The essential publication for BSAVA members

companion
JUNE 2014
Anaesthesia and
analgesia
Advances with
PetSavers P24
Clinical Conundrum
Hind limb swelling
P4
Acupuncture
for dogs
A perspective
P8
How to
approach
the canine
athlete
01 OFC June 2014.indd 1 16/05/2014 12:38
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Log on to www.bsava.com to access
the JSAP archive online.
EJCAP ONLINE
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issue of EJCAP visit
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Find FECAVA on Facebook!
3 BSAVA News
Latest from your Association
47 Clinical Conundrum
Crossbred dog with hind limb
swelling
812 Acupuncture for dogs
Perspective from Samantha Lindley
1314 Complementary and alternative
therapies
BSAVA position statement
1621 How to
Approach the canine athlete
2223 Fundraising
Stories from PetSavers supporters
2425 Advances in anaesthesia and
analgesia
With PetSavers
2628 WSAVA News
World Small Animal Veterinary
Association
29 BSAVA Publications
Supporting colleagues overseas
3031 The companion interview
Sophie Hemming
33 Regional CPD
Local knowledge close to home
3435 CPD Diary
Whats on in your area
companion is published monthly by the British
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companion should
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ISSN (print): 2041-2487
ISSN (online): 2041-2495
Editorial Board
Editor Simon Tappin MA VetMB CertSAM DipECVIM-CA
MRCVS
Past President Michael Day BSc BVMS(Hons) PhD DSc
DiplECVP FASM FRCPath FRCVS
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
Features Editorial Team
Andrew Fullerton BVSc (Hons) MRCVS
Design and Production
BSAVA Headquarters, Woodrow House
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Whats in JSAP this month?
Guidelines for recognition,
assessment and treatment of pain
T
his months issue of JSAP contains a
milestone document on veterinary
analgesia, produced by the World
Small Animal Veterinary Associations
Global Pain Council. This group comprising
world experts in veterinary analgesia was
established with the remit to raise global
awareness and provide a call to action based
upon the understanding that all animals are
sentient and, therefore, feel pain and suffer
from it. The groups initial goal was to
produce a Global Pain Treatise, providing
guidelines in recognition and management of
acute and chronic pain in dogs and cats,
which take account of the significant variation
in availability of analgesic drugs and
equipment in different parts of the world.
JSAP is delighted to publish this Treatise,
which provides accessible guidelines for all
veterinarians while also presenting a
substantial reference list for those requiring
further detail. The document starts by
covering the pathophysiology of pain, and
then moves to a discussion of assessing
pain and the various pain scoring systems
that are now in use in dogs and cats. The
major section of the Treatise moves on to
discuss the drugs and techniques available
for management of acute and chronic pain,
for all ages and situations. In addition (and
particularly useful for veterinarians with
minimal experience) the authors then detail a
variety of clinical scenarios ranging from
routine neutering procedures through to
major orthopaedic surgery, and suggest
possible analgesic protocols that may be
followed for each. The final part of the
Treatise presents the WSAVA Humane
Euthanasia Overview. While some readers
may consider this section to be out of place
in a document of this nature, it is a useful
reminder that pain relief can always be
achieved in animals, even though owner
resistance may make euthanasia a difficult
option to follow in certain cases.
ALSO IN THIS MONTHS ISSUE
Veterinary treatment and rehabilitaton
of indigenous wildlife [REVIEW]
Vascular eects of a polymerized bovine
haemoglobin soluton on isolated canine
arteries [PetSavers]
Canine arthrits associated with
Leishmania infecton
Positve pressure ventlaton in dogs:
indicatons, prognostc factors and
outcome
Serum Cardiac Troponin I concentratons
in cats with anaemia
Computed tomographic appearance of
canine thyroid tumours
The Global Pain Council has produced a
body of work that will revolutionize analgesia
provision for animals across the world. As
the authors themselves say: We cant
always know that our patient does hurt, but
we can do our best to ensure that it doesnt
hurt. The WSAVA Global Pain Treatise is
likely to play a monumental role in
guaranteeing we achieve this.
This 60-page paper is available online
and is free to download it is accompanied
by an editorial from Derek Flaherty, Professor
of veterinary anaesthesia and analgesia at
the school of veterinary medicine, University
of Glasgow.
Adapted from Flaherty D. JSAP 2014; 55: 290
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3
Summer Membership Renewals
M
embers who joined under the BSAVA Summer membership plan will
shortly be receiving their 2014 renewal letters. Dont forget,
renewing vet members get the latest BSAVA Small Animal
Formulary and the loyalty benefit BSAVA Guide to Procedures in
Small Animal Practice. Renewing VN members will receive the BSAVA
Casebook for Veterinary Nurses.
Renewing your membership is as easy as 1 2 3:
1. Log into the BSAVA website and visit the myBSAVA membership section
and select My invoices, or
2. Complete and post the payment slip with your card details or cheque
(attached to your letter), or
3. Consider switching to direct debit, and we will renew your
membership automatically.
If you have any queries about your membership you can contact the membership
services team on 01452 726700 or email administration@bsava.com.
Reward your colleagues today
T
he prestigious BSAVA Awards give you the chance to acknowledge the
inspiring work of colleagues who have made their own exceptional
contributions to our profession people we work alongside every day or
those whom we admire from afar.
All members of BSAVA are eligible to vote you can choose to nominate in just
one category, or nominate in multiple categories it is up to you. It takes just a few
minutes to encourage and honour a colleague visit www.bsava.com/awards for
details. The winners will be awarded at BSAVA Congress 2015. If you have any
questions please email awards@bsava.com.
Enticing you to Edinburgh
V
ets and VNs are guaranteed a weekend of excellent CPD and a good
time at BSAVAs Scottish Congress. You can download the full
programme online at www.bsava.com/scottishcongress or email
Ben Dales (b.dales@bsava.com) if you have any questions.
Case reports
Do you have an interesting or unusual case that you would like to share with
others? Veterinary surgeons, nurses and students are invited to submit
abstracts of no more than 400 words detailing the case and interesting
discussion points.
Selected cases will receive free registration on Saturday, a Gala Dinner
ticket and a BSAVA Manual of the winners choice will be awarded to the case
report deemed favourite by the audience. For more information or to submit an
abstract contact Gerard McLauchlan (gerard.mclauchlan@glasgow.ac.uk)
or Yvonne McGrotty (scottishbsava@vetsurgeon.org). Abstracts should be
submitted via email by Tuesday 1 July 2014, notice of acceptance will be
given by Saturday 19 July 2014.
Travel scholarship available
to members
T
he Frank Beattie scholarship was established in 1988 in memory of Frank,
a well respected veterinary surgeon and a long-standing member of the
BSAVA. It is awarded annually from a generous gift given by Franks
widow, Annie. The scholarship, worth 2000, is to help a BSAVA member
undertake a trip abroad to study a particular aspect of veterinary practice. To
apply for this scholarship email awards@bsava.com. The deadline for
application is 26 September.
J
ust before we left university an email went
around asking those who were staying in the
area to get involved in the local BSAVA region.
I felt that it would be good to make some
contacts amongst the local practitioners in the area so
I agreed to go along. The fact that we met in a local
pub might have influenced my decision!
Since then Ive been Treasurer, Secretary and
Chair of the East Anglia regional committee; a
Regional Rep and member of the Membership
Development Committee (MDC), and most recently
Chair of MDC. So now I oversee the committee whose
remit is to make sure we are providing the right kind of
support to members. We are well represented with
general practitioners and people from the regional
network, so we get a good balance of views and I
hope that this translates into worthwhile and valued
member benefits. Our big projects at the moment are
the expansion of nurse membership and undertaking
a survey of members so that we can understand their
needs better.
One of the best things about the veterinary
profession is the way that people are willing to give
their time and effort to improve things and this is
typified by BSAVA. I valued the networking when
I first joined East Anglia Region and I now enjoy
speaking to a whole variety of people from across
the profession.
BSAVA gives people the backup to turn their
ideas into actions and this can be a great feeling! It is
extremely rewarding working with like-minded people
in an organization that is run by vets and VNs for vets
and VNs with the same ultimate aim to improve the
welfare of animals.
Get to know
your BSAVA
colleagues
Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know Get to know
Volunteer
voice
Sheldon
Middleton
Find out how you can get involved as a
BSAVA volunteer, email Carole Haile
c.haile@bsava.com.
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Clinical conundrum
Helen Bowes, of Vets Now in
Coventry, invites readers to
consider a 4-year-old cross-breed
dog with hind limb swelling after
becoming trapped in a stair gate
Case presentation
A 4-year-old male neutered 40 kg cross-breed dog was presented
out of hours to an emergency clinic after becoming trapped in a stair
gate at the owners home whilst they were out. When found, his
body was suspended over the top of the gate with his left pelvic limb
caught between several of the vertical bars. It was estimated he had
been trapped for a maximum of 6 hours and the damage to the
surrounding walls was significant, indicating a prolonged struggle.
On presentation, he was ambulatory but unable to bear weight
on his left pelvic limb which was grossly swollen, with significant
bruising over the medial aspect of the femoral region. Clinical
examination revealed he was cardiovascularly stable with a heart
rate of 104 bpm, strong peripheral pulses, and normal cardiac and
chest sounds.
Mucous membranes were pink and moist with a normal capillary
refill time of 2 seconds. Neurological examination revealed
proprioceptive and placing deficits affecting the left pelvic limb, but
normal movement and sensation was evident in the right pelvic limb
and tail. A 1 cm x 3 mm wound was evident over the medial aspect of
the left hock joint, with some active bleeding.
Create a problem list based on
presentation and clinical findings
Non-weightbearing lameness
Proprioceptive deficits
Swelling of left hind limb
Bruising to medial left thigh
What would your differential diagnosis
consist of at this point?
Based on the clinical findings and problem list the
differentials in this case focus on the injuries sustained
to the left hind limb.
Inability to bear weight and swelling can be due to:
Trauma, including fracture or muscle, ligament or
tendon damage
Neurological injury
Compartment syndrome
Bruising and bleeding can be categorized as
follows:
Trauma to vasculature
Development of coagulopathy (such as
disseminated intravascular coagulopathy)
Extravasion of fluids from tissue compartment
What investigations would you
perform initially?
Unfortunately there were significant financial
restrictions limiting the investigation and treatment
of this case, meaning that only limited evaluation,
in the form of an abbreviated emergency minimum
database (Table 1) and urinalysis (Table 2) could
be performed. Ideally, a complete blood count,
Parameter Result Reference
interval
PCV 62% 3550%
Total solids 100 g/l 5575 g/l
Blood urea
nitrogen
15 mmol/l 3.67.1 mmol/l
Blood glucose 3.7 mmol/l 3.36.1 mmol/l
Table 1: Minimum database (abnormal results in bold)
Parameter Result Reference
interval
Gross urine
appearance
Cola dark
brown
Clear colourless
yellow
Centrifuged
appearance
Cola dark
brown, no
sedimentaton
Clear colourless
yellow, no
sediment
Urine specic
gravity
1.026 1.0151.045
Urine dipstck
results
Blood ++++ Blood ve
Table 2: Urinalysis results (abnormal results in bold)
04-07 CLINICAL CONUNDRUM.indd 4 19/05/2014 11:58
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Figure 1: (A) Haemoglobinuria in a dog with a splenic torsion.
(B) Myoglobinuria from a dog with heat stroke
A B
serum biochemistry and urinalysis would be
performed, these further additional tests and there
application in the management of this case are
discussed below.
A minimum database gives an indication as to the
possibility of bleeding into tissues based on
evaluation of packed red cell volume and changes in
total solids. It will also allow assessment of the
hydration state of the patient, thus allowing the
clinician to plan for future intravenous fluid therapy
requirements. Urinalysis is often a part of the
minimum database.
What is your interpretation of the results
of the minimum database (Table 1) and
urinalysis (Table 2)?
The colour of the urine is of significance. Dark brown
cola urine is indicative of myoglobin being
produced leading to the development of
myoglobinuria. Centrifuging the sample allows a
distinction between haematuria, haemoglobinuria
and myoglobinuria to be established. Haematuria
will show a collection of red blood cells in the
sediment with a normally clear supernatant above.
Haemoglobinuria will show little to no sedimentation
but the colour of the supernatant will be pink to red.
Myoglobinuria will again show limited sedimentation
but the supernatant will be dark brown. In this case,
there was no evidence of sediment; however, the
supernatant was dark brown, confirming the
presence of myoglobinuria. Figure 1 shows the
difference between urine samples.
