially noted in the left
carpus, subsequently progressing
to involve the right carpus.
Meloxicam had been given to
control the clinical signs. Despite
some initial improvement, the
lameness continued to progress.
There was then a sudden
deterioration, with luxation of the joints.
On clinical examination, the dog had marked difficulty in ambulating.
There was hyperextension and varus deviation of both carpi, with
marked swelling, effusion and pain on manipulation. Other joints
were normal on examination. Rectal temperature and the remainder
of the clinical examination were normal.
Create a problem list for this patient
Carpal joint swelling and effusions (bilateral)
Hyperextension and varus of carpi (bilateral)
Carpal pain (bilateral)
What differentials would you consider?
Osteoarthritis (OA) is a common condition in older
dogs. The presence of OA in multiple joints is common
and results in joint effusion, stiffness and pain.
Collapse of affected joints is unlikely.
A traumatic incident could result in the sudden
onset of severe lameness, joint effusion and luxation,
but in this case there was no history of any such event.
Furthermore, such an event would be unlikely to be
preceded by a progressive lameness or have a
symmetrical pattern.
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CLINICAL CONUNDRUM
Figure 1: Dorsopalmar and lateral projections of the
left carpus
Figure 2: Dorsopalmar and lateral projections of the
right carpus
What are your differential diagnoses for
this dogs arthropathy?
Failure to demonstrate the presence of bacterial
involvement, together with the changes in the synovial
fluid, strongly suggests the presence of a
polyarthropathy. Typically, cell counts found in
polyarthropathies are higher (>5000 cells/mm
3
) than
those found in uncomplicated degenerative joint
disease (usually between 1000 and 5000 cells/mm
3
),
although septic joints usually also have very high
nucleated cell counts. Initial investigation of a
polyarthropathy involves differentiating the disease into
non-erosive and erosive forms.
In the early stages of the disease when there are
minimal radiographic changes it may be difficult to
separate erosive from non-erosive polyarthritis. In such
nucleated cells (20,000/mm
3
), predominantly
neutrophils with some mononuclear cells, and blood
was also present; no bacteria were visible. No bacteria
were grown from synovial fluid inoculated into blood
culture bottles.
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CLINICAL CONUNDRUM
Clinical conundrum
cases synovial membrane biopsy may be required to
make the diagnosis and allow the appropriate
treatment protocol to be initiated. In this case the
changes on radiography are consistent with an
erosive arthritis.
How would you investigate an erosive
arthritis?
The most common cause of bilateral erosive
arthropathy is rheumatoid arthritis. Joint infections
uncommonly cause erosive disease.
The diagnosis of rheumatoid arthritis (RA) is made
based upon the human system introduced in 1959 by
the American Rheumatics Association (ARA) (see
Table 1). Typically, the clinical presentation is of a
18-year-old, small breed dog showing signs of joint
pain in the distal joints. Initially a single joint may be
affected but as the disease progresses it becomes
bilaterally symmetrical. Clinical pathology is often
unremarkable or shows non-specific changes
consistent with inflammatory disease. Synovial fluid
analysis usually shows increased numbers of white
blood cells, mostly neutrophils.
Infections including Ehrlichia sp., Borrelia
burgdorferi and distemper virus have been implicated
in the aetiopathogenesis of both erosive and non-
erosive polyarthritic disease, although evidence for
their role in RA is limited. B. burgdorferi has been
identified as a possible cause of septic arthritis, and
this may be erosive. Erosive arthritis associated with
leishmaniasis has also been documented, and erosive
septic arthritis due to Erysipelothrix rhusiopathiae has
recently been described. Other forms of septic
arthritis, if chronic, may result in erosions.
Further investigation of this case is centred on:
investigating whether an infectious agent is involved;
and excluding other co-morbidities that might
influence treatment choices. Thoracic and hindlimb
radiographs were unremarkable. Abdominal
ultrasonography identified a small splenic nodule that
was sampled by fine-needle aspiration. Cytology was
suggestive of benign nodular hyperplasia. This was
considered to be an incidental finding and unlikely to
be associated with the musculoskeletal disease. PCR
tests for Borrelia and Ehrlichia were both negative.
Rheumatoid factor was 6u (<5u normal).
Diagnosis
The severely erosive changes visible on radiographs,
in conjunction with the joint fluid cytology and other
clinical findings, including elevated rheumatoid factor,
are diagnostic for RA. In this case, six of the ARA
criteria are met.
Pathogenesis
RA is a progressive condition in which inflammatory
cells invade the synovium. Granulation tissue
containing synoviocytes and other inflammatory cells
develops from the synovial membrane (pannus). These
cells release a variety of inflammatory cytokines and
enzymes that result in erosion of the articular cartilage
and subchondral bone. Ultimately this results in
weakening and rupture of the ligamentous structures
of the joint, leading to joint collapse and luxation as
seen in this case. Although the aetiology remains
obscure, it is believed that some form of antigenic
stimulus renders the synovium antigenic, leading to
binding of IgG, subsequent complement activation
and inflammation.
Table 1: ARA guidelines for diagnosis of rheumatoid
arthritis, adapted for veterinary use
Criteria:
Morning stiffness
Pain in at least one joint
Soft tissue joint swelling
Soft tissue swelling of at least one other joint
within 3 months
Symmetrical joint swelling
Radiographic changes evident (erosions of
subchondral bone and periarticular osteopenia)
Elevated levels of rheumatoid factor (RF)
Poor mucin clot on addition of acetic acid
Characteristic histopathology of synovial
membrane
For the diagnosis of RA to be made, a minimum of
five of the ARAs criteria must be present. When
more than seven are present the case is termed
classical RA. Some authors believe that at least two
of the bold criteria must be present to diagnose RA.
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CLINICAL CONUNDRUM
AVAILABLE
FROM BSAVA
Edited by: John Houlton,
James Cook, John Innes
and Sorrel Langley-Hobbs
Conditions of joints, bone, tendon
and muscle
Assessing and treating lameness
Focus on arthritis
Postoperative rehabilitation
Step-by-step illustrated Operative Techniques
BSAVA Member: 59.00
Non-members: 89.00
What is your choice of treatment?
The goal of treatment in RA is to slow the rate of
progression and alleviate the clinical signs associated
with the condition. It is important to inform owners that
progression is likely despite treatment. Many cases are
eventually euthanased due to inability to ambulate
and/or severe joint pain.
Treatment of RA is centred on the use of
immunosuppressive therapy. A variety of drugs have
been used to control the disease, although in most
cases progression is merely slowed rather than
prevented. Long-term prognosis is considered poor,
due to the severity of joint destruction in most cases.
The prognosis is best where minimal joint changes are
visible on radiography at the start of treatment.
Corticosteroid therapy alone is rarely sufficient to
control affected dogs and additional therapy is usually
required. A variety of cytotoxic agents have been used
as adjunctive therapy, including azothioprine,
cyclophosphamide, ciclosporin and gold salts. All of
these drugs may have significant side effects and it is
