companion june2012

What about welfare?Impact of legislationP4

Clinical ConundrumA case of melaena

P8

How To…Place chest drains

P12

The essential publication for BSAVA membersThe essential publication for BSAVA members

companionJUNE 2012

The importance of endocrine disease

01 OFC June.indd 1 21/05/2012 10:02

2 | companion

companion is published monthly by the British Small Animal Veterinary Association, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB. This magazine is a member-only benefit. Veterinary schools interested in receiving companion should email [email protected]. We welcome all comments and ideas for future articles.

Tel: 01452 726700Email: [email protected]

Web: www.bsava.com

ISSN: 2041-2487

Editorial Board

Editor – Mark Goodfellow MA VetMB CertVR DSAM DipECVIM-CA MRCVS

Past President – Andrew Ash BVetMed CertSAM MBA MRCVS

■■ CPD Editorial TeamSimon Tappin MA VetMB CertSAM DipECVIM-CA MRCVSPatricia Ibarrola DVM DSAM DipECVIM-CA MRCVS

■■ Features Editorial TeamCaroline Bower BVM&S MRCVSAndrew Fullerton BVSc (Hons) MRCVSMathew Hennessey BVSc MRCVS

■■ Design and ProductionBSAVA Headquarters, Woodrow House

No part of this publication may be reproduced in any form without written permission of the publisher. Views expressed within this publication do not necessarily represent those of the Editor or the British Small Animal Veterinary Association.

For future issues, unsolicited features, particularly Clinical Conundrums, are welcomed and guidelines for authors are available on request; while the publishers will take every care of material received no responsibility can be accepted for any loss or damage incurred.

BSAVA is committed to reducing the environmental impact of its publications wherever possible and companion is printed on paper made from sustainable resources and can be recycled. When you have finished with this edition please recycle it in your kerbside collection or local recycling point. Members can access the online archive of companion at www.bsava.com .

3 BSAVA NewsLatest from your Association

4–7 What about Welfare?The impact of the Animal Welfare Act

8–11 Clinical ConundrumConsider a case of melaena in an 8‑year‑old Labrador Retriever

12–18 How To…Place chest drains

20–22 The Importance of Endocrine DiseaseThe approach to a case of hypercalcaemia

23–27 Microchipping: the Hot PotatoUpdate on the Microchip Advisory Group

28–29 WSAVA NewsThe World Small Animal Veterinary Association

30–31 The companion InterviewGraeme Eckford

32 PetSaversCanine hypothyroidism

33 Focus On…Scottish region

34–35 CPD DiaryWhat’s on in your area

Additional stock photography Dreamstime.com© Anatoly Maslennikov; © Dora Paris; © Spongecake; © Wojciech Plonka; © Yudesign

Getting an award for your contribution to your profession can really bowl some people over. Certainly the case for

Carmel Mooney, receiving the Woodrow Award this year: “I am honoured and humbled, not to mention surprised by this award. It was unexpected and it is completely brilliant.”

The BSAVA Awards that take place at Congress are unique in that general practitioners are as likely to appear as well known academics like Carmel on the honour roll – because anyone can be nominated – and nominations come from the BSAVA membership.

What and howYou don’t have to nominate someone for every award – you can nominate for just one if you want to. Here are the categories:

■■ The Melton Award – for meritorious contributions by veterinary surgeons to small animal practice

■■ The J.A.Wight Memorial Award – recognises outstanding contributions to the welfare of small animals

■■ The Woodrow Award – for outstanding contributions in the field of small animal medicine

■■ The Blaine Award – for outstanding contributions to the advancement of

Nominate now to honour good workWhen the BSAVA Awards committee meets in October it will be relying entirely on your nominations – please consider honouring a friend or colleague by 14 September

small animal medicine or surgery■■ The Simon Award – for outstanding

contributions in the field of veterinary surgery

■■ The Amoroso Award – for outstanding contributions to small animal studies by a non-clinical member of university staff

■■ The Bourgelat Award – the primary recognition for really outstanding contributions to the field of small animal practice

You can nominate online at www.bsava.com/awards, download a form from the website to send in, or email [email protected] if you would like us to send you a form.

Putting yourself in the mixNot all the awards are nominated – prizes also go to the best JSAP papers and CRAs. Rob Harper won the best Clinical Research Abstract presented by a practitioner. He said: “I was very surprised but I am pleased to win this award and that other people value this research.”

Finally – the Frank Beattie Travel Scholarship offers an opportunity for a BSAVA members to undertake a trip abroad to study a particular aspect of veterinary practice. More details can be found online. ■

02 Page 02 June.indd 2 21/05/2012 14:10

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Virgin Atlantic is offering BSAVA members entry into their frequent flyer programme at the enhanced Silver member level, and a fast track to the exclusive benefits of Flying Club Gold membership, including giving you 100% more miles.

As a Silver Flying Club member you will receive:

■ 50% more Flying Club miles whenever you fly with VA. ■ Priority airport treatment with Premium Economy Check-in,

whatever your class of travel. ■ Complimentary Regus Business World Gold Membership, giving

you access to office facilities around the world, worth £199 a year. ■ Two complimentary First Class upgrade vouchers for travel on each

of the Gatwick Express and Heathrow Express trains.

To take advantage of the Virgin Atlantic Flying Club, BSAVA members should visit the membership benefits section at www.bsava.com – in the Ancillary Benefits section you can download a PDF which will allow you to enrol for the scheme. Also see the flyer inside this edition of companion. ■

The Worldwide Veterinary Service was delighted with the response by BSAVA Congress delegates to their request to bring old veterinary manuals and texts to their stand at the event, for distribution overseas. Tessa Polard, WVS Charity Support & Projects Manager, says, “Thank you for your support – we collected around 20 boxes at Congress which contained 287 books that we valued at approx £10,700”. You can still donate your old manuals, your time and your money to WVS – visit www.wvs.org.uk. ■

Book collection success

NEW BENEFIT

Flying Club membership

BSAVA wants to find ways to make it easier for you to take part in consultations and have your sayAwarenessSally Everitt, BSAVA’s Scientific Policy Officer, spent some time at Congress talking to delegates about how we could encourage more participation in consultations. Many said they often just weren’t aware of them. At www.bsava.com/consultations there are links to those currently open. So, although we do our best to inform members about consultations here in companion, it is worth checking this part of the site regularly as often we don’t get enough notice before we go to print.

TimeThere was also an issue of time of course – so now Sally provides key details of the consultation and relevant questions for you to answer – rather than having to read lots of documents and begin with a blank page.

Is it worth it?Another theme that came up in Sally’s conversations was ‘my lone voice won’t count’ – however, because you are a member of BSAVA your voice does count – and we make sure that we do our very best to have play an active part in any consultation that we’re invited to participate in. And of course you don’t have to wait until a consultation to get in touch with us – you can send comments and concerns at any time to [email protected] and we’ll make sure they get to the right person. ■

BSAVA wants to find ways to make it easier for you to take

Your views do count!

03 Page 03 June.indd 3 21/05/2012 10:09

4 | companion

What about wel fare?The Animal Welfare Act has now been in force for five years. BSAVA’s Scientific Policy Officer Sally Everitt looks at the impact of the legislation and asks what we need to do to improve the welfare of companion animals

The Animal Welfare Act 2006 received Royal Assent on 8 November that year and came into force on 27 March 2007 in Wales and on 6 April 2007 in England. Scotland has similar

legislation in the form of the Animal Health and Welfare (Scotland) Act 2006, and Northern Ireland has the Animal Health and Welfare (NI) Act 2011. There are slight variations in legislation in the devolved regions; for example, regulations regarding tail docking, compulsory microchipping in Northern Ireland, and the proposed introduction of dog breeding regulations in Wales.

These animal welfare Acts update previous animal welfare legislation and bring together the effects of 22 separate Acts of Parliament, going back to the Protection of Animals Act 1911 (POAA). However, there remain a number of other Acts which affect the welfare of companion animals and involve local authority licensing:

n The Pet Animals Act 1951 (as amended in 1983) – which protects the welfare of animals sold as pets

n Animal Boarding Establishments Act 1963 – which covers establishments where the boarding of animals is being carried on as a business

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companion | 5

What about wel fare? n Breeding and Sale of Dogs (Welfare) Act 1999,

Breeding of Dogs Act 1991 and Breeding of Dogs Act 1973 provide protection for dogs used in breeding establishments.

The Animal Welfare Act 2006 (AWA) extends the previous requirement not to cause unnecessary suffering by introducing a duty of care making owners and keepers responsible for ensuring that the welfare needs of their animals are met. These include the need to:

n Have a suitable environment (place to live) n Have a suitable diet n Exhibit normal behaviour patterns n Be housed with, or apart from, other animals

(if applicable) n Be protected from pain, injury, suffering and

disease.