Although the urine specific gravity was
considered normal based on the test result, this may
not actually be the case. The presence of myoglobin
in the urine can lead to increased urine specific
gravity due to the size of the molecule. However,
renal tissue damaged by the myoglobin means that
the concentrating ability of the kidney may be
affected, lowering the urine specific gravity. In this
case it is difficult to know whether the urine specific
gravity is a true representation of renal function or
not. The results may be attributable to the length of
time of entrapment, which prevented access to both
water and food. They may also relate to extravasation
of fluids into the tissues of the hind limb.
The minimum database shows evidence of
haemoconcentration and hyperproteinaemia, both are
consistent with dehydration.
Blood tests to look at creatine kinase (CK) and
aspartate aminotransferase (AST) levels would be
useful, as CK is a marker of muscle injury. A
persistently high level an hour after an injury has been
sustained is suggestive of ongoing damage to the
myocytes and leakage of the enzyme from the
myocyte cytoplasm. It is not, however, specific to the
cause of muscle damage and differentials include
trauma, inflammation and degeneration.
Potassium can be elevated if there is substantial
muscle damage, due to its release from cells.
Furthermore, lactate can be measured systemically
and from each hind limb. Measuring lactate from
each hind limb individually allows a comparison
between each limb and offers the clinician
information on whether the microvasculature of the
limb is affected. Elevated lactate would be expected
from the affected limb in comparison to the non-
affected limb, due to crush damage to the tissues
and microvasculature, as well as leakage of lactate
from the cells themselves.
What further investigations could you
consider performing next?
Radiographs of the limb of the affected limbs were
discussed with the owner, to exclude the possibility of
fractures. Unfortunately finances precluded
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Clinical conundrum
radiographs being taken at this stage; a fracture was
felt unlikely from examination of the limb but the
owners were aware that a fracture could not be
completely excluded.
Blood smears, a complete blood cell count,
clotting times and buccal mucosal bleeding times
would have been useful to give an indication as to
whether disseminated intravascular coagulopathy is
developing. A reduced platelet count and increased
clotting times are all suggestive of exhaustion of
platelet and clotting factor reserves.
The final additional investigation that could have
been performed is muscle manometry. This test aims
to measure the pressure within the muscle
compartments of the affected leg in comparison to
the unaffected leg. In cases of compartment
syndrome the pressure would be expected to be
higher in the affected muscle groups. An in-house
muscle manometer can be created in much the same
way as an in-house central venous pressure
manometer can be made. Figure 2 shows the set-up
for a muscle manometer.
Do the investigations lead you to a
diagnosis?
The swelling of the affected limb, in addition to
myoglobinuria, leads to a working diagnosis of
compartment syndrome with associated
rhabdomyolysis.
Compartment syndrome develops when damage
to tissues, especially muscles, leads to swelling and
increasing pressure within the tissue compartment.
The tissue compartments are delineated by the fascia
and connective tissues that surround them. Cases of
compartment syndrome can occur in any trauma
patient, including those with fractures.
Typically the affected area will be swollen and
non-compliant to surface finger pressure, and the
patient will be in acute pain. Arterial pulses are
typically still present in the affected limbs, as the
pressure rise in the affected compartment is
insufficient to occlude the arteries. Normal muscle
compartment pressure is 08 mmHg with a mean of
4 mmHg (5.4 cm H
2
O). In cases of compartment
syndrome the pressure can increase to 2630 mmHg
(35.440.8 cm H
2
O).
Rhabdomyolysis is defined as the breakdown of
skeletal muscle, and leads to the breakdown
products being released into the bloodstream.
Myoglobin released into the bloodstream will
accumulate in the renal tubules. A plasma
myoglobin concentration >1.65 mg/dl leads to
myoglobinuria. At a plasma myoglobin
concentration >100 mg/dl the urine becomes visibly
Figure 2: (A) Close-up
view of the set-up of a
muscle manometer
made in the clinic.
1 = Intravenous fluids
running through a giving
set to the 3-way tap.
2 = Butterfly needle from
3-way tap into affected
muscle compartment. 3
= Fluid is measured from
the calibrated fluid level
at 0 to the point where it
equilibrates to the
muscle pressure.
(B) This demonstrates
the relation between the
patient and the muscle
manometer. 1 = Needle
placed into affected
muscle compartment.
2 = Zero is calibrated at
the height of the water
column at the point of
entry into the muscle
and read in cm of water
A
B
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CONTRIBUTE A CLINICAL CONUNDRUM
If you have an unusual or interestng case that you
would like to share with your colleagues, please submit
photographs and brief history, with relevant questons
and a short but comprehensive explanaton, in no more
than 1500 words to companion@bsava.com
All submissions will be peer-reviewed.
Guidelines for Clinical Conundrum submissions can be
found online at www.bsava.com/companion
discoloured. This level of myoglobinuria correlates
to 200 g of muscle tissue being destroyed.
Myoglobin cast formation occurs in the renal
tubules due to the effects of increased water
resorption from the filtrate, myoglobin interacting
with protein and acidification of the filtrate by high
uric acid levels. The end result is that of renal
tubular necrosis, reduced glomerular filtration rate
and disruption of the electrolyte regulation.
What is your immediate treatment plan?
The release of myoglobin is considered to be
nephrotoxic and so the first line in this case was to
start intravenous crystalloid therapy with Hartmanns
fluid to try and preserve renal function, improve
perfusion and correct dehydration. Initially, three
20 ml/kg boluses were given, each over a 15-minute
period, which led to an improvement in peripheral
perfusion. Peripheral pulses were of better quality
and volume and there was a modest reduction in
heart rate. After initial fluid resuscitation, the fluid
rate was reduced to 6 ml/kg/hr and perfusion was
monitored closely to prevent a reduction in blood
pressure that could have affected the kidneys.
An indwelling urinary catheter was placed to allow
monitoring of urine output and urine colour. Urine
output gradually improved over the first 24 hours,
being >2 ml/kg/hr in response to the fluid therapy.
Treatment of the kidney injuries relies mainly on fluid
therapy and management of any hyperkalaemia and
hypocalcaemia. In the human field dialysis is often
employed to allow the kidneys time to recover from
the insult.
Analgesia was given and continued with
buprenorphine at 0.02 mg/kg i.m. q6h. The hock
wound was stapled, although there was continued
bleeding and a pressure bandage was applied.
What further treatment could have been
instigated?
In cases of compartment syndrome, treatment
needs to address the increased pressure within the
affected muscle compartments to prevent further
damage to the muscle and the effects of myoglobin-
induced nephrotoxicity. Fasciotomy, where the
restricting fascia of a muscle compartment is
incised, may be indicated to reduce the increased
pressure. Surgery would also facilitate removal of
necrotic tissues.
In many cases open wound management is then
continued, followed by delayed primary closure.
Vacuum-assisted closure has also been described.
The alternative of amputation was also discussed on
cost and humane grounds; however, the owner the
owner elected to continue supportive management.
Outcome
Unfortunately, 40 hours after admission signs of
systemic inflammatory response syndrome (SIRS) and
disseminated intravascular coagulopathy (DIC) were
noted and rapidly progressed. The dog was unable to
move, with continuing swelling of his left hind limb, and
developed oedema in his other limbs.
Heart rate, respiratory rate and temperature all
increased despite intravenous fluid therapy and
analgesia. The hock wound had continued to bleed
despite treatment and this continued bleeding made
clinicians suspicious of the development of DIC. The
owners elected for euthanasia as this point due to the
very poor prognosis.
Further reading is available online.
MORE ONLINE
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Perspectives:
Acupuncture for dogs
Samantha Lindley of Long View
Veterinary Services and co-editor
of the BSAVA Manual of Canine
and Feline Rehabilitation,
Supportive and Palliative Care,
explores the evidence for the use of
acupuncture in our canine patients
A
cupuncture is becoming widely used in
veterinary practice, yet there is still
scepticism amongst some in the profession
who view a lack of evidence of effect as
evidence of lack of effect. This review will first tackle
why there continues to be a relative dearth of quality
clinical studies in acupuncture, before going on to look
at the evidence for the use of the technique in the dog.
Definition of acupuncture
Defining what is meant by acupuncture is vital. One of
the problems in research and in the review of the
literature is that acupuncture is not a consistently
applied technique. It is not a drug with a defined dose
rate and pharmacological structure. Acupuncture, by
some definitions, can include techniques that involve
no needles at all, minimal needling or robust electrical
stimulation of needles.
For this review, acupuncture is defined as: The
insertion of a solid needle into the body for the
purpose of alleviating pain and disease (Figure 1).
Approaches to acupuncture
Acupuncture is used in, but does not represent the
totality of, traditional Chinese medicine (TCM), where
needling is used alongside herbs and other
techniques. TCM diagnosis is complicated and based
on an empirical, historical system of medicine devised
at a time when the knowledge of physiology and
pathology was relatively rudimentary. It is valid within
the system for which it was designed the problems
occur when it is forced into a modern context.
The western or scientific approach starts with an
orthodox diagnosis, and treatment is based upon
neurophysiological principles and the examination of
the patient. It is highly individualized, but relates
directly to current understanding of disease
processes. Over 1000 vets in the United Kingdom
have been taught this approach to date.
Despite these two, apparently widely differing,
approaches, vets applying acupuncture according
to either approach often end up putting needles in
roughly the same places. Acupuncture is a stimulus,
and whether the practitioner thinks they are
influencing the flow of qi or inhibiting activation of
the limbic system, there are a limited number of
neurophysiological pathways through which one can
influence pain and disease.
How acupuncture works
For pain
Acupuncture works by stimulating the nervous system.
Because the needles are atraumatic they primarily
stimulate fast pain fibres that signal potential tissue
damage and trigger the bodys potent response to
pain and injury, creating responses in different areas.
Locally: For example, where the needle is
inserted. VIP (vasoactive intestinal peptide) and
CGRP (calcitonin gene-related peptide), and nerve
Figure 1: Acupuncture is defined as
the insertion of a solid needle into the body
for the purpose of alleviating pain and disease
08-12 Acupuncture.indd 8 16/05/2014 13:52
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9
growth factor (NGF) are stimulated. These are also
released when there is injury and their effect is to
promote healing. These factors are the mechanism
by which the wound-healing effects of acupuncture
demonstrated both clinically and experimentally
are achieved.
Segmentally: The stimulus travels in type ii and iii
myelinated fibres in muscle to the dorsal horn of
the spinal cord in the segment at which the needle
was placed. Signalling of new potential tissue
damage is more important than the transmission of
pre-existing signals from C fibres (i.e. the clinical
pain) and so these are inhibited by encephalinergic
interneurons in the dorsal horn.
Heterosegmentally: The stimulus travels to the
brain where it triggers release of beta-endorphin,
serotonin and noradrenaline from the
periacqueductal grey and other structures. These
then act via the dorsolateral funiculus (descending
inhibitory pain pathways) to damp down pain at
every spinal segment, although this effect is most
potent at the segment treated.
Other effects
Subsequent treatments of acupuncture, provided they
are close enough together, increase the production of
messenger RNA for preproencephalin. In other words,
the body produces more endogenous opiate for the
same pain stimulus. This is one reason why the
acupuncture response appears to be long lasting in
some patients.
Acupuncture also has the potential to modulate and
normalize autonomic function by indirect effects on
the lateral grey matter from which efferent nerves arise.
Challenges of research into acupuncture
There is a lot of positive basic research into
acupuncture. Most of the information above comes
from studies in the 1960s on laboratory animals. Many
of these studies used acute pain models, such as tail
flick latency in rats, to demonstrate that acupuncture
does raise pain thresholds.
More recently, functional magnetic resonance
imaging (fMRI) studies have demonstrated
deactivation of the limbic system (the area in the brain
controlling emotion and therefore the suffering
component of pain).
The challenge is to demonstrate that these
observed effects translate into improvement in clinical
disease, at which point a decision needs to be made
as to whether a study will be looking at efficacy
(i.e. when compared with placebo/no treatment) or
effectiveness when compared with a standard
treatment or added to a standard treatment.
Efficacy studies will at some point be necessary
when there is a cost to the treatment. Such costs
include: safety (and acupuncture, although safe, is
not completely safe); patient welfare; and financial
and time considerations. In the United Kingdom,
efficacy studies on animals are deemed experimental
(because there is no intention to treat the control
group) and subject, quite rightly, to Home Office
regulations, limiting such studies to institutions
geared up for such procedures, or to researchers
outside the United Kingdom.
Effectiveness studies are more pragmatic and
arguably of more use to the practitioner who wants
to know whether adding acupuncture to their current
protocol for treating, for example, osteoarthritis (OA)
is likely to be of benefit (regardless of whether it is
the needle specifically penetrating the skin that is
having the effect) so that they can advise their
client accordingly.