important to discuss these with the owner before
initiating therapy.
The aim with all of these treatments is to taper the
dose gradually to the minimum level required to
achieve control. Ideally, the success of therapy should
be assessed on the basis of synovial fluid analysis and
adjustments made as necessary. Initial assessment
should be made 1 month after the start of treatment.
Appropriate response to treatment (a decrease in
cellularity) allows tapering of the drug dose.
Analgesia is generally required in most animals
since the condition is often advanced at the time of
diagnosis, resulting in significant joint pain.
Synovectomy is reported as being beneficial in
cases that are diagnosed early. Stabilisation of luxated
or subluxated joints is an important element of
treatment, relieving the pain of severely affected joints.
Arthrodesis, with the incorporation of a bone graft,
would be the treatment of choice in an attempt to
salvage severely eroded joints. However, the potential
for complications following surgery is considerable,
both due to the underlying disease process and
immunosuppressive therapy being likely to result in
protracted healing.
Patient outcome
Ideally this dog would have had surgery for
arthrodesis of the carpi. Unfortunately, the quality of
the cortical bone in the proximal metacarpi and
carpal bones was very poor, causing concerns
over the feasibility of screw placement. This patient
was therefore a poor surgical candidate. Attempts
were made to stabilise the carpi using an external
carpal support (Carpo-flex, Vet Instrumentation)
to help reduce the pain associated with the
unstable joints.
The dog was treated with oral prednisolone
(2 mg/kg q12h) and ciclosporin (5 mg/kg q12h) in an
attempt to prevent further disease progression. He
was reassessed 1 month after initiation of treatment,
and synoviocentesis performed. There was marked
reduction in cellularity of the joint fluid. The dose of
prednisolone was reduced to 5 mg q24h for 2 weeks
then to 5 mg q48h. The ciclosporin was discontinued
at this time since there was no evidence of progression
to involve other joints.
The long-term prognosis for this dog is poor since
there is no hope of restoring function to the affected
joints and the carpal supports produced only mild
improvement in ambulation.
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HOW TO
How to
How to utilise blood
products in small animals
Gillian Gibson, clinical
pathologist at Axiom
Veterinary Laboratories,
helps us make the
most of this precious
resource
Blood component therapy
Initial blood collection, using a suitable
anticoagulant and collection system,
yields whole blood containing red blood
cells (RBCs), white blood cells (WBCs)
and platelets suspended in the liquid
plasma portion. Historically whole blood
has been most often administered to small
animal patients, often collected at the time
of need. However, blood components
can be separated using variable-speed
temperature-controlled centrifuges,
according to standard blood banking
protocols.
Advantages of component therapy include:
Specific replacement therapy only
giving the patient what is needed and
reducing the risk of transfusion reactions
One unit of donated blood can be used
to help more than one patient
Maximises the storage life of blood
products.
The production of components is
limited by the availability of specialist
equipment and skills (e.g. referral hospitals
with in-house blood banks) but, following
recent legislative changes, licensed UK
pet blood banks are now able to provide
components for more widespread use.
The components of whole blood most
often used in veterinary transfusion
medicine are RBCs and plasma products.
RBCs contain haemoglobin, which is
necessary for oxygen transport from the
lungs to the rest of the body. RBC
transfusions provide the recipient with an
additional red cell mass and consequently
increased oxygen-carrying capacity.
Plasma products are a source of
coagulation factors and various plasma
proteins that may be used to replace
them in states of deficiency. Platelet
products are not readily available and
will not be discussed here. Table 1
summarises the properties and uses of
different blood products.
Blood product preparation
To prevent microbial contamination of any
of the component products, a closed
collection system must be used, and the
transfer of the components from the
collection bag to the individual satellite
storage bags is achieved by a system of
integrated tubing (Figure 1). In these
closed systems there is no exposure of the
Figure 1: Closed collection system used for blood component processing
collection bag or its contents to air prior to
administration, other than when the needle
is uncapped to perform venepuncture at
collection.
The collection and processing of blood
components following appropriate
guidelines provides a supply of products
with little risk of microbial contamination
and maximal storage times. Plasma is
separated from the RBCs by
centrifugation; the red cells separate to the
bottom of the collection unit and the
plasma can be removed and stored
separately (Figure 2). The prepared units
are sealed with a hand held clip sealer or
heat sealer prior to storage.
If blood is collected into an open
system, one in which there is one or more
additional sites of potential bacterial
contamination during blood collection or
processing, all components must be used
within 24 hours. Using syringes with added
anticoagulant to collect blood is an
example of an open system.
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HOW TO
How to utilise blood
products in small animals
Figure 2: Separation of plasma and PRBCs. (A) Collection bags in a specialised variable-speed
temperature-controlled centrifuge. (B) Following centrifugation, the plasma component is gently separated
from the RBCs by gentle pressure. The plasma is transferred to a separate empty storage bag that is
connected to the original blood collection bag by integral tubing. (C) Plasma and PRBCs are stored
separately and may be used for different patients
A B C
Blood component Constituents/properties Storage Indications
Red blood cell products
Fresh whole blood
(FWB)
RBCs, platelets, coagulation
factors and plasma proteins all
present and functional
Must be used within 8 hours of
collection
Thrombocytopenia or
thrombocytopathia causing severe
uncontrolled or life-threatening
haemorrhage; anaemia with
concurrent coagulopathy
Stored whole blood
(SWB)
RBCs and plasma proteins, but not
functional platelets or coagulation
factors
Stored at 16C for approximately 28
days; depends on anticoagulant used
Anaemia with concurrent
hypoproteinaemia
Packed red blood
cells (PRBCs)
Red blood cells RBCs separated from plasma, stored at
16C for 20 days; or extended to 35
days with use of appropriate
preservative
Clinically symptomatic euvolaemic
anaemia (e.g. IMHA, non-regenerative
anaemia)
Plasma products
Fresh frozen plasma
(FFP)
All plasma coagulation factors,
including labile coagulation factors
V and VIII, and plasma proteins
Separated from PRBCs and frozen
within 8 hours of collection; stored at
20C for up to 1 year*
Acquired or inherited coagulopathies
(e.g. inherited factor deficiencies,
vitamin K deficiency, vitamin K
antagonist intoxication, DIC, severe
liver disease)
Stored frozen
plasma
Some vitamin-K dependent factors,
albumin and globulin
FFP >1 year of age, or plasma not
frozen within 8 hours, or FFP that has
been thawed and refrozen. Many useful
clotting factors and anti-inflammatory
proteins will have been lost. Stored at
20C for 5 years*
Vitamin K deficiency, vitamin K
antagonist intoxication,
hypoproteinaemia (colloidal support)
Cryoprecipitate
(CPP)
von Willebrand factor, factor VIII,
factor XIII, fibrinogen and
fibronectin
Extracted from FFP. Stored at 20C for
