Companion April 2014 Low Res

The essential publication for BSAVA members
companion
APRIL 2014
How To...
Manage urethral
obstruction
P18
Clinical Condundrum
Seizures in a Spaniel
P8
Plugged into pets
Digital opportunities
P14
Celebratng 40 YEARS of improving the health of pets
01 OFC April.indd 1 19/03/2014 12:54
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companion
companion is published monthly by the British
Small Animal Veterinary Association, Woodrow
House, 1 Telford Way, Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB. This magazine
is a member-only 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 (print): 2041-2487
ISSN (online): 2041-2495
Editorial Board
Editor Mark Goodfellow MA VetMB DPhil 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
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
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wherever possible and companion is printed
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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 Making a difference
40 years of funding
812 Clinical Conundrum
Seizures in a Spaniel
1417 Plugged into pets
The digital profession
1823 How To
Manage urethral obstruction in dogs
2426 CSF
Collection from the new
Procedures Guide
27 Petsavers
How you can get involved
2829 WSAVA News
World Small Animal Veterinary
Association
3031 The companion interview
Marge Chandler
33 Regional CPD
Local knowledge close to home
3435 CPD Diary
Whats on in your area
Additional stock photography:
www.dreamstime.com
Alexei Sysoev; Enika; Ivonne Wierink; Kennosuke;
Mholod
Whats in JSAP this month?
Diagnostic accuracy of three
biopsy techniques in dogs
with intra-nasal neoplasia
EJCAP ONLINE
To access the latest
issue of EJCAP visit
www.fecava.org/EJCAP.
Find FECAVA on Facebook!
T
he purpose of this study was to
determine if nasal biopsies taken
at rhinoscopy are more accurate
for diagnosing neoplasia than
biopsies taken blindly or using advanced
imaging for guidance. A retrospective
study was carried out of 117 dogs with
nasal mass lesions. The dogs were
divided into three groups according to the
method of nasal biopsy collection:
advanced imaging-guided, rhinoscopy-
guided or blind biopsy. Signalment,
imaging and rhinoscopic findings, and
histopathological diagnosis, were
compared between groups.
The proportion of first attempt
biopsies that confirmed neoplasia was
determined for each group. The study
found no statistically significant
differences in the proportion of biopsies
that confirmed neoplasia obtained via
advanced imaging-guided, rhinoscopy-
guided or blind biopsy techniques.
The authors conclude that, in dogs
with a high index of suspicion of nasal
neoplasia, blind biopsy may be as
diagnostic as rhinoscopy-guided biopsy.
Repeated biopsies are frequently required
for definitive diagnosis.
Adapted from Harris B.J., et al. JSAP 2014; 55: 219224
ALSO IN THIS MONTHS ISSUE
PetSavers: Feline blood genotyping
versus phenotyping, and detecton of
non-AB blood type incompatbilites in
UK cats
PetSavers: Comparison of CT pulmonary
angiography and point-of-care tests for
pulmonary thromboembolism diagnosis
in dogs
Lef atrial size, atrial functon and lef
ventricular diastolic functon in cats with
hypertrophic cardiomyopathy
Management and complicatons of
anaesthesia during balloon valvuloplasty
in dogs
Evaluaton of a joint distractor to
facilitate arthroscopy of the tbio-tarsal
joint in dogs
Log on to www.bsava.com to access
the JSAP archive online.
02 Page 02 April.indd 2 19/03/2014 12:54
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I
started out as Secretary of the South West
Regional Committee, and more recently I
became Regions Co-ordinator, so I work
alongside all 12 regional committees, the BSAVA
Board, and the team of staff at HQ. I get a lot out of
volunteering for BSAVA. It is with great pleasure
that I watch as the Regions meet the challenge to
provide high quality, affordable CPD and there is a
real family feeling within BSAVA. It is a privilege to
be able to contribute something to an Association
which has provided me with education and support
throughout my professional life. Ive met some real
characters, and have been able to pick the brains
of some very clever people as I drive them to
speak at our CPD events!
It seems to come as a surprise to many
members and non-members that the Regions
actually hold the balance of power within the
Association, and so members and volunteers
opinions actually make a huge difference to
BSAVA policy. Volunteering doesnt have to take
up a lot of your time, and it can be a lot of fun,
very sociable, and there are lots of perks. Fresh
ideas are always welcome and this Association is
driven by its grass roots we want you! Just get in
touch with your regional committee or with the
team at Woodrow House.
Get to know
your BSAVA
colleagues
Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know
Volunteer
voice
Andrea
Lynch
Find out how you can get involved as a
BSAVA volunteer, email Carole Haile
c.haile@bsava.com.
You dont want to miss a thing
Your Associations financial health
E
nclosed with this edition of companion you will find the highlights
from BSAVAs Annual Report. In March we sent the full document
to those who have not opted out of receiving it. This is a large
document, which is available online, so if you received one and
want to help us save money and the environment next year, then please
email administration@bsava.com.
BSAVA Northern Ireland
Conference
T
here is still time to plan your visit to Armagh on 2324 May for two days
of top quality CPD for vets and nurses with lectures by Dan Brockman,
Aidan McAlinden, Ian Self, Louise ODwyer and Alistair Gibson.
With a focus on the abdominal patient and an emphasis on the
management of surgical cases, topics will include patient stabilisation,
decision making and of course the surgery itself including safe anaesthesia
and adequate analgesia. Further information is available from VetNI by
emailing info@vetni.co.uk or phoning 02825 898543.
T
he facility to remind yourself of
lectures you loved, or to catch
up on those you missed, means
BSAVA Congress lasts all year
round for members. It also means that
even if you were not able to make it to
Birmingham you can still benefit from
the CPD. We hope to have all the talks
from 2014 online in the podcast archive
before the end of April. You will need to
be registered with the website as a
member in order to access this
exclusive content. If you have any
problems then email administration@
bsava.com or call 01452 726700
(MondayFriday 95). You can still
access lectures from previous years too
of course, thousands have been
downloaded from last year heres the
current top ten from 2013
1. Congestive heart failure
Adrian Boswood
2. Closed and open tooth
extraction Alexander Reiter
3. Coughing cats Angie
Hibbert
4. ACE inhibitors what is the
evidence? Larry Adams
5. Feline jaundice Andrea
Harvey
6. Approach to azotaemia
Hattie Syme
7. Feline pancreatitis Andrea
Harvey
8. Approach to renal haematuria
and proteinuria Larry Adams
9. Managing chronic kidney
disease in cats Larry Adams
10. Managing protein-losing
nephropathies Hattie Syme
03 Page 03 April.indd 3 18/03/2014 14:53
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T
he first forty years of life give us the text: the
next thirty supply the commentary, said the
great 19th century German philosopher Arthur
Schopenhauer.Over the duration of a typical
human lifetime, he expected that a blossoming of
youthful vigour and achievement would inevitably give
way to a period of quiet contemplation.
For the sake of animal welfare and veterinary
understanding, it must be hoped that this pattern
doesnt shape the fortunes of the first UK charity set
up to focus exclusively on supporting clinical research
into companion animal diseases. The BSAVAs
PetSavers charity has worked energetically and
effectively over 40 years to help generate the scientific
knowledge needed to rewrite standard reference
books on veterinary care. Yet its task is far from
complete and, while client expectations continue to
grow, clinical researchers will feel compelled to
maintain this momentum over the next four decades.
Since its formation, the charity has distributed
more than 2 million in well over 100 grants for
research projects or veterinary training. Harrow-based
practitioner Pedro Martn Bartolom is chairman of the
PetSavers management committee which approved
funding for nine projects last year, worth up to 8,000
a year each and for a maximum of three years.
Making a difference from the start
Asked to point out some of the highlights of the
research funded by the charity, Pedro picks the very
first award made as the one that set the standard that
all subsequent grant holders have needed to match.
This was for a sum of 1225 given to David Bennett, a
postgraduate student in the 1970s at the Glasgow
veterinary school, to investigate immune-mediated joint
diseases in the dog and cat.
David was able to develop the tests needed to
characterize several different forms of autoimmune
disease, based on samples of blood and joint fluid
from affected animals. This included the first
identification of a canine rheumatoid arthritis, which
would prove to be a much rarer condition in dogs than
in humans. Although we thought these diseases had
existed for some time, they were largely undiagnosed
until this study was carried out and it was only as a
result of the financial support of CSTF (which became
Making a
difference
for forty years
PetSavers was set up by the BSAVA in 1974
under its original name of the Clinical Studies
Trust Fund. Its mission was to fund vital
clinical research into the prevention,
treatment and/or cure of illnesses and
conditions affecting pets, so that our
companion animals can enjoy longer, fuller
and healthier lives. John Bonner examines
what the charity has achieved
in its first four decades
and asks what can be
expected in the future

04-07 PetSavers Four Decades.indd 4 19/03/2014 08:33
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PetSavers in 1996) that their accurate diagnosis and
classification became possible, Pedro explained.
The main reason why these conditions were
difficult to diagnose was that cases often presented
with a raised temperature, suggesting an infectious
cause. Also there were rarely any signs of lameness as
all the limb joints tended to be equally badly affected
and so the animal moved with a generalized stiffness.
Developing the tests to allow an early diagnosis
produced considerable welfare benefits, as the
animals pain could be greatly ameliorated through
treatment with immunosuppressive drugs.
That one project produced a fine crop of 10
papers published in the veterinary literature and laid
the foundations for Davids PhD. Now a professor of
small animal clinical science back at the institution
where he began his research career, Prof. Bennett
continued to explore various inflammatory conditions
in the dog and cat, and over the years he has gained
funding from the same charity for five further
research projects.
Making a difference in practice
Although the majority of PetSavers grants have gone
to those in academic posts, the awards are also
available to veterinary surgeons in private practice.
Of course the main benefit that practitioners receive
from their efforts in raising funds for the charity will
usually be through the rapid dissemination of
knowledge about techniques developed by the
award winners.
Geoff Skerritt was a young anatomy lecturer at
Liverpool veterinary school in 1980 when he received
a CSTF grant worth around 2000 to purchase
equipment and develop the techniques for
electromyography (EMG) and electroencephalography
examinations in companion animals.
Such technology was in regular use at the time in
human medicine but despite the efforts of Ian Griffiths
at Glasgow veterinary school, the veterinary profession
had yet to appreciate the value and versatility of these
technologies. Geoff was able to adapt equipment
made for the human health market to measure nerve
conduction in smaller patients. He went on to refine
those techniques, both as the lead clinician for the
universitys neurology referral service and after
leaving academia to set up the ChesterGates private
referral practice. We use these techniques pretty
routinely now as a diagnostic tool in neurology cases.
Ian was the pioneer but thanks to the PetSavers award,
I was able to follow up behind and carry on that work,
he said.
One of the first conditions to be studied using EMG
was progressive axonopathy in the Boxer. This was a
devastating inherited disease which caused great
distress for the affected animals and their owners. It is
a condition that many newly qualified practitioners may
have never heard of, let alone seen. That is a tribute
both to the diagnostic accuracy of the technology and
the efforts of Boxer breeders and their veterinary
advisors to identify affected lines and avoid breeding
from them.
Making a big difference with small funds
An impressive aspect of PetSavers record is that it
has consistently produced excellent results while
distributing fairly small sums of money. Professor
John Innes, now one of Geoffs colleagues at the
ChesterGates hospital, won the first of his five
PetSavers grants as a postgrad at the Bristol
veterinary school. This first award was for 11,000 for
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would be of little interest to the big funding
agencies like the BBSRC or the Wellcome
Trust, yet can be very important in the early
stages of an academic career.
A key feature of the PetSavers grants
system is that it will only support studies
into naturally occurring diseases in
companion animals and any grant
application involving experimental studies
in laboratory animals will be turned down.
Overall, there are few sources of funding
for clinical research in companion animals,
which is why PetSavers is so important. On
those occasions where the major funders
like the Wellcome Trust are prepared to
look at these species, the researcher will
usually have to develop a comparative
medicine angle to the project, just to keep
them interested, Prof. Innes notes.
Making a difference long term
One area where the PetSavers
committee is prepared to follow the
example set by the big funding
institutions is in providing longer term
support for early-stage researchers.
Organizations like the Wellcome Trust
have realized there is value in making
significant investments in training and
developing the research skills of young
scientists. So PetSavers has followed suit
and introduced the first of a new stream
of MDR (masters degree by research)
grants which provided one-year grants
worth up to a maximum of 35,000. Gina
Pinchbeck at the University of
Liverpool was the first recipient
under this scheme in 2012 for
her study on the prevalence of,
and risk factors for, extended-
spectrum beta-lactamase-producing
bacteria in companion animals.
