The essential publication for BSAVA members

companion
AUGUST 2011
Clinical Conundrum
Lethargy in an
English Setter
P7
2012 Congress
Designing
science
P11
How To
unravel feline
alimentary lymphoma
P14
The greyhound
business
01 OFC August.indd 1 20/07/2011 10:57
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companion
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 Grant Petrie MA VetMB CertSAC CertSAM MRCVS
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.
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possible and companion is printed on paper made from sustainable resources and
can be recycled. When you have finished with this edition please recycle it in your
kerbside collection or local recycling point. Members can access the online archive of
companion at www.bsava.com .
3 Association News
Latest news from BSAVA
46 Leader of the pack
Peter Laurie, Chief Executive of the Racing
Greyhound Trust
710 Clinical Conundrum
Consider a case of lethargy in a young English Setter
1113 Congress 2012
How the science programme is created
1418 How To
Unravel the mysteries of feline lymphoma
19 CPD
Practical courses in abdominal imaging and haematology
2021 Publications
The challenge of recurrent skin infections
2223 Petsavers
Abby Boles fundraising pet owner
24 BVA Congress
Making an impact in a changing world
2527 WSAVA News
The World Small Animal Veterinary Association
2829 The companion Interview
Barbara Cooper
30 Meet Your Region
Spotlight on North East Region
31 CPD Diary
Whats on in your area
Additional stock photography Dreamstime.com
Bringer; Elena Schweitzer; Saniphoto; Willeecole
Changes to
pet travel rules
On 30 June Defra announced that
the UKs derogation will end on
31 December this year. BSAVA will
help you manage this change
I
t is very likely that you have read in the vet press, if not the
national press, about the change to the UKs pet travel rules.
These changes dont come in until January 2012; however,
BSAVA has a plan to help you and your clients consider the
implications of the new rules.
A head start
We immediately published a joint statement on the day of the
Ministerial Announcement, as well as a simple guide to the
rules on our Pet Travel pages in the Advice section of the
website. We then worked with some of the UKs top experts to
produce a selection of some likely Frequently Asked
Questions and a poster for display in your practice, sent as an
insert in this edition of companion, and to all practices on our
database with the latest practice newsletter.
At the time of going to press the Association was going
through its review process for all its Pet Travel material, so its
worth making regular visits to these pages online for more
information. You will find all the relevant useful Defra and
AHVLA links on our pages too.
Vet response
The Pet Travel pages include the joint statement from BVA and
BSAVA, and this was sent by BVA to all the key editorial desks
for both the national and veterinary media. At the time of this
statement, BSAVA President Andrew Ash added; BSAVA
believes that it is vital that pet owners fully consider all the
risks and implications of travelling with their animals outside
the United Kingdom. In addition to rabies there are many other
important diseases present in Europe that are a risk to both
animal health and welfare and human health.
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ASSOCIATION NEWS
BSAVA TEAMS UP WITH
NOTTINGHAM TRENT
A
fter a successful review at Woodrow House
on 21 June, BSAVA announced that
Nottingham Trent University will be the
accrediting body for the new Postgraduate
Surgery and Medicine Certificates.
Dr Frances Barr, BSAVA Academic Director,
says, This is an exciting new venture in
postgraduate CPD, and will ultimately lead to
qualifications which are achievable for those in
practice and directly relate to their experience.
Finding the right partner to validate the
programmes was especially important.
These new qualifications are primarily aimed at
veterinary surgeons in small animal practice who
have a particular interest in small animal medicine
or surgery. This appeals particularly to BSAVA
President Andrew Ash, who heads a six site
practice in Sussex. He says, I see more and more
busy people who want some recognition for the
time they spend fulfilling their CPD requirement
and with these discipline-based certificates I can
see a way that you can now be rewarded with a
greater breadth of knowledge and confidence,
plus a certificate to show for your efforts.
Gill Richards, Director of Professional
Development at Nottingham Trent, says, What
has inspired us most is the impressive quality of
the teaching team and materials, and the
innovative response to meeting a national demand
for a course of this quality.
Enrolment will open in October. Initially, courses
will be limited to 30 in each programme. Anyone
interested in enrolling for one of these certificate
programmes can email academicdirector@
bsava.com or call 01452 726700.
ASSOCIATION NEWS
FECAVA IN ISTANBUL
The 17th FECAVA Eurocongress will take place in
Istanbul from 710 September. The congress will
be held at the Istanbul Ltfi Krdar Convention &
Exhibition Centre (ICEC). The ICEC and adjacent
Rumeli Fair & Exhibition Hall are within the
Conference Valley, offering more than 6,000 guest
rooms within easy walking distance to ICEC,
including six 5-star hotels.
Visit www.kenes.com/fecava/
I
n 2004 Elizabeth Mullineaux applied for, and was awarded BSAVAs travel
scholarship. The award led her on a journey to the other side of the world.
Liz had been developing her interest in indigenous wildlife and had made
some connections with rehabilitators and vets in New Zealand. In order to take
a closer look at their work, this vet from general practice in the West Country
decided to take an in-it-to-win-it approach and applied for the Frank
Beattie Travel Scholarship.
The scholarship was established in 1988 in memory of Frank Beattie, a
well respected veterinary surgeon and a long-standing member of the
BSAVA. It is awarded annually from a generous gift given by Franks widow,
Annie. The scholarship is awarded to help a BSAVA member undertake a
trip abroad to study a particular aspect of veterinary practice.
The process of application was really easy, says Liz. People often fail
to apply for these things so you may be only one of a handful of applicants
your odds will be better than you think. Its really special getting the
award. One of the nicest things was chatting to Mrs Beattie, who couldnt be
more enthusiastic about all the trips people do in her late husbands name.
The trip led Liz on another journey. The trip really inspired my interest,
spending time with like-minded people always does that. After I came back
from New Zealand I registered for a part-time clinical doctorate with the
University of Edinburgh, using case material from the wildlife casualties that I
see through my work in practice. I finished this in February this year.
The scholarship might most obviously appeal to someone in academia
wanting to see practice with an overseas specialist. However, applications
are especially encouraged from practitioners. Its a great opportunity, Liz
enthuses, but just needs some imagination and the confidence to apply.
The fund is usually 2k, however due to a lack of an appropriate
application in 2011, 4000 will be awarded to a successful applicant in 2012.
Application forms and details can be obtained from secretary@bsava.com or
online at www.bsava.com the deadline for applications is 11 November.
4000 travel
scholarship
available
There is 4K on offer to
the successful applicant
of the Frank Beattie
Travel Scholarship
LtoR: Chris Royle
(Nottingham Trent),
Ann Ord (Nottingham
Trent), Frances Barr
(BSAVA), Gill
Richards (Nottingham
Trent), Andrew Ash
(BSAVA), Matt Henn
(Nottingham Trent)
03 News.indd 3 20/07/2011 11:47
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GREYHOUNDS
Baptism of fire
If it wasnt for his genuine love for the sport
of greyhound racing, Peter Laurie would
have been tempted to pack in his new
career just a fortnight or so after starting
work. That was in 2006 when he was
installed as the first welfare officer at the
British Racing Greyhound Board (BRGB).
His initiation period turned into a
baptism of fire when The Sunday Times ran
an expose on the fate of retired
Greyhounds submitted to the tender
mercies of David Smith, a builders
merchant from Seaham in County Durham.
For 10 apiece, he dispatched them with a
address the welfare and regulatory
problems in greyhound racing. Firstly, an
owner and a trainer found to have acted as
intermediaries between Smith and the
dogs owners were permanently banned
from any association with the sport.
More importantly, the sports two
governing bodies, the BRGB and the
National Greyhound Racing Club,
commissioned a report by the economist
Lord Donoughue which was finalised in
November 2007. Its recommendations
included the merger of those two bodies to
form the Greyhound Board of Great Britain
(GBGB), which took effect in January
2009. Then, recognising that good
regulation is the cornerstone of good
animal welfare, the new unitary body
pressed Defra to introduce the Welfare of
Racing Greyhounds Regulations, which
were passed in March 2010 as an
amendment to the Animal Welfare Act.
Involving the profession
Among the main requirements of those
rules was the licensing of all greyhound
tracks, either by the GBGB for the 25
remaining commercial tracks, or by the
local authority for the small numbers of
previously unregulated flapping tracks.
They also insist that a veterinary surgeon
Leader
of the pack
Peter Laurie caught the greyhound racing bug as a
schoolboy. After accompanying a friend to an evening
at the Wimbledon dog track, they went into partnership
as owners of a dog called the Whitgift Flyer. But an
injury cut short that Greyhounds career and it spent
the rest of its days as the Lauries family pet. Now, as
the new Chief Executive of the Racing Greyhound
Trust, Peter wants to make sure that every dog has the
same opportunity for a new life. John Bonner reports
legally held captive bolt pistol and buried
them on his land. A few months later, Smith
was fined 2000 for breaching the
Pollution Prevention and Control (England
and Wales) Regulations in disposing of
waste perhaps maybe as many as
10,000 canine carcases without a permit.
The case caused outrage among
animal lovers both outside and inside the
racing greyhound industry and certainly
did considerable damage to the reputation
of the sport. However, unusually by the
sclerotic standards of British sports
administrators, the greyhound authorities
acted swiftly and decisively to identify and
Peter Laurie has a lifetime of
interest in greyhounds
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GREYHOUNDS
must be present for every race meeting
and must be able to inspect each runner.
As a rapidly rising star within the BRGB,
Peter was involved both in organising the
merger and in lobbying for the new
regulatory framework. After taking on an
increasing range of responsibilities in
welfare and doping control at the newly
formed Greyhound Board of Great Britain,
he was eventually offered the unwieldy title
of Deputy Director of Regulation and
Manager of Welfare and Integrity Services.
But from the beginning of July, his
office door will carry the somewhat
snappier inscription Chief Executive at the
Retired Greyhound Trust (RGT). This
organisation on the other side of London to
the GBGB has close links to his old
employer, not least in the form of an annual
grant, currently worth about 1.6 million.
Raised from the GBGBs voluntary levy on
betting transactions, this grant helps fund
the Trusts national and local greyhound
welfare activities.
A safe bet
Having formerly worked at the grassroots as
a kennel hand, trainer and owner, Peter has
taken a keen interest in the changes that
have occurred in the sport at a local level.
Since August 2008, five of the main tracks
have closed at Coventry, Hull, Portsmouth,
Reading and Walthamstow. Moreover, both
the numbers of licensed trainers and the
numbers of dogs being registered with the
GBGB have fallen during the past 5 years,
but Peter insists that this is not an indication
that the sport is in terminal decline.
Greyhound racing is alive and well,
he says. Even though the numbers of
people attending tracks has fallen, the
sport is sustained by off-course betting
which is currently worth a staggering 2
billion a year. Despite the recession and
the increasing competition from betting on
a widening range of other sports,
greyhound racings share of this trade has
held up remarkably well. Indeed, the
GBGBs revenue from the 0.6 per cent
voluntary levy is growing again, showing
that the sport has emerged from its recent
doldrums. As a betting product,
greyhound racing is an extremely good
one. The sport is very straight, the
bookies have a reasonable margin and, for
the punters, a Greyhounds performance is
remarkably consistent.
Welfare improvements
Peter points out that one of the reasons for
the reduction in the numbers of registered
Greyhounds from 10,500 in 2005 to 8,500
in 2010 was that Greyhounds are enjoying
longer competitive careers due mainly to
track improvements and a reduction in
racing injuries. There has also been a
change in the culture of greyhound racing,
with trainers and owners showing much
more concern for the welfare of their dogs
both during and after their racing careers.
A dog will normally start racing at
about 15 months and will usually have to
quit competitive work by about the age of
5 years, although Peter points to an
8-year-old which started as the favourite in
a recent race. But, inevitably, dogs that are
injured or become too old and slow will no
longer be able to compete so what
happens to them now?
A decade ago, up to 25% of the dogs
entering animal welfare charity kennels
were Greyhounds; now it is less than 1%,
Peter says. Many of those retired
Greyhounds will be kept as pets by their
owners, with many owners finding room
for 10 or more dogs. The creation and
growth of the RGT means that many
thousands are now found homes with
ordinary families, up from about 3,400 in
2005 to around 4,500 a year in 2009 and
2010. In addition to the trusts 70-odd
branches around the country there are
other local charities helping to re-home
retired and injured Greyhounds, and so the
gap between the numbers leaving racing
and the numbers finding loving homes has
narrowed considerably.
Inevitably, a proportion of dogs will
have to be euthanased but the racing
authorities insist that this must be done
humanely by a veterinary surgeon, and
anyone found to have broken that rule will
be expelled from the sport. Peter notes that
Greyhounds make great R.E.A.D dogs helping children with reading problems
become more confident by reading to a non-judgemental pet
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GREYHOUNDS
Leader of the pack
the GBGB asked for veterinary-only
euthanasia to be enshrined in the welfare
regulations but Defra wanted to retain the
flexibility that would enable others to
dispose of dogs in emergencies.
From athlete to pet
One question often asked about re-homing
Greyhounds is: when a dogs instinct and
training encourages it to chase and kill
small furries, how reliable will it be as a
pet? Yes, there are some dogs that we
cant re-home but the vast majority can be
readily de-trained so that they will leave
cats and other pets alone. It is very easy to
test whether a Greyhound is going to show
an interest in cats and if there is any doubt
we wouldnt re-home them in that sort of
setting. It is a question of matching a dog
to the right home, Peter explains.
For a number of reasons, Greyhounds
make excellent pets. They are very quiet
and docile animals. I have never known
one bite. They are good with children and
old people. They have short, low-
maintenance coats, and while they are not
fussy eaters they dont need to eat huge
amounts, Peter says. When a dog stops
regular training it may put on a kilo or so,
but you are not likely to see an obese
Greyhound, maybe partly because they
are so slim and it is easy to spot when they