Applying the lawFurther guidance on how welfare needs should be met is provided in the Act’s Codes of Practice, and although failure to comply with a provision of a code is not in itself an offence it may be used as evidence of liability in a prosecution under the Animal Welfare Act.

The law also increases to 16 the minimum age at which a person can buy an animal and prohibits giving animals as prizes to unaccompanied children under this age. Anyone who is convicted of cruelty to an animal, or does not provide for its welfare needs, may be banned from owning animals, fined up to £20,000 and/or sent to prison.

In theory the changes to the legislation make it possible not only to prosecute those who cause unnecessary suffering to an animal but also to enable Inspectors (such as RSPCA) to take action before an animal is suffering and to issue improvement notices.

Review of AWAThe post-legislative assessment of the Animal Welfare Act 2006, carried out in 2010, found that the prosecution rates on unnecessary suffering were similar before and after the introduction of the AWA. In 2009 the figures were:

n 896 people were found guilty of causing unnecessary suffering to animals

n 103 people were found guilty of failing to provide for the welfare needs of their animals

n 612 people were cautioned for not providing for the welfare needs of their animals.

However there is no breakdown in these figures to indicate the number of prosecutions, convictions or cautions relating to companion animals.

Figures from the RSPCA confirm that there has been a shift towards taking prosecutions under the Animal Welfare Act (AWA) rather than the Protection of Animals Act (POAA) (Figure 1).

0

500

1000

1500

2005 2006 2007 2008 2009

2000

2500 POAA AWA

Figure 1: Number of convictions under the Protection of Animals Act (POAA) 1911 and the Animal Welfare Act (AWA) 2006, 2005–2009Reproduced from www.rspca.org.uk


6 | companion

What about welfare?

The RSPCA also reports that although the increase in convictions may not have been large, in 2009 it received over 140,000 cruelty complaints and issued more than 75,000 welfare improvement notices which may have prevented a need for further investigation and possibly subsequent prosecution.

As well as reporting on prosecutions the RSPCA has been monitoring 30 indicators, on a yearly basis, in order to assess animal welfare in the UK. These include both generic and sector-specific indicators, which are given a traffic light system to indicate improvement, or lack of it.

The generic indicators include not only the number of prosecutions taken by the RSPCA, which has increased year on year (RED), but also such things as the proportion of schools that incorporate animal welfare into their curriculum (AMBER) and the number of people interested in improving animal welfare (GREEN). Sector-specific indicators for pets include the number of stray dogs collected by local authorities in the UK (RED), the number of healthy dogs being euthanased (AMBER ) and the number of dogs and cats which are microchipped (GREEN) (Figure 2).

The report acknowledged that there are limitations to their methods of assessing animal welfare and that the majority of data and statistical information concerning pets in the UK has been obtained from the RSPCA’s own sources.

PDSA Animal Wellbeing ReportLast year (2011) saw the publication of the first PDSA Animal Wellbeing (PAW) report. This report was based on a survey carried out in conjunction with YouGov. The survey was conducted using an online panel of 4,675 dog, 5,317 cat and 1,132 rabbit owners. The questions were based on the five welfare needs as detailed in the Animal Welfare Act and the responses were collated to produce a score for each type of animal representing how well each of their welfare needs were met, as well as an overall score for each species (Figure 3).

These figures show significant differences in our ability to provide for the needs of our pets, with dogs scoring reasonably well for environment and health, but less well for behaviour and companionship; cats scored best overall and rabbits scored particularly poorly for companionship and health. The report concluded that in 2011 pets in the UK are stressed, lonely, overweight, aggressive and misunderstood – but loved.

While none of these reports can claim to be measuring animal welfare directly they do provide strong evidence that there is still plenty of room for improvement.

Role of the vetVeterinary surgeons do not have any powers under the Animal Welfare Act but may be required to advise or

71 64 58

64 63 55

55 66 75

49 70 32

71 64 47

62 65 53

envi

ronm

ent

diet

beha

viou

rco

mpa

nion

ship

heal

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National index scores based on each welfare need

Overall national scores for each species

♥

Figure 3: Visual guide to the results of the PDSA report conducted by YouGov in 2010. An index score, out of 100, was produced for how UK pet owners met each of five welfare needs of their petsReproduced from www.pdsa.org.uk

TRAFFIC LIGHT DEFINITION 2005 2006 2007 2008 2009

RED Animal welfare has worsened

6 2 4 5 5

AMBER Negligible or no change

9 16 19 19 16

GREEN Animal welfare has improved

6 6 5 6 9

GREY Insufficient or no data

10 11 5 2 4

TOTAL 31 35 33 32 34

Figure 2: Trends in RSPCA assessed parameters, graded by “severity”Reproduced from www.rspca.org.uk


companion | 7

certify to an animal’s distress or suffering. However we do have a professional responsibility to animal welfare. The new Guides to Professional Conduct for both veterinary surgeons and veterinary nurses include the following oath:

“I PROMISE AND SOLEMNLY DECLARE that I will pursue the work of my profession with integrity and accept my responsibilities to the public, my clients, the profession and the Royal College of Veterinary Surgeons and that ABOVE ALL my constant endeavour will be to ensure the health and welfare of animals committed to my care.”

As noted by the Companion Animal Welfare Council (www.cawc.org.uk) the term ‘welfare’ is often used to encompass two different concepts. One relates to the physical health and evolutionary fitness of animals, the other to the quality of their subjective feelings (e.g. pain, fear, warmth, pleasure).

While the need to be protected from pain, injury, suffering and disease is considered one of the five welfare needs, our oath to ensure the health and welfare of animals committed to our care suggests wider responsibility than purely the prevention and treatment of disease.

The Animal Welfare Act states that it is the duty of the person responsible for an animal to ensure its welfare and that “a person commits an offence if he does not take such steps as are reasonable in all the circumstances to ensure that the needs of an animal for which he is responsible are met to the extent required by good practice”. Paragraph 3 of the AWA states that responsibility for the welfare of an animal falls to “a person responsible for an animal whether on a permanent or temporary basis” and that “being responsible for an animal includes being in charge of it”. Therefore, when animals are admitted to a veterinary clinic for care or treatment, the veterinary surgeons and veterinary nurses involved in the animal’s care and treatment have responsibility for the animal’s welfare needs.

As such members of the veterinary profession needs to consider not only the specific welfare needs of the different species and individual animals treated, but also the effect that treatment may have on an individual animal’s welfare. While it is generally considered that it is acceptable to deprive an animal of its welfare needs in the short term for long-term benefit, it is also reasonable to assume we could do a great deal more in veterinary practices to improve the welfare of animals under our care.

While as a profession we are becoming more conscious of the need for appropriate analgesia, we are probably still poor at considering the effect of our treatments on the animal’s other welfare needs. Quiet wards for cats and other small animals, suitable

bedding and nutrition are probably provided in the majority of practices, but the consideration of the various treatment options on the animal’s ability to express normal behaviour may be less common. One of the reasons for this may be that at present we have very few welfare assessment tools.

As well as considering the effect of the treatments we provide on animal welfare, veterinary surgeons and veterinary nurses are often in the position of advising and educating owners about the welfare of their pets. A survey of veterinary surgeons’ opinions on dog welfare issues indicated that obesity, chronic pain, breed-related conditions and behavioural problems were all considered to be commonly encountered welfare problems.

Veterinary surgeons also have a role in guiding their clients through decisions regarding their animals’ quality of life and decisions regarding euthanasia. n

USEFUL LINKS

1. www.bva-awf.org.uk/about/BVA_AWF_Tail_docking_guidance_Nov2011.pdf

2. www.rspca.org.uk/in-action/whatwedo/animalwelfareindicators

3. www.pdsa.org.uk/pet-health-advice/pdsa-animal-wellbeing-report

This article with references is available online at www.bsava.com/companion

Participate in quick web questionnaireWhat can vets do to promote animal welfare? Well, first we’d appreciate it if you could complete our online questionnaire – it won’t take long – the questions are below. If we get a good response we will report the results in a future edition of companion.

1. Do you think that the five welfare needs are a helpful way of considering animal welfare? If not what criteria would you use?

2. What do you consider to be the major welfare problems that you see in practice?

3. How can vets best promote animal welfare to their clients?

4. What can vets do to improve the welfare of animals under their care?

5. What should BSAVA do to promote animal welfare?

Go to www.bsava.com/consultations.