Many of the challenges of such studies are the
same as for any branch of veterinary science:
funding; consequent low numbers; and all the
different forms of bias.
Challenges unique to physical therapies
In efficacy studies, there must be a control or placebo
group. However, in a randomized controlled trial the
patient and assessor (and owner) must be blinded to
which animal receives the acupuncture. One technique
of achieving this is to remove the patient from the
owner and do everything to them in an identical way
short of needling them (because such physical
interaction and even pointing at the area of concern
can have real neurophysiological effects). A problem
with this is that some patients become very anxious on
being separated from their owners and such anxiety
may influence the effects of treatment.
However, a very common approach to blinding
assessor, owner and patient to who gets the real
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Perspectives: Acupuncture for dogs
acupuncture is to needle both groups. This is based
on the TCM principles of real acupuncture points with
real effects, and other places in the body, never having
been described or labelled as acupuncture points,
being somehow inert. So the real acupuncture group
gets needling in classical acupuncture points and the
sham or fake group receives needling elsewhere.
From the description of acupuncture earlier, it
should be readily realized that both groups have had
acupuncture. But, for the researcher, it will not matter if
both groups have a response; unless the response of
the real group is better than that of the sham group,
acupuncture will be dismissed as sham, and this
continues to be the case in studies in which the point,
has quite literally, been missed.
Acupuncture for chronic pain
Chronic pain is a common target for veterinary
acupuncture in the dog, and there are two further
challenges to consider.
Assessment: Obviously an intervention cannot be
assessed reliably if there are no standard ways of
assessing changes in a condition. Chronic pain
consists of four components: the sensory
component (the experience of a sensation that may
for example cause the animal to withdraw pressure
on the limb); the affective or emotional component
(that part, mediated by the limbic system, that
dictates how the animal feels about its pain, i.e. its
suffering); a cognitive component (remembering
situations in which there was pain; thinking about
the pain a smaller component than in humans);
and the motor component (physical movements
that have developed in response to the pain). Any
assessment should take at least the sensory and
the emotional components into account. Given that
we know acupuncture has greater effects on how
the patient feels about its pain than on the
sensation of pain that it feels, looking solely at
physical factors (such as force plate analysis) will
artificially skew a study away from a positive result.
Chronic pain is different from acute pain for many
reasons too complex to discuss here, but
essentially the presenting condition may not be
what is being treated by the intervention. For
example: 10 lame dogs may have radiographic
evidence of elbow OA. Acupuncture is used as an
intervention to see if it works in OA of the elbow.
However, some of those dogs may have non-
functional joints; some may be in a chronic silent
phase (i.e. no actual active inflammatory process
in the joint) and the joint may be non-painful, but
there may be residual and potentially painful
muscle pain in the associated limb girdle; some
patients may be in a state of central sensitization
where direct needling of the site would make the
pain worse; to say nothing of those dogs whose
primary problem is a hindquarter problem with a
weight shift exacerbating pain and lameness in the
forelimb. Applying the same acupuncture treatment
to these 10 dogs as though their condition was
identical is unlikely to produce the same outcomes,
whether acupuncture is effective or not. Much
larger numbers of animals and/or a more
individualized approach to each patient would be
needed (Figure 2).
The existing research
Habacher and Ernsts systematic review of 2006
concluded that there was not much evidence for
acupuncture in veterinary medicine. This review
was not confined to dogs and consisted of 17
case-controlled and 14 randomized controlled
trials. Many studies were of poor quality. Included in
the search were gold bead implantation into
acupuncture points (not acupuncture); laser
Figure 2: Acupuncture for elbow OA may actually target
secondary muscle pain in triceps and infraspinatus
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acupuncture (not acupuncture); and injection
techniques (not acupuncture).
The range of diseases treated reflected the TCM
approach that, in theory, everything can be treated. For
example, two studies looked at modifying the
behaviour of untamed wild horses with acupuncture
(not surprisingly negative). More surprisingly perhaps
was the suggestion that the use of acupuncture for
Cushings disease in dogs (although this was in fact
induced Addisons disease) merits further research, as
does the treatment of diarrhoea in piglets (which seems
an unusual choice of condition for which there are more
specific and more easily delivered treatments).
Experimental research
Healing
Sharif and colleagues based in Tehran have been
looking at the healing effects of acupuncture. In two
separate studies, using healthy dogs, they
demonstrated better recovery from the removal of a
section of Achilles tendon and of muscle in the groups
receiving acupuncture than in those groups that
received no treatment. Whether acupuncture was
having a direct effect on healing or whether the effects
were indirect as a result of the treated dogs being less
painful is unknown.
Visceral effects
The use of acupuncture to normalize functional
problems of the viscera is often overlooked in practice,
although there is clinical and experimental evidence in
various species to support it, e.g. irritative bladder
(man) and gastric acid output (rats). There are several
studies in dogs looking at gastric motility, appearing to
show that there are positive effects on gastric motility
and gastric emptying (Figure 3).
Nausea and vomiting
It has been demonstrated that, in humans,
acupuncture is effective in post-chemotherapeutic and
postoperative nausea and vomiting. The point tested in
most studies is the TCM point for nausea known as
PC6, located just above the carpus on the medial
aspect of the forelimb; this point was originally
described in humans. Vasopressin-induced emesis in
dogs was shown in one study to be significantly
reduced by electroacupuncture at PC6, but not at a
point in longissimus lumborum (BL21) or one in tibialis
cranialis (ST36). It was suggested that this effect is
mediated by the central opioid pathway, although why
that pathway would not be triggered by the other
points is unclear.
Anaesthetic studies
Kim and colleagues showed that haemodynamic
parameters did not change after electroacupuncture
during isoflurane anaesthesia. Intraocular pressure
(IOP) did decrease significantly in the same study,
although it is a large jump to suggest that acupuncture
may therefore be useful in clinical conditions with
increased IOP.
Perioperative analgesia is improved when
acupuncture is used in humans; a small study by
Gakiya and colleagues compared dogs given
morphine, or electroacupuncture, or a sham treatment
showed no difference between the morphine and
acupuncture groups, but rescue analgesia was
needed less frequently after acupuncture.
Gropetti and colleagues compared the use of
electroacupuncture with butorphanol for
ovariohysterectomy showed higher beta-endorphins,
lower end-tidal isoflurane and less rescue analgesia
with the acupuncture group. Although it may be
argued that butorphanol alone is not sufficient
analgesia for this procedure, and so not the best
comparator, those wanting to know whether
acupuncture achieves anything at all should be at least
mildly impressed by this result.
Figure 3: Points in longissimus muscles and over the sacrum
are segmental for functional bowel and bladder conditions
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Perspectives: Acupuncture for dogs
Clinical conditions
Dermatology
There appears to be good evidence from one study,
and a years follow-up, that acupuncture can have
some effect on the recurrence of canine otitis externa.
From experimental data in other species, acupuncture
does appear to have a positive effect on immune
function (Figure 4).
The extensive list of references referred to in the text
is available in the digital version of companion. If you
have any questons about accessing your member
benets online, email administraton@bsava.com.
REFERENCES
whether these same dogs would have had improved
scores with potent pharmacological analgesia.
Wobbler syndrome
A study by Sumano and colleagues of 40 dogs
suggests further clinical studies for this condition
would be merited; the study is not without its flaws and
a cure seems unlikely, but it may be possible to
modify such a dynamic lesion by acupuncture
stimulation of the neck muscles.
Disc disease
Several studies appear to show good results for the
treatment of disc disease and this would be worthwhile
following up.
Case reports
These are always interesting and helpful for stimulating
further studies and enthusiasm, but many of these are
of conditions that are arguably self-limiting and so do
not add to the body of evidence as such.
Conclusion
The challenges of acupuncture research are not
insurmountable. There is evidence of specific effects
in humans, so it is arguably more sensible to
concentrate on achieving meaningful numbers and
outcome measures for pragmatic trials of effectiveness
in the veterinary species.
Figure 4: This dogs
atopy resulted in lick
lesions over the
carpus but
acupuncture has
started to reverse
these effects
Osteoarthritis
The two main studies in this category fail to show a
positive effect of acupuncture. However, the study by
Hielm-Bjorkman and colleagues was evaluating gold
bead implants at acupuncture points for hip OA. Gold
beads were inserted through a 14 G needle; the control
group also had 14 G needles inserted around the hip.
There was no difference between the groups, but both
groups improved. As the authors themselves point out,
the study was done in the summer and all owners were
given general advice regarding management of OA.
Essentially, the difference between the two groups was
needle trauma in the hip girdle plus gold bead,
compared with needle trauma in the hip girdle
(Figure 5). Whatever relationship this technique bears
to acupuncture, it is not acupuncture.
The Kapatkin study on elbow OA (n=9) using force
plate studies and pain scores was well designed, but
failed to show improvement after acupuncture.
However, the authors themselves discussed numerous
possible confounding factors and additional factors
have been discussed above (acupuncture for chronic
pain). What would have been interesting to know is
Figure 5: Acupuncture for hip and back pain
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13
Complementary and
alternative therapies
T
he British Small Animal Veterinary
Association (BSAVA) recognizes
that owners may seek alternative
and complementary therapies for
their animals for a wide range of reasons;
however, in the interests of animal welfare:
The BSAVA recommends that owners
consider the evidence for a particular
treatment and the qualifications and
experience of the practitioner before
embarking on any complementary or
alternative therapy for their pet.
The BSAVA strongly recommends that
treatment of animals is only undertaken
after appropriate assessment and
diagnosis by a veterinary surgeon.
The BSAVA strongly recommends that,
whenever possible, treatment decisions
are based on sound scientific evidence
to support the safety and efficacy of
the therapy.
The BSAVA strongly recommends that
owners should seek advice from their
veterinary surgeon before using any
form of complementary or alternative
therapy in their animals.
Legal situation
The diagnosis of diseases in and injuries to
animals (including tests performed on
animals for diagnostic purposes), as well
as giving advice based upon such
diagnosis, and the medical or surgical
treatment of animals, are considered to be
acts of veterinary surgery as defined by
Section 19 of the Veterinary Surgeons Act
Scientific Committee
developed the
following Position
Statement for BSAVA
last year and this was
approved by Council in
November 2013
1966. Subject to a small number of
exceptions, diagnosis and treatment of
animals may only be carried out by
registered members of the Royal College
of Veterinary Surgeons (RCVS).
The Animal Welfare Act 2006 imposes
a duty on the owner of, or other person in
charge of, an animal to ensure that its
welfare needs are met. This includes the
need to be protected from pain, suffering,
injury and disease.
Veterinary Medicinal Products are
defined as any substance or combination
of substances presented as having
properties for treating or preventing
disease in animals; or any substance or
combination of substances that may be
used in, or administered to, animals with a
view either to restoring, correcting or
modifying physiological functions by
exerting a pharmacological, immunological
or metabolic action, or to making a medical
diagnosis. In the UK these products are
subject to control on the manufacture,
authorization, marketing, distribution and
post-authorization surveillance as detailed
in the Veterinary Medicines Regulations.
What is meant by
complementary and alternative
medicine?
Complementary and alternative
therapies are a diverse group of
practices and products not considered
part of conventional (mainstream)
medicine. Although complementary and
alternative is often used as a single
category, it can be useful to make a
distinction between the two different
ways of using these treatments.
Complementary therapies are used
together with conventional
medicine, while alternative
therapies are used instead of
conventional medicine although
they are sometimes used at the same
time as, but not in deliberate concert
with, conventional medicine. Integrative
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medicine is a term used to refer to
treatments that combine conventional
medicine with those complementary
therapies for which there is reasonable
evidence of safety and effectiveness.
Safety and efficacy
Health claims for many complementary
and alternative therapies are far in excess
of the available scientific data, and
sometimes in frank contradiction to
scientific evidence.
In making decisions about the use of
complementary and alternative therapies it
is important to consider their safety and
efficacy. Many people assume that all
complementary and alternative therapies
are natural and therefore safe, but this is
not always the case. All therapies may
produce unwanted side effects or may
interact with other therapies. In the case of
alternative therapies it is also important to
consider the welfare implications of
withholding conventional treatments.
There is a great deal of variation in both
the degree to which various
complementary and alternative therapies
have been scientifically tested, and to
which such testing has provided evidence
supporting their efficacy. Establishing the
efficacy of a therapy is not always
straightforward; many conditions may
fluctuate over time or resolve on their own.
Within any one branch of
complementary medicine, e.g. herbal
remedies or physiotherapy, there may be
products or procedures with reasonable
evidence of efficacy and safety for certain
conditions, but others for which the
evidence is poor or indicates that the
product or procedure is ineffective.