The majority of PetSavers funds are
still distributed as awards for the small-
scale projects that have launched a
number of illustrious careers, like that of
Making a difference for forty years
a study on cranial cruciate ligament
rupture in dogs; with additional funding
from the university it supported his PhD
and launched a career as a clinical
researcher so far lasting 22 years.
He points out that this is a common
thread in the PetSavers story, relatively
modest grants allow the researcher to
leverage further support from intramural
university funds or some other source. The
studies are often short-term projects which
Professor Michael Day, the current BSAVA
President. He gained the first of the seven
PetSavers Research Projects as well as
the two clinical residencies that he has
been involved with in 1991 for a study of
the pathogenesis of anal furunculosis in
the German Shepherd Dog.
This research identified the central role
played by T lymphocytes in the aetiology of
this condition and led other scientists to
develop the ciclosporin-based therapy that
has transformed the management of this
once common condition in the breed.
For that reason, this is one of the
projects that has really stood out for me as
practitioner, notes Pedro. I can remember
when we used to have to treat these dogs
surgically; it was a very messy and bloody
process. Being able to offer an effective
medical treatment has been one of the
most important advances that our charity
has helped to achieve.
Over the years PetSavers has
supported research and training in a wide
range of clinical disciplines, but by making
repeat awards to fund training in rapidly
growing fields, it has created the critical
mass of expertise needed to sustain that
progress. For example, the charity can
claim to have given significant impetus to
developments in veterinary oncology in the
UK. Under the supervision of Dr Jane
Dobson at the University of Cambridge, it
has funded three successive research
scholarships for Joanna Morris, Laura
Blackwood and Anneliese Stell, who each
went on to establish their own clinical
oncology referral services at other UK
veterinary schools; Glasgow, Liverpool and
London, respectively. Indeed, Laura went
on to take responsibility for supervising the
training of her own Petsavers oncology
scholar, Sarah Mason. Dr Mason
completed her residency at Liverpool in
2013 and was then appointed as a lecturer
in veterinary oncology.
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Making a difference
to rabbits
As well as helping some veterinary
interests to grow into mature academic
disciplines, the charity has been
instrumental in developing brand new
areas of professional activity. When Anna
Meredith trained at the Cambridge
veterinary school in the late 1980s, rabbits
were lumped together with other exotic pet
species, and together dismissed as being
worthy of only a single afternoons lectures.
Now, of course, rabbits are the third most
popular mammalian pet species and form
a significant and still growing element in
the caseload of both general practitioners
and referral veterinarians.
In 1992, Professor Meredith was
appointed by the University of Edinburgh
to head the first clinical and teaching
service in exotic pet and wildlife medicine
at a British veterinary school. Twelve years
later, she won funding from PetSavers for
the first ever residency in rabbit medicine
at a UK school.
This was undertaken by her
postgraduate student Michelle Ward who,
as part of her training, carried out a study
of the potential role of probiotics in
maintaining the health of the rabbit gut.
She was also a contributor to the second
edition of the BSAVA Manual of Rabbit
Medicine and Surgery which was
published in 2006.
Michelles grant was worth a total of
39,000 over 3 years but its lasting value
has been considerably greater. I am
sure that her appointment did a great
deal to raise the profile of rabbit medicine
in the UK. It really started the process
through which rabbits are now
BE A PETSAVERS PRACTICE
To register your interest in receiving the
latest PetSavers material and to nd
out more about becoming a PetSavers
practce visit www.petsavers.org.uk
or get in touch with Emma Sansom
info@petsavers.org.uk.
MORE THAN JUST FUNDING
As well as funding vital research, PetSavers
has resources for pet owners and veterinary
professionals, plus a host of opportunites for
fundraising.
Puppy and Kiten guides
Pet bereavement support
Photography competton
Running events
considered a mainstream companion
animal rather than just another exotic
pet, Anna recalls.
Making a difference to the
profession
As its current chairman, Pedro can take
considerable pride from the
achievements of the charity since it was
established by BSAVA in 1974. But he is
not satisfied that PetSavers is given the
recognition that it deserves, even within
the profession that was responsible for
its creation and has been the main
source of its funding.
Part of that reason is that it faces
intense competition in a very crowded
field. I have been told that you have
more charities in the UK that are devoted
to the welfare of animals than there are
for humans and I believe that may well
be true, says Pedro, who qualified from
the veterinary school at Zaragoza, Spain
in 1986.
Pedro is reluctant to change the way
that PetSavers operates or to devote a
large percentage of its income and
efforts into marketing. But he clearly
wants to do more to raise awareness of
the charity among its key audience of
small animal practitioners and their
regular clients.
So at BSAVA Congress there will be a
series of events to mark the 40th
anniversary of the organizations birth.
This will include a celebratory party and a
series of lectures highlighting the
achievements made by those veterinary
surgeons that have been in receipt of the
charitys funding. Those scientists have
also been asked to contribute to a
booklet and new fundraising material for
PetSavers which is due to be published
later this year.
We want to make this available as
widely as we can I am sure it will be
useful for practitioners in explaining who
we are, what we do and what else we need
to do, the Chairman says.
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Clinical conundrum
Sarah Mason, Lecturer in
Small Animal Oncology at the
University of Liverpool, invites
readers to consider the causes
of seizures in a 5-year-old
Springer Spaniel
Case presentation
A 5-year-old female neutered Springer Spaniel presented for
evaluation of seizures. The owners reported urine patches present
in the house on two occasions in the preceding days and on the
morning prior to presentation the dog had become weak on her
pelvic limbs and collapsed into sternal recumbency, whilst
remaining conscious, on two occasions. Two seizures were then
reported, the most recent thirty minutes prior to presentation.
Generalized muscle fasciculation was reported for ten minutes prior
to the episode. During the seizure episodes the dog was recumbent,
non-responsive, hyper-salivating and there were clonic movements
of all four limbs. No urination or defecation occurred. Each episode
lasted for less than two minutes and since the last episode the dog
had not regained consciousness.
Complete commercial dog food was fed twice daily. The dog was
a known scavenger and had had surgery on two previous occasions
to remove gastrointestinal foreign bodies, but there was no further
medical history. She was fully vaccinated, wormed and had lived
exclusively in the United Kingdom.
The dog was stuporous and had bilateral pupillary miosis. Body
condition score was 5/9. Heart rate was 88 bpm with no audible
murmur; femoral pulses were strong with no deficits. Mucous
membranes were pink and tacky with a CRT <2 seconds. Respiratory
rate was 64 bpm with no adventitious lung sounds. Rectal
temperature was 39.4C. Abdominal palpation was unremarkable.
A limited neurological examination was performed at this time.
Facial sensation was considered to be reduced based on lack of
both the blink and menace reflexes. The gag reflex was weak, but
spinal reflexes were normal.
What is your problem list?
Seizures preceded by muscle fasciculation
Stupor
Bilateral miosis
Pelvic limb weakness and collapse
Tachypnoea
Mildly elevated rectal temperature
Recent inappropriate urination
Consider the possible differential
diagnoses for each problem
The differential diagnoses for seizures are summarized
in Table 1.
Periodic muscle tremor can be due to
hypoglycaemia and electrolyte imbalance,
encephalopathy and acidbase imbalance or toxicity
(e.g. organophosphate, chocolate, amphetamine,
metaldehyde, bromethalin, mycotoxins), inflammatory
brain disease or, less commonly, lysosomal storage
and degenerative (e.g. dysmyelination,
neuronopathies) disorders.
Stupor can occur post-ictally, with primary
intracranial lesions (primary or metastatic neoplasia),
vascular (e.g. haemorrhage or ischaemia) or
inflammatory (e.g. granulomatous meningoencephalitis,
Extracranial causes
Hypoglycaemia
Hepatc encephalopathy
Toxins (e.g. ethylene glycol, metaldehyde)
Hypocalcaemia
Hyper- or hyponatraemia
Hyperosmolarity or hyperviscosity
Uraemic encephalopathy
Thiamine deciency
Intracranial causes
Neoplasia
Infammatory or infectous disease
(e.g. meningoencephalits)
Vascular conditons (e.g. haemorrhage, ischaemia)
Idiopathic epilepsy
Toxins (e.g. ethylene glycol, metaldehyde)
Congenital malformatons
Metabolic storage disease (e.g. gangliosidosis,
lipofuscinosis)
Trauma
Table 1: Differential diagnoses for seizures
08-12 CLINICAL CONUNDRUM.indd 8 19/03/2014 09:21
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steroid-responsive meningitis arteritis) conditions,
secondary to focal lesions (e.g. oedema formation,
obstruction of the ventricular system, herniation) or
from CNS dysfunction as a consequence of systemic
disease (e.g. hypoglycaemia, electrolyte disturbances,
hepatic encephalopathy or myxoedema coma), toxicity
(e.g. lead or metronidazole) or trauma and
degenerative conditions (lysosomal storage diseases
and congenital neurodegenerative diseases).
Bilateral miosis can be due to diffuse forebrain
disease, organophosphate toxicity, raised intracranial
pressure, opioid administration or, less likely, bilateral
Horners syndrome.
Hindlimb weakness and collapse is most commonly
due to orthopaedic (e.g. polyarthritis, bilateral cruciate
disease) or neurological (e.g. spinal cord, nerve,
neuromuscular junction or muscle dysfunction)
conditions. Less commonly, systemic disease presents
as progressive paraparesis (e.g. endocrine/electrolyte
disturbances, cardiorespiratory disease, toxins/drugs).
Paraparesis could reflect the post-ictal state.
Tachypnoea is most often due to intrathoracic
disease such as pleural disease (e.g. pleural effusion,
pneumothorax), pulmonary disease (e.g. inflammation,
infection, cardiogenic/non-cardiogenic oedema,
neoplasia, thromboembolism), mediastinal disease
and diaphragmatic hernia/rupture. It can also be
physiological (due to hyperthermia, pain, anxiety, fear,
exercise) or result from anaemia, metabolic acidosis or
central neurogenic hyperventilation. There were no
abnormalities on thoracic auscultation or examination
of the cardiovascular system, making many of these
abnormalities unlikely.
Elevated rectal temperature can be due to pyrexia
or hyperthermia. Pyrexia may be caused by infectious,
immune mediated or other inflammatory diseases such
as neoplasia. Hyperthermia can be due to inadequate
heat dissipation, excitement, exercise or stress, or true
fever due to an underlying disease. Either was
possible in this dog, although the prior seizure activity
and muscle tremors raised suspicion of hyperthermia.
Inappropriate urination can be due to medical
conditions affecting the urogenital tract (e.g. urinary
tract infection, urolithiasis, neoplasia), systemic
disease leading to altered behaviour, seizure/syncope
or primarily behavioural.
The seizures, stupor, miosis and collapse were
most likely related and extracranial conditions were
considered more probable, particularly given the
associated muscle tremor, paraparesis and the
symmetry of the abnormalities. However, intracranial
disease could not be excluded at this stage. Stupor
and miosis may have been caused post-ictally by any
underlying intra- or extracranial cause of seizures.
Tachypnoea with normal thoracic auscultation was
most likely an attempt to dissipate heat in this case.
Hyperthermia was most likely due to increased
muscle activity (seizures and tremor) but could also
represent true fever. Inappropriate urination was not
clearly related and not considered a priority for
investigation initially.
What initial tests would you recommend?
In view of the suspicion of an extracranial cause of the
seizures the following tests were performed. Blood was
submitted for haematology, biochemistry and blood
gas analysis to assess for further evidence of
metabolic or inflammatory disease (Tables 2, 3 and 4).
Blood pressure was measured (Doppler method) to
exclude hyper/hypotensive states and was normal.
Parameter Result Reference interval
RBC 7.29 5.78.8 x 10
12
/l
Haemoglobin 16.7 12.918.4 g/dl
HCT 0.49 0.370.57 l/l
MCV 68.0 58.871.2 f
MCHC 33.6 31.036.2 g/dl
MCH 23.4 19.525.5 pg
RDW 15.5 14.717.9%
White cell count 12.0 5.213.9 x 10
9
/l
Neutrophils 9.6 3.012.0 x 10
9
/l
Lymphocytes 1.2 1.34.1 x 10
9
/l
Monocytes 1.07 0.21.1 x 10
9
/l
Eosinophils 0.02 0.00.6 x 10
9
/l
Basophils 0.03 0.00.1 x 10
9
/l
Platelets 287 143400 x 10
9
/l
Table 2: Haematology results (abnormal results in bold)
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Clinical conundrum
What is your interpretation of the
laboratory results?
