The essential publication for BSAVA members

Clinical Conundrum
Labrador with acute
pelvic limb lameness
P10
How To
approach a
smelly ear
P14
companion
SEPTEMBER 2010
Physio in practice
Approach to
rehabilitation
P21
Open wide
dental extraction
in practice
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companion
3 Association News
Latest news from BSAVA
45 The Big Picture
Congress gets a brand new look
69 Dental Extraction
Alexander Reiter describes what tooth extraction entails
1013 Clinical Conundrum
Consider a case of traumatic hind limb lameness
1418 How To
Approach the smelly ear
1920 An Exotic Winter
A look at BSAVAs forthcoming Exotics Mini Modular
Course
2123 Publications
Physical therapies in practice
2425 Petsavers
Latest fundraising news
2628 WSAVA News
The World Small Animal Veterinary Association
2930 The companion Interview
John Tandy
31 CPD Diary
Whats on in your area
Additional stock photography Dreamstime.com
Amwu; Emprise; Jocic; Ragnarock; Serdar Tibet; Willeecole; Yobro10; Zts
companion is published monthly by the British Small
Animal Veterinary Association, Woodrow House,
1 Telford Way, Waterwells Business Park, Quedgeley,
Gloucester GL2 2AB. This magazine is a member
only benefit and is not available on subscription. We
welcome all comments and ideas for future articles.
Tel: 01452 726700
Email: companion@bsava.com
Web: www.bsava.com
ISSN: 2041-2487
Editorial Board
Editor Mark Goodfellow MA VetMB CertVR DSAM DipECVIM-CA MRCVS
Senior Vice-President Richard Dixon BVMS PhD CertVR MRCVS FRSE
CPD Editorial Team
Ian Battersby BVSc DSAM DipECVIM-CA MRCVS
Esther Barrett MA VetMB DVDI DipECVDI MRCVS
Simon Tappin MA VetMB CertSAM DipECVIM-CA MRCVS
Features Editorial Team
Caroline Bower BVM&S MRCVS
Andrew Fullerton BVSc (Hons) MRCVS
Design and Production
BSAVA Headquarters, Woodrow House
No part of this publication may be reproduced in any form without written permission
of the publisher. Views expressed within this publication do not necessarily represent
those of the Editor or the British Small Animal Veterinary Association.
For future issues, unsolicited features, particularly Clinical Conundrums, are
welcomed and guidelines for authors are available on request; while the publishers
will take every care of material received no responsibility can be accepted for any loss
or damage incurred.
BSAVA is committed to reducing the environmental impact of its publications wherever
possible and companion is printed on paper made from sustainable resources and
can be recycled. When you have finished with this edition please recycle it in your
kerbside collection or local recycling point. Members can access the online archive of
companion at www.bsava.com .
A
ll BSAVA memberships run from January to December, so it
will soon be time to renew your membership for 2011. If
youve not already set up a Direct Debit for your
membership, this is a great time to arrange it and save yourself
some money at the same time.
Annual Direct Debit (DD) payments receive a 10 discount
from the annual subscription fee so not only is this the easiest
way to make sure your membership is renewed promptly, it is also
the most cost-effective.
As well as the annual DD option, there is also another Direct
Debit payment plan being offered for the first time you can pay
monthly to spread the cost throughout the year. Conditions do
apply, so see the website for more details.
We recently sent out Direct Debit forms to all members not
currently using this easy option to renew their membership. As it
isnt possible to submit a DD application online, you should return
these forms immediately. If you have not received them you can
download them from www.bsava.com, or request them from
administration@bsava.com. If you have any questions our
membership team will be happy to help call 01452 726700,
95 Monday to Friday.
IMPORTANT DEADLINE: You only have until
29 October to change your membership payment
to one of these Direct Debit plans.
Easiest
membership
renewal
You will soon need to renew your
membership set up an annual Direct
Debit before 29 October to save 10
PRACTICE NEWSLETTER
DID YOU GET YOURS?
BSAVA recently sent their first newsletter for
practices principally a way of talking to
practice managers and those principal people
in your team who might otherwise not hear
from us in other ways. We want to make sure
that everyone is aware of what we can do for
the whole practice and how we can help
nurses and managers too. Did your practice
manager get their copy? If so make sure
they return the reply slip as we might be able
to help streamline some things for you like
membership renewal and Congress registrations.
Email c.haile@bsava.com if you have any questions.
Let us
make life easier
As a busy practice manager you will have a lot of people to keep happy and your own busy workload to maintain. BSAVA would like to help, and this newsletter is the rst in a series designed purely for the practice manager. We hope that you will feel that the information is useful and perhaps will pin it on your notice board to highlight CPD
courses, manuals, Congress, online
resources and the range of bene ts available to vets and nurses in your practice.
We appreciate that booking events for members of the practice team may be a task that falls to you and are keen to help where we can. For example, comments on the
online booking process for Congress 2010 have been taken on board and we will be launching an improved group booking
process this year. It would help us if we
could link you as the practice manager to your practice within our database. If you are happy for us to do this, please complete the reply slip included within this newsletter and return it in the enclosed envelope. The reply slip contains a few quick questions
concerning you and how much input your practice has in relation to buying services for vets within your practice; this will help us to understand how we may expand our
services to help you. If you have any other ideas about how we can help your practice, there is a space for additional comments. All completed reply slips sent in by
17 September 2010 will be entered into a draw to win a copy of the new BSAVA Manual of Canine and Feline Rehabilitation,
Supportive and Palliative Care; 10 runners up will each receive a free copy of the
BSAVA Manual of Practical Animal Care.
If you need any further information please contact the Membership and Customer
Services Team on 01452 726717 or via email on administration@bsava.com.
from BSAVA
forthepractice
Issue 1 Summer 2010
Get more involved
BSAVA is an association run by members for members. We have 12 regions throughout the UK and each is run by a local team of professionals who know the needs of the people working in that area. We are also run by Standing Committees that in uence all areas of the association, including manuals, courses, Congress and member bene ts. Find out more about getting involved email Carole Haile at c.haile@bsava.com or talk to the volunteers in your region.
Members do best
The practice budget goes further and the right support is more accessible when you are a member of the BSAVA. There are discounts of at least a third on manuals, CPD and Congress, plus online resources and bene ts to make professional life easier and more rewarding. From the complimentary copy of each edition of the invaluable BSAVA Small Animal Formulary and subscriptions to JSAP and companion, to the cost-effective day and evening CPD courses made available locally through our network of regions, BSAVA nds practical, useful ways to ful l its remit to promote excellence in small animal practice through education and science.
Membership runs from January to December and it couldnt be easier to join. You can join online at www.bsava.com, request an application form by emailing us at administration@bsava.com, or call us on 01452 726700 if you have any questions then a member of our team is waiting to talk to you.
Bene ts in focus
Great reduction on BSAVA Congress
registration
Free Congress MP3 podcasts
Exceptional discounts on BSAVA courses Unbeatable savings on BSAVA manuals Complimentary copy of the BSAVA Guide to Procedures in Small Animal Practice Complimentary copy of the BSAVA Small Animal Formulary
Complimentary subscription to JSAP and companion
Cost-effective, accessible regional CPD Exclusive online resources
Health and Safety advice
Free room hire at BSAVA HQ
Ancillary bene ts insurance, stationery, car hire
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ASSOCIATION NEWS
F
rances is a European Specialist in Veterinary
Diagnostic Imaging, and a double diplomate of
the Royal College of Veterinary Surgeons and
the European College of Veterinary Diagnostic
Imaging. She has worked both in practice and as an
academic, with 26 years working in Higher Education,
and has a rich and long history of working as a BSAVA
volunteer, culminating in her taking on the presidential
mantle in 2007.
The BSAVA postgraduate programme provides
both Frances and the Association with a huge
challenge one that aims to provide the best possible
educational offering to the profession, particularly to
both of which carry a higher risk of
contracting rabies. Children are often
unaware of the danger that dogs transmit
rabies and may not tell their parents when a
bite, lick, or scratch has occurred from an
infected animal, says Briggs.
The good news of course is that rabies is easily
preventable. Vaccination prior to possible exposure is
a crucial part of health management of domestic
animals, and is the single most important factor in
rabies prevention, said Peter Costa, Global
Communications Coordinator for the Alliance for
Rabies Control.
The World Rabies Day initiative also raises money
towards local rabies prevention and control
programmes, with eight projects funded since 2008.
Through the World Rabies Day campaign we continue
to engage all the major stakeholders associated with
rabies to take action, says Costa. We invite everyone
to join the team that is Making Rabies History! More
information on World Rabies Day can be found at the
official web site, www.worldrabiesday.org.
World Rabies Day
28 September will mark the
World Rabies Day initiative, when
partners will be working together
to make rabies history
T
o most of us the figures will be shocking,
especially for a disease that is entirely
preventable more than 55,000 people, mostly
in Africa and Asia, die from rabies every year thats
one person every ten minutes. Children are often the
most at risk.
World Rabies Day is led by the Alliance for Rabies
Control and supported by numerous human and
animal health organisations worldwide. Rabies is
primarily a disease of children, who are particularly at
risk from this terrible disease, due to their close
contact with dogs, the major global source, said
Dr Debbie Briggs, Executive Director of the Alliance
for Rabies Control. Children are more likely to suffer
multiple bites and scratches to the face and head,
New Academic Director
for Postgrad Qualification
In July BSAVA announced the
appointment of Dr Frances Barr
as Academic Director with the
task of launching the new BSAVA
Postgraduate Qualification in
association with the Open
University in 2012
those in practice. Grant Petrie, BSAVA
President, says Producing a postgraduate
qualification is a natural progression to
BSAVAs current CPD offering there is
clearly a need for it and we have a strong
legacy as a provider of quality CPD. We want
to make sure that the profession is served
well with a programme designed by vets for
vets. As a charity with education at the core
of our remit, BSAVA is best positioned to
create something that will keep investing in
the knowledge and talent of the profession.
However, we always knew that we would
need an exceptional individual to oversee the
programme, and, in Frances Barr, we know
we have that person.
The BSAVA postgraduate programme will
launch in 2012, with more information about
registration available at Congress 2011 and
online from April next year. Frances Barr will
begin working with the Open University and
the BSAVA team from November. For more
information about the BSAVA postgraduate
course email administration@bsava.com or
visit the CPD section at www.bsava.com.
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Congress Chair, thinks this new look does
that job well, We want people everywhere,
from all over the globe, to know when they
see these images they are looking at
something relating to the worlds largest
and leading small animal congress and
that they need to stop and find out more.
So this is what you need to be
looking out for in the coming months
from thepreview out now, to the
registration forms that will be landing on
your mat in October keep an eye out
to make sure you are the first to
benefit from the information and
offers contained inside. n
Congress make over
Being the biggest and most established small animal Congress in the world
has never meant that the Congress Committee rest on their laurels. There are a
number of new initiatives once again this year and they have come up with a
new look too
T
he 2011 event will see the start of a
whole new image for Congress
something fresh and contemporary to
represent the scale and excellence of the
conference and provide a way of everyone
being able to identify with the material
easily and quickly.