Assessing the evidence
Some people, including owners, therapists
and veterinary surgeons, may perceive that
the therapies work as a result of belief in
the therapy (placebo effect); anecdotal
evidence (extrapolation from hearsay or
personal experience of a single or small
number of cases) or errors in inference
(cognitive bias).
There are three factors strongly
associated with whether or not any one
medical treatment is likely to be
efficacious:
1. A rational scientific basis
Modern medicine works, and it works
because it is founded on a scientific
base. Although not all treatments used
in conventional medicine have a strong
evidence base in the sense of rigorous
clinical trials showing their efficacy,
they do have a rational scientific/
pathophysiological basis for their use.
2. Degree of certainty
The effects of some treatments are so
clear cut that further testing is not
required. It has famously been pointed
out that rigorous clinical trials are not
needed to prove that parachutes
reduce morbidity and mortality among
people falling from aeroplanes.
Similarly, one does not need rigorous
trials to show that intravenous
anaesthetics cause a rapid, profound
loss of consciousness suitable for
carrying out surgery. However, the
effects of many treatments are much
less certain; e.g., they are less closely
associated in time with their effect, or
the effect caused is much less
dramatic, smaller and/or more variable
in magnitude and/or time of onset. In
such circumstances, given the variable
time courses of many diseases, it can
be remarkably difficult to determine
whether a given treatment is actually
efficacious or not.
3. Evidence
When there is anything less than
absolute certainty about the efficacy of
a treatment, then evidence is important
in deciding whether a treatment is safe
and efficacious. However, history has
also shown that evidence both in the
form of clinical experience and
individual clinical research results
can be misleading. The process of
evidence-based (veterinary) medicine
exists to improve our confidence by
formally and systematically searching
for all of the relevant evidence and
formally and systematically grading the
quality and reliability of that evidence.
Choosing a practitioner
Regulation exists to protect patient
safety: it does not by itself mean that
there is scientific evidence that a
treatment is effective.
Currently, practitioners of two
complementary and alternative medicines
are regulated in the same way as
practitioners of conventional medicine.
They are osteopathy and chiropractic.
This regulation is called statutory
professional regulation.
If you want to use a complementary
and alternative medicine where
practitioners are not regulated by
professional statutory regulation, you
should make use of professional bodies or
voluntary registers, where they exist, to
help you find a practitioner.
You may want to check what
arrangements there are for complaining
about a practitioner. For example, does the
association or register accept complaints,
and what action will they take if you have
concerns about your treatment?
You can nd all updated BSAVA
Positons in the Resources secton
of www.bsava.com.
POSITION STATEMENTS
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This is a valuable MEMBER BENEFIT
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Good grief! My patient
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Handy tips on nursing of
small exotic mammals
4 September
The main species discussed will be rabbits,
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hedgehogs. The points raised in theory
sessions will also be addressed in
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SPEAKER
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Feline
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Scared of
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Building confidence and skills
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2 September
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orthopaedic examination, diagnostics and
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as principles of orthopaedic surgery and
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All prices are inclusive of VAT. Stock photography: Dreamstime.com. Chrispethick; Northernprairie; Zaretskaya
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How to approach
the canine athlete
I
n equine sports medicine veterinary surgeons play a
central role in the management of performance-
related issues, including injury prevention and
restoration of athletic activity. For the small animal
practitioner however, management of the canine
athlete is often an entirely new concept. Consequently,
the client can be left with a lame dog, a feeling of
extreme disappointment and perhaps even a
reluctance to seek veterinary advice in the future. They
will often turn to paraprofessionals of varying ability for
treatment, occasionally to the detriment of the dog.
Common disciplines include Agility, Obedience,
Sled racing, Canicross, Flyball, Greyhound racing,
Field trialling and Shepherding (Figure 1). Each
discipline places different demands on the individual
in terms of skill requirements, muscle strength, power
and endurance, as well as focus and concentration.
Equally, each discipline will predispose to a specific
complement of injuries (Figure 2).
Understanding movement
Prior to embarking on a management plan, it is
essential that the clinician is well versed in exercise
physiology and the principles of sports-related
training, along with having the ability to diagnose and
appropriately treat commonly encountered
performance-related problems. Rest and non-steroidal
therapy are rarely appropriate, or successful,
standalone treatment options in these patients.
Historically, orthopaedic examinations and
interventions have largely focused on the kinematics of
movement, with little thought to how the injury affects
the kinetics of movement globally or how global
movement patterns can affect local motion kinematics
and predispose to injury.
Understanding global movement patterns is key to
becoming proficient in the management of sporting
dogs. For non-performance animals, an improvement
in mobility following treatment may be viewed as a
clinical success, even if the patient retains a slight or
even moderate degree of lameness. In a performance
animal however, anything less than restoration of full
athletic activity is deemed a failure.
A sound animal is often far removed from being
able to tolerate the demands of rigorous and repetitive
training. Restoring soundness on its own is merely the
first step on the recovery ladder, and a good clinician
should be able to assist with rehabilitation of
musculoskeletal structures, training regimes, nutrition
and injury prevention in order that the patient can
attain full physical fitness.
Movement in vertebrates is the result of complex
and highly coordinated mechanical interaction
between bone, muscles, ligaments and joints. It is
controlled by the nervous system and influenced by
external load or force. Injury to, or a lesion within, any
of the elements of this system will change the
relationship within the system and lead to tissue
degradation, instability or disability of movement, and
eventually result in a clinical pattern of lameness.
During any form of sporting activity the load placed
on both the musculoskeletal and neuromotor system is
increased. How an individual adapts to this increasing
challenge will, in the end, determine both athletic
potential and predisposition to injury. The veterinary
surgeon has a role to play, often in conjunction with a
physiotherapist in being able to: modify, manipulate
and control the mechanical environment to prevent
injury; correct for movement abnormalities; and
facilitate tissue healing and repair. Certain disciplines
predispose to certain injuries, due to numerous factors
such as:
Lack of movement variability
Rapid acceleration and deceleration of body
segments
Abnormal body positioning
Extreme nature of the challenge
Endurance requirements
Lowri Davies of the SMART
(Sports Medicine and
Rehabilitation Therapy) Clinic
helps us consider the different
needs of our more athletic
canine patients
Figure 1: Welsh Collie Trial champion
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Tools for diagnosis
Other factors, such as nutritional status, endocrine
function and the individuals immune status, can affect
both performance and predisposition to injury. The
diagnosis of the presenting problem should be
followed by diagnosis of the cause of the problem, with
imaging being regarded as a means of confirming
diagnosis rather than a fishing exercise.
Detailed history taking and examination
procedures should be the diagnostic cornerstones.
Some tools, such as video imaging, however, are
invaluable when it comes to assessing functional
movement patterns and in determining whether these
are contributing to chronic overuse injury patterns.
From this the clinician should be able to ascertain:
Which muscle groups the animal relies on to
complete the task
Dynamic stability during performance (to include
local and global stabilization)
How the injury alters performance
The demands of the performance on the body and
how this varies depending on the sport; i.e. Agility
will challenge the participant differently to
Obedience or Canicross
In this way the patient must be viewed not only in
terms of the injury or individual limb lameness but
rather as a complete system. For example, if we take
the case of cranial cruciate disease, most veterinary
literature ignores the concept of the joint as an
organ. Rather, discussion centres on either the
biology or the biomechanics of the cranial cruciate
ligament (CCL) when attempting to address causes
and treatment options. In order to provide the best
therapeutic approach it is essential to consider the
joint as an organ system, the correct functioning of
which requires that all tissues comprising the joint
must work together, biomechanically and
biologically, to maintain joint health and allow full,
pain-free function.
Thus, successful treatment should consider not
only the CCL but also the synovium, joint capsule,
articular cartilage, menisci and subchondral bone. It
must also consider the neuromuscular consequences
of injury, such as alteration in somatosensory and
proprioceptive function. Since the stifle joint is part of
the locomotor system, any rehabilitation programme
should consider how the changes within the stifle
joint affect the system as a whole, i.e. the back, trunk
and other limbs.
Getting a good view
The second challenge that a veterinary surgeon faces
is that the majority of diagnostic or imaging options
available to us look at anatomical or structural changes
within the recumbent animal. Lameness issues in the
canine athlete may be of physiological origin and only
manifest under certain conditions of performance or
activity. For example, the lameness may only present
on certain surfaces, after a certain period of activity or
after one particular activity. Accurate diagnosis can
therefore be a challenge and is often time-consuming.
It should include:
A thorough history, including identifying
performance- or training-related issues
Detailed observation and gait analysis, including
video analysis of the dog in training
Gentle palpation and manipulation of the complete
musculoskeletal system
As the patient is examined, it is easy to forget that it
is a living, moving structure. A muscle group may only
be painful when it is actively contracting, or a structure
may only be painful in one position; so the patient
should be assessed dynamically at all times, not only
when trying to establish on which leg it is lame. The
limb should be moved around and individual muscle
performance or responses should be gauged. The
limiting factors to joint motion should be identified: in
other words, do they reside within the joint or within the
surrounding structures? The quality and control of the
movement should be assessed; if control is lost, at
which point during the stride does that loss of control
occur; is it seen throughout the stride or only during
the outer ranges of motion?
Figure 2: Weaving in agility requires excellent balance to
allow rapid change of direction and can lead to sliding
injuries of the fore limb along with trauma to the hypaxial
and epaxial musculature of the trunk
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How to approach the canine athlete
Clinical examination
At rest, the animals stance should be assessed
(Figure 3), looking to see if the animal stands square
through the axial and appendicular skeleton. The
animal should be viewed from the front, sides, back
and above. Any deviation in the thoracic and lumbar
spine should be noted, along with any lordosis or
kyphosis. All four limbs should be positioned vertically
under the body; any movement away from this plane
points to compensatory weight shifting. In the healthy
individual, 30% of body weight should be taken by
each fore limb and 20% by each hind limb.
Limbs may be abducted to reduce the load and/or
adducted to increase the load placed through them
(Figure 4). Fore limbs can be pulled under the body to
increase the load in front and move the centre of
gravity forwards. When the fore limbs are pushed out
in front of the body and the pelvis is rotated caudally to
facilitate increased loading of the hind limbs, the
Figure 3: Examination of posture in the standing patient
Figure 4: Pronounced abduction and offloading of the left
hind limb coupled with a forward shift in centre of mass and
increased loading of the left fore limb
Figure 5: Gait
analysis on grass;
the uneven
surface can assist
with highlighting
subtle lamenesses
centre of gravity is moved backwards. Any such
change in the animals centre of gravity alters the load
on the various components of the musculoskeletal
system and affects the balance of tissue injury and
repair. A successful treatment protocol should restore
normal weight distribution in all gaits.
The animal should be viewed at the walk and trot,
both in a straight line and on the circle. If possible the
dog should be assessed on different surfaces and on
sloping ground (Figure 5). Many subtle lamenesses
are not obvious on level, tactile surfaces; if the animal
is placed on a wooden floor where greater effort is
required to control movement, then often the lameness
will be more pronounced.
The gait should be described further in terms of:
cranial and caudal components; stance and swing
phases; arcs of flight; and linearity of the movement.
Attention should also be paid to individual joint motion;
e.g. increased stifle flexion or hock extension may be
seen when hip extension is reduced. The movement or
otherwise of the pelvis and the lumbar, thoracic and
cervical spine should be noted. The laterality of
movement should also be gauged: is there equal
movement on either side of the median plane, or is it
greater to the left or right? The control of limb and
trunk motion should also be assessed: is it smooth and
synchronous or erratic and disjointed?
Palpation and manipulation
Following on from gait assessment, a thorough
palpation and manipulation of the individual should be
undertaken. Information regarding general muscle
symmetry, muscle mass and resting tone should be
collected. Subtle changes within individual muscles,
including odema, trigger point formation and the
presence of lactic acid, should be identified (Figure 6).
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Skin and fascial mobility are good indicators of the
individuals hydration status, whilst focal tightness can
point towards regional pathology. Subclinical
dehydration can contribute to poor aerobic
performance, fatigue and tissue injury, and must be
identified and corrected for.
The whole body should be assessed, starting at
the head and working down the fore limbs, back,
abdomen and hind limbs. Tightness or spasm in one
muscle may well affect joint range of motion and have
significant implications for gait, e.g. pathology of the
biceps brachii may well inhibit elbow extension
(Figure 7). Whilst pain in an individual muscle may
reflect local strain, it may equally reflect an imbalance
of breakdown and repair within the muscle fibres in
response to overload as a result of compensatory
weight shifting away from another painful focus.