8 | companion

Clinical conundrum

Problem list n Lethargy n Inappetence n Weight loss n Pale mucous membranes n Hyperkinetic pulses n Tachycardia n Cardiac murmur n Melaena

The pale mucous membranes were most likely due to anaemia causing a haemic or functional cardiac murmur and tachycardia/hyperkinetic pulses as a consequence of decreased blood viscosity

gastritis; gastric neoplasia; portal hypertension secondary to end-stage liver disease; uraemic gastritis; gastrinoma; mast cell tumour)

n Intestinal ulceration (inflammatory bowel disease (IBD); neoplasia (lymphoma, adenocarcinoma, leiomyoma, leiomyosarcoma, gastrointestinal stromal tumour))

n Hypoadrenocorticism n Infection (Campylobacter, Clostridium

perfringens, Salmonella, parvovirus, hookworms)

n Swallowed blood (epistaxis, oral bleeding, haemoptysis)

n Coagulopathy (thrombocytopenia, specific factor deficiencies, rodenticide toxicity, disseminated intravascular coagulation)

n Severe acute pancreatitis n Chronic intussusception n Gastrointestinal ischaemia (infarction;

mesenteric torsion; volvulus; vascular malformation)

n Severe oesophageal disease (oesophagitis; neoplasia)

The recent history of NSAID administration made gastric ulceration a possible differential, although the weight loss was more suggestive of a chronic condition. Hypoadrenocorticism is an uncommon but important cause of melaena. Regurgitation would be expected with oesophageal disease and the absence of bleeding at other sites made a coagulopathy less likely. Gastrointestinal ischaemia and acute pancreatitis were unlikely in the absence of abdominal pain.

Construct an initial diagnostic plan, justifying the reasons for each investigationHaematology was performed to confirm and assess the severity of anaemia and

Kirsty Roe of Willows Veterinary Centre and Referral Service invites companion readers to consider a case of melaena in an 8-year-old Labrador Retriever

Case presentationAn 8-year-old male neutered Labrador Retriever presented with a history of lethargy and inappetence for 24 hours. No vomiting or diarrhoea were reported; however, dark faeces (Figure 1) had been noted on the day of presentation and weight loss had been detected over the previous few months.

Meloxicam had been given at a standard dose for 3 days prior to presentation following an injury to the tail tip. A proprietary dry dog food was being fed. The dog was quiet but alert and in poor body condition (score 3/9) with pale mucous membranes and bounding, hyperkinetic femoral pulses (rate 160 per minute). Thoracic auscultation revealed a grade I/VI systolic murmur, loudest over the left heart base. Abdominal palpation was unremarkable; however, rectal exam revealed the presence of melaenic faeces.

Figure 1: Melaenic faeces: the breakdown products of haemoglobin cause the black discoloration

and decreased vascular resistance. Primary myocardial disease could also cause mucous membrane pallor, tachycardia and a cardiac murmur; however, hypokinetic pulse quality would be expected. The primary problem was therefore melaena. Lethargy, inappetence and weight loss were considered secondary to the underlying disease process.

Differential diagnoses for melaena

n Gastric ulceration (gastric foreign body; secondary to NSAIDs or corticosteroids; acute or chronic

08-11 CLINICAL CONUNDRUM.indd 8 21/05/2012 11:14

companion | 9

measure the platelet count. A reticulocyte count was performed to assess the degree of red blood cell regeneration (Table 1). A regenerative anaemia would be expected with haemorrhage or haemolysis (unless acute in presentation as a regenerative bone marrow response takes 3–4 days). Biochemistry was performed to measure plasma proteins (which might be decreased with small intestinal disease) and to look for signs of liver dysfunction (such as hypoalbuminaemia, hypoglycaemia, hypocholesterolaemia, low urea) or for electrolyte abnormalities suggestive of primary hypoadrenocorticism (hyperkalaemia in 90% of cases and hyponatraemia in 80% of cases) (Table 2). Coagulation times were measured to assess secondary haemostasis (Table 3).

How does interpretation of the results help refine the differential diagnosis?A moderate to severe regenerative anaemia was present, consistent with haemorrhage or haemolysis: gastrointestinal tract haemorrhage was most likely with the history of melaena and with panhypoproteinaemia. Neutrophilia with a left shift can occur with inflammation, infection, immune-mediated disease or neoplasia. In this case it was suspected to be a non-specific effect of marrow hyperactivity in response to anaemia. Mild thrombocytopenia was thought to be due to increased platelet consumption following haemorrhage.

Panhypoproteinaemia is consistent with blood loss, protein-losing enteropathy (PLE) or rarely severe protein-losing nephropathy (PLN). Hypocalcaemia is to be expected in a patient with hypoalbuminaemia due to a reduction in the protein-bound

Parameter Result Reference range Units

WBC 21.9 6.0–15.0 x109/l

Neutrophils (absolute) 17.96 2.50–12.50 x109/l

Band neutrophils (absolute)

0.44 0.00–0.40

Lymphocytes 2.19 0.50–4.80 x109/l

Monocytes 1.10 <0.80 x109/l

Eosinophils 0.22 0.00–0.80 x109/l

RBCs 2.66 5.50–8.50 x109/l

Hb 6.0 12.0–18.0 x109/l

HCT 0.196 0.38–0.57 %

MCV 73.7 61.0–80.0 fl

MCHC 30.6 30.0–36.0 g/dl

Reticulocyte count 376.6 <140.0 x109/l

Platelet count 125 150–450 x109/l

Smear Red cells show moderate anisocytosis and polychromasia

Table 1: Haematology results (abnormal results in bold)


Albumin 22.0 25.0–40.0 g/l

Globulin 19.8 20.0–45.0 g/l

Sodium 144.0 135.0–155.0 mmol/l

Potassium 3.70 3.60–5.60 mmol/l

Chloride 113.3 100.0–116.0 mmol/l

Calcium 2.15 2.45–3.10 mmol/l

Phosphorus 1.07 0.80–1.60 mmol/l

Urea 5.5 2.5–6.7 mmol/l

Creatinine 62.4 20.0–150.0 µmol/l

Cholesterol 2.40 3.20–6.20 mmol/l

Bilirubin 1.1 0.1–5.1 µmol/l

ALT 19.9 5.0–60.0 IU/l

CK 220.6 20.0–225.0 IU/l

ALP 23.1 <130 IU/l

Glucose 6.8 2.8–4.9 mmol/l

Table 2: Biochemistry results (abnormal results in bold)

Table 3: Coagulation times


Prothrombin time (PT) 17.4 14–19 Seconds

Activated partial thromboplastin time (APTT)

100.5 75–105 Seconds


10 | companion

Clinical conundrum

calcium fraction. Differentials for hypocholesterolaemia include malabsorption (due to exocrine pancreatic insufficiency or small intestinal disease), liver failure, hypoadrenocorticism or starvation. Liver failure was unlikely, as other biochemical indicators of liver dysfunction were not present and there was no history of starvation. Atypical hypoadrenocorticism (where glucocorticoid deficiency alone is present with normal mineralocorticoid concentration) can cause anaemia, hypoalbuminaemia and hypocholesterolaemia with normal electrolyte concentrations and therefore remained a possibility.

The normal coagulation times excluded congenital clotting factor deficiency and rodenticide toxicity. PT and APTT can be normal in disseminated intravascular coagulation so this could not be ruled out.

What initial treatment should be considered?A blood transfusion was performed with one unit of DEA (dog erythrocyte antigen) 1.1-negative packed red blood cells; PCV post-transfusion was 29%. Blood typing prior to transfusion was not performed as DEA 1.1-negative dogs can be used as universal donors; no cross-match was required as the dog had not received any previous transfusions. Omeprazole 1 mg/kg was administered slowly intravenously to decrease gastric acid secretion. No further NSAID therapy was administered.

What further investigations may be helpful at this stage?Urinalysis to look for proteinuria as a cause of hypoalbuminaemia is advised. The amount of protein on a urine dipstick should be interpreted relative to urine specific gravity; if significant proteinuria is Table 4: Folate and cobalamin concentrations


Folate 4.7 8.2–13.5 µg/l

Cobalamin <150.0 >275.0 ng/l

present, a urine protein:creatinine ratio should be measured and culture performed to rule out infection. Thoracic radiographs (dorsoventral and two lateral projections) to look for evidence of possible metastatic disease and abdominal radiographs to look for evidence of gastrointestinal neoplasia or small intestinal obstruction are recommended. Due to the suspicion of PLE, serum folate and cobalamin should be measured, although normal concentrations of these vitamins do not rule out the presence of small intestinal disease. An ACTH stimulation test would be required to diagnose hypoadrenocorticism, and faecal parasitology (for hookworms) and culture to look for bacterial infection resulting from or contributing to the melaena.

ResultsUrinalysis revealed no proteinuria, ruling out PLN. Thoracic and abdominal radiographs showed no abnormalities. Faecal parasitology was unremarkable and culture was negative. Both folate and cobalamin were low (Table 4). Hypocobalaminaemia occurs due to malabsorption from chronic, severe distal small intestinal disease, whereas low folate occurs with proximal small intestinal malabsorption. Dietary deficiency of these vitamins was ruled out from the history. Exocrine pancreatic insufficiency is another frequent cause of cobalamin deficiency but was considered unlikely as there was no history of polyphagia or diarrhoea.