Until now BSAVA has used a
completely different image each year for
the event something that the President
has selected to represent the culmination
of their presidential year. And that tradition
will still continue in part. This year Grant
Petrie is launching the new-look Congress
design by incorporating the unique
commissioned artwork of Will Shakspeare,
who has made a series of handmade glass
animals from his studio in Taunton, and we
will be using abstracts of his beautifully
blown glass on the covers for 2011. See
www.shakspeareglass.co.uk.
Creating an identity
Congress committee have worked with a
team to create what those in the know call
a new brand identity. But whatever its
called, it has now given BSAVA a
representative image for Congress that is
strong, professional and recognisable all
over the world.
Leading veterinary excellence
54th Annual Congress 31 March 3 April
The ICC / NIA Birmingham UK
thepreview
Leading veterinary excellence
Leading veterinary excellence
There are four colours in the new
scheme, with blue being the primary one
well use across most of the printed
material. Then theres the unique, bold
animal graphics clearly not realistic
portrayals, but clever representative
graphics that highlight the range and
variety of species the companion animal
vet might see on any given day.
BSAVA Congress is all about leading
veterinary science alongside opportunities
to socialise, as well as getting a unique
view of whats going on in industry.
Combining all that into a single identity was
never going to be easy but John Williams,
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Congress make over
COUNTDOWN
TO
n Book online to save 5% on your
registration available in
October 2010
n Early Bird Deadline
3 January 2011
n Practice Badge Deadline
10 March 2011
Visit www.bsava.com or email
congress@bsava.com for more details
2011 HIGHLIGHTS
There are 40 lecture streams, more than
100 expert speakers, and over 250
individual lectures a totally peerless
scientific programme. You can fulfil your
entire annual CPD requirement by
attending Congress and listening to
some of the lectures you missed online
afterwards at your leisure.
Cant come for the whole four days?
For the first time you will be able to take
advantage of the weekend pass which
for a member booking before the Early
Bird Deadline means just 227 for top
quality science, as well as access to the
exhibition and the chance to have a fun
weekend with friends and colleagues. You
can find out more online or from your
registration pack.
2011 will also see additional interactive
lectures so you can participate in votes
and answer questions using the easy-to-
use key pads. There are new management
and communication streams too, with the
return of the popular lectures from recent
years and most cutting edge topics. For
the first time some streams will have
simultaneous translation into Spanish
and Polish, which is going to add to the
international flavour of our event.
Discover Congress highlights and
download the Scientific Programme
online at www.bsava.com or email
congress@bsava.com if you have
any questions.
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DENTISTRY
T
ooth extraction is required where a disease
process is too advanced for the teeth to be
saved. In addition, financial and other
considerations may lead an owner to request it. The
most common indications for tooth extraction are:
In dogs periodontal disease; endodontic disease
from tooth fracture (Figure 1); and the presence of
persistent deciduous teeth
In cats tooth resorption; retained root remnants;
and stomatitis.
Preparation
The clients approval must be obtained for the extent of
treatment to avoid the potential for future litigation.
The patient needs to be of reasonable health to
undergo general anaesthesia. An endotracheal tube
with inflated cuff and an oropharyngeal pack will
prevent fluid and debris from entering the trachea or
Dental extraction
Tooth extraction is a frequently performed
procedure in small animal practice.
Alexander Reiter, a contributor to the
BSAVA Manual of Canine and Feline
Dentistry, describes what is entailed
Figure 1: Left maxillary fourth premolar tooth in a
dog with a complicated crownroot fracture. The
detached slab (asterisked) is being raised with a
periodontal probe ( Alexander M Reiter)
DENTISTRY
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DENTISTRY
oesophagus. The jaws are securely propped open
without unnecessary strain on the temporomandibular
joints. Additional pain control is achieved with regional
anaesthesia (nerve blocks).
Professional dental cleaning followed by rinsing
with chlorhexidine gluconate (0.12%) aids in
reducing bacteraemia and prevents debris from
contaminating the extraction site. Tooth extraction is
a surgical procedure, and sterile instruments should
be used. Perioperative antibiotics are given in patients
that are debilitated and immunocompromised, in
those with endocrine disorders, cardiovascular
disease, severely contaminated wounds or systemic
infections and to patients receiving permanent
implants and transplants.
Dental radiographs are obtained prior to tooth
extraction to evaluate alveolar bone health and
variations in root anatomy, and to determine the
presence of dentoalveolar ankylosis or resorption of
roots that could complicate the extraction procedure.
Safety measures during the extraction procedure
include wearing safety glasses, masks and gloves.
The patients head is cradled over the bridge of the
maxilla with the palm of the free hand during maxillary
tooth extractions. During mandibular tooth extractions,
the lower jaw can be cradled in the palm of the free
hand, or the individual side can be grasped between
the thumb and forefinger.
The size of dental elevators should closely fit the
size of the tooth or root segment being elevated.
Elevators are grasped with the butt of the handle
seated in the palm and the index finger extended
along the blade of the instrument to act as a stop
should the instrument slip.
Techniques
Teeth are anchored to alveolar bone of the mandible,
incisive bone and maxilla by the gingiva and
periodontal ligament. These tissues must be severed,
stretched or torn to allow delivery of the tooth to be
extracted. In the dog the incisors, canines, first
premolars and mandibular third molars are single-
rooted teeth; in the cat, the incisors, canines and,
commonly, the maxillary second premolars are
single-rooted. The cats maxillary first molar may be
treated as a single-rooted tooth even though it may
have two roots that are usually fused together. Tooth
extraction is performed using the closed technique
(without mucoperiosteal flap) or open technique (with
mucoperiosteal flap to expose alveolar bone).
Closed extraction
Closed extraction begins with incising the gingival
attachment around the tooth with a scalpel blade.
Then the tip of a dental elevator is inserted into the
space between the tooth and the alveolar bone. A well
controlled rotational motion on the shanks long axis
between the root and a fulcrum point is performed to
create a slow, gentle and steady pressure on the
tooth, which is held for 10 seconds to break down the
periodontal ligament fibres. The elevator can also be
placed perpendicular to the tooth or crownroot
segment to lever it out of the alveolus through the
line of least resistance, with a fulcrum point preferably
on alveolar bone (horizontal rotation) and not on
adjacent teeth, unless the tooth used as a fulcrum is
to be extracted as well. Multi-rooted teeth must be
sectioned to provide multiple single-rooted segments.
Extraction forceps should only be applied when the
tooth is very loose. The extracted tooth or crownroot
segment is examined, ensuring that the entire root
has been removed (obtain a radiograph if uncertain).
The alveolus is debrided, sharp bony edges are
smoothed with a diamond-coated round bur and
water irrigation (alveoloplasty), the extraction site is
rinsed, and the wound is closed with synthetic
absorbable monofilament suture material (such as
poliglecaprone 25).
Open extraction
Open extraction is performed when raising a
mucoperiosteal flap with a periosteal elevator after
creation of one or two releasing incisions that extend
from gingiva into alveolar mucosa. Removal of
alveolar bone overlying the root(s) (alveolectomy) by
as much as one to two thirds of the length of the
root(s) is accomplished with a round bur and water
irrigation (Figure 2), and multi-rooted teeth are
sectioned (Figure 3).
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DENTISTRY
Dental extraction
This is followed by elevation of the tooth or
crownroot segments (Figure 4), debridement of the
alveolus, alveoloplasty (Figure 5), and rinsing of the
extraction site.
The periosteum at the connective tissue side of
the flap base is incised with a scalpel blade in a
distomesial direction. Metzenbaum scissors are used
to bluntly undermine the flap (Figure 6) before it is
apposed in a tension-free manner to the palatal/
lingual gingiva by means of simple interrupted sutures
(Figure 7).
Figure 2: Mesial and distal releasing incisions are
made, and a mucoperiosteal flap is raised.
Alveolectomy is performed over the mesiobuccal
and distal roots with a round bur and water irrigation
( Alexander M Reiter)
Figure 3: The mesiobuccal (MB) root and distal (D)
root are separated, followed by separation of the
mesiobuccal root from the mesiopalatal (MP) root
( Alexander M Reiter)
Figure 4: The mesiobuccal root is elevated and
extracted, and its apex is inspected to ensure
removal of the entire root ( Alexander M Reiter)
Figure 5: The slab (S) and all crownroot segments
are extracted and on display. Alveoloplasty is
performed with a round diamond-coated bur and
water irrigation. ( Alexander M Reiter)
Figure 6: The periosteum at the flap base is incised
with a scalpel blade, and the flap is further released
by blunt dissection with Metzenbaum scissors
( Alexander M Reiter)
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DENTISTRY
Utilizing good instrumentation
and applying proper
techniques will help to
avoid complications
DENTISTRY
AVAILABLE
FROM BSAVA
The BSAVA Manual of Canine and Feline
Dentistry, 3rd edition, is designed for vets
in practice, concentrating on common
conditions and procedures. Full-colour
photos and specially drawn illustrations
illuminate the text throughout.
Contents
Orodental anatomy and physiology; Oral and
dental diagnostics; Anaesthesia and analgesia;
Operator safety and health considerations; Dental
instrumentation and equipment; Developmental
oral and dental conditions; Canine infectious,
inflammatory and immune-mediated oral
conditions; Feline inflammatory, infectious and
other oral conditions; Physical orodental
conditions; Other oral and dental conditions;
Dental surgical procedures; Index.
Download a sample chapter online at
www.bsava.com
Member price: 45
Non-member price 69
Figure 7: The extraction site is closed with simple
interrupted sutures ( Alexander M Reiter)
Postoperative management
Opioids and non-steroidal anti-inflammatory drugs are
used for pain control and to reduce tissue swelling
associated with open extractions. Chlorhexidine
digluconate (0.12 %) gel is applied to the extraction
site twice daily for 2 weeks. Unless there is a well
founded reason for antibiotic administration, antibiotics
should not be used.
Water is offered once the animal has recovered
sufficiently from anaesthesia. Soft food is offered
824 hours after anaesthesia and maintained for
about 2 weeks. Hard treats and chew toys are
withheld while the oral tissues heal.
Possible complications of tooth extraction include:
fractured roots; haemorrhage; trauma to adjacent
teeth, permanent tooth buds and soft tissue; sublingual
oedema and salivary mucocele; orbital trauma;
fracture of the alveolus or jaw; oronasal
communication; trauma from opposing teeth; tongue
hanging out of the mouth; emphysema and air
embolism; and local and systemic infection. Utilizing
good instrumentation and applying proper techniques
will help to avoid these complications.
companion readers wishing to know more regarding
surgical extractions are reminded that How to perform
a surgical extraction featured in companion March
2009 and can be downloaded from www.bsava.com.