During joint manipulation, total range of motion
along with a functional pain-free range of motion of an
individual joint should be established. Pain within the
functional range of motion is likely to be of greater
clinical significance than that encountered when the
joint is pushed to endstage flexion or extension.
However, pain in the outer ranges of motion may well
affect jumping performance or performance times.
The quality of joint motion and the nature of the
endstop should be assessed along with joint stability.
The elastic properties of individual muscle groups
should be tested. Tension in the hamstrings can limit
the cranial phase of the hind limb stride, whilst
quadriceps dysfunction may limit stifle extension.
All manipulation should be carried out slowly, in
order to inhibit muscle spindle activity and facilitate
stretch through activating golgi tendon organ
receptors. Best practice should include examination of
both the standing and recumbent patient (Figure 8), as
altering the patients posture can often help identify
painful foci.
Injury types
Injuries of the canine athlete can largely be
differentiated into acute trauma and chronic overuse
injuries. Acute injuries may be due to extrinsic causes,
such as a direct blow from another individual or piece
of equipment, or intrinsic e.g. tissue strain. Acute
injuries to the musculoskeletal system are relatively
rare in the canine athlete compared to human athletes.
The most commonly encountered include: acute
rupture of the CCL, either in isolation or in conjunction
with collateral ligament damage; traumatic fractures;
and muscle strains.
Overuse injuries are more commonly encountered
and include shoulder joint instability, biceps
tendonitis, lumbosacral disease, illiopsoas muscle
strain and non-specific neck or back pain that may or
may not be associated with a shifting lameness. The
Figure 6: Palpation of the paraspinal musculature enabling
assessment of muscle mass and tone along with signs of
pathology including odema, spasm, myofascial trigger points
and local concentrations of lactic acid
Figure 7: Fore limb manipulation for assessment of elbow
extension and restrictions in the biceps brachii Figure 8: Examination of the recumbent patient
1621 HOW TO.indd 19 16/05/2014 15:25
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cause of overuse injuries can include extrinsic factors
such as the type of training surface, the intensity of
training and the type of equipment. Intrinsic factors
include gait biomechanics, conformation, neuromotor
patterns, muscle imbalances, lack of flexibility, age
and body composition.
Laboratory testing
Although not commonly encountered, conditions such
as hypoglycaemia, exertional rhabdomyolysis and
anaemia are seen more frequently in the canine athlete
than in the population at large. Some endurance
sports such as sled racing can also lead to low levels
of free thyroxine, due to increased use within the body
rather than clinical hypothyroidism.
Laboratory analysis prior to the onset of training
should be considered in the elite athlete in order that
they are able to train effectively and improve
performance; e.g. aerobic function may well be
severely impaired if the animal has a reduced red
blood cell count.
Conditioning and training
Inappropriate nutrition and conditioning can both
predispose to injury in the canine athlete. A failure to
address either can lead to poor adaptations during
rehabilitation and a failure to return to athletic activity.
Veterinary surgeons involved in sports medicine
should be able to provide appropriate advice
regarding both nutrition and conditioning to fulfill their
role in assisting with injury prevention.
Rest following injury or due to seasonal nature of
the activity results in rapid loss of cardiovascular
endurance and a slower downregulation of skeletal
muscle fitness, with loss of endurance and power-
generating capacity. Inevitably a loss of flexibility will
occur, particularly in the presence of low grade
pathology. This can manifest as either reduced range
of motion at the level of a specific joint or a general
loss of flexibility such as in the vertebral column where
a large number of individual units function as a whole
(Figure 9). It is necessary to work strategically towards
regaining performance levels of fitness by employing
appropriate training methods, a factor which becomes
even more important when rehabilitating after injury.
A large proportion of human, canine and equine
athletes are training and competing at the extremes of
their capabilities. This places significant stress on the
body which is reflected in changes within the
endocrine and immune systems. Exercise training and
exercise itself is known to cause predictable
Figure 9: Assessing lateral flexion of the cervical vertebrae
How to approach the canine athlete
physiological changes with corresponding alterations
in peripheral blood components. These changes can
reflect both normal physiological adaptations and
pathophysiological abnormalities resulting from the
stress of exercise.
One study on sled dogs demonstrated changes in
their blood parameters compared to the population at
large. A moderate increase in their total white blood
cell count was seen, mainly due to a significant
increase in neutrophil numbers coupled with a
decrease in lymphocyte counts; alterations in red
blood cell parameters were also seen. These changes
can be attributed to two factors, namely an increase in
plasma volume and gastrointestinal losses.
Endurance training in dogs has been shown to
cause a 1327% increase in plasma volume with a
concurrent drop in packed cell volume. Human and
canine studies have also demonstrated exercise-
induced gastrointestinal bleeding. A drop in
haemoglobin concentrations can potentially affect
energy partitioning and push energy generation
towards increased anaerobic metabolism, thereby
increasing fatigue and muscle pain and reducing
function. At a higher level it can significantly alter
performance and contribute to overtraining problems.
Regular sampling can give invaluable advice
regarding the individuals immune system and allow for
steps to be taken to prevent further damage through
alterations in the training intensity and/or appropriate
drug therapy.
Equally, thyroid hormone function can be affected
by training. Many canine and human athletes will
commonly have serum thyroxine (T4) concentrations
lower than the reference range, yet clinical
hypothryoidism is uncommon. Thyroid hormone
1621 HOW TO.indd 20 16/05/2014 15:25
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21
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of companion. If you have any questons about
accessing your member benets online email
administraton@bsava.com.
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controls the bodys metabolic rate and these hormones
can be altered via feedback mechanisms as a
consequence of metabolic rate changes. They affect:
Metabolism of fat and carbohydrate within the body
Oxygen uptake by the body organs heart, liver,
kidneys
Growth and development of the musculoskeletal
system
Reproduction
Hair and skin condition
Activity levels
Exercise tolerance and pain
Results from human studies have shown that
exercise and training can have variable implications on
thyroid hormone concentration and function. The effect
of exercise on thyroid hormone concentrations in dogs
have also been evaluated in a few studies. The results
are variable, with some showing that training and
sprint racing did not have a significant impact on
serum concentrations of free T4, T3 or thyroid
stimulating hormone (TSH) in racing Greyhounds but
did decrease total T4 concentrations. In others,
however, serum T4 and fT4 concentrations were found
to be 40% lower than in the reference population.
Similar changes have been seen in Alaskan sled dogs.
This alteration is likely to be associated with increased
metabolism and clearance of thyroid hormone, as well
as volume of distribution and disposal rate.
Thyroid hormone levels alter most dramatically
during the course of training. After periods of extreme
exercise a marked and sustained (4-day) increase is
seen in serum TSH concentrations. Training individuals
with low levels of circulating thyroid hormone can often
be unrewarding and even damaging to the individual
depending on the severity of the deficiency. Again,
repeated sampling throughout the season will help to
detect the problem in the early stages and allow
measures to be taken to prevent it reaching a stage
where the animal is showing clinical signs such as
extreme exercise intolerance, fatigue and muscle pain.
Nutrition
Achieving the correct balance of nutrients to maximize
athletic performance and tissue repair is integral to the
wellbeing of the canine athlete. There is a need for
disciplined specific nutrition: sprinting dogs require
readily available glycogen stores for energy; while
endurance breeds will need to adapt to using fat as
the major energy source.
It is not easy to predict the daily calorie
requirement for an individual athlete. The daily energy
requirement (DER) is a measure of the daily calorie
requirement for the maintenance of body weight and
condition and varies widely from animal to animal. The
resting energy requirement (RER) is the amount of
calories required by an animal at rest in a
thermoneutral environment and does not support
exercise, growth or reproduction. The RER is
determined by (body weight in kg)
0.75
x70. For active
and working dogs, the following calculations have
been used:
Light work 2x RER
Moderate work 3x RER
Heavy work 48x RER
The timing and frequency of feeding can be critical
in the canine athlete. Feed too close to an event and
performance will be impaired; however, lack of energy
substrate can lead to lack of focus, loss of
performance and, ultimately, collapse through
hypoglycaemia. In athletes undergoing sustained
athletic activity, preloading in the days preceding the
competition may assist with making glycogen and fatty
acids available.
Conclusion
Successful management of the canine athlete requires
a holistic approach, taking into account the individuals
psyche, nutrition, hydration and training regime. Subtle
changes can make the difference between soundness
and injury, as well as enhancing performance times.
The clinician will be challenged with a need to revisit
exercise physiology and performance nutrition, as well
as being well versed in the more commonly
encountered disciplines of lameness diagnosis and
management and acute injury management. The
satisfaction of returning an athlete to peak physical
performance is immense and will ensure a loyal client
for years to come.
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Celebratng 40 YEARS of improving the health of pets
E
ven though I have now run ten London
marathons I still find it very humbling and really
quite emotional when I line up at the start. You
stand there packed liked sardines with
thousands of other people who for the next few hours
share a common goal; namely to complete a gruelling
26.2 mile course around the streets of the capital for
their chosen charity.
Many carry the names and photos of loved ones
who have passed away on their backs; others wear the
brightly coloured vests of their charity or are adorned
with ridiculous costumes often of insane proportions or
weight. This year was no exception. As I stood
nervously waiting for the starters gun I was rubbing
shoulders with six rhinos, several cartoon characters
and a man dressed as Freddy Mercury carrying a
vacuum cleaner.
The ease with which you complete a marathon is
directly proportional to the amount of training you have
done, so as my training schedule this year has been
decimated by work commitments this was not going to
be a year for personal bests. The crowds as always
were three deep all the way round the course and were
packed tightest at the major landmarks.
Cutty Sark is the first landmark, which heralds
seven miles, then Tower Bridge which marks the
halfway mark. The twisting streets around Canary
Wharf are always my nemesis as the third quarter of
the race from fourteen to twenty miles seems to go
on for ever. However, as you leave the skyscrapers
behind and run up towards the Tower of London and
then get sight of the London Eye and beyond it Big
Ben, you know that the last mile beckons.
Summoning up the very last dregs of energy you
sprint down the last 800 metres along Birdcage Walk,
past Buckingham Palace and then round into the Mall
past hysterical crowds to the finish. This year has been
the first time I have run for PetSavers and I would like
to thank everyone involved for giving me the
opportunity to put something back into a charity that
has supported me in the past. n
London Marathon
On a sunny Sunday in April
an estimated 36,000 people
took part in the Virgin London
Marathon. The runners
included BSAVA volunteer
Sue Paterson, who raised
over 2300 for PetSavers.
Heres her story
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T
he End to End challenge is considered to be the
ultimate cycle challenge within the UK. Peter will
start his epic challenge on Saturday 26 July at
Lands End on the south-westerly tip of England.
Pedalling 969 miles Peter will pass through some of the
most stunning and remote countryside in the British Isles,
via the lochs and mountains of Scotland to the North
coast and finishing at John OGroats nine days later.
Peter Haseler, practice owner and a keen cyclist,
explained the appeal of the challenge: As a way to keep
fit, I try to ride my bike as often as possible and usually ride
to work. So far my bike has clocked up 10,000 miles and
has helped me to complete the coast-to-coast challenge.
So I decided to take on the End to End challenge to raise
money for charity and because it is considered to be the
ultimate cycle ride challenge in the UK.
Asked why he took on this tough challenge for
PetSavers he said, I chose PetSavers because as a
practising vet I understand the frustration of conditions
that affect animals and which need further research to
progress with future treatments. Peter is hoping to raise
1,000 to benefit PetSavers vital research and would be
very grateful for any support that people may be able to
give. Please visit www.justgiving.com/Peter-HaselerPS
to lend your support.
If youve been inspired by Peters challenge and would
like to take part in a cycle event yourself, but dont want to
cycle the length of Britain, why not take part in the Wiltshire
100 a heroic 100 miles through Wiltshire. Alternatively, if
you are looking for a fun family day out there is also the
Wiltshire Big Wheel Ride, which consists of a 45 mile route
and a 12 mile route for families with children. n
Become a PetSavers
10K Team Member
E
very year PetSavers has had a strong team of runners taking
part in the London 10K and over the years has raised more than
50,000 to support vital clinical research. To commemorate our
40th anniversary we are hoping to have a 40-strong team of
runners taking part in this years event. We are already halfway there
with a 22-strong team of runners comprising a wide variety of talents
from first timers to more experienced sporting enthusiasts, and from all
over Europe.
Team member Thibaut Chassange, a French Osteopath, said:
I chose PetSavers as I am an animal lover, and even if I am a
human osteopath close friends of mine are involved in the
development of animal osteopathy within the UK (pets, horses and
exotics animals!). They have got a good working relationship with vets.
A pet can change your life for me it is essential, in return, to help
create the best life for animals by supporting research, helping vets,
and developing animal osteopathy.