putting on weight. And they dont need a
huge amount of exercise they may be
elite athletes on the track but they are
couch potatoes when they are off it.
Funding and research
As the RGT has grown, an increasing
proportion of its income comes from the
fund-raising efforts of its local branches
rather than its grant from the GBGB. Peter
hopes that the veterinary profession, which
through the 2010 regulations, was given a
central role in protecting Greyhound
welfare on the track, can also play an
important role in looking after retired
Greyhounds. He asks that practitioners will
help to promote the idea of retired
Greyhounds as suitable family pets for their
clients. They could also help in raising both
the profile of the RGT and the funding it
needs by publicising local events being
organised by the Trusts branches.
Some practices are already helping the
charity by offering the same sort of
discounts on clinical procedures that are
often available to the more established
animal welfare charities, and Peter would
like the same service to be available to all
its branches around the country. He would
also like to enlist the professions research
skills in investigating Greyhound health and
welfare issues, such as severe dental
disease which is a noted problem with the
breed and probably results from a
combination of genetic and environmental
(especially dietary) factors, he says.
Neutering
Another research project he would like to
sponsor is an extension of a pilot study
carried out by Durham practitioner Jacqui
Molyneux, which provided some evidence
that neutering has no effect on the
performance of Greyhound bitches. If this
could be proven conclusively, then it would
have significant impact on the welfare of
female Greyhounds, which would become
much more valuable for their owners. It
would reduce the costs associated with
oestrus suppression treatments to allow
bitches to continue racing and would
reduce disruption to the training schedule.
Self-interest forms part of the reason
why Peter would like owners to neuter
female Greyhounds as soon as it becomes
clear that they are not to be used for
breeding. The charity insists that all dogs
passing though its kennels are neutered
before being re-homed and early neutering
could potentially save the charity a
significant expense.
There is no reason in the sports rule
book why neutered bitches should not
compete in races at any level but very
few trainers would countenance having
the procedure carried out in a working
bitch. You have got to remember that this
is very much a cottage industry and the
people in it are resistant to change. If we
could provide the evidence needed to
show them that neutering has no effect
either way on the performance of a
Greyhound bitch then we may be able to
make some progress. n Twiggy is a regular supporter of the charity
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CLINICAL CONUNDRUM
Clinical
conundrum
Eleanor Raffan of the
University of Cambridge
invites companion readers to
consider a case of waxing
and waning lethargy in a
young English Setter
Case presentation
A 10-month-old male English Setter presented
with a 7-week history of intermittent lethargy,
inappetence and weight loss. Signs had been
episodic and the owner reported the dog to be
normal on presentation. Four weeks previously
a left fore lameness associated with embedded
grass awns in the interdigital spaces had been
present. Carprofen and antibiotic treatment
(potentiated amoxicillin, cefalexin) resolved
the lameness but not other signs. The dog was
fully vaccinated and de-wormed.
On physical examination the dog was quiet
but responsive, and thin. A full physical
examination was unremarkable.
(PSS) was considered as a unifying diagnosis. Grass
awn migration causing inflammation/infection was also
possible. The weight loss was explicable by reduced
calorie intake, but could have been exacerbated by
maldigestion, malabsorption, systemic illness or
protein-losing disease. The fact that clinical signs
had been episodic suggested that a metabolic or
immune-mediated disease was most likely.
Construct a diagnostic plan
Investigation would be best centred on looking for
evidence of inflammatory/infectious disease. However,
in cases where a patient has episodic clinical signs
diagnosis may not always be achieved when the dog
is asymptomatic. The owners were counselled on this
possibility and because blood results and urinalysis at
the time of the grass awn removal had been
unremarkable, the decision was made to re-examine
the patient as soon as clinical signs recurred.
Re-presentation
On day 7 the dog re-presented with signs identical to
previous episodes. He was depressed, with a stilted
gait. Rectal temperature was 39.5C. Respiratory rate
(22 breaths/min) and effort, heart rate (114 beats/min),
pulses, hydration, auscultation and abdominal
palpation were normal. Manipulation of the neck, left
elbow and stifles was painful. Neurological
examination was normal except for the depression.
Create an updated problem list
New problems:
n Neck pain
n Joint pain
n Pyrexia
n Depression
Continued problems:
n Lethargy
n Inappetence
n Weight loss
What are your revised differential
diagnoses for the case?
Neck pain can be due to immune-mediated or other
meningitides, encephalomyelitis, intervertebral disc
disease (IVDD), trauma, or discospondylitis.
Create a problem list for this case
n Lethargy (episodic)
n Inappetence (episodic)
n Weight loss
Consider the differential diagnosis for
your problems. Can your differentials be
prioritized based on the history and
physical examination findings?
Lethargy can be due to pain, pyrexia, systemic disease
(infectious, inflammatory, neoplastic, organ failure),
metabolic/endocrine disease (hypoadrenocorticism,
hepatic encephalopathy, electrolyte abnormalities,
hypothyroidism, hyperadrenocorticism), or central
nervous system (CNS) disease. Inappetence is
associated with similar problems.
The dogs age meant that portosystemic shunt
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CLINICAL CONUNDRUM
Clinical conundrum
Pain in multiple joints may occur in non-erosive
polyarthritis due to immune-mediated disease/infection,
erosive (rheumatoid) arthritis, haemarthrosis, or
developmental/degenerative joint disease. Because of
the identical presenting signs, it was suspected that
neck/joint pain had been present but unidentified in
previous episodes. On balance, such a waxing/waning
clinical presentation and the diffuse nature of the dogs
pain would be most suggestive of immune-mediated
disease, with infectious, traumatic and degenerative
diseases being less likely.
Pyrexia was thought to be secondary to
inflammatory/infectious disease because the dog was
not attempting to dissipate heat. Depression was
thought a secondary problem given the pain and fever.
An inflammatory or infectious cause of joint and
possibility meningeal disease was considered most
likely to account for all observed clinical signs, and
investigations centred on these regions.
What is your initial diagnostic test? Why?
Haematology was performed to look for evidence of
infection/inflammation, in conjunction with biochemistry
to screen for systemic or organ-specific disease.
Urinalysis completed the minimum database by
investigating renal function. Results are shown in
Tables 1,2 and 3.
Parameter Result at
presentation
Reference
range
WBC (x10
9
/l) 23.60 6.0017.00
Neutrophils (x10
9
/l) 19.1 3.011.5
Lymphocytes (x10
9
/l) 4.0 1.04.8
Monocytes (x10
9
/l) 0.2 0.21.5
Eosinophils (x10
9
/l) 0.2 0.11.3
Basophils (x10
9
/l) 0.0 0.00.5
RBC (x10
12
/l) 5.74 5.508.50
Hb (g/dl) 13.90 12.0018.00
HCT(l/l) 0.388 0.3700.550
MCV () 68 6077
MCH (pg) 24.1 19.524.5
MCHC (g/dl) 36 3237
RDW (%) 13.6 13.217.8
Platelets (x10
9
/l) 277 175500
WBC comment Absolute
neutrophilia
RBC comment Normal
Platelet comment Consistent
with count
Plasma protein (g/l) 68 6080
Fibrinogen (g/l) 4 24
Table 1: Haematology results
Table 2: Biochemistry results
Parameter Result at
presentation
Reference
interval
Sodium (mmol/l) 144.9 135.0155.0
Potassium (mmol/l) 3.78 3.505.80
Chloride (mmol/l) 107.2 105.0120.0
Urea (mmol/l) 2.0 3.38.0
Creatinine (mol/l) 65 45150
Glucose (mmol/l) 6.2 3.45.3
Total protein (g/l) 66.8 60.080.0
Albumin (g/l) 38.4 25.040.0
Globulin (g/l) 28.4 25.045.0
Calcium (mmol/l) 2.87 2.302.80
Ionised calcium
(mmol/l)
1.430 1.1801.400
Phosphate (mmol/l) 1.37 0.781.41
ALT (IU/l) 39 2159
AST (IU/l) 20 2032
CK (IU/l) 64 76228
ALP (IU/l) 169 3142
GGT (IU/l) 7 010
Total bilirubin (mol/l) 5.3 2.017.0
Cholesterol (mmol/l) 5.08 2.505.90
Cystocentesis
samples
Initial
investigation
6 weeks post
discharge
Specic gravity 1.046 1.041
pH 6.00 5.50
Protein Trace Trace
Glucose Negative Negative
Ketones Negative Negative
Bilirubin + Negative
Blood Trace Trace
WBC 4 <5
RBC 7 <5
Gross
description
Dark yellow Dark yellow,
cloudy
Urine sediment 23 epithelial
cells/hpf, sperm.
Blood could be
iatrogenic
Bacteria ++,
occasional
epithelial cells
and sperm
Culture No growth Heavy pure
growth of
Enterobacter
cloacae*
Table 3: Urinalysis results
* Sensitive to: enrofloxacin, trimethoprim/sulphonamide, ampicillin.
Resistant to: amoxicillin, cefovecin, oxytetracycline, cefalexin,
metronidazole.
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CLINICAL CONUNDRUM
Assess the haematology, biochemistry
and urinalysis results. How do they alter
your approach to the case?
Mature neutrophilia without lymphopenia and
hyperfibrinogenaemia are consistent with
inflammatory/infectious disease. Low urea and CK
were attributed to low muscle mass. Mild
hypercalcaemia, hyperphosphataemia and elevation
of ALP were considered consistent with the patients
young age; to further support this, a lack of
azotaemia and hypersthenuria suggested that there
was no renal insufficiency. However, mild elevations
in ALP can be seen with gastrointestinal signs and
can be secondary to systemic inflammatory disease
and PSS.
Given the pronounced pain on joint manipulation
and the haematology changes, PSS was now
considered an unlikely diagnosis and a bile acid
stimulation test was not deemed essential prior to
anaesthesia. An inflammatory or infectious disease
involving the joints and/or meninges was still
considered the main differential diagnosis and
investigations were centred on examination of these
anatomical regions and looking for distant disease that
might act as a trigger for the disease process centred
on the joints.
Which diagnostic tests are now
appropriate?
Given that pain was centred on the joints, the
patient was anaesthetised for radiography of multiple
joints and neck, to look for evidence of erosive
arthropathies, soft tissue abnormalities or IVDD.
Given the previous history of lameness due to grass
awns, thoracic and abdominal radiographs and
abdominal ultrasonography were also performed to
look for evidence of a migrating foreign body (grass
awns) or another focus of infection or inflammation
that could be the trigger for immune-mediated
disease. Radiography and ultrasonography of all
areas was unremarkable.
While anaesthetised, CSF sampling and
arthrocentesis were performed and samples taken for
cytology (Table 4) and bacterial culture to determine
whether there was evidence of an inflammatory or
infectious disease. Excess sample material was
reserved in case further tests were required.
How do you interpret the results of the
imaging and fluid analysis? What
differentials can be ruled in or out?
Normal imaging findings were not supportive of
cervical discospondylitis, IVDD or cervical fracture.
Furthermore there was no evidence of erosive or
degenerative joint disease.
CSF. Cisternal collection
Protein (g/l) 0.18 <0.25
CSF
nucleated
cells (/l)
35.0 06
CSF RBC 0.0
Cytological
ndings (see
Figure 1)
The cytospin preparation showed
increased cellularity consistent with
the count given. The cells were
almost all neutrophils, some of these
being poorly preserved. Organisms
were not seen. Small numbers of
moncytes and macrophages were
present. Occasional lymphocytes
were also seen.
Arthrocentesis
Joints
sampled
Left and right carpus, left elbow,
right tarsus, left and right stie.
Cytological
ndings
Left carpus (see Figure 2) and left
elbow smears were moderately
hypercellular consisting of
approximately 30% neutrophils
and 70% mononuclear cells in a
proteinaceous background. No
bacteria were seen. In the remaining
joints the smears were hypocellular:
small numbers of mononuclear cells
were seen.
Table 4: CSF and synovial fluid analysis
Figure 1: High
power view of CSF
Figure 2: High
power view of
synovial fluid
from the left
carpus
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CLINICAL CONUNDRUM
Clinical conundrum
The neutrophilic pleocytosis seen on the CSF
analysis is most consistent with inflammation. Such
abnormalities are consistent with immune-mediated
meningitis, ehrlichiosis, bacterial meningitis or
neoplasia. The latter options would not usually cause
waxing/waning signs and cell counts are usually
higher in bacterial meningitis. Distemper or protozoal
infections would usually have additional signs and a
different cytological picture.
The neutrophilic joint fluid was most suggestive of
immune-mediated polyarthritis, borreliosis or
ehrlichiosis. Septic polyarthritis was unlikely given the
dogs age (usually young puppies) and the fact that
neutrophils were non-degenerate. Other infectious
causes are rare and/or not recognised in the UK.
The resulting top differentials were immune-
mediated meningitis and polyarthritis, ehrlichiosis
(Anaplasma phagocytophilum, Ehrlichia canis) and
borreliosis. The latter is not proven to cause CNS
disease in dogs but does in humans. It was felt that
if an immune-mediated disease was present it was
likely to be primary, as signs preceded previous
drug treatment and infection (with grass awn) and
no further trigger had been identified during
diagnostic investigation.
Are there any further tests you would do
on fresh or stored samples?
Synovial fluid and CSF were submitted with blood for
Ehrlichia and Borrelia PCR. This assay can detect even
minute amounts of DNA from a suspected pathogen,
so these tests are more sensitive than relying on
detection of pathogens on cytology samples and more
specific for active infection than serology.
How would you manage the dog?
After recovery from anaesthesia, analgesia was
continued with buprenorphine. NSAIDs were not
used because corticosteroid treatment might be
required and concurrent use can cause severe
gastrointestinal ulceration. Doxycyline (10 mg/kg
PO q12h) was started to treat possible ehrlichiosis
or borreliosis.
The following day, the dog remained markedly
painful and depressed. PCR results were not
anticipated for at least a week. As infection was
unlikely compared to immune-mediated disease, the
decision was made to start a cautious dose of
prednisolone (1 mg/kg PO q24h). Within 24 hours, the
dogs demeanour improved and he ate.
How would you manage the case now?
An improvement in clinical signs on treatment with
corticosteroids is consistent with the diagnosis of
immune-mediated meningitis and polyarthritis.
Treatment is aimed at controlling pain and reducing
joint inflammation. Initially parenteral analgesia was
required (buprenorphine). This controlled pain well but
an alternative, oral analgesic with good efficacy in
such dogs is paracetamol.
By day 9, the dog was markedly brighter, in less
pain and eating well. He was discharged on
prednisolone and doxycycline.
How long would you continue treatment?
How would you monitor the response?
What treatment complications can be
anticipated?
Doxycycline was stopped after culture and PCR results
proved negative (day 19). This confirmed the
suspected diagnosis of primary immune-mediated
meningitis and polyarthritis. The prednisolone dose
was reduced over 6 months by halving the dose at
6 weeks and monthly thereafter. Before each dose
reduction, the dog was checked carefully for any
recurrence of clinical signs, particularly joint/neck
pain. Some authors recommend repeating joint taps
and/or CSF analysis to confirm remission; we did not
perform this because cytological abnormalities usually
correlate with clinical signs.
At a 6-week check, biochemistry