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CLINICAL CONUNDRUM
Clinical
conundrum
Gareth Arthurs of the Royal Veterinary College
and the British Veterinary Orthopaedic
Association considers a case of traumatic
hind limb lameness
Case presentation
A 4-year-old male black Labrador presents with acute onset right
pelvic limb lameness. Two days previously, the dog jumped out the
back of a Land Rover and got his right hind foot caught in the tow
bar of the vehicle. Physical examination shows that the dog is
clinically stable. Orthopaedic examination shows grade 3 of 5
lameness of the right pelvic limb with visible instability of the right
hind pes. Examination of the pes of the pelvic limb is very well
tolerated and does not seem to cause the dog discomfort or pain
but there is valgus instability originating in the region of the mid
pes. No other abnormalities are observed.
4. Haematology and biochemistry prior to
sedation or general anaesthesia. Assessment of
the dogs haematological and biochemical status
is a sensible consideration prior to any chemical
restraint. This patient was a young healthy dog with
no indication of a metabolic problem, and trauma
was localised to only the right pes; therefore
haematology and biochemistry were not
performed. However, arguably a haematocrit, total
solids, electrolytes and urea/creatinine could have
been measured for a minimum baseline.
Because of the benefits of radiography, the dog
was anaesthetised and the right pes was
radiographed. The radiographs are shown in Figures 1
and 2.
What steps are you considering for further
investigation in this case?
1. Radiograph the pes under sedation or general
anaesthesia. This is the simplest diagnostic test
most likely to give useful further information.
2. Further palpation under sedation or general
anaesthesia. This is a sensible consideration as many
orthopaedic patients are too stressed or in pain to
allow detailed physical examination whilst conscious.
However, this patient tolerated conscious examination
very well. Repeat examination under sedation was
performed that showed dorsal and medial instability of
the mid pes.
3. CT examination of the pes. The numerous tarsal
bones and their complex shapes and 3-dimensional
overlapping relationship can make interpretation
of tarsal bone pathology challenging from the
2-dimensional images of radiographs. Generally,
radiographs are sufficient for gross pathology such as
luxations or simple fractures but CT is invaluable for
more complex fractures. However, CT imaging is
significantly more expensive than radiography and
life-sized images that can be used for pre-operative
templating and intra-operative reference are not
produced. For these reasons CT was not performed
in this patient.
Figure 1: Dorsoplantar
radiograph of the right
pes
Figure 2: Mediolateral
radiograph of the right
pes
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CLINICAL CONUNDRUM
Describe the radiographs and the
abnormalities you can see
The mediolateral view of the pes shows no
abnormality. The dorsoplantar view of the right pes
shows subtle enlargement of the centrodistal tarsal
joint and the lateral aspect of the tarso-metatarsal joint.
In addition, mild lateral malalignment of the metatarsal
bones relative to the proximal tarsal bones is visible.
If you cant see these abnormalities or
youre unconvinced, what could you do
to clarify this?
Radiograph the contralateral limb comparing
radiographs of the normal to the affected limb can help
to highlight subtle abnormalities that might otherwise
not have been noticed. In this case, radiographs of the
contralateral (left) pes were taken and compared: see
Figures 3 and 4. Comparison of the dorsoplantar views
of the left and right sides highlights the widened
centrodistal and lateral tarso-metatarsal joints of the
right pes. In addition, the position of the 3rd tarsal
bone relative to the 4th is abnormal on the right side.
What is the diagnosis so far?
Instability and subluxation of the centro-distal tarsal
and lateral tarso-metatarsal joints with mild lateral
malalignment of the distal pes.
Is this the final diagnosis? Is this
sufficient information to plan treatment
for the dog?
No, it is not although the problem has been localised
based on static radiographs, the dynamic component
is unknown. In other words, what is the impact of this
instability during weight bearing? In what planes is the
pes stable or unstable? These are important questions
to answer as they will influence the treatment options.
What is the next diagnostic step?
Take stress radiographs of the affected pes and if
necessary, compare them with stress radiographs
of the normal limb. The pes should be stressed in
all four planes, i.e. dorsal, plantar, medial and lateral.
Stress radiographs of this dog are shown in Figures 5
to 8. The red arrow indicates the direction of the
applied stress.
Figure 3: Dorsoplantar
radiograph of the left pes
2 = 2nd tarsal bone, 3 = 3rd tarsal
bone, 4 = 4th tarsal bone,
C = central tarsal bone.
Figure 4: Mediolateral
radiograph of the left
pes
Figure 5: Dorsoplantar
radiograph of the right
pes with laterally applied
stress
Figure 6: Dorsoplantar
radiograph of the right
pes with medially applied
stress
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CLINICAL CONUNDRUM
Clinical conundrum
What is your interpretation of these
radiographs?
The stress radiographs show that the pes is stable to
dorsal and medial directed forces. However, plantar
and laterally directed forces demonstrate gross
instability of the pes with centrodistal luxation and
lateral tarso-metatarsal subluxation with secondary
lateral and plantar malalignment of the metatarsal
bones. The dorsoplantar view shows that the
metatarsal bones, 3rd and 2nd tarsal bones are
united and mechanically stable as one unit, and the
central, 4th and more proximal tarsal bones are
mechanically stable as one unit. In addition, the first
tarsal bone has fractured.
The primary instability is loss of dorsomedial
support and subsequent luxation of the centrodistal
joint. The subluxation of the lateral aspect of the
tarso-metatarsal joint is secondary and much less
severe, as it is constrained by the intact lateral
collateral ligaments; these are demonstrated to be
intact, as the pes is stable to medially applied stress.
What are the treatment options for this
dog?
1. Partial tarsal arthrodesis standard lateral
approach. This is a procedure that fuses most of
Figure 7: Mediolateral
radiograph of the
right pes with dorsally
applied stress
Figure 8: Mediolateral
radiograph of the right
pes with plantar applied
stress
the joints of the weight bearing axis of the pes/
tarsus, i.e. the calcaneo-quartral joint and the
lateral aspect of the tarso-metatarsal joint. It is
typically performed by application of a plate to the
lateral aspect of the tarsus from calcaneus to the
4th metatarsal bone. This is an option for this dog,
as it would stabilise the pes and give good results
longer term. The disadvantage is that it involves
arthrodesing two joints that are effectively normal
and the affected centrodistal is not directly
addressed. To address these limitations, a medial
approach could be considered.
2. Atypical partial tarsal arthrodesis medial
approach. The surgical approach is made on the
medial aspect of the pes and the plate applied to
the medial aspect; thus the centro-distal joint is
arthrodesed directly. However, application of the
plate to the medial aspect is much more
challenging because of the irregular medial
surface contour of the tarsal bones. A medial
approach would also necessitate fusion of two
unaffected joints the talocentral and medial
tarso-metarsal joints.
3. Selective arthrodesis of only the centrodistal
joint. As this is the location of the primary
instability, this seems a logical approach.
However, can this be achieved and, if so, how? A
relatively small dorsomedial incision is made, only
the affected joint is treated surgically and surgical
dissection is much reduced. Far fewer implants
are placed as a simple 2 screw and tension band
wire is sufficient to effect the arthrodesis. However,
is such a simple surgical solution strong enough?
The critical fact is that plantar support of the pes/
tarsus is intact confirmed radiographically as
application of dorsal stress caused no plantar
instability. As plantar support is intact, the surgical
reconstruction is protected from, and does need
to withstand, the main forces of weight bearing, as
these are borne by the reconstructed tarsus and
not the implants.
4. Surgical repair of the fractured first tarsal
bone. Theoretically this is appropriate but in reality
the fractured bone is so small that reliable
purchase of any implant in the bone would be very
challenging and there would be a high risk of
further fracture during implant placement
5. Conservative management by external
coaptation. As previously discussed, plantar
support of the pes is intact; therefore conservative
management could be effective if it would reliably
maintain the pes/tarsus in reduction. However, as
the subluxated tarsal bones are imperfectly
reduced in the neutral radiograph (see Figure 1),
this would not be improved with a dressing.
Imperfect reduction means that residual instability
of the joint may persist, which could result in
persistent instability or development of
degenerative joint disease.
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CLINICAL CONUNDRUM
BVOA AUTUMN MEETING
BVOAs annual autumn meeting will this year will be held in Dublin,
1214 November. The scientific programme promises the usual
stimulating mix of UK and international speakers with small animal
veterinary and human orthopaedic backgrounds. The provisional
scientific programme includes:
Imaging of the shoulder joint, including advanced imaging and with an emphasis on comparative
aspects between canine and human shoulder joint imaging
Shoulder joint arthroscopy and the management of ligamentous injuries of the shoulder
Developmental conditions of the shoulder joint
Miscellaneous condition of the shoulder joint, such as mineralization of the tendons of the peri-scapular
muscles, and caudal glenoid fragmentation.
Management of soft tissue injuries of the human shoulder a physiotherapists perspective
Imaging and management of skeletal neoplasia of the forelimb
For more information www.bsava.org.uk/bvoa/ or email bvoa@btinternet.com
Given these options what would you do?
In this case, a selective centrodistal joint arthrodesis
was performed. A dorsomedial approach was made to
the centrodistal joint and the incision was situated so
as not to be directly over the implants in order to
avoiding problems of skin healing directly over the
implants. The subluxated centrodistal joint was
identified, and further exposed. The pes was
manipulated to increase exposure and the articular
cartilage was removed using a high speed bur.
Cancellous bone graft was harvested from the
proximal right tibia and packed into the centrodistal
joint. The subluxated joint was reduced and
immobilised using pointed reduction forceps. A
laterally directed 2.7 mm cortical screw was placed in
the central tarsal bone, and another in the 2nd tarsal
bone, which also engaged the 4th tarsal
bone laterally.
An orthopaedic washer was placed beneath the
head of each screw and narrow gauge orthopaedic
wire was placed in a figure-of-eight pattern between
each screw head to apply compression and stability
across the arthrodesis site. After placement of the
implants, tarsal alignment and stability were
checked, and were normal. The surgical site was
flushed thoroughly and closed in a routine manner.
The post-operative radiographs are shown in
Figures 9 and 10.
How would you manage this case post-
operatively?
In this case, the right pes was placed in a cast for
6 weeks post-operatively; a splinted dressing or
modified Robert Jones support dressing would have
been good alternatives. The dog was confined to lead
walks only and re-radiographed at 6 weeks post-
operatively: the radiographs showed no evidence of
implant loosening, and early evidence of union of the
centrodistal joint. The dressing was removed and the
dog remained confined to lead exercise only. The dog
was re-examined and the pes was re-radiographed at
12 weeks post-operatively; these showed mature
union of the talo-central arthrodesis site with no
evidence of implant related problems. The dog was
returned to normal activity over the next 6 weeks and
recovered uneventfully.
Figure 9: Dorsoplantar post-
operative radiograph of the right
pes
Figure 10: Mediolateral
post-operative radiograph
of the right pes
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HOW TO
How to
Approach the
smelly ear
Janet Littlewood of Veterinary Dermatology
Referrals, Cambridge, guides us through this often
frustrating problem
E
ar disease is a common reason for
the presentation of small animals in
general veterinary practice. After
preventive health care, dermatological
conditions are the most common reason
for pet owners seeking veterinary
attention. Otitis is the third most common
dermatological presentation for dogs, and
second commonest for cats, accounting
for 22% and 19% of dermatological
cases, respectively
1
.
