The essential publication for BSAVA members

companion
FEBRUARY 2014
Top Tips
For rabbit surgery
P12
Free microchipping
What will you do?
P4
Clinical Conundrum
Haematochezia in a
Bichon Frise
P8
Avian anaesthesia
01 OFC February.indd 1 20/01/2014 08:46
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companion
companion is published monthly by the British
Small Animal Veterinary Association, Woodrow
House, 1 Telford Way, Waterwells Business Park,
Quedgeley, Gloucester GL2 2AB. This magazine
is a member-only benet. Veterinary schools
interested in receiving
companion should
email companion@
bsava.com. We welcome
all comments and ideas
for future articles.
Tel: 01452 726700
Email: companion@
bsava.com
Web: www.bsava.com
ISSN (print): 2041-2487
ISSN (online): 2041-2495
Editorial Board
Editor Mark Goodfellow MA VetMB DPhil CertVR DSAM
DipECVIM-CA MRCVS
CPD Editor Simon Tappin MA VetMB CertSAM
DipECVIM-CA MRCVS
Past President Mark Johnston BVetMed MRCVS
CPD Editorial Team
Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVS
Tony Ryan MVB CertSAS DipECVS MRCVS
Lucy McMahon BVetMed (Hons) DipACVIM MRCVS
Dan Batchelor BVSc PhD DSAM DipECVIM-CA MRCVS
Eleanor Raffan BVM&S CertSAM DipECVIM-CA MRCVS
Features Editorial Team
Andrew Fullerton BVSc (Hons) MRCVS
Design and Production
BSAVA Headquarters, Woodrow House
No part of this publication may be reproduced
in any form without written permission of the
publisher. Views expressed within this
publication do not necessarily represent those
of the Editor or the British Small Animal
Veterinary Association.
For future issues, unsolicited features,
particularly Clinical Conundrums, are
welcomed and guidelines for authors are
available on request; while the publishers will
take every care of material received no
responsibility can be accepted for any loss or
damage incurred.
BSAVA is committed to reducing the
environmental impact of its publications
wherever possible and companion is printed
on paper made from sustainable resources
and can be recycled. When you have finished
with this edition please recycle it in your
kerbside collection or local recycling point.
Members can access the online archive of
companion at www.bsava.com .
3 BSAVA News
Latest from your Association
46 Microchip update
Latest on compulsory
michrochipping
811 Clinical Conundrum
Polyuria/polydipsia in a young
Bichon Frise
1213 Top tips for rabbits
Imaging and surgery
1419 How To
Anaesthetize a bird
2021 Pyothorax expertise
Vanessa Barrs at Congress
2225 Specialist meetings
Affiliated Groups at Congress
26 Countdown to Congress
Last minute tips
27 To split or not to split
A PetSavers-funded study
into immune-mediated
haemolytic anaemia
2829 WSAVA News
World Small Animal Veterinary
Association
3031 The companion interview
Kirstie Shield
33 Regional CPD
Local knowledge close to home
3435 CPD Diary
Whats on in your area
Additional stock photography:
www.dreamstime.com
Alexey Poprotskiy; Andres Rodriguez; Auris;
Byelikova; Deniskelly; Erik Lam; Frenc; Iqoncept;
Isselee; Jocic; Khmel08; Michael Pettigrew
F
eline injection site sarcomas are
therapeutically challenging
because of their locally invasive
nature. Several protocols
recommend that the two perceived
high-risk adjuvanted vaccines should
be administered into distinct anatomical
sites (left hind leg leukaemia, right
hind leg rabies), which should aid
surgical resection. This has resulted in a
change in tumour distribution with an
increased proportion situated caudal
to the diaphragm when such a policy
is adopted.
The aim of this study was to determine
UK cat owners attitudes towards surgical
treatments of different anatomical regions.
A cross-sectional study of an anonymous
convenience sample of UK cat owners was
conducted from September to December
2012 using an internet-based survey.
208 owners responded. Of these,
39% said they would pursue surgery
regardless of tumour site, and 1% said
they would not pursue surgery. Of the
remainder, respondents would not allow
OTHER PAPERS IN THIS MONTHS JSAP
Review Paper: Advances in sof tssue
minimally invasive surgery
Computed tomography in surgical
treatment of recurrent draining tracts
Iron status and C-reactve protein in
canine leishmaniasis
Phenotypic characterizaton of canine
epileptoid cramping syndrome in the
Border Terrier
Bromide serum levels following an oral
loading dose in epileptc dogs
Log on to www.bsava.com to access
the JSAP archive online.
amputation of the forelimb (20%), hindlimb
(15%) or tail (15%); 26%, 32% and 27%
would not have surgical treatment of the
inter-scapular region, chest or abdomen,
respectively. The majority of respondents
were willing to travel up to 100 miles for
radiotherapy or chemotherapy (66% and
69%, respectively).
The authors conclude that the current
feline vaccine site recommendations may
not be appropriate for UK cat owners.
Adapted from Carwardine, D., et al. JSAP 2014; 55, 8488
Whats in JSAP this month?
Owner preferences for
treatment of feline injection
site sarcomas
EJCAP ONLINE
New issue of EJCAP
now available visit
www.fecava.org/ejcap.
Find FECAVA on Facebook!
02 Page 02 February.indd 2 20/01/2014 14:22
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Collect your
new Formulary
at Congress
D
ont forget to pick up
your 2014 member
benefit and loyalty
benefit publications
from the membership service
team on the BSAVA stand on
the balcony. Vet members can
collect the new edition of the
BSAVA Small Animal Formulary.
The loyalty benefit for paying vet members who
have renewed their membership for 2014 is a new
edition of the BSAVA Guide to Small Animal
Procedures. Vet Nurse members who have
renewed their membership for 2014 will receive a
new loyalty benefit, the BSAVA Casebook for
Veterinary Nurses.
CLINICAL CONUNDRUM
Readers are encouraged to re-read the Clinical Conundrum from
Januarys companion online at www.bsava.com, where a few
minor inconsistencies have been rected.
Membership renewals
I
f you havent done so already, now is the time to renew your BSAVA
membership. If you have any questions regarding your membership
please contact our Membership Services Team on 01452 726700 or
email administration@bsava.com who will be happy to help.
I
n November BSAVA wrote to Public Health England to ask if they would be
prepared to review their risk assessment for front line staff in veterinary
practices (i.e. veterinary surgeons, veterinary nurses and receptionists)
regarding pre-exposure rabies vaccination. On 24 December BSAVA
received a response which explained that risk categories for inclusion in the
free rabies pre-exposure vaccine list are determined by the Joint Committee on
Vaccination and Immunisation (JCVI) which is an advisory committee of the
Department of Health.
It is this committee that is responsible for any change in policy and PHE
issues the vaccines in line with this advice. However, the letter indicated that
as there had not been a review for some years. It was their view that there was
merit in JCVI revisiting the issue, and so they plan to submit a discussion
paper to propose a clearer definition of the groups at occupational risk and to
update the description of those groups. Public Health England went on to
suggest that BSAVA may wish to make a direct approach to JCVI to stress the
particular concerns of frontline veterinary staff and request a review of the
current rabies pre-exposure vaccination policy, which we have now done.
Members can read both the letters online at www.bsava.com/consultations
and we will update you about the progress of this matter as soon as we hear
from the Joint Committee on Vaccination and Immunisation.
PHE response on
rabies
vaccines
for vet
staff
Your views please
T
his is a busy time for consultations and we
encourage you to get involved with BSAVAs
various contributions. The RCVS is currently
consulting on the proposed new Royal Charter
as well as putting out a call for evidence on meeting
the expectations on the provision of 24-hour
emergency veterinary care.
Just after Christmas the Scottish Government
announced a consultation promoting responsible dog
ownership in Scotland (Microchipping and other
measures).
Following the report of the Advisory Council on the
Misuse of Drugs there is also likely to be a consultation
on the classification of Ketamine.
To contribute to BSAVA responses on consultations
please visit the website www.bsava.com/
consultations or email Dr Sally Everitt directly
s.everitt@bsava.com . Your involvement in these
consultations is invaluable.
03 Page 03 February.indd 3 20/01/2014 09:26
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Microchip
update
BSAVAs Head of Scientific Policy, Dr Sally Everitt,
outlines the current situation regarding compulsory
microchipping and the role of Dogs Trust in the
free supply of microchips
A
s you will be aware, the
Government announced that it
would be introducing compulsory
microchipping for all dogs in
England from 6 April 2016 (1 March 2015 in
Wales). The announcement also included
the information that Dogs Trust would make
available a free microchip for all unchipped
dogs in England and Wales.
The Dogs Trust offer of free microchips
extended to providing free microchips to
local authorities, housing associations and
veterinary surgeries. A letter sent to
veterinary practices shortly after the
announcement in February stated that they
would like to work with as many practices
as possible to offer free microchips to dog
owners. In this letter it stated that Dogs
Trust would provide the free microchips to
every practice that wishes to participate,
with the proviso that no charge is made
when using them. The campaign is
expected to last for 12 months and
participation will be entirely voluntary.
Mixed reaction
The initial announcement received what
can best be described as a mixed reaction
from the veterinary profession, as while the
04-06 Microchipping.indd 4 20/01/2014 12:05
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microchip itself was to be provided free of
charge by Dogs Trust the other costs
associated with implantation and
administration would be borne by the
participating veterinary practice. There was
concern that providing microchipping free
of charge was not only devaluing the role
and expertise of the veterinary practice
team but also sending out the wrong
message over responsible dog ownership.
While there is sympathy for those
owners who were genuinely unable to
afford the costs of microchipping, the
extension to all dog owners not only
imposes a cost on veterinary practices but
also removes a source of revenue. There
was also concern that participating in the
scheme could create an expectation
amongst clients that microchipping is a
free service which would continue after the
Dogs Trust scheme ends.
Getting it right
While BSAVA has always supported
compulsory microchipping, we expressed
concern that the announcement from
Defra to the effect that All dogs in
England to get free microchips had been
made prematurely without full
consideration of the implications and
consequences, and that in order for
compulsory microchipping to be
successful it is important that all stages in
the chain from supply of microchips
through to registration and maintenance of
the databases are properly funded.
Although it has been suggested that
taking part in the Dogs Trust scheme to
provide free microchips through veterinary
practices has the potential to bring in
people who would not normally attend the
practice, it is not clear that these people
will necessarily be willing or able to pay for
other veterinary services.
Northern Ireland experience
When compulsory microchipping was
introduced in Northern Ireland, Dogs
Trust ran a similar scheme. While this
had reasonably wide uptake, the
feedback from our members involved in
the campaign received mixed reviews.
When asked in a BSAVA consultation in
2013 if they considered that providing
free microchipping as part of the Dogs
Trust scheme had been a positive or
negative experience for the practice,
only a quarter of respondents
considered it to have been a negative
experience while equal numbers
considered it to have been a positive
experience or neutral experience.
Probing this a little more deeply the
majority of respondents noticed an
increase in footfall as a result of the
scheme but few reported any increase in
turnover. In general, practices were
happy to be able to provide this service
for their own clients but did not feel either
the practice or animals benefitted from
additional veterinary services to
non-clients. Most did not feel that they
gained long-term clients from this
initiative. Here are some of the comments
about this experience:
Lots of new people came into the
practice, quite a few just had the free
microchip but others bought worm/flea
treatments and some have become
on-going clients of the practice.
The footfall increased but there was no
increase in turnover. We had no issue with
our own clients receiving free microchips
which they often did at booster vaccination
time. The vast majority of non-clients
purchased nothing else from the practice.
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Microchip update
I think it was a positive thing as an aid to
reinforce our already-bonded clients and new
puppy owners, but the new clients with
adult dogs for chip were (with some nice
exceptions) almost always with dogs that
had never seen a vet before, just wanted chip
n go and discussions about routine
healthcare, feeding, behaviour etc. just
bounced off them. Although some of them
would buy a pink diamante collar on the way
out a much bigger priority than a worming
tablet it would seem.
Dealing with the fallout
There were some concerns expressed in
Northern Ireland about the administration
of the scheme, where the Dogs Trust
actually provided the microchips, with
some practices reporting problems with
delivery of the microchips. However, at the
time of going to press, we understand that
in England and Wales practices will be
able to use microchips from their normal
supplier and claim back a fee from the
Dogs Trust for every chip implanted. There
was also some uncertainty about how long
the scheme would run for and again we
understand that this has been clarified on
this occasion with the Scheme due to run
for one year from 1 April 2014.
Here is a comment received via the
consultation about administrative problems:
Support staff were under considerable
strain with the admin side of microchipping.