Marked hypoglycaemia explained the pelvic limb
weakness, seizures and muscle tremors.
Hypoglycaemia may be caused by excessive
secretion of insulin or insulin-like factors (insulin
producing islet cell tumour or insulinoma,
extrapancreatic tumour/islet cell hyperplasia),
decreased glucose production or abnormal glucose
metabolism (hypoadrenocorticism, liver disease,
growth hormone deficiency, glycogen storage
disease), excess glucose consumption (sepsis,
extreme exercise, some forms of neoplasia),
iatrogenic/drug associated (administration of insulin,
oral hypoglycaemics, xylitol and others),
paraneoplastic (e.g. leiomyoma/myosarcoma,
hepatocellular carcinoma, renal carcinoma), fasting,
malnutrition or artefactual causes.
Starvation, extreme exercise and iatrogenic causes
were excluded based on history as far as possible.
Acquired hypopituitarism and growth hormone
deficiency are rare conditions, but the possibility of a
pituitary tumour could not be excluded. Glycogen
storage disorders are also rare and less likely in a
previously normal mature dog. Results did not support
sepsis, liver disease or hyperviscosity, but further
testing would have been required to exclude some of
these conditions completely.
Although urea was slightly low other markers of
liver function were normal making liver disease
unlikely. Low urea can also be spurious or due to
diuresis/increased renal excretion. Mild lymphopenia is
common and non-specific.
The most likely explanations for the marked
hypoglycaemia were insulin excess,
hypoadrenocorticism and toxicity. Stupor and bilateral
miosis were considered most likely secondary to
diffuse forebrain changes.
How would you manage the dog in the
short term?
Glucose was administered by intravenous bolus
(2.5 ml of 50% glucose solution diluted to 5% in
Hartmanns solution) and then as an infusion
(Hartmanns solution with added glucose to 2.5%), as
the patient was initially unable to receive oral
medication or food. The tachypnoea and hyperthermia
resolved within a few hours, consistent with these
signs occurring secondary to seizure activity. As the
dogs mentation normalized frequent oral feeding was
initiated. As the dog presented during a bank holiday
weekend some test results were not immediately
available and diazoxide (3 mg/kg twice a day) was
added to the dogs treatment to improve blood glucose
levels prior to excluding conditions which may have
responded to prednisolone.
Total protein 68 5778 g/l
Albumin 33 2331 g/l
Globulin 35 3457 g/l
Urea 2.1 2.56.0 mmol/l
Creatnine 71 20110 mol/l
Potassium 3.6 3.45.6 mmol/l
Sodium 148 140153 mmol/l
Chloride 113 99115 mmol/l
Calcium 2.7 2.22.7 mmol/l
Inorganic phosphate 0.87 0.82.0 mmol/l
Glucose 1.8 3.55.6 mmol/l
ALT 19 750 IU/l
ALP 36 0100 IU/l
Bilirubin 9 020 mol/l
Cholesterol 5.5 3.26.5 mmol/l
Table 3: Serum biochemistry results (abnormal results in bold)
pH 7.40 7.357.45
pCO
2
35 3440 mmHg
HCO
3
21.9 2024 mmol/l
Base excess 3 5 to 5 mEq/l
tCO
2
23 1725 mmol/l
Table 4: Venous blood gas analysis
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Figure 1: (A) Right lateral thoracic radiograph. (B) Right lateral abdominal radiograph
A B
Figure 2: (A) Post-contrast CT image showing a nodule on the left limb of the pancreas
(blue arrow). The spleen is evident lying against the body wall on the right of the image
and the kidney can be seen as a white oval structure on the left of the image (contrast
medium uptake evident). The small oval objects to the mid left of the abdomen are
loops of intestine. (B) Post-contrast CT image showing an enlarged pancreatic/duodenal
lymph node (red arrow). Both kidneys can be seen in this more caudal slice and only the
tail of the spleen is evident ventrally
A B
What further investigations would
you perform?
ACTH stimulation test to exclude
hypoadrenocorticism, although marked
hypoglycaemia is unusual in this disorder
A bile acid stimulation test to exclude hepatic
insufficiency
Serum insulin levels (given suspicion for
insulinoma) measured at the same time as
documented hypoglycaemia
Urinalysis to assess for common causes for
inappropriate urination such as urinary tract
infection
Abdominal and thoracic radiography and
abdominal ultrasonography to assess for
insulinoma and other neoplasms that can cause
hypoglycaemia (Figure 1). In addition, any
evidence of primary hepatic disease or sepsis
might be identified; although these conditions were
considered unlikely from the clinical pathology
results.
Urinalysis, bile acid and ACTH stimulation tests
were unremarkable. Imaging was performed while
serum insulin levels were pending.
What is your interpretation of the
radiographs (Figure 1)?
A metallic gastric foreign body was documented,
which is likely an incidental finding; unfortunately this
precluded a detailed ultrasonographic examination of
the pancreas by a very experienced ultrasonographer.
It was decided to perform an abdominal CT scan in
order to gain better images of the pancreas (Figure 2).
This revealed a mass in the right limb of the pancreas
and an enlarged pancreatic/duodenal lymph node.
Both were then aspirated under ultrasound guidance
(Figure 3) and submitted for cytological examination
(Figure 4). No hepatic nodules were evident on CT or
ultrasonography, and the urinary tract appeared normal.
What is your assessment of the findings
at this stage?
Imaging and cytology were highly supportive of
insulinoma. As the dog presented over a holiday
weekend serum insulin results were not
Figure 3: (A) Ultrasonographic appearance of the enlarged pancreatic/duodenal lymph
node (green arrow). (B) Ultrasonographic appearance of the pancreatic nodule, located
following identification on CT (yellow arrow)
A B
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Figure 4: Photomicrograph showing the appearance of the
neuroendocrine cells
immediately available. The gastric foreign body was
considered most likely an incidental finding given the
history, the lack of gastrointestinal signs and small
amount of metallic material within the faecal material in
the colon. Normal urinalysis and imaging ruled out
obvious lower urinary tract disease as a cause of the
inappropriate urination and it was attributed to
probable seizures unnoticed by the owners; this
problem also subsequently resolved.
How would you treat a suspected
insulinoma?
The intravenous glucose was gradually withdrawn and
small frequent meals introduced. Diazoxide was
continued and prednisolone (0.5 mg/kg once a day)
was added to the dogs treatment.
Serum insulin levels became available and
confirmed the presence of an insulinoma; serum
insulin levels are inappropriately high (41 IU/l,
reference interval 11.629 IU/l) in the presence of
concurrent hypoglycaemia. Once the serum glucose
levels were more stable, an exploratory laparotomy to
allow a partial pancreatectomy and lymphadenectomy
was performed and the gastric foreign bodies were
removed via gastrotomy. Histology confirmed the
presence of a neuroendocrine tumour, consistent with
an insulinoma.
Diagnosis
Metastatic insulinoma (stage 2).
Stage 1 insulinoma describes a primary tumour within
the pancreas only, with no regional lymph node or
distant metastases; stage 2 describes regional lymph
node metastases, but no distant metastases; and
stage 3 describes the presence of distant metastases.
Outcome and long term management
Recovery from surgery was uneventful. Blood glucose
levels returned to normal post-surgery, diazoxide was
stopped and prednisolone was withdrawn over a
period of two weeks. The dog was discharged
72 hours post-surgery with instructions to monitor for
any further signs of hypoglycaemia or pancreatitis.
While fructosamine was not checked at initial
presentation, because the test was not immediately
available and imaging studies had confirmed the
suspicion of a pancreatic mass, this could be useful
for monitoring for recurrence of hypoglycaemia before
clinical signs become evident. It was recommended
that fructosamine levels be checked monthly for
monitoring purposes and re-staging performed at
three months; however, the owners declined follow up
and six months after discharge the clinical signs
recurred and the dog was euthanized.
Conclusion
Insulinoma is an uncommon tumour in dogs but is an
important differential diagnosis in patients presenting
with hypoglycaemia. Around 50% of affected patients
have metastasis at presentation with regional lymph
nodes (as in this case) and the liver commonly
involved. Management can be medical, surgical or a
combined approach, and median survival times can
be in the region of 1226 months depending on the
stage of disease. Dogs in clinical stage one are
significantly more likely to remain free of
hypoglycaemia than dogs in stages 2 or 3, and dogs
with clinical stage 3 disease are more likely to have a
shorter survival time than dogs with stage 1 or 2
disease. This dog remained free of clinical signs for six
months, however the client elected for euthanasia at
this time rather than pursuing further medical or
surgical treatment which may have prolonged the
dogs life.
Clinical conundrum
For more information or to book your course
www.bsava.com
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These regular monthly lunchtime (12 pm) webinars are
FREE to BSAVA Members just book your place through
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This is a valuable MEMBER BENEFIT
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Top tips and tricks
for closing and
reconstructing wounds
in small animal practice
24 June
This course is designed to cover the key
elements and most practical
aspects of wound
reconstruction
SPEAKER
Jackie Demetriou
VENUE
The Bridge, Wetherby
FEES
BSAVA Member:
240.00 inc. VAT
Non BSAVA Member:
360.00 inc. VAT
Companion animal
diabetes mellitus
management in practice
An up-to date, holistic,
21st century view
21 May
This course is uniquely focused on
diabetes mellitus, an increasingly common
endocrinopathy, presented by two
worldwide experts in the field and guided
by evidence-based medicine
SPEAKERS
Stijn Niessen & Yaiza Forcada
VENUE
Hatfield Oak Hotel, Hatfield
FEES
BSAVA Member: 240.00 inc. VAT
Non BSAVA Member: 360.00 inc. VAT
Practical haematology
Detective work
for nurses
5 June
The aim of this
interactive course is to
introduce the veterinary
nurse to microscopy and
provide the basis for
identifying haematological
abnormalities
SPEAKER
Kostas Papasouliotis
VENUE
Woodrow House, Gloucester
FEES
BSAVA Member: 172.00 inc. VAT
Non BSAVA Member: 257.50 inc. VAT
All prices are inclusive of VAT. Stock photography: Dreamstime.com. Danilobiancalana; Witthayap
13 CE Advert April.indd 13 19/03/2014 09:43
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I
n the space of a decade, digital and mobile technologies
have revolutionized the way we work and socialize. Over
the past five years the rise of Twitter, Facebooks market
consolidation, and novel mobile apps like Instagram
have accelerated connectivity and digital literacy.
Unsurprisingly it has not stopped there. The next wave
of connected technologies, tentatively labelled the internet
of things, envisions a web of intelligent sensors and
responsive devices that encompasses everything from
smart homes to personalized medicine.
Digital products for the tech-hungry consumer are
readily available, partly due to the wave of enterprise
released by Silicon Valley entrepreneurs. Todays pet
market is awash with bright ideas and the freely available
technology to realize them. It is a brave new world that the
veterinary professional steps into and some of us do so
quite unprepared.
Look at the dizzying array of pet related gadgetry as
evidence: everything from apps to track your pets GPS
collar and measure fitness, to cam-loaded pet feeders
and robotic self-cleaning litter boxes. Play and interact
remotely with your pet, feed them using your Smartphone,
talk to them from the office via a remote camera and
provide treats.
Plugged into pets
Robin Fearon explores the digital
landscape and the opportunities this
offers the veterinary profession
14-17 Digital Pets.indd 14 19/03/2014 09:48
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15
Even the humble name tag has
received an upgrade, sporting a QR code
and GPS tracking to alert you when your
pet has roamed too far. Pet owners have
an arsenal of interactive toys to play with
and this is only the beginning.
It may take a discerning mind to sift
through the opportunities available to the
profession. Vets and vet nurses are in the
distinguished position of knowing what is
best for animal health and welfare so it is
a good idea to bone up on technology to
be in a position to advise clients.
The web of vets and pets
Many veterinary practices have taken up
social media with enthusiasm and that
interface is where many owner interactions
first happen. Susie Samuel, managing
director of VetHelpDirect and web 2.0
specialist, believes practices have quickly
realized the benefits. Social media is
better suited for vets to use than any other
profession or industry I can think of, she
says. Practices with Facebook pages have
built up communities of local pet owners
and they are right at the centre of it.
If it had casually escaped anyones
notice, pets are rampant on the internet.
From cat Twitter accounts to canine
Instagram streams or social petworks,
such as Catmoji, Dogster and Bunspace
(for rabbits), the net is owned by furries.
It is everyones favourite subject to talk
about their animals, says Susie. Vets
have got a stream of material coming
through their doors every day. We have
been given the perfect gift.