Otitis is a variably painful condition,
usually accompanied by an aural exudate,
which is often malodorous. Ear and head
carriage are often affected due to
discomfort, but cranial nerve and central
neurological deficits may also be present.
Head shaking and scratching at the ear are
common signs. With increasing chronicity
and pain this may reduce, but animals will
resent being handled or touched around
the head and may be depressed, appear
systemically unwell and even become
aggressive towards owners.
When presented with an animal with
ear disease the practitioner has to consider
both the need to initiate appropriate
therapy to relieve the discomfort of the
otitis and the need to identify the
underlying cause of the inflammatory
condition. The ear is a specialised skin
structure and is subject to a range of
primary dermatological conditions which
may initiate pathology (Table 1), allowing
secondary infections to develop (Table 2).
Of all the potential primary causes of otitis
externa, the most common underlying
problem in chronic or recurrent cases is an
allergic dermatosis, principally atopic
dermatitis (Figures 1 and 2).
Figure 1: Ceruminous otitis externa in a
cat with atopic dermatitis and flea bite
hypersensitivity
Figure 2: Ceruminous otitis externa in an
atopic West Highland White Terrier; the
condition was unilateral in this case
Foreign bodies
Grass awns
Parasites
Otodectes cynotis
Demodex canis/felis
Sarcoptes scabiei (pinnal)
Hypersensitivity disorders
Atopic dermatitis
Adverse cutaneous food reactions
Contact, particularly drugs
Keratinisation defects
Endocrinopathies
Hypothyroidism
Sex hormone imbalance
Primary idiopathic seborrhoea
Neoplasia
Ceruminal gland adenocarcinoma
Other skin tumours
Inflammatory masses
Feline nasopharyngeal polyps
Proliferative otitis
Eosinophilic
Necrotising
Immune-mediated
Erythema multiforme
Other autoimmune conditions, usually
pinnal
Juvenile cellulitis
Table 1: Primary causes of otitis externa
Yeast infection
Malassezia spp., predominantly
M. pachydermatis
Bacterial infection
Staphylococcus pseudintermedius
-haemolytic streptococci
Gram-negative bacteria
Escherichia coli
Proteus spp.
Klebsiella spp.
Pseudomonas aeruginosa
Anaerobes
Bacteroides spp.
Otitis media
Descending
Ascending
Chronic progressive pathology
Table 2: Secondary causes and
perpetuating factors in otitis externa
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HOW TO
Aetiology and pathogenesis
The normal healthy ear canal produces
minimal secretions from the sebaceous
and modified apocrine (ceruminous)
glands. The secretions are carried
upwards and distally, with the upward
migration of the epithelial cells of the
stratum corneum, and out of the external
auditory meatus. Inflammation results in an
increase and alterations in glandular
secretions, overcoming the normal upward
escalatory cleaning mechanism, which in
turn enhances the growth of microbes.
Malassezia organisms are part of the
normal flora of the canine and feline ear
and are found in small numbers in up to
36% of normal dogs
2
. Increased humidity,
from both secretions and water in the ear
canals, enhances the growth of yeast
organisms
3
and Malassezia organisms are
present in up to 76% of cases of otitis
externa
4
, often in combination with
Staphylococcus pseudintermedius.
With increasing chronicity bacterial
infection tends to supersede yeast infection.
A range of opportunistic organisms may be
implicated. This picture may then be further
modified by the use of antimicrobial
preparations which may select for resistant
organisms, resulting in the therapeutically
challenging clinical presentation of
Pseudomonas otitis. This progression of
disease is accompanied by a change in the
gross nature of the aural exudate, initially
ceruminous brownish and waxy or more
yellow-orange in colour, to a purulent
off-white to greenish exudate which may be
obviously slimy or mucoid and often with an
offensive odour (Figure 3).
Inflammation of the external ear canal
results in hyperplasia of the integument
lining the canal and of the glands. The
resulting narrowing of the lumen of the
canal, further impairs the normal
drainage function of the ear and
enhancing the microenvironment for
microbial multiplication (Figure 4).
Chronic inflammation is accompanied
by fibrosis, progressive stenosis and
calcification of the cartilage structures of
the external ear canal. Ears that have been
previously affected by otitis externa are
more at risk from future episodes of
infection if the inflammatory changes are
not fully reversible.
Otitis media is a common complication
of chronic otitis externa. Middle ear
involvement was noted in 52% of cases of
chronic otitis in dogs, compared with 16%
of acute cases
5
. In 82.6% of ears with
chronic otitis concurrent otitis media was
present, with the tympanum intact in 71%
of cases. Bacterial isolates from the
horizontal ear canal and tympanic bulla
were different in terms of organisms and/or
antibiotic sensitivity profile in 89.5% of
cases. Neurological complications may
accompany otitis media (Table 3 and
Figure 5) and the anatomical structure of
the middle ear means that progressive
pathology (granulation tissue formation,
osteomyelitis) and chronic irreversible
changes may ensue.
Figure 3: Purulent otitis externa due to
Pseudomonas aeruginosa infection in an
atopic Basset Hound
Figure 4:
Chronic otitis
externa with
ceruminous
exudate in an
atopic German
Shepherd Dog,
showing
hyperplasia,
thickening and
lichenification
of the pinnal
integument and
stenosis of the
external
auditory
meatus
Figure 5: Otitis media in a Weimaraner
secondary to chronic otitis externa due to
atopic dermatitis, with left-sided facial
paralysis
Deafness
Horners syndrome
Facial paralysis
Glossopharyngeal damage
Vestibular disease
Meningoencephalitis
Table 3: Neurological complications of
otitis
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HOW TO
Approach the smelly ear
Approach to the case
History Effective client communication
is of paramount importance. History
relating to the current ear problem is
obviously important, but the clinician must
not forget to gather information pertaining
to the presence of concurrent clinical
signs or previous manifestations relating
to a more generalised dermatosis
(Table 4). Owners often ignore or
misinterpret signs of mild pruritus in dogs,
such as regular foot-licking, an itch-
scratch reflex (ticklish spot) and excessive
perineal or preputial attention.
cotton bud will collect material for
microscopical examination.
Exudate should be spread on to two
microscope slides:
The first mixed with either liquid
paraffin or potassium hydroxide for
examination for external parasites
The second heat fixed and stained with
a rapid cytological stain for
identification of microbes and cells.
Ceruminous otitis externa is
characterised by increased numbers of
squames (some of which may be
nucleated) increased numbers of yeast
organisms (>10 per high power field), a few
bacterial cocci and occasional to a few
inflammatory cells (Figures 6 and 7).
Cases of purulent otitis may have
mainly coccoid bacteria or a mixture of
cocci and bacilli, with many neutrophils
(both degenerate and band neutrophils) as
well as increased squames (Figure 8).
The cytological findings in cases of
parasitic otitis, foreign bodies and
neoplasia are variable, depending on
duration of disease and secondary
opportunistic infection.
Significance of bacteria If bacterial
cocci are identified, a presumptive
diagnosis of S. pseudintermedius infection
is justified and empirical selection of
antibiotics is appropriate unless the case is
long-standing and has failed to respond to
appropriate antibiotics previously. All cases
in which bacterial rods are identified should
have swabs submitted for bacterial culture
and sensitivity, preferably by minimum
inhibitory concentration techniques rather
than by disc diffusion methodology.
Otoscopic examination is likely to
need sedation or general anaesthesia. In
cases of acute onset of signs of otitis, this
should be undertaken at the first
presentation in case of the presence of a
foreign body, but in cases of chronic or
recurrent otitis it may be more appropriate
to instigate some initial therapy prior to
scheduling this procedure.
Otoscopic examination allows an
assessment of the patency of the vertical
and horizontal canals and the nature and
extent of the inflammatory process, and
may allow visualisation of the ear drum.
Video-otoscopy allows excellent and
detailed visualisation of the ear canal and
Signalment
Age
Parasites and allergies often
young animals
Tumours and endocrinopathies
often older animals
Breed
Predispositions to atopic disease
Predispositions to hypothyroidism
Acute onset or gradual, progressive
Unilateral or bilateral
Recurrences
Time of year, seasonality
Other dermatological signs
Pruritus, especially pedal
Pyoderma
Scaling/seborrhoea
Table 4: History in cases of otitis
Clinical examination of the patient
should include general examination, in
case of systemic abnormalities and the
likelihood of needing sedation or general
anaesthesia to assess the ear problem
fully, and a complete dermatological
examination.
Examination of the ear in the conscious
patient may be limited to: an assessment of
the pinnae and external auditory meatus,
noting the presence and nature of any
exudate; and external palpation of the
vertical ear canal, to assess rigidity and
pain. Difficulty or pain on opening the
mouth often accompanies middle ear
pathology and an assessment of cranial
nerve function should be conducted.
Cytological examination of aural
exudate should be undertaken in all
cases where discharge is evident at the
external auditory meatus. Sometimes the
outer ear may appear relatively clean,
but considerable exudate is present in the
ear canal and gentle introduction of a
Figure 6: Cytology of ceruminous
exudate, showing large numbers of yeast
organisms, squames and occasional
bacterial cocci, but no inflammatory cells
Figure 7: Cytology of aural exudate from
a case with mixed yeast and bacterial
infection, showing several nucleated
squames and moderate numbers of yeast
organisms and bacterial cocci, with
streaks of chromatin from degenerate
neutrophils and clumps of inflammatory
debris and some intact neutrophils
Figure 8: Cytology of purulent aural
exudate showing many neutrophils,
mostly degenerate, with streaks of
chromatin, clumps of inflammatory
debris and bacterial rods
even the middle ear in larger animals, with
accompanying specialised instrumentation.
However, a good quality hand-held
otoscope is adequate in the majority of
cases. If the ear drum cannot be seen, it
should be assumed to be ruptured and
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HOW TO
cleansing agents chosen appropriately. If
visible, the tympanum may show evidence
of pathology in the middle ear, with loss of
transparency, thickening and bulging.
A full assessment of middle ear
involvement may require imaging by
radiography or magnetic resonance
imaging, which should be conducted
without any attempts to clean the ear
canal(s) so that the presence of fluid /soft
tissue densities can be evaluated without
the prior introduction of cleaning solutions.
Considerable information can be obtained
by performing myringotomy; the authors
preferred instrument is a Spreulls needle
rather than a soft catheter, since the
rigidity of the needle allows for more
accurate manipulation in the middle ear,
avoiding the auditory ossicles and round
and oval windows, and an assessment of
the nature of the lining of the bulla (bony or
soft, suggesting the presence of
granulation tissue).
In chronic or recurrent cases, where
flushing under general anaesthesia is
planned as part of the therapeutic protocol,
and particularly cases where placement of
ear wicks is intended, anti-inflammatory
therapy should be initiated prior to
otoscopy. High anti-inflammatory doses of
steroids are indicated (prednisolone
12 mg/kg daily). This will give some
immediate relief to the animal and
controlling the inflammation will enable
more effective cleansing both by the
clinician and subsequently by the owners.