What are the most likely differential diagnoses considering all the results so far?Diffuse small intestinal disease was suspected, with the differentials of IBD, lymphangiectasia or lymphoma considered most likely. The gastrointestinal haemorrhage could have been due to concurrent NSAID-induced ulceration or gastroduodenal ulceration due to the primary underlying disease.

What further investigations would you perform?Abdominal ultrasonography is advised to look for thickening, loss of normal layering or mass lesions in the gastrointestinal tract. Upper gastrointestinal tract endoscopy would allow direct visualisation of oesophageal, gastric and duodenal mucosa and enable gastric and duodenal mucosal biopsy. Ultrasound examination revealed a 3 cm diameter area of irregular gastric wall thickening with a resultant reduction in the normal layered appearance of the gastric wall consistent with focal ulceration, inflammation or neoplasia (Figure 2). Gastroscopy revealed a bleeding ulcer in the body of the stomach, with no mucosal thickening or irregular edges, typical for an NSAID-induced ulcer (Figure 3). Duodenoscopy revealed mild mucosal hyperaemia and a mottled mucosal surface (Figure 4). Endoscopic biopsy samples were taken from the ulcer periphery (to avoid perforation) and from the grossly normal stomach and


companion | 11

CoNTRiBUTe A CliNiCAl CoNUNdRUM

If you have an unusual or interesting case that you would like to share with your colleagues, please submit photographs and brief history, with relevant questions and a short but comprehensive explanation, in no more than 1500 words to [email protected] submissions will be peer-reviewed.

Figure 2: Abdominal ultrasound image showing region of gastric body thickening

Figure 3: endoscopic image of bleeding gastric ulcer

Figure 4: endoscopic image of duodenum

duodenum. Histopathology revealed moderate lymphoplasmacytic gastritis and moderate lymphoplasmacytic enteritis with villus atrophy.

DiagnosisA diagnosis of IBD was made, with concurrent gastric ulceration most likely due to NSAID treatment.

How would you manage and treat this case?Treatment was aimed at preventing further gastric ulceration and aiding ulcer healing, supplementing vitamin deficiencies and managing IBD. Omeprazole 1 mg/kg orally q24h was prescribed for 4 weeks: either proton pump inhibitors (PPIs) or histamine-2 receptor antagonists can be used to increase gastric pH, although PPIs are more efficacious and inhibit gastric acid completely. The ulcer was also managed with sucralfate 1 g orally q8h. This is a sulphated disaccharide-aluminium hydroxide complex that adheres to ulcerated tissue and provides a barrier to

acid penetration. It also stimulates endogenous prostaglandin synthesis in the gastric mucosa.

Parenteral supplementation with vitamin B12 1000 µg once a week for 6 weeks followed by a final dose 30 days after the 6th dose was advised. A blood test was recommended to recheck the vitamin B12 level 30 days after the final dose. In a patient with cobalamin deficiency, serum folate concentrations may be falsely normal or increased and therefore re-evaluation of serum folate concentration after cobalamin supplementation is advised. Although there is less known about folate deficiency and supplementation, as few dogs have been described with clinical signs that are definitively due to folate deficiency, folate supplementation is advised in patients with decreased serum folate concentration. Folic acid 400 µg orally q24h for 30 days was therefore prescribed and re-evaluation advised 1–3 weeks after supplementation was stopped.

A hydrolysed protein diet was fed exclusively for 2 months as a dietary trial:

dietary management is a key component in treating patients with IBD. A positive response to dietary modification (hydrolysed or novel-protein) in 60–88% of dogs with lymphoplasmacytic enteritis has been reported. Metronidazole 10 mg/kg q12h for 4 weeks was also prescribed as this has immunomodulatory properties in addition to antibacterial action and is usually the first drug of choice in dogs with IBD with mild to moderate histopathology changes and clinical signs.

Four weeks after presentation PCV was 40%, the panhypoproteinaemia had resolved and the dog had gained 5 kg in bodyweight. n


12 | companion

How to place chest drains

Kate Murphy of Bath Veterinary Referrals takes us through the procedure step by step

Pleural space diseases are relatively common in dogs and cats, with drainage of the pleural space being both therapeutic and

diagnostic. Recently small-bore catheters have become available to the veterinary market, allowing easier placement via a Seldinger technique compared with the traditional wide-bore trocar drains. This article describes a number of different ways to place chest drains; the method the author uses is described below and, where appropriate, alternative approaches are identified.

Small-bore chest drains are suitable for the drainage of air (Figure 1) or fluid (Figure 2) from the pleural space of dogs and cats, but are limited by their narrow gauge. The larger diameter of the wide bore tubes allows rapid removal of larger volumes of fluid or air. Small-bore and wide-bore drains can be used to instil lavage fluid into the pleural space of animals with pyothorax, however wide bore drains are more effective at removing flocculent material compared with small bore drains, particularly in dogs.

When to place a chest drainIf there is only a small amount of fluid or air, or if you only want diagnostic samples, these may be obtained via thoracocentesis; however, for more complete drainage of the chest, the placement of a drain is recommended.

The drain can also be left in situ to facilitate further drainage if the fluid or air continues to accumulate. If the fluid

Figure 1: Right lateral radiograph of a dog showing a pneumothorax

Figure 2: Right lateral radiograph of a dog showing pleural effusion

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companion | 13

obtained is haemorrhagic, it is recommended to only take a diagnostic sample. The PCV of this fluid should be checked and a coagulation profile and platelet count assessed if possible. If the fluid is confirmed as blood, then further drainage should only be performed if the patient does not improve with oxygenation and rest, since the signs (dyspnoea/tachypnoea) are not due solely to the volume of fluid but also to hypoxia.

Where to put the drainThe site for drain entry can be determined by physical evaluation or ultrasonographic findings, or the tube can be placed emperically at the 7th–8th intercostal space at the level of the costochondral junction (fluid), mid-way up thoracic wall (air and fluid) or in the dorsal third of the chest (air). Ultrasonography (Figure 3) can be very helpful in guiding the best place for drainage if fluid is only present in pockets or if one side is more severely affected.

What do you need?

For small-bore Seldinger drain placement:■■ Small-bore chest drain set (Figure 4)

which contains:■– 14 and 18G ‘over-the-needle’

catheters (introducers)■– 60 cm J-tip guidewire■– Additional suture wings for catheter■– Closed one-way valve bung■– Tethered cap■– 14G, 20 cm radiopaque

polyurethane catheter with multi-fenestrated tip and suture wing.

For wide-bore trocar drain placement:■■ Suitable chest tube (diameter

approximately equal to mainstem bronchus):■– 10–16 Fr for cats and small dogs■– 16–20 Fr for small to medium dogs■– 20–32 Fr for large and giant dogs■– In practice your choice may be

Figure 4: A small-bore chest drain kit containing a catheter, guidewire and drainFigure 3: An ultrasound image of the thorax showing anechoic pleural fluid

dictated by the options in the cupboard, e.g. a selection of 2–3 sizes may be kept such as 10 Fr, 16 Fr and 20 Fr.

■■ The length of tube should be sufficient for the tip to sit at the level of the second rib once placed.

■■ Connectors for the tube (variety of options such as Christmas tree adapter and three-way tap and bungs or one-way valve connector, Heimlich valve, centesis valve).

■■ Gate clamp/non-traumatic forceps.

Additional equipment for both types of drain placement:■■ Clippers.■■ Surgical preparation solution.■■ Local anaesthetic, e.g. lidocaine 1–2%.■■ Sterile gloves.■■ 20 ml syringe with tip suitable for the

type of connector■– Luer-lock for most connectors and

catheter-tip for rubber tubing.

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14 | companion


■■ Extension set and three-way tap or centesis valve/chest tube adapter.

■■ Tubes for sample collection (EDTA for cytology and plain tubes (one for culture and one for biochemical analysis)) and clean slides for direct smears.

■■ Bowl/jug for collection of fluid.■■ No. 11 scalpel blade.■■ Suture material.■■ Sterile dressing.■■ Buster collar.

How to prepare the patient and the site■■ Oxygenate the patient in a non-

stressful manner, e.g. flow-by oxygenation.

■■ Intravenous access should be established to administer fluids and provide access for anaesthetic agents or drugs if the patient deteriorates (e.g. cardiopulmonary arrest).

■■ Prepare equipment for intubation and ventilation in case decompensation occurs.

■■ Administer systemic analgesia.■■ Clip the site widely and prepare

aseptically.■■ Maintain the patient in sternal

recumbency during preparation and then move to lateral recumbency just before the drain is inserted if desired. For small bore tubes, some clinicians maintain the patient in sternal recumbency throughout placement, but this requires considerable familiarity with the technique and patient anatomy.