Online, pet owners enthusiastically
share images and thoughts about their
companions in their millions. Cats and
dogs monopolize the rich archive of
internet memes images repeatedly
posted until they achieve cultural status
with Boo the Pomeranian, grumpy cat,
singing huskies and catbeards as serial
performers. YouTube channel The Pet
Collective features everything from live
puppy cams and animal facts to pet
re-enactments of Hollywood blockbusters.
VetMart director Caroline Johnson
says her first response to web-enabled
pets was as a quirky emerging trend.
Two years on and that is still my view,
she says. What drives this behaviour is
that owners are passionate about their
pets. People who have common
interests congregate online. The
difference is that online communities
can be on a massive scale.
As founder of an online marketplace for
vets and owners, Caroline sees massive
crossover potential for mobile apps,
GPS-enabled devices and cams. What
they effectively do is deepen our
understanding about animals and what
they get up to when we are not around,
she says. Huge numbers of animal owners
are curious about that.
I also think apps that help with
exercise and obesity are good for animal
and owner. It helps to strengthen the
humananimal bond. For vets it represents
an opportunity to make a sale or, more
importantly, to develop a service offering
for owners.
Pet aids and devices will continue to
emerge whether vets choose to provide
owner advice or not. Forward thinking
animal health and pet merchandising
companies have already produced apps
for making practice appointments, dog
walking and even pet first aid.
Leading the way
Growth in pet spending in emerging
markets and the worlds largest pet
consumer marketplace, the US, is rising to
match this. Pet ownership in China is
expanding based on an emerging middle
class, as elsewhere in Asia, added to the
growing number of couples who would
rather own pets than have children.
America is simply the worlds most
advanced pet and veterinary market,
social media is
better suited for vets
to use than any other
profession or industry
I can think of
Susie Samuel
One of the cats taking part
in the University of Georgia
& National Geographic
KittyCam Project
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Plugged into pets
kick-starting many of the trends registered
worldwide. Annual pet spending in the US
in 2012 was 32.4bn ($53.33bn), or
roughly half of pet product and service
sales globally.
Even a cursory search into digital
trends shows that the US is the launchpad
for many products before their take-up in
Europe and the UK. Another advanced
market for pet products is Japan, the
birthplace of the robotic dog Aibo and the
humble Tamagotchi.
The Tamagotchi was a seminal
development in pet tech taken up
enthusiastically by the Western world.
Ostensibly an electronic game on a
keyring, owners had to feed their
Tamagotchi, play with and take care of it by
pressing the right buttons. As basic as it
was, in some ways it offered potential pet
owners an insight into animal welfare.
Several years later games developer
Nintendo took the concept one stage
further with the game Nintendogs for its
DS console. Players learned about dog
care as an adjunct to playing with their
digital canine friend. To date it is the
second best selling DS game of all time.
Canine charity Dogs Trust endorsed the
product as a way for people to learn more
about the commitment needed in pet
ownership.
In research and in reality
Fast forward a few years and the advent of
pet cams with night vision offer a cats eye
view of pet behaviour. Consumers and
researchers both have access to the
technology and thanks to projects run by
the University of Georgia and the Bristol
Vet School, cams have provided a window
into both feline and canine behaviour.
Emily Blackwell is the Dogs Trust
lecturer in canine behaviour and welfare at
the University of Bristol. Her research into
separation anxiety uses cameras
extensively. We use small and hidden
cameras to see what goes on when dogs
are left alone, she explains.
Channel Fours Dispatches on
13 January this year was one of three
commissioned programmes involving
Emilys group. Entitled Dogs: their secret
lives, Emily worked alongside well-known
vet Mark Evans to reveal details of
domestic dogs affected by separation
related behaviour. Hidden cameras
captured the fear and panic unleashed
when some owners go out to work.
Digital technologies such as the
remote treat dispenser, with a built in
camera and phone, do provide a way
for owners to interact with their pet while
at work, but Emily is not convinced that
it offers a solution to separation
problems. Im not sure how effective it
is going to be, apart from getting a dog
to sit in front of the box waiting for the
owner to respond, she says. It could
be counterproductive.
Potential exists for remote digital
control, especially in the area of play.
Systems that offer the ability to interact with
cats using a laser pointer are well received.
More fanciful technologies such as owner
holograms are less likely to hit the mark.
Again it does not appear to be a substitute
for having the owner present, says Emily.
Though I have no doubt that there will be
imaginative and inventive ways for
technology to be incorporated into
activities and enrichment for dogs.
Next stage technologies for
environmental enrichment are in the
pipeline. Giving pets the ability to affect
their environment, allowing dogs to open
doors or control temperature is being
discussed by Dogs Trust. Ultimately Id
like to see a rehoming centre where they
could choose which individuals they were
paired up with and when they interact with
them, says Emily.
Having witnessed the large proportion
of dogs with behaviour problems brought
on by owner separation, suitably adapted
houses could improve the lot of dogs left at
home. Predictability and control are the
most important things to an anxious dog,
says Emily. If we can give them that
QR codes are replacing the humble name tag
what they effectively
do is deepen our
understanding about
animals and what they
get up to when we are
not around
Caroline Johnson
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RESEARCH PAINED EXPRESSIONS
The University of Lincoln is looking to
recruit for a research project into feline
facial expressions. Working with computer
scientsts, Daniel Mills and his team will use
pictures of cats and visual learning systems
to triangulate facial landmarks associated
with pain. It is a four and a half year project
sponsored by the charity Feline Friends.
Anyone interested in more details can
contact Daniel Mills dmills@lincoln.ac.uk.
Related links and further informaton
available online.
MORE ONLINE
through technology it would be a really
positive thing.
What about welfare?
Accepting that technology can increase
our understanding as veterinary
professionals or pet owners does mean
making judgements about what is suitable
for animals. Behaviourists raise real
concerns about well intentioned products
that play to human ideas about positive
pet interaction.
University of Lincoln researchers, led
by Professor of Veterinary Behavioural
Medicine Daniel Mills, regularly use digital
technology to assess the petowner
relationship. It opens doors, he says.
Trying to understand the stresses they are
under and how to resolve them is
important. Technology can provide the
basic information we need.
Research projects underway at Lincoln
include a GPS and camera study of feline
wandering to assess risk taking, and a
study of the effects of dog ownership on
elderly people. As new technologies
become available they help to fine-tune
understanding. Video was a leap forward
for behaviourists. It has given us so much
more confidence in the diagnoses we can
make, says Daniel.
GPS and other wearable trackers help
create a more rounded picture. We are
getting to the stage where we can use
accelerometers to work out each animals
gait, says Daniel. It allows us potentially
to personalize veterinary medicine.
Personalized medicine is allied to the
idea of an internet of things. We already
implant microchips for identity, so
sensors to measure your pets vital signs
or insulin levels could be next. Dutch
company Sparked opened the way in
2011 by implanting dairy cows with
sensors so farmers can assess herd and
individual health.
what they effectively do is
deepen our understanding
about animals and what they get
up to when we are not around
Daniel Mills
Where next?
Internet everywhere is the trend to watch.
It is there already in exercise trackers.
Relating human activities to animal
activity and benchmarking yourself
against other owners, setting targets, I
think will become really important, says
Susie Samuel. Measuring heart rate or
insulin levels, even if it is only the owner
recording it in an app, could be just
around the corner.
Vets can wait for technology to drop
into their laps, or they could be among the
first to develop concepts in veterinary
medicine. There is no reason why vets
could not drive the agenda, says Susie
Samuel. From what we have seen so far
early adopters get a head start. They
should be horizon scanning.
Being the first to talk about emerging
technologies and taking part in social
media does not make you frivolous, or a
revolutionary, but it does make sound
business sense, adds Caroline Johnson:
It is about sharing enthusiasm and
developing that bond with owners. It also
positions vets a little bit more at the front
end, more cutting edge than the
traditional practice.
Working out which technologies are
helpful, positive for pet health and welfare,
harmless fun or counterproductive, will
take time. Arriving early at the party at least
provides veterinary professionals with a
few discussion points.
If nothing else, the rise and rise of
digital demonstrates that deciding whether
to join the conversation is not optional. It is
a huge opportunity to join in the fun, to be
amongst everybody while it is happening,
says Caroline. Wherever your target
audience gathers online, you would be
mad not to join in.
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How to manage
urethral obstruction
in dogs
U
rethral obstruction is not uncommon in the
male dog and represents a potentially
life-threatening condition. This article aims to
cover the diagnosis and subsequent
management of the patient to the point where the
obstruction is relieved and urine flow is either
temporarily or definitively re-established (Figure 1).
Clinical history and assessment
The clinical history will typically include frequent
attempts to urinate associated with varying degrees of
success. Urethral obstruction does not have to result in
absence of urine flow; dysuria resulting from partial
urethral obstruction as also be reported or noted to
precede complete obstruction.
Cases present at a point along a spectrum of
clinical signs of systemic illness ranging from
discomfort associated with an overfull bladder, to
depression and finally collapse associated with shock,
post-renal azotaemia and hyperkalaemia. Clinicians
should also be aware that rupture of the bladder is
possible, resulting in a temporary improvement in the
comfort of the dog and a small or absent bladder on
abdominal palpation.
Clinical examination should include assessment of
the level of dehydration, the cardiovascular status of
the patient and size of the bladder. It should be
remembered that clinically significant hyperkalaemia
can slow the heart rate sufficiently to be within normal
limits or slow, despite the clinical picture being that of a
dog in which tachycardia would be more appropriate.
Attempts at manual urine expression should be
performed with caution (if performed at all) due to the
significant risk of iatrogenic bladder rupture and likely
pain reaction from the dog. Rectal examination is
indicated to assess for possible prostatomegaly,
prostatic pain and urethral enlargement (e.g.
transitional cell carcinoma or granulomatous urethritis).
A minimum database should be performed on a
blood sample where possible (Table 1).
Electrocardiogram (ECG) assessment can be useful but
is not essential provided potassium levels are measured
and the cardiac rate and rhythm is carefully assessed.
Bradycardia caused by hyperkalaemia can be
characterized by a number of ECG changes, including
small or absent P waves and spiked T waves (Figure 2).
Stabilization
Successful stabilization requires that the kidneys are
able to function without hindrance from either poor
Chris Shales from Willows
Veterinary Centre and Referral
Service works us through the
approach to this challenging
presentation
Stabilization
Imaging
Clinical
examination
Initial
diagnostics
Definitive
treatment
Intermediate
treatment
Figure 1: Flow diagram to illustrate the logical progression of these cases from
presentation to treatment
Packed cell
volume (PCV)
Always interpreted together and
assessed using a microhaematocrit tube,
centrifuge and a refractometer. Used to
assess the level of dehydraton and direct
uid management protocol
Total solids
(TS)
Glucose (and
ketones)
Ketoacidosis is an important diferental
diagnosis
Electrolytes
(Na
+
, Cl
, K
+
,
Ca
2+
)
Measurement of potassium is essental,
partcularly in cases with potental for
hyperkalaemia
Urea Azotaemia, if present, is usually post-
renal, but the owners need to be warned
that the potental for pre-existng renal
dysfuncton cannot be ruled out untl
the obstructon has been resolved and
kidney functon re-assessed
Creatnine
Table 1: Minimum database for blood work in suspected
cases of urethral obstruction
18-23 HOW TO.indd 18 19/03/2014 11:11
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perfusion or obstruction to urine flow.
Intravenous access should be established soon
after admission and appropriate fluid therapy provided
based on the degree of dehydration, presence of
hypovolaemic shock and potassium level. Fluid
therapy and restoration of renal urine output either by
passage of a urethral catheter or cystocentesis usually
results in correction of azotaemia and hyperkalaemia.
Whilst most cases of hyperkalaemia will resolve
using the treatment discussed, patients with severe
bradycardia (below 60 bpm) or where the potassium
level is very high (above 77.5 mmol/l) are likely to
benefit from additional support whilst the renal function
is restored. Treatment of hyperkalaemia is outlined in
Table 2 and additional details are available in the
BSAVA Small Animal Formulary.
Cystocentesis is useful in dogs when urethral
catheterization is unsuccessful in order to restore renal
urine output or to enable retrohydropulsion of
obstructing uroliths with a lower risk of iatrogenic
bladder rupture. Whilst there are concerns that
cystocentesis can result in uroabdomen or peritonitis
secondary to urinary tract infection, leakage is rarely
clinically significant and the risks are usually justified
by the benefits gained in this situation.
Imaging
Once the dog is stable, the cause of the urethral
obstruction can be investigated using conventional
radiography with the option of ultrasonography if there
is significant suspicion of bladder or prostatic
pathology (e.g. transitional cell carcinoma,
cystolithiasis, prostatitis, prostatic carcinoma).