up to 1 year*
Replacement therapy for deficiencies
of von Willebrand factor, factor VIII
(haemophilia A) or fibrinogen
Cryosupernatant/
Cryo-poor plasma
Many clotting factors, including
vitamin K-dependent factors II, VII,
IX and X, other anticoagulant and
fibrinolytic factors, albumin and
globulin
Produced from a unit of FFP by
separation from CPP. Stored at 20C
for up to 1 year*
Coagulopathies or hypoproteinaemias
not requiring supplementation of the
CPP components
Table 1: Summary of blood component properties, storage requirements and indications for use. (*from date
of collection)
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HOW TO
Utilise blood products
in small animals
Storage of blood products
RBCs are refrigerated.
Temperature maintained at 16C,
checked daily with a refrigerator
thermometer.
A dedicated household refrigerator is
often suitable, as long as there is low in
and out traffic (e.g. it is not used for
storing frequently used products such
as vaccinations).
Store upright.
Plasma products are frozen.
Temperature maintained at 20C or
below, checked daily with a
thermometer to ensure maintenance of
adequate storage conditions.
A dedicated household freezer may
suffice, but the temperature within the
freezer may vary depending on the
storage compartment and it is therefore
important to check the temperature in
each compartment.
When the plasma is still liquid, an
elastic band is placed around the
middle of the bag to create an
indentation (waist) during freezing. The
band is removed once the unit is frozen
hard. Loss of this waist in a stored
frozen plasma unit suggests that the
unit has thawed and refrozen, which
could compromise the plasma quality.
Care should be taken not to drop the
frozen plasma units as they are
vulnerable to cracking.
Choosing the appropriate blood
product for the patient
RBC products
RBC products may be indicated in any
anaemic patient, regardless of the cause
of anaemia (haemorrhage, haemolysis or
impaired erythropoiesis) if they will
benefit from an additional red cell mass
and hence increased oxygen-carrying
capacity.
Tachypnoea
Tachycardia
Bounding or poor peripheral pulses
Pallor
Collapse
Lethargy or weakness
Decreased appetite.
Plasma products
Plasma products are most commonly used
to treat inherited or acquired
coagulopathies. Plasma is of little benefit in
hypoproteinaemic patients, and other
modes of therapy (synthetic colloids,
nutritional support) are recommended.
Administration of blood
products
Blood types are determined by species-
specific inherited cell surface antigens.
Incompatibility between species or
individuals may result in transfusion
reactions or neonatal isoerythrolysis. A
more in-depth discussion regarding blood
types and cross-matching may be found in
the BSAVA Manual of Canine and Feline
Emergency and Critical Care, 2nd edn.
However, these general guidelines should
be followed:
Canine
Blood type of donor and recipient
should be assessed prior to
transfusion.
If it is not possible to type the recipient,
ideally a DEA 1.1-negative donor
should be used.
DEA 1.1-negative recipients should
only receive DEA 1.1-negative RBCs.
DEA 1.1-positive recipients may receive
either DEA 1.1-negative or DEA
1.1-positive RBCs.
Feline
Incompatibility transfusion reactions
can be fatal.
There is no precise packed cell volume
(PCV) below which RBC transfusion should
be administered. Consideration of a
number of factors, including volume status,
rate of onset of anaemia, ongoing losses
and patient clinical condition, must
influence the decision to transfuse. General
guidelines are offered below.
PCV
Almost all patients with a PCV 12%
would benefit from a transfusion.
Any patient with a PCV 20% should
be considered a transfusion candidate.
Some patients with a PCV >20% may
benefit from a RBC transfusion (e.g.
acute haemorrhage with ongoing
blood loss).
Chronic anaemia is typically better
tolerated than acute anaemia due to
compensatory mechanisms.
Volume status
Animals with a reduced red cell mass
but a normal intravascular volume
(euvolaemic anaemia) may benefit from
a RBC transfusion but not require the
volume of accompanying plasma;
therefore a PRBCs transfusion would
be recommended. Examples would be
animals with immune-mediated
haemolytic anaemia (IMHA) or a
non-regenerative anaemia.
In animals with volume depletion as a
consequence of acute haemorrhage
(hypovolaemic anaemia), a whole
blood transfusion or the combination of
appropriate components (e.g. PRBCs
plus plasma) would be recommended.
Clinical signs
Clinical signs are the most important factor
in deciding when to administer a RBC
transfusion. The following signs suggest
that the patient may benefit from additional
oxygen-carrying support:
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HOW TO
Blood type of donor and recipient must
ALWAYS be assessed prior to
transfusion.
Type A cats should only receive type A
blood or plasma.
Type B cats should only receive type B
blood or plasma.
Type AB cats may receive either type
AB (preferable) or type A (acceptable)
blood and ideally only type AB plasma.
Cross-match recommendations
Cross-matching should be carried out:
Prior to first transfusion in cats
When the recipient has previously been
transfused (>4 days prior)
When there is history of a transfusion
reaction
If the patients transfusion history is
unknown.
Figure 3 provides a description of an
abbreviated in-house slide cross-match
method that may be used in an emergency
situation if laboratory services are not
available.
Route of administration
Blood products are usually
administered intravenously.
If venous access is not possible (e.g.
neonatal patient) the intraosseous route
may be used.
Blood products should not be given
intraperitoneally.
Filter
An in-line filter is required for all products
with a maximum size of 170260 m; this is
usually incorporated within a standard
blood infusion set.
Filtration removes any small blood clots
and particles that could be harmful if
infused into the recipient.
Microaggregate filters of 1840 m are
Figure 4:
Example of a
paediatric
blood filter that
may be used in
line with small
blood
transfusions
Figure 5: Formula for calculating the volume of whole blood required for transfusion
Volume (ml) =
85 (dog) or 60 (cat) x bodyweight (kg) x [ (desired PCV actual PCV) / donor PCV ]
available and can be placed in line
when infusing small volumes of
product or blood collected in syringes
(Figure 4).
Dose
The amount of product to be given greatly
depends on the product type, indication
1. Collect blood into an EDTA tube from recipient and donor.
2. Centrifuge tubes to settle the RBCs, remove the supernatant and transfer to a
clean, labelled glass or plastic tube.
3. For each donor prepare 3 slides labelled as major, minor and recipient control.
4. Place 1 drop of RBCs and 2 drops of plasma on to each slide according to the
following:
Major cross-match = donor RBCs + recipient plasma
Minor cross-match = recipient RBCs + donor plasma
Recipient control = recipient RBCs + recipient plasma
5. Gently rock the slides to mix the plasma and red cells and examine for
haemagglutination after 15 minutes (presence of agglutination indicates
incompatibility); recipient control agglutination will invalidate results.
Figure 3: Abbreviated slide cross-match procedure
for administration, and desired response in
the patient. A useful formula to calculate
the amount of whole blood required for
transfusion is noted in Figure 5. In general
most patients will receive:
Whole blood: 1022 ml/kg
PRBCs or FFP: 612 ml/kg
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HOW TO
Utilise blood products
in small animals
Product quality inspection
Stored RBC products should be
examined for any discoloration of the
cells or suspension fluid (e.g. brown