The 10K race takes place in central London in a great carnival
atmosphere with entertainment en route. This years event is on Sunday
13 July. The run is suitable for novices and seasoned runners alike and
for people from all walks of life. If you want to be part of the Team all we
ask is that you raise 100 for PetSavers to help us continue our work.
You can apply online at www.petsavers.org.uk. n
Cycling from Lands End to John
OGroats, the furthest possible
distance in the British Isles, is a
classic challenge that many
dream of completing and
Birmingham-based vet Peter
Haseler is preparing to do just
that, all in the name of raising
funds for PetSavers
Coast to coast
Become a PetSavers Hero
If youve been inspired by these stories
and would like to organize your own
event, or receive further information about
any of the activities mentioned or other
ways in which you can help, contact
Emma Sansom on 01452 726723 or email
info@petsavers.org.uk for more details.
22-23 PetSavers Fundraising.indd 23 16/05/2014 14:06
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Advances
in veterinary
anaesthesia
and analgesia
Celebratng 40 YEARS of improving the health of pets
T
he anaesthesia and analgesia projects that
PetSavers has funded have been both
numerous and diverse, and include both
laboratory-based studies (whose results would
have direct relevance to clinical work), and projects
performed with the help of clinical cases presented to
the investigators. Unlike other grant awarding bodies,
however, PetSavers does not fund any research in
experimental animals, so the work they support has to
be (by definition) of unequivocal clinical benefit to the
animal population.
Real impact in practice
Many of the studies sponsored by PetSavers have
been based on work performed previously in
humans, and which have allowed the development of
drugs now widely used in veterinary practice. For
example, buprenorphine is one of the most frequently
used analgesic agents prescribed for acute pain in
dogs, cats and rabbits, a drug whose initial
characterization in the dog was facilitated by a
PetSavers grant.
Other funded projects have illustrated, however,
that not all techniques that work well in humans are
necessarily as effective in animals; for instance,
although the use of topical morphine to relieve ocular
pain is widely described and accepted in humans, a
PetSavers study demonstrated that topical morphine
did not appear to produce pain relief in dogs or cats
who had corneal ulceration.
While this may seem like a negative result, it
highlighted to veterinary anaesthetists and
ophthalmologists that morphine applied directly to the
eye could not be relied upon to provide adequate
analgesia to these patients and alternative techniques
were required.
Encouraging innovation
Other projects funded by PetSavers have not
necessarily followed on from human work, but the
results from them have proven to be of direct
relevance to both the veterinary and human
populations: for example, a PetSavers study on the
use of artificial blood demonstrated that this may
have detrimental effects by causing significant
contraction of canine blood vessels, and this led to a
re-assessment in veterinary practice of the type of
case this product is used in.
Professor Derek Flaherty of the
University of Glasgow explains how
PetSavers has been instrumental
in developing companion animal
anaesthesia and analgesia over the
past two decades. During times
where it has been difficult to secure
grant funding for any type of study,
they have been one of the major
supporters of veterinary clinical
research within the UK
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Since a similar type of artificial blood is also used
in humans, this has highlighted potential concerns
about the continued development of this solution.
Ongoing PetSavers studies in the field of anaesthesia
include one on the use of computer technology to
deliver specific blood concentrations of sedation in
dogs, with a view to the development of safer
sedative techniques.
Developing specialists
However, PetSavers funding is not just about
research projects: to date, they have financially
supported three residency positions in veterinary
anaesthesia and analgesia, two of which have been
completed and resulted in the generation of two
diplomate (specialist) anaesthetists. This may seem
like a small number, but it is important to consider
that the pool of specialists in each veterinary
discipline is much smaller than that of human
medicine. In the UK as a whole there are currently
only around 25 or so veterinary anaesthesia/
analgesia specialists, so PetSavers has been
responsible for just under 10% of these a very
impressive contribution. In addition, once qualified,
each specialist anaesthetist can then train their own
residents, so the input from PetSavers begins to grow
exponentially. The third PetSavers residency position
in anaesthesia/analgesia is currently ongoing, and is
actually one of my own residents, so I have particular
reason to be grateful for the funding PetSavers
provides for these posts.
Author biography
Derek Flaherty qualified from the University of
Glasgow in 1988 and then spent six years
working in small animal practice before
returning to Glasgow to undertake a residency
in veterinary anaesthesia. He holds diplomate
status in veterinary anaesthesia and analgesia
from both the Royal College of Veterinary
Surgeons and the European College of
Veterinary Anaesthesia and Analgesia, and
has also gained specialist status from both
professional bodies. He is now both Professor
of Veterinary Anaesthesia and Analgesia at
Glasgow and Head of the Anaesthesia Service
at Glasgow.
AVAILABLE FROM BSAVA
BSAVA Manual of Canine and Feline
Anaesthesia and Analgesia
2nd editon
Edited by Chris Seymour and
Tanya Duke-Novakovski
Professor Derek Flaherty is an
author in the BSAVA Manual of
Canine and Feline Anaesthesia
and Analgesia, 2nd editon.
The administraton of safe and reliable anaesthesia is
important for all veterinary surgeons, and good control
of pain afer injury, either traumatc or surgical, is one of
the most important ethical responsibilites. This Manual
covers these topics in depth.
Pain assessment and management
Anaesthetc equipment and patent monitoring
Pharmacology and specic patent management
Legal and ethical aspects
Local and regional anaesthesia
WHAT THEY SAY
The authors and editors have done an outstanding job
JOURNAL OF THE AMERICAN VETERINARY MEDICAL
ASSOCIATION
Member price: 55.00
Price to non-members: 85.00
Buy online at www.bsava.com
24-25 PetSavers Anaesthesia.indd 25 16/05/2014 15:09
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I
t has been a busy time for the WSAVA Executive
Board as we gear up for World Congress now only a
few months away. Details are still being finalized but
it promises to be a stellar event. The opening
ceremony will be graced by the presence of
Archbishop Emeritus Desmond Tutu and promises to
be an exciting and entertaining African themed affair.
The scientific programme looks excellent and we
expect a big turnout.
This year too, for the first time, we are developing
outreach programmes in conjunction with our
Congress. Two of these offer registrants the
opportunity to volunteer in clinics in South Africa. In
addition, we are expanding our educational mission to
other countries on the continent by sending WSAVA
speakers to provide CE.
Continuing our African theme, the WSAVA
Foundation has also developed an exciting outreach
programme to train the trainers in several African
countries. Called the African Small Companion Animal
Network (AFSCAN) and supported by a grant from
Zoetis, it will kick off shortly. Companion animal care
A message
from the WSAVA
President Colin Burrows
reports on a busy time for the
WSAVA and some exciting
new outreach programmes
and education have been lagging behind in many
African countries and we hope to effect change by
working with educators in the veterinary colleges to
enhance curricula, particularly with regard to
infectious disease.
Our Congress Steering Committee has also been
busy. Plans to host our 2016 Congress in the USA fell
through and, late last year, we called for other bids
from member countries in the Americas. Bids were
received from Brazil, Colombia, Ecuador and
Uruguay. After much deliberation the CSC
recommended, and the Executive Board endorsed,
the bid from Colombia. Assuming Assembly
ratification the 2016 Congress will be held in the
beautiful and historic Caribbean city of Cartagena.
Finally, the WSAVA Executive Board met in
February in Las Vegas at the Western Veterinary
Conference for a marathon set of meetings. A number
of decisions were made together with
recommendations that will go to the Assembly for
discussion and ratification. One of the most important
was to begin a search for a new Congress Liaison
Officer to replace Dr Jolle Kirpensteijn, who has done
and continues to do such a great job for the WSAVA.
We also prioritized points from our strategic plan that
we hope to complete in 2014. These are:
1. To create regional engagement for our member
associations
2. To create a member only network with the ability to
provide e-learning
3. To begin the process of creating a central
secretariat. We have just one staff member at the
moment, Mrs June Ingwersen, who does a
terrific job, but we have grown and need
additional support.
We also have a new award the Henry Schein
Community Service Award which will be presented
each year at the gala dinner during Congress. We are
most grateful to the Henry Schein Company and to all
our industry sponsors for their support. n
26-28 WSAVA NEWS.indd 26 16/05/2014 15:10
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WSAVA Foundation launches
African Small
Companion
Animal Network
At a press briefing at BSAVA Congress the
WSAVA announced a major initiative to
support the veterinary profession in Africa
animal veterinarians work hard, their
numbers are few, they are geographically
isolated and often held back by a lack of
training and support.
Through AFSCAN we aim to harness
global support to build a networked
community of individuals and institutions
across Africa which can give immediate
help in tackling zoonotic, infectious and
parasitic diseases in a more coordinated
way. Longer term, it will help to create the
sustainable infrastructure that is so
important in supporting small animal
veterinarians across the continent and
driving up standards of veterinary care.
We have a range of projects planned for
the next two years in areas including rabies
reduction, education, and health and
welfare and will announce a more detailed
project plan shortly.
The challenges in Africa are great but
with AFSCAN we have a real opportunity
to help advance the veterinary profession
across the continent and, in so doing,
improve the lives of millions of animals and
humans, said Professor Michael Day,
Vice President of the Foundation and
Senior Vice President of BSAVA. Were
grateful to the organizations that are
already supporting AFSCAN and to
Zoetis, which as a founding sponsor has
provided significant resources through its
commercial and strategic alliance
colleagues in ensuring the success of
this initiative. n
T
he WSAVA Foundation, which
funds improvements in the
veterinary care of companion
animals worldwide through science
and education, has unveiled a ground-
breaking scheme to advance standards of
veterinary care across Africa.
The African Small Companion Animal
Network (AFSCAN) aims to facilitate the
creation of a sustainable network of
companion animal veterinarians,
associations and specialist groups in
Sub-Saharan Africa in order that they go
on to form new small animal veterinary
associations across the continent. It is the
creation of these veterinary associations
leading, as they do, to enhancements in
collaboration, training and best practice
sharing, which have proved pivotal in
driving enhancements in overall standards
of veterinary care in other regions of the
world, notably Eastern Europe.
The AFSCAN project, the first phase of
which runs from April 2014 until April 2016,
has been developed by the WSAVA
Foundation with the backing of the global
animal health company Zoetis and a
consortium of other supporters. It aims to
achieve its goal through initiating activities
in key areas, including:
n Offering grant funding for specific
veterinary projects and establishing
links between African veterinary
researchers and those in institutions in
American or European countries
n Increasing support for and coordination
of rabies control projects
n Expanding training and CE
programmes for veterinary
professionals
n Supporting surveillance systems to
monitor infectious and parasitic
diseases in companion animals
n Looking for new funding opportunities
in cooperation with current and future
consortium members.
Africa is the worlds second largest
continent and contains some of the worlds
fastest growing countries, said Dr Gabriel
Varga, President of the WSAVA Foundation
and Director of Business Operations for
Zoetis North Europe region. Unfortunately,
it is also plagued by many of its most
dangerous diseases and, while small
Professor Colin Burrows, WSAVA President, Dr
Lawson Cairns, WSAVA CE Coordinator for
Africa and Dr Gabriel Varga, President of the
WSAVA Foundation and Director of Business
Operations for Zoetis North Europe region, at
the BSAVA Congress briefing
26-28 WSAVA NEWS.indd 27 16/05/2014 15:10
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WSAVA news
www.wsava.org/artcle/
wsava-volunteer-veterinarians-
opportunites-claw
www.wsava.org/artcle/
volunteer-community-veterinary-clinics-
africa-now
MORE ONLINE
C
ontinuing its African focus,
the WSAVA has also
announced WSAVA Global
Outreach, an initiative using
veterinary volunteers to help share the
knowledge and experience of its
members more widely around the
world. It will operate for the first time
through a programme of outreach
initiatives serving as an extension to the
WSAVA World Congress which takes
place in Cape Town, South Africa, from
1619 September 2014.
As part of Global Outreach, the
WSAVA is calling for volunteers for two
initiatives around World Congress:
The WSAVA Animal Wellness
and Welfare Committee (AWWC)
Programme
The AWWC is offering the opportunity for
up to ten veterinarians registered to
attend World Congress to volunteer for
Community Led Animal Welfare (CLAW),
a respected animal welfare organization
whose work is supported by the
International Fund for Animal Welfare
(IFAW). Volunteers will provide their
services during a six day placement
from 813 September 2014, assisting
CLAW personnel in running mobile
veterinary clinics that provide basic
health care and education for the
animals of impoverished communities
and their owners.