Survey radiographs and uncomplicated
transurethral catheterization can often be performed
with the dog conscious or under sedation. Male dogs
that have developed dysuria secondary to conditions
such as reflex dyssynergia, prostatomegaly,
granulomatous urethritis or neoplasia can usually be
catheterized without significant difficulty, and then
proceed to investigation and biopsy as appropriate.
In cases of obstruction secondary to urolithiasis,
general anaesthesia is usually preferable due to the
high probability of the requirement for
retrohydropulsion and a retrograde positive contrast
urethrogram. Alfaxalone may be a preferable
induction agent due to its reduced suppression of
Normal
P
R
R
R
T
T
T
Late hyperkalaemia
Early hyperkalaemia
Figure 2: Diagrammatic representation of ECG changes that
can occur in the presence of hyperkalaemia
Restore
renal urine
output
Relief of the obstructon via transurethral
catheterizaton, if possible, or cystocentesis
to re-establish renal urine output
Support
renal
functon
Fluid therapy to improve renal perfusion.
Sodium chloride (0.9% NaCl) is ofen
considered where there is concern
regarding hyperkalaemia, but Hartmanns
soluton is usually acceptable provided the
kidneys are supported and functoning
Calcium
(boro)
gluconate
Antagonizes the efect of hyperkalaemia
on the cardiac acton potental, increasing
the strength of contracton and providing
protecton against bradyarrhythmia for
1030 minutes. Administered slowly to
efect whilst monitoring the ECG
(0.51.5 ml/kg of 10% calcium (boro)
gluconate slow i.v.)
Glucose Whilst cellular glucose uptake under
the efect of insulin results in temporary
intracellular sequestraton of potassium,
administraton of glucose alone is
unlikely to result in a sufcient increase
in endogenous insulin to afect blood
potassium levels. As such administraton of
glucose alone can not be relied upon
Glucose
and insulin
A combinaton of intravenous regular
insulin (0.250.5 IU/kg) and dextrose
(2 g dextrose for each unit of insulin)
can be utlized in cases of hyperkalaemia
refractory to the management techniques
listed above. Intensive monitoring of blood
glucose is required
Table 2: Treatment of hyperkalaemia
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How to manage
in dogs
the cardiorespiratory system. Propofol, when used,
should be given slowly to effect.
n Begin with a plain lateral radiograph, bearing in
mind that it may be necessary to pull the hind legs
forwards or backwards to enable imaging of the
urethra without the femurs being superimposed over
the area of interest (Figure 3). Be sure to assess
which position the legs need to be in to achieve a
clear view of the region you are most interested in
(usually just caudal to the os penis) (Figure 4).
Assessment of the probable location of the
obstruction by passing a catheter can be helpful.
n Ventrodorsal radiographs can be used to confirm
the anatomy of the bladder and abdomen but are
of limited use in assessment of the urethra.
Once the cause of the obstruction has been
identified, treatment options can be considered. In the
case of urethroliths, retrohydropulsion is the technique
of choice to move the obstruction back into the
bladder prior to definitive treatment.
In the event that the cause of the obstruction is not
clear, or the clinician wants to confirm completion of
successful retrohydropulsion, a positive contrast
urethrogram is necessary.
Positive contrast retrograde urethrogram
n 3050 ml of iodinated contrast medium (150 mg/ml)
is drawn up into a syringe and used to prime a
standard polyurethane male catheter of
appropriate size for the dog. An extension set may
also be used to distance the operator from the
primary X-ray beam.
n The catheter is introduced approximately
24 cm into the urethra to ensure that the side
openings are within the urethra, and the
catheter secured in position by firmly clamping
the distal penis with atraumatic forceps (e.g.
bowel clamps) (Figure 5).
n The radiograph is taken as the contrast
medium is injected into the urethra, to ensure
the urethra is filled with contrast medium (a
dynamic study) (Figure 6). Appropriate
protective clothing must be worn.
n The clinician can then assess the contrast
medium column within the urethra for evidence of
filling defects that could be clinically significant
(e.g. stenosis, urethroliths) (Figure 7). Gas
bubbles can be misleading (Figure 8) and
usually disappear or change if the study
is repeated.
Figure 4: Plain lateral radiograph with the hind legs pulled forward.
A radiopaque urolith is visible a short distance caudal to the os penis
Figure 3: Plain lateral radiograph of a male dog with the femurs obstructing
visualization of the caudal os penis. Be sure not to over-interpret the
presence of the fabellae at the caudal aspect of the stifle joint
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Figure 5: Photograph showing an example of iodinated contrast medium
and water used to dilute it prior to use. There are two examples of
atraumatic forceps suitable for use on the distal penis. The bow of the
bowel clamps has been exaggerated slightly to adapt them for use on
the penis
Figure 6: Positive contrast urethrogram in a dog following successful
retrohydropulsion. There are no filling defects within the contrast
medium column. Limb positioning was challenging in this Pug and this
was considered a suitable compromise given the anatomical limitations
on limb movement
Figure 7: The flow of contrast medium within the urethra is obstructed by
an intraluminal urethrolith, resulting in a typical golf tee shape to the
contrast medium column
Figure 8: The filling defect (red arrow) in this contrast urethrogram has not
prevented contrast medium flow, is centralized within the contrast
medium column, conforms to the dimensions of the urethra and is very
smooth, all of which suggest an air bubble is most likely. The artefact was
absent when the study was repeated (Figure 6)
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How to manage
in dogs
Figure 9: The retrograde urethrogram confirmed successful retrohydropulsion and the
clinical suspicion of a ruptured urinary bladder. There is a low volume contrast medium
bloom associated with the prostate gland in this entire male. The rupture occurred just
prior to presentation to the referring vet and had been associated with a significant
improvement in the comfort level of the dog. The dog proceeded to theatre for
recovery of the retropulsed uroliths and repair of the bladder
A normal positive contrast urethrogram should be
obtained following successful retrohydropulsion
(Figure 6).
Retrohydropulsion
The morbidity and potential complications associated
with urethrotomy indicate that retrohydropulsion should
be used whenever possible to force uroliths back into
the bladder.
1. Consider decompressive cystocentesis to prevent
bladder rupture (Figure 9).
2. Never use the catheter to push against uroliths
causing obstruction, as this will risk iatrogenic
urethral rupture.
3. Advance a transurethral catheter of the largest size
suitable for the dog to the level of the obstruction.
4. Occlude the distal penile urethra either with a firm
grip or a bowel clamp to prevent normograde
egress of saline.
5. Place a finger per rectum (an assistant may be
required) and used to occlude the urethra
proximal to the obstruction by compressing it
against the ischium.
6. Use a 30 or 50 ml syringe to instil saline into the
urethra with firm pressure. The finger per rectum
can usually appreciate the filling of the urethra
and can periodically release the compression to
allow rapid flow of saline into the bladder. This
inflation/release procedure is repeated until the
obstruction is relieved or the clinician accepts
that the obstruction cannot be resolved.
With the appropriate technique and level of
patience, most uroliths can be successfully
repositioned within the bladder.
Once the uroliths are in the bladder, the dog can
either be taken straight to theatre for definitive
treatment or catheterized as a temporary measure to
allow more time for stabilization or to enable definitive
treatment to be carried out at a more suitable time
(Figure 1). Foley catheters are preferable to more
rigid catheters when left in place for any significant
length of time. Definitive treatment requires removal
of all uroliths via a cystotomy. (This was discussed in
the How To article in October 2009 companion by
Chris Shales).
Failure of retrohydropulsion
Retrohydropulsion can take a significant amount of
time and may require additional cystocentesis
procedures to prevent overfilling of the bladder. Every
effort should be made to achieve successful relief of
the obstruction as failure to do so results in one of the
three following scenarios:
1. Placement of a temporary cystostomy tube to
allow urine drainage and afford the urethra time
to recover from spasm or swelling for several
days before trying retrohydropulsion again.
Spasmolytic and anti-inflammatory medication
could be considered in the interim. Uroliths in the
bladder could be removed at the time of tube
placement to potentially avoid the need for a
second laparotomy/cystotomy in the future.
Future retrohydropulsion procedures should then
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be performed with the cystotomy tube open to
prevent pressure build-up in the recently
operated upon bladder. Successful
retrohydropulsion necessitates the cystotomy
incision be re-opened to recover the dislodged
uroliths, and the desire to avoid this may lead to
the cystotomy procedure being postponed rather
than being performed at the time of temporary
cystostomy tube placement.
2. Placement of a temporary cystotomy tube to allow
urethrotomy surgery to be carried out at a more
suitable time. Cystotomy may need to be
performed at the same time as the urethrotomy if
cystoliths remain present.
3. The dog proceeds directly to theatre to undergo
urethrotomy and cystotomy.
Dalmatians
Whilst steps are being taken to reduce the incidence
of urate stone formation in this breed, cases
presented with urethral obstruction due to radiolucent
uroliths need to be managed in a way that takes into
account the significant risk that the stones will
re-form. Permanent urethrostomy can be considered
significantly earlier than would be appropriate in
other breeds.
Conclusion
Urethral obstruction can be a challenging but
rewarding clinical presentation. Consideration of the
pathogenesis and relevant anatomy are important in
achieving a successful outcome. n
WHAT HOW TO WOULD YOU DO?
Over the last 6 years we have produced 72 How To
features. This popular series aims to ofer accessible
guides to a range of subjects. We have covered selectng
the right urinary catheter and performing a gastropexy,
to microchipping chelonians and reading an ECG.
What would you like to see as the subject of a future
How To artcle? Is there an expert youd like us to
try to commission writng on a mater relatng to their
specialist area?
Please email companion@bsava.com and a member of
our Editorial Board will get back to you.
AVAILABLE FROM BSAVA
BSAVA Manual of Canine and Feline
Nephrology and Urology
2nd editon
Edited by: Jonathan Elliot and Gregory Grauer
Diseases of the kidney and bladder are among the most
common presentng disorders in general practce. This
Manual reviews these conditons and ofers concise
informaton on ways to diagnose and treat them.
n Chapters on cystoscopy and lithotripsy
n Chronic kidney disease covered in depth
n Management of glomerulonephrits
n Internatonal contributors
WHAT THEY SAY
...clearly writen, organized and concise... charts and
diagrams are helpful... color images are of excellent
quality... will serve as an excellent reference textbook for
veterinary students and practtoners alike...
JOURNAL OF THE AMERICAN VETERINARY
MEDICAL ASSOCIATION
Member price: 49.00
Price to non-members: 79.00
BSAVA Manual of Canine and Feline
Abdominal Imaging
Edited by: Robert OBrien and Frances Barr
The introductory secton of this Manual outlines the
approach to abdominal imaging, with chapters dedicated
to radiography and ultrasonography. The second secton
is devoted to imaging of the abdominal spaces and
the common structures, including the vasculature and
lymphatc system. The remainder of the Manual is given
over to the individual body systems.
n Normal radiographic anatomy
n Radiographic variatons seen with disease
n Chapter dedicated to abdominal masses
n Contrast radiography, ultrasonography, CT and MRI
WHAT THEY SAY
extremely useful for the general veterinary practtoner
and a valuable learning tool for veterinary students
AUSTRALIAN VETERINARY JOURNAL
Member price: 49.00
Also available
as an e-Book
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The second edition of the BSAVA Guide to
Procedures in Small Animal Practice was launched
at Congress 2014. Here, the editors, Nick Bexfield
and Karla Lee, take companion readers through
the procedure on cerebrospinal
fluid collection
SITE SELECTION
Cerebrospinal uid (CSF) is more commonly collected
from the cerebellomedullary cistern as it is easier,
usually results in a larger sample volume, and
is typically associated with less iatrogenic blood
contaminaton than collecton from the lumbar cistern.
In cases of focal central nervous system (CNS) disease,
samples are more likely to be abnormal when they are
collected caudal to the lesion. Therefore, in animals
with lesions involving the spinal cord or canal, lumbar
cistern samples are more consistently abnormal than
samples collected from the cerebellomedullary cistern.
Collecton from both sites can be considered in cases
of diuse pathology or when one of the samples is
contaminated.