Otoscopic examination can be scheduled
for a few days to a week later, depending
on whether bacteriology samples have
been submitted.
Medical management of otitis
The recent trend in the management of
otitis has been towards topical therapy
without use of systemic antibiotics. Much
higher concentrations of drugs can be
achieved by medicating the ear directly
rather than by systemic administration of
drugs. Some clinicians will still employ
systemic medication in some cases of
Malassezia otitis, particularly when
concurrent Malassezia hypersensitivity is
present, and for cases of streptococcal
bacterial otitis. Opinion in the veterinary
dermatology field appears to be divided in
respect of the use of systemic drugs in
cases of otitis media.
A) Thorough initial and repeated
ongoing cleaning of the ear canal(s)
This is an essential prerequisite to allow
effective specific topical therapy.
Inspissated deposits of wax may require
the use of ear curettes or forceps to
remove material from the ear canal,
but in most cases the exudate can be
softened by use of light oils or
lubricants (liquid paraffin or propylene
glycol), or ceruminolytics
(sulphosuccinates, lactic acid or acetic
acid). The ear canals can then be
flushed and cleansed.
Choosing an ear cleaner There are
many ear cleaners available on the
veterinary market and factors to be
considered in selecting a suitable cleaner
should include irritancy, safety in the
middle ear in case the ear drum is
ruptured, efficacy at cleaning and
antimicrobial effect. Cleaners containing
organic acids tend to have better
antimicrobial effects, but are more
astringent and may not be well tolerated by
some patients, particularly in the presence
of significant inflammation.
For cleaning under general
anaesthesia some clinicians prefer to use
water or sterile saline, in order to avoid
damage to the middle ear and associated
structures, but dilute chlorhexidine
(<0.05%) and acetic acid at low
concentrations (2.5%) are safe in the
middle ear and have antimicrobial
properties. TrizEDTA solution is also safe
in the middle ear and can be used after
an acidic cleanser to neutralise the
solution, as well as having a potentiating
effect on some antibiotics. However, use
of TrizEDTA alone as a cleaner may
enhance or encourage the growth of
yeast organisms; this can be avoided by
using solution with added chlorhexidine
or ketoconazole.
Whilst ear flushing under sedation or
general anaesthesia is usually without
complications, neurological disturbances
may ensue in a small number of cases and
owners should be warned of the risk at the
time of obtaining consent for the procedure.
B) Treatment of infections
Choosing a medication Most medicated
ear preparations authorised for veterinary
use in the UK include:
An antifungal agent (nystatin,
tiabendazole, monosulfiram,
clotrimazole, miconazole)
An analgesic or anti-inflammatory
agent: most include a glucocorticoid,
such as prednisolone, betamethasone
or dexamethasone
An antibiotic: the antibiotics included in
ear drops effective against Gram-
positive organisms include fusidic acid,
framycetin, neomycin, gentamicin and
marbofloxacin. Some of these are also
effective against some Gram-negative
organisms, with polymixin B another
good first choice antibiotic.
In cases of Pseudomonas infection,
bacterial resistance is a very significant
problem, which may arise due to
intermittent or incomplete treatment of otitis
externa. Some isolates may be sensitive to
veterinary labelled drugs, but often the
clinician will have to use a drug off-label,
such as silver sulphadiazine 1%,
enrofloxacin solution, ceftazidime,
piperacillin, tobramycin or ticarcillin. Whilst
some of these drugs are potentially ototoxic
and are not recommended for use if the ear
drum is ruptured, the risks of ongoing
infection and potential extension of
pathology into the cranial vault may
necessitate the use of one of these drugs.
Interestingly for some of these, particularly
the aminoglycosides, there may be less
ototoxicity with local use in the ear than with
systemic use. The toxicity of agents in the
middle ear may relate more to the vehicle
carrying the drug than to the drug itself.
Drugs in aqueous solution are far safer in
the middle ear than those in an oily vehicle.
C) Daily owner care
Cleaning Where the owner is able to,
and the dog permits, the ear canals should
be cleaned daily with an appropriate
cleaner until there is no further discharge
evident. It is vitally important that the client
is given suitable instruction in how to clean
their pets ears properly.
Medicating Medicated drops should
be applied at least 1520 minutes after
cleaning, allowing time for the dog to
shake out residual cleaner and exudate
that cannot be wiped away. This ensures
that when the medication is applied it can
contact the surface of the integument
rather than sit in a puddle of exudate and
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HOW TO
Approach the smelly ear
cleaning solution. In most cases medicated
drops should be applied twice daily.
The duration of treatment will depend
on the chronicity of the condition, but
should continue until beyond cure of
infection and will usually be of the order of
13 weeks. Response to treatment should
be assessed at appropriately scheduled
re-examinations. Failure to follow up cases
of otitis externa is a clear factor in the
development of chronic resistant infections
D) Use of ear wicks in case of poor
patient compliance or resistant
infection
Where patient compliance is poor, or
resistant infections are present, the
placement of polyvinyl A ear wicks followed
by impregnation with antibiotic solution to
give a high local concentration of drug is
often effective in securing bacteriological
cure. The ear wicks are left in place for
710 days, with the owner maintaining
hydration of the wicks by introduction of
antibiotic solution every other day. Ear
wicks are usually well tolerated if the dog is
on adequate anti-inflammatory doses of
glucocorticoid at the same time. At the time
of wick removal further cytological
assessment and bacterial culture should
be undertaken.
Management of otitis media
Surgical intervention is indicated if there
are chronic inflammatory changes in the
middle ear; in such cases medical
management is inappropriate. Those cases
amenable to medical therapy may need to
have the middle ear flushed on several
occasions. A cuffed endotracheal tube is
essential to prevent aspiration of material
entering the nasopharynx via the auditory
(Eustachian) tube.
The tympanic bulla should be flushed
with 510 ml of warm sterile saline gently
introduced in a ventral direction via a
Spreulls needle and solution and debris
aspirated. The procedure is repeated until
the aspirate is clear. Topical antibiotics in
aqueous solution chosen on the basis of
culture and sensitivity testing and systemic
steroid therapy should be employed.
Brainstem auditory evoked response
(BAER) studies in patients with otitis media
have shown improved hearing in those
successfully treated with topical
marbofloxacin, gentamicin, clotrimazole
Neoplasia
Stenosis of ear canal
Proliferative/nodular hyperplasia
Calcification of ear cartilages
Bony changes to bulla
Granulation tissue in middle ear
Neurological deficits, deafness
Failure to respond to medical therapy
Table 5: Indications for ear surgery
and silver sulphadiazine. A profound
reduction in BAER was documented after
treatment with ticarcillin and tobramycin,
more severe with the latter drug. However,
if successful treatment obviates the need
for total ear canal ablation (TECA), the
residual auditory function may be better
than after surgery.
Diagnosis and management of
underlying disease
Many of the manifestations of otitis
observed are secondary; the primary
causes of otitis externa will require
appropriate investigations in order to
reach a definitive diagnosis and enable
specific therapy to be initiated. The
therapeutic requirements of the ear
pathology may delay some diagnostic
procedures, particularly where steroid
therapy would interfere with tests and
interpretation of results. However, it may be
appropriate to initiate an elimination diet
whilst appropriate therapy for the ear
disease is conducted. When other diseases
have been ruled out, allergen-specific IgE
testing can be undertaken at a later date
when steroid therapy has been withdrawn.
Managing recurrence Recurrent
episodes of otitis externa are a risk even
when the underlying disease process is
correctly identified and appropriate
treatment regimes initiated. Many cases
will require ongoing prophylactic aural
care. The atopic Labrador Retriever who
enjoys a regular swim is an example of a
dog at risk of Malassezia overgrowth. The
aim of routine treatment is to maintain
normal aural health, with a normal,
non-inflamed integument over the whole of
the external ear and a normal population
of microbial flora (i.e. a few yeast
organisms and no bacteria). This can be
achieved by regular use of an ear cleaner
that has antimicrobial and astringent
properties, the frequency of use
depending on the individual patients
needs, but usually between 12 x weekly
to 12 x monthly.
Some authors advocate the use of
topical medicated ear drops on an
intermittent, pulse-treatment basis, but
this author considers that this may
enhance the risk of selecting for resistant
bacterial strains and the benefits of this
treatment probably lie in the regular use of
a topical glucocorticoid.
Since the majority of cases of recurrent
otitis externa are due to underlying atopic
dermatitis, the primary pathological event
in these cases is cutaneous inflammation,
often starting on the pinnal surface and
then extending down the ear canal. If this
allergic inflammation can be kept under
control, then episodes of otitis and
secondary infection will be minimised.
Suitable agents to achieve this include
prednisolone succinate or phosphate
drops applied to the ear canal(s) and
hydrocortisone aceponate spray for the
pinnal surfaces 23 times weekly. More
chronic, lichenified changes may require
the use of more potent steroids such as
dexamethasone or betamethasone in
solution for the ear canals or in gel
formulation for the pinnae.
Indications for surgery
Some cases will require surgical
intervention because of the primary
disease process, such as neoplasia or
inflammatory polyps. Whilst many cases of
otitis externa are suffering from primary
medical rather than surgical disease
processes, repeated episodes of otitis may
result in chronic progressive pathology,
sometimes termed end-stage otitis and
TECA surgery is indicated in such cases
(Table 5). Occasionally the difficulties of
ongoing management in uncooperative
patients not amenable to regular treatment
may indicate the need for surgical
intervention even when irreversible
pathology is not present, since removal of
the ear canal removes the source of pain
and inflammation, albeit at the cost of
significant hearing loss.
References 15 and further reading list
available to download from
www.bsava.com
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D
uring three days of exotics lectures,
presentations, videos and interactive case
studies with video presentations, delegates will
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Tuesday 5 October: Medicine, surgery
and emergency care
The first course will cover small exotic pet mammals
(rabbits, rodents and small marsupials) and consider
the latest medical and surgical approaches to exotic
pets. There will be particular emphasis on:
Critical care and emergency medicine of small
mammals;
Surgery and anaesthesia, diagnosis and
management of renal failure, hepatic
lipidosis in rabbits and rodents;
Hormonal disease and control of
reproduction in ferrets;
An approach to neoplasia and
surgical and chemotherapeutic
options in ferrets and rabbits.
An exotic
winter
Tuesday 2 November: Medicine,
surgery and emergency care of
cage birds and raptors
The second course will look at cage birds and raptors.
The main focus will be on:
Critical care and emergency medicine for birds;
Techniques for safe anaesthesia of the sick bird;
How to manage avian fractures;
Common soft tissue surgical techniques;
An approach to interpreting haematology,
biochemistry and cytology tests. And how to
get the most out of them;
A logical approach to the feather plucking
parrot;
Management of the persistent bumblefoot case.
Tuesday 7 December: Medicine, surgery
and emergency care of reptiles
The final session will cover reptiles and amphibians,
exploring:
How to approach the anorexic snake;
Interpreting haematology and getting the most
from biochemistry and cytology tests;
Techniques for safe anaesthesia of the
compromised reptile patient;
Common soft tissue surgical
techniques;
Managing venomous
reptiles in the practice.