At the start, Dogs Trust wanted lists of
owners and numbers for verification of
their chips. Politely told to do their own
audit. Support staff were relieved and
happy when the free period of
microchipping came to an end. The public
thought that this was a government
sponsored scheme and therefore the vets
were being reimbursed by government.
Respondents also mentioned more
serious problems that arose and the
expectation that it would be the veterinary
surgeon who would sort these out, free of
charge, even if they had not carried out the
original implantation:
Lots of problems with the microchipping
done at free events. Not completing
paperwork, not chipping them properly or
checking that the chip is in following
implantation. We had lots of people in the
practice expecting us to fix the problems as
we are their vet.
A lot of the people coming in were only
interested in the free microchip and had no
interest in other services. One owner
brought in an Akita with a broken leg for a
free microchip (despite the fact it was
already microchipped!), as an attempt to
get a free consultation!
Dogs Trust Free Microchipping
through Vets campaign
Dogs Trust is launching their Free
Microchipping through Vets campaign
and we understand that letters have now
been sent out to practices. The BSAVA
consider that the decision whether to
participate in the scheme should be a
matter for individual practices. Here are
some questions that have been raised by
veterinary surgeons during the last year
some of these will be answered by the
Dogs Trust list of Frequently Asked
Questions; some will be questions for
individual practices to consider.
1. How does the cost of our microchips
compare with the amount Dogs Trust
will reimburse?
2. What additional paperwork will be
required in claiming back money for
microchips implanted under the
scheme?
3. Do we have the resources in terms of
staff and consulting room space to
provide this service?
4. Can the practice run free microchip
clinics at a certain time and offer
normally priced microchips at
other times?
5. Who in the practice will carry out the
free microchipping (vets, nurses,
other members of staff trained to
implant microchips)?
6. Do we want to offer health checks or
advice at the time of microchipping to
benefit the animal or to encourage
owners to purchase other products or
services from the practice?
7. Will the scheme allow us to implant
microchips free of charge at the time
of another chargeable service e.g.
vaccination, neutering?
8. Can free microchips be used in dogs
that require microchipping for other
reasons, e.g. tail docking/pet
passports?
9. Will a person coming for free
microchipping who has not previously
been to the practice become a client?
10. Will we ask for proof of identity from
non-clients who wish to participate in
order to ensure registration details are
correct? (There is no requirement to do
this as the responsibility for ensuring
that the owner and animals details are
correct will rest with the owner/
registered keeper)
11. How will we deal with animals
presented for microchipping which
have significant health problems of
which the owner is unaware and may
not be willing or able to address?
12. If the person offers to make a donation
how will this be handled does it have
to go to Dogs Trust or could it go to
another charity which the practice
supports? n
At the time of writing BSAVA had not
received the FAQs from Dogs Trust,
as soon as we do this will be made
available online at www.bsava.com
and we will inform members as and
when we have any new information.
04-06 Microchipping.indd 6 20/01/2014 12:05
For more information or to book your course
www.bsava.com/cpd
Learn@Lunch
webinars
These regular monthly lunchtime (12 pm) webinars are
FREE to BSAVA Members just book your place through
the website in order to access the event. The topics will
be clinically relevant, and particularly aimed at those in
first opinion practice. There will be separate webinar
programmes for vets and for nurses.
This is a valuable MEMBER BENEFIT
Coming soon
26 February Hospitalizing rabbits (nurses)
19 March Acute airway investigation (vets)
26 March ECGs (nurses)
Book online at
www.bsava.com/cpd
Stock photography: Dreamstime.com. Countrymama; Viorel Sima; Winterling
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P
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Dispensing
course
20 March
BSAVA dispensing course meets the RCVS
Practice Standards Veterinary Hospital
Pharmacy course requirements and is also
AMTRA-accredited.
SPEAKERS
Fred Nind, Phil Sketchley, Pam Mosedale, Mike Jessop,
Michael Stanford, John Millward, Sally Everitt
VENUE
Aldwark Manor, York
FEES
BSAVA Member:
240.00 inc. VAT
Non-member:
360.00 inc. VAT
Is it me or are
these lenses on
this microscope
covered in oil?
A very practical guide to getting
the most out of in-house cytology
7 May
The course will provide practical tips on
setting up and using a microscope, staining
methods and sample collection techniques.
SPEAKER
Emma Dewhurst
VENUE
Woodrow House, Gloucester
FEES
BSAVA Member: 240.00 inc. VAT
Non-member: 360.00 inc. VAT
Whats new in
allergies in dogs
and cats
1 May
This course will describe the current
advances in immunology, microbiology and
cutaneous physiology, which direct the
practicing clinician in the diagnosis and
treatment of allergies.
SPEAKER
Stephen Shaw
VENUE
Hilton, Stansted Airport
FEES
BSAVA Member:
240.00 inc. VAT
Non-member:
360.00 inc. VAT
A
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07 CE Advert February.indd 7 20/01/2014 09:38
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Clinical conundrum
Silvia De Cecco and Massimo
Orioles, interns at Vets Now
Referrals-Kent, invite companion
readers to consider a case of
intermittent haematochezia and
polyuria/polydipsia in a young
Bichon Frise
Case presentation
A 5-year-old female entire Bichon Frise presented with a history of mild
intermittent haematochezia and recent polyuria and polydipsia (PU/PD).
The patient had no history of travel outside of the United Kingdom and was
regularly vaccinated and wormed.
Despite the occasional presence of fresh blood, the faeces were normal in
shape and texture. The owner did not report abnormalities in defecation
frequency, tenesmus or dyschezia. No progression of the
condition was noticed over time. An initial trial with
antibiotic therapy (amoxicillin/clavulanate at 20
mg/kg BID for 10 days) did not lead to
improvement in clinical signs; no other
medications were given and the dog was
not currently on any treatment. A marked
increase in water intake was noted 3
weeks prior to presentation, with an
increased frequency of urination; no
signs of dysuria were reported.
On physical examination the dog was
bright, alert and responsive. Body condition
score was 4/9. Mucous membranes were
hyperaemic and moist, with a capillary refill
time of <2 sec. The oral cavity was thoroughly
examined and revealed no evidence of
periodontal or gingival disease. Heart rate
was 100 bpm with regular good quality
pulses. Respiratory rate was 20 bpm and
thoracic auscultation was unremarkable.
Abdominal palpation was normal. Rectal
temperature was 38.9C and no
abnormalities were found on rectal
examination. A systolic blood pressure
measurement of 130 mmHg was recorded
using a Doppler technique (right recumbency,
left metacarpal artery, relaxed demeanour).
Create a problem list for this
patient and list the principal
differential diagnoses
Haematochezia
This refers to the presence of fresh blood
in the stools. It can originate from the
colon, rectum or anus and perineum and
could be due to:
Primary gastrointestinal disease (colitis/
proctitis)
Dietary sensitivity/allergy
Inflammatory bowel disease (IBD)
Infectious causes (bacterial, viral,
fungal and parasitic)
Neoplasia
Haemorrhagic gastroenteritis
Extra-gastrointestinal disease
Coagulopathies and
haematological abnormalities (e.g.
thrombocytopenia, anticoagulant
toxicity, hyperviscosity)
The chronic, intermittent and non-
progressive nature of the haematochezia
made neoplasia and haemorrhagic
gastroenteritis unlikely, whereas other
causes of primary gastrointestinal disease
remained possible. Some conditions such
as thrombocytopenia and erythrocytosis
could not be ruled out at this stage. In
addition, a systemic coagulopathy may be
the cause of the chronic mild intermittent
bleeding episodes, but they are rarely
solely confined to the gastrointestinal tract.
Polyuria and polydipsia
Polyuria and polydipsia (PU/PD) in the dog
is generally recognized when urine
production is >50 ml/kg/day and water
consumption is >100 ml/kg/day. Although in
our case the daily intake was not measured,
the owner reported a sudden and obvious
increase in water consumption.
Polyuria is often the primary condition
with compensatory polydipsia, although
primary polydipsia is possible. Taking into
account the clinical information gained to
date the differential diagnoses for the
PU/PD include:
08-11 CLINICAL CONUNDRUM.indd 8 20/01/2014 11:14
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Secondary to gastrointestinal disease
Endocrine disease
Hyperadrenocorticism
Diabetes mellitus
Central diabetes insipidus
Acromegaly
Renal disorders (chronic renal failure,
pyelonephritis, renal glycosuria)
Neoplasia (often as a result of
paraneoplastic hypercalcaemia)
Liver disease
Electrolyte disorders (hypercalcemia,
hypokalaemia)
Miscellaneous (hypothalamic disease,
hyperviscosity syndrome)
Primary polydipsia
Some differential diagnoses are less
likely without a supportive clinical history
or physical examination findings
(hyperadrenocorticism, liver disease) but
cannot be excluded without further
investigation.
Hyperaemic mucous membranes
Causes of hyperaemic mucous
membranes may be physiological or
pathological. The former can be stress or
exercise related, whereas the latter may
be observed in vasodilatory shock and in
cases of erythrocytosis. At this point the
cause was unknown; however, shock was
unlikely as the dog was bright and alert
with a normal heart rate, pulse quality and
capillary refill time, similarly the dog did
not seem particularly stressed or excited.
Outline a diagnostic plan for
this patient
Haematology, biochemistry and urine
analysis are suggested first-line tests to
evaluate the presence of the systemic and
endocrine diseases listed above. The
evaluation of coagulation times (PT, aPTT)
are also indicated to detect disorders of
secondary haemostasis, although, as
discussed, these would be an unusual
cause of intermittent haematochezia
without evidence of bleeding elsewhere.
Haematology results are shown in
Table 1 and urinalysis in Table 2. Serum
biochemistry and a coagulation profile
revealed no abnormal findings.
Parameter Result Reference interval
RBC 13.3 5.58.5 x10
12
/l
HCT 0.86 0.370.55 l/l
Hb 23.0 12.018.0 g/dl
MCV 64.4 60.077.0 f
MCH 17.3 18.530.0 pg
MCHC 26.8 30.037.5 g/dl
WBC 13.91 5.5016.90 x10
9
/l
Neutrophils 9.24 2.0012.00 x10
9
/l
Lymphocytes 1.93 0.504.90 x10
9
/l
Monocytes 1.50 0.302.00 x10
9
/l
Eosinophils 1.24 0.101.49 x10
9
/l
Basophils 0.01 0.000.10 x10
9
/l
Platelets 221 175500 x10
9
/l
Table 1: Haematology results from Day 1
(abnormal results in bold)
Parameter Result
Specifc gravity 1.015
Glucose Negatve
Bilirubin Negatve
Ketones Negatve
Blood Negatve
pH 6.5
Protein 2+
Leucocytes Negatve
Sediment analysis Occasional granular cast
and white blood cell
UPC rato 2.1 (reference interval
<0.5)
Table 2: Urinalysis results from Day 1
(abnormal results in bold)
pulmonary disorders causing
chronic hypoxia). Alternatively, it
may be inappropriate due to the
neoplastic over production of
EPO or pathology within the
kidney which affects oxygen
delivery and therefore leads to
increased EPO production (e.g.
renal carcinoma or lymphoma).
Mild erythrocytosis can also
occur due to endocrinopathies
such as hyperthyroidism in cats
and hyperadrenocorticism in
dogs, as both cortisol and
thyroxine stimulate increased
production of EPO.
Primary erythrocytosis
(polycythemia vera) is an
abnormal proliferation of
erythroid cells which occurs
independent of EPO production.
Urine analysis
Proteinuria may be caused by
physiological or pathological
conditions. Physiological proteinuria
(strenuous exercise, seizures, fever,
stress) is often transient and abates
when the underlying cause is
corrected. Pathological proteinuria can
be considered either as non- urinary
(Bence Jones proteins,
haemoglobinuria, myoglobinuria,
genital tract inflammation) or urinary.
Urinary proteinuria is further classified
How do the clinicopathological
findings help to refine the
differential diagnosis?
Haematological abnormalities
Marked erythrocytosis, defined as an
increased haematocrit, red cell
numbers and haemoglobin, was
considered the most important and
marked clinicopathological finding.
Erythrocytosis can be relative or
absolute (Figure 1).
Relative erythrocytosis, defined as
an increased packed cell volume
(PCV) with a normal total red blood
cells number, resulting from a
decrease in plasma volume, was
excluded as the hydration status
was normal on examination.
Absolute erythrocytosis is defined
as a true increase in RBC mass. It
is further classified as primary or
secondary, based on whether it is
driven by erythropoietin (EPO)
which is the hormone produced by
the kidney to stimulate red blood
cell production.