■■ The drain can be placed under local anaesthesia, local anaesthesia and sedation or general anaesthesia■– In compliant patients only local

anaesthesia may be required for small-bore Seldinger drain placement

■– For wide-bore trocar drain placement general anaesthesia is preferred

■– Inform owner of the anaesthetic risks.

■■ Inject local anaesthetic at the site of insertion, through all tissue layers (an intercostal nerve block could also be performed at the site of entry and 2–3 intercostal spaces cranially and caudally).

Figure 5: Cat positioned and prepared for placement of a small-bore drainFigure 6: A small incision is made with a scalpel blade to facilitate placement of the drain

■■ Place fenestrated drape over the site of insertion.

What to avoidWhen placing the drain try to avoid the intercostal vessels and nerves, which run on the caudal aspect of the ribs, and the internal thoracic arteries, which run along the ventral aspect of the thorax. Avoid inflation of the lungs at the time of trocar/needle entry into the chest to avoid iatrogenic damage to the lungs.

How to place a small-bore drain using the Seldinger technique■■ A subcutaneous tunnel is not essential

with small-bore drains; however, it may be preferable in case of inadvertent tube removal.

■■ Ensure the patient is positioned comfortably (Figure 5).

■■ Palpate the 8th intercostal space having pulled the skin in a cranial direction (hence creating the subcutaneous tunnel) and insert the 14G catheter on the cranial border of the rib in a slightly ventral direction. (Although an 18G catheter is provided, the author finds placement of the

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Figure 7: The guidewire is fed through the catheter in a cranioventral direction

Figure 8: The drain is fed over the guidewire and into the chest

Figure 9: The drain is aspirated to confirm appropriate positioning

drain more difficult with this and prefers to use a 14G intravenous catheter unless in a very small patient.) If preferred a small incision can be made with a scalpel blade at the site of entry to facilitate passage of the drain (Figure 6).

■■ The position on the body wall for site entry is determined by the reason for drain placement (air, fluid or both) – see above.

■■ Once the catheter enters, advance it completely into the pleural space over the needle and then remove the needle. Keep a thumb over the end of the catheter to avoid significant air entry into the chest.

■■ Thread the guidewire through the catheter (Figure 7) and advance the guidewire in a cranioventral direction approximately 10–20 cm or until resistance is felt (do not let go of the guidewire).

■■ Remove the catheter over the guidewire (leaving the guidewire in situ).

■■ Take the multi-fenestrated small-bore drain and advance it over the guidewire into the pleural space (Figure 8) to the level of the suture wings in a cranioventral direction flat to the chest wall. If full placement of the drain into the chest is not desired due to patient size, then the spare suture wings can be fixed in position near the exit from the chest wall.

■■ It is important to ensure that all of the drainage holes lie within the thoracic cavity (also applicable to wide-bore drains).

■■ Remove the guidewire and attach a three-way tap, centesis valve or closed one-way valve connector and aspirate gently to check for adequate positioning (Figure 9).

■■ Secure the drain to the skin using suture material and the suture wings (Figure 10).

■■ Place a sterile dressing over the site of drain insertion and apply a light

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Figure 12: A small incision to the diameter of the drain is made to allow passage through the skin at the 10th intercostal space. A drape is not used in these pictures for ease of illustration

Figure 10: The drain is sutured in position with the suture wings. In this case a centesis valve is attached to the drain. An additional set of suture wings, or a finger trap suture, could have been placed closer to the exit from the body wall to prevent drain migration

Figure 11: Right lateral thoracic radiograph showing good positioning of a small-bore drain post placement

dressing or body suit to keep the drain close to the thoracic wall. Occasionally, an extra suture on the extension tubing of the drain helps to avoid tension on the drain.

■■ If you are unhappy about drain function, consider radiography to confirm positioning (Figure 11).

■■ Place a buster collar to stop patient interference.

How to place a wide-bore trocar drain■■ Using a No. 11 scalpel blade make a

small incision (Figure 12) in the skin over the 10th intercostal space at the appropriate level dependent upon whether you are draining air (dorsal third), air and fluid (mid-way) or only fluid (costochrondal junction).

■■ Insert the tube through the small incision (Figure 13) and tunnel through the subcutaneous tissues in a slightly

ventral direction until the tip lies at the 8th intercostal space (the subcutaneous tunnel reduces air leakage around the drain).

■■ Hold the tube and trocar perpendicular to the chest wall (avoiding the caudal aspect of ribs) and firmly advance it

into the chest wall (hold the tube with the other hand close to the chest wall to prevent it from being advanced too far) (Figure 14; NB in the series of pictures the skin has been pulled forward to create a subcutaneous tunnel as described below).

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■■ Once the tube is in the chest gently advance it a short distance over the end of the trocar to protect the sharp tip, and then advance the tube and trocar in a cranioventral direction parallel to the chest wall a small distance before advancing the drain off the trocar to approximately the level of the 2nd rib (Figure 15).

■■ Remove the trocar while firmly

Figure 13: The drain will run in a subcutaneous tunnel from the 10th to the 8th intercostal spaces before entering the chest. The 2 rib spaces have been marked to enable their identification within the sterile field

Figure 14: The drain is held perpendicular to the chest wall and advanced firmly into the pleural space. The skin is pulled forward in this picture, so that its release creates a subcutaneous tunnel

Figure 15: Advance the drain off the trocar until the tip lies at the level of the 2nd rib

Figure 16: Once the trocar is removed occlude the tube until the chosen connector is attached

holding the tube.■■ Temporarily occlude the tube with

non-traumatic forceps or by manual occlusion (Figure 16) and attach the chosen connector.

■■ Remove the forceps and gently aspirate the fluid/air (Figure 17).

■■ Secure the tube to the chest wall using a finger-trap suture (Figure 18).

■■ Place a sterile dressing over the site of

tube insertion and apply a light dressing or body suit to keep the tube close to the thoracic wall.

■■ If the tube is not functioning easily consider thoracic radiography to confirm correct positioning (Figure 19).

■■ Place a buster collar to prevent patient interference.

■■ In addition to repeating intercostal nerve blocks, intrapleural

Figure 17: Gentle aspiration allows collection of the air/fluid

Figure 18: The drain is secured using a finger-trap suture

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18 | companion

ACKNOWLEDGEMENTS

The author would like to thank the University of Bristol photographic unit, Sophie Adamantos and Simon Tappin for the use of Figures 5–9 and 12–18, respecti vely.

performed in an aseptic manner.■■ Ideally patients with chest drains

should be constantly/frequently monitored to ensure safety of the drain and connections, to prevent patient interference and to monitor for changes in respiratory rate and pattern.

■■ It is common practice to drain the pleural space every 4 hours; however, more frequent drainage may be needed at the time of initial placement and less frequent drainage as the patient approaches drain removal.

■■ The dressing and bandage should be changed at least once daily, more frequently if there is discharge.

■■ If the drain insertion site appears inflamed/infected, a swab should be submitted for bacterial culture and sensitivity testing.

■■ If the drain appears non-functional, it may have become blocked by tenacious secretions. Gentle flushing

in an aseptic manner may clear the blockage.

■■ If the drain becomes non-functional (e.g. kinking) it should be removed.

■■ Drainage should be gentle (maximum of 2 ml suction applied) as the drain can collapse due to excessive suction pressure.

■■ Palpate around the chest wall. Any subcutaneous air suggests a possible air leak within the drainage system or displacement of the drain from the chest cavity such that drainage holes now sit subcutaneously. This situation needs a logical assessment to find the source of the problem.

■■ The drain is usually removed when fluid/air production has reduced to approximately 2–4 ml/kg/day.

■■ After removal of the drain, apply a sterile dressing over the insertion site and closely monitor patients in case of air leakage into the pleural space. Some clinicians place a purse string suture around the insertion site to achieve skin apposition on tube removal.

Placement of chest drains is an essential therapeutic technique for the small animal practitioner, as it allows rapid alleviation of the signs of pleural space disease. The advent of small-bore drains for veterinary use allows drainage of the pleural space in almost all patients, reducing the need for placement of the more daunting wide-bore trocar drains. ■

Figure 19: Right lateral radiograph showing good positioning of a wide-bore drain following placement


administration of local anaesthetic could be considered (also applicable for small-bore drains).

Alternative approaches■■ The skin is pulled forward and the tube

inserted directly over the 7–8th intercostal space (i.e. no subcutaneous tunnelling). Once the skin is released after tube placement, a subcutaneous tunnel is created.

■■ The drain can be placed without the use of a trocar. Forceps are used to create a subcutaneous tunnel and then are advanced into the chest via the appropriate intercostal space. The forceps are then used to grasp the tip of the tube and feed it through the subcutaneous tunnel and into the chest.

