The essential publication for BSAVA members

companion
AUGUST 2013
How To
Interpret spinal
radiographs
P12
Clinical Standards
Are we ready?
P4
Clinical Conundrum
Progressive
abdominal distension
and jaundice P8
Panda breeding
programme at
Edinburgh Zoo
01 OFC August.indd 1 18/07/2013 09:33
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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 benet. Veterinary schools
interested in receiving
companion should
email companion@
bsava.com. 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
CPD Editor Simon Tappin MA VetMB CertSAM
DipECVIM-CA MRCVS
Past President Mark Johnston BVetMed MRCVS
CPD Editorial Team
Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVS
Tony Ryan MVB CertSAS DipECVS MRCVS
Lucy McMahon BVetMed (Hons) DipACVIM MRCVS
Dan Batchelor BVSc PhD DSAM DipECVIM-CA MRCVS
Eleanor Raffan BVM&S CertSAM DipECVIM-CA MRCVS
Features Editorial Team
Andrew Fullerton BVSc (Hons) MRCVS
Mathew Hennessey BVSc MRCVS
Design and Production
BSAVA Headquarters, Woodrow House
No part of this publication may be reproduced
in any form without written permission of the
publisher. Views expressed within this
publication do not necessarily represent those
of the Editor or the British Small Animal
Veterinary Association.
For future issues, unsolicited features,
particularly Clinical Conundrums, are
welcomed and guidelines for authors are
available on request; while the publishers will
take every care of material received no
responsibility can be accepted for any loss or
damage incurred.
BSAVA is committed to reducing the
environmental impact of its publications
wherever possible and companion is printed
on paper made from sustainable resources
and can be recycled. When you have finished
with this edition please recycle it in your
kerbside collection or local recycling point.
Members can access the online archive of
companion at www.bsava.com .
3 BSAVA News
Latest from your Association
47 Are We Ready for Clinical
Standards?
A look at where we are and
where we might be going in
small animal practice
811 Clinical Conundrum
A case of progressive abdominal
distension and jaundice
1219 How To
Interpret spinal radiographs
2022 Conservation at Work
Efforts to breed giant pandas at
Edinburgh Zoo
2425 Travel Scholarship Winner
Winner of the 2013 Frank Beattie
Travel Scholarship, tells of her visit
to the University of California
2627 Cats Come First for Award
Winner
The J.A. Wight Memorial Award
winner tells us about her work
2829 PetSavers
Pedro Martn Bartolom talks
about why fundraising is so vital
to the profession
3031 Nice work and you can get it
Veterinary adventures in Fiji
3233 WSAVA News
The World Small Animal
Veterinary Association
3435 The companion Interview
Gyles Brandreth
37 Letters from the Regions
News from your local groups
3839 CPD Diary
Whats on in your area
Additional stock photography:
www.dreamstime.com
Harperdrewart; Isselee; Photowitch
EJCAP ONLINE
Dont forget that as a
BSAVA member you are
enttled to free online
access to EJCAP
register at www.fecava.org/EJCAP
to access the latest issue.
Find FECAVA on Facebook!
T
ransfusion of blood products is an
important component of veterinary
emergency medicine. Donors must
be carefully selected to minimise
risk of transmission of blood-borne
infectious agents. This study by Karen
Crawford and colleagues from the
University of Bristol and Pet Blood Bank
UK was devised to assess the prevalence
of such agents in healthy, non-travelled
UK dogs screened as prospective donors.
EDTA blood samples were screened
usng PCR for haemotropic mycoplasmas,
Bartonella, Babesia, Leishmania, Ehrlichia
and Anaplasma spp. Dogs with positive or
inconclusive results underwent repeat
testing. Four of 262 dogs had positive or
inconclusive results at initial screening.
Repeat PCR testing in each dog was
negative, and none of the dogs developed
clinical signs of disease.
The positive results on initial
screening may have represented false
positives from sample contamination or
amplification of non-target DNA. It is also
possible that dogs were infected at initial
sampling but successfully cleared
infection prior to repeat testing. The low
number of positive results obtained
suggests that prevalence of these agents
in a population of healthy UK dogs is low
and that use of blood products is unlikely
to represent a significant risk of
transmission of these diseases.
Adapted from Crawford, K., et al. JSAP 2013; 54: 414417
OTHER PAPERS IN THIS MONTHS JSAP
Urine concentratons of xanthine,
hypoxanthine and uric acid in Cavalier
King Charles Spaniels
Treatment of canine idiopathic
immune-mediated haemolytc anaemia
with mycophenolate mofetl and
glucocortcoids
Renement of the dose of doxapram to
counteract the sedatve eects of
acepromazine in dogs
Canine physical rehabilitaton: range of
moton of the forelimb during stair and
ramp ascent
Comparison of buprenorphine or
methadone with meloxicam for analgesia
in dogs undergoing orthopaedic surgery
Whats in JSAP this month?
Log on to www.bsava.com to access
the JSAP archive online.
Infectious agent screening
in canine blood donors
02 Page 02 August.indd 2 18/07/2013 11:34
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Fancy a weekend
inEdinburgh?
O
ver 150 of your colleagues
have already signed up for
Scottish Congress; we have sold
all the exhibition space and the
Ceilidh band is warming up ready for a night
of dancing. There is still time for you to join
us in Edinburgh this Summer for 16different
topics over two days delivered by highly
respected speakers. Further information
is available at www.bsava.com/
scottishcongress or email Ben Dales
b.dales@bsava.com . With prices starting
at just 199 for BSAVA Vet Members for the
whole weekend, 155for VN members,
and with great day rates also available,
you cant afford to miss this weekend of
superb CPD in a really great city.
Making the most of your region?
B
SAVA has 12 regions, all run by volunteers, who organise quality
cost-effective CPD on a regular basis. As a non-for-profit organisation
working for you, we can keep fees low and standards high.
Courses are usually aimed at the general practitioner or nurse
looking to update their current knowledge and techniques. It is also a great
opportunity to meet and share experiences with local colleagues. So if you
havent been to a meeting for a while take a look at the courses in the Diary on
the inside back pages, or for more information about getting in touch with your
regional representatives: email administration@bsava.com or visit the
website www.bsava.com .
V
ets, VNs and pet owners should pick
up a camera and capture playful pets
to compete in this years PetSavers
Photography competition. The theme is
Mischievous Pets those moments when we
catch our companions getting into places they
shouldnt or even just looking like that want to
get up to high jinx.
The competition is free to enter and open to
all UK residents: pet owners, vets and vet
nurses children and adults. The deadline is
31January 2014, and the winners will be
notified by email by 1 March. Our judges for this
years competition will be the PetSavers
Chairman, Pedro Martn Bartolom, and our
guest judge, awarding-winning pet
photographer Paul Walker find inspiration at
his website www.pawspetphotography.co.uk .
You need to enter online at www.petsavers.
org.uk and please encourage your clients to
enter too, by requesting flyers and posters to
display in your practice.
Time to nominate
Y
our nominations for BSAVA Awards need
tobe in before 26 September. You can
nominate online at www.bsava.com/
awards or use the form inside this issue.
This is also the deadline for applications for the Frank
Beattie Travel Scholarship. On pages 2427 we look
at some of the recent winners. Please consider
nominating someone who has inspired you and deserves this
prestigiousprofessional recognition, and also come along to the
ceremony at Congress it will take place on Thursday.
Today
THURSDAY
September
Exciting
developments
coming soon
W
e are continuously working to develop
member services and
communications for you, and in July
we launched a new monthly
members e-newsletter to keep you up to date
with all things membership and BSAVA.
Hot on the heels of this well be launching a
brand new membership system and website
toward the end of the year. The new website will
give members a vastly improved user experience,
including search and navigation as well as the
freedom to manage your own personal
membership profile in myBSAVA.
In readiness for the launch of the two new
systems, we are asking members to log in to the
existing website to check and update their
profiles, particularly their address as we will be
mailing launch details to you in the autumn. If you
have any questions about your login, please email
administration@bsava.com .
In the meantime, watch this space for further
updates and sneak previews on the launch of the
two new systems.
Snap up a
photo
prize
30 August 1 September
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Are we ready for
clinical stan dards?
A look at where we are
and where we might
be going in small
animal practice
T
he RCVS Practice Standards
Scheme (PSS) is a voluntary
accreditation scheme which aims
to encourage higher veterinary
standards and reassure the public that
minimum standards are being met. Around
half the practices in the UK are accredited
under the scheme.
Practices can be accredited at three
levels. Core standards relate primarily to
legal requirements for running a veterinary
practice as well as guidance as set out in
the RCVS Code of Professional Conduct.
Itis now a professional requirement to
practice to a level of the core standards
even if you are not a member of the
Scheme. General standards are intended
to demonstrate high standards of clinical
care and, in the case of small animal
practices, the facilities required for
veterinary nurse training. Those practices
accredited as hospitals are expected to
provide additional facilities and protocols
for the investigation and treatment of
morecomplex cases.
The scheme is coordinated by the
Practice Standards Group (PSG) which is a
steering committee chaired by a
representative of the Royal College of
Veterinary Surgeons and comprising
representatives from all the major
veterinary and veterinary nursing
organisations in the UK. Pam Mosedale is
the BSAVA representative on the Practice
04-07 Clinical Standards.indd 4 18/07/2013 09:54
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Standards Group; she was a Practice
Standards Inspector from the beginning of
the BSAVA practice standards scheme and
continued with the RCVS scheme.
At the end of last year the RCVS
carried out a consultation on the future
development of the Practice Standards
Scheme. They admitted that the current
scheme is perceived to place too much
emphasis on equipment and paperwork,
and suggested that they would like to
focus more on the behaviours of
veterinary staff that make a difference
to the standard of care provided by
the practice.
What do we mean by standards?
In broad terms standardisation is the
process of rendering things uniform, while
standard can be used to refer to both the
means and outcome of standardisation.
It has been said that there are
essentially four categories of standard:
1. Design standards These are
structural specifications which ensure
uniformity and compatibility. A
veterinary example would be the Luer
fittings on needles and syringes.
2. Terminological standards These
are systems of nomenclature, coding
or classification which facilitate
communication. The development of
VeNom Coding to produce a standard
set of clinical veterinary terms is an
example of this.
3. Performance standards These do
not prescribe what has to be done or
how something should be done but
only what the result of that action
should be. They are often used to
regulate professional work and are
widely used in the NHS.
4. Procedural standards These
delineate the steps that should be
taken when specified conditions are
met, e.g. clinical practice guidelines/
policies or protocols.
Assessing standards
When considering clinical standards or
standards of care we are usually
considering procedural and performance
standards which look at processes and
outcomes, respectively.
The recent report by the Nuffield
Trust (Rating providers for quality a
policy worth pursuing?) suggested that
there could be at least 5 reasons for
assessing standards:
To increase accountability (to clients,
regulators or other stakeholders)
To aid choice by users
To help improve the performance of
providers
To identify and prevent failures in the
quality of care
To provide public reassurance as to
thequality of care.
However, it went on to say that while
ratings, provided they were simple and
valid, could act to improve accountability
for the quality of care, they could also lead
to a distortion of priorities as attention was
focused on aspects of care that are
measured relative to those that are not. It is
therefore very important to consider
carefully the standards of care to be
assessed and to select appropriate
methods for assessing them.
The National Health Service has
embraced the idea of measuring standards
of care in human medicine and has a
range of systems in place to do this.
The National Outcomes Framework is
intended to provide a national level overview
of how well the NHS is performing, by
looking at a range of indicators grouped
around five domains that set out the
high-level national outcomes that the NHS
should be aiming to improve.
Are we ready for
clinical stan dards?
Domain 1 Preventng people from dying
prematurely
Domain 2 Enhancing quality of life
for people with long-term
conditons
Domain 3 Helping people to recover
from episodes of ill health or
following injur
Domain 4 Ensuring that people have a
positve experience of care
Domain 5 Treatng and caring for people
in a safe environment; and
protectng them from avoidable
harm
Within each of these domains specific
indicators and areas for improvement are
detailed, for example:
Treatng and caring for people in a
safe environment and protectng
them from avoidable harm
Overarching indicators
5a Patent safety incidents reported
5b Safety incidents involving severe harm
or death
5c Hospital deaths atributable to problems
in care
Improvement areas
Reducing the incidence of avoidable harm
5.1 Incidence of hospital-related venous
thromboembolism (VTE)
5.2 Incidence of healthcare associated
infecton (HCAI)
i MRSA
ii C. difcile
5.3 Incidence of newly-acquired category 2,
3 and 4 pressure ulcers
5.4 Incidence of medicaton errors causing
serious harm
Improving the safety of maternity services
5.5 Admission of full-term babies to
neonatal care
Delivering safe care to children in acute
setngs
5.6 Incidence of harm to children due to
failure to monitor
5
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Are we ready for
clinical standards?
The Quality and Outcomes
Framework (QOF) is a voluntary incentive
scheme for GP practices, rewarding them
for how well they care for patients. The
QOF contains groups of indicators, against
which practices score points according to
their level of achievement. The idea is that
QOF gives an indication of the overall
achievement of a practice across a range
of areas, for which they score points. Put
simply, the higher the score, the higher the
financial reward for the practice.
The National Institute for Health and
Care Excellence (NICE) is tasked with
developing the clinical and health
improvement indicators for the QOF.
The current indicators are divided into
broad groups relating to particular areas
of care including cancer, cardiovascular
disease and endocrine, nutritional and
metabolic disease.
Example QOF Indicators
The percentage of patients with cancer
diagnosed within the preceding 15
months who have a review recorded as
occurring within 3 months of the
practice receiving confirmation of the
diagnosis
The practice can produce a register of
people with peripheral arterial disease
The percentage of patients with
peripheral arterial disease in whom the
last blood pressure reading (measured
in the preceding 15 months) is 150/90
or lower
The blood pressure of patients aged 40
and over is recorded in the preceding
5years for at least 80% of patients
The percentage of patients with
diabetes who have a record of a
dietary review by a suitably
competent professional in the
preceding 15 months
Each of these indicators is backed up
by evidence-based guidelines and is put
through both a consultation and piloting
process before it is included in the QOF.
Although we are starting to develop clinical
guidelines in veterinary practice (e.g. those
from the International Renal Interest
Society (IRIS) for renal disease in dogs and
cats; the WSAVA on vaccination and
nutritional assessment; or the AAHA
guidelines) we do not currently have a
mechanism for assessing how their use
impacts on the quality of care provided.
Standards in veterinary practice
Veterinary practice has a number of
significant differences from medical
practice in the UK. There is no National
Health Service for pets, either as a
coordinating body to fund the
developmentand introduction of clinical
guidelines or to provide financial incentives
for veterinary practices to meet agreed
clinical standards. So how would we go
about measuring standards of care in
veterinary practice?
The American Animal Hospital
Association (AAHA) has an accreditation
scheme which states that practices are
evaluated on stringent quality standards
that encompass all aspects of pet care.