Secondary erythrocytosis may
be appropriate, in response to
systemic hypoxia (most
commonly right-to-left shunting
cardiac diseases and
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Clinical conundrum
as non-renal (i.e. lower urinary tract inflammation or
haemorrhage) or renal, commonly seen in
glomerular lesions, but also in renal parenchymal
inflammation and haemorrhage.
Given that no other significant abnormal findings
were detected on urine analysis or on abdominal
imaging, the definitive origin of the proteinuria was
still considered unknown. A second UPC ratio
repeated 2 days after the patient was discharged
revealed a normal value suggesting stress due to
hospitalization as a possible cause.
At this stage, the PU/PD, and possibly the
haematochezia, were thought likely to be secondary
to the hyperviscosity resulting from the increased
RBC mass, and evaluations focused on the
underlying cause for the erythrocytosis. Other
reported signs of erythrocytosis due to increased
viscosity include seizure activity, abnormal
behaviour, ataxia, blindness and tremor, but were
not reported in this case.
What are the main differentials to
consider at this stage?
Absolute primary erythrocytosis
Absolute secondary erythrocytosis (appropriate or
inappropriate)
Which diagnostic procedures may help
to further narrow the differentials?
The next step is to determine whether the increase in
RBC mass is physiologically appropriate or
inappropriate. After hypoxic causes have been
Parameter Result Reference Interval
P
a
O
2
85 85100 mmHg
P
a
CO
2
37.6 3440 mmHg
pH 7.35 7.357.45
HCO
3
21 2024 mmol/l
Base excess -5 -50 mmol/l
HCT >75 3550 l/l
Table 3: Arterial blood gas results
Erythrocytosis
Absolute
Primary
Primary
erythrocytosis
(polycythemia
vera)
Secondary
Appropriate
Cardiac disorder
Respiratory disorder
Haemoglobin disorder
Kidney neoplasia
Miscellaneous neoplasia
Non-neoplastc kidney
disorders
Inappropriate
Hyperadrenocortcism
Hyperthyroidism
Acromegaly
Relatve
Dehydraton
Splenic
contracton
Endocrinopathy
Figure 1: Flow chart showing the differential diagnoses for erythrocytosis
excluded, causes of secondary inappropriate
erythrocytosis should be investigated. The following
tests were performed:
Arterial blood gas analysis (Table 3):
Decreased arterial partial pressure of oxygen
(P
a
O
2
) may suggest secondary appropriate
erythrocytosis due to EPO release and red cell
production in response to hypoxia; this is most
commonly seen with cardiopulmonary disease.
Hypoxia is defined as a P
a
O
2
of >70 mmHg when
an animal is breathing room air. As increased
blood viscosity may interfere with arterial blood
sampling, phlebotomy to lower the PCV can be
considered before blood gas analysis is
performed. Pulse oximetry can be used if arterial
blood gas analysis is unavailable. Usually a
saturation lower than 92%, determined by repeated
measurements, confirms hypoxia. In this dog,
arterial blood gas analysis was within normal limits,
which provided no evidence for hypoxaemia as the
cause of the erythrocytosis.
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Table 4: Erythropoietin serum concentration
Parameter Result Reference interval
Erythropoietn 10.1 8.228 MIU/ml
80%
75%
70%
65%
60%
55%
50%
45%
40%
1
DAY
P
C
V
3 11 15 23 33 40 46 51 65 86 136 149 208 117
Figure 2: Change in red cell numbers over time, measured as packed cell volume (PCV).
The yellow dots indicate occasions when phlebotomy was also performed
Thoracic and abdominal imaging:
Thorough examination of the cardiopulmonary
system by physical examination and imaging can
help to advance the diagnostic process when
investigating for causes of secondary absolute
erythrocytosis. This is particularly important if
hypoxaemia is detected on blood gas analysis. It
should be noted that animals with erythrocytosis
and hypoxaemia are usually cyanotic. Dogs with a
right-to-left shunting patent ductus arteriosus
classically have differential cyanosis (caudal
mucous membranes such as the prepuce and
vulva are cyanotic, whereas oral mucous
membranes are not) and do not usually have a
heart murmur.
After hypoxaemic causes have been excluded,
abdominal imaging can help to identify
pathological processes involving the kidneys or
other abdominal organs.In this dog thoracic
radiographs, echocardiography and abdominal
ultrasonography were unremarkable.
Erythropoietin:
Serum EPO concentration was found to be normal
(Table 4). This result is supportive of primary
erythrocytosis as it does not provide evidence of
an underlying over production of erythropoietin
(either appropriate or inappropriate) to increase red
cell numbers.
viscosity by lowering the RBC mass. The goal is to
maintain the PCV around 6065%, therefore
phlebotomy should be perfomed regularly until
RBC numbers are controlled. Phlebotomy (removing
1520 ml of blood per kg bodyweight) should be
accompanied by replacement fluid therapy (usually an
equal volume of a balanced crystalloid solution is
administered over 3060 minutes) to restore circulating
volume. If aggressive phlebotomy is performed, a
plasma transfusion may be considered to avoid
depletion of plasma protiens and coagulation factors.
Several therapies including chemotherapy and the
administration of radioactive phosphorus have been
suggested to suppress red cell production. The
chemotherapy agent of choice is hydroxyurea (loading
dose 3050 mg/kg orally once a day, after one week
reduce to 15 mg/kg orally once daily, then titrate to
effect), although other alkylating agents have also been
used with mixed results. Hydroxyurea acts by inhibiting
DNA synthesis, causing reversible myelosuppression
without affecting RNA or protein synthesis. Usually the
effect of hydroxyurea is enhanced by reducing the PCV
with phlebotomy.
Outcome and follow-up
Phlebotomy was performed on three occasions in the
6 weeks following diagnosis (Figure 2), until the PCV was
consistently lower than 60%. The clinical signs improved
rapidly as the red cell numbers fell and were controlled
completely as red cell numbers normalized. Hydroxyurea
was introduced as long term therapy and was well
tolerated by the patient. Nine months later there has
been no recurrence of the clinical signs or appreciable
side effects to the medication. The haematochezia also
resolved and the owners report the dog has a good
quality of life. Although the prognosis for primary
erythrocytosis is guarded, most cases have a good
response to treatment and the long term outcome is
often reasonable if the PCV can be well controlled.
What is the most likely cause of
erythrocytosis at this stage?
Primary erythrocytosis (polycythemia vera) is the
most likely diagnosis and this diagnosis has been
made by excluding all other potential causes of
erythrocytosis. Primary erythrocytosis is defined as an
abnormal proliferation of erythroid precursors in the
bone marrow that follow a normal pattern of
maturation. Therefore, despite being considered a
myeloproliferative disorder, the erythroid precursor
mature into normal RBCs; this occurs independently of
EPO. Primary erythrocytosis, caused by a mutation in
the JAK2 gene leading to defective EPO receptors has
been reported in humans and dogs. JAK2 genetic
testing was not performed in our patient.
What treatment would you suggest?
Therapy for primary erythrocytosis is based on the
reduction of the RBC mass by phlebotomy and
suppression of erythroid production in the bone
marrow. Phlebotomy has been advocated as initial
therapy in any symptomatic patient to reduce
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Top tips for rabbits:
imaging and surgery
Continuing our occasional series highlighting
practical tips from authors featured in the
BSAVA Manual of Rabbit Surgery, Dentistry
and Imaging and the BSAVA Manual of
Rabbit Medicine
Epiphora in rabbits and dacryocystography
By Vladimir Jekl
Nasolacrimal duct obstruction due to the apical elongation or other tooth
apex pathology is the most common cause of epiphora in rabbits. The
optimal way in which to reach the diagnosis is dacryocystography.
The patient is placed in lateral recumbency on the X-ray cassette, with
the affected side uppermost to facilitate contrast medium administration.
Using CT to detect a prolapsed
gland of the third eyelid
By Michael Fehr
An 8-year-old female, spayed, vaccinated rabbit
was presented with a large lump under her eye
that had developed over the last few days. She
had a history of dental problems and had had
conjunctivitis 15 weeks prior. She had also had a
runny nose for a few days.
Clinical appearance
Post-contrast right lateral radiograph of
the normal nasolacrimal duct in a rabbit.
The arrows indicate the tortuous route
of the contrast medium. A small amount
of the contrast medium (iomeprol) can
be seen in the nasal cavity
Obvious distension of the nasolacrimal
duct due to apical incisor elongation
After administration of a
topical analgesic, 0.51 ml
of iodine-based contrast
medium (e.g. iohexol, iomeprol:
300400 mg iodine/ml) is instilled
into the nasolacrimal punctum,
which is situated on the lower
eyelid close to the medial
canthus of the eye.
TIP: Initial administration of a
small amount of contrast medium
(0.30.5 ml) is recommended to
prevent inhalation and
superimposition over the
nasolacrimal duct.
Right lateral and dorsoventral
radiographs should be taken
immediately.
Following the procedure,
application of a protective eye
gel containing retinol and
anti-inflammatory drugs is
recommended to protect the
superficial eye structures.
The differential diagnoses were: prolapse of
the deep gland of the third eyelid; lymphoma of
the Harderian gland; retrobulbar abscess.
Radiography might or might not be diagnostic.
A coronal CT scan showed a prolapsed enlarged,
Coronal CT scan showing a
prolapsed, enlarged,
hypodense lacrimal gland
at the lateroventral aspect
of the left globe
hypodense dilated
lacrimal gland. The
diagnosis was
prolapse of the deep
gland of the third
eyelid. Treatment
options are surgical
removal of the
prolapsed gland or
replacement using a
pocket technique. Both
options are described
in the BSAVA Manual
of Rabbit Surgery,
Dentistry and Imaging.
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Flushing the tear duct
By Richard Saunders
Whilst general anaesthesia is required to
enter the bony foramen and apply
sufficient pressure to unblock and flush
the nasolacrimal duct, most conscious
rabbits will tolerate a catheter being
placed into the single lower lid punctum
and gentle flushing into the soft tissue
portion of the duct. Topical ocular local
anaesthetic drops are applied to the
area, and a 2420 G intravenous
cannula (without metal stylet) is placed
into the punctum.
The key to successful cannulation of
the duct is in gentle eversion of the
The punctum is identified in the ventral eyelid
lower eyelid with the thumb and forefinger,
pulling it laterally and ventrally with a
slightly rolling action, to position and
partially open the punctum.
Various suggestions have been
made as to the exact nature of flushing
solutions, with the addition of antibiotics
or products to break down purulent
material. However, the most important
requirement is the physical removal of
purulent material and establishing the
patency of the duct, as this will allow
drainage of tears through the duct,
preventing their overflow on to the skin
of the face. Sterile isotonic saline or
Hartmanns solution are ideal; they
should be warmed to body temperature
before use to avoid discomfort to the
rabbit. Flushing should be carried out
regularly (e.g. daily) until patency is
restored, if possible.
Skin incisions for
rabbit spays
By William Lewis
When spaying rabbits it is helpful to
make the skin and abdominal incision in
the optimal position.
If the incision is too cranial, the
surgeon will encounter the caecum or
small intestines. These may get in the
way of the surgical procedure; or they
will require handling or manipulating,
with a risk of inducing ileus or, in the
worst case scenario, accidentally
lacerating these organs.
If the incision is too caudal, the
bladder is likely to exteriorize and get in
the surgeons way. Because of the short
ovarian attachments , it may also be
difficult to manipulate the ovaries out of
the abdomen if the incision has not been
made far enough forward.
Texts give the landmarks for the skin
incision as midway between the
umbilicus and the pubic symphysis.
Depending on the size and age of the
rabbit, as well as the amount of fat in the
abdomen, it may be difficult to localize
the cranial brim of the pubic symphysis.
This may result in the incision being made
in a less than optimal area.
A useful alternative landmark is to use
the last (i.e. most caudal) pair of nipples as
a guide to making the incision. If a line is
drawn between the last pair of nipples, the
incision should be roughly 1 cm cranial
and 1 cm caudal to this line, along the
midline of the rabbit. In a sexually mature
rabbit the cervix with its associated fat will
lie immediately under the incision and can
be lifted out of the wound without any
searching. Incising in this area also
prevents the caecum coming out through
the wound.
Many rabbits have asymmetrically
placed nipples. In these cases, a line
should be drawn from each of them,
laterally across the abdomen. A third
line drawn along the rabbits midline
and between these first two lines will
then mark the correct site to make
the incision.
If the surgeon follows these easy
landmarks the incision will always be
made in exactly the correct position to
allow the cervix and uterus to be
exteriorized from the abdomen easily,
with no searching and without the
caecum getting in the way.
The midline incision is made perpendicular to
the line drawn between the last nipple pair.