Care and maintenance of the chest drain■■ Any drain intervention (dressing

changes or drainage) should be

This article with references is available online at www.bsava.com/companion

12-18 HOW TO.indd 18 21/05/2012 12:27

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20 | companion


The first edition of the BSAVA Manual of Small Animal Endocrinology was published in 1990. At that time several

endocrine disorders were well recognised in small animals, including canine hypothyroidism, feline hyperthyroidism, canine hyperadrenocorticism and both canine and feline diabetes mellitus. Hormone analyses were becoming more routine, but were largely based on adaptation of human assays with consequent difficulties in reliable interpretation. The treatments usually involved extrapolation of dosages and regimens as prescribed for human use.

To date, almost all known endocrine disorders recognised in humans have been diagnosed in dogs and cats and whilst some remain unusual or rare, an increasing number such as feline hyperaldosteronism are becoming more common as appropriate diagnostic tests are more frequently implemented. So today, endocrine diseases are not only significant in their own right as distinct clinical entities, but are becoming increasingly more important as differentials that must be ruled in or out depending on the presenting complaint of the animal.

A range of hormone assays are now available, some of which are species-specific and many that are available in dedicated specialized veterinary laboratories. In addition, a range of therapies have been developed that are

The problems identified included: polyuria and polydipsia, occasional vomiting, partial anorexia and depression. Given the non-specific nature of the latter signs, and the likelihood of being secondary to the primary disease process, the prioritised problem was considered to be the polyuria and polydipsia. A wide variety of disorders can potentially result in polyuria and polydipsia, including:

■■ Hypothalamic/behavioural disorders resulting in polydipsia with consequent polyuria

■■ Disorders that cause polyuria with compensatory polydipsia.

In veterinary medicine the latter is more common, potentially caused by a wide range of disorders that interfere with arginine vasopressin (AVP; also known as antidiuretic hormone (ADH)) production, release or action, renal disease, disorders that interfere with the medullary concentration gradient and diseases that result in osmotic diuresis.

InvestigationInitial investigations attempted to rule in or out the more common causes of polyuria and polydipsia through evaluation of a complete blood count (CBC; Table 1), serum biochemistry tests (Table 2) and importantly urinalysis (Table 3).

The CBC was unremarkable whilst urinalysis confirmed isosthenuria consistent with the history of polyuria and polydipsia. The serum biochemistry profile revealed a number of abnormalities, most notably azotaemia and severe hypercalcaemia. The increase in albumin concentration was too mild to account for the severe hypercalcaemia. The findings were considered consistent with the clinical problems identified.

Carmel Mooney, Head of Small Animal Clinical Studies at University College Dublin and co-editor of the new BSAVA Manual of Canine and Feline Endocrinology takes companion readers through the approach to a case of hypercalcaemia

specifically authorised for dogs and cats with increasing support and further research by their respective manufacturers.

Case detailsA 7-year-old intact male chocolate Labrador Retriever (pictured) was presented to the UCD Veterinary Hospital with a 3-month history of progressively worsening polyuria and polydipsia. The dog had also vomited occasionally during this time, intermittently exhibited reduced food intake and had lost some weight. On physical examination the dog was quiet but alert, and this apart no other abnormalities were detected.

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Renal disease is associated with azotaemia/isosthenuria and occasionally hypercalcaemia, but ionized calcium concentrations are rarely elevated. As a consequence an ionized calcium concentration was measured which proved to be markedly elevated at 1.98 mmol/l (reference interval: 1.12–1.42 mmol/l). The azotaemia was therefore considered more likely a consequence than a cause of hypercalcaemia and an alternative reason for the development of hypercalcaemia was sought.

Causes of hypercalcaemiaThere are many potential causes of hypercalcaemia, but the most common include:

■■ Malignancy (lymphoma, multiple myeloma, anal gland adenocarcinoma)

■■ Hypoadrenocorticism (occasionally atypical without electrolyte abnormalities)

■■ Hyperparathyroidism■■ Hypervitaminosis D.

Table 1: Haematology results (normal morphology of cells; platelets clumped but normal in number)

Parameter Reference interval Patient value

Packed cell volume (PCV) 0.37–0.55 l/l 0.53

Haemoglobin (Hb) 120–180 g/l 193

Red blood cells (RBCs) 5.5–8.5 x 1012/l 7.66

Platelets 200–500 x 109/l –

White blood cells (WBCs) 7–17 x 109/l 5.5

Neutrophils (M) 3–11.5 x 109/l 4.31

Neutrophils (B) – –

Lymphocytes 1–4.8 x 109/l 1.16

Monocytes 0.2–1.3 x 109/l 0.22

Eosinophils 0–1.3 x 109/l 0

Basophils 0 0

Table 2: Serum biochemistry results

Parameter Reference interval Patient value

Protein 60–78 g/l 71.6

Albumin 27–35 g/l 36.0

Globulin 28–45 g/l 35.6

Phosphate 0.9–1.9 mmol/l 1.88

Sodium 137–149 mmol/l 159.1

Chloride 99–110 mmol/l 115.9

Alanine aminotransferase (ALT) 5–20 IU/l 35

Alkaline phosphatase (ALP) 5–50 IU/l 45

Potassium 3.7–5.8 mmol/l 4.25

Creatine kinase (CK) 0–50 IU/l 57

Amylase 0–730 IU/l 685

Lipase 0–130 IU/l 62

Urea 3.5–8.6 mmol/l 35.1

Creatinine 20–130 µmol/l 548

Glucose 3.3–6.5 mmol/l 5.0

Cholesterol 3.2–6.5 mmol/l 5.29

Bilirubin 0–10 µmol/l 6.7

Calcium 2.3–3.0 mmol/l 4.20

Table 3: Urinalysis results (non-active sediment; culture negative; sperm present)

Parameter Patient value

Specific gravity (SG) 1.011

Nitrate –

pH 5.0

Protein Trace

Glucose –

Ketones –

Blood –

Bilirubin –

Epithelial cells Few

Casts –

Crystals –

Bacteria –

White blood cells (WBCs) –


22 | companion


The latter was considered less likely as serum phosphate concentrations were not simultaneously elevated. Hypoadrenocorticism was easily ruled out by performing an adrenocorticotropic hormone (ACTH) stimulation test (pre-cortisol and post-cortisol concentrations were 327 nmol/l and 914 nmol/l, respectively). Malignancy is always considered the most likely cause of hypercalcaemia and despite no detectable abnormalities on physical examination (including rectal examination), survey radiographs of the thorax, spine and long bones were performed together with abdominal ultrasonography. No abnormalities were detected. Cervical ultrasonography was also performed and no parathyroid nodule was apparent, but it was not possible to definitively rule out hyperparathyroidism as this test is not 100% sensitive.

Given the difficulties in diagnosing the cause of the hypercalcaemia, blood samples (taken prior to the initiation of treatment) were submitted for both parathyroid hormone (PTH) and parathyroid hormone related protein (PTHrp) measurement. A veterinary laboratory was selected in order to ensure appropriate validation of the assays used for the dog. Results indicated a normal, and appropriately suppressed, PTH concentration of 30 pg/ml (reference interval: 18–130 pg/ml)

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Member price: £49.00Non-member price: £80.00

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Figure 1: Serum ionized calcium concentration (reference interval: 1.12–1.42 pmol/l) in a dog with hypercalcaemia treated initially over 2 days with intravenous fluids and furosemide and then pamidronate intravenous infusion. The arrow marks the start of the pamidronate infusion

0Day

8Day

7Day

6Day

5Day

4Day

3Day

2Day

1Pre

0.5

1

1.5

Ser

um

ion

ized

cal

ciu

m

mm

ol/l

2

2.5

Ionized calcium

and an elevated PTHrp concentration at 2.8 pmol/l (reference interval: <1.0 pmol/l). These results indicated that malignancy was the most likely cause of the hypercalcaemia and that further tests should be directed at seeking its origin. Subsequent evaluation of gut biopsy samples indicated gastrointestinal lymphoma.

TreatmentGiven the severity of the hypercalcaemia and its association with azotaemia, treatment was required from the outset in this patient. As a definitive diagnosis was not possible initially, the underlying cause could not be removed. Consequently, treatment was instituted to enhance urinary calcium excretion and to prevent further bone resorption.

Parenteral fluids and furosemide were considered the initial treatments of choice. Standard therapy suggests normal saline be administered at twice the maintenance rate (5 ml/kg/h) or higher depending on the hydration status of the individual animal together with repeated intravenous injections of furosemide at a dose of 2–4 mg/kg q8–12h, initiated once the patient is fully hydrated. After 2 days, over which the electrolyte concentrations were checked and fluid rate and potassium supplementation varied, the ionized calcium concentration had only decreased to 1.73 pmol/l.