They state that their standards focus on the
quality of care in the areas of anaesthesia,
contagious diseases, dentistry, pain
management, patient care, surgery and
emergency care. There are 46 mandatory
standards, which all practices must meet,
as well as around 900 general standards
which are marked on a points system,
allowing practices some flexibility in the
standards which they choose to meet.
Examples of mandatory (M) and
general standards required for
AAHA-accredited Hospitals
Anaesthesia
MA3
A patient assessment is performed by
a practice team member prior to the
administration of any premedication,
sedation, or anaesthetic.
AN8
The practice uses the American
Society of Anesthesiologists (ASA)
physical status scale for pre-anaesthetic
case classifications:
Grade 1 Normal patient with no
organic disease
Grade 2 Patient with mild systemic
disease
Grade 3 Patient with severe systemic
disease that is a constant threat to life
Grade 4 Patient with incapacitating
systemic disease that is a constant
threat to life
Grade 5 Moribund patient
Pain management
MA23
Pain assessment is considered part
of every patient evaluation regardless of
the presenting complaint.
PM2
Pain management is individualised for
each patient.
Rationale: Many variables have the
potential to influence the response to pain
management in an individual patient.
Examples of these variables include:
Species, breed, age, dimeanor, and
relative size of the patient
Physical status and specific disease
processes of the patient
Concurrent medications including
anaesthetics and sedatives
Severity and anticipated duration of
pain
Knowledge and skills of the individuals
providing the patient care
Client Service
CS8
The practice evaluates, at least
annually, how its services and hours
match community needs, considering
issues such as:
The appropriateness of appointment
scheduling
The need for emergency services
04-07 Clinical Standards.indd 6 18/07/2013 09:54
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The need for house calls
The need for early pick-ups or
drop-offs
ASAVA Scheme
The Australian Small Animal Veterinary
Association (ASAVA) also has an
accreditation scheme. This scheme is
closely based on the AAHA scheme but
involves not only an inspection of the
premises but also the completion of an
accreditation manual providing details of
the practice under the headings of:
Personnel and procedures; Equipment;
and Structure. There is a separate section
to cover nursing care which includes the
provision of diagnostic, pre-surgical,
surgical and recovery procedures, as well
as custodial care. Specific requirements in
this area include:
All patient care provided by the
nursing staff must be under the
supervision of a veterinary surgeon
All patients must be positively and
properly identified (sufficient to
differentiate between two like animals)
during their hospital stay
Each medication must be entered on
the patients medical record, showing
date, name of drug, type, dose, route
of administration (when more than
one route is acceptable), and
frequency of administration
The practice staff must demonstrate
humane care of animals. The facility
must provide for the care and
prevention of animal abuse or
neglect of patients.
In order to achieve accreditation the
practice must also submit five sets of
medical records covering medical, surgical
and dental cases. These records should
include estimate/consent/admission forms,
in-hospital progress notes including cage
side charts and fluid balance charts, and
anaesthetic charts and pathology reports if
appropriate. Random examples of medical
records are also viewed during the
inspection. The practice must also submit
three sets of radiographs providing details
of the animal, its medical history and the
radiographic techniques used, as well as a
report on the radiographs and comments
on their quality.
What clinical standards should
we have in the UK?
This is a question that is much easier to
ask than to answer. In a recent BSAVA
member consultation 80% of respondents
were in favour of the Practice Standards
Scheme incorporating standards related to
the quality of care. However the responses
below show we need to think carefully
about what we mean by quality and what
standards we measure:
That very much depends on the standards
included, since this is a voluntary scheme
and if it were created with a lack of
pragmatism it may reduce uptake of the
scheme overall, whilst if it is realistic it
could genuinely be of value.
Yes but only if it did not impinge on
clinical decision making, the best vets
Iever worked with were in mixed practice,
the practices would be considered low
level by the practice standards scheme but
the level of care is better that I have seen in
many hospital practices. The practice
standards scheme is a bit like the hotel
rating scheme, many brilliant small hotels
are only 3 because they do not have wifi
and broadband and swimming pools and
spas and 24 hour room service but instead
they have antiques and seashores and
honesty bars.
Participate in a new consultation
BSAVA would like to engage members in
the process of developing appropriate
clinical standards for small animal practice.
We see this as an ongoing process but in
the first stage we would like to get some
general ideas about the sorts of standards
that you consider appropriate and how you
think that they could be measured. We will
feed this information back to you through
the website and a further article in
companion, when we will try to get more
detail about specific standards.
The results of this consultation will also
be fed in to the Practice Standards Group,
so it is a real opportunity to influence
decision making. Please take a few
minutes to complete our questionnaire,
which can be found on the BSAVA website
at www.bsava.com/consultations, or
email your comments to Sally Everitt at
s.everitt@bsava.com .
Questions in the
consultation
What do you see as the benefits of
introducing clinical standards into
the Practice Standards Scheme?
What do you see as the problems
of introducing clinical standards
into the Practice Standards
Scheme?
Which areas do you think
appropriate for the introduction of
clinical standards?
How do you think these clinical
standards should be measured?
Do you think there are some areas
where it is not appropriate to
introduce clinical standards?
You are welcome to provide any
other comments.
1
2
3
4
5
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Clinical conundrum
Case presentation
A 6-year-old male neutered Bichon
Fris presented with a one-week
history of progressive ascites and a
4-week history of weight loss. He
had been hospitalised 3 weeks
previously for severe vomiting and
collapse, from which he had
recovered with symptomatic
treatment (intravenous fluid
therapy and antibiotics).
Appetite was reported as
normal. There was no recent history
of polyuria/polydipsia, further
vomiting or diarrhoea. The dog was
up to date with vaccinations and
anti-parasitic medication.
Sarah Mason, a Petsavers Resident in
Small Animal Oncology at the University
of Liverpool, invites readers to consider a
case of progressive abdominal distension
and jaundice
Table 1: Causes of icterus
Pre-hepatc
Intravascular or extravascular haemolysis (primary immunemediated haemolytc anaemia;
secondary to drugs, toxins, underlying conditons)
Hepatc
Results from decreased uptake by hepatocytes or decreased bilirubin conjugaton due to
decreased functonal mass.
Examples of causes of hepatc icterus include infammaton (acute or chronic hepatts), infecton
(leptospirosis, canine adenovirus1), lipidosis (mainly cats), toxic insults and infltratve neoplasia
(lymphoma, metastatc neoplasia)
Post-hepatc
Obstructve causes include conditons aectng the gall bladder (cholangits, cholecystts,
cholelithiasis, biliary mucocele) and biliary system (compression of the common bile duct by an
enlarged pancreas (pancreatts)/duodenal mass, neoplasia/stricture of the common bile duct)
Physical examination
On presentation the dog was bright and
responsive, with a body condition score
of 2/9. Heart rate was 100beats/min
and respiratory rate was 44breaths/min,
with slightly increased inspiratory effort.
Mucous membranes were moist and
severely icteric. The abdomen was
markedly distended with a palpable
fluid thrill. Physical examination was
otherwise normal.
What is your problem list?
Rationalise the differential
diagnoses
n Icterus
n Peritoneal effusion
n Tachypnoea with slight increase in
respiratory effort
n Previous episode of vomiting and
collapse
n Weight loss and thin body condition
Causes of icterus can be divided into
three groups (pre-hepatic, hepatic and
post-hepatic).
Pre-hepatic causes were considered
less likely given the lack of clinical
findings consistent with significant
anaemia and red cell destruction. Sepsis
was considered unlikely as the dog was
clinically well. Hepatic icterus results
from decreased uptake by hepatocytes
or decreased bilirubin conjugation due
to decreased functional mass. Post-
hepatic (obstructive) causes result from
decreased excretion of bile from the gall
bladder. Differential diagnoses for icterus
are listed in Table 1. Chronic
hepatobiliary disease was considered
most likely, given the history of previous
illness and weight loss.
Peritoneal effusion can be
characterised as a transudate, modified
transudate or exudate (Table 2), and
can be due to many underlying
08-11 CLINICAL CONUNDRUM.indd 8 18/07/2013 10:04
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aetiologies. Differentials cannot be
excluded until abdominocentesis is
performed, but haemoabdomen was
considered less likely given the lack of
clinical evidence of anaemia.
Tachypnoea with slightly increased
effort was most likely due to the large
peritoneal effusion; however, concurrent
thoracic disease could not be excluded.
The previous episode of vomiting and
collapse could be due to numerous
conditions including: primary
gastrointestinal conditions (severe gastritis,
gastroenteritis), conditions affecting other
abdominal organs such as pancreatitis,
hepatitis, cholangitis, prostatitis or
peritonitis, systemic disease (azotaemia,
sepsis, metabolic/endocrine disease),
vestibular disease and toxicity.
Weight loss and thin body condition
with good appetite can be due to
maldigestion, malabsorption of nutrients or
secondary to systemic disease.
Overall, the combination of icterus with
peritoneal effusion and weight loss, and
the chronic history, with no clinical signs
consistent with anaemia or cardiac disease
made hepatobiliary disease most likely.
What initial diagnostic plan
would you consider?
Haematology is indicated to exclude pre-
hepatic icterus and to look for evidence
of inflammation (Table 3). Serum
biochemistry is required to assess liver
enzymes and liver function given the
suspicion of hepatobiliary disease (Table
4). Clotting times need to be assessed
as hepatic disease is suspected and
hepatic biopsy may be indicated for
further diagnosis.
Abdominocentesis is indicated to
characterise the abdominal effusion
(Table5). Urinalysis is included as part of
the minimum database and to assess renal
concentrating ability (Table 6)
Efusion type Aetology Characterisaton
Transudate Results from changes in Starlings forces within capillary
beds, due to decreased colloid osmotc pressure
(hypoalbuminaemia) or increased hydrostatc pressures
(portal hypertension)
Total protein:
<25 g/l
Total cell count:
<1.5 x 10
9
/l
Modifed
transudate
Modifed transudates result from increased vessel
permeability and can occur as a consequence of
rightsided congestve heart failure, neoplasia and other
intraabdominal infammatory conditons (e.g. pancreatts,
hepatts)
Total protein:
>25 g/l
Total cell count:
17 x 10
9
/l
Exudate Exudates include blood (haemoabdomen secondary to
coagulopathy or ruptured abdominal neoplasia), septc
peritonits secondary to a ruptured viscus, and bile from a
ruptured biliary tract
Total protein:
>30 g/l
Total cell count:
>7 x 10
9
/l
Table 2: Body cavity effusions
Parameter Reference interval Value day 1 Value day 3 post surgery
RBC 5.78.8 x 10
12
/l 6.24 3.93
HGB 12.918.4 g/l 14.8 9.8
HCT 0.370.57 l/l 0.45 0.29
MCV 58.871.2 f 72 73.9
MCHC 3136.2 g/dl 32.8 33.6
RDW 11.914.5% 14 16
Platelets 143400 x 10
9
/l 186 285
WBC 618 x 10
9
/l 14 20.8
Neutrophils 3.98 x 10
9
/l 10 17
Band neutrophils <1 x 10
9
/l 0.56 1.1
Lymphocytes 1.34.1 x 10
9
/l 2.1 2.1
Monocytes 0.21.1 x 10
9
/l 0.85 0.62
Eosinophils 00.6 x 10
9
/l 0.14 0.01
Basophils 00.1 x 10
9
/l 0.01 0.01
Retculocyte count <60 x 10
9
/l 81 351
Smear
examinaton
Unremarkable Polychromasia and
anisocytosis consistent
with regeneratve picture
Table 3: Haematology (abnormal results in bold)
Parameter Reference interval Value day 1 Value day 3 post surgery
Chloride 99115 mmol/l 100
Potassium 3.85.3 mmol/l 5.2
Sodium 140153 mmol/l 144
Calcium 2.22.7 mmol/l 2.39
Phosphate 0.82 mmol/l 1.04
Urea 3.56 mmol/l 3.1
Creatnine 20110 mol/l 43
Cholesterol 3.26.5 mmol/l 6.2
Total bilirubin 020 mol/l 76.2 13.5
Total protein 5778 g/l 45
Albumin 2331 g/l 24
ALP 0100 IU/l 2384
ALT 750 IU/l 254
Glucose 3.55.5 mmol/l 4.6
Table 4: Biochemistry (abnormal results in bold)
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Clinical conundrum
How do the test results help you
refine your differential
diagnoses?
Normal red cell parameters exclude
pre-hepatic icterus. The significant
increase in ALP and bilirubin made
post-hepatic icterus/biliary disease
significantly more likely than primary
hepatic icterus. Endocrine conditions
associated with ALP (diabetes mellitus,
hyperadrenocorticism) were considered
unlikely as these are not likely to cause
peritoneal effusion.
Mildly increased ALT was considered
most likely secondary to the biliary
disease, and low urea can be due to low
protein intake or diuresis as well as
hepatic dysfunction. Normal albumin,
glucose and clotting factors made
hepatic dysfunction less likely. Bilirubin
crystaluria was consistent with the
hyperbilurinaemic state.
Abdominal fluid analysis confirmed bile
peritonitis (Figure 1; Table 5), most likely
secondary to biliary obstruction and
rupture given the lack of history of trauma.
Refined differential diagnoses for bile
peritonitis:
n Cholecystitis
n Biliary mucocele
n Biliary neoplasia
n Cholelithiasis
n Severe pancreatitis/pancreatic
neoplasia
What further investigations are
indicated to differentiate
between the causes of
post-hepatic icterus?
Ultrasonography is indicated to assess the
biliary tract further. Screening thoracic
radiographs are required to exclude
metastatic disease and comorbidities
causing the increased respiratory effort.
cPLI was considered but not performed as
pancreatic inflammation rarely results in
rupture of the gall bladder, and this test
may be positive in the presence of
peritoneal effusion.
What is your interpretation of
the abdominal ultrasound image
(Figure 2)?
Abdominal ultrasonography revealed a
distended gall bladder (4.2 x 3.4 cm)
containing echogenic solid material
measuring approx 2 cm (Figure 2). The
wall of the gall bladder was not well
visualised due to shadowing from the
surrounding bright mesentery. Further
evaluation revealed that the common bile
duct and intrahepatic ducts did not
appear dilated.
There is also a large volume of
hypoechoic peritoneal effusion. The
mesentery throughout the abdomen is
hyperechoic and thickened. The right side
of the liver is enlarged and rounded. The
parenchyma is homogeneous. The
pancreas appears homogeneous and
normal in size.
These findings support the clinical
picture of bile peritonitis most likely caused
by gall bladder rupture, and rule out acute
pancreatitis as the cause of the obstruction.
A
B
Figure 1:
(A) Abdominal
effusion
(B) Cytology of
peritoneal
effusion;
note pigment
uptake by
macrophages
Parameter Value
Total cell count 5.5 x 10
9
/l
WBC 4.6 x 10
9
/l
Polymorphs 85%
Mononuclear cells 15%
RBC 0.9 x 10
9
/l
Urea 3.4 mmol/l
Creatnine 41 mol/l
Total bilirubin 311 mol/l
Table 5: Abdominal fluid analysis
Parameter Value
Colour Orange
SG 1.035
Glucose neg
Bilirubin 4+
Ketones neg
Blood neg
pH 6.50
Protein Trace
Urobilinogen neg
Leucocytes
(dipstck)
neg
Sediment analysis Bilirubin crystals
Table 6: Urinalysis
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What is your interpretation of
the thoracic radiograph
(Figure 3)?