The arrow is pointing to the umbilicus
The cervix is visible immediately under the
incision site
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How to
anaesthetize a bird
Joanna Hedley, Clinician in
Rabbit, Exotic Animal and Wildlife
Medicine at the Royal (Dick)
School of Veterinary Studies, talks
us through avian anaesthesia
Figure 1:
Subcutaneous fluids
may be easily
administered in the
inguinal region
A
naesthesia of birds has often been viewed
as a high-risk procedure, to be avoided if
possible. Birds have minimal functional
residual capacity, so even a brief period of
apnoea may rapidly lead to hypoxia and cardiac
arrest. Having a higher metabolic rate than mammals
of a similar size also leads to rapid drug metabolism,
heat loss and, potentially, hypoglycaemia. However,
by understanding the relevant differences between
birds and mammals, it should be possible to minimize
these risks and provide the same standard of
anaesthetic care for birds as for our traditional
companion animal patients.
Preparing your patient for general
anaesthesia
Most birds undergo general anaesthesia for
investigations or treatment of underlying disease. Birds
have adapted to hide signs of disease; this means that
they may often have been sick for some time, but just
present to the veterinary surgeon once the disease is
advanced and the problem can no longer be hidden. It
is therefore important to perform at least a basic
clinical examination and stabilize the avian patient
before proceeding to general anaesthesia.
A full clinical examination may require sedation
or anaesthesia, especially in the stressed patient,
and handling should be limited in these cases.
Stress can result in the release of catecholamines,
causing hypertension, reduced renal perfusion and
even predisposition to cardiac arrhythmias and
sudden death. This is unlikely in a well socialized
parrot or raptor, but is a higher risk in small birds
less accustomed to handling, such as canaries or
finches. Observations from a distance are generally
more useful than a prolonged physical examination
in these cases.
After initial assessment, the avian patient should be
stabilized in a warm (2530C), quiet enclosure, ideally
away from the sights and sounds of predator species
such as cats and dogs. Hydration deficits should be
corrected, although assessment of hydration status
can be difficult in the avian patient. Severely
dehydrated patients may have skin turgor and sunken
eyes, but any bird which has undergone a period of
anorexia should be assumed to be 510% dehydrated
even if this is not obvious on clinical examination.
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Drug Dose Route of
administraton
Meloxicam 0.20.5 mg/kg q24h
or half dose q12h
s.c., i.m., orally
Lidocaine <2 mg/kg Applied to
afected area
Bupivacaine <2 mg/kg Applied to
afected area
Butorphanol 12 mg/kg q24h i.m.
Table 1: Examples of analgesic agents used in birds Figure 2: Birds should be held firmly in a towel for mask induction to prevent struggling
Maintenance fluid requirements for most birds are
estimated to be 50 ml/kg/day, although smaller birds
such as passerines, with a higher metabolic rate, may
require volumes up to 100 ml/kg/day.
Fluid therapy may be provided in a variety of ways
but oral and subcutaneous routes are preferred for the
initial management of most cases. Oral fluids may be
administered into the crop or proventriculus at 1020
ml/kg. Subcutaneous fluids may be administered into
the inguinal fold (Figure 1). Subcutaneous space is
limited but warming the fluids to approximately 30C
and the addition of hyaluronidase (1500 IU/l) should
increase fluid absorption. Intravenous or intraosseous
routes should be considered for more critical patients,
but cannulas are generally placed under sedation or
anaesthesia unless the patient is collapsed. In
addition to restoring hydration status, nutritional
support should also be provided. This may be in the
form of the birds normal diet or via tube feeding a
commercial recovery formula.
Once the patient is stabilized, pre-anaesthetic
fasting is recommended to reduce the risks of
regurgitation and aspiration. Parrots will generally need
to be fasted for 24 hours until their crop is empty.
Raptors may need to be fasted up to 12 hours until
they have cast up the undigestible parts of their last
feed. Birds smaller than 100 g are at much higher risk
of hypoglycaemia due to their rapid metabolic rate and
so should only be fasted for less than 30 minutes or in
the case of very small patients not at all.
Analgesia should always be provided for any bird
with a potentially painful condition, ideally before the
painful stimulus (Table 1). Signs of pain can be difficult
to detect so evaluation of analgesics can be difficult.
NSAIDs appear effective but should be avoided in
dehydrated patients or those with renal compromise.
Opioids may also be used, but birds appear to have
more kappa than mu opioid receptors, so butorphanol
is thought to be a more effective analgesic than mu
opioid agonists. Local anaesthesia should be
considered for surgical procedures, although care
should be taken to avoid exceeding the toxic threshold
in smaller patients.
Induction of anaesthesia
Induction of general anaesthesia is usually performed
by administration of volatile agents such as isoflurane
or sevoflurane via a mask. The patient should be firmly
restrained during this process (Figure 2) to prevent
accidental self-trauma, which has been known to
occur during chamber induction. Masks may need to
be adapted for particularly small patients or those with
a long beak, or created from bottles or syringe cases.
Premedication with midazolam (0.51 mg/kg i.m.),
butorphanol (12 mg/kg i.m.) or a combination of
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How to anaesthetize a bird
Figure 3: Induction via the medial metatarsal vein may be easily performed in swans
Figure 4: Intubation may be performed in small birds using an intravenous catheter
these has been advocated in recent years to
reduce both stress at induction and the anaesthetic
gas concentration required for maintenance.
Disadvantages include the stress of increased
handling to premedicate the bird and the potential for
a longer recovery, so premedication will not be
appropriate in every case but should definitely
be considered.
Some birds, such as waterfowl, have developed a
considerable capacity for breath-holding and will
almost always require premedication or injectable
induction agents for a smooth induction. An
intravenous catheter may be placed in the medial
metatarsal vein for administration of the induction
agent (Figure 3). Various protocols may be used,
including induction with alpha-2 agonist/ketamine
combinations, alfaxalone or propofol.
How to maintain anaesthesia
For a short procedure, such as blood sampling,
intubation may not be necessary but in most cases
once a suitable plane of anaesthesia is achieved,
intubation should be performed (Figure 4). Birds have
no epiglottis so the glottis is easily visualized by pulling
the tongue forwards with atraumatic forceps. The avian
trachea has complete cartilaginous rings and the
mucosa is easily damaged, so the use of a non-cuffed
tube is recommended to avoid pressure necrosis. The
tube should be carefully secured in place using a tie or
tape to minimize movement, that could lead to the
formation of tracheal strictures following the
anaesthetic. Some species such as Blue and Gold
Macaws seem particularly prone to tracheal strictures
following intubation. It may be preferable to maintain
these birds on a mask for shorter procedures or place
an air sac tube for longer procedures to avoid potential
tracheal trauma. Small birds (<100 g) may also need to
be maintained on a mask if intubation is not practical
due to the diameter of the trachea. However,
specialized small endotracheal tubes are commercially
available; alternatively, urinary or intravenous catheters
may be adapted for the purpose.
Once intubated, birds should be maintained on
gaseous anaesthesia and often require intermittent
positive pressure ventilation (IPPV) performed either
manually or, ideally, by a mechanical ventilator.
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Figure 5: An intravenous catheter may be placed in the
basilic vein
Figure 6: Fluids may be given via an intraosseous cannula placed in the ulna
Care should be taken to maintain the temperature
of the bird during anaesthesia. Due to their high
surface area-to-volume ratio and rapid metabolism,
hypothermia can be a significant problem. The
background room temperature should be kept warm
and supplementary heating aids such as circulating
water blankets, warm towels and microwaveable heat
pads may help to maintain the animals temperature.
Warm scrub solutions should be used to prepare
surgical sites, and plucking should be minimized if
possible. Intravenous or intraosseous fluids should
also be warmed prior to administration.
How to monitor anaesthesia
Anaesthetic monitoring is critical in birds, as changes
in the depth of anaesthesia, breathing and heart rate
can happen quickly. Respiratory rate and rhythm
should be monitored constantly and IPPV provided as
necessary, as even a brief period of apnoea may
rapidly lead to cardiac arrest. Even if the bird is
breathing, it may not be ventilating adequately due to
body position under anaesthesia, tube position or
reduced respiratory rate.
Respiratory rates may be set at 1015 breaths/
minute. The appropriate pressure will depend on the
size of the individual patient, but it is best to start with
a low pressure and then to increase this slowly until
small breathing movements are seen, resembling
those of the conscious bird. Apnoea is such a
common and significant complication of avian
anaesthesia, that many practitioners prefer to
mechanically ventilate their patients throughout the
procedure to prevent problems.
Fluid therapy should be continued throughout
anaesthesia and intravenous or intraosseous access
should be established for longer procedures.
Intravenous catheters may be placed in the basilic
(Figure 5), right jugular or medial metatarsal veins. The
choice of location may depend on the species of bird
and procedure being performed.
Catheters can be sutured in place for the duration
of the anaesthesia but may be difficult to maintain in
recovery, so are often removed at this point to avoid
self-removal by the bird and potential haemorrhage.
Intraosseous cannulas may be placed in the distal ulna
(Figure 6) or proximal tibiotarsus. Spinal needles may
be used or, for smaller patients, hypodermic needles
may be of more appropriate size. Needles should be
placed aseptically and will need to be taped or
sutured in place.
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How to anaesthetize a bird
Figure 8: The corneal reflex may be checked with a damp
cotton bud and should remain present throughout
anaesthesia
Capnography is therefore very useful to
assess the effectiveness of ventilation. End-tidal
carbon dioxide should be monitored throughout
anaesthesia and ideally maintained between 35 and
45 mmHg. Pulse oximetry may also be used but
readings are not consistently accurate in avian
patients and so generally just provide a guide to
whether levels of oxygenation are increasing,
decreasing or constant.
The heart may be auscultated using a
paediatric stethoscope and a pulse may be
palpated over the brachial artery (Figure 7).
A Doppler probe can also be secured in this
location to provide a constant audible monitor of
heart rate and potentially to allow indirect blood
pressure monitoring. Indirect monitoring may
underestimate blood pressure, especially if the cuff
size is too big, but can be used to reflect trends in
pressure. Systolic blood pressure should ideally be
Figure 7: The brachial pulse may be easily palpated in the axillary region
maintained at >90 mmHg; if levels fall below this,
fluid therapy should be tailored accordingly.
Reflexes which can be assessed include jaw
tone, toe pinch and the cloacal reflex. However, care
should be taken when checking the toe pinch of a
raptor or jaw tone of a large parrot. Eye position
generally stays central during anaesthesia, but the
corneal reflex can be checked with a damp cotton
bud and should remain as indicated by the nictitating
membrane moving across the eye (Figure 8). The
speed of this response will indicate the depth of
anaesthesia although the reflex may be abolished if
checked too frequently.
In the event of an avian anaesthetic emergency,
the speed of response is critical. Emergency drugs
should be easily accessible and for critical patients,
appropriate dosages should be drawn up in syringes
ready for use prior to the induction of anesthesia
(Table 2).
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Figure 9: Birds should
be monitored closely
throughout recovery
and held in an upright
position
Drug Dose Indicaton
Adrenaline 0.11 mg/kg i.v.,
i.o., intratracheal
Cardiac arrest
Atropine 0.010.5 mg/kg i.v.,
i.o., intratracheal
Suspected
supraventricular
bradycardia
Diazepam 0.11 mg/kg i.v.,
i.m.
Seizures
Doxapram 520 mg/kg i.v., i.o.,
intratracheal
Respiratory arrest
Table 2: Examples of emergency drugs used in birds. Lower
doses are suggested initially, with incremental increases if
no response is seen
Recovery
Recovery following anaesthesia is generally thought
to be the time of highest risk for avian patients, so
careful monitoring is required throughout this
period. If IPPV has been given, this should be
continued during recovery until the bird is self-
ventilating normally. The endotracheal tube should
remain in place until jaw movements increase and
voluntary breathing occurrs. The bird should be
held upright, with the head supported and the body
only gently restrained (Figure 9) to prevent any
restriction of breathing, until the bird is able to
perch. At this point it can be placed in a
pre-prepared warm incubator and should be
closely monitored until movement is coordinated.
Analgesia should be continued in the
post-anaesthetic period for any painful procedure,
even if the bird is not showing any obvious signs of
pain. In addition to NSAIDs and opioids, the use of
tramadol may also be considered for those animals
likely to need longer term analgesia. Food should be
offered as soon as the bird is no longer ataxic, and if
not eating within 2 hours, tube feeding should be
carried out to prevent hypoglycaemia. n
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Congress 36 APRIL 2014
Pyothorax expertise
at Congress
Q
One would assume that a
penetrating injury would be
the major cause of this
condition; is that so?