was consistent
with steroid treatment and young age. The owners
reported pollakiuria. This prompted repeat urinalysis
which identified bacterial infection (see Table 3).
Urinary tract infections are common during
immunosuppressive steroid treatment and may not be
associated with marked clinical signs because of the
anti-inflammatory effect of those drugs. Ampicillin
(20 mg/kg PO q8h x 3 weeks) cleared infection
(confirmed by negative culture 1 week after treatment
finished). Throughout treatment the dog had standard
corticosteroid side effects of polydipsia, polyuria and
poor hair regrowth.
The dog continued to be free of clinical signs to the
end of treatment and is well to date, a year after
discontinuation of treatment.
Discussion
Primary immune-mediated meningitis and
polyarthritis is a recognised syndrome and steroid
treatment is usually successful, although side effects
as seen in this dog are well recognised. Diagnosis is
often complicated by waxing and waning signs and
by subtle physical findings; joint and neck
manipulation should be performed on all dogs with
pyrexia of unknown origin and pain investigated.
For treatment, usually prednisolone is started at
higher doses than used here. The lower dose was
introduced pending infectious disease results and
complete clinical remission once they had been
received meant that increasing the dose was not
felt justified. n
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Congress
F
or the current Chair, Sorrel Langley-Hobbs,
organising next years Congress has been a long
term project requiring meticulous planning for her
and the 18-strong team. But all that hard work has
come good with the completion of arrangements for an
event which will be bigger than ever. It will have
40 different veterinary streams and 16 for nurses, with
213 veterinary and 78 nursing lectures. There will be 65
speakers from the UK and 39 from abroad, including
16 from the US, seven from the Netherlands, three from
Australia, two each from Germany, Spain and
Switzerland, and one from Belgium, Canada, the Czech
Republic, Finland, France, Italy and South Africa.
Going global
Preparations began a little earlier than usual for the
2012 Congress because next years meeting is
unusual even by the standards we have come to
expect. That is because BSAVA is hosting the event for
the World and European small animal veterinary
associations, WSAVA and FECAVA.
There is certain to be a greater number of foreign
veterinary surgeons and nurses visiting the NIA and
ICC in April 2012 but the event has always had a
strongly international flavour. Our aim for the scientific
programme at BSAVA Congress is always to invite a
broad spectrum of experts from around the world to
speak for us. This concept has not changed for
WSAVA although there is perhaps slightly more
emphasis on widening the net of where the speakers
are invited from. However, the emphasis on only
inviting experts in their fields and speakers with a
reputation for being entertaining educationalists has
stayed the same, Sorrel points out.
One difference next year could be in the way that
this scientific data is presented. The WSAVA requests
that the event host provides a simultaneous translation
service in their own language for any group of 40 or
more people from a particular country, as long as they
give reasonable notice. BSAVA had a practice run last
year giving Spanish and Polish delegates attending
lectures in one of the main halls a translation service in
Bringing the best to Britain
You are probably only just
beginning discussions about
getting as many members of the
team as possible to BSAVA
Congress next April. Yet the
organisers of the Scientific
Programme have already
finalised arrangements for the
2012 meeting and are well on the
way with 2013. John Bonner talks
to some of the people whose
long-term planning ensures that
BSAVA Congress registration
remains the hottest ticket in town
for vets and VNs
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Congress
their native tongue. The experiment was
judged a success and allowed BSAVA and
the ICC staff an opportunity to iron out any
technical problems.
Selecting speakers
Early birds are notably successful in
securing the best diet. And the same
principle holds for the people who compile
the menu of scientific presentations that
will feed the minds of BSAVA delegates.
When you are inviting the best
speakers in the world, you do need to
contact them early, explains Ian Ramsey,
who will take over next year as the
chairman of the Scientific Programme
Committee. They are much in demand and
their time is limited. If they are only giving a
few presentations you have to make sure
that you are in there first. All speakers have
heard of BSAVA and they like coming but it
is vital to ask them well in advance.
At a time when the science
underpinning veterinary practice is
advancing so quickly, there are obvious
drawbacks in inviting expert speakers two
years ahead of the meeting. Their ideas on
what is novel and interesting may well
change over that time and so the usual
practice is to secure the services of the
best speakers and only then begin
negotiating with them on what exactly they
are expected to talk about.
As Sorrel and Ian will confirm, choosing
both the speakers and the subject matter is
very much a team effort from all the
members of the committee. As these are
recognised experts in their chosen field
from academia and private practice, they
are familiar with what is going on in the
scientific literature and know who the rising
stars are in any particular branch of clinical
practice. They are also regular attendees at
veterinary congresses abroad and can use
these as scouting missions for identifying
the most talented and engaging speakers.
Sue Murphy from the Animal Health
Trust is a member of the committee with
particular responsibility for organising the
oncology and clinical pathology streams.
She says there are two main criteria in
choosing subjects for those sessions.
The first is to ensure that the material is
relevant to the needs of first opinion
practices focusing on the common
malignancies that they are likely to see
rather than the more obscure conditions
that will often be the main talking points at
events for referral practitioners. The
BSAVA audience may want to be kept up
to date with a condition like canine
mammary tumours. So we will choose that
subject if there has been nothing on it for a
couple of years. We will only come back to
a subject that has been covered recently if
there is something new to say.
The second driver in choosing material
is horizon scanning, to alert clinicians to
the developments that are likely to
influence their approach to practice in the
future. A good example from this years
programme was the masterclass delivered
by Doug Thamm, a veterinary oncologist at
Colorado State University, on the newly
licensed chemotherapy agents of the
tyrosine kinase inhibitor group. For the
meantime, this entirely new class of drugs
for treating mast cell tumours is likely to be
used mainly in specialist referral centres.
But any veterinary surgeon is authorised to
use the product and so it is important that
they understand the indications for using
this product and are fully aware of any
safety considerations for both the patient
and clinical staff, Sue notes.
A team effort
Although the guidance by experts is
invaluable, the choices of material for the
Congress sessions are not made by the
individual specialists alone; their
suggestions have to be discussed with the
rest of the committee to ensure that their
ideas fit in with the broader programme.
The goal is to have a balanced selection
of the different types of presentation
basic and advanced, interactive and
current, controversial issues, etc. Care is
also taken to avoid a clash between
traditional discipline-based and themed
sessions. So if, for example, a dentistry
specialist has been invited to participate in
a session on the theme of oral disease and
wants to address the subject of oral
tumours, then there is no point in having
similar material in the oncology stream.
So, overall it may take five or six sessions
of the committee before it completes the
Bringing the best to Britain
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Congress
transformation of a blank sheet of paper
into the final programme.
Entry level to cutting edge
As a soft tissue surgeon in referral
practice, John Williams, chair of the
organising committee for the whole
congress, is hoping to find time at the
2012 meeting to attend the session on
the genuine cutting edge of veterinary
science and practice, the techniques that
will be part of tomorrows practice,
delivered by pioneers from around the
world. Those speakers include Jimi Cook
from the University of Missouri on
strategies for cartilage resurfacing in the
dog and Bjorn Meij from Utrecht on new
techniques in pituitary surgery for
Cushings disease patients.
At the other end of the scale, BSAVA
Congress aims to help those at the
beginning of their clinical career and is
introducing streams on clinical decision
making for young graduates and those
returning to practice after a career break.
These will generally be short 15 to 20
minutes sessions on the factors to be taken
into account when deciding to take a
biopsy, operate on a patients cataracts,
etc. The ground rules for making these
decisions are not something that can be
readily taught at veterinary school and are
usually picked up after gaining experience
of the constraints faced in everyday
practice, John observes.
Pride of the nurse programme
BSAVA has always recognised the
importance of veterinary nurses to the
profession and this has recently been
reinforced by welcoming them as members
of the Association. The approach to
choosing speakers for the nursing streams
has changed radically over the years.
There are three veterinary nurses on the
2012 committee (Joan Freeman, Liz
Sweeney and Lucy Goddard). They help
we are looking at
novel solutions
using technology to
address sessions
that fill quickly
Congress
BOOK EARLY
Online booking opened 1 August. It is
anticipated that there will be an
increased demand for Masterclasses
and social tickets for 2012, so early
booking is advised. The Early Bird
deadline is 12 January.
NOMINATE AN
AWARD WINNER
The prestigious BSAVA Awards will be
presented at Congress.
Please nominate now. Deadline is
11 November 2011. You can nominate
in every category, or just a single
category. It is really important that a
wide cross section of the profession is
nominated and recognised and so we
encourage you to consider
participating in this great opportunity
to recognise the work of your peers.
Nominate online at www.bsava.com/
nominations or email congress@
bsava.com for a form.
CLINICAL
RESEARCH
ABSTRACTS
Submission of Clinical Research
Abstracts takes place 20 September
20 October. For more information
visit www.bsava.com/congress or
email congress@bsava.com with
your enquiry. Submissions from those
in general practice are especially
encouraged.
choose both speakers and topics and have
influenced a change to increase the
number of presentations by and for nurses.
Reinforcing the unique by the profession,
for the profession aspect of Congress.
There is also an international element to
the nursing programme this year too
in-keeping with it being a World Congress.
Charlotte Donohoe is an award winning
veterinary technician and the emergency
referral coordinator in the small animal ICU
at the University of Guelph, Ontario. Some
of the topics Charlotte will cover at BSAVA
are emergency triage skills, thermal burns,
respiratory emergencies, GDV management
and fluid therapy evaluation, Joan explains.
More for managers too
The Association is also keen to open the
door to other members of the veterinary
team and will be hoping to attract more
practice managers with an increase in the
number of management sessions at next
years event. Another way that we are
encouraging these colleagues to attend is
by offering free entrance to the exhibition
hall at the weekend for those registered to
attend the management sessions on the
Thursday and Friday, John points out.
Spreading the net wider to attract even
greater numbers of delegates to Congress
will inevitably put even greater pressure on
the organisers and local staff. There is a
constant challenge in finding extra facilities
to accommodate everybody who wants to
attend the scientific and social events. In
2012 we are looking at novel solutions