Mobile clinics run by the South African
Veterinary Associations Community
Veterinary Clinic (SAVA-CVC)
WSAVA launches
WSAVA Global
Outreach to enhance
veterinary care
worldwide, and is
looking for volunteers
Vets go wild
The WSAVA-SAVA Community
Veterinary Clinics Programme
WSAVA is also offering the opportunity for
ten veterinarians to volunteer for a five day
placement working with the South African
Veterinary Associations Community
Veterinary Clinic (SAVA-CVC) in the run up
to World Congress. They will assist with
activities including running mobile
veterinary clinics and providing basic care
such as vaccination and parasite
treatments. Volunteers will also have the
opportunity to carry out basic diagnostics
and treatment including neutering.
WSAVA President Colin Burrows says:
If we all work together, we can help to
build a better future for everyone in the
profession. WSAVA Global Outreach is an
example of this and will enable us to create
a lasting legacy in every region that hosts
World Congress. I hope that WSAVA
veterinarians will embrace these
volunteering opportunities to help deprived
communities in Africa while broadening
their own experience.
Further details on how to apply
for both volunteer programmes can be
found at www.wsava.org and
www.wsava2014.com. n
WSAVA FACULTY OUTREACH PROGRAMME
Recognizing that many African veterinarians
will be unable to travel to Cape Town for
World Congress, Dr Lawson Cairns, Regional
Coordinator for WSAVA CE in South Africa, has
arranged for several of its world-renowned
speakers to extend their stay to lecture in
other African countries. These will include
Botswana, Kenya, Mozambique, Namibia
and Zimbabwe.
This CE initatve will form a key part of
the programme of all future WSAVA World
Congresses, contnuing with the 2015 event
which takes place in Bangkok, Thailand,
in May.
26-28 WSAVA NEWS.indd 28 16/05/2014 15:10
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Supporting our
international
colleagues
A
lex Elson, an RVC graduate who
now works as a veterinary
surgeon in New Zealand, reports
that South Pacific Animal Welfare
(SPAW) was delighted to receive the gift of
a copy of the BSAVA Textbook of
Veterinary Nursing.
An island adventure
SPAW recruits teams of volunteer vets and
vet nurses to the Pacific Islands to provide
spay/neuter and general veterinary
services, predominantly for dogs and
cats, all free of charge. Other medical and
surgical cases are treated and there is a
big emphasis on parasite control and
parvovirus vaccination. SPAW offers
varying programmes depending on need,
and volunteers have also helped in animal
husbandry and with the occasional marine
case. SPAW always partners with local
agencies and is currently running projects
on Tonga, Vavau, Niue, Fiji, Rarotonga
and Samoa.
The textbook will reside in the semi-
permanent clinic building in Tonga, where
it will be of great use to the volunteers.
Alex says: To volunteer with SPAW is
most rewarding. I have completed four
trips and am about to embark upon a
fifth. Adaptability, a sense of humour and
a desire to mix with other like-minded
volunteers are essential, as is an interest
in the island way of life and the education
on responsible care of animals at a local
level. For further information on becoming
a SPAW volunteer, email volunteer@
spaw.org.nz or visit their website
www.spaw.org.nz.
Reptile know-how in Nairobi
John and Margaret Cooper reported on a
workshop on the care, health and welfare of
BSAVA Publications
Committee is
committed to helping
the veterinary
community in all parts
of the world here are
a few stories from our
international colleagues
Margaret Cooper
presented the BSAVA
Manual of Reptiles
2nd edition at the
Reptile Workshop
reptiles held at the National Museums of
Kenya, Nairobi, last summer. The aim of the
workshop was to broaden the knowledge of
those Kenyans who already work with
reptiles, to provide training to others,
especially biologists, in the correct care of
these animals, and to guide veterinarians in
the recognition of health and diseases. It
also covered the international and Kenyan
perspectives on the legal and ethical
aspects of keeping reptiles.
The number of people expected to
register was 40 but on the day the
workshop attracted 68 participants. These
were a mixture of reptile-keepers,
professional herpetologists/biologists,
members of the veterinary profession, and
university academic and technical staff.
Professor and Mrs Cooper
presented books to the Museum
Librarian, Ms Asha Owano, and to the
Snake Park Curator. This workshop
successfully familiarized participants
with the biology of reptiles and helped
them understand health and disease
issues and appreciate the importance
and value of Kenyas reptiles.
A village clinic on Tongatapu
Young Kenyan vets learning techniques at the
Reptile Workshop
29 Publications Books Abroad.indd 29 16/05/2014 15:52
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|
companion
Sophie
Hemming
BVSc MRCVS
the companion interview
Sophie Hemming leads a double life as a caring
small animal vet and a hard-tackling front row
forward in the increasingly competitive world of
womens rugby. A stalwart of both Bristol Ladies
and the England international side, she hopes to
be part of the team that brings home the
Womens Rugby World Cup from the
tournament in France in August. She has
worked at the Avenue Veterinary Centre in the
north of Bristol since July 2004.
Q
Tell us about how you got into
rugby and how your playing
career developed.
A
I wasnt really aware of rugby as a
sport before going to University.
At school, I was very involved with
orchestras and choirs. I did a little bit of
competitive swimming, occasionally
played lacrosse, and my school had a
rowing club which trained on a Saturday
morning. This didnt clash with music so
I joined when I was 13 or so. I found that
I was much more suited to a sport
requiring strength than sports like netball
or lacrosse, as I wasnt that quick!
I continued rowing until I left school.
My first choice of vet school, Bristol,
had one big drawback my sister
happened to be three years into a medical
degree there. However, I reckoned that
Bristol was probably a fairly big place and
that I was unlikely to run into her unless
I needed some money or laundry so it
was the place for me. My sister Anna was
also a very proficient rower and had been
a Gold Medallist at the Henley Royal
Regatta with Bristol University that year.
I decided that having followed in her
footsteps at school for years, I didnt want
people to be calling me Anna forever, so
was keen to try something new. The
freshvet brochure had lots of information
about the different clubs that were
available for vet students. My mum was
having a look and spotted that there was a
womens vet rugby team and suggested
I gave it a go.
My new vet friends Alice and Shelley
had played rugby at county level. They
persuaded me that I should go to a
taster day for the university rugby squad.
This initially seemed very daunting as I
didnt know anything about the sport, but
in actual fact Shelley and Alice were in
the minority as most of the players were
newcomers.
After two sessions, a quick lesson in
tackling and in how to bind in the scrum,
I was deemed ready for my first game. We
played at Coombe Dingle and the squad
was short of a second row, so I slotted in
there. I remember asking the coach (also a
vet, Emily) what I should do if I got the ball.
That was deemed an unlikely event so the
question wasnt answered. I dont really
remember much about my first game apart
from two things firstly, I did get the ball
(and was told to run forwards) and
secondly, I loved it.
My first season flew by and I asked for
a pair of rugby boots for Christmas.
Season two then started and I continued
to love the game and learn more of the
laws, until I broke my leg in a game
against Southampton University in
December. I continued to watch training
30-31 Interview.indd 30 16/05/2014 15:12
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31
I remember standing
there alongside my
team mates feeling
the shivers up the
back of my neck
sessions, and when I was able to join in
again the university coach encouraged
me to train hard in order to attend some
regional academy trials that summer.
I was selected and was then chosen for
the England Students squad in my third
year. This was the start of my England
career and gave me a taste of what it was
like to wear an England shirt. I went on to
captain England Students, then played for
England Academy and England A while
still at University.
I was first selected for the England
team to play Scotland in the first game of
the Six Nations in February 2007.
I currently have 67 caps.
Now that you are in your early thirties,
are you thinking about retiring from top
class rugby?
My major goal is to win the World Cup in
Paris this summer. I am doing everything
I can to be in the best physical condition in
order to be selected for the tournament.
I will make decisions about whether I
continue playing for my club (Bristol
Ladies) and country after that.
After you do retire from the sport,
do you plan to continue being
involved somehow?
When I do retire from playing rugby, I think
that I will want a bit of time out from the
sport initially in order to do some other
things. Ive dedicated so much of my life to
the sport and although I have loved it, it will
be great to have some free time to go on
holiday, see family and friends, and try
some other challenges!
You have mostly worked in mixed
practice. That and rugby are both
physically demanding activities. Where
do you get the energy?
I worked as a mixed practice vet from
qualification until last year when the farm
and equine side of the business was sold.
Since then I have been a small animal vet.
Rugby and farm work are definitely both
very physical but I found that the strength
work I did in the gym helped me on many a
challenging calving!
My England coach, Graham Smith, has
often commented about my quick reflexes
on the pitch and I think that having to
dodge frequent kicks from livestock has
helped in that department. Im very
dedicated to both my job and my rugby so
that helps me to juggle everything
although I have had to make many
choices over the years to miss friends
weddings, family get-togethers etc., and
my boyfriend has had to endure many a
day when my energy levels have been
completely sapped!
How do you manage to combine
your veterinary career with your
rugby career?
In the England team, we talk about
choices instead of sacrifices ultimately
it is a massive honour to be able to play for
England, and something that Im very
proud to have achieved. My family will
vouch for me when I say that I was not the
most organized person growing up, but
trying to fit in a time-consuming job and
playing rugby for England has forced me to
do more and more planning over the years
to the point that my England teammates
now tease me for it! In reality, it has meant
lots of planning of my training sessions
around work schedules, continuously
packing multiple bags for sessions before
and after work, very early starts to train
before work with the EIS (England Institute
of Sport) at Bath University, and battling
traffic to get back to Bristol for work while
drinking a protein shake.
How do you negotiate the time off to
play in tournaments abroad?
Mark Picton, my boss at Avenue Vets, is
fantastic and has really supported me to
continue playing for my country. Most of
the time off is taken as annual leave, and
I also try to work extra bank holidays, etc.
to accrue a few extra days. This year is
an exception, as there is a very full
training schedule in the build up to the
World Cup this summer. Ive used a lot of
holiday but have also got support from
the RFU to employ a locum at the
practice while I am away.
What has been the highlight so far of
your sporting career?
The most memorable is playing New
Zealand at the Twickenham Stoop in the
World Cup Final in 2010. We had sung the
National Anthem and then faced the Haka.
After their players had finished their war
dance, the full stadium erupted in a chant
of Swing low, sweet chariot. I remember
standing there alongside my teammates
feeling the shivers up the back of my neck,
and felt so proud to be representing my
country. Just 80 minutes later, this massive
high was followed by the lowest of my
sporting career. We lost the World Cup
final to New Zealand 1310.
Another rugby highlight was in
November 2013, being asked to be
England vice captain and scoring two
tries against Canada, who were fifth in the
world rankings.
30-31 Interview.indd 31 16/05/2014 15:12
BSAVA MANUAL OF
Exotic Pets 5th edition
A FOUNDATION MANUAL
BSAVA MANUAL OF
Feline Practice
A FOUNDATION MANUAL
BSAVA MANUAL OF CANINE AND FELINE
Surgical Principles
A FOUNDATION MANUAL
BSAVA MANUAL OF CANINE AND FELINE
Radiography and Radiology
A FOUNDATION MANUAL
this new manual would
be a great addition to the
library of any new
graduate
VETERINARY RECORD
BSAVA Member Price
49.00
Price to non-members: 79.00
remains a must-have
for the veterinary practice
library
VETERINARY RECORD
BSAVA Member Price
49.00
Price to non-members: 79.00
an excellent, one-stop
resource on the surgical
principles imperative for
a successful surgical
outcome
DOODYS REVIEW OF BOOKS
BSAVA Member Price
49.00
Price to non-members: 75.00
an excellent book for
(starting) general
practitioners looking for
a handbook that is both
practical and easy to read
VETVISUALS
BSAVA Member Price
55.00
Price to non-members: 85.00
For more information or to order
www.bsava.com/publications
BSAVA reserves the right to alter prices where necessary without prior notice.
BSAVA Publications
COMMUNICATING VETERINARY KNOWLEDGE
Lay the foundations
for success
Veterinary students entering their nal years of study and new graduates
encountering practice for the rst time need to be aware of the common conditions
they will face and the protocols they will need to undertake. The BSAVA Foundation
Manuals have been put together to provide this information in a straightforward,
practical and easily accessible format. From routine radiography, through aseptic
surgical technique, to dealing with a blocked cat or a snake that cant shed its
skin, BSAVAs Foundation Manuals give you what you need to know
32 Publications Advert June 2014.indd 32 16/05/2014 15:13
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33
Local
News from BSAVA Regions
knowledge
North East poisons meeting hits the spot
North East Region was very privileged to be able to entice Alex
Campbell back to the veterinary world one Sunday in March to update
us on the latest in poisons. Alex, formerly of the Veterinary Poisons
Information Service, was perfectly complemented by Jackie Belle and
we had a great turnout of 45 delegates.