A
No, it is surprising to most people
that fighting and biting is not the
most common cause of
pyothorax in cats. In older case
series this was more common and
probably reflected a higher proportion of
entire male cats more likely to engage in
territorial aggression. A bite wound to the
chest of a cat can certainly result in direct
inoculation of bacteria from the oral cavity
into the thoracic cavity, and bite wounds
have been identified in some affected cats.
However, recent case series do not
support fighting and biting as the most
common cause of pyothorax. This is also
supported by the evidence showing that
free-roaming cats with outdoor access are
not more likely to get pyothorax than indoor
cats. Furthermore, male cats, more likely to
engage in territorial aggression, are not
over-represented, and other diseases
transmitted by biting, such as feline
immunodeficiency virus are not common in
cats diagnosed with pyothorax.
So what does happen to cause this
condition?
What is clear, in all studies, is that the
bacteria isolated from the thoracic cavity of
cats with pyothorax are the same species
as those found in the mouth and throat of
comorbidities reflecting age-related
susceptibility, such as feline leukemia virus
infection, may be present.
Being from a multi-cat household also
increases the risk. For what reason?
In one study, cats with pyothorax were
nearly four times as likely to have come
from a multi-cat household compared to
cats without pyothorax. The authors of
that study suggested that fighting and
biting would be more likely in a multi-cat
household, and that this would be the
cause of the pyothorax. However,
behavioural studies do not support this
concept of aggression in stable multi-cat
households as explained earlier, and FIV,
which is primarily spread by intercat
aggression, was only present in 3% of
cats tested.
The increased risk of pyothorax in
multi-cat households more likely reflects
the increased risk of exposure to upper
respiratory pathogens due to direct contact
with other cats harboring these pathogens
(nasal discharge, grooming) and indirect
contact (food, water bowls, contact with
human carers), with subsequent
development of URTIs.
How frequently would you expect a
typical small animal practitioner to
encounter such a case?
Pyothorax is not common, but certainly not
rare. A busy small animal practice might
encounter one or more cases of pyothorax
per year. Presentations are more common
in emergency centres, since cats often do
not present until late in the disease process
when their respiratory reserve is exhausted.
What are the typical clinical signs?
The most common respiratory signs are
increased respiratory rate and a restrictive
pattern of respiration (rapid, shallow
respiration with inspiratory dyspnoea).
Heart sounds may be muffled due to the
accumulation of thick purulent exudate in
the thoracic cavity. Similarly, lung sounds
healthy cats. The question is: how did
these so called normal flora get from the
mouth into the chest cavity?
The single biggest risk factor for
pyothorax is pre-existing upper respiratory
tract infection. URTIs are common in cats
and are often mixed viral (e.g. feline
herpesvirus 1 and feline calicivirus) and
bacterial (Mycoplasma species, Bordetella
bronchiseptica) infections. A URTI can
cause damage to the mechanism that
prevents upper respiratory secretions from
reaching the lower respiratory tract. This
mechanism of mucociliary clearance is an
important host defence mechanism against
bacterial colonization of the lower
respiratory tract. Failure of this mucociliary
escalator is thought to be the mechanism
by which these bacteria gain access to the
lower respiratory tract, initially causing
pneumonia, with infection then spreading
into the pleural space, so-called
parapneumonic spread.
Young cats are at greater risk of
developing a pyothorax. Why is that?
Young age is a risk factor due to biological
rather than behavioural reasons. It has
been shown that young cats less than 12
months of age are more likely to develop
atypical infections such as pyothorax with
concurrent lungworm or roundworm
infections. In these cases the bacterial
species may be of gastrointestinal rather
than oropharyngeal origin, e.g. Escherichia
coli or Salmonella species. Also, other
Vanessa Barrs of the University of Sydney
has a longstanding interest in the
management of pyothorax, a major medical
emergency for feline practitioners. She will
be passing on her knowledge to colleagues at BSAVA
Congress in April but in the meantime she gave John
Bonner an inkling of what they may expect to hear
20-21 Congress Science.indd 20 20/01/2014 12:51
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Congress 36 APRIL 2014
may be decreased ventrally or, in some
cases where there is concurrent severe
pneumonia, lung sounds may be increased
dorsally. Fever is often present, but its
absence does not rule out pyothorax, and
some cats with severe, advanced
infections will be hypothermic.
Those signs described seem fairly non-
specific is it a challenging diagnosis?
Diagnosis can be challenging, because
respiratory signs can be hard to detect.
This is illustrated by one study where 40%
of owners did not detect any respiratory
problem with their cat but sought veterinary
attention because of lethargy and loss of
appetite. These signs are common to most
feline illnesses and are of little help to the
investigating practitioner. A thorough
clinical examination will usually enable
detection of respiratory disease but even
then signs can be subtle. Pyothorax should
be considered as a differential diagnosis
for unexplained fever.
What would be the main differential
diagnoses?
Major differentials for pyothorax include all
other causes of pleural effusion, including
transudates, modified transudates,
exudates and hemorrhagic effusions, since
the diseases that cause these can result in
presentation for dsypnoea. Of these, the
five most common causes of feline pleural
effusion are cardiac disease, feline
infectious peritonitis, pyothorax, idiopathic
chylothorax and neoplasia. Clinical signs
and signalment are helpful to rank these
for example if fever is present and the cat
is young, the major differentials would be
feline infectious peritonitis and pyothorax.
The presence of cardiovascular
abnormalities such as a gallop, murmur,
arrhythmia or jugular distension/pulse
results in a higher ranking for cardiac
disease. However, some cats with right- or
left-sided congestive heart failure may not
have obvious localizing signs, and cardiac
causes cannot be ruled out. If available,
echocardiography can allow the clinician
rapidly to rule out this diagnosis. If not
available, obtaining a pleural fluid sample
enables the clinician to readily identify the
presence of a pleural exudate. Usually this
procedure is performed after the presence
of pleural effusion has been confirmed on
radiography. However, if dyspnoea is
life-threatening at presentation and a
restrictive pattern of respiration is present,
blind thoracocentesis can be performed
to drain the thoracic cavity of effusion and
obtain a sample for fluid analysis.
Are there any figures on survival rates?
Until recently, pyothorax in cats was
considered to have a poor prognosis.
However, it has become clear that most
cats that survive the first 48 hours following
presentation can be successfully treated
with aggressive medical management. For
cats in which thoracostomy tubes are
placed to drain the effusion, survival rates
of 80 to 95% are reported.
What are the good and bad prognostic
indicators?
Not many studies have determined
prognostic indicators for pyothorax, so it is
difficult to place a lot of value on these until
further studies become available. In one
study of 80 affected cats, hypersalivation
and low heart rate at presentation were
poor prognostic indicators. Many cats with
low heart rates were also hypothermic.
Hypothermia and bradycardia can reflect
septic shock in cats. Placement of a
thoracic drain and survival beyond the first
48 hours after presentation are good
prognostic indicators for pyothorax.
Antimicrobial treatment may have to
start before the results of bacterial
culture are available. So what would you
recommend as a reliable combination to
begin the treatment?
Antimicrobials suitable for initial empirical
treatment of typical feline pyothorax
include penicillin G (e.g. benzylpenicillin
potassium or benzylpencillin sodium) or
an aminopenicillin (e.g. ampicillin or
amoxicillin) alone or in combination with
metronidazole. Alternatively parenteral
monotherapy with a potentiated penicillin,
e.g. amoxicillin/clavulanate can be used.
At what stage should the vet recommend
surgical treatment?
Indications for exploratory surgery at
diagnosis include detection of pulmonary
or mediastinal abscess, or very loculated
effusions on imaging. It is also indicated
when medical management fails, as
determined by persistence of effusion
37 days after placement of thoracic drains
(thoracostomy tubes), or if there is
development of a pneumothorax or drain
obstructions caused by pleural adhesions.
Do surviving cats recover full lung
function and are there any other
long-term impacts?
Surviving cats generally have excellent
respiratory compensation after treatment,
even after removal of a lung lobe or
pneumonectomy (resection of all lung
lobes from one side of the thorax). In a
recent case series four cats that had
pneumonectomy survived to discharge
and an excellent quality of life was reported
on long-term follow-up. Careful monitoring,
oxygen supplementation, pain relief, blood
transfusion and thoracostomy tube
management were important factors in the
successful postoperative recovery of these
cats. Disease recurrence is uncommon
(around 5% of cases) and, generally,
long-term impacts are rare. n
VANESSA AT CONGRESS
Thursday 3 April
n Dealing with the difcult cat: Alimentary
lymphoma, chronic rhinits, pyothorax
n Small Group Session: Feline medicine
cases
n Interactve case-based medicine: Feline
pancreatts
20-21 Congress Science.indd 21 20/01/2014 12:51
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Congress 36 APRIL 2014
Specialist
Groups
at Congress
On the Wednesday of Congress, BSAVA helps
its Affiliated Groups hold their own meetings,
offering even more CPD to those with special
interests. For full details and registration
please contact the organisations directly
Association of Veterinary
Soft Tissue Surgeons
(AVSTS)
Venue: Hall 7, ICC
Website: www.avsts.org.uk
Contact: Alison Young
avstsadmin@fsmail.net
The Association of Veterinary Soft Tissue Surgeons
welcomes all vets and nurses involved with canine
and feline soft tissue surgery cases, and aims to
provide a thought-provoking discussion forum at its
two annual meetings. The spring meeting in
Birmingham on the Wednesday of BSAVA Congress
week traditionally covers Whats new and hot? and
in 2014 we have another great line-up, including
Professor Gerhard Oechtering from the University of
Leipzig, Laurent Findji from the VRCC, Stephen
Baines from The Willows, and Nick Bacon from
University of Florida. Our autumn meetings, held on a
non-half-term Friday/Saturday, allow a theme to be
explored with greater depth and breadth, and benefit
from inclusion of the comparative aspects from
human surgery, as well as fine food, wine, and
laughter. See website for further details of our 2014
meetings and to find out how to join our society.
www.avsts.org.uk
British Association of
Veterinary Emergency
and Critical Care (BAVEC
Venue: Crompton Room, Austin Court
Website: www.bavecc.org.uk
Contact: Toby Birch
toby@coastwayvets.co.uk
BAVECC is a small but enthusiastic group of
veterinary nurses, practitioners and ECC specialists
who have a special interest in dealing with the
emergency or intensive care patient. We meet
every year for a dedicated CPD event during the
pre-BSAVA Congress day, during which we have
lectures dealing with current veterinary ECC topics
and also a guest speaker from the human intensive
care medical field. This year we will discuss Fluid
dilemmas. Please join us. For further information and
to register, please contact Toby Birch or register
online at www.bavecc.org.uk
British Veterinary Behaviour
Association (BVBA)
Venue: Hall 10, ICC
Website: www.bvba.org.uk
Contact: Jaqi Bunn
bvba@outlook.com
The British Veterinary Behaviour Association is a
friendly group consisting of UK and international
members with a common interest in companion
animal behaviour. We are always happy to welcome
new members to our meetings, whether they have
just an interest, or are working in the field of
behaviour. Our membership includes people in
veterinary practice, veterinary students, behaviour
science students, behaviour professionals,
academics, researchers and pet charity workers. Our
diverse membership enjoys the exchange of ideas
and expertise.
We invite you to attend our annual BSAVA
Congress study day in Birmingham on 2 April 2014
and the topic this year is Aggression: medical or
mental? Our speakers will explore how we approach
the diagnosis and management of aggression in dogs,
cats and caged birds, with particular reference to
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Congress 36 APRIL 2014
establishing the underlying cause. For anyone with an
interest in pet behaviour, this is an event you should
not miss.
We are delighted to welcome Danille Gunn-
Moore and Sarah Heath (cats), John Chitty (caged
birds), and Gary Landsberg and Clare Rusbridge
(dogs), who will discuss important medical and
behavioural differential diagnoses, illustrating their
points using case examples and leading us to a
greater understanding of aggression in cats, dogs
and caged birds. All our speakers are accomplished
and experienced in their field, and anyone attending
this study day can expect to be well entertained, as
well as taking home plenty of useful advice. In
addition the programme will include a range of short
presentations on other aspects of domestic animal
behaviour selected from submitted abstracts.
Refreshments, including lunch, are provided, and
there will be the opportunity to visit and talk to our
various sponsors during breaks.
British Veterinary
Dental Association
(BVDA)
Venue: Lodges 1 and 2, Austin Court
Website: www.bvda.co.uk
Contact: Rob Pascoe
horse_dentistry@hotmail.com
The morning sessions for the BVDA annual scientific
meeting in association with the BSAVA Congress will
focus on endodontic techniques, including a guest
speaker from Birmingham Dental School, Mr Philip
Tomson, discussing the emerging subject of
Regenerative endodontics.