using technology to address sessions that
fill quickly, there will be a dedicated
overflow room to see these lectures live
and we are looking at ways of delivering
the sessions within the venue onto
delegate laptops or smartphones. This is
an exciting area for us so watch this space
for how this will be developed, he adds.
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HOW TO
How to
Editor of companion, Mark
Goodfellow, takes a fresh look
at one of the most common
feline lymphomas
Unravel the mystery
of feline alimentary
lymphoma
L
ymphoma is the most common cancer in the cat,
comprising a heterogeneous group of neoplasms
that arise from the lymphoreticular cells of the
lymph nodes, spleen, bone marrow and elsewhere in
the body. Classically lymphoma was regarded as a
disease of the young feline leukaemia virus (FeLV)-
positive cat but, as understanding of this disease has
grown and the prevalence of FeLV has reduced, a
marked change in signalment, presentation and
aetiopathogenesis of lymphoma in cats has come to
be recognised.
FeLV as a cause of lymphoma in the
1960s to 1980s
Feline leukaemia virus was the most common cause of
haemopoietic tumours of the cat during the
1960s1980s, when 6070% of feline lymphoma
cases were associated with FeLV antigenaemia. At this
time the mean age of cats diagnosed with lymphoma
was 25 years and the most common presentations
were the (T cell) mediastinal and/or multicentric forms
of the disease.
Development of lymphoma is a direct consequence
of FeLV infection. The virus hijacks the cellular
organelles and, following random insertion of viral DNA
(provirus) into host DNA, new virus particles are
budded from the cell membrane. After initial infection,
FeLV spreads to the bone marrow and infects
haemopoietic stem cells. Provirus is randomly inserted
into the host DNA. An insertion of viral DNA next to a
host gene (most commonly myc) that codes for cellular
proliferation may ultimately lead to neoplasia. The
association with FeLV antigenaemia is so strong that it
has been suggested that cats infected with FeLV are
60 times more likely to develop lymphoma than are
their FeLV-negative counterparts. Overall a quarter of
FeLV-positive cats are expected to develop lymphoma
during their lifetime.
Why is lymphoma more common
nowadays when we vaccinate for FeLV?
Over the past 2030 years a profound change has
occurred in viral status, presentation, signalment and
anatomical sites affected by lymphoma in cats. This
change appears to coincide temporally with the
widespread use of FeLV diagnostic assays, FeLV
vaccination and other preventive regimes associated
with a reduction in the prevalence of FeLV infection in
the feline population.
So perhaps it is not unexpected that a decline in
the prevalence of FeLV has been mirrored by a decline
in prevalence of FeLV-associated lymphoma. Overall,
however, the prevalence of feline lymphoma appears
to be increasing, possibly due to an increase in our
ability to identify affected cats and/or due to an
increase in the relative frequency of the abdominal
forms. At present it is unclear which of these is most
likely or if it is a combination.
It should be noted that use of sensitive diagnostic
techniques such as PCR have clouded the picture
somewhat. We now know that cats that have been
infected with FeLV at some point during their life time
will have FeLV proviral DNA incorporated into their
genome, and will be positive on PCR, even if they are
FeLV-negative on ELISA (i.e. they are not
antigenaemic). Whether subsequent development of
lymphoma later in life is as a result of this provirus is
unclear. But, given that PCR demonstrated FeLV
provirus in 25% of cats with intestinal lymphoma that
were seronegative for FeLV antigen by ELISA, the virus
may still be playing an important, if hidden, role in the
pathogenesis of feline lymphoma.
There is a growing body of evidence that
lymphoma may be associated with, or the endpoint of,
chronic inflammation. Serial histological documentation
of worsening inflammatory bowel disease in cases that
subsequently develop intestinal lymphoma supports
this hypothesis. Perhaps the same may be true of nasal
lymphoma in cats with a history of chronic rhinitis.
Finally, the role of environmental factors is
beginning to be recognised. Exposure to cigarette
smoke is a risk factor for developing lymphoma in
humans and the same appears to be true in cats. Cats
exposed to environmental tobacco smoke are 2.4
times more likely to develop lymphoma than their
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HOW TO
smoke-free counterparts. If they have been exposed
to tobacco smoke for >5 years, the risk increases to
3.2 times. Exposed cats are also more likely to
develop the alimentary form of the disease. Thus, it
may be that human lifestyle has not only resulted in
disease in our pet cats but also has contributed to the
changed pattern of lymphoma presentation over the
past 30 years.
Presentation of the cat with lymphoma
The cohort of affected animals now differs markedly
from those affected in the FeLV era: the median age
of cats diagnosed with lymphoma is now 11 years and
only a minority (814%) of these older cats are
FeLV-positive. Whilst all anatomical forms of lymphoma
still occur, the alimentary form is by far the most
common.
The anatomical forms traditionally associated with
FeLV antigenaemia, such as mediastinal lymphoma,
still occur, and in a distinct group of young FeLV-
positive individuals the traditional presentations are still
most common, but this group is clearly separate from
the older affected majority.
Given that alimentary lymphoma is the most
prevalent form and that its treatment is (unlike other
feline lymphoma) tailored specifically to the histological
grade, the remainder of this article will deal with this
presentation alone. However, the majority of points
regarding investigation and therapy remain valid,
irrespective of the site of the disease.
Alimentary lymphomaa disease of the
older cat
As noted above, gastrointestinal lymphoma has
become the most common anatomical presentation
(3272%) and occurs most frequently in older (median
11 years) FeLV-negative cats. The disease usually
results in segmental or generalized thickening of the
small intestine. The stomach, caecum and colon are
rarely affected, but lymphoma is still the most
common gastric tumour in cats. In most cats with
intestinal lymphoma, the mesenteric lymph nodes are
involved. No breed predilection has been identified.
As discussed above, cats with intestinal lymphoma
have a low incidence of FeLV antigenaemia but a role
for prior FeLV infection may be suggested by a
positive PCR result.
Presentation
Cats with alimentary lymphoma usually present with a
chronic history of anorexia and weight loss of several
months duration. Vomiting and diarrhoea are present
in less than half of cases and other uncommon clinical
signs include lethargy, weakness, polydipsia, polyuria,
pica, and abdominal swelling. Clinical examination
may reveal thickened bowel loops or an abdominal
mass, but will yield normal results in many cats with
alimentary lymphoma.
Diagnostic clues
The most common clincopathological finding is
hypoalbuminaemia, which occurs in approximately half
of patients. Other noteworthy abnormalities include
anaemia (non-regenerative or regenerative), elevation
in liver enzymes and hypocobalaminaemia. Elevations
in liver enzymes are suggestive of neoplastic lymphoid
infiltration into the hepatic parenchyma although
normal liver enzyme concentrations do not exclude
this possibility. As in other circumstances,
hypocobalaminaemia results from distal small intestinal
disease. As in all forms of feline lymphoma, and in
contrast to canine lymphoma, hypercalcaemia is rare.
Table 1: Normal small intestinal widths in the cat. (Newell et al., 1999)
Species Duodenum Remainder of small intestine
Cat 2.4 0.51 mm
(range 1.33.8 mm)
2.09 0.37 mm
(range 1.63.6 mm)
Figure 1: (A) Transverse ultrasonogram showing a thickened loop of intestine with complete loss of
layering. This appearance is typical of, but not specific for, intestinal lymphoma. (B) Ultrasonographic
appearance of the normal small intestinal wall. 1 = Lumen (containing mucus); 2 = Mucosa; 3 = Submucosa;
4 = Muscularis; 5 = Serosa.
Reproduced from BSAVA Manual of Canine and Feline Abdominal Imaging
A B
1
2
3
4
5
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Unravel the mystery of feline alimentary lymphoma
Unfortunately abdominal radiography often yields
normal or non-specific findings, such as a reduction in
intra-abdominal contrast, dilation of small intestinal
lumen or the presence of an ill-defined soft tissue
opacity which might be a mass. In contrast, abdominal
ultrasonography is very useful and may identify
mesenteric lymphadenopathy, a thickened intestinal
wall (Figure 1 and Table 1), disruption of intestinal wall
architecture and bowel hypomotility or ileus. These
ultrasonographic features are not unique to lymphoma
but can be distinct from those seen in inflammatory
bowel disease (in which intestinal wall layering is
usually preserved), or intestinal adenocarcinoma (in
which focal eccentric intestinal luminal narrowing
usually occurs without associated lymphadenopathy).
Unfortunately normal ultrasonographic findings do not
rule out a diagnosis of alimentary lymphoma.
To biopsy or not to biopsy? That is the
question
Cytological examination of fine needle aspirates of
mesenteric lymph nodes or thickened intestinal wall,
retrieved under ultrasound guidance, can be sufficient
to achieve a diagnosis. However, the treatment
choices and prognosis for cats with alimentary
lymphoma are dependent on tumour grade. Grading,
and definitive diagnosis, is achieved most
appropriately by histopathological examination of a
biopsy specimen. This may be procured by
endoscopy or laparotomy.
Endoscopy (Figure 2) has the obvious advantages
of being non-invasive and requiring no post-procedure
convalescence, but samples obtained are superficial
and there is a risk of missing submucosal (often
high-grade) disease. Furthermore, an endoscope is
unable to reach the jejunum and ileum, where most
lymphoma lesions are located.
Laparotomy (see Figure 3) has the advantage of
allowing full-thickness intestinal biopsy and, in
addition, allows specimens of the liver, mesenteric
lymph nodes and pancreas to be obtained, even in the
absence of gross lesions. Laparotomy has the
disadvantage that chemotherapy must be delayed for
1014 days after surgery to prevent dehiscence or
delays in wound healing. It is noteworthy that
attempted resection of apparently focal alimentary
lymphoma has not been correlated with increased or
decreased survival times.
In general, tumour stage does not appear to be
predictive of outcome in cats with lymphoma. The cost
and invasiveness of complete staging should therefore
be weighed against the benefit of the additional
information gained. However, it should be remembered
that these older patients may have comorbidities that
can influence prognosis and treatment choices. Thus,
as a minimum, all patients in which lymphoma has
been confirmed should have a complete haematology,
serum biochemistry and urinalysis profile performed,
in addition to determination of FeLV and FIV status
prior to undertaking definitive lymphoma treatment.
Treatment choice is dictated by the
histological findings
Feline alimentary lymphoma is categorised
histologically into one of three grades: low-grade
(lymphocytic or small cell); intermediate or high grade
(lymphoblastic or large cell). This classification guides
treatment choices and is indicative of prognosis. As
discussed above, inflammatory bowel disease may be
a precursor to intestinal lymphoma and, on occasion,
immunohistochemical stains are required to
differentiate the two. This distinction is of profound
clinical and prognostic relevance, as cats with
inflammatory bowel disease may have a significantly
better prognosis than those with alimentary lymphoma
if treated appropriately.
Treatment protocols are distinct for the different
forms of feline alimentary lymphoma.
Figure 2: Alimentary lymphoma does not have a
pathognomonic appearance, so biopsies are
required to achieve a diagnosis and grade the
disease
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High-grade (lymphoblastic, immunoblastic or
large cell) lymphoma is treated with conventional
CHOP or COP-based protocols. The COP protocol
(cyclophosphamide, vincristine and prednisolone) is