or purple) and the presence of clots, as
these changes may indicate bacterial
contamination, haemolysis or other
storage lesions.
Plasma bags should be examined for
evidence of thawing and refreezing
(disappearance of the waist), and
cracking or tearing of the bag.
Preparation
Stored RBC products need not be
warmed prior to use, unless they are
being given to very small animals or
neonates.
PRBCs stored without an added
preservative may be resuspended or
co-administered with 100 ml of
physiological saline to decrease
viscosity and improve flow (Figure 6).
Frozen plasma products are gently
thawed in a warm water bath. The
plasma bag should be placed inside a
sealed plastic bag prior to immersing in
the water bath to protect the injection
ports from possible microbial
contamination.
Method and rate of administration
Blood products are most commonly
infused by gravity flow, although
infusion pumps validated for the
administration of products may also be
used (see Figure 6).
Small volumes (<100 ml) are often
delivered by syringe driver or slow,
intermittent, small-volume bolus
injections (Figure 4).
Animals should not receive any food or
medications during a transfusion.
To prevent incompatibility reactions,
only 0.9% saline may be
simultaneously administered through
the same catheter as a blood product.
All infusions should be completed
within 4 hours.
The rate of administration is dependent
on the cardiovascular status of the patient,
and care should be taken when infusing
patients with risk of volume overload (e.g.
cardiovascular disease, renal failure).
During the first 20 minutes use an
infusion rate of 0.251.0 ml/kg/h.
If the transfusion is well tolerated, the
rate is increased to deliver the
remaining product over 4 hours.
NOTE: If the patient is at risk of volume
overload, do not exceed 34 ml/kg/h.
Monitoring the transfusion
patient
The patients vital signs should be
measured prior to (baseline) and every
1530 minutes during, as well as 1, 12
and 24 hours following the transfusion.
These include:
Attitude
Rectal temperature
Pulse rate and quality
Respiratory rate and character
Mucous membrane colour and
capillary refill time.
Any change in plasma or urine colour
indicative of haemolysis may be significant
and should be noted. Blood samples to
reassess PCV or clotting times are usually
obtained at some time point after
completion of the transfusion, unless
deterioration of the patient requires
otherwise. Repeating these parameters
provides an assessment of efficacy as well
as helps to determine whether a further
transfusion is required.
Transfusion reactions
Any undesired side effect noted as a
consequence of a blood product
transfusion is considered a transfusion
reaction. Reactions are classified as
immunological, non-immunological and
delayed. Prompt recognition and
treatment of potential adverse transfusion
reactions is essential.
Figure 6: PRBC transfusion being
administered to a dog. Note the use of a
specialised blood infusion set that allows
co-administration of physiological saline.
When a preservative has been added to
the PRBCs prior to storage,
co-administration with saline is not
required. An intravenous fluid pump
validated for the administration of red
cells is being used in this case
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HOW TO
REGISTERS AND BANKS
The Animal Blood Register (www.animalbloodregister.com) is a national donor
database for UK pets, and Pet Blood Bank (www.petbloodbankuk.org) is a not for
profit charitable organisation offering a full range of transfusion products. These
organisations give veterinary surgeons in practice previously unattainable access to
lists of matched donors and to blood products respectively. This freedom
from the necessity for individual practices to health screen and cross
match local donors and be proficient in blood collection allows the use
of blood products more widely than has previously been possible.
See the BSAVA Manual of Canine and Feline Haematology and
Transfusion Medicine and BSAVA Manual of Canine and Feline
Emergency and Critical Care for useful information.
RBC incompatibility reactions
(immunological) may cause acute
haemolysis and can be life-threatening.
Signs may include:
Pyrexia
Tachycardia
Tachypnoea
Weakness
Salivation/vomiting
Diarrhoea
Haemoglobinaemia
Haemoglobinuria.
Non-haemolytic immunological
reactions are acute allergic/anaphylactic
reactions, signs of which include:
Oedema
Erythema
Pruritus
Urticaria
Vomiting
Dyspnoea.
Non-immunological transfusion
reactions may often be avoided by
rigorous donor screening and adherence
to blood banking protocols. Such
reactions include:
Anaphylactoid (often a consequence
of rapid infusion rate)
Volume overload
Transmission of infectious disease
Hypocalcaemia (secondary to
excessive citrate anticoagulant)
Polycythaemia and hyperproteinaemia
(excessive volume of blood product
administered)
Dilutional coagulopathy
Microbial contamination (signs may be
similar to acute haemolytic reaction)
Hyperkalaemia, acidosis,
hyperammonaemia,
hypophosphataemia (storage lesions)
Air embolus.
Treatment of acute transfusion
reactions
1. Stop transfusion:
a In case of allergic/anaphylactic
reaction, if reaction subsides may
restart transfusion at 2550% of
previous rate
b If signs of acute haemolytic
reaction, do not continue with
transfusion.
2. Donor and recipient blood type,
product type and expiration date
should be confirmed, and a cross-
match may be performed (if not done
prior to transfusion).
3. Treat any clinical signs of shock,
including fluid therapy.
4. Antihistamines:
a Chlorpheniramine: Maximum
recommended dose 0.5 mg/kg
q12h (dogs and cats)
i. Dogs: small to medium,
2.55 mg/dog i.m. q12h
ii. Dogs: medium to large, 510
mg/dog i.m. q12h
iii. Cats: 24 mg/cat orally q12h.
b Diphenhydramine 12 mg/kg i.m.
q12h (dogs and cats).
4. Corticosteroids: Dexamethasone
0.51.0 mg/kg i.v.
5. Monitor for development of fluid
overload.
6. Monitor for development of hypotension
or oliguria.
7. Administer H
2
blockers, colloids,
dopamine and/or aminophylline as
needed.
8. Samples of both donor and recipient
blood should be evaluated for
haemolysis, and saved for microbial
culture and infectious disease testing
if required.
9. Broad-spectrum antibiotics may be
administered if bacterial contamination
is suspected.
Delayed haemolytic reactions may
be recognised by an unexpected
decline in the PCV or by jaundice
developing at some time 221 days
post-transfusion. These often do not
require any specific therapy.
Finally
It is important to note on the patients file
that it has received a blood product
transfusion, and to make the owner aware
that this information should be passed
along to other veterinary surgeons that may
be caring for their pet in the future.
PETSAVERS
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16+ category
1st Place In Love with My
Foster Mum by Mandy Fielding of
Middlesex
2nd Place Launch! by
Catherine Speakman of North
Yorkshire
3rd Place Golden in the
Snow by Andrew Hilton of
Shropshire
Junior category
1st Place Badger the
Surfer Mouse by Benedict
Coward, age 15 of Dorset
2nd Place Jack by the
River by James Arbuckle, age
14 of Mansfield
3rd Place Autumn
Shadows by Owen Arbuckle,
age 11 of Mansfield
E
ach year Petsavers runs a digital
photographic competition, inviting
entries from vets and their clients.
In a change to previous years, the 2011
competition did not have a theme,
which allowed entrants to submit any
picture that they felt demonstrated
their photographic expertise or
showed off the individual personality
of their much-loved pet.
This year the competition was a great
success with over 600 entries, many of
which were of an extremely high quality,
giving the judges a very hard task indeed.
However, we think that the winning