The highlight of the afternoon sessions will be
lectures from Dr Christopher Snyder, Clinical Assistant
Professor in Veterinary Dentistry and Oral Surgery at
the University of WisconsinMadison. He will be
talking on the subject of maxillofacial fractures and
injuries in dogs and cats.
Alongside an exciting range of lectures, there will
be range of exhibitors displaying the latest range of
veterinary dental instruments and materials. For further
details and to register, please visit the BVDA website
www.bvda.co.uk
British Veterinary
Dermatology
Study Group (BVDSG)
Venue: The Crowne Plaza Hotel,
Birmingham
Website: www.bvdsg.org.uk
Contact: bvdsg@conf-co.net
The British Veterinary Dermatology Study Group
holds two annual meetings a day meeting prior to
BSAVA Congress in April, and a weekend meeting
usually in November. Both meetings attract eminent
speakers from home and abroad, covering all
aspects of veterinary and human dermatology.
Members also have an opportunity to present their
own work and findings at each meeting in the form of
abstracts or short communications. The pre-Congress
meeting will be held at The Crowne Plaza Hotel,
Birmingham and is entitled: Pyoderma: bog standard
or multiresistant? The BVDSG has secured R. Mueller
and J.M. Blondeau as the international speakers.
The next autumn meeting is to be held on 1516
November at the Radisson Blu Hotel, Manchester
Airport, and is entitled: Hairs, hormones and
hounds. For further details please email
bvdsg@conf-co.net or visit www.bvdsg.org.uk or
www.bvdsgmeetings.com
British Veterinary
Orthopaedic
Association (BVOA)
Venue: Hilton Metropole Hotel, Birmingham
Website: www.bsavaportal.com/bvoa
Contact: Ciara@torvet.co.uk
The BVOA is the BSAVAs biggest affiliate
organisation, comprised of orthopaedic specialists
and general practitioners, and known for its popular
and sociable scientific meetings focusing on varied
topics. The 2014 Spring Meeting will explore the
mysteries of feline orthopaedics with speakers
including Harry Scott, Sorrell Langley-Hobbs and
Denis Marcellin-Little. Hosted at the Hilton Metropole
Hotel, Birmingham, the day will include refreshments
and notes. Clinical research abstracts may be
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Congress 36 APRIL 2014
eligible for the Lesley Vaughan Prize.
Registration is via the BVOA website
www.bsavaportal.com/bvoa where the benefits of
membership are detailed. For 35 per year (or 90
with a subscription to the journal Veterinary
Comparative Orthopaedics and Traumatology)
members receive discounts on meeting and CPD
registration, a biannual newsletter, access to the BVOA
forum Google Group for case discussion and online
resources. The BVOA funds research projects and
information regarding grants is available on the
website. The BVOA Facebook page also provides
news and updates from the association. Autumn
Meeting 2426 October, Brighton.
European
Association of
Veterinary
Diagnostic Imaging (British and
Irish Division) (EAVDI-BID)
Venue: Hall 9, ICC
Website: www.eavdi.org/eavdi-bid-home-page
Contact: Andrew Parry
andrew.parry@willows.uk.net
The British and Irish Division of the European
Association of Veterinary Diagnostic Imaging is
open to any veterinary surgeon, student,
radiographer or nurse with an interest in veterinary
diagnostic imaging. The division organises two
regular meetings each year, one meeting in
Birmingham, on the Wednesday prior to BSAVA
Congress, and a further two-day meeting in the
following November. Our Autumn meeting this year
will be a joint meeting with the Veterinary
Cardiovascular Society on 1415 November.
This year EAVDI-BID will be holding a BSAVA
Congress meeting in Hall 9 of the ICC. The
meeting is themed on neuroimaging. Lectures will
be on a broad range of subjects within this
discipline and lecturers include Holger Volk
speaking on syringohydromyelia, Sebastien Behr
speaking on inflammatory CNS disease and Chris
Lamb speaking on meningeal disease. A film-
reading quiz will finish the day. Prices are
deliberately kept as low as possible to encourage
new membership:
Resident/Intern: 90.00
EAVDI member: 107.00
Non-EAVDI member: 135.00
For further details, registration and programme
please visit: www.eavdi.org/eavdi-bid-home-page
or contact the chairman Andrew Parry.
International
Cat Care (ICC)
Venue: Hall 5, ICC
Website: www.icatcare.org/vets
Contact: Amanda Blencow
amanda@icatcare.org
This years ISFM feline symposium on the day before
BSAVA Congress will be focusing on Practical feline
therapeutics: How do I treat ? for those everyday
feline problems that are commonly seen in general
practice. The aim is to provide a new focus and
up-to-date practical advice on these issues.
Lectures will be given by Alberta de Steffano
(Animal Health Trust), Vanessa Barrs (University of
Sydney), Angie Hibbert (Langford Veterinary
Services), Sarah Caney (Vet Professionals), Sheila
Wills (University of Bristol) and Daniel Mills
(University of Lincoln).
Topics covered will include: inappetent cats and
the use of pharmacological stimulants, idiopathic
epilepsy in cats, chronic upper respiratory infection in
cats, stress and the use of facial pheromone versus
when to use drugs, hyperthyroidism, and herpesvirus
infection, amongst others. Get 5 off your registration
price if you register online via www.icatcare.org/vets
Small Animal Medicine
Society (SAMSoc)
Venue: Hall 8, ICC
Website: www.samsoc.org.uk
Contact: Alison Hall
samsoc@vetsurgeon.org
Members of SAMSoc include specialist internists and
general practitioners from the UK and abroad who
Specialist Groups at Congress
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Congress 36 APRIL 2014
share a passion and enthusiasm for small animal
medicine. New members are always welcome and
membership is only 29.
SAMSoc organises two meetings each year, with
lectures aimed at practitioner and specialist level. The
Spring meeting is held every year at BSAVA Congress
and is suitable for everybody with an interest in small
animal medicine. This year the day will include the
following exciting sessions:
Guillermo Couto Can we cure lymphoma?
Elizabeth Villiers Flow cytometry: how does it
work and how can I use it to help my patients?
Lizza Baines The met check: diagnostic imaging
for the cancer patient
Dr Caroline Shiach IMHA and ITP in people
The meeting is still only 100 and includes course
notes and lunch (if registration completed before
3 March). To book your place at the meeting or to
become a SAMSoc member please contact Alison
Hall or visit the website. Submissions for the case
report competition should be sent to Sheena.
Warman@bristol.ac.uk by 17 February 2014.
Details of our autumn meeting, held in November,
are available on our website. SAMSoc also offers a
500 travel scholarship annually to any SAMSoc
member. For more information please contact
david@andersonmoores.com
Veterinary Cardiovascular
Society (VCS)
Venue: Hall 11, ICC
Website: www.bsavaportal.com/
vcs/Meetings.aspx
Contact: Jan Cormie
treasurer@vcs vet.co.uk
Membership of the Veterinary Cardiovascular Society
is open to any veterinary surgeon or veterinary nurse
from the UK and abroad with a special interest in
cardiology. Annual VCS membership: 25. The society
holds two meetings a year, a one-day pre-BSAVA
Congress Spring meeting at the ICC in Birmingham
and a two-day Autumn meeting, usually in
Loughborough in November (1415 November 2014).
We also offer travel grants annually to VCS members to
help them attend the ECVIM or ACVIM Congresses, as
well as cardiology small project research grants.
The VCS pre-BSAVA Congress Spring meeting
will focus on the clinical effects of heart disease
and failure (heart rate, occurrence of coughing), the
new IDEXX test for NT-proBNP and Doppler
echocardiography, with speaker Professor John
Bonagura. There will also be a panel discussion
and case reports. The meeting will emphasize a
practical approach to common issues encountered
in general practice.
Registration costs
Before 14 March
Members: 125
Non-members: 150
After 14 March
Members: 150
Non-members: 175
Last date for registration is 24 March. Cost includes
lunch and proceedings.
Please visit our website for access to the full
programme and details of how to register:
www.bsava.com/vcs
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Congress 36 APRIL 2014
Time well spent is money saved
A
t a time when value for money and wise buying decisions are vital, the
extensive commercial exhibition at Congress will once again showcase the
latest innovations, services and products. With so much to see and plenty of
exclusive discounts, this is your chance to make sure you make the most of
special offers, as well as negotiate the best deals for you and your practice and
discuss new products with industry experts.
Real savings can be made when taking advantage of the amazing discounts and
offers available within the Exhibition Vouchers Booklet. At Congress 2013, there were
28 tablet computers up for grabs, over 600 worth of shopping vouchers, 2 HD TVs
and a number of discounts on CPD workshops, products and services, so it really
pays to visit the Exhibition.
Theres an App for that
BSAVA Members
can register for
FREE Exhibition-
only passes.
Visit the website
for details.
Cant come to
Congress for
the four days
but want to
check out
what is on
offer in
the NIA?
Party night
D
ust off your dancing shoes and
get ready to laugh with Congress
Party Night on Saturday 5 April,
which will have live music
provided by rock/pop band Lawson and
laughs aplenty from Marcus Brigstocke
and Rhodri Rhys.
Countdown
to Congress
R
egistrations for Congress have
been flooding in. The team at
Woodrow House HQ is busy
keeping up with demand, and
the volunteers responsible for making
Congress happen are checking the
finer details to ensure their colleagues
from all over the UK and from overseas
get the most benefit from. From the
Committee Chair Farah Malik to our
registration team we all want this to
be a year that provides you with more
knowledge, confidence, inspiration,
and connections.
If you have not registered yet then
there is still plenty of time visit
www.bsava.com or if you have any
questions email congress@bsava.com
or call 01452 726700 and a member of
our team will be happy to help.
O
ur IT team has been working hard on a
brand new and much-improved App for
Congress which will enable you to:
See the most up-to-date Scientific programme,
with lecture details and locations
Browse the full list of speakers
Build your own personal schedule to plan your
time effectively
View the full Exhibitor listings and
company details
Send us your feedback and comments
Find out useful delegate information
View Congress-related tweets
The App will be available prior to Congress.
Members will be the first to hear when it goes
live. To download it for free, just head over
to the Apple AppStore (for iPhone/iPad)
or Google Play (for Android).
Enhance your
Congress
experience
G
et closer to the experts with a
number of Small Group Sessions
and Practical Workshops; visit
www.bsava.com/congress to
find out more.
26 Congress Social.indd 26 20/01/2014 13:11
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For more informaton about PetSavers
studies email info@petsavers.org.uk.
I
mmune-mediated haemolytic anaemia
(IMHA) remains an important cause of
critical illness in dogs, with a case
fatality of 3070%. Thromboembolic
disease is reported as the most common
complication, but a large number of dogs
are euthanased due to an inability to control
the disease (either in the short or long term)
and due to long-term complications such
as side effects of treatment.
In the treatment of immune-mediated
diseases such as IMHA with
glucocorticoids, we often fail to achieve
disease remission or cure without
unacceptable side effects. In humans,
studies have shown that among systemic
treatments involving the same total dose of
glucocorticoids, split-dose regimens such
as twice-daily dosing tend to be more toxic
than single daily-dose methods.
A veterinary perspective
So far, there are no data available for
veterinary patients on whether a single
dose regimen would be as effective but
less toxic than the conventionally used split
regimen, as has been shown in human
patients. Therefore, the aim of this study is
to look at the efficacy (initial response as
well as long-term outcome) and associated
side effects of two different treatment
protocols a more empirical twice-daily
versus a once-daily regimen.
All dogs with a provisional diagnosis of
IMHA will be eligible to be enrolled in this
study pending further diagnostic testing.
After exclusion of underlying disease
processes, dogs with primary IMHA will be
Celebratng 40 YEARS of improving the health of pets
randomized to receive prednisolone either
as a single daily dose or as a conventional
split dose. Concomitant therapy consisting
of a second immunosuppressive drug,
gastroprotectants and antithrombotic
medication will be the same for each group.
Efficacy of the single daily dose will be
assessed in comparison to the
conventional split-dose regimen regarding
initial response, effects on lypmphocyte
profile and long-term outcome.
Furthermore, common side effects of
glucocorticoids will be assessed by
performing a serum biochemical profile,
routine urinalysis, non-invasive blood
pressure measurement (NIBP),
thromboelastography (TEG), assessment of
muscle mass and body condition scores,
dermatological assessment, and by using
a standardized questionnaire.