often associated with adverse gastrointestinal effects
(vomiting, diarrheoa, anorexia) but these are usually
manageable with supportive treatment. Both vincristine
and cyclophosphamide are myelosuppressive and
thus haematology must be performed weekly initially
and treatment withheld if neutropenia develops.
Thankfully cyclophosphamide rarely causes sterile
hemorrhagic cystitis in cats.
Addition of doxorubicin to create a CHOP protocol
is of questionable benefit in the case of high-grade
feline alimentary lymphoma. Based on a small number
of studies, remission rates are no better than using a
COP-type protocol but those cats who do respond
appear to survive longer. Doxorubicin, whilst not
cardiotoxic to cats, is profoundly nephrotoxic and its
use necessitates frequent monitoring of renal function;
furthermore, it is often associated with the adverse
effects documented above. At present we are unable
to identify those cats that are more likely to benefit
from the addition of doxorubicin to their cytotoxic
regime and the decision of whether to add this drug is
made on a case-by-case basis. Overall, only 2030%
of these patients achieve full remission, and median
survival times are 23 months only.
Low-grade, lymphocytic alimentary lymphoma has
a good prognosis, with 70% of cats achieving
complete remission and median survival time of 17
months. Given the more slowly progressive nature of
their disease a more tempered cytotoxic protocol is
appropriate based on chlorambucil, an alkylating
agent, and prednisolone. Adverse reactions to
chlorambucil are rare but can include gastrointestinal
toxicity, myelosuppression and hepatotoxicity.
Haematology and serum biochemistry should be
performed weekly for the first month of treatment and
every 3 months thereafter.
Intermediate-grade intestinal lymphoma is treated
with a COP- or CHOP-type protocol. In these patients
addition of doxorubicin may be of benefit,
but this is based on factors above and beyond survival
advantage alone (expense, toxicity and clinician
experience). Unfortunately, apart from histological
grade there are few other prognostic indicators to help
the clinician and client to make treatment choices.
Figure 3: Intestine loops layered for multiple
intestinal biopsy, stack and snip. Biopsy samples
have been taken from the duodenum, jejunum and
ileum
Initial response to treatment is correlated with overall
survival and this suggests that until our understanding
of prognostication of this disease improves, a
treatment trial should be considered in all cats.
Supportive care plays a vital role in maintenance of
quality of life when treating alimentary lymphoma. Oral
appetite stimulants such as cyproheptadine can be
useful in increasing voluntary food intake. As previously
mentioned, these patients may benefit from cobalamin
supplementation as deficiency results in anorexia.
Anti-emetics may aid control of nausea and vomiting,
which may result from the disease itself or as a
consequence of therapy.
What does the future hold?
In summary, the pattern of lymphoma in cats has
changed over the past three decades, with the
majority of patients now presenting in older age with
previously uncommon anatomical forms unrelated to
FeLV antigenaemia. One such form, alimentary
lymphoma is now the commonest presenting form of
lymphoma and its histological grade is strongly
predictive of response to treatment and prognosis.
This separation of lymphoma into subcategories with
differing behaviours, treatments and prognosis is likely
to become the norm as we better understand this
complex and diverse disease. No longer does one
protocol or prognosis suit all and personalised
treatment protocols, devised on a case-by-case basis,
as are the aim of human oncology practice, are within
the grasp of the veterinary surgeon. n
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HOW TO
Unravel the mystery of feline alimentary lymphoma
There are various COP- & CHOP-style
protocols and the reader is advised always
to seek advice from a veterinary oncologist
prior to undertaking treatment with an
unfamiliar protocol. Doxorubicin and
vincristine are vesicants and must be
delivered through an intravenous cannula
placed cleanly on the first attempt
CHOP Protocol
n Cyclophosphamide* 200 mg/m
2
i.v./p.o., weeks
2, 7, 13, 21
n Vincristine (Oncovin) 0.7 mg/m
2
, i.v., weeks 1, 3,
6, 8, 11, 15, 19, 23
n Prednisolone 2 mg/kg, p.o., q24h for 28 days;
then 1 mg/kg, p.o., q48h until relapse or adverse
steroid effects, in which case taper dose and
discontinue
n Doxorubicin 25 mg/m
2
, i.v., weeks 4, 9, 17, 23
COP Protocol
n Cyclophosphamide* 300 mg/m
2
i.v./p.o. q21days
n Vincristine (Oncovin) 0.75 mg/m
2
, i.v., q7days for
4 weeks then every third week
n Prednisolone 2 mg/kg, p.o., q24h for 1 week;
then 5 mg, p.o., q48h until relapse or adverse
steroid effects, in which case taper dose and
discontinue
Chlorambucil & Prednisolone Protocol
(for lymphocytic alimentary lymphoma (low
grade) only)
n Chlorambucil 15 mg/m
2
tablet, p.o., for
4 consecutive days every third week
n Prednisolone 10 mg/cat/day p.o., q24h until
relapse or adverse steroid effects, in which case
taper dose and discontinue
*25 mg cyclophosphamide tablets suitable for cats are
available. Seek advice from the VMD
SELECTED CHEMOTHERAPY PROTOCOLS USED BY
THE AUTHOR FOR CATS WITH ALIMENTARY LYMPHOMA
This article previously appeared in an alternate form in Bristol
Vet Schools Feline Update and is reprinted and modified with
their permission.
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CPD
COURSE INFO
Thursday 22 October 2011
Rutland House Referrals,
St Helens, Merseyside.
Fees:
BSAVA Member: 325.00
Non-member: 487.50
COURSE INFO
Tuesday 29 November 2011
Woodrow House, Gloucester.
Fees:
BSAVA Member: 325.00
Non-member: 487.50
A
bdominal ultrasonography is
increasingly used in general
veterinary practice and provides a
very useful non-invasive way of evaluating
the internal architecture of the abdominal
organs. This is why specialists Esther
Barrett and Nic Hayward have designed a
one-day course for practitioners who
already have some experience with
ultrasound and are ready to focus on the
more challenging aspects of canine and
feline abdominal ultrasonography.
Hands-on and practical
With plenty of time to get hands-on
practice under the close supervision of
experienced tutors, the aim is to improve
your scanning abilities and confidence in
exploring those hidden depths that can
challenge us in general practice. This will
be especially valuable for GPs who are
already confident locating and evaluating
the liver, spleen, kidneys, bladder and
prostate and now feel ready to approach
the more challenging areas of the small
animal abdomen.
Although Esther and Nic cant promise
that you will go home able to find every
adrenal in every patient, by the end of the
day you should be much more confident in
your ability to search logically for the
adrenals and the pancreas, to
systematically evaluate the gastrointestinal
tract, to locate and follow the major vessels
through the abdomen, and to locate and
evaluate the major abdominal lymph nodes.
Time with experts
During the day, mini-lectures explaining the
logical approach, normal appearance and
common abnormalities of the organs being
evaluated will be interspersed with longer
practical sessions, One of the biggest
problems for the general practitioner is
finding the time and appropriate patients
for practising new techniques; for the
course, limited delegate numbers should
allow you to get plenty of practice, with
Scanning the
hidden depths
Esther Barrett and
Nic Hayward will explore
abdominal ultrasound
techniques in an invaluable
and practical course
experienced tutors on hand to provide
practical tips and assistance.
Your tutors, Esther Barrett and Nicolette
Hayward, both hold the RCVS and
European Diplomas and are recognised as
RCVS and European Specialists in
Veterinary Diagnostic Imaging. They share a
passion for encouraging the use of non-
invasive imaging techniques, in particular
ultrasonography, in general practice and do
their best to provide entertaining and
informative CPD. The course is kindly
sponsored by BCF Technology. n
W
ant to learn about the wealth of
information which can be gained
from examining the blood film and
gain a greater understanding of the
information your analyser generates?
Blood film examination is vital in
evaluation of anaemia, helping you to
answer: Is the anaemia regenerative or
non-regenerative? Is there evidence of
immune-mediated haemolytic anaemia,
Heinz body anaemia, iron deficiency or an
infectious cause?
High-quality microscopes will be provided
for each delegate to use.
The speaker, Elizabeth Villiers, has
years of experience in laboratory medicine
and teaching. She has a good
understanding of the needs and challenges
of the busy practitioner and aims to give
practical information, which is useful and
relevant to daily practice, especially to vets
with in-house laboratories. For more
information visit www.bsava.com. n
Practical haematology
Elizabeth Villiers will focus on the laboratory diagnosis
of haematological disorders with a course that is aimed
at veterinary surgeons with an in-house haematology
analyser and a microscope, who want to improve their
diagnostic skills in haematological disease.
On this course at Woodrow House in
November you will also learn about
leucocyte patterns in different diseases
and how to identify a left shift and toxic
change, which are key features seen in
sepsis. This is also your chance to
discover how to unravel cases with high
leucocyte counts.
The course will combine lectures with
case discussions and, importantly,
practical sessions using a teaching
microscope and delegate microscopes.
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PUBLICATIONS
Recurrent infections have always been a challenge
in the long-term management of skin disease. In
recent years this has been compounded by the
resistance of Staphylococcus species to commonly
used systemic antibiotics. Rosanna Marsella and
Hilary Jackson, co-editors of the forthcoming new
edition of the BSAVA Manual of Canine and Feline
Dermatology, explain further
T
en years ago Staphylococcus
intermedius in dogs was almost
uniformly (>95%) sensitive to various
fluoroquinolones, amoxicillin/clavulanate,
oxacillin and first-generation
cephalosporins. However, the situation is
quite different in 2011. Many strains of
S. pseudintermedius (formerly
S. intermedius) the pathogen responsible
for pyoderma in dogs have become
resistant to cephalosporins as well as other
commonly used antibiotics such as
clindamycin, potentiated sulphonamides
and fluoroquinolones. This resistance has
grown exponentially over the last two years
and has been detected worldwide. For
these reasons, appropriate and
responsible antibiotic use, in addition to
the prompt identification and correction of
underlying diseases, has become even
more essential.
Clinical signs
The most common bacterial skin infections
include:
Pyotraumatic dermatitis presents with
hot spots and moist eczema. It is
initiated by an irritant reaction, but the
surface of the skin quickly becomes
colonized with cocci.
Superficial pyoderma presents with
papules, pustules (Figure 1), multifocal
areas of alopecia, macules and
epidermal collarettes. Since pustules
are transient, most cases only have
evidence of secondary lesions and are
presented for multifocal hair loss,
malodour, pruritus or scaling. It is
typically a truncal disease, with the
groin being a commonly affected area.
Bacterial folliculitis presents with a
multifocal alopecia (Figure 2) and
typical moth-eaten appearance.
Deep pyoderma presents with
nodules and draining tracts. Hair
follicles rupture and release their
contents into the dermis. Pressure
points are frequently affected and
pododermatitis is present in many
cases. Pododermatitis is particularly
challenging to manage, as hairs and
keratin embedded in the dermis act as
foreign bodies and perpetuate
inflammation and infection.
It is important to remember that once an
infection has developed, pruritus is present
in most cases, regardless of the underlying
cause. For this reason, the patient needs to
be reassessed following resolution of the
infection to determine whether or not the
underlying condition is pruritic.
Diagnosis
The diagnosis is made based on the
clinical signs and cytology. Samples for
cytology can be obtained from pustules or
draining tracts and stained with a modified
Wrights stain (e.g. Diff-Quik