pictures are really great and hope you
will see that they made the correct
decisions. The photography competition
was open to all UK and Ireland residents
who are amateur photographers,
including pet owners, vets and veterinary
nurses. Entrants were judged in two
categories: adults (16 and over) and
junior (under 16s). Prizes have been
awarded in the form of photography
vouchers to the photographers of the top
three photos from each category: 1st prize
= 200, 2nd prize = 100, 3rd prize = 50.
The winning pictures were exhibited at
Congress but, in case you missed them,
here they are
Pet pictures
win prizes
And the winners of the 2011 Petsavers
photo competition are
For more details about Petsavers and submitting a picture for the 2012 competition
please visit www.petsavers.org.uk or email info@petsavers.org.uk
Improving the health of the nations pets
A
A
D
E
F
B
C
B
C
D
E
F
20 Petsavers.indd 20 21/03/2011 13:18
companion
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21
T
he WSAVA One Health Committee (OHC) held its
inaugural meeting over two days preceding the
NAVC meeting in Orlando, Florida, in January
2011. The OHC was launched officially at the 2010
Geneva WSAVA Congress.
One Health proposes the unification of the medical
and veterinary professions with the establishment of
collaborative ventures in clinical care, surveillance and
control of cross-species disease, education, and
research into disease pathogenesis, diagnosis, therapy
and vaccination. The concept encompasses the
human population, domestic animals and wildlife, and
the impact that environmental changes (environmental
health) such as global warming will have on these
populations. The WSAVA OHC was established to
ensure that small companion animals have a prominent
role in the global One Health agenda.
Progress towards
One Health
Michael Day reports on the
inaugural meeting of the
WSAVA One Health
Committee and the first One
Health conference
CORE MEMBERS OF
THE ONE HEALTH
COMMITTEE:
Michael J. Day (Chair; University of Bristol,
UK)
Jolle Kirpensteijn (WSAVA Board; Utrecht
University, the Netherlands)
Alex Thiermann (OIE; Paris, France)
Carol Rubin (CDC; Atlanta, USA)
Michael Lappin (Colorado State University,
USA)
Sarah Cleaveland (Glasgow University, UK)
Chand Khanna (NIH; Maryland, USA)
Clarisa Palatnik-de-Sousa (Federal University
of Rio de Janeiro, Brazil)
Umesh Karkare (Practitioner Representative;
Mumbai, India)
Members of the WSAVA One Health Committee at
the inaugural meeting: (L-R): J. Kirpensteijn,
M. Lappin, M.J. Day (Chair), C. Rubin,
C. Palatnik-de-Sousa, C. Khanna
2123 WSAVA News.indd 21 21/03/2011 11:56
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WSAVA NEWS
At the January meeting, the OHC agreed that there
are three key areas of One Health with which it should
engage:
The humancompanion animal bond
Comparative and translational medicine
Zoonotic infectious disease.
It was decided that the initial focus of the
committee will be in the area of zoonotic infectious
diseases. There are already many excellent initiatives
related to key zoonotic diseases (in particular rabies)
and the committee will endorse and support such
initiatives.
The strength of the WSAVA lies in scientific
education and communication, and an immediate
output from this committee will be the provision of
quality information for the global practitioner network.
In order to disseminate the One Health message and
such information, the OHC has established a web
page (accessible from the WSAVA website) and has
registered the first One Health Facebook page.
WSAVA members should check the OHC website for
the latest One Health information and are encouraged
to interact directly with us through Facebook.
The WSAVA OHC has already had one review
paper published (Veterinary Record 2010; 167: 847)
and has another in press (Parasites and Vectors). The
committee presented two papers at the 1st
International One Health Conference in Melbourne,
Australia, in February 2011, ensuring that companion
animals are strongly represented in this first truly
global discussion of One Health.
The committee also decided that, in order to raise
the global profile of the One Health initiative, a WSAVA
Global One Health Award will be established. This
award will be given to an individual who is very
prominent in One Health and will be presented at the
WSAVA Congress accompanied by a One Health
lecture. A second award will be made to the Congress
presentation that best encapsulates the One Health
philosophy; it is hoped that this will encourage younger
members of the profession to engage with One Health.
The next meeting of the OHC will be held at the
Centers for Disease Control and Prevention in Atlanta,
Georgia, in the autumn of 2011.
The work of the WSAVA OHC is made possible by
a consortium of industry sponsors who have
contributed to the WSAVA Foundation specifically to
fund this project. The OHC is grateful to our sponsors
who include at the time of writing (in alphabetical
order): Bayer Animal Health, Hills Pet Nutrition,
Whos
speaking
on skin?
A preview of the
dermatology sessions to
be held at the 2011
WSAVA World Congress
in Jeju, Korea
Masahiko Nagata
ASC, Japan
Lecture topics:
Clinical approach to
pruritus in dogs
Clinical approach to
alopecia in dogs
Ralf Mller
Ludwig Maximilian
University Munich, Germany
Lecture topics:
Atopic dermatitis in dog
and cat An itchy problem
Adverse food reaction in dog and
cat Food for thought
Fungal skin disease in dog and cat
Can look like any dermatitis
Sonja Zabel
Colorado State University,
USA
Lecture topics:
Shampoo and topical
treatment
Common feline skin disease
Pyoderma
Chiara Noli
European Society of
Veterinary Dermatology, Italy
Lecture topics:
Demodicosis in dogs
and cats: how to diagnose and treat
it successfully
Cytology in dermatology: how to
perform and interpret it correctly
2123 WSAVA News.indd 22 21/03/2011 11:57
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|
23
WSAVA NEWS
Volcano Fountain
Show at Lotte Hotel,
Jeju
2011 WSAVAFASAVA WORLD
CONGRESS SECRETARIAT
Sun-in Bldg. 773-7 Yeoksam-dong, Gangnam-gu,
Seoul, Korea
Tel: +82-2-3461-1140
Fax: +82-2-3461-1340
Email: wsava2011@unineo.com
Official website: www.wsava2011.org
Intervet/Schering-Plough Animal Health, Mrial, Nestl
Purina, Novartis Animal Health, Pfizer Animal Health,
Waltham and the WSAVA itself.
One Health conference
The Commonwealth Scientific and Industrial Research
Organisation (CSIRO) recently hosted the 1st
International One Health Congress in Melbourne,
Australia (1416 February 2011).
Over the past few years, the One Health concept
has brought together experts working in the areas of
animal and human disease. One Health has provided
a new synthesis for public health and veterinary
communities, particularly in the United States, Europe
and Australia. However, there is an urgent need and a
growing interest to broaden the agenda to incorporate
a truly global perspective and to include
environmental issues.
This 1st International One Health Congress aimed
to achieve these goals by focusing clearly on the risks
and challenges brought about by the interactions
between animal and human health and the
environment. These were considered in the general
context of the science and research being undertaken,
but critically the focus was on the outcomes that need
to be achieved to manage the growing risks to global
health effectively.
Speakers included:
Laureate Professor Peter Doherty
Dr Alex Thiermann
Dr Henrik C. Wegener
Professor Mark M. Rweyemamu
Dr David Heymann
Professor John Mackenzie
Dr Peter Daszak
Dr Martyn Jeggo
The Congress programme featured keynote plenary
sessions, expert panel/debates, Out of the Box
Sessions and the development of outcomes across the
following themes that ran throughout the Congress:
Setting the scene
Disease emergence
Environmental drivers
Trade, food security and food safety
Science, policy and political action
Global survival
The Fountain Show recreates the spectacle of a
volcanic eruption and was produced by SPECTRA
Company, the producer of the Volcano Show at Mirage
Hotel in Las Vegas. It describes the battle between the
spirits of water and fire, the natural forces that formed
the ancient Jeju, and the giant dragon that suppressed
the battle. The Fountain Show features dazzling
special effects such as an exploding rocky mountain
and a fire-breathing dragon. The 12-minute
performance begins at 8:30pm every day in the
outdoor garden on the 1st floor of Lotte Hotel, Jeju.
KEY DATES REMINDER
Early Bird: Ends 30 April 2011
Pre-Registration: 1 May30 September 2011
Visit www.wsava2011.org to register or find
more information.
2123 WSAVA News.indd 23 21/03/2011 11:57
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companion
THE companion INTERVIEW
Sue Shaw
BVSc(Hons) MSc DipACVIM DipECVIM-CA
FACVSc Cert Arts (Arch) MRCVS
Q
You have become known within
the profession through your
work in highlighting the threat
from exotic diseases. How did you
become involved in that area?
A
Prior to arriving in the UK, I had
travelled and trained in countries
where a wide variety of infectious
diseases were present, and lectured in this
subject while at Murdoch. It was an
unusual situation for me to work in a
country where infectious diseases were
primarily viral and limited by vaccination;
the rest were considered exotic. This
changed in 1998 with the Kennedy report
and I expected there to be a rapid increase
in exotic diseases being imported into the
UK. I established the Acarus Laboratory in
1999 as I knew there would be demand for
information and diagnostics.
Were you in practice earlier in your
career?
Yes, about five years of private practice in
Australia including 18 months in mixed
practice in southern Tablelands of NSW,
12 months of locums travelling throughout
Australia and two years in exclusive small
animal practice in Melbourne.
What do you consider to be your most
important achievement during your
career?
Establishing the Acarus Laboratory.
What has been your main interest
outside work?
Landscape archaeology as it relates
especially to buildings. They are still
standing and so can be studied using
techniques that are not invasive, i.e. no
destructive excavation. I have special
interest in old maps and relating these to
existing landscape features around villages.
Where and when were you happiest?
I am happiest outside in the landscape with
a map and book for wildlife identification.
The western coastal landscapes of UK and
Ireland are favourites.
Sue Shaw was born in Sydney and grew up in
Canberra and Launceston, Tasmania. Her father was
a teacher and her mother a physiotherapist. She has
two siblings, a brother and a sister, both younger.
She graduated in veterinary medicine from the
University of Sydney in 1973 and then spent six
months backpacking around Europe. She gained
postgraduate qualifications in the US before returning
to Australia in 1982 to take up a lectureship in small
animal medicine at Murdoch University in Perth,
Western Australia. In 1991 she moved to the UK and
was senior lecturer, Department of Clinical Veterinary
Science, University of Bristol until her retirement in
December 2010. She is a diplomate of both the
American and European Colleges of Veterinary
Internal Medicine and Fellow of the Australian College
of Veterinary Scientists. At Bristol her research
interests were in the epidemiology and
immunopathogenesis of vector-borne and zoonotic
infectious diseases of dogs and cats. She also set
up the Acarus Unit for investigation of companion
animal arthropod-borne infections. She has been an
independent member of the Veterinary Policy Group
of the BVA and was a much-valued chairman of the
BSAVA Scientific Committee
24-25 Interview.indd 24 21/03/2011 11:58
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25
NI CONGRESS
BSAVA
Northern
Ireland
Congress
F
ollowing an extremely
successful conference last
year, BSAVA Northern Ireland is
looking forward to returning to
Belfast for our 2011 Congress. Our
conference will be held over the
weekend of 2022 May 2011 in the
Europa Hotel, Belfast.
We will be concentrating on all
things orthopaedic this year and we
are delighted to welcome the Bionic
Vet himself, Noel Fitzpatrick, to give
the veterinary lectures. He will be bringing us right up to date with current procedures for
the common orthopaedic conditions encountered in practice.
As always, the BVNA are holding their conference alongside us and they will also carry
the theme of orthopaedics. The nursing lectures will be given by Julian Hoad, whose
enthusiasm for his subject ensures that he is always a popular lecturer.
We are looking forward to our return to the Europa Hotel in Belfast. Its recent
refurbishment affords us excellent conference facilities in luxurious surroundings. In
particular, we will have a first-class exhibition hall for our Trade Exhibition which will also
include a nail bar and cocktail masterclasses, which have proved extremely popular.
Alongside the first-rate CPD on offer, we will be kicking up our heels at our Annual
Gala Dinner. This is held in the opulent Grand Ball Room in the Europa and will be
followed by dancing the night away to the live five-piece band Brazil.
Holding our conference in Belfast provides convenience for our vets and nurses in
Northern Ireland to access high-quality CPD. However, with Northern Irelands two main
airports within 30 minutes of the hotel and the ferry terminal only a bus ride away, this
conference is also a great option for our colleagues on the mainland. Only a short flight
from the UK and you have a great weekend break in Belfast along with superb,
cost-effective CPD what more could we ask for?!
You can register for the BSAVA Northern Ireland weekend conference by visiting the
BSAVA website www.bsava.com or by returning the registration form on the back of
the conference brochure, which you can also download from this website.
Who has been the most inspiring
influence on your professional career?
Professor Bill Clark at Murdoch for all
aspects of teaching and Professor Ed
Breitshwerdt for vector-borne diseases.
What was your most important
decision, and why?
Moving from Australia to the USA for
my postgraduate training. There were
no opportunities in Australia for
residency training in small animal
medicine at that time.
What has been the most frustrating
aspect of your working life?
Trying to keep up with university
expectations in all three areas;
clinical, research excellence and
teaching, at the same time as coping
with the insidious increase in
administrative duties associated with
increased student/staff ratio.
What is the most significant lesson
you have learned so far in life?
If youve achieved all that you can in a
phase of your life, dont hang round
harking back to the old days. Move on to
another challenge.
If you were given unlimited political
power, what would you do with it?
Drop it and run fast in the opposite
direction!
If you could change one thing about
your appearance or personality, what
would it be?
I would wear my heart on my sleeve less
often and shut up more frequently!
What is your most important
possession?
My dual passports.
What would you have done if you
hadnt been a vet?
Landscape historian involved in
interaction between conservation and
sustainability.
PRICES
BSAVA Members Non-members
EARLY BIRD PRICES (before 9 April 2011)
Whole weekend 260 440
Friday pm 90 150
Saturday 160 280
Sunday am 90 150
LATE REGISTRATION PRICES (after 9 April 2011)
Whole weekend 320 500
Friday pm 120 180
Saturday 190 310
Sunday am 120 180
B
e
l
f
a
s
t