We hypothesize that a single daily dose
regimen will be as effective as a split-dose
regimen based on the initial response and
long-term outcome. Furthermore, we
hypothesize that an initial single daily dose
regimen followed by an every-other-day
maintenance protocol will be associated
with fewer side effects and higher owner
compliance and satisfaction.
Study potential
The ability to achieve a quick remission of
the disease without owner perception that
the side effects of the drug are worse than
the disease itself will have a major impact
on patient management and outcome.
The results of this study will have the
potential to be transferable to other
To split or not to split
that is the question
Barbara Glanemann
Barbara Glanemann graduated from the
University of Leipzig, Germany, in 2001. Afer
completng a doctoral thesis at the University
of Zurich, Switzerland, Barbara accepted a
positon as Intern in a private referral centre
in Switzerland in 2004. On completon of this
programme she entered the joined residency
programme in small animal Internal medicine
at the University of Giessen, Germany, and
the Royal Veterinary College of London and
gained her Diplomate ECVIM-CA in 2008.
Prior to returning to the RVC as a lecturer
in small animal medicine in December 2009
Barbara worked as a specialist in a private
referral centre in Southern England.
Barbara Glanemann discusses her
study into immune-mediated
haemolytic anaemia
common conditions requiring long-term
glucocorticoid therapy, such as immune-
mediated meningitis, immune-mediated
polyarthritis, etc.
The proposed study will also be the
first to evaluate the effect on lymphocyte
populations of glucocorticoids in the
treatment of canine IMHA. It will be among
the first to examine CD4
+
FOXP3
+
Tregs in
the context of a spontaneous canine
autoimmune disease. This is an area of
intense research in people, reflecting the
immunotherapeutic potential of Tregs in
infectious, autoimmune, allergic and
neoplastic disorders. n
27 PetSavers.indd 27 20/01/2014 13:32
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I
am honoured and humbled by the confidence
shown in me in the recent WSAVA election. I was not
expecting to assume the WSAVA presidency so
soon but I am committed to continue to drive
progress towards our goals of improving companion
animal care around the world.
I would like to thank Jolle Kirpensteijn for all that he
has done for the WSAVA. He has been a wise mentor
and his willingness to resume the presidency when
Professor Peter Ihrke resigned for reasons of ill health
gave me time to better learn and understand the many
facets and intricacies of our organization. Jolle has
been a fantastic leader and a great ambassador for
the WSAVA. I thank him for his years of loyal service.
Meanwhile, I am proud to assume the responsibility
of leading this great organization. Both the support we
provide to our members globally and our contribution
on the world stage in areas such as One Health are
growing fast. Our committees and task forces are
working productively, plans for World Congress 2014
Congress are virtually complete and registration is
going well. I am also pleased to report that the
readership of our digital global journal Clinicians Brief
continues to grow.
WSAVA is your association and, as your elected
leader, I really want to hear from you. What ideas do
you have to help us deliver our mission? What can
we do to enhance the work of your members? How
can we help you? I would welcome your thoughts
and contributions.
Thank you again for your support and for the work
that you do for our profession. n
Colin Burrows
A message from the
new President
Incoming WSAVA President
Colin Burrows wants to hear
from you
28-29 WSAVA Feb.indd 28 20/01/2014 13:19
Introducing a new
veterinary oath
for the WSAVA
The WSAVAs Animal Welfare and Wellness
Committee has been working to develop a simple
voluntary oath for the global profession
A
n oath should be central to
everything that vets do, guiding
their decisions and ensuring that
they act in the best interests of
patients at all times. Yet many countries do
not have an oath, or other professional
affirmation of the role of vets in the
community. In countries with an oath, most
fail to recognize the concept of animal
welfare, focusing purely on the importance
of relieving suffering.
The WSAVAs Animal Welfare and
Wellness Committee (AWWC) believes this
is an important omission and has been
As a global veterinarian, I will use my
knowledge and skills for the benefit of our
society through the protection of animal
welfare and health, the prevention and
relief of animal suffering and the promotion
of One Health. I will practise my profession
with dignity in a correct and ethical
manner, which includes lifelong learning to
improve my professional competence.
This oath is voluntary but the
committee hopes that all members of
WSAVA will wish to adopt it. The AWWC
will announce the oath formally at the
World Congress in 2014, but in the
meantime the Committee plans to launch a
new award to highlight members who really
embody the values the oath stands for.
Details of the award criteria and how to
enter will be announced shortly. n
working to develop a simple voluntary oath,
which reflects all aspects of the vets role.
In doing this, Committee members
examined the veterinary oaths used around
the world and also talked to member
associations to understand their
expectations of an oath. Having done this,
the committee has now developed a new
oath that highlights the importance of
animal welfare and is relevant to all
veterinary practitioners. It can be used on
its own, as an adjunct to an existing
statement or as a guide to associations or
groups looking to develop their own oath:
There will also be the opportunity to
visit neighbouring countries, including
Botswana, Mozambique, Namibia and
Lesotho, with volunteer lecturers to help
teach local veterinarians. This will appeal
particularly to those with an interest in
lecturing and education and this work
will serve as an extension of WSAVAs
CE programme.
In addition, the organizers are hoping
to run an activity based around supporting
South Africas endangered rhino population
and are also looking for volunteers for a
pre-Congress stream to help educate local
animal health inspectors. More details on
both of these will be available soon.
The social outreach programme will
be welcomed by many communities that
usually have only limited access to
veterinary services, and is an ideal
opportunity to give something back
to Africa. For more details visit
www.wsava2014.com. n
Make a difference by
taking advantage of a
unique social outreach
opportunity
World Congress 2014
W
orld Congress 2014 takes
place from 1619 September
in Cape Town. It will be an
ideal opportunity to be
updated with the latest in veterinary
science and to exchange ideas with
colleagues from around the world. The
social programme will ensure you
experience the best of South African
hospitality, food and wine, while the
opportunity to take a wildlife safari is not to
be missed. However, this World Congress
will be truly unique. It will also be about
reaching out and providing much-needed
support to indigent communities in
Johannesburg, Cape Town and Durban.
The organizers are partnering with the
International Fund for Animal Welfare (IFAW)
and the South African Veterinary Association
to develop a range of social outreach
programmes, including opportunities to
participate in clinics involved with the
WSAVAs rabies vaccination campaign. This
will include basic diagnostics and
treatments and may involve neutering
clinics. Arrangements are being finalized
and work will be carried out in conjunction
with local animal welfare institutions.
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28-29 WSAVA Feb.indd 29 20/01/2014 13:19
30
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Kirstie Shield
DipAVN(Surgical) RVN LCGI
MBVNA
Q
Tell us about how you chose your
career.
A
I knew from a young age that I
would become a veterinary nurse.
Once Id completed work
experience in practice, I knew it was the
life for me. After A levels, teachers
encouraged me to apply for university.
However in my heart of hearts I was
adamant that veterinary nursing was
really what I wanted to do. So in the
midst of half-heartedly filling out my
UCAS form, I also sent out multiple
letters and CVs to local veterinary
practices in the hope that someone
would give me a chance. As luck would
have it, a local practice invited me for an
interview. The rest, as they say, is history.
How important has professional
development been to your VN career?
I am not ashamed to admit that I was
known as a bit of a geek at college, and
that this is still the case today. I qualified
as a VN in 1999 and was awarded the
Top Veterinary Nurse accolade from
Hartpury College. I was as proud to wear
my green uniform and badge then as I still
am today. Veterinary nursing has been an
important part of my life and has shaped
me into who I am today this is quite a
proclamation; however I know that any
fellow veterinary nurses reading this will
identify with that feeling.
As a newly qualified VN, my thirst for
further knowledge led me to study and
work towards the RCVS Diploma in
Advanced Veterinary Nursing. Gaining this
qualification is one of the highlights of my
professional career to date, and in part
awakened my professional awareness,
eventually leading me to my contribution
to the BVNA.
Tell us about your current role and how
you balance the various responsibilities
of a Head Nurse.
The practice that gave me my very first
opportunity some 17 years ago has also
played quite a role in shaping my career.
I attribute the passion I have for my
profession to being part of this team. I am
very lucky to work in an environment where
high standards of care are paramount, and
the team around me is committed to giving
our patients the very best. After
experiencing life in other practices of
Kirstie Shield qualified as a VN from Hartpury College,
Gloucester, in 1999. Since then she has nursed in both
first opinion and referral practice. She attained the
RCVS Diploma in Advanced Veterinary Nursing
(Surgical) in 2006, the A1 Assessors award in May
2007, the City and Guilds Licentiateship in Veterinary
Nursing in 2009, and she most recently trained as a
clinical coach for student nurses. Kirstie is a practising
Veterinary Nurse in a large mixed practice and
RCVS-accredited Small Animal Veterinary Hospital in
Chippenham, Wiltshire. She has been the Head
Veterinary Nurse at this practice since 2006 and is the
current President of the BVNA.
the companion interview
30-31 Interview.indd 30 20/01/2014 13:22
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31
various shapes, sizes and types, I returned
to this practice as Head Veterinary Nurse
seven years ago. The provision of quality
nursing care is something that the whole
practice team is proud of and supports
whole-heartedly.
I try to achieve a good balance
between undertaking the day-to-day line
management duties necessary to lead a
team effectively, and ensuring that I am
able to do plenty of hands-on clinical work.
I will always be a veterinary nurse at heart
and am never happier than when in a busy
prep room doing what we veterinary nurses
do best. My aim as the Head Veterinary
Nurse will always be to maintain and
uphold the values of delivering a high
standard of nursing care to our patients
and clients. I hope that I am always able to
ensure that my own clinical skills facilitate a
lead by example approach.
After gaining my A1 assessor
qualification and subsequently training as
a clinical coach, I have had the pleasure of
seeing many student nurses join the RCVS
register of veterinary nurses and have
witnessed their pride when wearing the
coveted bottle green uniform and badge
for the first time. It takes me back to the
day that I qualified. The role that Veterinary
Nurses play in the training and mentoring
of students contributes to the ownership
that we feel for the future of our profession,
and must be maintained as another part of
what makes us special.
What do you get out of your involvement
with BVNA?
When I joined BVNA in 2001 I admired the
work undertaken by a Council comprised
of elected veterinary nurses working on a
volunteer basis. I identified with their
passion and dedication to represent our
profession, ensuring that the voice of the
veterinary nurse is heard throughout the
wider veterinary profession and
disseminated to the public. I became
BVNA Regional Co-ordinator in 2005, and
felt great satisfaction in representing our
profession on a regional level. This
prompted me to take the plunge, and
stand for election to BVNA Council in
2008, subsequently; I was ratified on to
Council in October 2008. My time on
Council has been everything I could wish
for, and more. I have had the pleasure of
working with like-minded veterinary nurses
from all over the country, all with the
common aim of representing and
contributing to our profession. The BVNA
office team, based at our headquarters in
Essex, shares Councils drive, vision and
passion for our profession. I could not
wish to work with a more hardworking and
supportive team of people.
What have been the key achievements
since youve been involved with BVNA,
and what do you hope still to achieve?
I have been responsible for a variety of
different areas, including being an
internet observer, regional co-ordinator
team leader, Honorary Secretary and
Honorary Treasurer. This has given me a
solid understanding of the workings of
the Association and these experiences
are assisting me enormously in the role
of President.
We must remember how far veterinary
nursing has come in the past 50 years.
There is no doubt that the professional
reputation of the veterinary nurse has
grown, and will continue to do so. The
BVNA encourages all veterinary nurses to
practise and work to the Code of
Professional Conduct set out by the RCVS.
We must ensure that we understand the
professional responsibilities that we have to
our clients, patients, colleagues and the
wider public.
Professional excellence and
recognition of the veterinary nursing
profession is at the heart of everything we
do. Ultimately we seek protection of our
Veterinary Nurse title and wish to see the
statutory regulation of our profession. In
order to aspire to this, every veterinary
nurse must validate this status with
contribution and professionalism and
continue to act in the name of veterinary
nursing with the utmost integrity. On behalf
of our members, we will continue to
represent the values and priorities of
veterinary nursing and will work to maintain
strong relationships with other veterinary
representative associations and our
regulatory body. We pledge to stand
shoulder to shoulder with our veterinary
colleagues to work together in order to
shape the future of our profession with
maturity, confidence and belief.
Being BVNA President must be a career
highlight?
The opportunity to serve as BVNA
President is undoubtedly an experience
that I will remember forever. Reflecting
upon my first three months as BVNA
President, I have been overwhelmed in the
most positive sense. I have been
encouraged and uplifted by the level of
support that has been demonstrated
towards the work of the BVNA and have
had the pleasure of meeting respected
colleagues from the veterinary associations
and our regulatory body. It is clearly
evident to me that the veterinary nurse is
held in high regard by the wider veterinary
profession. This is something we must
maintain and build upon; as the veterinary
nursing profession matures, we must
realise that our opinions and contributions
are heard and, most importantly, we must
realise that they are essential.