Right lateral and dorsoventral thoracic
radiographs were obtained and
revealed only compression of the lung
fields and reduced serosal detail in the
cranial abdomen consistent with
large-volume effusion.
Treatment
An exploratory coeliotomy is indicated to
repair the ruptured biliary system. At
surgery approximately 1.4 litres of bile-
stained abdominal fluid was removed from
the abdomen. Exploration showed
extensive bile staining of all mesenteric
and omental fat, and omental adhesions to
the gall bladder and proximal duodenum
from the pylorus to two-thirds of the way
down the descending duodenum.
The gall bladder was enlarged and a
necrosed area was evident on the gall
bladder wall; the remainder of the visible
biliary tree was normal. Patency of the
common bile duct was confirmed by
catheterisation and flushing with saline.
Omental adhesions were dissected off the
gall bladder and cholecystectomy was
performed. A liver biopsy was taken for
histopathology and culture, and bile was
collected for bacterial culture. The
Figure 2: Ultrasonographic appearance of the
gall bladder
Figure 3: Lateral thoracic radiograph.
Compression of the caudal lung lobes and large
volume abdominal effusion
abdomen was lavaged with sterile saline
prior to closure.
The dog recovered well from his
surgery and was discharged 3 days later;
the serum bilirubin having improved, at
13mol/l.
Bile and liver culture were negative;
however the patient had been receiving
antibiotics at the time of sampling,
possibly hindering successful culture.
Histopathology revealed focally extensive
necrosis, mucosal ulceration and
associated inflammatory changes present
within the gall bladder, which had resulted
in proliferations of fibrovascular connective
tissue within and around the wall.
There were mild to moderate chronic
inflammatory and fibrotic changes
associated with the bile ducts within the
liver. These changes could all be a
response to a chronic ascending bacterial
infection of the biliary tree or to more distal
obstruction. There was no evidence of a
neoplastic process in any of the sections.
The changes in the liver are not suggestive
of chronic hepatitis.
The dog was prescribed oral
amoxicillin/clavulanate twice daily for a
further 2 weeks to continue treatment for
possible bacterial cholangitis seen on
histopathology.
Discussion
Bile peritonitis is an uncommon
presentation in practice but should be
included in differentials for peritoneal
effusion. In one study of dogs diagnosed
with bile peritonitis, half had sustained
trauma and the other half presented with
biliary rupture secondary to necrotizing
cholecystitis as in this case. Bilirubin
concentration of effusion was shown to be
useful in diagnosing the condition with the
concentration of bile in the effusion being
greater than twice that of serum.
Outcome
The dog presented two weeks
postoperatively for suture removal and was
clinically very well with no evidence of
icterus or abdominal distension. No follow
up biochemistry has been performed due
to financial constraints. n
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How to interpret
spinal radiographs
S
pinal radiography is an important
tool, which can be utilised in
general practice to diagnose many
osseous, and some soft tissue,
lesions of the spine. However, it is
important to:
Understand the limitations of
radiography
Understand how to optimise acquisition
of the radiographs
Optimise your interpretation of the
radiographs to achieve the maximal
use of the technique
Be familiar with common abnormalities
identified on spinal radiographs
Appreciate when there are superior
techniques available.
Limitations of radiography
It is important to have performed a full
clinical and neurological examination
before performing any diagnostic tests,
especially those that require sedation or
general anaesthesia to ensure that you
have correctly localised the lesion. Any
lesions seen on radiographs should be
correlated to your neurological localisation
to help assess their significance.
In general, radiography can provide
useful information about osseous lesions
that lead to potential neurological signs for
the patient, for example vertebral fractures,
vertebral luxation, congenital vertebral
abnormalities and vertebral neoplasia.
Radiographs may also provide information
about lesions that extend into the vertebrae
from surrounding tissues (e.g.
discospondylitis or soft tissue neoplasia),
or may be suggestive of a lesion (e.g.
intervertebral disc extrusion).
It is important to remember that not
all lesions identified on spinal
radiographs may be significant, for
example some congenital vertebral
abnormalities, calcification of the
nucleus pulposus, ventral spondylosis or
diffuse idiopathic skeletal hyperostosis
(DISH) are rarely significant.
Radiographic change can also
substantially lag behind the clinical
picture. Patients with discospondylitis
may have a normal radiograph of the
affected disc space(s) for 24 weeks
despite the patient having clinical signs.
For bone lysis to be seen on radiographs
(e.g. secondary to a vertebral tumour) up
to 50% of the cancellous bone has to be
lost. The sensitivity of radiography for
common problems is relatively poor. For
intervertebral disc extrusions the
sensitivity for diagnosing the correct site
is only 6070%, which is far from
adequate when decompressive spinal
surgery is to be performed.
Due to divergence of the X-ray beam,
the vertebrae and the width of the
intervertebral disc spaces can be distorted
unless they are at the centre of the beam.
This may lead to artefactual narrowing of
the intervertebral disc spaces. There may
be soft tissue disease processes occurring
within the same region as the osseous
abnormality, which may or may not be
related (e.g. syringomyelia, subarachnoid
diverticula, inflammatory disease,
neoplasia or intervertebral disc disease).
How to optimise acquisition of
spinal radiographs
In order to maximise the diagnostic
information that can be obtained from
spinal radiographs, the patient must be
properly positioned. To facilitate this the
patient should be heavily sedated or
anaesthetised as long as there are no other
contraindications. Rotation of the vertebrae
should be minimised by the use of foam
wedges, ties and troughs (Figure 1). If
rotation is identified then the patient should
be repositioned and the radiograph
retaken as many times as is necessary.
On the lateral view
The transverse processes in the
cervical and lumbar spine should be
superimposed
The rib heads within the thoracic spine
should be superimposed
The wings of the ileum should be
superimposed
On the ventrodorsal view
The dorsal spinous processes should
be central on the vertebrae
The spine should also be straight
It is important to have orthogonal views
(i.e. a lateral and ventrodorsal) as
significant lesions (even vertebral luxations)
can readily be missed on a single
radiograph. Some lesions may not be
obvious on one lateral view but become
more obvious on the opposite lateral view,
so ideally both left and right lateral views
should be taken. For patients with a
suspected vertebral instability the tube
head can be rotated horizontally to obtain
Victoria Doyle, European and RCVS
Specialist in Veterinary Neurology, works
us through these challenging images
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the ventrodorsal view while minimising
movement of the patient.
Stressed views of the spine, e.g. for
atlantoaxial subluxation or caudal cervical
spondylomyelopathy (Wobbler syndrome),
can cause marked neurological
deterioration. Ideally, these should be
avoided or done with extreme caution for a
minimal amount of time.
It is important to centre the beam on
the region of interest to minimise distortion
from divergence of the X-ray beam.
In the cervical spine, the beam should
be centred on C34 and C67
An additional view centred on the
atlantoaxial region should be taken
if atlantoaxial subluxation is
suspected
In the thoracic spine, the beam should
be centred at T67 and at the
thoracolumbar junction
In the lumbar spine, the beam should
be centred at L34
The beam should be centred on the
lumbosacral region if a lesion in this
region is suspected
If a lesion is identified then further
images centred on the lesion can
provide additional information
The exposure should also be checked
to ensure the radiograph is not over- or
under-exposed or important diagnostic
information could be missed.
How to optimise interpretation
of spinal radiographs
It is very useful to have a system for
evaluating radiographs to ensure that no
area is overlooked and to prevent
focusingon an obvious lesion and
overlooking one that is more subtle.
Theorder is not important and can be
tailored to personal preference as long
asall areas are evaluated.
Assess the paraspinal structures
Count the vertebrae
In dogs and cats there should be:
7 cervical vertebrae
13 thoracic vertebrae
7 lumbar vertebrae
3 fused sacral vertebrae
It is possible to have greater or
fewer vertebrae especially within the
lumbar spine without it necessarily
causing neurological signs
Assess the vertebrae for alignment to
one another in both planes (lateral and
ventrodorsal)
Assess the anatomy of the vertebrae
(e.g. congenital vertebral abnormalities,
presence of growth plates (Figure 2),
fracture lines/fragments)
Figure 1: The correct positioning to obtain spinal
radiographs. The white lines indicate the level at which
the beam should be centred. (A-C) The correct
positioning for cervical radiography; foam pads are
placed under the nose and the neck to ensure a true
lateral view. (D-E) The correct positioning for
thoracolumbar radiography; foam pads have been
placed between the legs to ensure a lateral view of
the spine
A C
E D
B
Figure 2: Lateral view of the atlantoaxial
junction in a normal 6-week-old Boston Terrier.
The apparent separation of bone (arrowed)
ventral to the atlas is part of the developing
body of the vertebra
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How to interpret spinal radiographs
Assess the vertebral canal diameter
within the vertebrae and over the
intervertebral disc spaces
Assess the dorsal spinous processes
individually
Assess the articular processes
(articular facets) individually
Assess the intervertebral foraminae
(e.g. size, shape, uniformity,
opacification)
Assess the intervertebral disc spaces
individually (e.g. width compared to
those immediately adjacent to it,
opacity)
Assess the vertebral endplates
individually (e.g. for signs of sclerosis
or lysis)
Try to familiarise yourself with the
normal vertebral anatomy by using
textbooks or a spinal model. Also try to
familiarise yourself with the lesions that are
unlikely to be clinical significant so that
their presence is not overinterpreted.
Abnormalities that can be
identified on spinal radiographs
It can be helpful to view these conditions
under categories using the DAMNITV
mnemonic:
Degenerative
Anomalous
Metabolic
Nutritional/Neoplastic
Idiopathic, Inflammatory/infectious
Traumatic, Toxic
Vascular
Degenerative
Intervertebral disc disease
Classical radiographic changes
suggestive of intervertebral disc
disease include:
Narrowing of the intervertebral disc
space (Figure 3)
When compared to adjacent
intervertebral discs only
The narrowing may not be
uniform across the disc space
and can make the space
appear wedge-shaped
Extruded mineralised material may
be evident within the vertebralcanal
Opacification of the intervertebral
foraminae at the affected site(s)
Alteration in the normal shape of
the intervertebral formaminae at the
affected site(s)
Narrowing of the articular process
joint
Vacuum phenomenon
Accumulation of gas within the
intervertebral disc
It is important to bear in mind that
the accuracy of detecting the correct
site of an intervertebral disc extrusion is
only 6070%.
Cervical spondylomyelopathy
(Wobbler syndrome)
A common neurological condition in
large (e.g. Dobermann) and giant
breed dogs (e.g. Great Dane)
It can be seen in smaller breeds
(e.g.Chihuahua and Yorkshire Terrier)
Changes associated with this disease
include:
Congenital stenosis of the vertebral
canal
Hansen type II disc disease
(annulus fibrosus protrusion) and
tipping of the vertebrae (especially
seen in Dobermann)
Ligamentous hypertrophy
(ligamentum flavum and dorsal
longitudinal ligaments)
Synovial cysts arising from the
articular facets (possible)
Articular facet degenerative joint
disease (especially seen in giant
breeds)
Spinal radiographs can identify
stenosis and degenerative joint
disease affecting the articular
facets but cannot identify the soft
tissue changes, which also occur
with this condition
Two recent studies have shown that
radiographs cannot accurately identify
the site of compression and so should
not be used in isolation to guide
surgical planning (Figure 4)
Stressed views are not recommended
as spinal cord compression can be
acutely exacerbated leading to marked
neurological deterioration
Degenerative lumbosacral stenosis
Common in middle-aged to older large
breed dogs (e.g. German Shepherd
Dog.) See Figure 5.
Radiographic changes which can be
identified with this condition include:
Sacral osteochondrosis
Transitional vertebrae
Ventral spondylosis
Subluxation of L7S1
Endplate sclerosis of L7S1
Degenerative joint disease of the
articular processes
Figure 3: Lateral views of the (A) cervical and
(B) lumbar spine in two dogs with acute
intervertebral disc herniations. (A) There is
narrowing of the C3C4 disc space.
(B) Mineralised disc material is present in the
L2L3 disc space, projecting into the vertebral
canal and causing opacification of the
intervertebral foramen (arrowed)
A
C3
C4
B
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Accuracy is not 100% and therefore
radiography can lead to diagnosing
false positives and false negatives.
Additional imaging using advanced
techniques (e.g. CT and MRI) as well
as electrodiagnostics are needed to
improve the accuracy of diagnosis.
Articular process degenerative joint
disease/hyperostosis
These changes may not be
significant unless there is
impingement of the vertebral canal
or the nerve root
The changes can form secondarily
toinstability
Ossification of the dura
Bone plaques form on the dura mater
Cervical and lumbar regions are most
commonly affected
This is generally clinically insignificant
Mineralisation of the nucleus pulposus
Many chondrodystrophic dogs will
have mineralisation of the nucleus
pulposus
As long as the mineralised material
remains within the nucleus pulposus
and does not extrude, it is unlikely to
be significant (Figure 6)
Ventral spondylosis deformans
New bone formation ventral to the
vertebrae, which can form ventral
bridges of bone across the
intervertebral disc (Figure 7)
The edges of the new bone formation is
generally smooth
Its a non-inflammatory process
Associated with degeneration of the
annulus fibrosus
Typically forms on the thoracic and
lumbar vertebrae in older dogs
Unlikely to be significant in isolation as
the bone formation does not enter the
vertebral canal
However, it can be seen in association
with more significant lesions (e.g.
intervertebral disc protrusions and
degenerative lumbosacral stenosis)
Sacral osteochondrosis
A condition associated with
degenerative lumobosacral disease in
German Shepherd Dogs and is
therefore likely to be significant
Calcinosis circumscripta
Mineralisation of the ligamentous
structures dorsal to the atlantoaxial
region or dorsal to the mid thoracic
spine (Figure 8)
A
B
Figure 4: (A) Lateral cervical radiograph and
(B) myelogram from an 8-year-old
Dobermann with cervical stenotic
myelopathy. Note the tipping of C6 and the
severe compression of the spinal cord at
C5C6 and C6C7. There is a significant
compression at C67 seen on the myelogram
which is not apparent on the plain radiograph
Figure 5: (A) Neutral and (B) extended lateral
radiographs of a 7-year-old German Shepherd
Dog with degenerative lumbosacral stenosis.
Note the ventral spondylosis, proliferation of
the articular processes and the tunnelling of the
dorsal lamina, which is accentuated on
extension of the pelvis
A
B
Figure 6: Lateral radiography of the
thoracolumbar spine showing opacity of the
T11T12, T12T13 and L1L2 intervertebral disc
spaces. Note the narrowed intervertebral
foramen and opacity in the spinal canal at the
L1L2 disc space (arrowed), which should raise
suspicion for intervertebral disc herniation. The
opacification seen at T1112 and T1213 is still
within the nucleus pulposus and so is unlikely to
be significant at this stage.