BSAVAs Exotics Mini Modular
Course starts in October with
specialists Simon Girling and
Romain Pizzi at Mottram Hall
in Cheshire
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CPD
An exotic winter
ROADSHOW:
A PRACTICAL APPROACH
TO WOUND MANAGEMENT
Speakers: Geraldine Hunt & Ronan Doyle
13 October Novotel, Newcastle
15 October Holiday Inn, Cambridge
18 October Chilworth Manor, Southampton
20 October Thistle, Brands Hatch
BSAVA Members: 203.28 inc. VAT
Non-members: 304.91 inc. VAT
BSAVA MANUAL OF
EXOTIC PETS, 5TH EDITION
Edited by: Anna Meredith and
Cathy Johnson-Delaney
This edition is the Foundation Manual for information across
the range of exotic pets, from small mammals, through birds,
reptiles and amphibians, to invertebrates. Commoner pets
such as rabbits, rodents and budgies retain their place.
However, the ever-increasing range of non-traditional pets
encountered by the veterinary surgeon in practice is
reflected in coverage of new groups such as marsupials,
ratites and crocodilians.
Biology, husbandry, handling and restraint
Diagnostic approach to common conditions
Supportive care
Anaesthesia and analgesia
Common surgical procedures
Euthanasia
Drug formulary
Member price: 49.00
Non-member price: 75.00
SIMON GIRLING BVMS (Hons) DZooMed CBiol MSB MRCVS
RCVS Recognised Specialist in Zoo & Wildlife Medicine
Simon has worked in first opinion and referral exotic species practice for the last 16 years. He gained his RCVS
Diploma in Zoological Medicine in 2002 and his RCVS Specialist status in Zoo & Wildlife Medicine in 2003. He
is Senior Vice President of the British Veterinary Zoological Society and has acted as chief examiner for both
the RCVS Certificate and Diploma exams in Zoological Medicine. Simon has contributed to several books on
exotic species, including acting as co-editor for the BSAVA Manual of Reptiles, 2nd edition and as an author in
the BSAVA Manual of Psittacine Birds, 2nd edition. He is currently the Head of Veterinary Services to the Royal
Zoological Society of Scotlands Edinburgh Zoo and also co-owns a first opinion and referral exotics and small
animal practice in Perth. Simon is also an Honorary Senior Lecturer in Zoological Medicine at Glasgow
University Vet School.
ROMAIN PIZZI BVSc DZooMed FRES MACVSc (Surg) MRCVS
RCVS Recognised Specialist in Zoo & Wildlife Medicine
Romain has performed wildlife, zoo, and exotic animal veterinary work on five continents, holds an MSc in Wild
Animal Health, the RCVS Certificate and Diploma in Zoological Medicine, and Membership of the Australian
College of Veterinary Scientists by examination in Small Animal Surgery. Former pathologist at the Zoological
Society of London, he is currently veterinary surgeon at Edinburgh Zoo and lectures in Zoo and Wildlife
Medicine at the University of Nottingham. He is responsible for veterinary care to the more than 3000 annual
wildlife cases at the Scottish SPCA Wildlife rescue centre. His particular interest is in endoscopy and minimally
invasive surgery.
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PUBLICATIONS
A
sk people about physiotherapy and most will be
aware of human physiotherapists and what they
can do. They will have a reasonable idea of the
importance of their role in the rehabilitation of the
human patient, even if they do not have personal
experience. Ask the same question in a veterinary
context, however, and many would say they were
unaware even of the existence of veterinary
physiotherapists, let alone be able to suggest how one
could help their pet.
What is physiotherapy?
One definition of physiotherapy is the physical
approach to promote, maintain and restore physical,
psychological and social well being (Chartered
Society of Physiotherapists). Although this is a
definition made for human physiotherapy, it is equally
applicable to the veterinary patient (Figure 1).
Physiotherapists have been rehabilitating human
patients for over 60 years, and the focus of many
within the profession has been to grow continually and
evolve knowledge and skills by building upon the
evidence base in the published literature to support
the techniques and treatment strategies adopted.
Veterinary physiotherapy is an even younger
profession, with the first interest groups being
established just over 25 years ago. The profession
does, however, have the advantage of being able to
extrapolate from much of the literature to support
transferable skills from the human to the veterinary
patient. There are currently two recognised interest
groups, connected with accredited postgraduate
qualification courses, to which practising veterinary
physiotherapists can belong: the Association of
Chartered Physiotherapists in Animal Therapy
(ACPAT); and the National Association of Veterinary
Physiotherapists (NAVP).
Physiotherapy can be employed to complement
traditional treatment strategies employed by the
veterinary surgeon in a number of different specialties
and patient scenarios:
Neurology e.g. the postoperative neurosurgical
case; patients with degenerative myelopathies
Medicine e.g. maintaining function in a patient
with acute medical illness
Orthopaedics e.g. after femoral head and neck
excision; following repair of traumatic fracture injury
Critical care e.g. prophylactic management of a
recumbent patient to avoid potential secondary
complications of the musculoskeletal or respiratory
systems
Care of the elderly patiente.g. acute and chronic
pain management in osteoarthritis.
Physical
therapies
in practice
As BSAVA launches its
groundbreaking Manual on
rehabilitation and supportive
care, Helen Fentem-Jones MSc
ACPAT MCSP, from Dick White
Referrals in Cambridgeshire,
looks at the role of physiotherapy
in the veterinary practice
PUBLICATIONS
Figure 1: Gym balls can be used to encourage weight
bearing in both dogs and cats
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PUBLICATIONS
The Veterinary Surgeons Act (1966) requires that
physiotherapists work following referral by a veterinary
surgeon. This close collaboration between
physiotherapists and veterinary surgeons can only
work for the better for the patient outcome.
Working together
Currently the majority of veterinary surgeons will refer
animals requiring physiotherapy to an outpatient
physiotherapist. These therapists may work in a
number of ways, such as offering outpatient clinics
from local veterinary practices, or from their own
facilities, or even visiting the patient in their own home.
Once seen by the physiotherapist, the owner will
be given a structured home exercise plan, designed
on an individual basis to tackle their pets specific
functional deficits. This will be carried out at home with
their pet and the patients progress reassessed at
regular intervals until the desired goal has been
achieved. At the same time the therapist will keep in
regular contact with the veterinary surgeon, providing
them with updates as to the patients progress, as well
as highlighting any areas of concern.
At present, inpatient physiotherapists are few and
far between, and tend to work predominantly in
secondary referral centres. Inpatient physiotherapy
has the advantage of being delivered by the therapist
much more intensely in the acute stages. This can
provide very rapid recovery times in certain patient
groups (potentially shortening length of hospital stay)
as well as having a prophylactic effect with regard to
complications such as respiratory infections. Other
advantages include direct face-to-face contact with
the vet in charge of the case.
No-one can predict what the future holds; however,
the acknowledgment by vets that one method of
continuing to advance and improve patient care
involves the transposition of treatment strategies
employed in the human field, would lead to the more
prevalent use of physiotherapy and hydrotherapy, on
both an inpatient and an outpatient basis.
Techniques
Physiotherapists use a number of different treatment
strategies to achieve restoration of function, including:
movement and rehabilitation therapies; manual
techniques; soft tissue techniques; electrophysical
modalities; hydrotherapy; and expert advice.
Movement therapies incorporate a very broad
spectrum from passive range of movement
exercises to the obstacle course. Multiple benefits
include the nourishment of synovial joints,
maintenance of soft tissue length, progressive
strengthening of weakened muscle groups (Figure 2),
proprioceptive re-education, resorption of oedema,
optimising the healing process, analgesic effects and
optimising respiratory function.
Physical therapies
in practice
Figure 2: Using a Cavaletti pole to encourage
strengthening of the flexor muscle groups through
greater range
Manual techniques include mobilisations and
manipulations of the joints, predominantly for relief of
stiffness and/or pain relief. Mobilisations may be
physiological (movements done in the same pattern as
would be produced voluntarily by the muscles) or
accessory (movements that cannot be produced
voluntarily, e.g. glides). These techniques can have
immediate positive effects in increasing range of
movement of a previously limited joint
1
. Manual
techniques also includes those used to treat the
respiratory patient, such as coupage, percussion,
rib springing and vibrations. When used in
combination with positioning for postural drainage and
ventilation/perfusion matching, these have been shown
to be effective at aiding secretion clearance and
improving ventilation.
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PUBLICATIONS
Soft tissue techniques include massage,
myofascial release, trigger point deactivation and
sustained stretches. Massage can be defined as
manipulation of the soft tissues to affect a desired
system. The systems that can be influenced include
muscular, skeletal, digestive, respiratory, circulatory,
lymphatic, endocrine, emotional, mental and
nervous. The technique can be used to aid
lymphatic drainage (resolving oedema), to loosen
restricted soft tissue (e.g. muscle spasm of irregular
scar tissue) and to aid restoration of normal
movement. It can also be used to aid pain relief and
to relieve stress
2
.
Electrophysical modalities encompass the
application of a number of different types of energy
including therapeutic ultrasound (different
wavelengths to diagnostic ultrasound), light energy
(lasers), electromagnetic energy (pulsed
electromagnetic therapy, PEMT), thermal energy (hot
and cold packs) and pulsed electrical impulses
(transcutaneous electrical nerve stimulation,
TENS; neuromuscular electrical stimulation, NEMS).
When prescribed appropriately, these can create
multiple positive results. For example, lasers have
been show to improve wound healing significantly
3

and PEMT can assist the healing of multiple tissues
including soft tissues, bone
4
and nerve. Even
something as simple as cold can create profound
physiological effects and, when used in combination
with compression, has been shown to reduce oedema
significantly
5
(Figure 4).
Hydrotherapy is the use of water for therapeutic
benefit. It involves the use of properties such as
buoyancy, hydrostatic pressure, viscosity, resistance
and surface tension, to assist or resist movement
according to the desired therapeutic effect.
Hydrotherapy can either be done on a water
treadmill or within a pool. It can exercise similar
muscle groups to land-based exercise but in a more
supported environment. If the water depth is to the
level of the lateral epicondyle, 15% of the animals
weight is supported by buoyancy; the exercise can
then be progressed by reducing water depth
(support) and so strengthening antigravity/extensor
muscle groups. Advantages of hydrotherapy include
increasing range of movement (so strengthening
Figure 4: Using the principle of ice, elevation and
compression to resolve oedema in the limb of a
recumbent dog
The NEW Manual for the whole veterinary team
Pain management
Clinical nutrition
Physiotherapy, hydrotherapy, acupuncture
Evidence-based and patient-centred
Unique case study approach
Fully illustrated throughout
Member price 49
Available September 2010
the majority of veterinary
surgeons will refer animals
requiring physiotherapy to an
outpatient physiotherapist
PUBLICATIONS
flexor muscle groups through greater range),
general cardiovascular fitness, and mental
stimulation when on restricted exercise regimes. It
is recommended that the hydrotherapist is registered
with the Canine Hydrotherapy Association and thus
is adequately trained to monitor the patients
throughout the course.