Veterinary nurses are immensely proud
of the work we undertake. We are
passionate and thrive on the camaraderie
of the veterinary team and the difference
that we make on a daily basis. We
endeavour to go the extra mile for our
patients, clients and students and find
great satisfaction in providing top quality
trained, loving care. Whats not to be proud
of? Could anyone ask for any more from
their chosen career... except perhaps
some extra hours in the day?
it is clearly evident to
me that the veterinary
nurse is held in high
regard by the wider
veterinary profession
30-31 Interview.indd 31 20/01/2014 13:22
For more information or to order
www.bsava.com/publications
BSAVA reserves the right to alter prices where necessary without prior notice.
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Rabbits make up a considerable and growing proportion of the caseload in
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32 Publications Advert February.indd 32 20/01/2014 13:22
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33
Local
News from BSAVA regions
knowledge
You and your region
When attending regional meetings, can you
please bring your membership card as this
helps with registration on the day, making the
sign-in as easy as possible
Dont forget that if you attend a regional
meeting, you can get an additional 5 off
BSAVA publications
The following regions would really like your
help and are looking for volunteers: South
West (specifically Cornwall), East Anglia,
East Midlands, North West and North East
Regions. If you are interested in finding out
more, please contact Jennie on
j.bartholomew@bsava.com. If you are not in
one of these regions and still would like to get
involved, please let us know and we can pass
your details over to the committee
If you are a Tweeter follow us
@BSAVAREGIONS
South West neurology
survival guide
Laurent Garosi is one of our foremost neurologists in
the UK, being a Diplomate of the European College of
Veterinary Neurology and currently President of
ECVN. We are delighted that he has agreed to head
to the West Country to present this day course
offering a pragmatic approach to neurology for
general practitioners.
Neurology is one of the most challenging and
daunting specialties in veterinary medicine, particularly
as a large part of this field is emergency-based. Spinal
disease, neuromuscular weakness, seizures and loss
of balance are common clinical presentations in
practice. This day course aims to provide a logical no
nonsense step-wise diagnostic approach, all illustrated
with extensive video clips.
The meeting will be held at The Gables Hotel,
Falfield, Gloucester GL12 8DL (just north of Bristol) on
7 March.
Geriatric cats in Southern Region
We are delighted to announce a day meeting with Martha Cannon, who
will speak to us about lifestage challenges in geriatric cats on Sunday
9 March. Martha is one of only the few veterinary surgeons in the UK who
has been awarded the Diploma in Small Animal Medicine (feline). Topics
of this meeting, at the Apollo Hotel in Basingstoke, will include:
Renal failure
Hyperthyroidism
Hypertension
Arthritis
Vaccination in older cats
Running geriatric cat clinics
The meeting is being kindly sponsored by
Boehringer Ingelheim and by Royal Canin.
North East does dermatology
In December Chris Dale spoke to a packed audience (32 delegates) on
commonly encountered problems in dermatology, explaining how to avoid
pitfalls and how to ensure best practice in a GP setting with minimal
equipment. Chris also dispelled lots of myths surrounding one of the most
frustrating problems we encounter, and the thing he gets a lot of phone calls
about demodicosis.
The audience was rapt throughout, with lots of audience participation, and
delegates felt much more positive about what they could achieve in their own
practices. We enjoyed it so much that we are going to ask Chris if he will come
back next year and give us another entertaining and encouraging talk on a
different dermatology topic. Thanks to IDEXX and Virbac for their support for
this event.
West Midlands gets teeth into CPD
Members in the West Midlands are benefitting from superb CPD thanks to
the efforts of the local committee. Last October we had a wonderfully
engaging meeting presented by Dr Martin Whitehead from Chipping Norton
Veterinary Hospital on Evidenced-based veterinary medicine its history and
processes, and how it applies to our everyday practice. It all provoked plenty
of audience debate.
On the weekend of 2223 February, in conjunction with the British
Veterinary Dental Association, we are holding a two-day course on practical
dentistry a mix of lectures and hands-on use of dental equipment,
radiography, charting and extraction technique, and all at a bargain cost for
BSAVA members of 449. This is open to people from any region but places
are limited.
33 Regions.indd 33 20/01/2014 13:27
34
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companion
CPD diary
LUNCHTIME WEBINAR
Wednesday 19 February
13:0014:00
Enterotomy and enterectomy
Speaker: Richard Coe
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 26 February
13:0014:00
Hospitalising rabbits
Speaker: Anna Meredith
Online
Details from administration@bsava.com
EVENING WEBINAR
Monday 24 February
20:0021:00
Hip osteoarthritis: when is it
time for surgery and what
options are there?
Speaker: Eithne Comerford
Online
Details from administration@bsava.com
EVENING WEBINAR
Thursday 27 February
20:0021:00
Problem-based approach to
respiratory disease
Speaker: Eleanor Raffan
Online
Details from administration@bsava.com
DAY MEETING
SCOTTISH REGION
Thursday 20 February
Infectious diseases and
zoonoses
Speaker: Rory Bell
Best Western Station Hotel, Dumfries
Details from scottish.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Friday 21 February
Rabbit dentistry and
surgery of the head:
a practical workshop
Speaker: Frances Harcourt-Brown
Clifton College, Bristol
Details from southwest.region@bsava.com
WEEKEND MEETING
WEST MIDLANDS REGION
Saturday 22 February
Sunday 23 February
Practical canine dentistry:
radiography, cleaning and
extractions (with BVDA)
Speaker: Rachel Perry
Solihull College
Details from westmidlands.region@bsava.com
DAY MEETING
METROPOLITAN REGION
Saturday 1 February
Canine endocrinology
Speakers: Mike Herrtage and Lucy Davison
The Holiday Inn, Barnet Bypass
Borehamwood WD6 5PU
Details from metropolitan.region@bsava.com
DAY MEETING
NORTHERN IRELAND REGION
Sunday 2 March
How to survive the neurological
consultation
Speaker: Laurent Garosi
Dunadry Hotel, Co. Antrim
Details from nireland.region@bsava.com
DAY MEETING
Thursday 6 March
Advances in management of
parasitic skin disease
Speaker: Patrick Bordeau
Hilton, Stansted Airport
Details from administration@bsava.com
DAY MEETING
Tuesday 4 March
Wound management and infection
control for nurses
Speaker: Louise ODwyer
Woodrow House, Gloucester
Details from administration@bsava.com
EVENING MEETING
SOUTHERN REGION
Thursday 6 February
Imported diseases: plus pub quiz
and fish and chip supper
With Annual Regional Meeting. Fundraiser
for PetSavers and Mission Rabies
Speakers: Luke Gamble and Michael J Day
The Potters Heron Hotel, Hampshire
Details from southern.region@bsava.com
EVENING MEETING
NORTHERN IRELAND REGION
Thursday 6 February
Reconstructive surgery
Speaker: Terry Emerson
VSSCo, Lisburn, Co. Antrim
Details from nireland.region@bsava.com
EVENING MEETING
NORTH EAST REGION
Thursday 6 February
Rabbit dental
Speaker: Bob Partridge
IDEXX, Whetherby
Details from northeast.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Thursday 27 February
Clinical nutrition in practice
Speakers: Penny Watson and Marge Chandler
Kendleshire Golf Club, Bristol BS36 2TG
Details from southwest.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Friday 28 February
Clinical nutrition in practice
Speakers: Penny Watson and Marge Chandler
Kingsley Village, Cornwall TR9 6NA
Details from southwest.region@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Tuesday 18 February
The PUB Clinical Club:
endocrine disease
Speaker: TBC
The Royal Oak, Ockbrook
Details from eastmidlands.region@bsava.com
DAY MEETING
Thursday 6 February
Oh no! Another patient with
skin disease: what should
I do first?
Speaker: Rosario Cerundolo
Hilton, Stansted Airport
Details from administration@bsava.com
February
March
EVENING MEETING
SOUTH EAST REGION
Thursday 13 February
Dealing with the emergency
patient
Speaker: Ava Firth
Venue: Leatherhead Golf Club, Surrey
Details from southeast.region@bsava.com
34-35 CPD Diary February.indd 34 20/01/2014 13:45
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35
EXCLUSIVE FOR MEMBERS
Extra 10% discount on all BSAVA
publicatons for members atending any
BSAVA CPD event.
All dates were correct at tme of going to print; however, we
suggest that you contact the organizers for confrmaton.
LUNCHTIME WEBINAR
Wednesday 19 March
13:0014:00
Acute airway investigation
Speaker: Mickey Tivers
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 30 April
13:0014:00
Oxygen supplements
Speaker: Karen Humm
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 26 March
13:0014:00
ECGs
Speaker: Pedro Oliverio
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 23 April
13:0014:00
Advances in MCT
Speaker: Susan North
Online
Details from administration@bsava.com
EVENING MEETING
WEST MIDLANDS REGION
Thursday 20 March
From the Trenches: top tips to
deal with emergencies efficiently
Speaker: Aofie OSullivan
Three Pears Beefeater Grill, Worcester
Details from westmidlands.region@bsava.com
EVENING MEETING
WEST MIDLANDS REGION
Tuesday 25 March
Radiographic appraisal for nurses
Speaker: Paul Mahoney
Willows Veterinary Centre and Referral
Service, Solihull
Details from westmidlands.region@bsava.com
EVENING MEETING
METROPOLITAN REGION
Tuesday 11 March
Top Ten Tips: getting the most out
of haematology at the reference
lab as well as your clinic
Speakers: Graham Bilbrough and
Susan Randell
Riverside House, Berkshire
Details from metropolitan.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Friday 7 March
Survival guide to neurology in
practice
Speaker: Laurent Garosi
The Gables Hotel, Falfield
Details from southwest.region@bsava.com
DAY MEETING
SOUTHERN REGION
Sunday 9 March
Geriatric cat
Speaker: Martha Cannon
Apollo Hotel, Basingstoke
Details from southern.region@bsava.com
DAY MEETING
Thursday 20 March
BSAVA dispensing course
Speakers: Fred Nind, Phil Sketchley,
Sally Everitt, Mike Jessop, Pam Mosedale,
John Millward and Mike Stanford
Aldwark Manor, York
Details from administration@bsava.com
EVENING MEETING
NORTH EAST REGION
Sunday 23 March
Poisons: what they do to pets and
what to do about them
Speakers: Alex Campbell and Jackie Belle
Gomersal Park Hotel, Bradford
Details from northeast.region@bsava.com
EVENING MEETING
SOUTH WEST REGION
Thursday 20 March
Hairless hounds and mangy mutts
Speaker: Natalie Barnard
Bridgewater Canalside Centre, Somerset
Details from southwest.region@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Tuesday 18 March
The PUB Clinical Club
Speaker: TBC
The Royal Oak, Ockbrook
Details from eastmidlands.region@bsava.com
April
May
OTHER UPCOMING BSAVA CPD COURSES
See www.bsava.com for further details
BSAVA Educaton
Wednesday 14 May
SAVSNET
Southern Region
Thursday 15 May
Orthopaedic problems of
the forelimb in dogs
Metropolitan Region
Sunday 18 May
Whats new for old cats?
South West Region
Tuesday 20 May
Cranial cruciate ligament disease:
where are we now?
Wednesday 21 May
Companion animal diabetes mellitus
management in practce: an up-to-date,
holistc, 21st-century view
BSAVA Educaton
Wednesday 21 May
Endocrine diagnostcs
DAY MEETING SCOTTISH REGION
Sunday 23 March
An interactive cased-based
medicine and surgery session
Speakers: Clare Knottenbelt
and Kathryn Pratschke
Glasgow Vet School
Details from scottish.region@bsava.com
EVENING WEBINAR
Tuesday 29 April
20:0021:00
Choosing the right way to deal
with a fracture update
Speaker: Gareth Arthurs
Online
Details from administration@bsava.com
DAY MEETING
Thursday 1 May 2014
Whats new in allergies in cats
and dogs
Speaker: Stephen Shaw
Hilton, Stansted Airport
Details from administration@bsava.com
DAY MEETING
Wednesday 7 May 2014
Is it me or are these lenses on this
microscope covered in oil? A very
practical guide to getting the most
out of in-house cytology
Speaker: Emma Dewhurst
Woodrow House, Gloucester
Details from administration@bsava.com
34-35 CPD Diary February.indd 35 20/01/2014 14:36
36 April 2014
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valuable knowledge
for the entire practice
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36 OBC - Congress.indd 36 20/01/2014 13:46