The essential publication for BSAVA members

Keeping Britain Safe

UKs defence against
imported disease
P4
How to
Manage lymphoma
cases
P12
companion
AUGUST 2009
Blood typing
For blood transfusions
P21
Investigation of
a depressed and
vomiting cat
companion
2 | companion
3 Association News
Introducing the International
Affairs Committee
46 Keeping Britain Safe
Defending the UK from
imported diseases
7 BSAVA Expands
CPD Roadshows
Haematology, Feline Infectious
Disease and Orthopaedics
811 Clinical Conundrum
Consider investigation of a
depressed and vomiting cat
1215 How To
Manage the systemically
unwell, substage b, case of
canine lymphoma
1618 GrapeVINe
From the Veterinary
Information Network
1920 Barrier Nursing
Paula Hotston Moore explains
the role of barrier nursing
2122 Petsavers
Latest fundraising news
2325 WSAVA News
The World Small Animal
Veterinary Association
26 The companion Interview
Maggie Fisher
27 CPD Diary
Whats on in your area
companion is produced by BSAVA exclusively for its members.
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B
y the time an Officer joins the Board
they are likely to have been
volunteering with the Association for
more than a decade. So why do they do it?
I first got involved in the regions largely
by accident, but quickly found I really enjoyed
meeting the other people on our committee
and influencing the kind of CPD I could
access in Scotland, says Richard Dixon,
current BSAVA President. Quickly I came
to really enjoy the camaraderie and
friendships I made and, as well as contributing
to something valuable in the profession, I
have made some great friends and had a lot
of fun albeit I never for a second imagined I
might end up being President. I have spent
time with some great people and learned a
huge amount from them, not to mention it
has been a great laugh!
How to get started
Like Richard, most of our volunteers, began
in the regions, where you really get to
influence the Association at grass roots
level creating relevant, valued CPD for
your local colleagues and obviously you
get to attend the courses free of charge
when you are on the committee. You will
get to help decide on subjects, speakers and
venues for courses, as well as influence the
wider activities in the Association the
views of our Regional Officers are key in
our decision making. If you want to know
more about volunteering in the regions then
ISSN 2041-2487
why not go along to your next regional
meeting (details online at www.bsava.com
and in the back of companion) or email
c.haile@bsava.com and we will put you in
touch with your relevant Chairperson.
Other opportunities
As well as the regions, the BSAVA is run by
a series of standing committees, including
Publications, Education, Scientific,
Congress and Membership Development
(see opposite for more information on
International Affairs). All are run by
volunteers. Each meet around 3 times a
year, in either London or Gloucester. The
Chairman for each committee sits on
Advisory & Management, the group that
represents the membership and leads the
agenda for the Association.
Whats in it for you?
As well as the opportunities to network
and the feeling of giving something back,
we like to think we look after our
volunteers well. Of course, all expenses are
reimbursed, so when you travel to a
meeting or stay overnight your costs are
covered, and we try to make any
committee fun as well as effective. Plus,
many key volunteer positions have free
Congress registration. So if you want to
know more and get involved wed like to
hear from you. Email c.haile@bsava.com or
call 01452 726717. n
The BSAVA is your Association, run by vets for vets.
We often get asked about how to get started as a
volunteer so heres what you need to know
companion | 3
ASSOCIATION NEWS
INTRODUCING THE
INTERNATIONAL
AFFAIRS
COMMITTEE
So that members can understand how the
Association works on your behalf, over the
coming months companion will introduce
the work of its various committees. Here is
what IAC is doing on your behalf
T
he International Affairs Committee (IAC) liaises between
BSAVA and international veterinary associations, providing
information and recommendations about issues in Europe
and worldwide that impact on the small animal practitioner. Also,
via its member representatives on various European and
international veterinary associations, IAC works to inform debate
on animal welfare and matters affecting the veterinary profession,
plus advancing the dissemination of veterinary scientific knowledge
internationally. IAC members ensure that communication is
maintained with other UK veterinary associations active
internationally, in particular working with the BVA and the RCVS
within the UK Coordination Group.
Recent issues for IAC include: lobbying to maintain the
derogation in order to decrease the risk of rabies, vector-borne
disease and Echinococcus multilocularis entering the UK; and also
raising concerns that the EU Animal Health Stategy, which covers
the health of animals transported to, from and within the EU,
concentrates on food-producing animals and therefore needs to
better safeguard and promote the welfare of companion animals.
Members of IAC also play a role in UEVP/FVE discussions on
professional codes of conduct, the provision of out-of-hours
emergency care and CPD requirements in the veterinary profession
throughout the EU.
IAC aims to promote veterinary CPD internationally. Each year,
a group of vets from another European country are invited to
BSAVA Congress, free of charge, providing them with an
opportunity to benefit not only from the scientific lectures, but also
to meet vets from many different countries and exchange
knowledge and experiences. BSAVA, via WSAVA, also contributes
funds for the provision of CPD in sub-Saharan Africa (information
about the latter is regularly published in the WSAVA News section
of companion). n
Acronyms:
FECAVA: Federation of European Companion Animal
Veterinary Associations
FVE: Federation of Veterinarians of the EEC (European BVA)
UEVP: Union European of Veterinary Practitioners
(European SPVS)
David
Wadsworth
As WSAVA
President,
Davids role is to
provide extra
insight into the
WSAVA and its activities during
his term of office.
Mike Jessop
Mike is BSAVAs
representative
for UEVP (Union
of European
Veterinary
Practitioners).
This is a committee to
represent the practitioners at
the Federation of Veterinarians
in Europe (FVE).
Jo Arthur
Jo is responsible
for informing
the BSAVA
membership of
the international
veterinary issues
dealt with by the other
members of the IAC, and
BSAVAs support (via IAC and
WSAVA ) of veterinary CPD in
other countries.
Kenelm Lewis
Kenelm is past
president of
SPVS and elected
to be SPVS
representative
at UEVP.
Julian Wells
The WSAVA is
represented on
IAC by Julian
Wells, the
BSAVAs WSAVA
Assembly
representative.
Richard Dixon
As President,
Richard sits on
IAC as the
BSAVA Officer.
The Officer is
there to bring a
more diverse experience
of other BSAVA activities
to IAC and help identify any
opportunities for collaboration
with other committees.
Alistair Gibson
Alistair recently
took on the role
of Chair of IAC,
co-ordinating all
activities of the
committee. He
has previously volunteered for
BSAVA in the regions and as
Public Relations Officer.
Stephen Ware
Stephen has
served IAC for
some years. As a
Vice-President of
FVE he acts as a
link between UK
interests (especially practitioner
interests) and the FVE.
Chris
Laurence
Pets in Europe,
a group of
companion
animal welfare
organisations, is
raising the profile of companion
animals in the EU.
As Chairman of PIE he has
common interests with IACs
European work and they work
closely together on issues such
as the PETS scheme.
Simon Orr
Simon is an
Officer of
FECAVA and a
BSAVA Past
President. This
liaison gives
BSAVA immediate access to the
FECAVA Board and from there
provides another avenue to
influence UEVP and FVE.
Wolfgang
Dohne
Wolfgang is
BSAVA
representative at
FECAVA and
responsible for
the Annual Visiting Program of
Veterinarians from Emerging
Veterinary Associations to
BSAVA Congress.
Andrew
Robinson
Andrew is
Secretary
General of
UEVP.
Want to get more involved with BSAVA?
For details about volunteering email Carole Haile
c.haile@bsava.com or call 01452 726717.
Whos who on IAC
4 | companion
DEROGATION
KEEPING BRITA IN SAFE
A
shford resident Mrs Janet Hunt
found a route into the veterinary
textbooks when she took her dog
for a walk along a pathway near a long
distance lorry park. It seems likely that
this is where the dog was bitten by a tick
which is presumed to have been brought
to Britain as an unwelcome passenger on
a vehicle arriving from the Continent.
As a result, Caffreys, a 10-year-old Welsh
Springer Spaniel, contracted the first case
of canine babesiosis to be confirmed in an
animal that had never travelled outside
the UK.
Mrs Hunt and her dog took their fateful
walk in 2005. Since then there has been no
evidence that an infective population of the
brown dog tick Rhipicephalus sanguineus
the normal host for the babesiosis parasite
has become established in Kent, or
anywhere else in the UK. The main factor
keeping the disease out of these islands is
the requirement for any dog entering the
British veterinary organisations were pleased with the
European Commissions proposal to extend the UK
derogation from EU harmonised rules on pet imports
until December 2011. This gives the BVA and BSAVA
more time to lobby for an effective system that facilitates
movement of animals into the UK without increasing the
risks of introducing exotic disease. Yet, whatever future
decisions are made in Brussels, our main defence against
imported disease will not be through international trade
rules but the professional skills of individual veterinary
surgeons. John Bonner reports
Caffreys, a 10-year-old Welsh Springer Spaniel that had the first case of canine babesiosis to be confirmed in an animal that
had never travelled outside the UK. Courtesy of Veterinary Record.
companion | 5
DEROGATION
KEEPING BRITA IN SAFE
country under the Pet Travel Scheme to
have been treated with an acaricide 24 to
48 hours before arrival.