) for
examination. Cocci are frequently seen
within neutrophils (Figure 3). In cases of
deep pyoderma, eosinophils and
macrophages can also be detected. If
pustules are not present in patients with
superficial pyoderma, tape cytology can
The challenge of
recurrent skin infections
Figure 3: Cytology of a pustule
(Diff-Quik

stain) from a patient with

staphylococcal pyoderma. Note the
presence of cocci within the neutrophils
Figure 1: Pustule: a primary lesion of
superficial pyoderma
Figure 2: Multifocal alopecia caused by
bacterial folliculitis
2021 Publications.indd 20 20/07/2011 11:43
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PUBLICATIONS
be performed on epidermal collarettes and
erythematous areas.
Sensitivity testing
Culture and sensitivity testing is advocated
in refractory cases and patients with deep
pyoderma. It is also recommended in
patients with superficial pyoderma who
have previously been exposed to various
classes of antibiotic.
Most laboratories perform either a disc
diffusion (Kirby Bauer) or a minimum
inhibitory concentration (MIC) test.
(Individual laboratories should be
contacted for advise on sample collection
and transportation.)
Meticillin-resistant (MR) staphylococci
carry the MecA gene. This gene codes
for PBP2a (penicillin-binding protein)
and confers resistance across many
classes of antibiotics, including
penicillins and cephalosporins.
Resistance to oxacillin is indicative of
meticillin resistance and is used as a
screening test. The presence of the
MecA gene can be confirmed by PCR.
PBP2a is detected using a rapid latex
agglutination text.
Some laboratories report the
presence of inducible resistance to
clindamycin. A D test is performed
on all erythromycin-resistant,
clindamycin-sensitive strains of
Staphylococcus. If positive,
clindamycin should not be used.
In most cases of pyoderma
S. pseudintermedius is the causative
agent. However, other coagulase-positive
strains (S. schleferi, S. delphini, S. aureus)
have occasionally been isolated.
Treatment
Superficial pyoderma requires treatment
for 34 weeks (710 days past complete
resolution of clinical signs) with systemic
antibiotics. However, it is currently
recommended that mild superficial
infections are treated topically with
frequent baths in chlorhexidine, ethyl
lactate, piroctalamine or benzoyl peroxide.
This can be followed by the use of a
leave-on antibacterial spray, if available.
Shampoos designed to reduce the skin
pH are also effective antibacterial
treatments. Localized lesions can be
treated with topical preparations including
fusidic acid, gentamicin, polymixin and
neomycin. Deep pyoderma requires
treatment for 23 months (1 month past
complete resolution of clinical signs) with
systemic antibiotics.
DUE LATE 2011: Pyoderma is just one of the many skin diseases
covered in the new edition of the BSAVA Manual of Canine and
Feline Dermatology. To register your interest in this Manual, visit the
Forthcoming titles page at www.bsava.com.
References are available on request.
CLINICAL CASE:
MAGNUM
History
A 3-year-old NM German Shepherd Dog
presented with a 2-year history of
seasonal recurrent superficial pyoderma.
Treatment involved 2-week courses of
cefpodoxime proxetil and occasional
injections of cefovecin. Recurrent
infections become more frequent after
the cessation of treatment, and
enrofloxacin was prescribed to treat the
clinical signs. After several further
courses, no benefit to treatment was
reported.
Examination and diagnosis
Magnum was referred for a second
opinion. On physical examination large
areas of alopecia, lichenification and
hyperpigmentation were detected on the
ventral neck and abdomen and in the
inguinal area. Scaling and crusting were
present in the dorsal lumbar area.
Cytology revealed a large number of
cocci and neutrophils with occasional
yeasts (0-1 yeasts/high power field).
An aerobic culture was submitted for
sensitivity testing. Initial results did not
confirm the poor response to
cephalosporins; however, upon testing
for PBP2 it was confirmed that the
Staphylococcus was resistant to all
cephalosporins and to potentiated
penicillins.
Treatment
Chloramphenicol at a rate of 50 mg/kg
orally q8h was prescribed. Topical
therapy with benzoyl peroxide baths
(twice weekly) was also recommended,
along with the use of an oxychlorine
spray (three times a day on all affected
areas).
A follow-up examination was
scheduled after 4 weeks. A marked
improvement was noted, although the
clinical signs had not completely resolved
and cocci were still detected on cytology.
An additional 3-week course was
recommended. At the next follow-up
examination the infection had resolved
completely and pruritus was dramatically
decreased, localized to the face and feet.
Due to the seasonal nature of the
disease, and the distribution of the
lesions, a tentative diagnosis of atopic
dermatitis was made and an intradermal
skin test performed. Positive reactions
were found towards trees and weeds.
Allergen-specific immunotherapy was
initiated to address the underlying
disease in the hope of decreasing
further relapses.
THE AUTHORS ANTIBIOTIC CHOICES
It is important that systemic antibiotics are used for the appropriate duration and at
the appropriate dose. The dose required is often at the higher end of the dosing
regimen. Use of sub-therapeutic doses promotes resistance and should be avoided.
First line of defence
Cefalexin: 2230 mg/kg orally q12h
Amoxicillin/clavulanate: 22 mg/kg orally q12h
Clindamycin: 11 mg/kg orally q12h
Second line of defence
Potentiated sulphonamides (e.g. trimethoprim/sulfamethoxazole):
2230 mg/kg orally q12h
Third-generation cephalosporins and fluoroquinolones should only be used if
absolutely necessary. It should be noted that some resistant strains of Staphylococcus
may only be sensitive to chloramphenicol, amikacin or gentamicin. Many antibiotics in
these groups have significant side effects and the clinician is advised to seek expert
advice before prescribing them (see BSAVA Guide to the Use of
Veterinary Medicines at www.bsava.com for further information).
2021 Publications.indd 21 20/07/2011 11:43
PETSAVERS
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Improving the health of the nations pets
Tell us about Shanna your
Golden Retriever who inspired
your support of Petsavers
I picked Shanna from a litter when she was
6 weeks old and I was 13. We already had
two other Golden Retrievers in the house
but Shanna and I grew up together and
she was my best friend always there for
me and listened to all of my problems.
Shanna was intelligent and learnt the
names of all of her toys so that you could
ask for one specifically (and she had a
lot!). She loved going to the vets.
When she was 9, Shanna was involved
in a car accident and nearly died, but our
vet, Fleur, saved her life and looked after
her all weekend while she was at the
surgery. (Its a bit off-topic but this is why
the Golden Retriever I have now is called
Fleur.) During the surgery for the accident,
Fleur found that Shanna had a tumour that
was impossible to reach. We were told that
the tumour was inoperable but as it was
not a current problem it would have to be
left alone. Two years later the tumour
became malignant and spread to her
spleen and her mammary glands. The vet
said that the two new tumours could be
removed but the original one still could not
so any fix would be temporary. At age 11
Shanna was too old for multiple surgeries
and chemo, so we played it out for the
next two months.
How did you find out about
Petsavers and what made you
want to get involved?
After Shanna passed away I was left
with the feeling that perhaps more could
have been done. I wanted to know that
there were people out there trying to
improve veterinary medicine so that in
future there would be no such thing as
inoperable tumours. After some internet
searching I came across Petsavers but,
as I had never heard of it, did nothing
further. A few months later I went to
Discover Dogs and came across the
Petsavers stand. That was a huge turning
point I now knew that Petsavers was real
and the work they were doing was what I
wanted to support.
What was your first fundraising
adventure?
I sent Petsavers some money and through
the mailing list heard about the British 10K.
I had never done a fundraiser before and
although I wasnt a runner I signed up.
After the event I wanted to do more to help
so volunteered for the Discover Dogs
stand, which led to volunteering for the
Congress stand. I ended up becoming a
runner and said to Mark and Gene that
I would like to do the London Marathon for
Petsavers if they could get me a place
(I had no luck with the ballot and didnt
want to run for anyone else).
Pet
owner
power
Abby Boles is a special
Petsavers supporter
because she is a pet
owner who understands
the need to advance
veterinary science in
order that her pets may
have a better quality of
life. Here she tells us
about why she does so
much for the charity and
how she believes vets
and pet owners can work
together to tell the
Petsavers story
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PETSAVERS
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Tell us all the things you have
done so far
I have run the British 10K (raising 200)
and London Marathon (raising 2,234).
I organised an auction at work (180)
and when I did some voluntary work for
a non-profit organisation my company
made a donation of 150 to a charity of
my choice. I tend not to think about my
involvement in Petsavers in terms of the
monetary amount alone, I think of it
more as raising awareness. There are so
many people out there who dont know
about Petsavers but by providing an
extra pair of hands hopefully I am
helping to spread the word to as many
people as possible. When I organised
the fundraiser at work I raised less
than 200, but in the process I told
400 people about what Petsavers is and
the work it does.
You help out on the stand at
Congress has this given you a
better picture of the veterinary
profession?
Yes it has I dont get to go to the
lectures but just walking round the
exhibition has shown me how many
different aspects of veterinary science
there are. I have met some great vets, and
vet nurses too!
How do you share the reasons
for your fundraising?
I have told a lot of other pet owners about
Petsavers over the last 5 years. When I
explain about what they do, it always
appeals, particularly as there are no
other charities out there who do the
same thing. I think anyone who has lost
a dog or a cat to anything other than
old age, or has had a pet suffer from a
disease (e.g. diabetes, cataracts) can see
the benefit of Petsavers.
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How do you think vets can
encourage their clients to
support animal charities and
Petsavers in particular?
From my experience I think that veterinary
surgeries could do a lot more to advertise
Petsavers. Leaflets and posters could be
displayed in waiting rooms and collection
boxes could be on the reception desks.
Sympathy cards could be handed out at
appropriate times. I believe that there are
a lot of people out there who would gladly
donate to Petsavers for the same reasons
I have, but they need to know about the
charity and its work in order to do so.
National advertising is a costly thing but
if some big vet chains could get involved
it would get the word out to so many
pet owners.
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BVA CONGRESS
Y
ou will almost certainly have read
that 2011 has been named World
Veterinary Year in recognition of the
250th anniversary of the foundation of the
worlds first veterinary school, in 1761 in
Lyon. 2011 also marks another unique
event in the history of animal health.
In May the World Organisation for
Animal Health (OIE) announced the
declaration of the eradication of rinderpest,
one of the worlds most dreaded animal
diseases; the global freedom status was
ratified by Ministers of Agriculture at the
Food and Agriculture Organization of the
United Nations (FAO) conference in June.
The BVA is delighted that this monumental
achievement which compares to the
eradication of smallpox in humans will be
the subject of the Wooldridge Memorial
Lecture to be given by Dr Peter Roeder
who led the Global Rinderpest Eradication
Programme from 2000 to 2007.
Global concerns
Also, to further illustrate how vets and
veterinary science can have a global
impact, the Overseas Group is organising a
full days programme at BVA Congress:
exploring current issues concerning
each provide a different viewpoint on
disaster management experiences and
possibilities; this will be an exciting
session, which should challenge existing
perceptions of veterinary work in disaster
situations and stimulate healthy debate.
BVA travel grant
The BVA overseas travel grant scheme,
which began in 1983, has also helped
students to develop beneficial life skills
such as communication, adaptability and
open-mindedness. This year the 100th
BVA travel grant will be awarded and the
Overseas Group felt it would be a fitting
gesture to celebrate this milestone. Former
grant recipients Harriet Auty (Tanzania
2002), Michelle Barrows (Uganda 1996),
Mark Eisler (Paraguay 1983) and Richard
Mellanby (Seychelles 1996) will talk about
how their experience overseas as a
student has helped to shape their career
and changed their outlook on life. n
Emma Pearson (BVA travel grant
recipient 2007) worked on a Vetaid
project in Tanzania with Maasai cattle,
and helping to sustain enhanced food
security involving small scale poultry and
goat production. She also assisted with
vaccinating dogs in the local community
Making an impact in
a changing world
BVA Congress, 2224 September, will be celebrating
the eradication of rinderpest in its Wooldridge
Memorial Lecture to be given by Dr Peter Roeder
livestock and global food security,
veterinary involvement in disaster relief and
management, as well as a session
celebrating 100 BVA overseas travel grants.
With the world population expected to
reach 9 billion by 2050, and global food
demand predicted to double in the same
timeframe, we are faced with the challenge
of producing and supplying enough safe
and nutritious food in a sustainable way.
Global annual meat production is
expected to expand from the current 228
million tons to 463 million tons by 2050,
with the cattle population estimated to
grow from 1.5 billion to 2.6 billion and that
of goats and sheep from 1.7 billion to 2.7
billion, according to FAO estimates. FAO in
2010 also called for investments in national
animal health and food safety
infrastructure. Vets will need to be actively
involved and at the leading edge of new
developments. We cannot afford to sit
back and leave this to others.
The BVA is honoured that Dr Juan
Lubroth, Chief Veterinary Officer at FAO,
will set the scene with an overview of
current issues concerning livestock and
global food security.
Welfare worldwide
Natural disasters often affect the most
vulnerable communities, many of which
are dependent on livestock and working
animals for their livelihoods. Where and
when should outside agencies intervene?
Disaster mitigation measures, rapid relief
or post-disaster rehabilitation: what are
the strengths and the risks of each?
Should hearts or minds lead animal
health and welfare interventions into
humanitarian disasters?
Colonel Neil Smith from the Royal Army
Veterinary Corps (RAVC), Ian Dacre from
the World Society for the Protection of
Animals (WSPA) and Emma Jowett, a
specialist in humanitarian relief work, will
BSAVA AT BVA
CONGRESS
As part of an initiative to provide
world-class CPD to BVA and BSAVA
members, BSAVA will deliver a superb
small animal scientific programme at
BVA Congress in London this
September. The programme will
include feline medicine,
gastroenterology medicine and
surgery, and cardiorespiratory
medicine. Speakers include Ian