C
a
t
h
e
d
r
a
l
:

J
o
s
e
m
a
r
i
a

T
o
s
c
a
n
o

|

D
r
e
a
m
s
t
i
m
e
.
c
o
m
if youve achieved
all that you can in a
phase of your life
move on to another
challenge
24-25 Interview.indd 25 21/03/2011 11:58
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companion
REGIONS
BSAVA Northern Ireland
Committee

Kerensa Scott Chair
Kerensa qualified from Liverpool in
2000. She spent 4 years in mixed
practice, including TVI work during the
FMD outbreak. She also practiced in
Australia and New Zealand. She has
since concentrated on small animal
practice. She has recently opened her
own practice and is enjoying the
challenges of running her own ship.
When not working, she spends much of
her time stopping her 2-year-old son
doing whatever it is hes not meant to be
doing. Sometimes she finds time for a
yoga class or a walk along the beautiful
East Antrim coast where she lives. She
dreams of snowboarding holidays and
sunny beaches in no particular order of
preference.

Barbara McConnell Lowry
Treasurer
Barbara graduated in 2002 from
Edinburgh University and after 4 years
in mixed animal practice, she opened
her own small animal clinic. She
combines this with some work as a TVI
in the local Southern Ireland abattoirs.
She is married to a farmer and has two
small children aged 2 and 3 years. She
has been a BSAVA regional officer for
4 years and is currently Treasurer.

Lynsey Hamilton Secretary
Lynsey qualified from the Royal
Veterinary College, London in 2001.
Since then she has worked in small
animal practice and currently works in an
8 vet first opinion and referral small
animal clinic in Belfast. Lynsey gained
her General Practitioner Certificate in
Small Animal Medicine in 2007 and still
enjoys regular CPD on this topic.

Laura Wallace Committee
member
Laura graduated from University College
Dublin in 2006. She initially worked in
mixed practice on the Tyrone Donegal
border before joining a small animal
practice in Belfast in the summer of
2009. Being the most recent recruit of
the veterinary team she states I enjoy
being part of such a large and busy
practice, availing myself of the
knowledge and skills of my experienced
colleagues. Outside of work she enjoys
the outdoors, country walks with her
hubby and black lab, the occasional
weekend of retail therapy...with her most
recent interest being in the restoration of
old furniture!!