The risks and you
As the Ashford incident showed, a treatment
given to animals entering these islands
through a properly regulated process will not
guarantee the UK and Irelands continued
freedom from canine babesiosis. So, in future
negotiations with EU partners, the pre-entry
acaricide administration could well be lost as
Britain may have to concentrate on
maintaining controls on other diseases such
as rabies and echinococcosis. Yet if that
element of the derogation is discarded,
there will be a significantly increased risk of
the condition becoming endemic. In that
event, small animal practices will have
responsibilities in both tracking the spread
of the disease and ameliorating its effects on
the native dog population.
Along with leishmaniosis, ehrlichiosis
and dirofilariasis, babesiosis is one of
those conditions present on the Continent
which Defra asks practices to monitor
through its DACTARI voluntary surveillance
scheme. As those practitioners who have
seen cases in animals entering Britain
through the PETS scheme will know, the
diagnosis and management of these diseases
can be challenging.
Diagnosis
Laura Holm was a veterinary assistant at
Peter Edgars practice in Ashford when Mrs
Hunt brought in her dog. She recalls that
the dog was pyrexic but there was nothing
particularly remarkable in the clinical
examination. Certainly babesiosis would not
have been at the forefront of her mind. It
was an unlikely diagnosis as the dog had
never been abroad nor been a recipient of
donated blood. Moreover, like most vets,
her first suspicion on seeing a Springer
Spaniel with haemolytic anaemia was that it
would be an immune-mediated condition.
However, by the next morning the dog
was markedly jaundiced and this surprisingly
rapid deterioration suggested that the
condition could be more serious. Laura sent
a blood sample for analysis to a commercial
laboratory, which proved a wise decision.
An external lab will usually be better
equipped than an in-house facility to
diagnose accurately a condition like
babesiosis from a blood smear. But even
with an appropriate staining agent, spotting
the protozoan merozoites within the dogs
erythrocytes was not straightforward, as
only about 1.5 per cent of the cells had been
parasitised. Despite the rapid diagnosis and
treatment with imidocarb a treatment for
bovine babesiosis available for use in dogs
under the Cascade system the dog died
about 60 hours after the initial presentation.
Leishmaniosis
The exotic disease most likely to be seen in
a dog arriving in Britain from the Continent
is leishmaniosis. The DACTARI website lists
49 cases in PETS scheme travellers and
residents of quarantine kennels between
2001 and 2008. However, that is a mere
fraction of the actual number of cases here
in the UK that could provide a reservoir of
infection for this important zoonotic
pathogen if global warming allows its vector,
the sandfly (Phlebotomus spp.) to gain a
foothold in Britain. In a paper in Veterinary
Parasitology, Sue Shaw of Bristol University
Leishmaniosis: nasal and pinnal dermatopathy with onychopathy
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6 | companion
DEROGATION
reports 257 cases between 2005 and 2007
diagnosed either at her own or at one of
her collaborating labs.
Even with this recent influx of cases, the
majority of small animal practices have
never seen a dog with leishmaniosis and
they will find that making a definitive
diagnosis is extremely tricky, according to
Jon Wray, an internal medicine specialist at
Dick Whites Newmarket referral practice.
He has seen several cases with typical
presenting signs, including crusting skin
lesions, enlarged lymph nodes, uveitis and
epistaxis. However, a definitive diagnosis is
achieved through direct observation of the
parasite in bone marrow or spleen
aspirates. These are not routine techniques
in most first opinion practices and the
chances of obtaining a false negative are
high, even when supplemented by PCR tests
to detect the parasites DNA, he warns.
Brighton-based veterinary
dermatologist Charlie Walker points out
another problem in diagnosing leishmaniosis
is that it may take up to a year between
infection and the onset of clinical signs. As
such a foreign trip may not be mentioned
immediately by the client and it is up to
the clinician to probe into the dogs travel
history. On their own, the skin lesions are
not very specific and with the pressures of a
10 minute appointment system, there would
be a strong likelihood of the owner being
sent home with antibiotics and a medicated
shampoo, he says.
Treatment
Given the lack of an authorised product for
treating leishmaniosis in the UK, both vet
and owner are likely to face an unpleasant
surprise when a diagnosis is confirmed. The
Veterinary Medicines Directorate is able to
KEEPING BRITAIN SAFE
Clinical symptoms of leishmaniosis
Right: Pinnal margin ulceration
Below right: Onychopathy
haemorrhagic paronychia
advise practitioners on sourcing treatments
from abroad but these are likely to
eye-wateringly expensive. Charlie says he
was quoted a figure of 450 (before any
mark up) by the importing company for
supplying one of the two products available
on the Continent.
Spanish veterinary surgeon Carlos
Macias confirms that even where there is a
locally licensed product available the
treatment costs will be substantial, though
well below the prices paid in the UK. Vets
at his neighbouring practices in Malaga
would expect to pay the wholesaler about
110 Euros for a 60 ml bottle of milteforan,
sufficient to treat a 20 kg dog for the
recommended 28 day course, he says.
After the initial course of treatment,
the disease can be kept under control by
the much cheaper drug allopurinol and the
chances of a complete remission are good,
provided the dog is not re-exposed to
infective sandflies, Jon Wray states. Before
starting down that road, it is important for
the vet to spend a lot of time discussing the
practicalities with the owner. They must be
aware that this is a very demanding
treatment, financially, emotionally and in
terms of time.
Mary Crackles, from the Westmoreland
Veterinary Group in Kendal, has just
confirmed her first leishmaniosis case and
highlights the need to educate clients about
the risks before they take their animals
abroad. In endemic areas it is possible to
minimise the chances of exposure by
keeping the animal indoors when the flies
are most active at early morning and late
evening and to use insect repellent collars
or pour-ons. Of course, it is important to
tell the client that in most cases when they
are only going abroad for a couple of weeks,
it is in the dogs best interests for it to be
kept at home.
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companion | 7
CPD
BSAVA EXPANDS
CPD ROADSHOWS
In the coming months there are three Roadshows
touring the UK, bringing more choice and international
specialists to a region near you. This is the very best CPD,
at a convenient location and at a cost that means members
are getting great value from their CPD budget
Roadshow Fees
For more information or to book visit www.bsava.com, email administration@bsava.com or call 01452 726700.
Members price 191.83 inc. VAT Non members price 287.74 inc. VAT
Mike Conzemius &
John Innes
4 November 2009
Northern Ireland:
Venue to be confirmed
11 November 2009
Metropolitan: Bellhouse Hotel,
Beaconsfield
Mike Conzemius & Michael
Gulliard
6 November 2009 Kent/Surrey &
Sussex: Venue to be confirmed
9 November 2009 North East:
Novotel, Newcastle
Michael Lappin &
Danille Gunn-Moore
16 October Chilworth
Manor, Southampton
18 October Hilton,
Dunkeld
19

October Mottram Hall,
Cheshire
21 October Miskin Manor,
Nr Cardiff
Guillermo Couto & Michael Day
09 September Daventry Hotel,
Northamptonshire
11 September Mottram Hall,
Cheshire
14 September Marriott Hotel,
Huntingdon
16 September Gorse Hill, Woking
Haematology in practice all you need to know
In eight largely case-based presentations
you will be taken through laboratory
evaluation of the haemogram, the types of
anaemia and disorders of leucocytes,
disorders of haemostasis and the practical
aspects of blood transfusion. Led by
Professor Guillermo Couto from the Ohio
State University and supported by Professor
Michael Day from the University of Bristol,
this day of CPD will bring you up-to-date
with the latest developments in clinical
haematology. Both are internationally
recognized speakers in this fundamental
area of clinical practice.
Feline infectious disease
There have been a number of significant
advances in feline medicine in the last
several years. Professor Danille Gunn-
Moore of the UK and Professor Michael
Lappin of the USA both have active, ongoing
clinical research studies concerning
respiratory diseases, gastrointestinal
diseases, vaccines, and blood borne agents.
They will provide you with an enlightening
group of case based lectures emphasizing
issues that will provide immediate benefit to
your feline patients. For selected lectures,
audience response devices will be used to
highlight important questions and the
opinions of the group. Emphasis will be
placed on new techniques for the diagnosis
and management of cats with rhinitis,
cough, dyspnoea, diarrhoea, and fever. In
addition, Professor Lappin will provide a
brief update on feline vaccine guidelines and
his work with antibodies against feline
tissues induced by over vaccination.
Orthopaedics
Pelvic limb lameness is very common in dogs
with hip dysplasia and cruciate disease being
the two most common orthopaedic
conditions. Accurate diagnosis, disease-
staging and appropriate decision-making are
critical for successful case management. This
roadshow will deal with common conditions
of the canine pelvic limb and is designed for
primary care practitioners who wish to
update or refresh their knowledge in this
area. 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 will
be explained. Dr Conzemius is a leading
authority on cruciate disease and has
published some paradigm-shifting papers in
this area. John Innes has research
programmes in cruciate disease at University
of Liverpool and Mike Guilliard brings a
wealth of experience from referral practice.
In a rapidly changing area, it is essential for
vets to be up to date with current thinking.