Ramsay, Hattie Syme and Sue Murphy
(feline), Penny Watson, Alex German
and John Williams (gastro), and Mike
Martin, Adrian Boswood, Pete Mantis,
Sophie Adamantos and Jackie
Brearley (cardio). For more information
visit www.bsava.com/bvacongress.
24 BVA Congress.indd 24 20/07/2011 11:25
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One Health Committee as the appointed voice for
companion animals and their veterinarians worldwide.
Companion animal veterinarians play a significant role
in the One Health concept because of their strategic
position in reporting the emergence or re-emergence
of zoonotic infectious diseases at the companion
animalhuman interface. It is therefore imperative that
adequate surveillance systems are in place. We also
see major benefits for human health from comparative
research into spontaneously arising disorders of
companion animals and believe there is a wider
societal aspect because of the humancompanion
T
he World Organisation for Animal Health (OIE)
and World Small Animal Veterinary Association
(WSAVA) have signed a memorandum of
agreement to promote increased collaboration
between the two organisations in the area of One
Health a movement which aims to encourage human
health and veterinary professionals to work together to
eradicate disease. Under the terms of the agreement,
the WSAVA, an association of associations,
representing more than 80,000 small animal veterinary
surgeons from all over the world, has been granted full
observer status at the annual OIE General Assembly.
The OIE is the intergovernmental organisation
responsible for improving animal health and welfare
worldwide and is responsible for the global
surveillance of animal diseases, including zoonoses.
The organisations will collaborate on a range of
activities, including the development of global standards
and guidelines to improve companion animal health,
and the continuing education of companion animal
veterinary surgeons. They will also implement practical
measures including developing communication
campaigns to increase awareness of infectious disease
surveillance and reporting programmes.
WSAVA President Jolle Kirpensteijn said The
agreement with the OIE confirms the WSAVA and its
WSAVA and
OIE join forces to
promote One Health
(Left to right) Professor Michael Day (Chairman of the WSAVA One Health
Committee), Professor Jolle Kirpensteijn (WSAVA President),
Dr Bernard Vallat (Director General of OIE) and Dr Alex Thiermann
(President of the Terrestrial Animal Health Code of the OIE)
More progress towards the
goal of collaboration to
eradicate disease
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WSAVA NEWS
animal bond. Id like to thank my colleagues Dr David
Wadsworth and Professor Michael Day, Chairman of
the WSAVA One Health Committee, for their hard work
which has paved the way for this agreement and we
look forward to working together to achieve our
common goal.
Dr Bernard Vallat, Director General of the OIE,
added: The One Health concept recognises that
human and animal health are inextricably linked. As we
work to promote, improve and defend the health and
wellbeing of all species and to detect and report
diseases at the humananimal interface, greater
collaboration with all specialties of the veterinary
profession is essential. The WSAVA represents an
important segment of practicing veterinarians, who until
now have not been closely linked with the OIE. We are
delighted to sign this agreement and look forward to the
insight, experience and expertise the WSAVA team will
bring to our work on behalf of companion animals.
B
SAVA Senior Vice-President Grant Petrie was
among those speaking at the WSAVAs first
global webinar on 31st May. This was a popular
event, with over 300 delegates from around the world
signing in. The 90-minute session was entitled A
Practical Approach to Feline Diabetes and Chronic
Kidney Disease. The other speakers were Elizabeth
Dill-Macky, a Diplomate of the American College of
Veterinary Internal Medicine and a member of the
Australian College of Veterinary Specialists, and Sarah
Caney, RCVS Specialist in Feline Medicine.
Webinar success
David Wadsworth, who chaired the webinar on
behalf of WSAVA, commented It was a novel
experience to be in contact with such a large number
of delegates while we were all sitting in the comfort of
our own homes or clinics. No long journeys or
registration queues, just CPD on demand!
In addition to the speakers, Id especially like to
thank Dr Lidiya Alaverdova of Hills Pet Nutrition for
providing the technical support and, in effect, running
the show. She put a tremendous amount of
background work into the webinar, making it the
professional and successful meeting it was. It will be
the first of many to come.
The webinar was the result of the WSAVAs annual
sponsors CE meeting in February. Information on
future webinars will be posted on the WSAVA website.
If there are topics youd like to suggest, please contact
WSAVA at wsavasecretariat@gmail.com.
WSAVA staged a global webinar
as part of the development of its
CE programme
atmosphere where you can share information and
achievements and build a sense of fellowship.
Full details and the registration form are available at
www.wsava2011.org
2011 WSAVA-FASAVA World Congress Secretariat
contact details:
Tel: +82 2 3461 1160 Fax: +82 2 3461 1340
Email: wsava2011@unineo.com
D
ont forget to register for the 2011 WSAVA-
FASAVA-KAHA Congress, set to take place in
Jeju, Korea, from 1417 October. It will offer a
comprehensive scientific programme delivered by
global experts from around the world in a social
GET REGISTERED!
25_27 WSAVA.indd 26 20/07/2011 11:29
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WSAVA NEWS
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27
A
s Chairman for WSAVA CE in Asia, Ive
been heavily involved with the WSAVAs
CE programme in Asia since 1999. During
this period, weve made excellent progress and,
as I hand over the reins to my successor, Id like
to update members on the current situation.
We started our work in Thailand and Malaysia
back in 1999 and both of these countries now
run their own courses. Thailand, of course, also
hosted the 2003 WSAVA Congress and the 2009
Federation of Asian Small Animal Veterinary
Association (FASAVA) Congress.
In India we host an annual CE seminar and,
to facilitate this, Indian veterinarians have formed
a national group of small animal associations
called the Federation of Small Animal
Practitioners Associations of India (FSAPAI), to
simplify the process and to ensure that CE is
rotated around this vast country.
In China we give CE courses in Beijing,
Shanghai and Guanzhou each year and we
usually end up in Hong Kong. China has also
progressed rapidly with small animal practice
having become far more sophisticated since we
commenced CE seminars. The Shanghai SAVA
now actively promotes CE with the annual
Chinese East/West Veterinary conference.
CE commenced in Taiwan in 2003 and the
country rapidly progressed to category three,
which means we help to provide the speakers
but the Taiwanese pay local costs and airfares.
The situation is similar in Korea and, of course,
that country will also host the joint WSAVA /
FASAVA Congress later this year. In 2010 we
held the first WSAVA CE programme in Vietnam
and this is something we hope to repeat.
Sri Lanka has had a mixed history of CE and
suffers from more financial restraints than the
other countries. The ASAVA has helped
tremendously here, providing funding to send
scholars from all over the world. In 2007, the first
FASAVA Congress was held in Australia in
conjunction with the WSAVA and, in time, the
Federation of Asian Small Animal Veterinary
Associations may take over some of the
management of CE in the Asian region.
This year I have decided to retire from the
WSAVA Asian CE programme and hand over
the reins to a successor. I have made many
friends in Asia and hope to continue to help
FASAVA as it grows. Id like to thank all those
who have helped me over the last 12 years to
make this such a positive programme. Following
my retirement I will continue to work in my
private specialty practice in Melbourne but
hope to remain active in CE and to give every
support to my successor.
WSAVAs Chairman for CE in
Asia, Roger Clarke, presents an
update to mark his retirement
CE in Asia
Roger Clarke
and his
translator
Connie Wang
during a CE
visit to China
25_27 WSAVA.indd 27 20/07/2011 11:29
THE companion INTERVIEW
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THE companion INTERVIEW
Q
Who has been the most
inspiring influence on your
professional career?
A
There is no one person but several
that have influenced my
professional career. Ailsa
Blockland during her period as President
of BVNA she inspired me to believe that
you could make a difference to veterinary
nursing as a profession and also that VNs
needed to broaden their horizons. My
parents for believing that I could make a
career out of what I wanted to do at a
stage when veterinary nursing was
considered a short-term role and there
were limited career opportunities.
Professor Lance Lanyon, retired Principal
of the RVC who had the vision to partner
Barbara
Cooper
Hon Assoc RCVS Cert Ed
Lic IPD DTM VN
Barbara Cooper was born in Kingston, Jamaica, to parents who were both doctors
working in a local hospital. When the family returned to the UK she was then
educated at King Edward VII School in Sheffield. She started her career in a small
veterinary practice before moving to a training practice and studying veterinary
nursing at Rodbaston Agricultural College. Barbara then spent seven amazing
years at Liverpool Veterinary School, becoming Head Nurse and completing a
teaching qualification that, in turn, took her back to Rodbaston as a lecturer. After
working as a Training Officer at Wood Green Animal Shelters in Huntingdon,
Barbara established The College of Animal Welfare, becoming its first Principal
(a role she still holds). She has been President of BVNA and was the first veterinary
nurse to Chair the RCVS VN Committee. Barbara holds a Diploma in Training
Management and was made an Honorary Associate of the RCVS in 1996 and of
BVNA in 1997. She has received the Nick Ryland Award for contributions made to
veterinary nursing and in 1999 was the first recipient of the Blue Cross Award for
Contributions to Education and Training in Animal Welfare. She is also a co-editor of
the BSAVA Textbook of Veterinary Nursing and Treasurer of the Companion Animal
Welfare Council, which seeks to influence animal welfare policy.
28-29 Interview.indd 28 20/07/2011 11:18
THE companion INTERVIEW
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work hard, be
honest and avoid
making judgements
about anything until
you know the facts!
the Royal Veterinary College with CAW
and Middlesex University in the
development of the first ever BSc(Hons)
degree in Veterinary Nursing in 1998.
There are many other people I could
mention that had initially small but
ultimately huge influences on what I have
done, including Peter Hignett, Rita Hinton,
Alistair Porter, David Bennett, Judy
MacArthur Clarke and Lawson Soulsby.
What is the most frustrating aspect of
your work?
The most frustrating aspect of my work
has got to be the paperwork that
unfortunately is a part of evidencing
everything you do, closely followed by my
day-to-day involvement in the business
side of the College.
What do you regard as the most
important decision that you have made
in your life?
The most important decision I made was in
1996 to purchase the College of Animal
Welfare when Wood Green Animal Shelters
was in severe financial difficulties. This not
only changed my destiny; it was how I met
my husband and some of the fantastic
people I now work with. At the time, and
facing the closure of the College, my motive
was purely to protect the students at the
College who were midway through their
training. Naively I thought that running a
College would be simple! In 1996, when the
management buyout of the College
occurred, the College employed six people
three of whom were part time. The College
now employs nearly a hundred staff and
has a turnover of more than 3 million a
year. It is the largest veterinary nursing
course provider in the UK but also has a
substantial involvement in animal care and
welfare. Our slogan really defines our
mission, vision and values: Contributing
towards animal welfare through education
and training.
What has been your main interest
outside work?
My main interest outside of work has got to
be horses. I am a keen follower of eventing
and have been fortunate enough to attend
three Olympic Games, two World
Equestrian Games and four European
Championships in support of the British
Eventing Team. I have three horses (two of
which I have bred): a 5-year-old Trakehner,
a thoroughbred and an Irish Sports Horse
(currently in foal to dressage stallion
Diamond Hit).
What is the most significant lesson you
have learned so far in life?
To work hard, to be honest and to avoid
making judgements about anything until
you know the facts!
If you were given unlimited political
power what would you do with it?
If I was given unlimited political power,
without doubt I would change two things. I
would reorganise the awarding of the
veterinary nurse qualification so that the
awarding body function is separate from
the professional body. I do not believe that
the regulatory body should be both
gamekeeper and poacher.
Secondly, Id make charities more
transparent in terms of their actual spend
on animal welfare. I would like to
encourage the largest charities to share
their expertise and financial resources by
supporting less well resourced charities. In
the animal welfare sector I often see our
worldclass charities frustrated by the rules
that do not allow them to help other, often
affiliated, charities doing key work that they
would like to support. I would introduce a
system of allowing smaller charities to
apply to the Charity Commission for a
grant from unused or excessive funds held
by large charities. I appreciate that this
would be a controversial step and there
would have to be a series of rules to
protect charities from excessive grant
applications but such a system would at
least stop charities stashing cash to the
detriment of those in need. If they dont
spend enough of their money on their
work, then my view is that someone else
should do it for them!
Which historical or literary figure do
you most identify with and why?
This is a really difficult question because I
dont have much time for reading and have
little interest in history and, unlike my
husband, I would rather be doing
something than reading about it. That said
a TV drama of any Jane Austen or
Catherine Cookson book can keep me in
an armchair for more than 10 minutes.
If you could change one thing about
your appearance or personality, what
would it be?
I would like to have been sufficiently fit,
talented and skilled enough to compete in
any equestrian sport at the Olympics. Just
once! Failing that breeding an Olympian
horse and watching it compete safely
would be nice!
What is your most important
possession?
My most important possessions have to be
my horses. I dont really care about
personal or material things as my credit
card statement shows!
What would you have done if you hadnt
chosen to work in the veterinary sphere?
I have always wanted to work in the
veterinary sphere and have never had any
aspiration to do anything else. I do love
cooking, so perhaps if I had been
unsuccessful in obtaining a veterinary
nurse training position in the early days,
I might have become a chef. n
28-29 Interview.indd 29 20/07/2011 11:18
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REGIONS
Meet
Your
Region
North East
As part of a continuing series,
this month companion features
BSAVA North East Committee