Figure 7: Lateral radiograph of the lumbar spine
showing spondylosis at the L1L2, L2L3, L3L4
and L4L5 intervertebral disc spaces
L1
L2
L3 L4 L5
L6
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Can cause variable neurological signs
from pain to tetra/paraparesis
depending on location and severity
Anomalous
Osteochondromatosis/multiple
cartilaginous exostosis
See Figure 9
Occurs in young dogs and cats
Bones formed from endochondral
ossification are affected in either the
axial or appendicular skeleton
Abnormal growths capped with
cartilage form on these bones and
undergo endochondral ossification
The growths stop when the other
growth plates close
Malignant transformation of the growths
can occur
Depending upon the site of the growth,
there may be impingement of the
vertebral canal resulting in spinal cord
compression
Atlantoaxial subluxation
This can result from aplasia/hypoplasia
of the dens or abnormal ligamentous
structures
Classically seen in young toy breed
dogs but must not be overlooked in
older large breed patients
A lateral radiograph should be taken
initially. The patients neck should be in
a neutral position or very slightly flexed
as moderate flexion can cause
significant neurological deterioration
A ventrodorsal view can be obtained if
necessary and if the risk of instability is
low, but care should be taken that the
neck is not flexed
An open mouthed view to visualise the
dens is not required
The C1 and C2 vertebrae should have
a linear alignment in the normal patient
(Figure 10)
Transitional vertebrae
Vertebrae at the thoracolumbar or
lumbosacral junctions can be
transitional and show features of the
vertebrae in the adjacent section
T13 may only have one rib (Figure 11)
This is unlikely to be clinically
significant unless it is not taken into
account when planning
decompressive spinal surgery in
this region as the wrong disc space
could be opened
Sacralisation of the L7 vertebrae can
occur with a relatively high frequency
(Figure 12).
In German Shepherd Dogs this has
been shown to predispose them to
degenerative lumbosacral disease
78% of German Shepherd Dogs
with degenerative lumbosacral
stenosis had transitional
lumbosacral vertebrae
The hypothesis is that the instability
caused by the transitional vertebrae
at the lumbosacral junction
predisposes affected dogs to
degenerative lumbosacral disease
Hemivertebrae
Part of the vertebrae (especially the
body) fails to form resulting in a
wedge-shaped vertebra
Butterfly vertebrae occur if the central
part of the vertebral body fails to form
(Figure 13)
How to interpret spinal radiographs
Figure 8: Lateral cervical radiograph of a
4-month-old Hungarian Viszla with calcinosis
circumscripta. Note the focus of mineralisation
dorsal to the atlas (arrowed)
Figure 9: Multiple cartilaginous exostoses in a
4-month-old Golden Retriever. The exostoses
are present on the ribs and, the bodies and the
spinous processes of the thoracic vertebrae
Figure 10:
(A) Lateral and
(B) ventrodorsal
views of the
normal adult
atlantoaxial
junction. The
dens is visible in
(B) (arrowed)
A
B
Figure 11:
Ventrodorsal
view of the
thoracolumbar
junction in a
Cocker Spaniel.
Note the 13th
vertebra (starred)
only has one rib
*
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They are most commonly seen in the
thoracic spine and the T8 vertebra is
most commonly affected
Screw-tailed breeds are over-
represented but other miniature and toy
breeds can also be affected
These vertebrae can be incidental
findings
However, they can cause stenosis of
the vertebral canal, instability and
abnormal angulation (kyphosis), which
can lead to neurological signs
They may also be associated with other
pathology including intervertebral disc
protrusions, subarachnoid diverticulae
and syringomyelia, which can be
responsible for neurological signs
Block vertebrae
The developing vertebrae fail to
segment and the vertebrae remain
fused (Figure 14)
They can be clinically insignificant
However, they can also affect the
stability of the spine, predisposing the
patient to intervertebral disc disease at
adjacent sites
Spina bifida
Results from the failure of the neural
tube and overlying tissues to fuse
(Figures 13 and 15)
Most commonly occurs in the lumbar
or thoracic regions
The dorsal spinous processes often
appear split/duplicated on the
ventrodorsal view
In some circumstances it can be a
clinically insignificant lesion but in
others it can cause severe neurological
deficits, for example sacrocaudal
dysgenesis in Manx cats
May have overlying lesions within the
skin (e.g. change in direction of the hair
growth, draining tract) or lesions of the
meninges (meningocele) or of the
meninges and spinal cord
(meningomyelocele)
Figure 12: Vetrodorsal radiograph of a
5-year-old German Shepherd Dog with
lumbosacral pain and evidence of sacralisation
of L7. Note the absence of the left transverse
process of L7
Figure 13: A young male Bulldog with a
butterfly vertebrae at L4 (arrowed). The patient
also has spina bifida affecting T12
Figure 14: Lateral (A) and ventrodorsal (B) views
showing a block vertebra at C2C3 and
complete absence of the dens in a 10-year-old
Poodle. The point at which the two vertebrae
are fused is visible (arrowed)
A
B
Figure 15: Vetrodorsal radiograph of the cranial
thoracic spine. There is spina bifida affecting
the first thoracic vertebra. Note the duplication
of the spinous process (arrowed)
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Nutritional
Hypervitaminosis A
Cats fed on large amounts of liver
Leads to excessive new bone formation
on the vertebrae resulting in anyklosing
spondylitis
Usually cervical vertebrae are affected
(can extend to lumbar vertebrae)
Vertebral column becomes rigid and
causes pain
Change of diet may not significantly
alter the bony changes
Neoplastic
Primary or secondary vertebral body
tumours (Figure 16)
Osteosarcomas, fibrosarcomas,
chondrosarcomas,
haemangiosarcomas, plasma cell
tumours, carcinomas, lymphomas
and liposarcomas are all reported
Show aggressive changes to the
bone, especially lysis, loss of
cortical outline and possible bony
proliferation
Pathological fractures are possible
Multiple myeloma (a disseminated
plasma cell tumour) will show
multiple osteolytic lesions in the
bone marrow
Tumours arising within the
surrounding soft tissues can cause
pressure on surrounding bony
structures (e.g. the intervertebral
foraminae and vertebral canal)
leading to bony destruction; for
example, malignant nerve sheath
tumours leading to enlargement of the
intervertebral foramen
Idiopathic
Diffuse idiopathic skeletal hyperostosis
(DISH)
Calcification of the various soft tissues
(Figure 17) occurs including:
The ventral longitudinal ligament
Ventral aspect of the annulus
fibrosus
Paravertebral soft tissues
At least four neigbouring vertebrae
must be affected to fulfill the
terminology
It appears as a more extreme version
of ventral spondylosis deformans
Almost half the Boxer dogs in one
study were affected by DISH
Very rarely causes neurological signs
Inflammatory/infectious
Discospondylitis
Infection of the intervertebral disc and
the endplates of the adjacent vertebrae
(Figure 18)
Infection can also affect the
surrounding soft tissue and enter the
vertebral canal (empyema)
Infection can be bacterial
(Staphylococcus intermedius or
S.aureus most commonly) or fungal
(Aspergillus spp.)
Often affects multiple sites, so it is
important to screen the entire
vertebralcolumn
Common sites include:
Lumbosacral junction
Caudal cervical spine
Mid thoracic spine
Thoracolumbar spine
Radiographic changes can lag
behindthe clinical picture for 24
weeks and include:
Narrowing of the intervertebral
discspace
Lysis and sclerosis of the adjacent
vertebral endplates
Pathological vertebral fractures
Traumatic
Vertebral fractures/luxations
See Figures 19 and 20
Patients with a suspected vertebral
fracture or luxation should not be
heavily sedated or anaesthetised, as
relaxation of the surrounding
musculature may cause movement
through the unstable area leading to
neurological deterioration
These patients should be strapped to a
spinal board to try to prevent further
movement
Lateral radiographs can be obtained of
the entire vertebral column as well as
any other part of the patients body
which may have sustained trauma, for
example the thorax to assess for rib
fractures, pulmonary contusions etc.
How to interpret spinal radiographs
Figure 16: Lateral radiograph revealing the
vertebral canal and the intervertebral foramen
at L6L7 are expanded and there is new bone
ventral to the body of L6 (arrowed). The cause
was a poorly differentiated sarcoma
Figure 17: Lateral view of the lumbar spine of a
Boxer with disseminated idiopathic skeletal
hyperostosis (DISH). Note the nearly continuous
new bone along the ventral margin of the
visible vertebrae
Figure 18: Lateral radiograph of an 8-year-old
Airedale Terrier with lumbar pain. Gross
irregular lysis and osseous proliferation of the
vertebral endplates of L7 and S1 (arrowed) can
be seen, which are compatible with
discospondylitis
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The X-ray beam can then be rotated
horizontally to obtain the orthogonal
view. In this way, the patient does not
have to be moved into dorsal
recumbency, which could readily cause
worsening of the injury
Appreciate when there are
better techniques available
The accuracy of spinal radiography is
insufficient for diagnosis and treatment
planning for some common neurological
diseases.
Spinal radiography for intervertebral
disc disease will only correctly identify
the site of disc extrusion in 6070% of
cases. Therefore, it is an inadequate
diagnostic test if the patient is going to
have decompressive spinal surgery
If the patient is going to be referred
for surgery then spending time
acquiring radiographs is of very
little benefit to the patient. The
patient will be anaesthetised for
more accurate diagnostic testing
(e.g. magnetic resonance imaging)
when the patient arrives
Chiari malformation is a prevalent
disease within small breed dogs
(especially Cavalier King Charles
Spaniels) resulting in neurological signs
including neck pain, phantom
scratching and cervical myelopathy. In
a recent study, 28% had atlanto-
occipital overlapping concurrently,
which can be responsible for pain and
a cervical myelopathy in its own right.
Unfortunately, neither of these
conditions can be accurately
diagnosed without advanced imaging
(MRI)
Only some of the changes associated
with caudal cervical
spondylomyelopathy can be identified
radiographically, and radiographs
cannot reliably identify the sites of
compression
Spinal radiographs cannot diagnose
intraparenchmal spinal cord lesions (e.g.
fibrocartilaginous embolism), inflammatory
disease (e.g. granulomatous
meningoencephalomyelitis) or
intramedullary neoplasia. In these cases
more advanced imaging (e.g. MRI) is
required for diagnosis.
A
B
Figure 19: (A) Lateral cervical radiograph of a
7-month-old Doberman that fell from a
balcony. The body of C2 is fractured and
displaced dorsally, causing severe compression
of the overlying spinal cord. (B) The fracture
was reduced by traction wires placed around
the heads of two screws situated in the caudal
body of C2. Additional screws were placed in C1
and C3 and the construct was stabilised with
polymethylmethacrylate cement
Figure 20: Radiographic confirmation of a
complete caudal vertebral luxation in a cat with
avulsion of the tail
NEUROLOGY MANUAL
Images for this How To
have been taken from the
BSAVA Manual of Canine
and Feline Neurology, 4th
editon, edited by Simon
Plat and Natasha Olby. This
editon of the best-selling
Manual has been fully
updated to cover all the latest advances
in the eld. Structured in the same
practcal way as the previous editon to
aid informaton retrieval, the new editon
includes the advances made in the use
of MRI, and includes new chapters on
neurological genetc disease testng and
counselling, adjunctve therapies, and
the importance of providing adequate
nutritonal support to neurological patents.
An accompanying DVD-ROM contains over
100 videos relatng to clinical presentaton,
examinaton and diagnosis.
Member price: 55
Non-member price: 89
Buy online at www.bsava.com
Conclusion
Spinal radiography is an important tool in
diagnosing many neurological conditions.
In order for the technique to be most
useful, the positioning of the patient is
crucial. Care should be taken over the
positioning to prevent acute neurological
deterioration in some conditions. Having a
system to ensure that the entirety of the
radiograph is examined can prevent
lesions from being overlooked. The
clinician should be familiar with the
common conditions that can be identified
on radiographs and which are likely to be
insignificant to prevent over interpretation.
The clinician should also bear in mind the
limitations of radiography and understand
when more advance techniques are
required.
References and further reading are available at
www.bsava.com .
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Conservation at work
O
n 4 December 2011, a pair of 8-year-old
giant pandas (Ailuropoda melanoleuca)
called Tian Tian (Sweetie) and Yang Guang
(Sunshine) arrived in Edinburgh by direct
flight from Chengdu Airport. They were greeted with
full ceremonial pomp and circumstance at Edinburgh
Zoo, but the piped bands, government officials and
ecstatic crowds failed to make an impact on either
panda as they both settled in quickly for a snooze
followed by some fresh bamboo.
Accompanying them on this historic journey were
representatives from the Royal Zoological Society of
Scotland (RZSS), which owns Edinburgh Zoo, Ian
Valentine (who had masterminded the pandas move to
Edinburgh) and Darren McGarry (Head of the Living
Collection). In addition, Professor Tang (Head of
Simon Girling, Head of Veterinary
Services at Edinburgh Zoo, has
been instrumental in the efforts to
breed giant pandas in Scotland.
He tells companion readers more
about this exciting new initiative
20-22 Publications Pandas.indd 20 18/07/2013 11:02
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Veterinary Services at the panda centre in Bifingxia)
and head panda keeper, known to all as Scott,
travelled with Tian Tian and Yang Guang and stayed at
Edinburgh Zoo for a month after their arrival to ensure
that they both settled in properly.
Mating strategy
It is perhaps appropriate at this juncture to provide
some background information on keeping and
breeding giant pandas. They are solitary creatures in
the wild; thus collections holding this species generally
keep animals separate because, although they eat
predominantly bamboo, they are carnivores and can
be very aggressive towards each other outside of the
breeding season.
Their mating strategy involves a short oestrus
period of 2436 hours, once annually, during which
time a female may be mated by several suitors.
Gestation time is variable, being anywhere from 80 to
180 days due to delayed implantation. Single cubs are
the norm, but twins do occur; however, a female rarely
rears both cubs in the wild.
There are fewer than 330 giant pandas in captivity
and only 41 outside China. Thus, breeding giant
pandas in captivity is complicated by their aggressive
nature and the short window of introduction, which
must be timed accurately. Various techniques have
been used to determine oestrus and ovulation in the
giant panda, including:
Behavioural cues, such as increased bleating
calls, a lordotic stance with elevated tail carriage,
increased playing and urination in water, and
vulvalswelling
Vaginal cytology using Papinocolaou stains, which
demonstrates two chromic shifts on average 10
and 2 days away from ovulation (although there is
significant variation between individuals)
Urine hormone analysis.
Urine hormone analysis has been shown to be the
most accurate technique although frequent collection
of undiluted and uncontaminated urine samples from
the floor of an enclosure is a considerable challenge!