8 | companion
CLINICAL CONUNDRUM
CLINICAL
CONUNDRUM
Samantha Taylor of the
Feline Centre, University of
Bristol, invites companion
readers to consider
investigation of a depressed
and vomiting cat
Parameter Result Reference
range
Urea 43.0
mmol/l1
6.510.5
Creatinine 1099
mol/l
133175
Phosphate 3.21
mmol/l
0.951.55
Potassium 7.80
mmol/l
4.005.00
Total
calcium
2.50
mmol/l
2.302.50
Glucose 6.20
mmol/l
3.507.50
Table 1
Case History
A 5-year-old, male neutered,
exotic shorthaired cat presented
with a 24-hour history of acute
vomiting, depression and
inappetence. The cat had access
outdoors, was fed a normal
commercial cat food and was up
to date with vaccination and
worming. Treatment with
intravenous fluids and antibiotics
for 12 hours prior to presentation
had not resulted in an
improvement in demeanour and,
although the vomiting had
stopped, the cat had become
progressively more depressed.
On examination the cat was
extremely dull and depressed but
responded to stimulation. The cat
was hypotensive (systolic blood
pressure 80 mmHg, Doppler
method) and bradycardic (heart
rate 100 beats per minute).
Abdominal palpation was
unremarkable and the bladder
small and non-painful.
Create a problem list; consider
differentials and suggest
management priorities at this
point
The cats main problems are vomiting,
hypotension and bradycardia. The
depression and anorexia are likely to be
secondary to the primary disease. Vomiting
can occur due to primary GI disease (e.g.
viral enteritis) or as a consequence of
systemic disease (e.g. renal failure). Given
the history of vomiting, the hypotension
could be the consequence of fluid loss. The
bradycardia is a concern and, given the
hypotension, sepsis is a consideration; but
electrolyte abnormalities such as
hyperkalaemia should also be considered.
The patients clinical status is critical, so
there are a number of diagnostic and
therapeutic priorities. Biochemistry
(especially glucose and electrolytes) and
haematology should be performed and
whilst results are pending the patient should
have an ECG performed in view of the
bradycardia. Fluid resuscitation is
appropriate given the hypotension,
beginning with a crystalloid bolus (10 ml/kg
over 20 minutes) whilst monitoring the
response with repeat blood pressure
measurement, along with heart and
respiratory rates.
Results
Relevant findings are shown in Table 1.
Outline the ECG findings and
interpret the biochemical
findings
Biochemistry showed:
Severe azotaemia
Severe hyperkalaemia
Moderate hyperphosphataemia
The ECG (Figure 1) shows absent
P waves, tall T waves, bradycardia and a
prolonged PR interval, typical of
hyperkalaemia. The azotaemia could be
pre-renal, renal or post-renal in aetiology.
Renal failure was considered most likely
given the hyperkalaemia and
hyperphosphataemia. The absence of a
palpable bladder and ascites made
Figure 1
companion | 9
CLINICAL CONUNDRUM
post-renal causes less likely, although a
uroabdomen could not be fully excluded.
Following the bolus of fluids the blood
pressure increased to 100 mmHg,
suggesting the hypotension could be due to
hypovolaemia. The bradycardia persisted
and the cat remained dull and depressed.
What further diagnostics and
treatment are appropriate at
this point?
Given the azotaemia it is vital to obtain a
urine sample. This will help characterise the
azotaemia as pre-renal or renal in origin
and to quantify urine output. Successful
urethral catheterisation does not
completely exclude post-renal azotaemia
(e.g. ruptured bladder) but allows
monitoring of urine output and further
diagnostic imaging if required (for example a
retrograde urine contrast study). This
patient is also likely to have a metabolic
acidosis, so blood gas analysis, if available,
could help determine whether aggressive
management measures such as bicarbonate
therapy are required. A urinary catheter
was placed and 5 ml urine drained from the
bladder (it was not known when the cat last
urinated). The urine was isosthenuric
(1.017), positive on a dipstick for blood,
protein and glucose. Urine revealed
numerous structures as shown in Figure 2.
Identify the structure seen on
urine sediment examination and
refine the diagnosis of
azotaemia in light of the
urinalysis
The structure is a granular cast. This type
of cast is the result of cellular degeneration
and presence can indicate tubular
degeneration, inflammation or necrosis. A
few can be seen in normal cats, but a large
number indicates tubular damage.
The isosthenuria combined with the
azotaemia suggests intrinsic renal failure
and the presence of blood, protein and
glucose in urine (with normal blood
glucose) is consistent with tubular damage.
The urinalysis results, along with the
clinical examination and biochemical
results, are consistent with acute intrinsic
renal failure (ARF).
Irrespective of cause, treatment
must be aggressive and has
three priorities
Continued correction of fluid
deficits and restoration of
renal perfusion
Fluid therapy should be continued to
correct remaining fluid volume deficits.
Continued boluses of crystalloid (0.9%
sodium chloride) along with close
monitoring of blood pressure, heart rate
and respiratory rate, or a reduced
continuous rate infusion are appropriate,
according to response and considering the
risk of overhydration. Fluid therapy can
then be adjusted according to ongoing
losses and by monitoring urine production.
Correction of electrolyte and
acidbase abnormalities
The severe hyperkalaemia requires prompt
treatment and may be resolved by the fluid
therapy and by restoring urine production.
In this case, treatment was initiated during
ongoing fluid therapy. Calcium gluconate
was administered to increase the threshold
potential for cardiac excitation and
antagonise the cardiotoxic effects of
hyperkalaemia. Treatment with an
intravenous bolus of glucose was also given
to induce endogenous insulin release and
reduce serum potassium. Hypertonic
glucose solutions must be given via a central
vein, or diluted appropriately. Treatment
with insulin was reserved to assess
response to the above therapies and fluid
resuscitation, and to avoid complications
such as severe iatrogenic hypoglycaemia.
Treatment with sodium bicarbonate
should not be routinely used without
appropriate blood gas monitoring, even
when acidosis is suspected, as inappropriate
dosing can cause severe metabolic alkalosis
and paradoxical CNS acidosis. In
hypovolaemic patients with hyperkalaemia
and a metabolic acidosis, the use of sodium
Figure 2: Urine sample (stained using standard techniques)
Picture K. Tennant
1
2
10 | companion
CLINICAL CONUNDRUM
CLINICAL CONUNDRUM
bicarbonate is often not necessary with
adequate fluid therapy; it should be
reserved for cases with severe acidosis and
only used after adequate volume
replacement. A detailed discussion of
bicarbonate therapy is beyond the scope of
this article but further information is
available in the BSAVA Manual of Canine and
Feline Emergency Medicine and Critical Care.
Restoration of urine
production
The most important factor in the restoration
of urine output is ensuring adequate
circulating volume and renal perfusion.
In this case, after adequate volume
replacement, urine output remained less
than 0.5 ml/kg/hour, so one dose of
intravenous furosemide (2 mg/kg) was
administered. Furosemide is a loop diuretic
that also induces kaliuresis and so is
indicated in hyperkalaemic cats with
oliguria/anuric renal failure. This resulted in
an improvement of urine production to
2 ml/kg/hour.
A repeat dose of 2 mg/kg can be given
intravenously if oliguria persists.
Alternative diuretics include mannitol,
which as an osmotic diuretic can
potentiate overhydration, and dopamine,
which as a positive inotrope probably
exerts most effects via improvement of
blood pressure as cats lack specific renal
dopamine receptors.
What parameters should be
monitored during treatment?
Urine output placement of a urinary
catheter was possible in this case
without sedation as the cat was
severely depressed. The catheter can
be drained intermittently to calculate
urine output or attached to a collection
system (Figure 3)
Pulmonary oedema, using physical
examination including auscultation of
the thorax, particularly in the face of
aggressive fluid therapy
Body weight at presentation and during
volume replacement to assess
correction of fluids deficits and indicate
volume overload
Figure 3: Cat with
simple closed urinary
collection system
3
10 | companion
companion | 11
CLINICAL CONUNDRUM
Figure 4: Lilium spp. and antifreeze,
common cause of ARF in cats
List the potential causes of
acute renal failure in cats and
from this list suggest the most
common toxic causes?
Causes of ARF
in cats
1. Toxins
Therapeutic medications
antibiotics (aminoglycosides,
tetracyclines)
NSAIDs
Chemotherapeutics (e.g.
doxorubicin, cisplatin)
Antifungals (amphotericin B)
Radiocontrast agents
Organic compounds
Ethylene glycol
Pesticides
Solvents
Plants Lilium spp. (e.g. tiger
lily, easter lily, day lily)
Heavy metals mercury, lead,
gold salts
Endogenous compounds
haemoglobin, myoglobin
Miscellaneous toxins grapes/
raisins, illegal drugs
2. Ischaemia
Hypovolaemia blood loss,
shock
Hypotension anaesthesia,
reduced cardiac output,
hypovolaemia
NSAIDs
3. Miscellaneous causes
Systemic diseases
hypercalcaemia, FIP, lymphoma
Pyelonephritis
End-stage chronic renal failure
The most common toxic causes of acute
renal failure in cats reported to the
Veterinary Poisons Service are:
1. Ethylene glycol toxicity (recent increase
in malicious poisonings reported)
2. Lilium spp.
3. Unknown toxicity.
(Alex Campbell personal communication,
illustrated in Figure 4)
ECG (particularly important in this case
during administration of calcium
gluconate and whilst the cat remained
hyperkalaemic)
Blood pressure adjust intervention
to maintain blood pressure above
90 mmHg to ensure adequate renal
perfusion
Urea, creatinine and phosphate to
document success of therapy
Electrolytes hypokalaemia may
develop during the polyuric phase of
ARF and serum potassium should
therefore be evaluated frequently
during treatment and supplemented
if required
Acidbase status, if possible
PCV and total solids (to monitor for
overhydration)
Central venous pressure, if possible
Monitoring of central venous pressure
allows adjustment of fluid therapy
accurately and avoidance of overhydration.