There were clear difficulties in decreasing the calcium concentration with standard therapy and, given the delays predicted with the return of the PTH and PTHrp measurement from the external laboratory, it was decided at that stage to implement a treatment with a more prolonged effect. As a consequence, the bisphosphonate pamidronate was administered intravenously at a dose of 1.3 mg/kg in 150 ml saline infused over 2–3 hours. The ionized calcium concentration normalized with 2 days and remained with the reference interval for 5 days (Figure 1) until the gastrointestinal biopsy samples were taken and a definitive diagnosis confirmed. Prednisolone was not used to reduced serum calcium as it would hamper further diagnostic testing and potentially reduce the efficacy of subsequent chemotherapy.

ConclusionThe use of PTH and PTHrp concentrations in this hypercalcaemic case is just one example of how the measurement of hormones has become a vital part in the diagnostic approach to different presenting problems in small animals. Its management with an intravenous bisphosphonate provides a new method for treating not just hyperparathyroidism and its consequences, but can be extrapolated to other clinical situations to the benefit of the patient. ■


companion | 23

June is National Microchip Month. Having helped establish the Microchip Advisory Group more than 15 years ago, BSAVA has a tradition of supporting such identification technology. Now MAG has a new structure within the industry, with the Association continuing to offer its support and expertise

Microchipping:the hot potato

Compulsory microchipping for dogs is back in the news after the Government announced plans to introduce legislation that is in part intended to help trace and

prosecute owners of ‘dangerous dogs’. Yet, whilst we’d all acknowledge that microchips alone aren’t a panacea for irresponsible dog ownership – or even automatically help return stray dogs to their owners, they can have a vital role to play. This is why BSAVA is keen to offer continued support for the industry as it attempts to provide the best services to the profession and pet owners.

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Microchipping: the hot potato

Then and nowEarlier this year participants decided that the Microchip Advisory Group (MAG) should be made up of suppliers, with the databases and users as associate members. When BSAVA helped found the group over fifteen years ago the entire concept was in its infancy – now both the technology and practice have gained wide recognition and the agenda has shifted.

Originally, the Microchip Advisory Group was made up of representatives from microchip companies, animal welfare groups and veterinary organisations – chaired and funded by BSAVA. Concerned only with the identification of non-food-producing animals, it developed a code of practice to establish minimum standards, and collated adverse reactions.

The overall aim was to provide a safe, permanent identification system for companion animals and equines and an effective reunification system for lost animals. Adherence to the code of practice became a requirement of membership of the Microchip Advisory Group.

Times changeBSAVA’s pivotal role in developing standards for industrial suppliers on the sale and implantation of the chips brought together the profession and industry. It also led to the adoption of best practice, and improved knowledge – which fitted perfectly with BSAVA’s remit to promote excellence in small animal practice through education and science.

So with the unified standard for encoding microchip data very well established, one of the remaining issues concerned the accessibility and quality of the databases. Andrew Ash, then President of BSAVA, put forward an idea for the MAGic (MAG identification centre) Project, which proposed a technological solution to the problems of finding out where the owner information for a particular pet is being kept.

Solution to a problemFor almost two decades police, local authorities, veterinary practices and animal welfare charities have been able to scan discovered lost dogs and inform their owners where to come and collect them. Of course that is the theory, but it isn’t always quite that simple. In practice almost half of stray dogs’ owners

are never traced, although the proportion that are contacted as a result of a microchip has increased steadily over the past decade and is now over a third.

When these chips were first introduced 20 years ago there was no unified standard (ISO) for the data contained nor for the scanners used to read them. MAG helped work towards standardisation, yet even now there are four different UK databases on which the owner’s details are kept. Even though there is an over-arching European database that tracks chip numbers, there is no single-track way for the person who picks up the stray dog to find out who owns the animal or its country of origin.

The contact details for the estimated 12,000 pets each week which are registered by their owner or acquire new owners having already been given a chip by a re-homing agency can be found on one of four main databases. Three of these are maintained by chip distributors (Avid, Pet Protect, and AnimalCare), while the Petlog system was set up and run by the Kennel Club.

Unrealised ambitionThe proposal put forward by Andrew Ash, and heavily supported by Dogs Trust, who even offered to part-fund the project with BSAVA, was for a universal portal to all databases solely for reunification, accessible via the internet or mobile telephone. Any organisation likely to be involved in taking charge of a stray would have their own log-in and would enter the number on the chip of the lost animal. The portal would then question all the available databases without requiring the sharing of data, resulting in ‘not one of ours’ or the owner’s details – so the vet, local authority officer or animal welfare charity worker could re-unite the pet with its owner.

At the time the new scheme was originally conceived, in December 2010, Andrew Ash said: “BSAVA believes that this solution is technologically feasible and has carried out some preliminary costings. These suggest that this project could be set up at an estimated cost of £30,000 to deliver a working portal. Additional costs would be incurred by the hosting databases in writing software to link with the portal. Ongoing costs would be limited to maintenance and the cost of emails. These costs could be met by

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companion | 25

either sponsorship of the site or a pro rata charge to the database companies.”

Whilst initially many in the group could see the benefits of such a scheme, ultimately concerns over data security and potential development costs for the distributors proved too much of an obstacle, and plans for setting up MAG Ltd and the MAGic portal were withdrawn.

Industry concernsSarah Fry is Sales Director for Pet Works, one of 11 chip providers that include their data on the Kennel Club system. She will be leading the new version of MAG and explains that one of the major concerns with BSAVA’s proposal was that of data ownership. Even though there was no need for a shared database with the MAGic system, distributors were uncomfortable about allowing others access to information which they regard as commercially sensitive, although the MAGic proposal included safeguards that BSAVA considered adequate.

Finance is considered an even more important issue for the chip suppliers. There were concerns that adding another search engine facility would increase the costs of a product with increasingly low profit margins as volumes have soared.

“There are a lot of companies in the market and prices have gone down considerably over the past 15 to 20 years”, Ms Fry explains. She points out that the wholesale price of a chip for the welfare charities is now heavily discounted and charges to veterinary practices have come down by 75% in the last two decades.

Finally, there were doubts in the industry as to whether an entirely electronic system will meet all the requirements of the reunification process. “There has to be someone there at the end of a phone. People who have lost a pet that they regard as a member of their own family will want to be able to call someone. There are those, of course, who may still not have a computer but for most, they will just want to feel they are doing everything possible to find their animal.”

Managing changeNorthern Ireland already has rules requiring dogs to be identified with a microchip. Wales is in the process of introducing compulsory microchipping and now

Defra is consulting on plans for England; only Scotland is not currently planning a similar system. So MAG’s industry partners will need to consider how it manages such change.

If a nationwide compulsory microchipping system is introduced, the resources of government and the companion animal industry would need to focus on a public education campaign, but the microchip companies question how effective this is likely to be. “We would need a system like car registration where the owner is held responsible for the vehicle until they send details of any change of ownership to the authorities in Swansea. There should be a similar obligation on the pet owner but there is always likely to be a section of society that ignores its responsibilities. It is clear that there is a large proportion of cars being driven around that are not taxed or insured,” Ms Fry notes.

The success of any microchip-based reunification system depends on the accuracy of the information that it contains. Each of the existing databases has a different way of meeting the costs of updating the pet owners’ contact details; for some there is a fee for each change of address, while other database owners charge a single fee for unlimited changes. So, for example, the owners can inform the database managers that they are going away and their pet is being looked after by somebody else, Ms Fry explains.

There is also an obligation on the database managers to check that the details given by any new owner of any dog are correct. If the system is unable to track the owner quickly and effectively, public confidence in the system will be quickly eroded, she concludes.

Covering the costsWith either an opt-in or compulsory scheme, clearly responsible dog owners understand the need to keep their details up to date and will probably accept there is a cost for those changes. But Ms Fry asserts that a system will have to be developed to try to ensure that these responsible owners are not subsidising efforts to keep in contact with the ignorant or less responsible dog owner.

“There are costs involved in running and maintaining a database; it doesn’t run on beans,” Ms Fry warns. “So it is essential for any owner that has

23-27 MAG.indd 25 21/05/2012 14:00

26 | companion

their dog chipped or acquires one already implanted, knows that it is not a one-off payment. It is important for vets and animal charities to make it very clear that there will be a continuing cost – as a pet owner, you will expect to continue paying for the costs of food, and veterinary expenses like vaccinations, why should the chipping service be any different?”

Chris Laurence, long-standing Chair of MAG, comments “It is hugely disappointing that the industry has missed an opportunity to bring microchipping systems into the 21st century in failing to advance the MAGic project. The potential income from a few pence on the cost of a chip is significant and could have been used to produce significant improvements that would have enhanced public knowledge and confidence.”

Making it workConcerns among microchip suppliers about data security and the economics of maintaining appropriate systems will need to be addressed if the government proposals for a compulsory microchipping system come in and are to achieve all their goals.

The ability to identify a dog properly for the purposes of certification is a major benefit for practitioners. But vets will need to be able to trace dogs easily as well and the MAGic proposal would have enabled the process of doing that rather than having to make a series of phone calls.