Indications
Suspected meningitis
Infectious or inflammatory CNS disease
Pyrexia of unknown origin
Suspected CNS lymphoma
Contraindications
Signs suggestive of raised intracranial pressure
(e.g. progressive obtundation; initial miosis than
later fixed mydriasis; extensor rigidity;
opisthotonos; irregular respiration)
Evidence of brain herniation on CT/MRI
Suspected active intracranial haemorrhage or
haemorrhagic diathesis
Luxation or vertebral instability of the caudal
lumbar vertebrae
Empyema or spinal epidural abscess
Infection of the soft tissues overlying the
puncture site
Patient at high risk of anaesthetic complications
Equipment
Materials for aseptic skin preparation
Spinal needle:
20 G (large or giant breed dogs) to 22 G (cats
and small dogs)
1.5 inches (cats) to 23 inches (dogs)
Sterile gloves
EDTA and sterile plain collection tubes
Sedimentation chamber
CSF collection
W
e have been delighted by the success of
the first edition, which suggests that this
Guide has become the number one
reference for step-by-step instructions
on diagnostic procedures performed routinely in
small animal veterinary practice. The second edition
aims to build on this success and to increase the
confidence and accuracy with which these
procedures are performed.
We have reviewed and updated all of the
procedures in the BSAVA Guide to Procedures in
Small Animal Practice in line with new editions of
BSAVA Manuals and with progress in the field of
veterinary medicine.
Cerebrospinal fluid sampling
lumbar cistern
24-26 Publications.indd 24 19/03/2014 11:30
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Patient preparation and positioning
General anaesthesia is essential
The animal is placed in lateral recumbency, with its
dorsum near the edge of the table
Flex the lumbar spine by moving the hindlimbs
cranially and have an assistant hold the animal in
this position
Locate the appropriate intervertebral space:
Dogs: L4L5 or, preferably, L5L6
Cats: L5L6 or, potentially, L6L7
This is done by palpating the iliac crests: the
small, difficult-to-palpate vertebral spinous
process found between the iliac crests is L7;
the much more prominent vertebral spinous
process immediately cranial to the iliac crests
is that of L6
Aseptic preparation for non-surgical procedures is
performed over an area at least 5 cm wide
Technique
1. The needle is inserted at an angle of 45
degrees to the skin, on the midline, and just
caudal to the appropriate vertebral spinous
process (e.g. caudal to the spinous process of
L6 to reach the L5/L6 space), with the bevel
facing cranially
L5 L7
2. Once the skin is penetrated, advance the needle
until it hits bone (the dorsal lamina). The stylet may
be left within the spinal needle
L5
Cranial
L6
L5 L7
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CSF collection
3. Walking the needle over the dorsal lamina is often
required to arrive at the resistant interarcuate
ligament. Allow the needle to pass through the
interarcuate ligament
4. When the needle passes through the cauda
equina/caudal spinal cord, this often elicits a tail or
leg twitch
5. The needle is advanced to the bottom of the spinal
canal. Remove the stylet and wait for CSF to flow
Cells can be concentrated using a homemade
sedimentation chamber. The flanged end of a 2 ml
syringe barrel (the end where the plunger would be
inserted) is clamped to a clean microscope slide
using bulldog clips after smearing Vaseline
or
another occlusive lubricant around the base to
form an airtight seal. 0.250.5 ml of CSF is put into
the chamber and left for 30 minutes; the
supernatant is then removed using a pipette. The
slide with adherent cells is then air-dried and
submitted to the laboratory unstained. Other tests
can be performed on the supernatant
Alternatively, rather than concentrating the
cells, they can be preserved by the addition of
3050% by volume of the animals own serum
(i.e. 0.30.5 ml serum to 1.0 ml CSF). This will
preserve the CSF cells for up to 48 hours after
collection. If this is done, it is important also to
submit a CSF sample in a plain tube without the
addition of serum to enable total protein
measurement and any other analyses
CSF in an EDTA tube is submitted for cytological
examination, total protein and total nucleated
cell count
CSF in an EDTA tube can also be submitted for the
detection of infectious diseases by PCR
CSF in a sterile plain tube can be submitted for
serology, bacteriological or fungal culture if
required
Potential complications
Cerebral and/or cerebellar herniation due to
changes in intracranial pressure resulting in
brainstem signs, respiratory arrest and death
Spinal cord trauma due to needle puncture
CNS haemorrhage
Iatrogenic infection
Eligible members who did not collect their
complimentary copy at BSAVA Congress will be
sent their Guide by the end of May. To purchase
additional copies online visit www.bsava.com
The illustratons for the BSAVA Guide to Procedures
in Small Animal Practce were drawn by S.J. Elmhurst
BA Hons (www.livingart.org.uk) and are printed with
her permission.
6. When the subarachnoid space has been entered,
CSF will appear in the needle hub. If no CSF
appears, retract the needle slightly or turn the hub
gently. If blood emerges from the needle hub, entry
into a local blood vessel is likely and the sample
will be less useful for cytological evaluation.
Remove the needle and make a fresh attempt with
a new needle
7. Collect CSF by allowing it to drip passively from
the hub into collecting vessels. Suction with a
syringe should not be applied
8. When a minimum of 0.5 ml CSF has been
collected, withdraw the needle in a single motion
9. Fluoroscopic/radiographic needle guidance might
be helpful in some cases
Sample handling
CSF is hypotonic compared to serum; the cells
within CSF swell rapidly and burst due to osmotic
lysis soon after collection. Ideally, CSF should be
either analysed or preserved for analysis within
3060 minutes of collection
Most CSF samples contain relatively few cells;
therefore, the sample can be concentrated by
some means prior to microscopic examination.
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Get involved
Cycling
Cycle with PetSavers by taking part in The
Wiltshire 100 Bike Ride which takes place
on 7 September. Take on the heroic
100-mile ride passing through Wilton,
Salisbury and the Avon Valley. If you want
to take part in an event closer to home, its
not a problem. Just email us to let us know
youre taking part and well support you
every step of the way. This years ride will
be held on Sunday 7 September and is
available to enter online at www.bike-
events.com.
Extreme events
For some people the thrill of a run or a walk
just isnt enough. Do you fancy a different
challenge? Why not join us in getting
Thanks to you, in the last forty years PetSavers has
funded over 180 clinical research and training
programmes that have led to some key breakthroughs
in the treatment of small animal diseases. But we want
to do more! Heres how you can get more involved
muddy and take on the worlds largest
obstacle course 20 miles 200 obstacles
The Rat Race Dirty Weekend at Burghley.
You can enter as an individual or as part of
a team. The event will take place on
Saturday 10 May, so theres plenty of time
to get in shape. To take part please contact
Emma Sansom on e.sansom@bsava.com
or call 01452 726723.
Get your
practice
involved
200 Project
We are asking for
the support of the
UK small animal
practices to each
raise 200
throughout 2014 to help us continue
funding crucial clinical research to improve
our knowledge and understanding of the
many conditions affecting small animals.
By joining our 200 Project we are
asking practices to pledge to raise 200
by whatever means they can. It can be
through taking part in external fundraising
events, organizing your own fundraiser in
the practice, selling our PetSavers
products, or simply placing an individual
donation. If every small animal practice
can raise at least 200 we can continue to
fund clinical research projects into small
animal diseases well into the future.
200 is invaluable to us and very
achievable for you to find out more about
joining the PetSavers 200 Project please
contact 01452 726723 or email info@
petsavers.org.uk.
Running events
We have events to suit all runners. Whether
you are looking for a fun run, marathon or
obstacle course, we would love to have
you as a part of Team PetSavers! There are
a range of events you can take part in to
support PetSavers from The British 10K
London Run and the Bath Half Marathon to
the Virgin London Marathon. You can sign
up to run in any events for us; we really
appreciate your efforts and we will give you
full fundraising and training support,
including a running vest.
27 PetSavers.indd 27 19/03/2014 12:58
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Greetings from a not so
warm and sunny Florida!
W
hile the cold and wet weather
at the start of 2014 put a
damper on our outdoor
activities here in Florida, the
WSAVA Executive Board and Committees,
as well as the WSAVA Foundation Board,
have been very active!
Id first like to congratulate Drs Polzin,
Cowgill and Lees and the members of the
Renal Standardization Project on the
successful completion of Phase One of
their study. Well bring you more details in a
future issue.
The Hereditary Disease Committee has
also been busy and I thank its chair, Dr Urs
Giger, on the relationship he has
developed with Wisdom Panel
. They have
now funded an additional three years of
this important project. I encourage you to
visit the WSAVA website and check under
Resources for a list of all canine and feline
New WSAVA Award
to be unveiled
WSAVA is delighted to
announce a new award
which will be presented
for the first time in Cape
Town in September 2014
T
he WSAVA Awards highlight
ground-breaking research and
achievement in global companion
animal care this year we are
delighted to announce a new award
which will be made for the first time at
World Congress in Cape Town in
September 2014.
The WSAVA Meritorious Service Award
will be presented annually during WSAVA
Congress to a veterinarian who has
contributed meritorious service to the
veterinary profession in the broadest
genetic diseases with known mutations
and an explanation of how to submit
samples for DNA testing.
The WSAVA Foundation has also been
busy under the leadership of new Chair
Dr Gabriel Varga. With the assistance of
Professor Michael Day and the Scientific
Advisory Committee, he has developed a
proposal to increase the footprint of the
WSAVA in Africa and to enhance education
in companion animal medicine and surgery.
Called the African Small Companion Animal
Network (AFSCAN), the project has been
funded through a generous grant from
Zoetis and is about to get underway.
The Executive Board met during the
Western Veterinary Conference in Las
Vegas. The agenda was long and I expect
to share more exciting news about
increased WSAVA activities and member
benefits soon!
sense: as a general practitioner, an
academic veterinary surgeon, or as a
veterinarian working in management or for
a company.
The judging committee will look for
candidates with a history of serving the
profession through holding voluntary roles
within professional organizations over a
period of years, or who have exhibited
professional expertise during their working
life. The award is international but the
Committee will consider strongly
candidates from the WSAVA region where
the World Congress is taking place that
year. The winner will receive $1,000 and a
plaque, as well as free registration, free
accommodation for four nights, travel and
the social events at WSAVA Congress.
To find out more about the WSAVA
Awards and the nomination process, please
contact wsavasecretariat@gmail.com.
WSAVA President
Colin Burrows shares
his thoughts
28-29 WSAVA.indd 28 19/03/2014 12:37
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T
he OHC works to ensure the
prominence of the small
companion animalhuman
interface in the global One Health
agenda.
The WSAVA One Health Committee
(OHC) works to promote three inter-related
aspects of One Health in relation to small
companion animal practice:
1. The importance of the humansmall
companion animal bond for the benefit
of human health and well being
2. The importance of zoonotic infectious
disease transmitted to man from small
companion animals or for which small
companion animals are a reservoir of
infection. Globally, the two most
significant such diseases are canine
rabies virus infection and canine
leishmaniosis
3. The importance of comparative and
translational clinical research into
spontaneously arising small companion
animal disease for the benefit of
veterinary and human medicine.
A short history
The WSAVA OHC was established in 2010.
It has an international composition,
including representatives from: the World
Organisation for Animal Health (OIE);
Centers for Disease Control and Prevention
(CDC); and National Institutes of Health
(NIH). The first One Health project (Phase I)
was supported by a consortium of industry
sponsors and was concluded at the end of
2013. Its achievements so far include:
Signing of a memorandum of
agreement with OIE (2011) making the
WSAVA the official voice for small
companion animal matters within the
OIE General Sessions
Hosting of a joint OIE-WSAVA
symposium at OIE headquarters in
Paris in November 2013. The
symposium was entitled Rabies and
Other Disease Risks from Free-roaming
Dogs and a major outcome was a
signed joint declaration on the control
of canine rabies. This outlined the key
requirements for global elimination of
canine rabies
COMMITTEE FOCUS: ONE HEALTH COMMITTEE
WHO SITS ON THE ONE HEALTH
COMMITTEE?
Professor Michael J Day, UK, Chairman
Dr Sarah Cleaveland, UK
Dr Umesh Karkare, India
Professor Chand Khanna, USA (NIH)
Professor Jolle Kirpensteijn, the
Netherlands (WSAVA Board)
Professor Colin Burrows, USA
(WSAVA Board)
Professor Michael Lappin, USA
Dr Carol Rubin, USA (CDC)
Dr Alex Thiermann, France (OIE)
Dr Gregg Takashima, USA
Dr Will Eward, USA
AFFILIATE MEMBERS
Professor Ed Breitschwerdt, USA
Professor Thijs Kuiken, the Netherlands
Establishment of the WSAVA One
Health Prize for the poster or free
communication delivered at WSAVA
Congress that best epitomizes One
Health. Awards were made in Korea
(2011), Birmingham (2012) and
Auckland (2013)
Identification of global eradication of
rabies virus infection as a significant
One Health target for companion
animal veterinarians. Engagement with
the Afya Serengeti Project, the Global
Rabies Alliance, the Partners for
Rabies Prevention (PRP) and the World
Society for the Protection of Animals
(WSPA). This led to the development of
WSAVA-branded dog collars and
owner wrist bands that were trialled in
the Afya Serengeti project to
temporarily identify vaccinated dogs
during vaccination campaigns.