If equipment is not available, then body
weight, urine output, PCV and total solids,
along with blood pressure, should be
monitored. Signs of overhydration include
tachypnoea, chemosis, serous nasal
discharge and pulmonary oedema.
Outcome
The cat remained polyuric, and fluid therapy
was adjusted accordingly. After 24 hours
the azotaemia had reduced and the cats
demeanour slowly improved. The cat
recovered normal urine-concentrating
ability with normal biochemistry after
72 hours of treatment, and remains
biochemically and clinically normal 3 months
later. In this case the cause of the ARF
remained unknown.
12 | companion
HOW TO
MANAGE THE SYSTEMICALLY
UNWELL, SUBSTAGE b, CASE
OF CANINE LYMPHOMA
HOW TO
Gerry Polton of North
Downs Specialist Referrals
discusses the management
of those more difficult
canine lymphoma cases
I
t has long been recognised that prognosis
in cases of canine lymphoma is
significantly affected by the apparent state
of systemic health at the time of diagnosis.
This reflects more than the simple fact that
moribund cases are fewer steps from
mortality. The management of these cases
is not something that receives attention in
the veterinary literature. The purpose of
this article is to help clinicians to consider
the management of those cases systemically
unwell at presentation, so called substage b.
While some cases of substage b lymphoma
sadly do show little or no response to the
management offered, others achieve
complete remission and a full quality of life
for prolonged periods.
Presentation
Affected cases can be divided into two
groups, those with obvious multicentric
lymphoma and those without. The
importance of this distinction is that the
former are usually diagnosed promptly, and
speed may be of the essence in regaining
control of the disease.
The aetiology of the substage b status
is varied (see Table 1). Efforts should be
made to understand the pathophysiology
of the patients ill health in order to
optimise management. Pathogenesis is
often multifactorial.
It has long been recognised in human
haemato-oncology that lymphoma
represents a broad umbrella classification of
lymphoproliferative disease. Refinements in
diagnostic capacity have led to the
development of a classification system that
incorporates clinical, histomorphological,
cytomorphological, flow cytometric and
cytogenetic characteristics to define
subtypes of disease. This extensive
classification effort is rewarded by more
accurate prediction of biological behaviour
and responses to therapy. Similar efforts
have been made in veterinary oncology with
a landmark study by Frdrique Ponce and
others (2004) demonstrating significant
survival implications for six different canine
lymphoma subtypes.
Substage b patients may present without peripheral lymphadenopathy
companion | 13
HOW TO
Pathogenesis Notes
Metabolic
derangements
Hypercalcaemia Varied causes, including PTHrP, IL-6, OAF
Hypoglycaemia Consumption by tumour
Uncoupling of energy
transduction pathways
Due to aberrant cytokine elaboration
Organ
dysfunction due
to infiltration
Renal insufficiency Chemotherapy doses may require
adjustment
Hepatic insufficiency Chemotherapy doses may require
adjustment
CNS involvement Neurological signs may be generalised or
focal
Respiratory compromise Widespread pulmonary infiltration is
unusual
Bone marrow See haematological aberrations
Haematological
aberrations
Neutropenia
Thrombocytopenia
Anaemia
Failure of production or immune-
mediated destruction of blood cells
Mass effect Partial airway obstruction
Vascular occlusion
Typically only in advanced cases without
other systemic compromise
Table 1: Causes of failure of systemic health seen in substage b lymphoma
PTHrP: parathyroid hormone related peptide, IL-6: interleukin 6, OAF: osteoclast
activating factor
Diagnostic considerations:
definitive diagnosis
Cytology
Cases of suspected lymphoma should
undergo appropriate diagnostic testing to
make a definitive diagnosis. For patients
with generalised lymphadenopathy, fine
needle aspiration and cytology can yield a
robust diagnosis and spare the need for
chemical restraint for biopsy. Further
refinements of the diagnosis can be
obtained by immuno cytochemistry or
flow cytometry. These should be discussed
with your laboratory prior to sampling, in
case specific sample-handling practices
must be observed.
Across a population of cases,
histological evaluation of an entire lymph
node remains a more reliable means of
diagnosis of lymphoma. However, in
addition to issues of anaesthetic safety,
both time and cost factors merit
consideration. A competent cytologist
could make a diagnosis of lymphoma in
minutes; the author advises that
practitioners interested in managing
lymphoma cases obtain lymph node
aspirates and perform in house cytological
evaluations regularly to gain confidence
with the techniques. While a diagnosis of
lymphoma may be best made by an
experienced cytologist, practitioners can do
both themselves and their cases a
tremendous service by confidently defining
that sample quality is adequate for diagnosis
and that the appropriate target has been
sampled prior to submission.
Lymphoid cells are easily disrupted by
forceful aspiration or smearing. The author
advises that samples are obtained without
suction and that only the weight of the
spreading slide is used to disperse cells in
the expelled sample.
Diagnostic considerations:
supporting data
Haematological evaluation
Haematological aberrations can arise for
numerous reasons. Cytopenias arise due
to bone marrow infiltration, immune-
mediated destruction of mature cells or
precursors, anaemia of chronic disease
(lymphoma or chemotherapy for
lymphoma) and significant haemorrhage.
Significant neutropenia predisposes patients
to sepsis, so broad spectrum antibiotic
therapy is indicated. Thrombocytopenia can
result in spontaneous haemorrhage that is
really only responsive to prophylaxis by
transfusion of fresh whole blood. Clinicians
must be aware that administration of
chemotherapy in these instances may
precipitate a lethal complication.
Anaemia due to haemorrhage is best
managed by diagnosis and treatment of the
inciting cause, and whole blood transfusion
Cranial vena caval syndrome as a
consequence of lymphadenopathy
Photo courtesy of Mark Goodfellow, UoB
if indicated. Anaemia of chronic disease is
usually mild to moderate and is typically not
addressed. In cases with other significant
signs of ill health, anaemia with a PCV of
20% or greater does not warrant
intervention. If PCV is less than 20% and
the patient is symptomatic, transfusion
should be considered as a short-term
measure while other health parameters are
given a chance to improve.
14 | companion
HOW TO
MANAGE THE SYSTEMICALLY UNWELL,
SUBSTAGE b, CASE OF CANINE LYMPHOMA
Biochemical evaluation
Hypercalcaemia and indicators of renal and
hepatic compromise are readily identified
on serum biochemical profiles.
Hypercalcaemia frequently responds
promptly to the administration of
lymphocytolytic therapy, such as
corticosteroids. It is critical that diagnostic
quality samples are obtained prior to
steroid administration, however, as the
chances of harvesting diagnostic samples
subsequently are reduced. Hypercalcaemia
induces cardiovascular and neuromuscular
compromise, and uncontrolled
hypercalcaemia precipitates renal failure.
This effect is exacerbated by reduced renal
perfusion, for example under anaesthesia.
Renal compromise may be due to
pre-renal effects, such as hypovolaemia due
to hypercalcaemia, or it may reflect renal
disease. Renal lymphoma can be diagnosed
on renal aspirate biopsy. If a diagnosis is
already made, ultrasonographic changes
consistent with lymphoma are adequate.
Hepatic compromise has far-reaching
implications. Frequently these cases are
anorectic, hypoproteinaemic, icteric and
vomiting. Dramatic weight loss can be seen.
Both renal and hepatic disease can lead to
marked alterations in metabolism of
chemotherapeutic agents. Usually this
results in increased plasma drug
concentrations due to failure of elimination,
and dose reductions are critical. Patients
with hepatic compromise can need
aggressive support in order to give them a
chance of recovery.
Imaging studies
Thoracic radiography is indicated to identify
the presence of intrathoracic masses.
Hypercalcaemia is more common among
cases with cranial mediastinal lymphoma
and there may be no evidence of lymphoma
affecting other sites. Massive intrathoracic
lesions can compromise respiratory
function. A single lateral thoracic projection
is often adequate to define presence or
absence of mediastinal disease.
Abdominal radiography is rarely helpful.
Significant lymphadenopathy can be missed
whereas hepatomegaly and renomegaly may
be recognised. Ultrasonography yields more
valuable information and, if a diagnosis
remains in doubt, aids biopsy of abnormal
structures. Clinicians must be aware of the
potential for biopsy-induced haemorrhage,
which is of greater concern in hepatic or
renal compromise.
Bone marrow sampling
Lymphoma can reside solely in the bone
marrow, so the diagnosis should not be
ruled out on the basis of absence of
evidence of disease in other body systems.
If haematological parameters indicate bone
marrow involvement and a diagnosis has
already been made, there are few
indications for marrow sampling. If the
diagnosis remains in doubt, however, or if
immune-mediated destruction of blood cell
precursors is suspected, sampling can be of
benefit for subsequent management.