Itreveals a cross-over of increasing oestrogen
metabolites and reducing progesterone metabolites,
which occurs 1014 days from ovulation. The
oestrogen metabolites continue to increase, resulting
in two peaks the second, higher peak, is followed
5hours later by ovulation and rapidly falling oestrogen
levels. This is the critical time for mating, particularly if
artificial insemination is being considered, as studies
have shown that both natural and artificial insemination
are most likely to be successful if carried out within
12hours of this final oestrogen peak (i.e. within 7 hours
following ovulation).
If at first you dont succeed
With this in mind, in the Spring of 2012, the decision
was taken to perform a number of monitoring tests on
Tian Tian, to attempt accurate determination of oestrus
and ovulation, but in the knowledge that we would only
see if a natural mating was possible at this time.
Vaginal cytology was performed using positive
reinforced training techniques, and urine samples were
analysed by the Reproductive Department at Chester
Zoo after being couriered down each day. Professor
Tang returned to Edinburgh to oversee the introduction
of Tian Tian and Yang Guang, which, based on
cytology, hormonal analysis and behavioural cues,
occurred on the 1st and 2nd April 2012.
Unfortunately, no natural mating occurred during
these introductions, but we had proven that we could
accurately map out oestrus and ovulation in Tian Tian.
Following the breeding season, Yang Guang was
anaesthetised and semen samples were collected for
analysis and cryopreservation. Analysis of the semen
samples confirmed that his fertility levels were good,
which boded well for the following season.
try again
In 2013, we geared up for the breeding season once
again and the RZSS made the decision, in conjunction
with staff from the Institute of Breeding Rare
Endangered African Mammals (IBREAM), to attempt
hormonal analysis of urine samples collected from
Female giant panda Tian Tian undergoing artificial
insemination with Frances Reed monitoring the anaesthetic
and Simon Girling attaching a fluid line. From left to right:
(background) Dr Frank Goeritz, Professor Zhoayubn Li and
Professor Wang; (foreground) Frances Reed, Jacqui Falgate,
Donna Brown and Simon Girling
Courtesy of Rob McDougall
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Conservation at work
TianTian using commercially available human test kits,
working once again with Chester Zoo, as well as using
behavioural and cytological cues to determine oestrus
and ovulation.
Veterinary specialists from the Institute of Zoo and
Wildlife (IZW) in Berlin assisted veterinary staff at
Edinburgh Zoo to collect semen from Yang Guang,
assess its fertility, and cryopreserve what was
collected. Again, the samples showed good levels of
sperm motility and survival post-freezing. Thus, all
was set for the 2013 season, where natural mating
was to be attempted, followed by artificial
insemination if required.
However, the very long, cold winter caused
TianTians season to be delayed later than had
previously been recorded. Her previous latest date
foroestrus was 15th April; this year she finally came
into heat on 21st April. This caused logistical
nightmares as the RZSS had again planned to
involveIZW veterinary wildlife reproduction specialists
Thomas Hildebrandt and Frank Goeritz, along with
cryopreservation specialist Josef Saragusty, in the
process the delay left them stranded in Edinburgh
forlonger than anticipated, which, thankfully, they all
bore with good humour!
After several false starts with fluctuating urinary
hormone levels, Tian Tian finally put us all out of our
misery late on the evening of the 20th April, when a
final sample rushed to our in-house laboratory
confirmed that she had peaked and ovulation was
about to occur. More drama was to follow, as attempts
to introduce Yang Guang to Tian Tian were met with
forceful rebuffs from Tian Tian. Professor Wang
(another veterinary surgeon who had flown over from
the giant panda centre in Bifengxia a week earlier to
lend advice and help with the introductions) solemnly
announced that there was no way a natural mating was
going to occur this year.
Artificial insemination
The decision to move straight to artificial insemination
was therefore made, and I undertook the necessary
calls to bring our teams of experts together for a late
night and early morning procedure.
The first step was to induce anaesthesia in Tian
Tian, using a combination of medetomidine and
ketamine previously used successfully with Yang
Guang, via a blowpipe dart. My colleagues at the
RZSS, Romain Pizzi (veterinary surgeon), Donna
Brown (head nurse) and Jacqui Falgate (veterinary
nurse), along with Professor Eddie Clutton and
Frances Reed (both veterinary surgeons) from the
Royal (Dick) School of Veterinary Sciences, assisted
in the maintenance and monitoring of her
anaesthesia as she was transferred to sevoflurane
and oxygen. Our German colleagues performed
transrectal ultrasonography to assess Tian Tians
reproductive tract and to confirm the presence of a
fresh corpus haemorrhagicum, indicating that
ovulation had just occurred.
Yang Guang was then anaesthetised, again via a
blowpipe dart followed by gaseous anaesthesia, for
the electro-ejaculation procedure and fresh semen
assessment. Health assessments were made of both
giant pandas at this time, including echocardiography
by cardiologist Craig Devine, blood samples,
electrocardiography and ultrasonography. Tian Tian
was then inseminated transcervically, using both
freshand frozen semen from Yang Guang, as well as
from semen from Bao Bao (an unrepresented giant
panda previously held by London Zoo and, before he
died, Berlin Zoo). All procedures having been
successfully carried out, both giant pandas recovered
uneventfully, with a final clear up and finish time of
6.30am the whole process having taken 7 hours
(although the duration of the actual anaesthetic
periods were much shorter).
Subsequently, both giant pandas have made an
excellent recovery. The challenge now is, of course, to
see if the process was successful but with delayed
implantation, we may have to wait a wee while
Male giant panda, Yang Guang, enjoying a bite of bamboo
20-22 Publications Pandas.indd 22 18/07/2013 11:02
For more information or to book your course
www.bsava.com
Learn@Lunch
webinars
These regular monthly lunchtime (12 pm) webinars are
FREE to BSAVA Members just book your place through
the website in order to access the event. The topics will
be clinically relevant, and are particularly aimed at those in
first opinion practice. There will be separate webinar
programmes for vets and for nurses.
This is a valuable MEMBER BENEFIT
Coming soon
21 August Medicines inspection for nurses
18 September GDV for nurses
16 October Hospitalising small animals for nurses
Book online at
www.bsava.com
Stock photography: Dreamstime.com. Isselee; Joesive47; Willeecole
Collapsed canids
to floppy felines
24 September
This one-day interactive course will focus
on patient assessment and emergency
management including interpretation of
benchside investigations.
VENUE
Woodrow House, Gloucester
SPEAKER
Sophie Adamantos
FEES
BSAVA Member:
233.00 inc. VAT
Non BSAVA Member:
350.00 inc. VAT
Delinquent
doggies and
mischievous moggies
23 October
This course is designed for all members of
the veterinary practice team, providing the
latest scientific knowledge necessary to
approach behaviour cases.
SPEAKER
Anne Seawright
VENUE
Holiday Inn, Taunton
FEES
BSAVA Member:
233.00 inc. VAT
Non BSAVA Member:
350.00 inc. VAT
F
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v
e
t
s

a
n
d
v
e
t

n
u
r
s
e
s
F
o
r

v
e
t
s

a
n
d
v
e
t

n
u
r
s
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s
I
n
t
e
r
a
c
t
i
v
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c
o
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s
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From well bird to
Im trying to die fast
17 September
Vets and nurses will
discover some of the
welfare and behavioural
needs of healthy psittacine
birds.
SPEAKERS
Neil Forbes & Matthew Rendle
VENUE
Lismoyne Hotel, Fleet, Hampshire
FEES
BSAVA Member: 233.00 inc. VAT
Non BSAVA Member: 350.00 inc. VAT
23 CE Advert August.indd 23 18/07/2013 11:03
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California learning
for travel scholarship winner
I
was very fortunate to be the recipient of the Frank
Beattie award 2013, which enabled me to travel to
UC Davis in California. I applied for this award
because I wanted to visit the radiation therapy
department of the veterinary school in order to learn
more about advanced radiation therapy for veterinary
oncology patients.
UC Davis has one of the largest veterinary
radiation therapy departments in the world, treating
around 200300 patients per year. Three specialist
veterinarians in radiation oncology and three veterinary
technicians staff the facility and work closely with their
colleagues in medical and surgical oncology.
Getting to grips
During my visit I worked closely with the veterinarians
and the physicist who takes care of the radiation
machine (linear accelerator or LINAC) and ensure that
it is correctly set up and functioning. Firstly I was
introduced to the radiation machine and its various
parts and controls. The physicist spent a long time
with me, explaining how all the different parts of the
machine contribute to generating and focusing the
radiation beam, which really helped me to appreciate
and understand the subsequent treatments.
During treatments I assisted with patient positioning
and learned about the different methods of reducing
the dose of radiation to the normal tissues to reduce the
risk of side effects whilst delivering a much higher dose
to the tumour itself. Before delivering each treatment
we took port films, which are essentially radiographs of
the patient in position and are used to line up the
radiation beam accurately each time.
I learned how to prescribe radiation and the
difference between prescribing the different types of
radiation (electron versus photon therapy) and, after
performing some practice calculations, I was
allowed to work out a simple prescription for a real
patient (under strict supervision of course!).
Electrons penetrate tissues more superficially than
photons and so are used to treat tumours on the
thoracic wall, for example, to reduce the risk of
causing damage to the lungs; photons are
prescribed for tumours in deeper tissues, like
appendicular osteosarcoma or nasal tumours.
Being challenged
The radiation oncologists taught me how to plan more
complex radiation prescriptions using the computer
planning software. Our first plan was challenging as we
were treating the lymph node chains in the neck of a
large Bulldog who had a lot of skin to spare! Ilearned
how to contour which means outlining the tumour (so
that the computer can work out how to position the
radiation beam) and the normal tissues (to let the
computer know that these should be avoided as much
as possible). Of course it is impossible to completely
avoid the nearby tissues and the planning process is a
complex task involving various compromises in order to
maximise the radiation dose to the tumour.
I was also introduced to strontium therapy, a
technique which I had read about but never seen
performed. This involves the application of a radiation
wand to superficial tumours such as squamous cell
carcinoma, a neoplasm that is very common in
Californian cats due to their high levels of sun
exposure. The procedure was very quick and easy
and the treated cats generally have a very good
Sarah Mason is the PetSavers resident in
small animal oncology who won the 2013
Frank Beattie Travel Scholarship. She used
the money to visit the University of California,
Davis, School of Veterinary Medicine
The treatment
room at UC Davis
showing the linear
accelerator
24-25 Awards Frank Beattie.indd 24 18/07/2013 11:03
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Now you can apply for the
Frank Beattie Travel Scholarship
outcome although affected patients in California do
tend to be presented with more superficial tumours
than here in the UK because owners are more aware
of the condition.
During my stay we treated some hyperthyroid cats
with radioactive iodine; another technique I had never
seen performed. Whilst it is straightforward in terms of
performing the injection, being involved with the cases
and clients and working alongside the veterinarians
with experience of this technique was a great
experience and gives me much more confidence to
discuss this option with my own clients.
Highlights
One of the highlights of my trip was assisting with a
case who was receiving stereotactic radiation therapy.
This is when a single fraction or small number of
fractions of radiation is directed very specifically to the
tumour volume. This technique is used to treat canine
brain tumours where there are surrounding important
structures, i.e. orbits and normal brain tissue. The dog
had an optic nerve tumour which had been surgically
de-bulked and I was able to follow the case from initial
presentation right through to treatment as follows:
1. CT of the brain was performed and an
immobilisation mask, pillow and frame was fitted to
the patients head to make sure it stayed in exactly
the correct position during treatment.
2. The CT and previous MRI scan were fused
(overlaid in the computer software) to allow
accurate treatment planning.
3. The treatment plan was designed, using complex
computer software.
4. A mock treatment was performed using a
phantom. This assesses correct delivery of the
radiation to the treatment site and also checks that
the computer-generated plan is physically possible
(the LINAC can rotate through 360 but the patient
or positioning equipment may prevent this).
5. The plan and doses were double and triple
checked.
6. Finally the patient was treated.
Overall my experience at UC Davis was excellent.
Iwas privileged to work with Doctors Kent, Theon and
Hansen and the very experienced radiation
technicians and physicist. All of them had endless
patience with me and my questions, and always had
time to explain and discuss cases.
The experience I gained at UC Davis has
significantly improved my understanding of different
types of radiotherapy treatment and the
considerations to be made when recommending and
planning treatment. I now have much more
confidence in discussing the treatment and its risks
and benefits with clients who are considering
radiation therapy for their pets.
I would like to thank BSAVA and Mrs Beatty for the
generous award which enabled me to undertake this
amazing learning experience. n
Sarah MaSon
Prior to training as a vet, Sarah completed a BSc in molecular
biology and a PhD in cell cycle regulaton, both at the
University of Glasgow. She then spent a year working as a
post-doctoral researcher at Harvard Medical School in Boston.
Sarah obtained her BVSc from the University of Liverpool in
2007, and worked for 2 years in practce in the north west of
England before returning to Liverpool in 2009, for her rotatng
internship. Sarah is currently the Petsavers resident in small
animal oncology, will complete her residency in the summer
of 2013 and plans to sit the ECVIM exam in Oncology in
March 2014.
The scholarship was established in 1988 in memory of Frank Beattie, a well
respected practising veterinary surgeon and long-standing member of
BSAVA, and is awarded annually from a generous gift given by Franks
widow, Annie. The scholarship, worth 2000, allows a member of the
BSAVAto undertake a trip abroad to study a particular aspect of
veterinarypractice. You can apply online at www.bsava.com/awards
or for information email s.everitt@bsava.com .
The deadline is 26 September.
a cat having
Strontium
plesiotherapy to treat
squamous cell
carcinoma of the
nasal planum
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Cats come first
for award winner
I
t was the ships cat that launched
Maggie Roberts on her career in
felinewelfare.
After graduating from Edinburgh
veterinary school in 1986, she took a job
at the Portsmouth practice responsible
forneutering feral cats trapped and
released back into a colony living around
the naval dockyard.
Maggie noticed that a surprisingly
high proportion of those cats brought to
her through the trapping programme had
an unusual physical feature
polydactylism. Intrigued, she did a little
research and discovered that there is a
traditional association between cats born
with extra toes and life at sea. So in
Norway, for example, any cats showing
this particular abnormality are known by a
nautical nickname.
There are various theories to explain
the link. Some say the extra digits help cats
to climb rigging or to keep their balance on
a lurching deck. But it is just as likely that
there is no logical explanation; merely that
for members of a perilous and
unpredictable profession, polydactyl cats
are considered lucky a more engaging
and useful alternative to a rabbits foot.
However many toes they may possess,
the nations cats are indeed fortunate that
Maggie developed her interest in this area.
Since becoming head vet at Cats
Protection in 2006, her energy and
persuasive powers have done much to
change attitudes among her veterinary
colleagues on an issue that could have a
than three hours beforehand and feed
them immediately on recovery. They can
also become hypothermic, so you should
avoid using too much surgical spirit and
ensure that you give them a heat pad to
keep them warm, Maggie explains.