Joan Hilland Committee
member
Meet
Your
Region
Northern Ireland
ADDITIONAL 2011
NORTHERN
IRELAND CPD
COURSES
Thursday 5 May
Day Meeting
Dispensing
Speakers: John Hird, Philip Sketchley,
Steve Dean, Fred Nind, Pam Mosedale
and Mike Jessop

Park Plaza, Belfast International
Airport BT29 4ZY
Thursday 8 September
Evening Meeting
Wound management
Speaker: Georgie Hollis

VSSCo, Lisburn BT28 2SA
Thursday 6 October
Evening Meeting
Abdominal surgery
Speaker: Liz Welsh

VSSCo, Lisburn BT28 2SA
Thursday 3 November
Evening Meeting
Cardiology
Speaker: Alistair Gibson

VSSCo, Lisburn BT28 2SA
Thursday 1 December
Evening Meeting
Forensics and the law
Speakers: John and Margaret Cooper

VSSCo, Lisburn BT28 2SA
For further information on events in
the Northern Ireland Region, email
nirelandregion@bsava.com, or visit
the www.bsava.com .
As part of a continuing series, this month
companion features Northern Ireland Region
26-27 Diary.indd 26 21/03/2011 11:59
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|
27
CPD diary
DAY MEETING
SURREY AND SUSSEX REGION
Thursday 21 April
Body cavity effusions
Speakers: David Walker and David Killick
Leatherhead Golf Club, Kingston Road,
Surrey KT22 0EE
Details from surreyandsussexregion@bsava.com
EVENING MEETING
NORTH EAST REGION
Thursday 5 May
The downside of foreign travel
Speaker: Susan Shaw
IDEXX Laboratories Wetherby,
Grange House, Sandbeck Way, Wetherby,
West Yorkshire LS22 7DN
Details from northeastregion@bsava.com
DAY MEETING
METROPOLITAN REGION
Sunday 8 May
Feline endocrinology
Speakers: Hattie Syme and Lucy Davison
Holiday Inn, Elstree, Barnet Bypass,
Borehamwood WD6 5PU
Details from metropolitanregion@bsava.com
WEEKEND MEETING
NORTHERN IRELAND REGION
Friday 20 Sunday 22 May
Northern Ireland 2011 Congress
From Bone to Bionic
Speaker: Noel Fitzpatrick
Europa Hotel, Great Victoria Street,
Belfast BT2 7AP
Details from nirelandregion@bsava.com
DAY MEETING
SOUTH WEST REGION
Monday 9 May
Two Sides to Every Story
Medical and surgical management
of tumours
Speakers: Tom Cave and Prue Neath
Redwood Hotel and Country Club,
Bristol BS8 3TG
Details from southwestregion@bsava.com
DAY MEETING
SOUTH WEST REGION
Monday 23 May
Two Sides to Every Story
Use it or lose it: management,
surgical and rehabilitation care of
the spinal patient
Speakers: Helen Mathie and Malcolm McKee
Hallmark Hotel, Gloucester GL4 6EA
Details from southwestregion@bsava.com
EVENING MEETING
SOUTH WEST REGION
Monday 23 May
Itchy dogs and cats
Speaker: Natalie Perrins
Room 011, Roland Levinsky Building,
Drake Circus, Plymouth University, Plymouth,
Devon PL4 8AA
Details from southwestregion@bsava.com
DAY MEETING
EAST ANGLIA REGION
Sunday 22 May
Cardiology
Speakers: Simon Swift and Sonja Fonfara
The Cambridge Belfry, Cambourne,
Cambridge CB23 6BW
Details from eastanglia.region@bsava.com
EVENING MEETING
MIDLAND REGION
Tuesday 17 May
Surgical update
Speaker: John Williams
The Hilton Warwick, A429 Stratford Road,
Warwick, Warwickshire CV34 6RE
Details from midlandregion@bsava.com
DAY MEETING
SURREY & SUSSEX REGION
Wednesday 18 May
Avian medicine
Speaker: Simon Girling
Holiday Inn Gatwick Airport, Povey Cross
Road, Horley RH6 0BA
Details from surreyandsussexregion@bsava.com
EVENING MEETING
SOUTHERN REGION
Wednesday 4 May
Practical tips on emergency
procedures
Speaker: Dominic Barfield
Potters Heron Hotel, Romsey SO51 9ZF
Details from southernregion@bsava.com
EVENING MEETING
MIDLAND REGION
Wednesday 4 May
A practical approach to collapse
and exercise intolerance in
small animals
Speaker: Malcolm Cobb
Best Western Premier, Yew Lodge Hotel,
Kegworth, Derby DE74 2DF
Details from midlandregion@bsava.com
DAY MEETING
Tuesday 26 April
Respiratory diseases of dog and
cat: a comprehensive review
Speaker: Brendan Corcoran
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Thursday 5 May
BSAVA Dispensing Course
Speakers: Phil Sketchley, Steve Dean,
John Hird, Fred Nind, Pam Mosedale and
Mike Jessop
Park Plaza Hotel, Belfast Airport
Details from administration@bsava.com
DAY MEETING
Tuesday 10 May
Emergency medicine part II:
trauma patients
Speakers: Sophie Adamantos and Dan Chan
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Thursday 12 May
Seizures: managing your epileptic
nightmare
Speaker: Mark Lowrie
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Tuesday 24 May
Too much fluid, too low flow:
caring for the patient with
heart disease
Speaker: Jo Dukes McEwan
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Wednesday 25 May
Advanced pain nursing
Speakers: Gwen Covey Crump and
Vicky Ford Fennah
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Tuesday 24 May
Geriatric cats
Speakers: Angie Hibbert and Jo Murrell
Kettering Park, Northants
Details from administration@bsava.com
DAY MEETING
Thursday 28 April
Endocrinology II: endocrine
emergencies, collapse and effect
on blood pressure
Speaker: Mike Herrtage
Radisson SAS, Manchester Airport
Details from administration@bsava.com
EVENING MEETING KENT REGION
Wednesday 4 May
CSI for vets: forensics and the law
Speakers: John and Margaret Cooper
Hilton Maidstone Hotel, Bearsted Road,
Weavering, Maidstone, Kent ME14 5AA
Details from kentregion@bsava.com
26-27 Diary.indd 27 21/03/2011 11:59
For more information or to
book visit www.bsava.com,
email administration@bsava.com
or call the Membership and Customer
Services Team on 01452 726700
seizures
Managing your
worst epileptic nightmare
with Mark Lowrie
Thursday 12 May 2011
Woodrow House, Gloucester
Fees:
BSAVA Member: 218.00
Non-member: 327.00

With an insightful video tour of
seizure-mimicking events in dogs
and cats, this interactive day
course aims to provide the general
practitioner with tips and tools for
managing these difcult cases,
which will help them to apply a
logical step-wise approach and
take realistic management plans
back to the practice.
28 OBC.indd 28 21/03/2011 12:00