Other considerations
Nutrition
Inappetence or anorexia, vomiting,
infiltrative intestinal disease and
hepatopathy will all contribute to a negative
energy balance. The metabolic demands of
Pretreatment lateral thoracic radiograph revealing mediastinal
lymphadenopathy in a severely hypercalcaemic Boxer
companion | 15
HOW TO
advanced lymphoma are great; adequate and
balanced nutrition can make the difference
between success and failure in these cases.
Risk of sepsis
Neutropenia due to bone marrow
infiltration and/or chemotherapy, exposes
patients to risk of bacteraemia and sepsis.
Extra attention to infection control
measures is warranted. In addition,
lymphoma can induce vasculitis, with
consequential systemic inflammatory
response syndrome (SIRS), mimicking
changes associated with septicaemia. Sepsis
promotes inappropriate cycles of coagulation
and thrombolysis; concurrent
thrombocytopenia exacerbates risk of
disseminated intravascular coagulation (DIC).
Water and electrolyte turnover
Substage b patients typically fail to consume
adequate water to compensate for
insensible losses. An attempt should be
made to quantify losses so that appropriate
replacement therapy can be provided.
Medications to limit losses through vomiting
and diarrhoea are advised.
Most patients are significantly
hypokalaemic. Plasma potassium
concentration may not accurately reflect
total body potassium depletion, as
potassium is primarily an intracellular cation.
Hypomagnesaemia is also recognised.
Potassium and magnesium deficiencies can
result in inappetence or anorexia.
Hypercalcaemia can be managed by
saline diuresis. Excessive volume
replacement should be avoided as cases
with significant renal insufficiency are unable
to excrete significant water loads; cerebral
oedema may result.
Case management
When a diagnosis of substage b lymphoma
has been made, priority must be given to:
1. Supporting the patient
2. Controlling the disease process
In order to support the patient, basic
nutrition, warmth, fluid and electrolyte
needs must be attended to. Inappetent or
anorexic patients should not be supported
on intravenous fluids alone. Assisted feeding
is mandatory; this can be greatly aided by
the placement of an appropriate feeding
tube. Investigations should be undertaken
to obtain supporting data, as presented
earlier, so that potential problems can be
anticipated and prevented or managed.
Control of the disease requires the
judicious use of chemotherapy.
Hypoalbuminaemia, hepatopathy and renal
insufficiency can all lead to apparent
overdose of chemotherapy due to reduced
plasma protein drug binding or relative
deficiencies of excretory metabolism.
Biochemical and haematological
parameters must be known prior to
chemotherapy so that appropriate dose
adjustments can be made.
Clinicians are strongly advised not to
embark upon unfamiliar chemotherapy
protocols when presented with a case of
lymphoma that is complicated by systemic
illness. Good decision-making in these
cases requires confident and timely
identification of progressive changes,
whether those changes represent
improvement or deterioration.
Prognosis
At the current time, knowledge of the
behaviour of distinct canine lymphoma
subtypes is rudimentary. Historically, B or
T cell immunophenotype has been
regarded to be predictive of outcome but
this is an oversimplification. In fact, in the
Ponce study (2004), the group of cases
exhibiting the best survival outcome were a
subgroup of T cell immunophenotype
whilst the cases exhibiting the poorest
prognosis were a subgroup of B cell
immunophenotype. Such a pattern would
not be predicted by the traditional
interpretation of effect of
immunophenotype on prognosis. This is a
rapidly developing field of veterinary
oncology; an experienced veterinary
haemato-oncologist should be consulted to
offer insight into the prognostic
information provided by flow cytometry
and detailed cytomorphological evaluations.
Conclusion
As a group, cases of substage b lymphoma
carry a poor prognosis. While in part this is
simply a reflection of their ill health, it is
unclear whether their prognosis would
remain poorer than comparable substage a
cases if complete remission were achieved.
Initial management of these cases can be
intensive and, with no guarantee of a
successful outcome, not all owners would
choose to pursue such an approach. It is the
authors experience, however, that many of
these cases can enjoy a normal-for-
lymphoma quality and length of life if
appropriate management is implemented at
an early stage. n
Ponce F, Magnol J-P, Ledieu D et al. (2004)
Prognostic significance of morphological
subtypes in canine malignant lymphomas during
chemotherapy. The Veterinary Journal 167,
158166
Dramatic clinical improvement
following treatment and resolution
of hypercalcaemia same dog as
in radiograph
16 | companion
VIN
James Fingeroth DVM, Diplomate ACVS,
Orchard Park Veterinary Medical Center, Orchard Park, NY
The palisading periosteal reaction would be consistent with HO, but only having a single bone involved would be quite
atypical. If no other lesions are found, you may need to work up for osteomyelitis or primary neoplasia at that site.
William Hornof DVM, MS, DACVR, VIN Consultant,
Chief Medical Officer, Eklin Medical Systems, Inc., Santa Clara, CA
Jim
I agree. The hallmark of HO is symmetry, and like you, I would not rule out localized tumor, and I would radiograph
the chest anyway.
Todd Beatty
Hello and thanks for the response!
Chest and abdominal rads were taken after the digit radiographs and nothing was found. A CBC, profile and U/A was
WNL barring a slightly elevated ALKP (248mg/dl). Abdominal ultrasound warranted? Or go straight to biopsy of digit?
Wound you trephine or take the entire digit? Thanks
The Veterinary Information Network brings together veterinary professionals from across
the globe to share their experience and expertise. At vin.com users get instant access to
vast amounts of up-to-date veterinary information from colleagues, many of whom have
specialised knowledge and skills. In this regular feature, VIN shares with companion
readers a small animal discussion that has recently taken place in their forums
Discussion: Hypertrophic Osteopathy
Todd Beatty DVM, Garden Grove
Animal Hospital, Winter Haven, FL
Hello: 6yr Male german shepard presented for
intermittent left rear lameness. Proximal
phalanx of third digit swollen and painful.
Radiographs taken. My interpretation based on
the periosteal pattern is hypertrophic
osteopathy (HO). Would you concur?
companion | 17
VIN
James Fingeroth
Sometimes an excisional biopsy via digit amputation makes the most sense, but since this is a weight-bearing digit, I
would think about just doing a needle biopsy to start. Be sure the client (and you) are prepared for the results being
inconclusive however. Hopefully you will get a definitive answer, but sometimes small specimens from a Jamshidi
needle or small trephine can be hard to process, or only show reactive bone (which you already knew). If the client
knows in advance that the biopsy could fail to establish a diagnosis, they will be less upset than if their expectation is
for a definite answer is unfulfilled.
Todd Beatty
Hello
Have been meaning to update this case. Abdominal ultrasound was negative. I went ahead in Feb 08 and biopsied the
lesion.....reports is as follows.
The dog did very well after amputation.
Only limped for 24 to 48 hours after
heavy exercise. Otherwise normal.
The dog represented for routine yearly
evaluation a few days ago. PE
unremarkable barring a firm swelling on
the medial aspect of the second digit.
Owner notes that dog seems more
uncomfortable in recent weeks.
Radiographs follow. I have asked the
pathologist for a recut. Any other
opinions or ideas??
The owner was prepared for a reactive bone diagnosis possibility. Five months later (July 08) we amputated the
digit due to progressive patient discomfort. Biopsy report as follows.
Biopsy
--------Amended Report--------
Microscopic Description: These are sections of tissue derived from multiple specimens submitted together in one
container. The specimens exhibit no natural borders and consist of varying proportions of well differentiated dense
mature bone and collagenous fibrous tissue. Several specimens contain small amounts of immature reactive bone.
Microscopic Findings: MULTIPLE SPECIMENS: WELL DIFFERENTIATED BONE AND FIBROUS TISSUE WITH
REACTIVE BONE.
Comment: The specimen indicates reactive periosteal bone proliferation, which is a response of bone tissue to etiologies
as diverse as trauma, infection and neoplasia. The cause was not apparent in these sections. There is no evidence of
neoplasia or inflammation.
Biopsy
MICROSCOPIC DESCRIPTION:
This specimen represents an amputated digit, part of the distal digital bone affected by fragmentation and necrosis. The
adjoining bone is reactive and a zone of periosteal fibrosis is identified. Synovial tissues are reactive. Inflammation is
limited to a few plasma cells.
MICROSCOPIC FINDINGS:
MILD FIBROSING CELLULITIS WITH NECROSIS OF DIGITAL BONE AND ASSOCIATED REACTIVE CELLULITIS,
THIRD DIGIT OF REAR FOOT
COMMENT:
Morphology is consistent with a chronic response to some type of trauma. No evidence of active infection or neoplasia is
seen.
18 | companion
VIN
Cathy Wilkie DVM, VIN Associate Editor,
Diagnostic Imaging, Animal Medical Hospital, West Vancouver, BC Canada
Todd, that looks more like atypical OA reaction on the lateral toe. My theory would be that the absence of the 3rd
digit is allowing the 2nd to come across laterally, putting strain on the medial collateral ligament at M-P1 of digit 2
and causing this large enthesiophyte. Its a pretty theory; Ill see if anyone can come up with a better one.