Preliminary data indicate that the
availability of collars and wrist bands
significantly increased the proportion of
dog populations vaccinated during the
2013 campaign. The initiative was
made possible with additional
generous funding provided by MSD
Animal Health.
Opportunities and challenges
The One Health concept has gathered
momentum with the WSAVA OHC
recognized globally as the champion of the
involvement of small companion animal
practitioners in One Health. The greatest
challenge has been securing the support
of the human medical community to a
concept that has been readily embraced in
veterinary medicine.
The WSAVA OHC counts amongst its
members individual veterinarians who work
in human research or disease control
organizations, and it has recently appointed
a dually qualified veterinarian and MD (Dr
Will Eward) from Duke University Medical
Centre, who will help foster our links with
the human medical profession.
Priorities for 2014
2014 marks the start of Phase II of the
activity of the OHC. We are grateful to
those members of the sponsorship
consortium who have re-engaged with the
project and pledged support for a further
three years. We also welcome new
consortium members. We have planned a
further programme of activity for the
201416 period that will commence with a
meeting at North Carolina State University
and Duke Medical Centre in June 2014.
Contact details
OHC Chair Professor Michael Day says: It
was an honour to have been tasked by
WSAVA with establishing the One Health
Committee and a privilege to have led this
group over the past three years. We have
become recognized as global leaders in
small companion animal One Health and
have had particular impact in highlighting
the importance of zoonotic infectious
disease that might be transmitted to man
from pets. The recent OIE-WSAVA joint
symposium on diseases of free-roaming
dogs was hugely successful and, for me,
the pinnacle of achievement so far. I look
forward to leading the Committee into a
second very productive period of activity
from 201416.
WSAVA ONE HEALTH COMMITTEE
SPONSORS
Hills
Zoets
Waltham
Bayer HealthCare
Merial
MSD Animal Health
Novarts
Nestl Purina
28-29 WSAVA.indd 29 19/03/2014 12:37
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Marge Chandler is an independent consultant
in small animal nutrition and internal medicine
and Honorary Senior Lecturer in Clinical
Nutrition at the Royal (Dick) School of Veterinary
Studies, University of Edinburgh. She also
provides a Nutrition Service through Vets Now
Referrals. Marge graduated from Colorado
State University, and after several years of
mixed practice, did a dual residency at
Colorado State and Massey University in New
Zealand. Marge is a member of the Australia
and New Zealand College of Veterinary
Scientists as well as a diplomate of the
American Colleges of Veterinary Nutrition and
Veterinary Internal Medicine and the European
College of Veterinary Internal Medicine. She is a
regular speaker at BSAVA Congress and an
author of several chapters in the BSAVA Manual
of Feline Practice.
Marge
Chandler
DVM MS MANZCVSc
DipACVN DipACVIM
DipECVIM-CA MRCVS
the companion interview
Q
Youve worked in various countries, are there
any key differences in the way the profession
operates? Why settle in the UK?
A
I did residencies in both small animal nutrition
and internal medicine, and the University of
Liverpool offered a position which included both
areas. After two years at Liverpool, I moved to a similar
position at the University of Edinburgh.
I moved to the UK after living in New Zealand for
four years, so have lived out of the USA for over two
decades. That makes it difficult to compare the
countries directly as there is a time factor; however,
everywhere Ive practised, pet owners want to do the
best for their pets and the veterinary health teams have
a similar enthusiasm for providing care.
What made you choose to take the career path you
did and focus on nutrition what is it about this
subject that you find particularly fascinating?
I have always had an interest in nutrition and actually
started out with an interest in equine nutrition. As an
undergraduate in California and then as a veterinary
student at Colorado State University I had excellent
nutrition teachers in Dr Wes Patton and Dr Lon Lewis
who both encouraged my interest. After several years
as a mixed animal practitioner I obtained a research
position at CSU working with Dr Sarah Ralston on
neonatal puppy nutrition research projects. From there
I started a double residency, with the goal of
becoming a diplomate both in the American College of
Veterinary Nutrition and the American College of
Veterinary Internal Medicine. I completed the first part
of my residency at CSU with Dr Steve Wheeler, an
internal medicine specialist with an interest in nutrition.
When he left to start a private referral practice in
Denver, I went to New Zealand to work with Dr Grant
Guilford at Massey University. Dr Guilford is ACVIM
boarded in small animal medicine and has a PhD in
small animal nutrition from the University of California
at Davis. Davis is the mother lode and spiritual home of
small animal nutrition because of the pioneering work
of Drs Quinton Rogers and James Morris. My interest
30-31 Interview April.indd 30 19/03/2014 12:41
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has been supported and fostered by
inspiring and brilliant individuals; working
with Dr Guilford was especially invaluable
for my career as he was a perfect mentor
for me.
Nutrition affects every aspect of an
animals health and is vital to the treatment
of many diseases, which makes it an
excellent pairing with an interest in internal
medicine as well as dermatology and some
of orthopaedics and dentistry, and
emergency medicine sorry if Ive left
anyone out! It is often the key part of a
therapy for many disorders.
Some say nutrition is a matter of
common sense what is your response
to these kinds of comments?
Nutrition is a science and we are learning
more about it every day. There are some
who figure they can feed themselves and it
is just common sense to feed their pets;
however, the subtle effects on immunity,
energy, coat quality, and risks of disease
may not be recognized. In human
medicine, nutrition is being recognized as
a primary risk factor for many diseases,
and we will learn more about that in our
patients as research progresses. As far as
the concept that if a person can feed
themselves they can successfully feed
their pets, we only have to look at the NHS
and reports about the costs of human
obesity and cancer, both of which have
nutritional risk factors and the incidence of
both are increasing.
Manufactured pet food was put under
the spotlight earlier in the year after a
television programme and a series of
media reports. What were your thoughts
about this?
The title of programme, The Truth about
Your Dogs Food, made it potentially sound
like an expose of commercial foods even
before the programme started. The
programme played on the emotive aspects
of the discussions, especially from those
against feeding commercial foods. The
veterinary surgeons and the Pet Food
Manufacturers Association (PFMA) CEO
Michael Bellingham appeared more
reserved as they tried to present the
science and evidence-based facts. It
would have been nice to see a more
balanced presentation.
How can general practitioners
communicate the science behind
nutrition to clients in a relevant way that
will encourage compliance?
The first steps for general practitioners
when talking about nutrition are to take a
diet history, determine the body condition
score, and weigh the pet at every consult.
Before discussing nutrition, we need to
know what owners are feeding. If it is not a
good quality commercial diet or the pet has
a nutrient sensitive disorder (e.g. chronic
kidney disease, obesity, etc), we may need
to find out the reasons for the owners
choice of food, and then we can discuss
nutrition with them. A survey has shown that
owners do want nutrition information from
the veterinary health care team. Nurses are
sometimes more able to communicate
effectively with owners in many health care
areas, and I have found an encouraging
enthusiasm about nutrition in the veterinary
nursing profession. Veterinary GPs need to
recognize the importance of diet, and this
could be driven from two directions. One is
owner interest in the area, and the other is
recognition by the veterinary schools of the
importance of education in small animal
nutrition so that the teaching of small animal
nutrition improves. In surveys we have
found many GPs do not feel they were
taught nutrition adequately and this
influences their confidence in providing
nutrition advice to owners. We have started
a group of European Veterinary Nutrition
Educators with the goal of improving
veterinary nutrition education.
What have been the key advances in
nutritional understanding in the past ten
years? And what is on the horizon that
we should be excited about?
There is exciting research on the effects of
specific foods and nutrients on
metabolism, for example, to increase the
bodys use of fat for energy and to increase
the lean body (muscle) mass. As obesity is
the most common nutrition disorder in pets
(and humans) in developed countries, the
research in this area is exciting and vital.
Obesity affects many aspects of health; in
humans they have even found effects on
cognition. Another interesting area that is
developing is nutrigenomics, which studies
the effect of diet on the expression of
genes. This has come a long way from
the genetic concepts that I was taught,
in that we now know the expression of
genes can be influenced by the
environment. We may also see diets
tailored to an individuals genetics as we
understand more about the interplay of
diet and gene expression. Another
emerging area of study is the intestinal
microbiome, which can be influenced by
diet and is likely to have effects on many
diseases, including gastrointestinal
disorders and even obesity.
What is the most important lesson life
has taught you?
Tough question and Im still learning. Pick
good mentors, take the risks needed to
change, enjoy and appreciate the good
people, animals and environment in your
life (including wine and dark chocolate!).
nutrition is a science
and we are learning more
about it every day
30-31 Interview April.indd 31 19/03/2014 12:41
For more information or to order
www.bsava.com/publications
BSAVA reserves the right to alter prices where necessary without prior notice.
BSAVA Publications
COMMUNICATING VETERINARY KNOWLEDGE
DONT JUST TAKE OUR WORD FOR IT
BSAVA Manual of
Canine and Feline
Rehabilitation, Supportive
and Palliative Care
Case Studies in Patient Management
Edited by Samantha Lindley
and Penny Watson
This Manual addresses the complex and often subjective area of rehabilitation and patient
care using a refreshingly new approach. This involves assembling a group of contributors
with a very wide range and depth of experience across the whole subject field, and tasking
them with collaborating to provide a global approach to many common clinical problems.
The unique team approach, with many gems of information imparted along the way, is
maintained throughout. The experience and common sense shines through in the case
discussions, combined with a full understanding and knowledge of how current state-of-
the-art practice can best be employed. No progressive practice should be without this
book. Practice teams will be reaching for this book again and again to improve the way
that they can provide additional clinical benefits to the cases they are treating.
JOURNAL OF FELINE MEDICINE AND SURGERY
In the best BSAVA tradition this Manual targets the veterinarian, nurse/technician, and
other professionals working in the private or referral small animal practice. The driving red
line is to offer the busy veterinary professional an evidence based update of core topics in
supportive care. This Manual is a very valuable instrument allowing the private practitioner
to offer knowledgeable and start of the art rehabilitation, supportive and palliative care to
a broad spectrum of patients, ranging from surgical, internal medicine and pain cases.
This will improve both animal welfare and client and operator satisfaction.
EUROPEAN JOURNAL OF COMPANION ANIMAL PRACTICE
Palliative medicine is a field of expertise in small animal medicine that has long been
neglected. The [Manual] provides valuable information for veterinarians confronted
with the challenge of improving the quality of life in dogs and cats with chronic
diseases that ultimately cannot be completely cured.
JOURNAL OF THE AMERICAN VETERINARY MEDICAL ASSOCIATION
BSAVA Member
Price: 49.00
This Manual has been developed for the whole veterinary team, drawing on their skills to help
patients achieve a full as possible function and quality of life after surgery, trauma or disease, and
to manage chronic conditions effectively for the benefit of the animal, owner and practice team.
We believe that the novel case-based approach provides a truly unique resource, replicating an
ideal team-based approach within veterinary practice. However, dont just take our word for it
here are some reviews of the Manual you may have missed:
32 Publications Advert April.indd 32 19/03/2014 12:42
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Local
News from BSAVA Regions
knowledge
Go South West for
Orthopaedics Excellence
BSAVA South West are offering a double orthopaedic delight this year
in the form of evening meetings brought to you by the Langford
dream team, Kevin Parsons and Neil Burton.
The first meeting is to be held on Tuesday 20 May, 7pm (for a
7.30pm start) till 10pm at the Cullompton Rugby Football Club,
EX15 1PZ is with Neil and is on the topic of Cranial Cruciate
Ligament Disease: where are we now? As a RCVS Recognized
Specialist in Small Animal Surgery (Orthopaedics), Neil will
endeavour to convey to us the latest evidence in cruciate disease
and which of the plethora of techniques to deploy in the various
situations we encounter (whether it be a FTS, TTA or TPLO)..
Refreshments will be provided by the rugby club and from previous
experience are expected to be substantial.
The second orthopaedic offering is provisionally entitled
Fracture Planning in Practice an interactive case discussion
session with Dr Kevin Parsons. The evening will focus on a
case-based approach to decision-making in fracture fixation. Kevin
aims to equip us with the skills required to choose which fracture
fixation technique will provide the best possible outcome for our
broken patients. This meeting is to be held on Wednesday 22
October in the Bristol area (venue to be confirmed please check
online). Both of these meetings have been generously sponsored by
Freelance Surgical Ltd.