Victoria Roberts
Chair
Victoria qualified from Liverpool
in 2000 and has nearly 40
years experience of breeding
and judging exhibition poultry
and waterfowl. She is honorary
avian lecturer at Liverpool Vet
School and Hon. Vet to The
Poultry Club, edits the British
Poultry Standards, has had a
column in Country Smallholding
for 10 years and is currently
President of the British
Veterinary Zoological Society.
She locums in her spare time,
has two working spaniels and
is an Editor of BSAVA Manual
of Farm Pets.

Hannah Langley
Treasurer
Hannah graduated from the
Dick Vet in 2008 and has
worked in small animal practice
ever since. She has a particular
interest in feline medicine, soft
tissue surgery and
anaesthesia. She spends a lot
of time with her family. Most of
her spare time is spent
gardening and doing DIY.

Tim Shearman
Secretary
Tim graduated from Glasgow
in 2000, having already gained
a BSc (Hons) in Microbiology
in 1995 from the University of
Bristol. He worked in a rural,
predominantly small animal
practice, and then moved to
The Minster Veterinary
Practice in 2002. Tim gained
his RCVS Certificate in
Veterinary Cardiology in
2009 and alongside small
animal first opinion work sees
referred second opinion
cardiology cases.
Committee members

Chris Robinson
Chris qualified in the eighties
from Edinburgh. He lives in
Durham and enjoys the variety
of small animal practice. Chris
loves seeking sponsorship
from companies, who he feels
have a vital role in helping
provide great CPD and also
allows them to meet us and
influence our choices.

Maurice Kelly
Maurice is a 1984 Dublin
graduate who spent his first
8 working years in mixed
practices in Scotland, The Lake
District and East Yorkshire. He
moved to Harrogate in 1992
and is a partner in a two-vet
small animal first opinion
practice. As a recent addition to
the local committee, his remit is
to ensure every practice has a
full set of BSAVA Manuals!

Helen OKelly
Helen qualified from Liverpool
in 1987 and has worked in a
variety of mixed and small
animal practices. She is
interested in nutrition as one of
the keys to health, having
raised twin boys with AiA
(allergy-induced autism). She
is married and lives in
Easingwold with the twins, a
GSD and a Toodle.

Robert Williams
Rob qualified from Dublin in
2001. He is currently working
at Minster in York, trying to do
a bit of surgery every day. He
is married to a vet and has
two spaniels.

Paul Spellman
Paul has been in practice for
30 years and is currently
employed as the senior vet and
clinical director in a 100%
corporate SA practice. He had
owned his own small animal
practice for 18 years. During
this time he successfully
achieved the Certificate in
Veterinary Anaesthesia.

Lucy Nowell
Lucy qualified from Cambridge
in 2001 and joined an equine
and small animal practice in
Surrey, after a short stint
working voluntarily for SPANA
in Morocco. She now works in
an equine and small animal
practice in North Yorkshire.

Julia Thomson
Julia is a small animal vet
working part-time at Oakbeck
Veterinary Hospital in
Harrogate and is the newest
member of the NE committee.
REMAINING 2011 NORTH EAST
REGIONAL CPD COURSES
For further details on these courses and 2012 courses, please
email northeastregion@bsava.com or visit www.bsava.com
Day Meeting Sunday 25 September
Six most common tumours and what to do
about them
Speakers: Jenny Helm and Kathryn Pratschke

Campanile Hotel, Bradford
Day Meeting Sunday 13 November
Id like to try this technique but
A step-by-step guide to practical medical
and emergency techniques
Speakers: Nick Bexfield and Karen Humm

The Bridge, Walshford, Wetherby, North Yorkshire LS22 5HS
BSAVA Road Show Monday 14 November
The essentials of rabbit
medicine in 1 day
Speakers: Karen Rosenthal and
Anna Meredith

The Bridge Hotel, Walshford,
Wetherby, North Yorkshire LS22 5HS
Details from administration@bsava.com
Day Meeting Thursday 8 December
Haematology
Speakers: TBC

IDEXX Laboratories Wetherby, Grange House,
Sandbeck Way, Wetherby, West Yorkshire LS22 7DN
30-31 Diary.indd 30 20/07/2011 11:26
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31
CPD diary
EVENING MEETING
NORTHERN IRELAND REGION
Thursday 8 September
Wound management
Speaker: Georgie Hollis
VSSCo, Lisburn BT28 2SA
Details from nirelandregion@bsava.com
EVENING MEETING
SOUTH WALES REGION
Wednesday 14 September
Backyard poultry: chickens for
chickens
Speaker: Victoria Roberts
Details from southwalesregion@bsava.com
DAY MEETING
Thursday 15 September
Cats are not small dogs: a day of
feline ophthalmology
Speakers: Sue Manning and Jim Carter
Crowne Plaza, Gatwick Airport RH11 7SX
Details from administration@bsava.com
EVENING MEETING KENT REGION
Wednesday 21 September
Treating the pet chicken
Speaker: Victoria Roberts
Best Western Russell Hotel, 136 Boxley
Road, Maidstone ME14 2AE
Details from kentregion@bsava.com
DAY MEETING
SOUTH WEST REGION
Tuesday 6 September
Backyard poultry
Speaker: Victoria Roberts
Sandy Park Conference Centre, Sandy Park
Way, Exeter, Devon EX2 7NN
Details from southwestregion@bsava.com
EVENING MEETING
NORTH WEST REGION
Wednesday 21 September
The rapid neuro exam
Speaker: Raquel Monteiro
Holiday Inn, Haydock
Details from northwestregion@bsava.com
DAY MEETING
EAST ANGLIA REGION
Sunday 25 September
High liver enzymes again:
where next?
Speakers: Roger Powell, Patricia Ibarrola
and Tim Scase
Animal Health Trust, Newmarket, Suffolk
Details from eastanglia.region@bsava.com
DAY MEETING
NORTH EAST REGION
Sunday 25 September
Six most common tumours and
what to do about them
Speakers: Jenny Helm and Kathryn Pratschke
Campanile Hotel, Bradford
Details from northeastregion@bsava.com
DAY MEETING
Tuesday 27 September
A practical guide to oncology: no
more lumps in your throat! Part I
Speaker: Mark Goodfellow
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
3-DAY EVENT
Thursday 22 Saturday 24
September
BVA CONGRESS 2011
Vets in a changing world
Royal College of Physicians, London
Details from www.bva.co.uk/congress
DAY MEETING
METROPOLITAN REGION
Wednesday 21 September
Emergency medicine
Speakers: Sophie Adamantos and
Lindsay Kellett-Gregory
Venue The Kennel Club, Piccadilly
Details from metropolitanregion@bsava.com
WEEKEND MEETING
SCOTTISH REGION
Friday 26 Sunday 28 August
26th Annual Scottish Congress
Edinburgh Conference Centre,
Heriot-Watt University
For more information visit www.bsava.com or
email scottishregion@bsava.com
DAY MEETING
Wednesday 14 September
All you need to know about
diabetes mellitus
Speaker: Grant Petrie
BSAVA Headquarters, Gloucester
Details from administration@bsava.com
DAY MEETING
Wednesday 7 September
Essential dispensing course
Speakers: P. Sketchley, S. Dean, F. Nind,
J. Hird, P. Mosedale, M. Jessop
Copthorne Hotel Effingham Gatwick RH10 3EU
Details from administration@bsava.com
DAY MEETING
Tuesday 20 September
Backyard poultry: problems and
solutions
Speaker: Victoria Roberts
The Park Royal, Warrington WA4 4NS
Details from administration@bsava.com
BSAVA ROADSHOW
SURREY AND SUSSEX REGION
Friday 23 September
Poisoning Road Show
Toxicology in the real world:
keep your patients
alive and well!
Speakers:
Elizabeth Rozanski
and Alex Campbell
Holiday Inn, Gatwick Airport
Details from administration@bsava.com
BSAVA ROADSHOW
EAST ANGLIA REGION
Monday 26 September
Poisoning Road Show
Toxicology in the real world:
keep your patients
alive and well!
Speakers:
Elizabeth Rozanski
and Alex Campbell
Animal Health Trust, Newmarket
Details from administration@bsava.com
BSAVA ROADSHOW
SOUTH WEST REGION
Wednesday 28 September
Poisoning Road Show
Toxicology in the real world:
keep your patients
alive and well!
Speakers:
Elizabeth Rozanski
and Alex Campbell
Padbrook Park, Cullompton, Devon
Details from administration@bsava.com
BSAVA ROADSHOW
NORTHERN IRELAND REGION
Friday 30 September
Poisoning Road Show
Toxicology in the real world:
keep your patients
alive and well!
Speakers:
Elizabeth Rozanski
and Alex Campbell
Hilton Templepatrick, Belfast
Details from administration@bsava.com
EVENING MEETING
SOUTHERN REGION
Thursday 29 September
Adrenal gland disease:
a case-based approach
Speaker: Kit Sturgess
Hampshire Court Hotel, Basingstoke RG24 8FY
Details from southernregion@bsava.com
DAY MEETING
Thursday 29 September
GIT II: oesophagus, stomach and
intestines
Speaker: Alex German
Radisson SAS, Manchester Airport
Details from administration@bsava.com
30-31 Diary.indd 31 20/07/2011 11:26
Examining blood lm with microscopes
Elizabeth Villiers
Practical
haematology
Tuesday 29 November 2011
Woodrow House, Gloucester
BSAVA member: 325.00 Non member: 487.50
www.bsava.com
See page 19 for more details
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