Todd Beatty
I could explain the 2nd digit as a result of increased strain, but I was also concerned about the palisading periosteal
reaction on the proximal phalanx of the fourth digit as well. This is very similar to the original problem.
Michael Harter VIN Associate Editor, Diagnostic Imaging,
Parasitology, Animal Medical Clinics, Rockford, IL
The fourth would now be the main weight-bearing digit.... I dont know.
Have you checked thorax radiographs again, lately?
Cathy Wilkie
I guess Im still not convinced for HO. It certainly wouldnt be wrong to repeat thoracic rads, though. No other feet
involved, right?
Todd Beatty
I was waiting for recut and VIN opinions before deciding on repeating rads. My theory is excess stress on the bone.
He is not lame on any other limbs despite having early cruciate disease on the right rear. I have not radiographed the
other digits.
William Blevins DVM,MS, DACVR, VIN Consultant, Otterbein, IN
Todd;
An additional cause of the periosteal reaction that you are seeing in these digits is local inflammation. If you increase
the blood flow to bone, it will make bone. The lateral digital reaction is probably as Cathy described.
I suspect that there was soft tissue inflammation that caused the periosteal reaction.
Todd Beatty
Additional sections from pathology are back......no new findings :/ Currently on anti-inflammatories.
Well see how we do!
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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
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This discussion has been edited for print. Find the full discussion online at www.vin.com/Link.plx?ID=71598
companion | 19
PUBLICATIONS
BARRIER NURSING
B
arrier nursing creates a physical
barrier between the member of staff
and the patient. The precise nature of
the barrier depends upon the type of
cross-infection, e.g. organisms spread via
the aerosol route require consideration of
shared air space, whereas faecal parasites
require attention to fomites.
Barrier nursing is employed:
When a suspected infectious disease is
present, in order to control the spread
of possible infection between patients
for example, in cases of MRSA, canine
parvovirus and cat flu. In these
situations other patients within the
veterinary hospital need to be
protected from the infected patient
To protect staff from a suspected
zoonotic disease for example, in a
suspected case of leptospirosis or
psittacosis. In cases of possible
zoonosis, human health and safety is of
prime importance and the spread of
infection from the patient to all
personnel must be avoided
To protect the patient itself from
infections elsewhere in the practice
for example, in neutropenic patients and
neonates or very young patients. In
these situations, it is the patient that is
at increased risk of contracting a disease
from elsewhere in the practice due to
its own health status.
Protective clothing
Since barrier nursing requires an actual
barrier between the member of staff and
the patient, a set of special clothing is
worn to create this barrier. A layer of
clothing over the top of usual work wear
is essential, ideally covering the whole
uniform rather than just the torso as
would be the case with a disposable apron.
Disposable gloves should be worn and
disposed of after handling the patient.
The clothing worn to nurse a particular
patient is then taken off, as it should only
be used for that one patient: this limits
the likelihood of transferring disease
between patients.
Isolation
Isolation of patients is often used in
conjunction with barrier nursing. For
isolation, a kennel area, situated away from
the main kennels, which is a separate kennel
unit in itself is used. In some practices, an
isolation kennel is not available due to space
constraints; however, in certain instances a
dog can be placed in the cat kennel area and
a cat placed in the dog kennel area. This
does not isolate the patient, but what it
does do is to reduce the risk of the spread
of disease between species. This practice of
dog/cat isolation may be utilised in cases
where the infectious disease is limited to a
particular species, for example in cases of
cat flu. It is by no means ideal, as the cat is
surrounded by dogs rather than in a quieter
Preventing the spread of
infection is an important
consideration in veterinary
practice. Here, Paula
Hotston Moore, Internal
Verifier in Veterinary
Nursing at the University of
Bristol and co-editor of the
BSAVA Manual of Practical
Animal Care, explains the
role of barrier nursing
Dog with suspected canine parvovirus in an isolation kennel
20 | companion
PUBLICATIONS
place, but is preferable to leaving the patient
in the cat ward with the likelihood of
spreading the disease to other cats.
The ideal isolation kennel is completely
separate to the main dog and cat wards.
The isolation kennel needs to be a complete
entire unit, with its own hand-washing
facilities and all its own equipment: bedding,
mop, bucket, cleaning materials, clinical
waste receptacles, thermometer and
stethoscope. Personal protective equipment
for personnel should be available in the
isolation area, as barrier nursing should
always be used in the isolation kennel. All
veterinary staff entering the isolation area
must wear protective clothing in order to
limit the spread of disease to other areas of
the practice premises. A viricidal
disinfectant bath should be placed at the
entrance to the isolation kennels and all
footwear should be dipped on the way into
and out of the isolation area. One member
of nursing staff should take charge of
isolation nursing to limit the possible spread
of disease between patients. Routine hand
disinfection must take place between
isolated inpatients (as with all inpatients)
and also on entry and exit of the isolation
area. The isolation kennels must not be a
walk-through area, again in order to restrict
the number of personnel entering and
leaving the isolation zone.
Nursing considerations
Thought must be given to the daily nursing
routine of inpatients. Some consider that
isolation cases should be nursed before
other patients in the main kennel area, due
to immunosuppressed isolated patients
being vulnerable to disease from the main
hospital area. Others feel that isolation
inpatients should be nursed after the main
hospitalised patients to cut down on the
possibility of transferring disease from
isolation to the main kennel area. Due
consideration should be given to the nursing
protocol and the reasons disseminated to
all staff so that they understand the
rationale behind such decisions.
Consideration should also be given as to
whether patients require isolation plus
barrier nursing, or whether barrier nursing
alone is required.
Patients with endoparasite infections
need barrier nursing rather than being
placed in isolation. This is because the
More information on isolation and barrier nursing in veterinary
practice can be found in the BSAVA Nursing Manual series:
To purchase your copy of these titles, visit our website at
www.bsava.com or telephone the Membership and Customer
Services Team on 01452 726700.
BARRIER
NURSING
infection is not transmitted by airborne
means and the patient can therefore
share the same environment and air
space as other patients. Barrier nursing
will reduce the spread of infection in
this case
A cat with suspected cat flu should be
both isolated and barrier nursed to limit
the spread of the disease to other cats
in the practice.
A bird with suspected psittacosis needs
to be isolated to limit the spread
between other patients as the disease is
transmitted via air space. Barrier
nursing must also be in place to limit the
spread of the disease to humans, since it
is zoonotic.
An isolation unit
(Reproduced from the BSAVA Manual of Practical
Animal Care)
A patient receiving barrier nursing care in the critical care unit
(Reproduced from BSAVA Manual of Canine and Feline Advanced Veterinary Nursing, 2nd edition)
BSAVA Manual of
Practical Animal Care
Member price 24.99
Non-member price 29.99
BSAVA Manual of
Practical Veterinary
Nursing
Member price 36.00
Non-member price 56.00
BSAVA Manual of
Canine and Feline
Advanced Veterinary
Nursing, 2nd edition
Member price 49.00
Non-member price 70.00
companion | 21
PETSAVERS
Improving the health of the nations pets
BLOOD TYPING IN CATS
PETSAVERS
P
etsavers Grant Awarding Committee
funds both residencies at academic
institutions and small projects both at
academic institutions and by vets in
practice. In the late 1990s Petsavers funded
Claire Knottenbelts residency and project
on feline blood typing at the Royal (Dick)
School of Veterinary Studies, Edinburgh.
Identifying types
Claires work clarified the prevalence of
the three blood groups (A, B and AB) in
cats in the UK. Most domestic short hair
cats and domestic long hair cats are
type A, with smaller numbers of types B
and AB. In pedigree cats, more type B
cats are found, but there is both breed
variation and, even within specific pedigree
breeds, blood type prevalence may show
marked geographic variation. In the group
of pedigree cats tested by Claire, 58.7%
of British Shorthairs, 29.2% of Birmans,
11.8% of Persians and 10% of Burmese
were Type B. In contrast 50% of Bengals
and Abyssinians, 22.2% of Somalis and
8.3% of Birmans were Type AB (However
it is notable that in some cases the total
number of cats tested for a given breed
was small).
Type B cats have naturally occuring high
titres of anti-A alloantibodies and
transfusion of type A blood into a type B
recipient results in an immediate, dramatic
and often fatal transfusion reaction. At first
it was believed that only one third of type A
cats have anti-B alloantibodies, but later
work in a group of cats in the USA showed
all the type A cats tested did so. Thus
type A blood transfused into a type B cat
also causes a transfusion reaction but this is
typically clinically less severe and is still
accompanied by the lysis of the transfused
erythrocytes.
Transfusions
The normal feline erythrocyte half-life is
approximately 40 days. Autologous and
allogenic matched transfusions of both type
A and type B blood are well tolerated, with
an erythrocyte half-life of approximately 29
days. However in the case of mismatched
transfusions, type B erythrocytes infused
into a type A cat have a mean half-life of
only approximately 2 days whereas type A
erythrocytes transfused into a type B cat
have a half-life of minutes to hours. Given
that a transfusion is often given to maintain
a patients PCV, transfusion of unmatched
Jo Arthur of Petsavers Grant Awarding Committee looks
at the importance of blood typing for blood transfusions
and in kittening queens, highlighting how a Petsavers
funded study has advanced veterinary knowledge
22 | companion
PETSAVERS
I
f a practice wishes to be able to provide
blood transfusions, when required, to
its feline patients, a list of appropriate
donors needs to be established. Criteria
for potential donors include being in good
health, aged one to eight years, weighing
at least 5kg, FeLV/FIV negative, and the cat
must not have travelled outside the UK.