References 15 available to download from
www.bsava.com
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PETSAVERS
Improving the health of the nations pets
London 10K
O
n 11 July, the World Cup final was not the only sporting event to take place;
over 25,000 runners gathered in London to take part in the British 10K
London Run. The Petsavers team had a great day out and despite the hot
weather everyone managed to complete the race. So far this has raised an estimated
2300 for Petsavers, with more sponsorship money to come. If you would like to
sponsor this years team in retrospect, please visit www.petsavers.org.uk to donate.
If you would like to take part in next years 10K then please get in touch early to
ensure you get a place as these are limited. If you would like to take part in any other
sponsored run or event on behalf of Petsavers, let us know and we can help
and support you.
Christmas Cards
P
etsavers produces Christmas cards each
year and this year they are available for a
bargain price of 3 for a pack of ten,
including postage and VAT. Petsavers cards are a
great way to spread the festive cheer to your
friends and colleagues, or you may like to send to
cards to your valued clients.
Order forms are available from the BSAVA on request, or cards can be purchased
online at www.petsavers.org.uk. If you work in practice and would like to make these
available to your clients we can send order forms to you to display in your reception.
Photography competition
T
he annual Petsavers photography competition is now open, so visit
www.petsavers.org.uk for full details on how to enter. There have been some
really creative entries in the past, so this year weve
decided to let your imaginations run wild and not limit
photos to a particular theme. This means you can send
in any picture of your pet you like! The judges will be
looking for qualities like humour and character in the
photos, as well as photographic skill. The Petsavers
website shows the winners of the previous years
competitions, so take a look to see what has caught
the judges eyes in the past to give you some ideas.
Which bact eria are associated with
feline chroni c gingivostomatitis?
A study undertaken by
David Bennett and David
Taylor at the Faculty of
Veterinary Medicine at
the University of Glasgow
and Marcello P. Riggio of
the Infection & Immunity
Research Group at the
University of Glasgow
Dental School
I
nflammatory diseases of the mouth of
the cat are very common. Feline
chronic gingivostomatitis (FCGS) is
characterised by inflammation of the
surfaces of the mouth that extends
beyond the tooth region and reaches as
far as the back of the throat. It remains
the most challenging inflammatory oral
disease to treat.
Many different bacterial species,
including several previously linked with
human periodontal disease, have been
implicated in FCGS. Viruses may also
play a critical role, with feline herpesvirus
(FHV), feline calicivirus, feline
immunodeficiency virus (FIV) and feline
leukaemia vius (FeLV) the centre of
much attention.
The treatment of FCGS is problematic.
Simple oral hygiene may be successful in
mild cases although extractions are often
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PETSAVERS
Which bact eria are associated with
feline chroni c gingivostomatitis?
necessary, and indeed the most successful
treatment for FCGS is extensive (all
pre-molar/molar teeth) or full mouth
extraction. Antimicrobial treatment is often
used but with poor results. Some evidence
exists as to the efficacy of interferon-omega
in the treatment of this disease, although
large-scale controlled studies have not
been carried out.
In our study funded by Petsavers we
investigated the types of bacteria
associated with both FCGS and a healthy
oral cavity, using both conventional culture
methods, which grow bacteria under
laboratory conditions, and also
DNA-based methods for identifying
bacteria. The advantage of DNA-based
identification methods is that, as well as
detecting bacteria that can be readily
grown in the laboratory, they can also be
used to identify bacteria which cannot be
grown under laboratory conditions and
also bacteria which have never previously
been identified.
Three healthy samples were analysed
for the presence of bacteria by culture
methods and the most frequently found
species were Pasteurella pneumotropica
(10.3%) and previously uncultured bacteria
(10.3%). In the nine FCGS samples
analysed, the most frequently found
bacteria were Pasteurella multocida subsp.
multocida (14.1%), previously uncultured
bacteria (14.1%) and Pasteurella multocida
subsp. septica (10.6%).
In the same samples, more different
types of bacteria were detected using
DNA-based methods. In the healthy
samples, the most frequently found
bacterium was Capnocytophaga
canimorsus (10.8%). For the FCGS
samples, the most frequently found
bacteria were Pasteurella multocida subsp.
multocida (33.1%) and Tannerella
forsythensis (13.2%). Overall, fewer types
of bacteria were found in the FCGS
samples compared to the healthy samples.
Bacteria that had not previously been
grown in the laboratory were found in both
the healthy samples (8.2%) and the FCGS
samples (8.4%). Of particular note was the
finding that a much larger proportion of
novel bacteria that had not previously been
identified were found in the healthy
samples (43.7%) compared to the FCGS
samples (8.8%).
Two healthy and nine FCGS samples
were tested for the presence of FeLV, FIV,
FCV and FHV. FeLV and FHV were not
detected in any samples. Both healthy
samples were positive for the presence of
FIV antibodies. FCV was isolated from
one of two healthy samples and from
seven of nine FCGS samples. We
concluded that fewer types of bacteria
are found in cats with FCGS than in
healthy cats. However, Pasteurella
multocida subsp. multocida is found to be
significantly more prevalent in FCGS than
in healthy cats and, consequently, may
play an important role in the disease.
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World Congress
highlights
Some 2,000 people visited
Geneva to make the 2010
congress a success
C
lose to 2,000 attendees from all over the world
came together in the international yet intimate,
historical and culturally diverse city of Geneva
in Switzerland to learn and to celebrate the collegiality
of veterinary medicine. Hosted by the Swiss
Association for Small Animal Medicine (SVK-ASMPA),
the 35th WSAVA World Congress was held in
conjunction with the 16th FECAVA, the 41st SVK-
ASMPA, and 5th FAFVAC Congresses. The scientific
programme featured 79 world-renowned veterinary
lecturers covering over 25 disciplines in 207 lectures
with English, French, and German translations,
including six State-of-the-Art Lectures (SOTALs).
Furthermore, there was WSAVA HumanAnimal
Interaction, WSAVA Hereditary Diseases, a FECAVA
Symposium and a North American Veterinary
Conference How I Treat stream, as well a Pre-
Congress Forum sponsored by the International
Veterinary Ear Nose and Throat Association. This was
complemented by a range of Short Communications
featuring abstracts that highlighted veterinary research
from around the globe.
The international appeal of the WSAVA World
Congress was reflected in the diversity of the attendees,
with 72 countries represented and people from every
continent but Antarctica. The five countries supplying
the most delegates were Switzerland, France, United
Kingdom, Germany and the United States.
Evenings were spent meeting old friends and
making new ones at a variety of lively social events.
The Opening Ceremony saw the presentation of the
prestigious WSAVA Awards and the evening closed
with cocktails served in the Exhibition area. Guests at
the Gala evening watched a gorgeous sunset over
Lake Geneva and the surrounding mountains, while
enjoying an hour-long cruise followed by an elegant
dinner aboard the cruise boat. The following night
hosted the Swiss Evening Party, which took place at
the historic Btiment des Forces Motrices, a former
hydroelectric plant on the Rhne River, where guests
were treated to a variety of Swiss foods, local wine
and Swiss music.
As the saying goes all good things must come to
an end. At the Closing Ceremonies the hard work of
the many volunteers was recognized and a
presentation was given by next years Congress host
featuring several traditional Korean dances, which no
doubt ensured that many of those present will join their
colleagues again for the 36th WSAVA Congress to be
held from 1417 October 2011 on the exotic island of
Jeju, Korea.
The Congress was supported by WSAVA Prime
Partner Hills Pet Nutrition, and partners Nestl Purina,
Novartis and Pfizer Animal Health. They joined the
87 exhibitors in the Exhibition Hall.
For more information and photos from the 2010
WSAVA Congress, visit the WSAVA homepage at
www.wsava.org.
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WSAVA NEWS
WSAVA Assembly Meeting
WSAVA President David Wadsworth provided assembly
members with updates from a very active WSAVA
leadership, including the Executive Board and various
committees. The months since the last meeting at the
2009 WSAVA Congress have seen the WSAVA become
an incorporated, not-for-profit entity in Canada, with the
WSAVA Charitable Foundation to follow shortly.
The Congress Steering Committee proposed the
following motions that will see the vibrant WSAVA
Congress enhanced while providing for the future
financial sustainability of the WSAVA:
The CSC had implemented the Assembly-adopted
motion to enter into a preferred partner relationship
with a Professional Congress Organizer (PCO)
through a Request for Proposal. This narrowed the
field to two international PCOs, with final selection
of the partner to be based on a case study of the
2014 WSAVA World Congress
The WSAVA World Congress will rotate through
three global regions, comprised of the Americas;
Europe, Africa, and the Middle East; and
Oceania/Asia.
The newly elected WSAVA Executive Board (from left to right): Walt
Ingwersen, Honorary Secretary (Canada); Di Sheehan, Vice President
(Australia); Veronica Leong, Board Member (Hong Kong); Shane Ryan,
Honorary Treasurer (Singapore); Jolle Kirpensteijn, President
(Netherlands); Peter Ihrke, President Elect (USA); David Wadsworth,
Past President (UK)
Kongressfotos and Karin Degasperi
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WSAVA NEWS
These were adopted by a majority vote of 2010
Assembly participants.
WSAVA Officer elections were held, which saw
Prof. Jolle Kirpensteijn (Netherlands) assume the
WSAVA Presidency. Prof. Peter Ihrke (USA) became
President-Elect, Dr Di Sheehan (Australia) moved
from Treasurer to Vice President, Dr Veronica Leong
(Hong Kong) retained her seat as seventh Board
Member, and Dr Shane Ryan (Singapore) joined
the Board as Honorary Treasurer. Dr David
Wadsworth (UK) assumed the Past Presidency
and Dr Walt Ingwersen (Canada) remained as
Honorary Secretary.
In addition, the past and ongoing contributions of
Prof. Ellen Bjerks to the WSAVA and international
veterinary community were recognized through her
receipt of the 2010 WSAVA Presidents Award. For
more information on this and other WSAVA award
winners, please see the July issue or visit the Awards
page at www.wsava.org.
The assembly members also voted in favour of
accepting one new affiliate member association, the
Academy of Veterinary Dentistry. Finally Cape Town,
South Africa was voted as the host of the 2014
WSAVA Congress.
More details will be provided in the Assembly
Minutes which will be available at www.wsava.org.
Proceedings available online
Proceedings from the WSAVA 2010 World Congress
are available online via the WSAVA website (link on
the right-hand column of the home page). The
WSAVA World Congress proceedings are also
available online in a partnership with IVIS
(International Veterinary Information Service), a New
York-based not-for-profit organization.
W
ith a mysterious and unique landscape
designated as a World Heritage site by
UNESCO, a relaxing atmosphere and a
fascinating traditional culture, Jeju will provide an
inspiring and unforgettable backdrop to the
WSAVA World Congress being held from 1417
October 2011.
The Korean Organizing Committee will develop
a structured and high-level scientific programme,
bringing vets, their families and companies from
around the world together to encourage one
another and build friendships. Top quality lectures
by world-renowned scholars will enable
participants to share and expand specialized
knowledge and experience. State of the art
information will be provided at the exhibition.