Topics covered included what to do with diclofenac ingestion,
ivermectin poisoning of Collies, what to do if owners use Super Glue
instead of eye/ear drops, unexpected places to find xylitol (some
meloxicam containing liquids!), what to do if you find an unidentified
toadstool in your patients vomit, when to induce emesis (and when NOT
to), what can be done about sudden unexplained deaths where toxicity
may be suspected, useful resources, and exotics and wildlife casualties.
Delegates came away with lots of new knowledge for instance, did
you know that some antifreeze products have colourant added, that
fluoresces under u/v light? Do you know what E967 is or that avocados
are toxic to psittacines? Are you aware of the imminent arrival in garden
centres of indoor Bonsai versions of cycads and how toxic they are?
Are you aware of the International Cat Care e-petition regarding
permethrin in spot-ons?
We were very grateful to Alex and Jackie for highlighting the
BSAVA/VPIS Guide to Common Canine and Feline Poisons, and for
involving our sponsors (Nick Carmichael from CTDS Ltd Laboratories
and Forum Animal Health who make Apometic) in the content of the
days lectures. Our PetSavers raffle raised a record 88.
South West memorial lecture
on dealing with stress
Weve all had those bad days or weeks in practice
where the pressure can occasionally become
overwhelming, leaving little or no time for family or
friends outside of work and affecting our ability to
enjoy the vocation we have chosen. BSAVA South
West Region have organized a day meeting for busy
vets, nurses or practice managers with Jenny Guyat
from Vet Dynamics, offering tips for reclaiming control
of your time, energy and sanity.
The course will run in Exeter on Tuesday 23
September and Bristol on Wednesday 24
September. The day will start by gaining more
understanding of the frequent problem of high
stress and poor time management in our profession
and looking at why we seem to have our own
particular brand of veterinary stress. We will then
explore the symptoms of stress, and the ways we
can think and act when feeling overwhelmed or too
busy and see if you can recognize any of them in
yourself or your colleagues.
We will cover the cycle of our own energy levels
and how the veterinary practice environment can often
hijack this cycle, with some ideas for combatting this
that can be shared back at the practice or at home.
Then finally we will get on to the treatment for the
condition some ways to manage workflow both at
home and in the practice that can help you to regain
your enthusiasm and enjoyment of your job, and to
achieve a better work life balance.
This course is presented in memory of Clare Main
BVetMed MRCVS. Clare was a passionate and caring
veterinary surgeon, whose cheerful disposition and
astonishing ability to organize in the face of adversity,
including her own illness, were the catalyst for creating
this day course. Clare was Secretary of BSAVA South
West Region and worked tirelessly in this role, on top
of her demanding job co-ordinating CPD at Langford
Vet School. Despite her overwhelming can-do attitude,
Clare was highly aware of the demands of veterinary
practice and its effects on home life, and as such was
an ardent supporter of the Veterinary Benevolent Fund,
to whom a percentage of the funds raised by this
course will be sent.
Southern Region gets to grips
with geriatric cats
Southern Region was delighted to welcome Martha Cannon
recently; an enthusiastic and engaging speaker who updated
us on how to treat diseases in geriatric cats. During this day
meeting Martha emphasized the importance of recognizing
health problems in those elderly, often fragile cats and how
to best approach treatment. She pointed out that the owners
of elderly cats often have a particularly strong bond to their
beloved animal, as we now commonly see cats living a very
long life. Early recognition of CRI, arthritis, high blood
pressure and hyperthyroidism were discussed. Martha also
highlighted new developments in treatment options and how to
best treat cats with multiple health problems. The meeting was
kindly sponsored by Boehringer Ingelheim and Royal Canin.
33 Regions.indd 33 16/05/2014 15:20
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companion
CPD diary
LUNCHTIME WEBINAR
Wednesday 18 June 2014
13:0014:00
Breed schemes
Speaker: Aimee Llewellyn
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 25 June
13:0014:00
CT/MRI: what is it?
Speaker: Andrew Parry
Online
Details from administration@bsava.com
June
July
EVENING MEETING
SOUTH EAST REGION
Wednesday 4 June
Suture materials
Speaker: Davina Anderson
Leatherhead Golf Club
Details from southeast.region@bsava.com
EVENING MEETING
CYMRU/WALES REGION
Wednesday 4 June
Fluid therapy in small animal
practice: are all fluids created
equal?
Speaker: Dan Holden
The Unicorn Inn, Cardiff
Details from cymru.wales.region@bsava.com
EVENING MEETING
SOUTH WEST REGION
Wednesday 18 June
Veterinary evidence: how do I find
it and is it any good?
Speaker: Rachel Dean
RSPCA, Bristol
Details from southwest.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Wednesday 25 June
Demystifying medicine
Speakers: Nick Bexfield and Mark Dunning
Hilton Bristol, Bradley Stoke
Details from southwest.region@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Tuesday 15 July
The PUB Clinical Club: Collapse in
the dog a night at the movies
Speaker: Mike Martin
The Royal Oak, Ockbrook
Details from eastmidlands.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Wednesday 9 July
Are you flummoxed by fluids?
Rethinking fluid therapy in
emergency patients
Speakers: Sophie Adamantos and
Christina Maunder
Darts Farm Shopping Village, Exeter
Details from southwest.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Thursday 26 June
Demystifying medicine
Speakers: Nick Bexfield and Mark Dunning
Kingsley Village, Cornwall
Details from southwest.region@bsava.com
DAY MEETING
Thursday 5 June
Practical haematology: detective
work for nurses
Speaker: Kostas Papasouliotis
Woodrow House, Gloucester
Details from administration@bsava.com
DAY MEETING
IN CONJUNCTION WITH AVSTS
Tuesday 24 June
Top tips and tricks for closing and
reconstructing wounds in small
animal practice
Speaker: Jackie Demetriou
The Bridge, Wetherby
Details from administration@bsava.com
DAY MEETING
EAST ANGLIA REGION
Sunday 22 June
Managing tricky wounds: tips from
an expert
Speaker: Jackie Demetriou
The Animal Health Trust, Newmarket
Details from eastanglia.region@bsava.com
EVENING MEETING
NORTH EAST REGION
Tuesday 3 June
Wound management for nurses
Speaker: Louise ODwyer
Chantry Vets, Wakefield
Details from northeast.region@bsava.com
DAY MEETING
NORTH WEST REGION
Wednesday 11 June
The acute abdomen
Speaker: John Williams
Holiday Inn, Haydock
Details from northwest.region@bsava.com
EVENING MEETING
CYMRU/WALES REGION
Wednesday 11 June
The highs and lows of the
hyperthyroid cat
Speakers: Caroline Gardner and
Ceri Gruffudd Jones
Riechel Hall and Conference Centre, Bangor
Details from cymru.wales.region@bsava.com
EVENING MEETING
SOUTHERN REGION
Tuesday 17 June
Recognition of the emergency
patient: including triage and
implementation of nursing plans
Speaker: Kath Howie
Old Basing Village Hall, Basingstoke
Details from southern.region@bsava.com
EVENING MEETING
SOUTH WEST REGION
Wednesday 11 June
Getting more out of your
haematology and understanding
your analysers
Speaker: Graham Bilbrough
Cullompton RFC, Devon
Details from southwest.region@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Tuesday 17 June
The PUB Clinical Club: TBC
Speaker: TBC
The Royal Oak, Ockbrook
Details from eastmidlands.region@bsava.com
DAY MEETING
METROPOLITAN REGION
Wednesday 18 June
Skin and ear disease in dogs
and cats
Speakers: Ross Bond and Anke Hendricks
Holiday Inn, Elstree
Details from metropolitan.region@bsava.com
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EXCLUSIVE FOR MEMBERS
Extra 5 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 16 July
13:0014:00
Pericardial disease
Speaker: Rachel James
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 23 July
13:0014:00
Triage of the poisoned patient
Speaker: Daniel Lewis
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 17 September
13:0014:00
Different diagnosis of haematuria
Speaker: Rob Foale
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 24 September
13:0014:00
Behaviour and fireworks
Speaker: Daniel Mills
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday 20 August
13:0014:00
Analgesia and pain assessment
Speaker: Jackie Brearley
Online
Details from administration@bsava.com
LUNCHTIME WEBINAR
Wednesday TBC August
13:0014:00
Basic ophthalmic exam
Speaker: TBC
Online
Details from administration@bsava.com
August
October
September
OTHER UPCOMING BSAVA CPD COURSES
See www.bsava.com for further details
Metropolitan Region
Sunday 5 October
Chronic feline gastrointestnal, pancreatc
and hepatc disorders
BSAVA Educaton
Tuesday 7 October
Interactve endocrinology
BSAVA Educaton
Tuesday 7 October
Making the complicated straightorward:
surgery for common hindlimb
orthopaedic joint conditons
BSAVA Educaton in conjuncton with VCS
Wednesday 8 October
Controversies in canine cardiology:
data or dogma? Dispelling myths in
canine cardiology
BSAVA Educaton in conjuncton with VCS
Thursday 9 October
Controversies in feline cardiology:
navigatng the nightmare of feline
heart disease
DAY MEETING
IN CONJUNCTION WITH BVOA
Tuesday 2 September
Scared of orthopaedics? Building
your confidence and skills in
practice
Speaker: Peter Attenburrow
Oulton Hall, Leeds
Details from administration@bsava.com
DAY MEETING
IN CONJUNCTION WITH VCS
Thursday 18 September
Getting the most from cardiac
diagnostics
Speaker: Mike Martin
Woodrow House, Gloucester
Details from administration@bsava.com
DAY MEETING
EAST ANGLIA REGION
Sunday 21 September
A day of interactive, case-based
ophthalmology
Speakers: Christine Heinrich and David Gould
The Animal Health Trust, Newmarket
Details from eastanglia.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Tuesday 23 September
Defusing the veterinary stress
time bomb
Speaker: Jenny Guyat
Exeter Court Hotel, Exeter
Details from southwest.region@bsava.com
DAY MEETING
SOUTH WEST REGION
Wednesday 24 September
Defusing the veterinary stress
time bomb
Speaker: Jenny Guyat
Hilton Bristol, Bradley Stoke
Details from southwest.region@bsava.com
DAY MEETING
Thursday 4 September
Good grief my patient is all fur and
teeth: handy tips on nursing small
exotic mammals
Speaker: Wendy Bament
Venue: TBC
Details from administration@bsava.com
DAY MEETING
METROPOLITAN REGION
Friday 5 September
Emergency surgery
Speakers: Dan Brockman and
Lindsay Kellett-Gregory
Venue: TBC
Details from metropolitan.region@bsava.com
DAY MEETING
NORTH EAST REGION
Sunday 28 September
Lets talk about sex!
Speaker: Gary England
Blackwell Grange Hotel, Darlington
Details from northeast.region@bsava.com
DAY MEETING
IN CONJUNCTION WITH BRAVO
Wednesday 1 October
Advanced ophthalmology: just
above basics and problem cases
Speaker: Jim Carter
Venue: Chilworth Manor, Southampton
Details from administration@bsava.com
DAY MEETING
WEST MIDLANDS REGION
Saturday 4 October
Veterinary examination, handling
and husbandry of reptiles,
small mammals and cage birds:
a hands-on day with the animals
Speakers: Sarah Pellett and
Nathalie Wissink-Argilaga
Animal Care Department, Solihull College
Details from westmidlands.region@bsava.com
EVENING MEETING
WEST MIDLANDS REGION
Tuesday 16 September
Communication
Speaker: Stuart Ellis
Wolverhampton Medical Centre, Wolverhampton
Details from westmidlands.region@bsava.com
EVENING MEETING
EAST MIDLANDS REGION
Tuesday 16 September
The PUB Clinical Club: topic TBC
Speaker: TBC
The Royal Oak, Ockbrook
Details from eastmidlands.region@bsava.com
34-35 CPD Diary.indd 35 16/05/2014 15:21
Morning lectures covering

Vets : : Critical Care Sophie Adamantos

: : Dentistry Norman Johnston

Nurses : : Welfare vs Ethics Hayley Walters

: : Critical Care Sophie Adamantos

13 hours of CPD (morning lectures and afternoon seminars)

for vets and nurses covering a wide range of topics

Extensive Trade Exhibition

Interactive Sessions

Gala Dinner with Ceilidh

2931 August
Edinburgh Conference Centre, Heriot-Watt,
Edinburgh, Scotland, UK
Email scottishcongress@bsava.com or
visit www.bsava.com/scottishcongress
to register and for full programme
Join the BSAVA Scottish Congress
Clan for an unmissable weekend!
36 OBC Scottish Congress.indd 1 16/05/2014 15:21