The written consent of their owners is
required. When my own cat, Prue,
required an emergency blood
transfusion, she was fortunate enough
to be Type A and to be at a referral
practice where one of the nurses cats
was a Type A registered blood donor.
The reason practices are dependent
on setting up their own list of potential
feline blood donors is because whilst the
pet blood bank is able to provide a range
of canine blood products, at the moment
it is not able to provide feline blood
products. However, the pet blood bank is
already identifying potential feline blood
donors, and it is hoped that feline blood
TRANSFUSIONS IN
PRACTICE AND THE
PET BLOOD BANK
Jo Arthur gives a brief
overview of the available
options and issues for
canine and feline blood
transfusions
products will be available in the future.
At the PETS or pests? lecture on
3 April at BSAVA Congress, Dr Susan
Shaw of the University of Bristol reported
that of the 183 dogs diagnosed positive
for Leishmania at her lab in the UK, three
had no travel history, but all had been
obtained from UK rescue societies.
There are also concerns that in the
future Leishmania may be transmitted to
dogs that have not travelled abroad,
either due to the northern migration of
the sandfly vector due to climate change,
or by direct transmission. Therefore,
ideally, 100% of the donated blood would
be sent for a Travel Screen, but this would
make the cost of the blood products
prohibitively expensive.
At present, the pet blood bank sends
aliquots from 10% of the donated canine
blood for a Travel Screen. To date, none
of the donated blood has tested positive
dogs that have travelled abroad are
excluded from donating blood, and at
present the number of cases of vector-
borne disease in dogs without a history of
travelling abroad is very small.
This is yet another issue that highlights
the importance of maintaining the
derogation, to avoid vector-borne disease
becoming endemic in the UK.
BLOOD TYPING IN CATS
blood not only exposed the patient to the
risk of a potentially fatal transfusion
reaction but also may only raise PCV for
a few days.
Kittening queens
The other situation where the blood type
of the feline patient is important is in
kittening queens. Type A or AB kittens
born to type B queens are at risk of
neonatal isoerythrolysis due to anti-A
antibodies in the mothers colostrum
ingested within 24 hours of birth. Not all
type A or AB kittens in the queens first
litter would necessarily be severely affected,
as 40% of the type B cats in Claires study
had relatively low anti-A antibody titres.
Testing
Claires work also validated the Rapid Vet-H
(Feline) desk top blood typing kit, which
enabled vets in practice to have a simple
and accurate method of blood typing cats.
Petsavers funds projects which do not
involve the use of experimental animals and
improve the
diagnosis and/or
management of
disease in small
animals, Claires
research enabled
vets in practice to
give blood
transfusions to
anaemic cats
much more
rapidly and
safely.
companion | 23
WSAVA NEWS
Did you know?
The largest number of visitors to the
website were from the USA, around
36% of the total, with the rest of the
top 10 being: UK, Canada, Australia,
Italy, Spain, China, France, Mexico,
and Germany
91% of visitors came directly to the
www.wsava.org site
Google was the most common
referral search engine
The most common search phrases used to reach our website included
WSAVA, tail docking, small animals and veterinary associations
The most popular pages viewed included those on microchip
identification, tail docking, congresses, news, and member
association pages.
T
he WSAVA website continues to be popular,
with more than 2 million hits last year, up 10%
on 2007 thats an average of around 175,000
per month or 5,800 per day. Page views were up by
20% compared to 2007, at over half a million. All in
all, these numbers indicate a continued and growing
interest in the WSAVA and its various initiatives.
Our member associations continue to be busy
implementing CE and a variety of other association
initiatives, and many have provided annual reports
that can be read on the member associations
pages on our website.
A few facts and figures about our
website
www.wsava.org
24 | companion
WSAVA NEWS
WSAVA NEWS WSAVA NEWS
W
orld Rabies Day is just
around the corner and wed
like to take this opportunity
to inform you about some new resources
and utilities available via our website
(www.worldrabiesday.org). We also
invite you to submit information about
any events you are planning for this
years campaign! We will be updating
our website throughout the coming
months and we encourage you to check
back regularly for new and helpful
planning materials.
WORLD RABIES DAY 20 09
The WRD team highlights
some of the events
surrounding World Rabies
day on 28 September
What are you doing?
We want to hear about your events! Please
send event information to: peter.costa@
worldrabiesday.org .
Attention: Shelters and human
associations
Weve recently initiated a web page just for
you, where you will find educational
materials that are freely downloadable.
The web page is available at: www.
worldrabiesday.org/EN/Get_Involved/
Shelters.html . For more information, please
contact Mylissia Stukey (Shelter Outreach
Coordinator) at mylissia.stukey@
worldrabiesday.org .
Get tweeting!
Follow World Rabies Day on Twitter
(twitter.com/worldrabiesday) and post
event stories/pictures on Facebook (www.
facebook.com/group.php?gid=35575735236).
View/download/submit video at our
YouTube site (www.youtube.com/user/
worldrabiesday) and join the WRD Flickr
Group (www.flickr.com/groups/wrd/)!
Educational materials
Resources from around the world are
available from the World Rabies Day
Education Bank (www.worldrabiesday.org/
EN/Education-Bank/english.html). Logos in
over 25 languages can be found at:
worldrabiesday.org/EN/Logo_Downloads .
html. Please contact us for specific
languages or to help create new logos.
Fundraising and advocacy
See what our global health advocates are
saying about World Rabies Day at www.
worldrabiesday.org/EN/Media_Center/
Perspectives.html . Read about some of the
fundraising projects currently underway at
www.rabiescontrol.net/EN/Programs/
Projects-Overview.html . Funds donated to
this initiative are used to support
4 2
5 3
1
companion | 25
WSAVA NEWS
WORLD RABIES DAY 20 09
Honouring the contribution of Anna Worth,
past AAHA president and WSAVA representative
W
e are sad to report that on
Saturday 16 May, Dr Anna
Elizabeth Worth, past
president of the American Animal
Hospital Association (AAHA) and
WSAVA representative, passed away
peacefully at home surrounded by her
family, following a valiant fight with
cancer. Her accomplishments and
far-reaching influence mean that she will
be greatly missed by members of our
profession around the world.
Anna was actively involved in
veterinary medicine at many levels.
Locally, she served on the Board of the
Bennington County Humane Society. She
also served as president of the Vermont
Veterinary Medical Association (VVMA),
where she founded and edited the VVMA
newsletter. She served as the Vermont
delegate to the American Veterinary
Medical Association from 1992 to 1999.
In 1992 she received the Massachusetts
SPCA Veterinarian of the Year Award,
and in 1997 the David Walker Award. She
served as chairperson for the Vermont
Cruelty Task Force and the Vermont
Animal Welfare Committee.
Across the past 12 years, Anna
became passionately involved with
AAHA. She served on numerous
committees and acted as the AAHA
representative for the CATalyst Council,
National Council on Pet Population Study
and Policy, and the WSAVA. In 2005 she
helped found the AAHA Helping Pets
Fund, which provides funds to pets and
clients in need. From 2008 to 2009,
during her illness, she served as AAHA
president where she championed student
advocacy and mentoring guidelines, and
had numerous speaking engagements at
veterinary colleges in the USA and
Canada. Despite all of this, she continued
to find time for other activities, including
a veterinary management group, the
AAHA Veterinary Management Institute,
and being president of the Society for
Veterinary Medical Ethics.
Anna grew up in a home where she
was allowed to bring her treasured
donkeys into her parents living room.
Her love for the outside world was
evident in her vocation and hobbies,
which included gardening, astronomy,
motorbikes, cycling, tennis, camping, and
boating. Anna was a voracious reader and
loved trying new things, travelling and
meeting new people. She was actively
involved in the community, participating
in the Parent Teacher Association, the
MAU High School Curriculum
Committee, and the Vermont Womens
Fund. She will be sadly missed.
A LIFE
REMEMBERED
community level
rabies control and
education programmes throughout the
world, with a specific focus on regions
with high human rabies cases and
uncontrolled rabies in dogs.
Partner with us!
World Rabies Day is supported by
partnering organisations throughout the
world if you are interested in becoming
a partner, please contact peter.costa@
worldrabiesday.org . A list of our current
partners can be found at: www.
worldrabiesday.org/EN/Our_Partners/
Our_Partners.html .
RITA 2009
The 20th International Conference on
Rabies in the Americas (RITA) will be
held 1923 October 2009 in Quebec
City, Quebec, Canada. For more
information see www.rita2009.org .
6
Photos 1 and 2: WRD 2008, Serengeti.
Tendeka Maiaiu and Suzanne McNabb;
Photo 3: WRD 2007, Zambia. Dr Perfecto
Buyamba Kabanshi; Photo 4: WRD 2008,
Swaziland. Dr Sihle Mdluli; Photo 5: WRD
2007, University of Manchester. Emm
Barnes; Photo 6: WRD 2007, Thailand.