An opportunity to experience a truly memorable
event awaits you in Jeju, Korea, in 2011. We look
forward to meeting and welcoming you. Visit
www.wsava2011.com for more information.
FUTURE CONGRESSES
Jeju, South Korea: 1417 October 2011
Birmingham, UK: 1215 April 2012
Christchurch, New Zealand: 69 March 2013
Cape Town, South Africa: 1519 September 2014
Welcome
from Jeju!
The Organizing Committee of the
2011 WSAVA World Congress
and the 3rd FASAVA Congress
welcome you wholeheartedly to
Jeju Island, South Korea

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THE companion INTERVIEW
John
Tandy
John Tandy was born and grew up in St Helens. His father worked 16-hour
days as a railway porter, allotment holder and poultry keeper, while his mother
looked after the home and family. He was educated at Cowley High School
and was accepted at Liverpool Veterinary School at 17. On qualifying in 1957
he spent three years in large animal practice (two years in Bristol and one in
Malton). He then set up his own practice back in his home town at a time
when the surge in pedigree dog ownership was taking place. This became
one of the earliest registered veterinary hospitals in the UK. He became
involved in professional politics, the pharmaceutical industry, producing
veterinary educational material, communication training, veterinary journals,
recruitment, university activity, animal welfare and conservation charities, and
a variety of local organisations. He is a happily married, and very proud father
and grandfather. John was the first president of the BVHA, the president of
SPVS and the president of the BVA.
Q
Who has been the most inspiring influence
on your professional career?
A
This is an extremely difficult question to answer
there have been so many inspiring people in
my life that have had influence on my career. I
must mention the maths master at my school who said
Tandy, one day you will either be Prime Minister or a
bandit chief but which ever it is you will finish up
being hanged. So far all his predictions are wrong!
Then there is Professor John George Wright; he was a
remarkable influence on me and many other students
that he taught. Alf Wight (James Herriott) worked in a
neighbouring practice during the time I was in Malton.
This man, who had a most remarkable talent, which for
a time was not fully appreciated, became a good
friend. Lord Soulsby is another inspiring friend and
mentor. Nobody has worked so hard on matters
relating to the profession, sometimes under very
difficult circumstances, than this man. I met Jane
Goodall over 30 years ago in the forest of Gombe
Stream in Tanzania, where she was studying her
chimpanzees. She is now a world leader in educating
mankind in the need to protect our environment and to
conserve our wild animal populations.
What is the most frustrating aspect of your work?
I have been involved with animal welfare and
conservation groups for many years, including 10
years as chairman of the Jane Goodall Institute. I have
become frustrated by the fact that I have not been
more successful in my efforts to raise sufficient income
and improve front line services to make the impact that
I would have wished.
What do you regard as the most important
decision that you have made in your life?
One important decision was to invite Ian Hughes to
join me as a partner in the practice. Another was the
trip I made a trip to the USA in the mid 1960s to visit
veterinary practices. The secretary of the American
Animal Hospital Association, Frank Booth, helped
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THE companion INTERVIEW
organise the trip. I looked in depth at the construction,
design and management of over 30 veterinary
practices in all parts of the country. I learned so much.
It was life changing. Before I went a senior member of
the profession said, Dont go John. They have nothing
to teach us! But, thank goodness, I did it my way!
What has been your main interest outside work?
Rugby Union has been one of my main interests
outside work. When I began my sporting life at
grammar school, the rugby master asked what
position I played. I confessed that I had never played
in any position. He said, Right, you are a hooker.
That is the position that I played for the next 35 years.
I went on to play for the school, the University and St
Helens (now Liverpool St Helens) and Malton. My last
game was representing past players of the Malton
club against the current side. At that time I was
president of SPVS and a fellow member of our team
was Norman Chandler, then president of BEVA.
Theres a challenge for current presidents!
When and where were you the happiest?
I thoroughly enjoy travelling the world. I am at my
happiest when in the company of my wife, family and
friends. It follows that I am at my happiest when
viewing the Andes or watching wildebeest migrating
across the Mara River, or sipping a glass of wine in
their company.
What is the most significant lesson that you have
learned so far in life?
Frank Sinatra sang I did it my way with passion, and
then there was the song from South Pacific Youve got
to have a dream. Combine the two songs and that is
the basis of the lesson that I learned.
If you were given unlimited political power what
would you do with it?
I would first become Schools Secretary and restore the
grammar school system, which allowed people from
poorer families to make progress based on ability
rather than some contrived political process. Once this
had been achieved, I would then become responsible
for health services. I would change the current NHS
inefficient bureaucratic system to one that involved
more competition for services with patient choice and
insurance payments. The premiums of those that could
not afford full payment would be subsidised from the
vast amounts of savings that would be made. My new
system would be based on the prevailing veterinary
health system. I realise that there would be some
political skirmishing to deal with but then I do have
unlimited power, do I not?
Which historical or literary figure do you most
identify with and why?
I suppose that I must change the question to who
would I wish to identify with and then I can say
Winston Churchill is the man. It is my view that
nobody, at least in my lifetime, has been dealt a
challenge of such magnitude as the Second World
War. Winston sorted it out with unbelievable courage,
clarity of thought, decisive action, leadership skills
and eloquence.
If you could change one thing about your
appearance or personality, what would it be?
My only thought for this was well you are a bit loud.
Maybe you should quieten down a bit. I sought help
from my wife; she suggested that, You should listen a
little more to what other people have to say before you
offer your own opinion. So there you have it!!
What is your most important possession?
I first thought that I should say my 22-year-old rusting
Mercedes was my most important possession.
However, with a little more thought I must declare that it
is Ty Mawr, my 300-year-old cottage in the hills of North
Wales. This is the place where I have been able to
spend so much time relaxing and sharing the odd glass
of wine with my family and friends for over 40 years.
What would you have done if you hadnt chosen to
work in the veterinary sphere?
Despite the recent bad press over the expenses
scandal, I know, personally, MPs who show remarkable
dedication. They work long hours, are completely
honest and do an important job for their constituents
and the country. I have enjoyed every minute of being a
veterinary surgeon but my second choice of career
would be that of a Member of Parliament.
I have enjoyed every minute of
being a veterinary surgeon but my
second choice of career would be
that of a Member of Parliament.
THE companion INTERVIEW
companion
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31
CPD diary
A broad network of regional branches
gives you the potential to meet like-minded
colleagues in your area and delivers
high-quality CPD on your doorstep.
Visit the CPD section at www.bsava.com
to find dates for local courses and details
for your regional committee.
All dates were correct at time of going to print;
however, we would suggest that you contact the
organisers for confirmation.
EXCLUSIVE FOR MEMBERS
Extra 10% discount on all BSAVA
publications for members attending
any BSAVA CPD event.
EVENING MEETING SOUTHERN REGION
Thursday 16 September
Ophthalmology: getting the most from your
diagnostic instruments
Speaker Peter Renwick
Potters Heron Hotel, Romsey SO51 9ZF
Details from southernregion@bsava.com
EVENING MEETING SOUTH WEST REGION
Wednesday 15 September
Common feline surgical techniques
Speaker Colin Whiting
Junction 24, Sedgemoor Auction Centre, North Petherton TA6 6DF
Sponsors Novartis
Detail from Rachel Sekules, rachelsekules@yahoo.co.uk,
07791628635
DAY MEETING NORTH WEST REGION
Wednesday 15 September
Dermatological Roadshow
Speakers Andrew Hillier & Sue Paterson
Mottram Hall, Cheshire SK10 4QT
Details from courses@bsava.com
DAY MEETING NORTH EAST REGION
Sunday 12 September
Abdominal surgery versus laparoscopy
Novotel Hotel, Ponteland Road, Newcastle Upon Tyne NE3 3HZ
Details from northeastregion@bsava.com
EVENING MEETING MIDLANDS REGION
Thursday 23 September
Endocrinology update with case studies
Speaker Grant Petrie
Yew Tree, Kegworth, Derby DE74 2DF
Details from midlandregion@bsava.com
DAY MEETING SOUTH WEST REGION
Monday 20 September
Dermatological Roadshow
Speakers Andrew Hillier & Sue Paterson
Woodbury Park, Exeter EX5 1JJ
Details from courses@bsava.com
DAY MEETING SOUTHERN REGION
Tuesday 21 September
Dermatological Roadshow
Speakers Andrew Hillier & Sue Paterson
Hampshire Court Hotel, Basingstoke RG24 8FY
Details from courses@bsava.com
EVENING MEETING KENT REGION
Wednesday 22 September
Top tips for oncological surgery
Speaker Terry Emmerson
Russel Hotel, 136 Boxley Road, Maidstone, Kent ME14 2AE
Details from Hannah Perrin, 01304 206989,
Hannah@burnhamhousevets.com
DAY MEETING MIDLANDS REGION
Friday 17 September
Dermatological Roadshow
Speakers Andrew Hillier & Sue Paterson
Yew Lodge, Kegworth DE74 2DF
Details from courses@bsava.com
EVENING MEETING SURREY AND SUSSEX REGION
Wednesday 29 September
Surgery of the upper respiratory tract
Speaker Benito de la Puerta
Leatherhead Golf Club, Kingston Road, Leatherhead KT22 0EE
Details from Jo Arthur, 01243 841111, joarthur85@btinternet.com
DAY MEETING SOUTH WEST REGION
Tuesday 28 September
GIT II: oesophagus, stomach and intestines
Speaker Alex German
BSAVA, Woodrow House, 1 Telford Way, Gloucester GL2 2AB
Details from Membership and Customer Services Team,
01452 726700, administration@bsava.com
DAY MEETING NORTH EAST REGION
Sunday 26 September
Through the keyhole or open doors?
open sesame!
Speakers Romain Pizzi & Liz Welsh
Novotel Hotel, Ponteland Road, Newcastle Upon Tyne NE3 3HZ
Details from northeastregion@bsava.com
British Small Animal Veterinary Association
Woodrow House, 1 Telford Way, Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB
Tel: 01452 726700 Fax: 01452 726701
Email: administration@bsava.com
Web: www.bsava.com
For more information or to
order visit www.bsava.com,
email administration@bsava.com
or call 01452 726700.
Order online to save on
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BSAVA Manual of Small Animal
Dermatology, 2nd edition
Edited by Aiden Foster and Carol Foil

Practical information

Problem-oriented

Clinical approach algorithms

Boxes highlight clinical entities
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BSAVA Manual of Canine and Feline
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Edited by Carmel Mooney and Mark Peterson

Sampling and assays

Common laboratory abnormalities

Common and uncommon conditions

Practical standard chapter format to aid information retrieval
I would thoroughly recommend the manual as an excellent addition to the
practice bookshelf... Veterinary Record
I would recommend that you have this book in your clinic, and that you
set aside a period of time when the book arrives to familiarize yourself with
the contents, so you will appear to be a true genius when your next derm
case walks in the door Veterinary Information Network
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New editions of both manuals will be published in 2011