There were also claims that earlier
neutering could cause developmental
problems such as growth plate fractures
and blockages in the urinary tract in tom
cats. But if anything, the research shows
there is a higher risk of orthopaedic injury if
males are kept intact for longer, as they are
more likely to stray and run the risk of traffic
accidents, she notes.
Spreading the message
British veterinary surgeons have been
slower than their colleagues abroad in
recognising that early neutering is a safe
and more effective way to manage the feline
population. But around 1000 practices
have now signed up on Cats Protections
list of clinics where welfare groups or
ordinary cat owners can have kittens
neutered earlier, before they are rehomed
or released back into a feral colony.
Instead of referring to early neutering
at 4 months, Maggie wants practices to
promote it as the norm. Although her side
appears to be winning the argument within
the profession, there is still a need for more
work in educating lay people. We do get
calls from people who are confused
because they have rung a practice and
been told by a receptionist that they dont
neuter babies. So the message doesnt
always get through. That is why we have a
video on our website showing that the
procedure is safe. Sometimes they need to
see it for themselves before they will
change their minds.
Some cat owners also cling to the
idea of letting their queen have one litter
before it is spayed, while failures by other
owners to book the procedure in good
time mean that many other cats have
accidental pregnancies. Therefore, while
90 per cent of owned queens are
eventually neutered, around 20 per cent
will already have bred.
Maggie Roberts, Director of Veterinary Services for
Cats Protection, was presented with the J.A.Wight
Memorial Award at this years BSAVACongress in
recognition of her outstanding contributions to the
welfare of companion animals. She tells us about
her work and offers her thoughts on the best age to
neuter kittens, controlling feral cat populations and
supernumerary digits
significant impact in reducing feline
morbidity and mortality.
Neutering champion
Maggie is an advocate of early neutering,
arguing that spaying cats before they
become sexually mature reduces deaths
due to infectious disease and starvation in
feral cat colonies. And it can also reduce
the numbers of owned cats having litters of
kittens that may grow up unwanted and are
eventually euthanased.
Her efforts have helped to change the
policy of the Cat Group, consisting of the
BSAVA and a number of companion animal
welfare organisations. This now states that
neutering can be undertaken at any stage
from about 8 weeks onwards, although
most pet cats should be treated at around
the 16 weeks stage, just before females are
likely to have their first season.
This overturns the advice given to
generations of veterinary students who
have been told that spaying is less risky if it
takes place at around 6 months of age.
However, research over the past decade,
has shown that there is no evidence of
increased complications, such as
postoperative bleeding, in kittens treated
earlier. Moreover, young kittens appear to
recover more quickly than those treated at
the standard age or older.
That is probably because they have
lower levels of body fat and a higher
metabolic rate. Mind you, it is important to
ensure they dont become hypoglycaemic.
So you need to starve them for no more
26-27 Maggie Roberts.indd 26 18/07/2013 11:20
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Is earlier neutering effective in reducing
the numbers of surplus cats that have to be
euthanased? Maggie says there is
anecdotal evidence to show that the
numbers of surplus cats is indeed reduced
in areas where earlier or peripubertal
neutering is widely practised. But then this
good work can be undermined if there is a
perceived shortage of kittens, as this may
encourage owners to breed a litter for
commercial reasons. There is a role for
practices in explaining to clients that there
are lots of cats available in welfare centres
and while they may have to pay a little
more than for these kittens than from
casual breeders, theyll arrive having
already been microchipped, vaccinated
and treated against fleas and worms.
Feral felines
Nearly 250,000 cats go through the
charitys network of 30 adoption centres
every year and it is also heavily involved in
the trap, neuter and return programmes
that first drew Maggie into the world of
feline welfare. The charity releases
between 20,000 and 25,000 feral cats a
year and will normally ensure that to
minimise stress, the animal is returned to
its home turf. Whether this can have any
effect on the numbers of feral cats in
Britain is unclear Maggie notes that there
are no reliable figures but if the estimates
are accurate in suggesting that there are
up to 2 million of these animals in the UK,
then the efforts of all the welfare charities
combined will only scratch the surface.
Maggie feels these efforts are
justifiable on welfare grounds. It is
important to be able to trap as near to
every cat in the colony as possible. If you
do manage that and there is a stable
population, then you will see tremendous
improvements in their health. There isnt
the same level of conflict over resources,
the same number of queens in a constant
cycle of pregnancy and lactation, and you
dont get the outbreaks of infectious
disease that you see when there are lots of
feral kittens about.
Leading the way
In her role as Director of Veterinary
Services for the charity, Maggies job is to
manage the team of professional vets and
nurses and provide advice and support to
the 250 or so volunteers all around the
country. Another important task is to help
maintain and possibly improve the
relationship that the various welfare
charities enjoy with the practising arm of
the profession.
She says it has been calculated that
around 90 per cent of small animal
practitioners in Britain have some
involvement with these charities and so this
is obviously a major part of practice
workload. Through her membership of the
newly formed Association of Charity Vets,
she is working with her colleagues to
improve standards and provide CPD for
practitioners on the sort of issues they are
likely to encounter with charity cases. The
eventual aim is for it to become a group
affiliated to BSAVA and its members are
working on the early stages of a BSAVA
Manual on shelter animal medicine.
Maggie argues that the profession has
been slow to recognise shelter medicine
as a separate clinical discipline, whereas a
specialist group has been active in the US
for many years. It is a challenging area of
practice because there is the need for
pragmatic decision making the charity
sector doesnt have a lot of money and so
we must aim to use it wisely. We cant
always carry out every test if we are going
to look after the interests of as many
animals as possible.
There is also a difference in the type of
cases that we see. In some ways it is more
like farm animal work as we are looking at
diseases from the perspective of a group
of animals rather than as individuals. Then
there is also the point that these animals
may be stressed through being in contact
with many others and they may not be in
the greatest health to begin with. So trying
to keep them healthy can be a really
interesting clinical challenge. n
NOW MAKE SOMEONE ELSE A WINNER
Maggies award was presented at BSAVA
Congress 2013. You can nominate now
for the awards that will be presented
next year. Deadline 26 September.
Visit www.bsava.com/awards .
26-27 Maggie Roberts.indd 27 18/07/2013 11:20
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Tell us about how you arrived at this role
inBSAVA.
I joined BSAVA soon after my arrival in the UK from
Spain in 1990 to benefit from the top quality CPD
BSAVA organises all over the country. In 2003 I
decided it was time to become involved and give
something back, so I volunteered for the Metropolitan
committee, where over time I held a number of
different posts; PetSavers Representative, Treasurer,
and Chairman.
Then I responded to a circular from my
predecessor, Philip Lhermette, requesting volunteers
for PetSavers Management Committee; I offered my
services and got accepted. One day, out of the blue,
Ireceived a telephone call from the then President,
Mark Johnston, offering me the Chair of PetSavers.
Although I felt really honoured for the offer, I have to
confess it was somewhat frightening due to the
responsibility it carries, but, on the other hand, the
challenge was too tempting not to accept it. The whole
thing is pretty exciting, especially working in close
collaboration with other really committed people, all
working hard to promote PetSavers and its good work.
What challenges do you think PetSavers faces
in the coming year?
In spite of the great job done so far and the benefits
achieved to pets, their owners and our colleagues
through the scientific developments our grants have
provided, our biggest challenge is still to become
close partners with all the small animal vets and
practices in the UK we really need their support in
order to continue helping them.
What are the key aims of PetSavers in the
coming year?
We would really like to raise our profile in all the UK
small animal practices, as well as within the
community in general. If every small animal practice
could raise at least 200 per year for PetSavers, we
would have enough regular funds to continuously
finance multiple studies Clinical Research
Projects (CRP) and Masters Degree by Research
(MDR) and every single one of them would be
relevant to the average small animal practice.
Thisis my 200 project.
Pedros
passion
Pedro Martn Bartolom is the latest
Chair of PetSavers to get caught by the
fundraising bug. Here he talks about
why this work is so vital to the profession
28-29 PetSavers July.indd 28 18/07/2013 11:22
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It must be said that less than 5% of our funding
comes directly from the general public, so we should
try to change that. As a small charity we do not have
the funds to compete by means of publicity
campaigns, so we are fully reliant on veterinarians to
introduce us to their clients.
How does PetSavers benefit the profession?
Simply by funding relevant research. Although
investigation on a weird, deep encephalic exotic
disease, transmitted to pets by some odd flies living at
over 4,000 meters high, may be very laudable
research, it is unlikely it would become relevant to a
great number of small animal vets. Whereas PetSavers
really excels is in funding studies that are relevant and
further the knowledge of the small animal vets in their
daily practice and, in doing so, help improving the
health of a great number of pets.
What can vets and VNs do to get involved?
BSAVA members, and the profession as a whole,
should embrace PetSavers as their friend; the friend
who could help them in their search towards medical
and surgical advances, in the same way their
knowledge has been widened by discoveries as a
result of collaboration with other colleagues. All that
is required from vets and VNs is to get to know of the
good work PetSavers does; they could then spread
the word among colleagues and the community that
PetSavers exists to improve the health of pets. The
more funds we get, the more veterinary knowledge
would advance, and the more small animal
conditions we would be able to treat. Talk to us
email info@petsavers.org.uk or come and see us
on our stand at Congress.
What takes place in practice now that has
been influenced by PetSavers?
The one study which always comes to mind is that of
PetSavers first ever grant. David Bennetts study on
autoimmune joint disease in dogs opened the door to
more appropriate diagnosis and treatment of many
joint diseases. Through the better understanding of
the condition, we now have many excellent drugs in
our armoury to treat osteoarthritis even in cats!
Another relevant study came from the current
President, Michael Day, on anal furunculosis, the
results of which led to the use of ciclosporin for the
treatment of the condition.
As a whole, it is always exciting waiting for the
outcome of any PetSavers-funded study and surely the
best it is still to come!
How are vets and VNs the perfect
ambassadors for PetSavers?
The beauty of PetSavers is that we could mention its
good work day-to-day in our practice, just by relating
some present treatments to the outcome of some or
other PetSavers-funded research.
People in veterinary practices are very
resourceful in developing fundraising ideas and we
would like to hear from all of them in order to learn
from their experiences. The sharing of the gained
knowledge would certainly become mutually
rewarding. We could provide support material for
their own ideas (posters, leaflets, etc.) or we could
also suggest fundraising ideas.
To help people in practice, we have a number of
useful guides for pet owners Kitten Guide and Puppy
Guide, as well as the supportive Coping With The Loss
of Your Pet guide. We also supply some excellent
products, such as heated pads and recovery blankets.
On top of all of that, we have a very dedicated and
helpful support staff at Woodrow House, as well as in
all our regions.
Finally, I would like to remind everyone that
PetSavers will be 40 years old in 2014 and, after all the
good work it has done for the health of our pets, it well
deserves a party. Please everybody feel free to join in.
With your help we could make 2014 really special.
For more informaton about PetSavers visit www.petsavers.org.uk
or email info@petsavers.org.uk .
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Louise and Grant Steel,
married vets from
South East England,
describe their veterinary
adventures in Fiji
Nice
work
and you
can get it
Fiji is a beautiful place with white
sandy beaches, crystal clear waters and
the friendliest people, but outside of
the idyllic tourist destinations it is a
relatively poor country. Traditional
ways of life continue in the villages
whilst local towns are busy, dusty
and hectic. Small animal veterinary
services are extremely limited.
The 330 islands that make up the
country are served by one private small
animal vet and the SPCA charity clinic.
Attimes the SPCA has a resident vet but
recently the huge number of stray and
owned dogs and cats it looks after have
been surviving with the sporadic care of
volunteer vets like ourselves.
A bumpy start
We arrived in Suva, the capital city, after
a long, bumpy four hour bus ride from
the airport in sweltering tropical humidity.
We met some very happy staff at the
clinic as, with no vet for the last 10 days,
there was a list of things to be getting on
with. Most memorably there was a
cardboard box in the waiting area with a
cats head poking out of it. Her gums
were white as a sheet and there was a
kitten firmly wedged in her pelvic canal.
We had no idea that just minutes after
getting off the bus Grant would be
scrubbed up, mid abdomen, pulling out
kittens. The cat survived along with one
healthy kitten, so a good start to our stay.
The majority of our work was neutering
and consulting, with skin disease (mange)
being the most common complaint. The
nursing staff at the SPCA are experienced,
efficient and fantastic to work with. I am
pleased to say that welfare is paramount
and they work tirelessly to care for every
animal that is brought in.
Firsts in Fiji
They had a good stock of analgesics and
anaesthetic equipment; we just had to get
used to using xylazine as a pre-med for
small animals. Antibiotics and vaccines
could be ordered in and other drugs were
donated from practices abroad. There was
an eclectic array of things which were
going out of date or have gone out of
fashion. Lots of Ovarid. However we were
able to provide a better level of care than
Imight have expected in some
L
ast November my husband Grant
and I took time off our usual vet jobs
to fulfil our desire to see a bit more
of the world. We spent a month in
the Pacific islands of Fiji, volunteering at
the Society for Prevention of Cruelty to
Animals (SPCA), a charity that has been
caring for the local animals since 1953.
30-31 Vets In Fiji.indd 30 18/07/2013 11:28
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circumstances, for example the TVTs
(transmissible venereal tumours) that I had
never seen before would miraculously
shrink and eventually disappear after a
month of weekly vincristine injections.
A clinical case of leptospirosis was
another first for me, as was repairing a
parrots fractured femur with a paper clip
as the basis of a splint.
Sadly we came across far too many
Paraquat poisonings. This is a tragic
situation where the Government used to
use weedkiller to try to kill off the stray
dogs. This policy has thankfully ended, but
local people will still use it if stray dogs are
causing a nuisance and as the pet dogs
roam free they were often also unintended
victims. The symptoms start off fairly
non-specific as Paraquat burns the airways
but rapidly progress to dyspnoea and
death, and treatment is ineffective. This is
an area where the SPCA is campaigning
hard to raise awareness of just what an
inhumane practice this is.
Neutering campaigns are offered as the
obvious and effective method of population
control. If you are lucky enough to coincide
your visit with one of the SPCAs island trips
then you will pack your surgical kits,
Pevidine and several litres of ivermectin into
a boat and head off to village halls on
remote islands for a few days. We were
offered a free stay in a beautiful 5 star
island resort in return for neutering all the
stray cats that were pestering their guests.
Nurturing understanding
The SPCA also has a hugely important
role in educating the local people in
better standards of animal care. It
shocked me how many well meaning
owners we met simply didnt realise that
nutrition, mental stimulation and preventive
healthcare are just as vital for animals as
they are for us.
Fiji is a paradise for parasites. Every
dog we saw had some degree of mange
and the puppies and kittens had the
classic pot belly full of worms. I found
myself explaining that rice alone wasnt
sufficient as a diet for dogs on several
occasions and I never figured out what
the ingredients were in the popular meat
dust but I dread to think.