Molecular Biology Center for Neurological
Diseases, Chulalongkorn University Hospital
26 | companion
companion INTERVIEW
Maggie Fisher was born in 1963 near Warrington in Cheshire and grew up on a small
market garden as the eldest of three sisters. Her maternal grandfather was a Ministry vet
and the challenge of his career appealed, so she applied to RVC and after five years
graduated as a vet in 1986. After a short period in mixed practice she returned to the
RVC as an intern and lecturer in parasitology. In 1993 she moved with her husband and
two small daughters to a small animal practice in Worcester, and since 1997 has developed
a consultancy in parasitology
You are known for your work in
parasitology; what drew you to
this specialism?
As recent graduates working in practices in
the Midlands, my husband and I realised that
on our combined income we couldnt afford
even the smallest house in the village where
I was working, so we decided to move back
towards London to make some money. I
was also struggling to smile at clients 5 or 7
days a week (and I wholly admire those of
you who are doing that day on day). I was
interested in everything and anything and
Dennis Jacobs at the RVC happened to have
a vacancy and so when we returned to
London I began the internship with him.
How did your work with the
European Scientific Counsel for
Companion Animal Parasites
come about?
Ruedi Schenker of Novartis had set up an
American group, CAPC and he wanted to
set up a European group. He approached
me to be the moderator. In coming
together as a group, the parasitological
challenges that face us in Europe became far
more apparent than they were to us as
individuals. Plus, as a group we were in a
better position to suggest what could be
done about them than we were as
individuals. There was a sense too, best
described by Jim Duncan our present chair,
that parasitological expertise has somehow
failed to get out of the ivory tower in a
user-friendly way. And ESCCAP was an
opportunity to address this.
What are ESCCAPs main aims?
The long term goal for ESCCAP is that
parasites are no longer a health issue for
pets or humans across Europe. This is
obviously some way off, and indeed when
preparing an abstract for the WAAVP
(World Association for the Advancement of
Veterinary Parasitology) conference later
this summer, I realised that probably, over
the past 3 years, parasites have become a
greater health issue. Having established
ESCCAP our ongoing challenge at both
European and national level is defining
priorities and fulfilling on these as we work
towards this goal.
What do you consider to be your
most important professional
achievement so far?
There is a distinction that I have only now
overcome: for many years I havent
considered myself a real vet as I dont
work in practice. Thus, my most important
professional achievement in practice was an
aural resection. Now I often develop
leadership skills in others or work within a
team and so in some senses achievements
are never all my own doing. I am proud of
having created and held a symposium at a
world conference to consider how the 3Rs
(reduction, replacement and refinement)
can be implemented into parasitology
research for regulatory purposes. Im also
proud to have played a part in raising
awareness of the value of the tick and
tapeworm treatment derogation within the
Pet Travel Scheme.
What has been your main interest
outside work?
I have tended to disappear into work as an
escape route, so outside interests are not
perhaps very well developed. Without
doubt, my main occupation is bringing up my
two daughters. And I love my mountain bike.
Who has been the most
inspiring influence on your
professional career?
In the UK probably Lord Soulsby. I was
privileged a few years ago to launch the
book (created as the final project of the
Allan White Educational Trust) that John
McGarry and I had written at a reception in
the House of Lords hosted by Lord Soulsby.
What would you have done if you
hadnt chosen to be a vet?
I remember as I cycled on the way to
collect my A level results I concluded that if
they didnt get me into vet school then I
would try again. So there was no plan B.
What is the most significant lesson
you have learned so far in life?
That each of us is powerful and it is only
possible to use it if we define what we want
to do clearly and are willing to let go of the
concerns and other constraints that we
place upon ourselves.
What is your most important
possession?
My Swiss army knife thats kept in my
handbag and I have to post to myself when I
discover it in my hand luggage at customs! n
THE
companion
INTERVIEW
CPD DIARY
companion | 27
CPD
DIARY
3
September
Thursday
Angiostongylus
Speaker Sheila Brennan
The VSSCo, Lisburn. Northern Irish Region
Details from Shane Murray, shane@
braemarvetclinic.co.uk, or VetNI,
028 25898543, info@vetni.co.uk
EVENING
MEETING
2
September
Wednesday
Cardiology: The Quest
Study, when not to use
pimobendan, and ACE
inhibitors are not dead
Speaker Mark Patesson
The Park Inn Hotel, Llanedeyrn, Cardiff
CF23 9XF. South Wales Region
Details from the Chairman or secretary,
southwalesregion@bsava.com
EVENING
MEETING
9
September
Wednesday
Orthopaedics: the diagnosis
and management of carpal
and tarsal problems
Speaker Hamish Denny
The University of Bristol, Langford
House, Langford, North Somerset
BS40 5DU. South West Region
Details from Kate Rew,
kate@linhayvet.co.uk
EVENING
MEETING
10
September
Thursday
Preparing for bonfire night
special. Drugs used to treat
behaviour/phobias
Speaker Danny Mills
The Acorn House Veterinary Surgery,
Linnet Way, Brickhill, Bedford
MK41 7HN. East Anglia Region.
Details from Graham Bilbrough,
graham-bilbrough@idexx.com
EVENING
MEETING
1
September
Tuesday
Sending your dog to rehab
Speaker Fiona Doubleday
The Potters Heron Hotel, Ampfield,
Romsey, Hampshire S051 9ZF.
Southern Region
Details from Michelle Stead, 01722
321185, mmstead@btinternet.com
EVENING
MEETING
10
September
Thursday
Practical haematology:
detective work for nurses
Speaker Kostas Papasouliotis
BSAVA, Woodrow House, 1 Telford
Way, Waterwells Business Park,
Quedgeley GL2 2AB.
Organised by BSAVA.
Details from the Membership and
Customer Service Team, 01452 726700,
administration@bsava.com
DAY
MEETING
13
September
Sunday
Considering behaviour in
veterinary medicine
Speaker Sarah Heath
The Pavilions of Harrogate, Great
Yorkshire Showground, Harrogate
HG2 8QZ. North East Region
Details from Karen Goff, 01924 275249,
northeastregion@bsava.com
DAY
MEETING
15
September
Tuesday
Endoscopy
Speaker P.J. Noble
The Swallow Hotel, Preston New Road,
Preston PR5 0UL. North West Region
Details from Simone der Weduwen,
01254 885248, beestenhof@
ntlworld.com
EVENING
MEETING
25
August
Tuesday
Oncology: medical treatment
for mast cell tumours and
assessment of the quality of
life of a cancer patient
Speakers Tom Cave and Rob Harper
The Holiday Inn Bristol Airport, Brunel
Room, A38 Bridgwater Road, Redhill,
Bristol BS40 5RB. South West Region
Details from Lennon Foo, lennonvet@
hotmail.com
EVENING
MEETING
10
September
Thursday
ECGs for dummies like me
Speaker Geoff Culshaw
The L.A Lecture Theatre R(D)SVS,
Edinburgh. Scottish Region
Details from Claire Robertson,
07792 251003, claireadriennelamb@
hotmail.com
EVENING
MEETING
9
September
Wednesday
Haematology Road Show
Speakers Guillermo Couto and Michael Day
Day meeting at the Daventry Hotel,
Sedgemoor Way, Daventry,
Northamptonshire NN11 0SG.
Organised by BSAVA
Details from the Membership and
Customer Service Team, 01452 726700,
administration@bsava.com
11
September
Friday
Haematology Road Show
Speakers Guillermo Couto and Michael Day
Day meeting at Mottram Hall, Wilmslow
Road, Mottram St Andrew, Cheshire
SK10 4QT. Organised by BSAVA
Details from the Membership and
Customer Service Team, 01452 726700,
administration@bsava.com
14
September
Monday
Haematology Road Show
Speakers Guillermo Couto and
Michael Day
Day meeting at the Marriott Hotel,
Kingfisher Way, Hinchingbrooke
Business Park, Huntingdon PE29 6FL.
Organised by BSAVA
Details from the Membership and
Customer Service Team, 01452 726700,
administration@bsava.com
16
September
Wednesday
Haematology Road Show
Speakers Guillermo Couto and
Michael Day
Day meeting at the De Vere Hotel, Hook
Heath Road, Gorse Hill, Woking GU22
0QH. Organised by BSAVA
Details from the Membership and
Customer Service Team, 01452 726700,
administration@bsava.com
For further details of CPD courses in your area,
please visit www.bsava.com
British Small Animal Veterinary Association
Woodrow House, 1 Telford Way, Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB
Tel: 01452 726700 Fax: 01452 726701
Email: administration@bsava.com
Web: www.bsava.com
For more information
or to order visit www.bsava.com,
email administration@bsava.com
or call 01452 726700
Special offers
on BSAVA Manuals
26
BSAVA Manual of Canine and Feline
Oncology, 2nd edition
Edited by Jane Dobson
and Duncan Lascelles

Focus on the clinical approach to care

Tumour biology, pathology, diagnostic

techniques and clinical staging

Ethical issues, emerging therapies

and nutrition
Member price 52
26
BSAVA Manual of Small Animal
Cardiorespiratory Medicine
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Edited by Virginia Luis Fuentes
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Problem-oriented approach

Diagnosis and treatment of disorders from

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Medical and surgical aspects and diagnostic

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Member price 53
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