North East explore
the inappetant cat
We know that cat owners tend to spend less time with their pets
than dog owners. Often they only notice that the cat is poorly
when the food is still there the next morning a more detailed
history may not be forthcoming. Its not all the owners fault: cats
rarely exhibit specific external signs of pain. They dont generally
cough when they have heart failure. They dont reveal exercise
intolerance. They go outside to have diarrhoea. Some of these
inappetant cats have abnormalities on routine haematology or
biochemistry. Its when they dont that it gets a bit more
challenging. This talk with Roger Wilkinson will look at the options
for where the general practitioner goes next.
The meeting will be held on the 7 May at Idexx, Wetherby
and is kindly sponsored by Hills. From 7.30pm, there will be deli
sandwiches and cakes, with the meeting taking place from
810pm.
Southern Region explore the
shoulder, elbow and stie
BSAVA Southern Region is pleased to announce an
afternoon meeting with Andy Moores who is an RCVS
Recognized Specialist in Small Animal Surgery
(Orthopaedics) and a European Specialist in Small Animal
Surgery. Andys clinical interests encompass all aspects of
musculoskeletal disease and traumatology, and during the
meeting Andy will take us through the mysteries of
orthopaedic problems of the shoulder joint, elbow dysplasia
and other elbow conditions, IOHC and humeral condylar
fractures and cruciate disease.
The meeting will be held on the 15 May from 28pm at
the Holiday Inn Express in Southampton.
Success at North Easts rst
joint vet and nurse event
The first joint vet and nurse stream in BSAVAs North East
Region was held at the end of 2013, with some sessions taking
place together and others in dedicated rooms. The vet stream
lectures were given by Adrian Boswood, a self-confessed
Southerner, who bravely ventured North to cover cardiovascular
disease of dogs and cats in the most entertaining style; from the
basics right up to current best practice and beyond, with some
fascinating trial news about current therapeutics.
Adrian effortlessly made a complex subject very clear and
applicable to general practice with several amusing and
fascinating digressions, and delegates left feeling much more
confident and better equipped to make the right choices when
working up a case, so helping us move further along the path
from conscious incompetence to conscious competence and
maybe even unconscious competence.
As our first nursing speaker, Charlotte Pace provided an
engaging and practical perspective on the nursing role in the
management of our cardiac patients. This began with a
pragmatic description of congestive failure starting as soon as
fluid starts to accumulate. Management was then discussed
based around the staging of heart disease and the nurses role
in those different stages.
A joint session on ECGs between the vets and nurses was
followed by the last session where Charlotte directed her focus
on the topics especially identified by the nurses present. This
was an event for the whole clinical team that went brilliantly.
33 Regions April.indd 33 19/03/2014 12:51
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companion
CPD diary
LUNCHTIME WEBINAR
Wednesday 30 April
13:0014:00
Oxygen supplements
Speaker: Karen Humm
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 18 June 2014
13:0014:00
Breed schemes
Speaker: Aimee Llewellyn
Online
LUNCHTIME WEBINAR
Wednesday 21 May
13:0014:00
Endocrine diagnostics
Speaker: Carmel Mooney
Online
LUNCHTIME WEBINAR
Wednesday 14 May
13:0014:00
SAVSNET
Speaker: Alan Radford
Online
LUNCHTIME WEBINAR
Wednesday 23 April
13:0014:00
Advances in MCT
Speaker: Susan North
Online
DAY MEETING
WEST MIDLANDS REGION
Wednesday 7 May
Holiday bugs
Speaker: Maggie Fisher
Wolverhampton Medical Centre, Wolverhampton
Details from westmidlands.region@bsava.com
AFTERNOON MEETING
SOUTHERN REGION
Thursday 15 May
Orthopaedic problems of the
forelimb in dogs
Speaker: Andy Moores
Holiday Inn Express, Southampton
Details from southern.region@bsava.com
EVENING MEETING
SOUTHERN REGION
Tuesday 17 June
Recognition of the emergency
patient; including triage and
implementation of nursing plans
Speaker: Kath Howie
Old Basing Village Hall, Basingstoke
Details from southern.region@bsava.com
EVENING MEETING
NORTH EAST REGION
Wednesday 7 May
The inappetent cat
Speaker: Roger Wilkinson
Idexx Laboratories, Wetherby
Details from northeast.region@bsava.com
April
May
June
EVENING WEBINAR
Tuesday 29 April
20:0021:00
Choosing the right way to deal
with a fracture update
Speaker: Gareth Arthurs
Online
DAY MEETING
Thursday 1 May
Whats new in allergies in cats
and dogs
Speaker: Stephen Shaw
Hilton, Stansted Airport
EVENING MEETING
Tuesday 6 May
Improving the health of pedigree
dogs
Speakers: Steve Dean and Tom Lewis
The Stepping Stones Pub, Dorking
Details from southeast.region@bsava.com
DAY MEETING
Wednesday 7 May
Is it me or are these lenses on this
microscope covered in oil? A very
practical guide to getting the most
out of in-house cytology
Speaker: Emma Dewhurst
DAY MEETING
METROPOLITAN REGION
Sunday 18 May
Whats new for old cats?
Speakers: Hattie Syme and Roseanne Jepson
Holiday Inn Express, 275 Old Street, London
Details from metropolitan.region@bsava.com
EVENING MEETING
SOUTH WEST REGION
Tuesday 20 May
Cranial cruciate ligament disease:
where are we now?
Speaker: Neil Burton
Cullompton Rugby Club, Devon
Details from southwest.region@bsava.com
DAY MEETING
Wednesday 21 May
Companion animal diabetes
mellitus management in practice:
an up-to-date, holistic,
21st-century view
Speakers: Stijn Niessen and Yaiza Forcada
Hatfield Oak Hotel, Hatfield
DAY MEETING
Thursday 5 June
Practical haematology: detective
work for nurses
Speaker: Kostas Papasouliotis
EVENING MEETING
NORTH EAST REGION
Tuesday 3 June
Wound management for nurses
Speaker: Louise ODwyer
Chantry Vets, Wakefield
Details from northeast.region@bsava.com
DAY MEETING
NORTH WEST REGION
Wednesday 11 June
The acute abdomen
Speaker: John Williams
Holiday Inn, Haydock
Details from northwest.region@bsava.com
AFTERNOON MEETING
SCOTTISH REGION
Thursday 29 May
Exotic emergencies
Speaker: Livia Benato
Dundee Discovery Centre
Details from scottish.region@bsava.com
34-35 CPD Diary.indd 34 19/03/2014 12:51
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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
suggest that you contact the organizers for confrmaton.
LUNCHTIME WEBINAR
Wednesday 25 June
13:0014:00
CT/MRI: what is it?
Speaker: Andrew Parry
Online
LUNCHTIME WEBINAR
Wednesday 16 July
13:0014:00
Pericardial disease
Speaker: Rachel James
Online
LUNCHTIME WEBINAR
Wednesday 23 July
13:0014:00
Triage of the poisoned patient
Speaker: Daniel Lewis
Online
LUNCHTIME WEBINAR
Wednesday 17 September
13:0014:00
Different diagnosis of haematuria
Speaker: Rob Foale
Online
LUNCHTIME WEBINAR
Wednesday 24 September
13:0014:00
Behaviour and fireworks
Speaker: Daniel Mills
Online
July
LUNCHTIME WEBINAR
Wednesday 20 August
13:0014:00
Analgesia and pain assessment
Speaker: Jackie Brearley
Online
LUNCHTIME WEBINAR
Wednesday TBC August
13:0014:00
Basic ophthalmic exam
Speaker: TBC
Online
August
September
OTHER UPCOMING BSAVA CPD COURSES
See www.bsava.com for further details
North East Region
Sunday 28 September
Lets talk about sex!
Educaton in conjuncton with BrAVO
Wednesday 1 October
Advanced ophthalmology: just above
basics and problem cases
West Midlands region
Saturday 4 October
Veterinary examinaton, handling and
husbandry of reptles, small mammals
and cagebirds a hands-on day with the
animals
Metropolitan Region
Sunday 5 October
Chronic feline gastro-intestnal, pancreatc
and hepatc disorders
BSAVA Educaton
Tuesday 7 October
Interactve endocrinology
DAY MEETING
METROPOLITAN REGION
Wednesday 18 June
Skin and ear disease in dogs
and cats
Speakers: Ross Bond and Anke Hendricks
Holiday Inn, Elstree
EVENING MEETING
SOUTH WEST REGION
Wednesday 18 June
Veterinary evidence: how do I find
it and is it any good?
Speaker: Rachel Dean
RSPCA, Bristol
DAY MEETING
SOUTH WEST REGION
Wednesday 25 June
Demystifying medicine
Speakers: Nick Bexfield & Mark Dunning
Hilton Bristol, Bradley Stoke
DAY MEETING
SOUTH WEST REGION
Wednesday 9 July
Are you flummoxed by fluids?
Rethinking fluid therapy in
emergency patients
Speakers: Sophie Adamantos &
Christina Maunder
Darts Farm Shopping Village, Exeter
DAY MEETING
SOUTH WEST REGION
Thursday 26 June
Demystifying medicine
Speakers: Nick Bexfield & Mark Dunning
Kingsley Village, Cornwall
DAY MEETING
Tuesday 24 June
Top tips and tricks for closing and
reconstructing wounds in small
animal practice
Speaker: Jackie Demetriou
The Bridge, Wetherby
DAY MEETING
Tuesday 2 September
Scared of orthopaedics? Building
your confidence and skills in
practice
Speaker: Peter Attenburrow
Oulton Hall, Leeds
DAY MEETING
Thursday 18 September
Getting the most from cardiac
diagnostics
Speaker: Mike Martin
DAY MEETING
Thursday 4 September
Good grief my patient is all fur and
teeth: handy tips on nursing small
exotic mammals
Speaker: Wendy Bament
Venue: TBC
DAY MEETING
METROPOLITAN REGION
Friday 5 September
Emergency surgery
Speakers: Dan Brockman &
Lindsay Kellett-Gregory
Venue: TBC
EVENING MEETING
WEST MIDLANDS REGION
Tuesday 16 September
Communication
Speaker: Stuart Ellis
Wolverhampton Medical Centre,
Wolverhampton
Details from westmidlands.region@bsava.com
34-35 CPD Diary.indd 35 19/03/2014 12:51
Structure
Students will study 2 modules.
Module 1: This will involve attending 20 individual one-day courses over a
period of 2 years (or you may study less intensively if you prefer, and spread this
module out over 3 or 4 years). After each one-day course, you will study online
there will be a range of study resources and activities for you. The topics
currently planned are:
Structure and function of the eye
Examination of the eye
Ocular diagnostics
Principles of ophthalmic surgery
The globe and orbit
The episclera, sclera and limbus
The eyelids and third eyelid
The lacrimal secretory and excretory systems
The conjunctiva and cornea
Practical surgery
Uveal tract and glaucoma
Lens and vitreous
Retina and choroid
Neuro-ophthalmology
Ocular neoplasia and ocular manifestations of systemic disease
Ophthalmology in exotic animals
Ocular injury
Ocular therapeutics
Problem-based approach
Revision session
After completing all 20 topics, you will sit a formal examination.
Module 2: After completion of Module 1, you will prepare and submit a
series of short case reports. After the case reports have been marked, you will
have an oral exam during which two of the cases submitted will be discussed
in more depth.
If you have any questions regarding the Certicate
please email certicate@bsava.com
or call 01452 726700
BSAVA Postgraduate Certicate in
Small Animal
Ophthalmology
Time frame
It will take you a minimum of 3 years to complete your
studies. You may study less intensively and spread your
studies out over 4 or 5 years if you prefer.
What will the qualication be?
PGCertSAOphthal
The intention is that this will be a Postgraduate
Certicate carrying 60 academic credits at
Masters Level. As such it is equivalent academically
to the RCVS CertAVP. Nottingham Trent University
is the awarding body. This is a qualication intended
for veterinary surgeons in general practice who have
a particular interest in the eld, and will not denote
specialist status.
Costs
The enrolment fee in 2014 will be 3075 plus VAT,
and this will cover the rst year of your studies.
You will have to pay a similar enrolment fee in each
of the rst 3 years of your studies.
Enrolment
You can enrol now on the BSAVA website:
www.bsava.com/cpd/
postgraduatecerticates
Places will be allocated on a rst come, rst served basis.
You must have been qualied for at least 1 year to apply.
You do not need to be working within the UK to apply,
but bear in mind the requirement to attend each of the
one-day courses.
Starts
M
ay
2014
36 OBC - PostGraduate Advert.indd 1 19/03/2014 14:10

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