Sadly, ignorance of suffering was also
something we encountered. We had to
surgically remove a metal chain that had
become embedded in a dogs neck after it
had been tied up in a yard for months. The
owners had only realised there was a
problem when they smelt the infection and
parted the fur to have a look. They were
apologetic when we explained the pain
that the dog must have been in and agreed
not to chain their dogs in future.
The Fijian people are warm, welcoming
and not naturally cruel. They often live a
hand-to-mouth existence. Slowly attitudes
are changing and people are starting to
see their animals as family members and
realising that they have needs too.
We were honoured to be invited by the
Police Commissioner to inspect his
departments working dog kennels and
create a report with recommendations for
their veterinary care and basic husbandry.
It was encouraging to see how seriously he
felt about their welfare.
One of the most heart-warming cases
we dealt with was the cardboard box full of
puppies whose young stray mother had
given birth in a mangrove swamp just
before the tide came in. The pups were not
only covered in mud but their mouths were
full of it too and they were essentially
drowning. However, after copious washes,
i/p glucose and nursing care from their
lovely mother, aptly named Mango, seven
of the litter survived. The resilience and
intrinsic loving nature of all the stray
animals we met never failed to impress me.
Fancy Fiji?
I would strongly encourage any other vets
or nurses to consider volunteering. Fiji is
obviously a long way to travel from the UK,
but if you happen to be on the other side of
the world and fancy an adventure then do
contact the SPCA via spca@kidanet.net.fj
or look them up on Facebook. They are
happy to have you for as much time as you
can offer and will give you accommodation,
sugar cane, laughter and some wonderful
memories in return. Just watch out for the
ant infestation in the kitchen.
Its not all hard work. The evenings
and weekends are often free for
exploring beaches and rainforests or
going snorkelling, diving or deep sea
fishing in a tropical paradise. If you are
looking for a complete change in lifestyle
then they are currently advertising for the
next resident vet, which is a minimum of
a one-year contract. Trust me, we were
very tempted.
A C
D E
B
(A) The police brought in a box of puppies found
in a flooded mangrove swamp
(B) The mangrove pups re-united with their
mother 7 survived
(C) Cat spays lined up in recovery
(D) This dog needed its tight metal chain
surgically removing from the skin folds of its
neck a very sad case of owner ignorance
(E) It wasnt all hard work
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WSAVA FOUNDATION SUPPORTS
MISSION RABIES
The WSAVA Foundaton is supportng
Mission Rabies, a project launched by charity
Worldwide Veterinary Service (WVS) (see
July issue of companion). Gabriel Varga,
Chair of the WSAVA Foundaton, says:
Through the projects we support, we aim
to improve companion animal care through
science and educaton. Mission Rabies is a
fantastc initatve which matches our brief
perfectly and we are delighted to support
Luke Gamble and the team. We are using
funds raised during our rst Fun(d) Run held
in Auckland at World Congress to back this
project and wish the Mission Rabies team
every success!
GLOBAL VETERINARY DERMATOLOGY
EDUCATION COMES TO ASIA
A group of dermatologists, primarily from the
American College of Veterinary Dermatology
(AVCD), has formed a group called Global
Veterinary Dermatology Educaton that aims
to promote veterinary dermatology in areas
of need around the globe. It works closely
with Jill Maddison, Chair of the WSAVA CE
Commitee, to identfy priority regions for
support. Vietnam has been selected for
2013 and Group member Dr Jeanne Budgin
will deliver a two-day seminar in Ho Chi
Minh City at the end of September. Sheila
Torres, a member of Global Veterinary
Dermatology Educaton, says: Were very
excited about this initatve and hope to
make a dierence as we work together
to achieve our ultmate goal of educatng
veterinarians around the world.
This is an initiative to help improve
standards in practice. More on this soon!
In the meantime, our own Committees
continue their work. New Body Condition
score sheets have been produced as part
of the Global Nutrition Committees Toolkit
and are available at www.wsava.org/
nutrition-toolkit .
The Animal Wellness and Welfare
Committee is developing a new global
veterinary oath, which will serve as a focus
point for us all. Theyll share their thoughts
on this soon. Meanwhile our VGG
Committee (see below) is gearing up for
fact-finding visits to Thailand and China in
June and July, then for a major OIE Rabies
Congress in November.
There is so much great work going on
around the WSAVA but it is important to
recognise those veterinarians who go one
step further in advancing clinical care.
This is the purpose of our Awards and
wed like you to start thinking now about
whom you should be nominating in these
three categories:
WSAVA Hills Excellence in Veterinary
Healthcare Award
WSAVA Hills Pet Mobility Award
WSAVA International Award for
Scientific Achievement
Full details on the nomination
procedure and what the judges are looking
are available from www.wsava.org .
Thank you all for contributing to our
global veterinary community!
Jolle
Update from
the President
Jolle Kirpensteijn
explains some of the
achievements and
things to look out for
from WSAVA
2
013 is racing past but writing this
message gives me the opportunity
to stand back and realise that, while
time is passing quickly, our level of
achievement is also high!
A recent personal highlight was my
participation in the VPAT regional
veterinary conference in Bangkok in May.
Whilst there, I visited several universities
and held discussions with veterinary
colleagues in the region. It was clear that,
in many cases, the work they are doing is
setting new standards for veterinary care.
Siraya Chunekamrai and other VPAT
leaders also explained our WSAVA One
Care promotion to key opinion leaders.
For more informaton on Mission Rabies,
please visit www.missionrabies.com
or contact Internatonal Director
Kate Shervell at kate@wvs.org.uk
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WHO SITS ON THE VACCINATION
GUIDELINES GROUP?
Michael Day
University of Bristol, UK (Chairman)
Ron Schultz
University of Wisconsin-Madison, USA
Hajime Tsujimoto
University of Tokyo, Japan
Richard Squires
James Cook University, Australia
Umesh Karkare
Private Practtoner, India
(co-opted for visit to India)
A short history
The VGG was established in 2006
following recognition by the WSAVA
Executive Board and Scientific Advisory
Committee (SAC) of the need for globally
applicable recommendations on best
practice for the vaccination of dogs and
cats. The Group has worked on three
projects: Phase I (200607), Phase II
(200910) and Phase III (201214).
Opportunities and challenges
The work of the VGG helps small animal
practitioners around the world to undertake
the fundamental practice of vaccination in
a standard and scientifically justified
fashion. Adoption of the VGGs Guidelines
will maximise the protection of dogs and
cats from infectious and sometimes
zoonotic disease, whilst simultaneously
minimising the risk of adverse reaction
postvaccination.
There are numerous challenges to be
overcome mainly relating to the education
of veterinarians about vaccinology, the
acceptance of our scientific Guidelines by
national associations, and the availability of
vaccineproducts.
Key activities
The VGGs first project (Phase I) was the
production of the 2007 WSAVA Vaccination
Guidelines for Dogs and Cats, a document
setting out recommendations on
vaccination best practice relating to major
canine and feline vaccine-preventable
infectious diseases. Although guidelines
had been produced previously, this was
the first time that recommendations were
made for both dogs and cats from a global
perspective. It was published in the Journal
of Small Animal Practice (Day et al., JSAP
2007; 48: 528541) and on the WSAVA
website in several languages.
Phase II involved a consultation with
WSAVA member countries on the 2007
Guidelines document, which informed a
substantial revision of the document,
published as the 2010 Guidelines (Day et
al., JSAP 2010; 51: 338356) which is
freely available to download online. This
included a series of infectious disease fact
sheets, designed to be downloaded and
used by practitioners in the context of an
annual health-check consultation.
The second part of Phase II was the
production of Guidelines on infectious
disease and vaccination for the owners
and breeders of dogs and cats. This was
produced to counter the misinformation
that is widely found on the internet. The
VGG recently published an abridged
version of these ownerbreeder
Guidelines focusing on the vaccination
of puppies, in order to make them more
accessible to owners and therefore more
widely used.
In Phase III, the Group will focus its
attention on the Asian continent a region
with particular problems relating to small
animal infectious disease, zoonotic
infection (i.e. canine rabies) and
vaccinology. The aim is to identify the
specific problems and issues, to produce a
White Paper suggesting solutions, and to
begin to provide education in vaccinology
for Asian small animal practitioners.
The core of this project is three site
visits to Asian countries. These visits
involve fact-finding meetings with
practitioners, academics, small animal
associations, government vaccine
regulators and industry representatives.
Inaddition, CE events are held for
practitioners. The first visit was to Japan in
July 2012, where around 380 veterinarians
participated in CE events in Tokyo and
Osaka. In September 2012 the Group
visited India, delivering CE to around
180veterinarians in Delhi and Mumbai.
Thefinal visit, to Beijing, Shanghai and
Bangkok, takes place in July 2013.
The Group is also gathering
informationfrom Asian practitioners via a
questionnaire. This has already been
distributed in Japan (over 110 responses)
and India (over 250 responses) and is
currently running in China, Thailand,
Malaysia, Indonesia, Vietnam and
SriLanka.
In terms of canine rabies control in
Asia, these efforts run in close parallel with
the work of the WSAVA One Health
Committee. Whilst in Japan, the Group met
with the Deputy Director of the OIE Asia
Pacific Region (Dr Tomoko Ishibashi) to
discuss the involvement of the OIE in
regional rabies control.
COMMITTEE FOCUS:
WSAVA VACCINATION
GUIDELINES GROUP
The WSAVA
Vaccination Guidelines
Group aims to develop
globally relevant
recommendations and
best practice protocols
for the vaccination of
dogs and cats
Priorities for 2013
Following the final site visit in July 2013, the
VGG will analyse the data received and
formulate recommendations which it aims
to publish early in 2014. The Group is
already considering a Phase IV project,
which is likely to involve a further revision to
the WSAVA Vaccination Guidelines.
VGG Chairman and BSAVA President
Professor Michael Day says: It has been
enormously exciting to work with and lead
the VGG over the past eight years. The
Vaccination Guidelines have made a
major global impact and are gradually
driving a change in vaccination practice
throughout the world. One of the greatest
achievements of the VGG has been in
providing the impetus for industry to
provide core vaccines with a minimum
duration of immunity of three or four years.
This has allowed veterinarians to
vaccinatein a more scientifically robust
and safer fashion, compared with previous
years, in which companion animals
received annual core revaccination.
Ibelieve that, of all WSAVA scientific
projects, our Vaccination Guidelines have
had the single greatest impact on
day-to-day small animal practice.
MSD Animal Health has been the sole sponsor of
the VGG since its inception and has provided
funding to allow the Group to undertake its valuable
and high-impact work. It is important to note that
the VGG is academically independent and that
MSD staff do not attend meetings or have editorial
control over documents.
(LR) Richard Squires, Michael Day,
Hajime Tsujimoto, Ron Schultz
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Gyles Brandreth is a reporter on BBC1s The One
Show, a regular on Radio 4s Just A Minute, and a
former MP and Government Whip. In his time he
has lived with a parrot called Mitou, a dog called
Ross, a pony called Tonka, a variety of hamsters
and gerbils and a large assortment of cats. He
has played the part of the dog Snoopy from the
Peanuts cartoon strip and was given the original
Fozzie Bear for his Teddy Bear Museum by the
Muppets creator, Jim Henson. He comes from a
long line of active animal lovers. His sister ran a
stables on Wandsworth Common in London and
his son-in-law is a vet in Teddington.
the companion interview
Gyles Brandreth
Q
Thank you for agreeing to be the
first ever PetSavers Patron. You
must get asked by lots of charities
to get involved, what made you say yes
to this one?
A
I am delighted to support PetSavers
(and of course honoured to be your
first ever Patron) because I believe
that we humans benefit in so many ways
from being pet owners. There is plenty of
evidence that pets help us to be happier
and healthier and it seems only right that
we re-pay them by helping them to lead
longer, happier and healthier lives
themselves. Understandably research into
human diseases and assorted health
problems attracts the greatest share of
available funding. But it is also important to
support research into animal health and
welfare, not only from a selfish point of view,
because we gain so much from our pets,
but because we all share the planet and
should be mutually supportive. This funding
is not going to come from government so it
is up to us as individuals to do what we can
to redress the balance and help ensure that
veterinary medicine continues to improve
and reflect the enormous strides being
made in human medical science.
What has been your own experience
with pets?
My parents owned a parrot called Mitou,
which I believe means parrot in Hindu or
Urdu, though I may well be wrong about
that. My mother was born in India and
always wanted an Indian parrot, though a
London flat (which is where I lived as a
child) was not really a suitable place for a
parrot. Mitou was allowed to fly freely
around the flat and caused havoc. He took
particular pleasure in pecking away at the
leather bindings of my fathers most
treasured books. One day I came home
from school and was informed by my father
that Mitou had escaped out of a window
which had carelessly been left open. It was
only when I was older I put two and two
together and realised my father had
probably been instrumental in helping
Mitou make a break for it. When I see the
34-35 Interview August.indd 34 18/07/2013 11:30
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it is up to us as individuals to do what
we can tohelp ensure that veterinary
medicine continues to improve and
reflect the enormous strides being
made in human medical science
flocks of green parrots which now colonise
the area of south west London where I live I
am pretty confident they are Mitous
descendants revelling in their freedom.
However, my experience with pets has
been largely as a cat owner. I cannot
imagine life without cats. It always
surprises me when people suggest that
cats do not have individual personalities.
Every cat is a unique individual with very
clear personality traits. When I was a small
boy my parents owned a quirky cat called
Griggs. I vividly remember Griggs
accompanying us on family holidays in my
fathers trusty car. He was, I now realise,
very patient (the cat not my father) and
after several years had built up an
encyclopaedic knowledge of some of the
livelier areas of the British Isles. I can recall
one particularly stressful occasion when he
leapt out of the car in central Glasgow. We
stopped in the street, as you could in the
1950s even in the city centre, and then
searched for him for hours making a
spectacle of ourselves calling his name
and making come hither noises, only to
find him snoozing comfortably underneath
the warmth of the engine when we
eventually returned to the vehicle.
Once when visiting the Cat Show I fell
in love with a Chocolate Point Birman but it
was not to be. Despite the seductive
charms of pedigree cats the time never
seemed right to introduce a new cat into
the family, so by pure chance and timing
my wife and I have always had moggies or
rescue cats. They have been an eclectic
bunch and we have loved them all. We
began with three black and white kittens,
the entire litter of a mouser kept by a local
Greek restaurant. Their names were
Oscar, Neville and Rosie. Oscar lived to
be 23 years old and became a legend in
his own lifetime. Since then we have had
Felix, Jack, Bruno, and currently share the
house with Viola and Portia beautiful
long-haired grey twins. Our three children,
who now have homes of their own, are
also keen cat owners.
When we were first together my wife
had a dog called Ross, a very handsome
smooth-haired Fox Terrier. We were
devastated when he died but we decided
that keeping another dog in central
London, when we both went out to work,
was not really practical, although I can see
the benefits of being taken for a daily walk
by your dog. Also I like the way that cats
are so self-sufficient. As someone once
said, dogs have masters but cats have
staff. I believe Cardinal Richelieu, French
King Louis XIIIs chief minister, would let his
cats sleep in the capacious sleeves of his
cardinals red robes. When the King
summoned him he would keep His Majesty
waiting rather than wake the cats before
they were ready. Cats prevent you from
getting too big for your boots. I am always
flattered when they condescend to give me
a little love and attention.
Tell us about the Thames wetlands
project you have been involved in and
how this is contributing to local wildlife.
We are fortunate to live very close to the
Wildfowl and Wetlands Trust on the south
bank of the Thames. The wetlands were
developed on land once owned by Thames
Water. Thames Water had four reservoirs
on 125 acres which became redundant
after the London ring main was built. By
that time Thames Water had been
privatised with share-holders and therefore
it was not possible for the land simply to be
donated, as the companys first duty was
to ensure a profit for the share-holders.
Several projects were suggested which
filled the local community with
apprehension, including a possible heliport
or an industrial estate. However, the
reservoirs were already a Site of Special
Scientific Interest (SSSI) and so had some
protection. The reservoirs were a
destination for birds migrating south to the
comparatively warm British climate to
escape the very cold northern winters.
Other rare species were also flourishing in
the reservoir area. The Barn Elms
Protection Association was set up with the
aim of keeping the area as a wildlife area
and at one point I was Chairman and my
wife was the treasurer; so we became very
involved with the campaign to save this
wonderful open space for the benefit not
just of the local people and the birds
themselves but as a resource for the whole
of London. David Milne, one of the
committee members, knew that Sir Peter
Scott had the ambition to create a Wildfowl
and Wetlands centre in a city environment
and suggested going to see him at
Slimbridge. After meeting this inspirational
man everything began to fall into place. It
was clear that a city-based version of
Slimbridge would be a wonderful addition
to London and Sir Peters reputation
attached to the project ensured it received
widespread support.
The rest, as they say, is history and
after a lot of hard work and some nail-
biting moments the dream became reality
when Berkeley Homes undertook to
develop the southern 100 acres as a
nature reserve when they were given
planning permission by Richmond Council
to build houses in the remaining 25 acres.
The whole process taught me that it is
possible to achieve amazing things with a
combination of inspiration, goodwill and
hard work. I will never forget the moment
when the silence was broken by the sound
of around a hundred diggers starting up
and beginning the process of turning the
redundant reservoirs into a vibrant, living
and evolving nature reserve. It is now a
magnet for bird watchers in the winter and
an educational resource for school parties
as well as being a wonderful day out for
families, who enjoy all the resources, the
seasonal events and activities. I urge your
readers to make a visit. I have a really soft
spot for the annual pantomime put on by
the very talented staff, where all the
characters are animals.
It was a privilege to meet Peter Scott,
and to have played a small part in
preserving this wonderful resource. For
more information on this and the WWTs
other sites check out www.wwt.org.uk .
34-35 Interview August.indd 35 18/07/2013 11:30
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36 Publications Advert August.indd 36 18/07/2013 11:31
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37
Letters from the Regions
Feline cardiology day meeting in Bristol
With Jo Dukes McEwan and Virginia Luis Fuentes, two of the countrys finest cardiologists
are brought together for what promises to be a highly practical and inspiring day meeting
on the edge of Bristol on 19September.
This day course will review the current approach to the classification of feline
cardiomyopathies, with particular emphasis on how to identify the cat at high risk of
cardiac calamity. The merits of different diagnostic tests available will be discussed, and
therapy approached according to presentation and stage of disease.
A case-based approach with interactive keypads for audience participation will be
used to highlight some of the diagnostic and therapeutic challenges involved.
Numbers are limited for this course, which is kindly sponsored by Ceva Animal Health.
It is likely to prove very popular, so please book early to avoid disappointment. Further
information is available from southwest.region@bsava.com .
Nicolette Hayward
North East interactive
neurology day
meeting
Graduating from Utrecht University in 1997,
Dr Gerard te Lintelo worked for two years in a
mixed practice in The Netherlands before
moving to the UK. He worked for six years in
a dedicated small animal practice in
Oxfordshire and obtained the Certificate in
Small Animal Surgery in September 2004.
Gerard set up Wear Referrals in 2005 where
he is now the clinical director. Gerard has
developed a special interest in neurology
and neurosurgery over the last seven years.
The meeting will focus on patient
assessment, diagnostic work-up and
treatment planning. An interactive case-
based approach will be used to discuss the
most common neurological patients as seen
in general practice. The meeting is held at
the Wetherby Bridge Hotel on 15 September.
Further information is available from
northeast.region@bsava.com .
PS
If you are based in the West Midlands
region, dont miss out on the Neurology
evening meeting with Dr Ulrike Michel
on 3

September in Wolverhampton.
Further information available from
westmidlands.region@bsava.com .
Feline medicine
weekend in Kent
This not-to-be-missed feline weekend, 1213 October, gives you the chance to benefit
from high quality CPD delivered by renowned speakers Diane Addie, Sarah Caney, Gerry
Polton and Elise Robertson.
This is an excellent networking and
learning opportunity that has a delicious
wine-tasting session, lunches, a three-course dinner and a small exhibition of niche
cat-related products (including a special
offer on the BSAVA Feline Practice Manual)
all included in the price. The course is ideal
for vets with a special feline interest,
particularly those studying for a postgraduate qualification. Advance registration is
essential as it is likely to sell out fast. You can book online at www.bsava.com or call
01452 726700. Register by 12 August for the Early Bird rate.
Jane Pomeroy
PS
Do you have a special interest in feline
medicine? There are further courses coming
up in October in the West Midlands and
in the South West. Visit www.bsava.com
fordetails.
Find out more
For full details of all of these courses visit www.bsava.com
and see the CPD diary on the following pages. If you have
any questions email administration@bsava.com or call
01452 726700.
37 Regions August.indd 37 18/07/2013 11:33
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companion
CPD diary
EVENING WEBINAR
Monday 5 August
20:0021:00
Management of lymphoma in
practice
Speaker: Mark Goodfellow
Online
Details from administration@bsava.com
DAY MEETING
Tuesday 24 September
Collapsed canids and
floppy felids: are fluids always
the answer?
Speaker: Sophie Adamantos
BSAVA Headquarters
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 14 August
13:0014:00
Investigating the itchy dog
Speaker: Janet Littlewood
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 21 August
13:0014:00
Medicines inspection
Speaker: Pam Mosedale
Online
Details from administration@bsava.com
EVENING MEETING
NORTH WEST REGION
Thursday 19 September
Avian emergencies
Speaker: Molly Varga
Brockholes Nature Reserve, Preston
Details from northwest.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Thursday 19 September
Feline cardiology
Speakers: Virginia Luis-Fuentes and
JoannaDukes-McEwan
Hilton, Bristol (Bradley Stoke)
Details from southwest.region@bsava.com
DAY MEETING
SOUTHERN REGION
Tuesday 24 September
People, pets and profits:
making it all work
Speaker: Alan Robinson
The Potters Heron Hotel, Ampfield, Romsey,
Hampshire SO51 9ZF
Details from: southern.region@bsava.com
EVENING MEETING
SOUTH WEST REGION
Thursday 26 September
Neurology: ten minute consults
Speaker: Tom Harcourt-Brown
Langford Vet School
Details from southwest.region@bsava.com
DAY MEETING
Thursday 26 September
How to work up an oncology case
in practice
Speaker: Tom Cave
Yew Lodge, Kegworth
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 18 September
13:0014:00
GDV
Speaker: Sam McMillan
Online
Details from administration@bsava.com
September 2013
LUNCHTIME WEBINAR
Wednesday 4 September
13:0014:00
Clinical pathology:
interpreting blood types
Speaker: Sverine Tasker
Online
Details from administration@bsava.com
EVENING MEETING
WEST MIDLANDS REGION
Tuesday 3 September
How to perform a neurological
examination
Speaker: Ulrike Michel
Wolverhampton Medical Institute, New Cross
Hospital, Wolverhampton WV10 0QP
Details from westmidlands@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Wednesday 11 September
Genetics and dog breeding
Speaker: Steve Dean
Yew Tree Lodge Best Western Hotel,
33Packington Hill, Kegworth, Derby DE74 2DF
Details from eastmidlands@bsava.com
EVENING MEETING
SOUTH WEST REGION
Tuesday 10 September
ECC for vets and vet nurses:
the crash scenario
Speaker: Sophie Adamantos
Cullompton RFC, Stafford Park, Knowle Lane,
Cullompton, Devon EX15 1PZ
Details from southwest.region@bsava.com
EVENING MEETING
CYMRU/WALES REGION
Thursday 19 September
The back of beyond
anorectal and perinial surgery
Speaker: Alasdair Hotston Moore
The Unicorn Inn, Llanedeyrn,
Cardiff CF3 6YA
Details from: cymru.wales.region@bsava.com
WEEKEND MEETING
EAST ANGLIA
Saturday/Sunday
21/22 September
Emergency thoracic and
abdominal cases
Speakers: Ms Karen Humm, Mr Roger Powell,
Ms Valentina Piola
Cambridge Belfry Hotel CB23 6BW
Details: eastangliaregion@bsava.com
DAY MEETING
Thursday 12 September
BSAVA Dispensing Course
Speakers: P.Sketchley, F.Nind, M.Stanford,
P.Mosedale, S.Dean, M.Jessop
Gipsy Hill Hotel, Exeter EX1 3RN
Details from administration@bsava.com
DAY MEETING
NORTH EAST REGION
Sunday 15 September
Neurology topics
Speaker: Gerard te Lintelo
Wetherby Racecourse
Details from northeast.region@bsava.com
DAY MEETING
Wednesday 17 September
From well bird to Im trying to die
fast: managing them all in practice
Speaker: Neil Forbes and Matthew Rendle
Lismoyne Hotel, Fleet
Details from administration@bsava.com
Friday 30 August
Sunday 1 September
Edinburgh Conference
Centre, Heriot-Watt,
Edinburgh
Details from
scottishregion@bsava.com
38-39 CPD Diary July.indd 38 18/07/2013 11:35
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EXCLUSIVE FOR MEMBERS
Extra 10% discount on all BSAVA
publicatons for members atending any
BSAVA CPD event.
All dates were correct at tme of going to print; however, we
would suggest that you contact the organisers for conrmaton.
EVENING MEETING
WEST MIDLANDS REGION
Thursday 3 October
Feline medicine: the evidence base
Speaker: Rachel Dean
The Barn Beefeater and Premier Inn,
Stratford Road, Hockley Heath, Solihull,
West Midlands B94 6NX
Details from westmidlands.region@bsava.com
DAY MEETING
Thursday 10 October
Ascitic Alsations, bradycardic
Boxers, coughing Cavaliers and
panting Pugs: everything you need
to know about canine cardiology
Speaker: Nuala Summerfield
BSAVA Headquarters
Details from administration@bsava.com
DAY MEETING
Friday 11 October
Haematological disorders in dogs:
from pallor to pred
Speaker: Polly Frowde
BSAVA Headquarters
Details from administration@bsava.com
DAY MEETING
Saturday 12 October
Canine case-based liver and
pancreatic disease
Speaker: Jon Wray
BSAVA Headquarters
Details from administration@bsava.com
DAY MEETING
Wednesday 23 October
Behaviour
Speakers: Sophie Oestreich
Holiday Inn, Taunton
Details from administration@bsava.com
EVENING MEETING
SOUTH WEST REGION
Wednesday 16 October
Managing diabetes mellitus
Speaker: Grant Petrie
Kingsley Village, Fraddon, Cornwall
Details from southwest.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Tuesday 15 October
Feline geriatric medicine
Speakers: Angie Hibbert and
Joanna Murrell
Westpoint Arena, Exeter EX15 1DJ
Details From southwest.region@bsava.com
DAY MEETING
Thursday 31 October
Chemotherapy in practice:
a life-changing experience
Speaker: Iain Grant
Yew Tree Lodge Best Western Hotel,
33 Packington Hill, Kegworth,
Derby DE74 2DF
Details from administration@bsava.com
EVENING MEETING
SOUTH WEST REGION
Thursday 31 October
The responsible use of
antibicrobials in practice
Speaker: Jill Maddison
Langford Vet School
Details from southwest.region@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Tuesday 15 October
Diagnosing and managing
fish/reptile diseases in practice
Speaker: Peter Scott
Yew Tree Lodge Best Western Hotel,
33 Packington Hill, Kegworth,
Derby DE74 2DF
Details from eastmidlands.region@bsava.com
LUNCHTIME WEBINAR
Wednesday 9 October
13:0014:00
Dealing with nasal tumours
Speaker: Jackie Demetriou
Online
Details from administration@bsava.com
October 2013
LINKED WEBINAR
Tuesday 22 October
20:0021:00
Canine haematological disorders
Speaker: Polly Frowde
Online
Details from administration@bsava.com
EVENING WEBINAR
Tuesday 15 October
20:0021:00
Wound healing
Speaker: Laura Owen
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 16 October
13:0014:00
Hospitalising small mammals
Speaker: Frances Harcourt Brown
Online
Details from administration@bsava.com
LINKED WEBINAR
Monday 21 October
20:0021:00
Canine cardiology
Speaker: Nuala Summerfield
Online
Details from administration@bsava.com
LINKED WEBINAR
Wednesday 23 October
20:0021:00
Canine liver and pancreatic
disease
Speaker: Nuala Summerfield
Online
Details from administration@bsava.com
OTHER UPCOMING BSAVA CPD COURSES
See www.bsava.com for further details
West Midlands Region
Tuesday 5 November
Dermatology of small animals
Metropolitan Region
Wednesday 6 November
All you need to know about rabbits in
2 hours!
BSAVA Educaton
Thursday 7 November
Chemotherapy in practce
North East Region
Sunday 10 November
Diarrhoea
North West Region
Tuesday 12 November
Spinal surgery
Southern Region
Tuesday 12 November
Recogniton of the emergency patent
BSAVA Educaton Learn @ Lunch
Webinar for vets
Wednesday 13 November
Top 10 dental tps
East Midlands Region
Wednesday 13 November
The evidence for/against surgical and
medical optons for the management of
hip dysplasia
Register at www.bsava.com
or call 01452 726700
Speakers: Diane Addie, Sarah Caney,
GerryPolton and Elise Robertson
Bridgewood Manor Hotel, Kent ME5 9AX
Early Bird 12 August
Feline medicine
weekend in Kent
Saturday 12 October
Sunday 13 October
FECAVA EUROCONGRESS
25 October
Dublin, Ireland
Visit www.fecava2013.org or email
info@fecava2013.org for more details.
38-39 CPD Diary July.indd 39 18/07/2013 11:35
There are colleagues who inspire us some from afar,
some close to home some we would even call our
heroes . Now you can honour the contribution of
thoseyou admire by nominating them for a
prestigious BSAVA Award.
Nominate before 26 September
Visit www.bsava.com/awards or
use the form inside this issue
Be our guest at the awards ceremony at Congress
on Thursday afternoon.
Only BSAVA Members can nominate.
Who do you love?
Stock photography: Dreamstime.com Beata Kraus