Microchipping: the hot potato

The BSAVA has worked hard over the years to bring the various interest groups together and will now support the pet microchip industry as it attempts to create a workable system. After a meeting just before this year’s Congress, the Association relinquished chair of the Microchip Advisory Group but insists it will continue to support the group in an advisory role when invited. The MAG working groups of microchip suppliers, databases and users will continue to meet several times annually to discuss the future of MAG and to continue its work.

For Andrew Ash, who along with several BSAVA Officers has invested considerable time and effort into trying to achieve a consensus among all parties involved in the microchipping issue, there is some disappointment that the universal database portal didn’t take off. However, he is optimistic that a way forward will be apparent when full details of the government’s plans eventually emerge.

“I am convinced that a cost-effective and fair system for reuniting lost dogs, and of course other pet species, will be possible at some point in the future. And the model that BSAVA proposed has shown the direction we need to go in. The Association will continue to support all interested parties in developing a system that will provide enormous benefits for our clients and improve the welfare of companion animals.” n

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companion | 27

Compulsory microchipping:the Defra consultation

BSAVA Scientific Policy Officer Sally Everitt outlines the Defra consultation currently underway and highlights the Association’s continued role in the reporting of adverse reactions

At the time of writing, Defra is holding a short consultation on a package of measures to tackle irresponsible dog ownership,

including the introduction of compulsory microchipping.

The consultation contains 5 options:

1. Do nothing and rely on owners and/or existing campaigns by dog charities and voluntary agreements to encourage voluntary microchipping

2. All dogs to be microchipped and their details registered on a database on transfer of ownership

3. All dogs to be microchipped (and registered) on transfer of ownership during the next 5 years, after which tim microchipping will become compulsory for all dogs (a compromise between options 2 and 4)

4. All dogs to be microchipped (and registered) within 12 months of the legislation coming into force

5. Require puppies only to be microchipped and registered on transfer of ownership

While the BSAVA consultation on this is likely to have closed by the time you read this article you still have the opportunity to respond to Defra directly by completing a short survey on their website www.defra.gov.uk/consult, which closes on 15 June.

Reporting adverse reactionsThe introduction of compulsory microchipping raises concerns about the safety of microchipping. While microchipping is considered to be a safe and effective method of permanent identification of companion animals, with many millions of microchips having been implanted worldwide, there are still those who question their safety.

BSAVA will continue to collect and collate details of adverse reactions concerning microchips. To date there have been 431 reports of adverse reactions between 1996 and 2011. If it is assumed that approximately 10 million microchips have been implanted into UK animals over the same period (assuming Petlog have 5 million animals on their database and this represents a 50% share of the population) this would give an adverse reaction rate of 0.4 in 10,000, which is the same order of magnitude as that reported for vaccines. However, it should be noted that the vast majority of these reports relate to migration, loss and failure of the chip and do not have any effect on the health and welfare of the animal.

In order for these figures to have credibility it is important that veterinary surgeons report all adverse reactions including migration, failure or any deleterious effects on the animal, including those caused by misplacement of the microchip, on the form provided on the BSAVA website – www.bsava.com ■

The role of the vet in the compulsory scanning of patients on first presentation to a practice and checking

the databases has been raised, with celebrity backing in the shape of Sir Bruce Forsythe. Calls for such a policy may increase if compulsory microchipping for dogs is introduced. BSAVA is keen to hear your views and is launching a consultation with members to find out:

■ Your views on scanning every new pet coming to your practice

■ Your experiences in tracing registered owners and getting details changed

■ Whether you have been involved in cases of contested ownership.

Go online to www.bsava.com/consultations to the “Compulsory Scanning consultation” to let us know your thoughts and find out a little more about the current debate. The consultation will be open until 31 July. We look forward to reporting your views and further developments regarding microchipping in a future issue of companion. ■

Your views on compulsory scanning

28 | companion

Twenty-four members of the Danish Small Animal Veterinary Association (DSAVA) have just achieved a globally recognised ISO 9001:2008 Quality

Standard. To earn this standard, organisations must conform to the requirements it sets out for a quality management system designed to:

■ Ensure they provide products that meet customer needs and conform with statutory and regulatory requirements

■ Enhance customer satisfaction by providing processes for continual improvement and conformity to customer needs and statutory and regulatory requirements.

In addition to meeting the requirements of this standard, DSAVA members are meeting a range of

Danish practices set sights on quality standardTeamwork by DSAVA members has achieved ISO recognition

professional standards relating to their working environment and clinical procedures.

The DSAVA opted to earn the externally accredited standard in the face of a stream of new legislation in Denmark. They felt that by taking a proactive approach and showing their commitment to quality management, they could maintain the high level of

regard in which the veterinary profession is held in the country.

Karina Ryborg, Chair of the DSAVA, explains: “Working towards

the standard has been challenging but has yielded

good results. The quality systems we’ve been developing support our business goals and many of the practical tools we’ve created have proved very beneficial. Because we’ve opted for a ‘sampling model’

where all the participating practices are members of the

same ISO certification system, if one of us fails, we all fail. It has

given us a strong incentive to work together and to share experience. It’s

been a team effort!”Karina has prepared a full paper which looks at the

DSAVA’s experience and offers advice for other WSAVA members considering this approach. ■

wenty-four members of the Danish Small Animal Veterinary Association (DSAVA) have just achieved a globally recognised ISO 9001:2008 Quality

Standard. To earn this standard, organisations must conform to the requirements it sets out for a quality management

Ensure they provide products that meet customer needs and

Enhance customer satisfaction by providing processes for continual improvement and conformity to customer needs and statutory and regulatory requirements.

In addition to meeting the requirements of this

has achieved ISO recognition

approach and showing their commitment to quality management, they could maintain the high level of

regard in which the veterinary profession is held in the country.

Karina Ryborg, Chair of the DSAVA, explains: “Working towards

the standard has been challenging but has yielded

good results. The quality systems we’ve been developing support our business goals and many of the practical tools we’ve created have proved very beneficial. Because we’ve opted for a ‘sampling model’




been a team effort!”Karina has prepared a full paper which looks at the

DSAVA’s experience and offers advice for other WSAVA members considering this approach.

just achieved a globally recognised ISO 9001:2008 Quality

Standard. To earn this standard, organisations must conform to

improvement and conformity to customer needs and statutory and

in the country.Karina Ryborg, Chair of the

DSAVA, explains: “Working towards the standard has been

challenging but has yielded good results. The quality systems we’ve been developing support our

beneficial. Because we’ve opted for a ‘sampling model’




been a team effort!”

Karina Ryborg

28-29 WSAVA NEWS.indd 28 21/05/2012 14:03

companion | 29

A website offering instant access to the latest scientific information on zoonoses transmitted by companion animals has been launched. Developed by the Companion Animals Multisectoral Interprofessional Interdiscipinary Strategic Think Tank on Zoonoses

(CALLISTO), the website can be found at www.callistoproject.eu and forms part of a project financed by the 7th Framework Programme of the European Commission. Members of CALLISTO are drawn from research institutes, universities and veterinary associations across Europe.

Nine partners, led by the Federation of Veterinarians of Europe (FVE), collaborated on the development of the website, which also includes details of forthcoming CALLISTO conferences and expert group meetings. Over the next three years, CALLISTO members will work to identify gaps in knowledge relating to the most important zoonoses linked to companion animals and recommend actions to prevent and reduce the risk to humans and livestock. The WSAVA One Health Committee is a full partner in the project and its chairman, Professor Michael Day, is a member of the CALLISTO Board and head of work package 3 of the programme, which synthesises data arising from the three annual conferences.

Professor Day says: “CALLISTO’s activities are aimed at promoting increased awareness of the importance of healthy and balanced human/animal relationships. We will be updating the site constantly and hope it will be the catalyst for a continuous exchange of information with key stakeholders and the general public so that we can work together to reduce the risk to humans of developing infectious diseases from companion animals.” ■

CALLISTO project gains momentum

The WSAVA’s 2013 Awards will be presented during the next WSAVA World Congress in Auckland, New Zealand, 6–9 March 2013. Nominations are invited for

the following awards:

■ The WSAVA Hill’s Pet Mobility Award: recognising the outstanding work of a clinical researcher in the field of canine and feline orthopaedic medicine and surgery.

■ The WSAVA Hill’s Excellence in Veterinary Healthcare Award: recognising outstanding work in promoting companion animal health care and the human-animal-veterinary bond through leading edge clinical nutrition and through advanced medical and surgical techniques.

■ The WSAVA International Award for Scientific Achievement: recognising the outstanding contribution of a veterinarian who has furthered the advancement of knowledge of the cause, detection and management of disorders in companion animals.

Nominations must be received by the WSAVA Secretariat by 16 July 2012 and can be submitted by email ([email protected]) or post. Full contact details are at www.wsava.org/contact.htm. Nominations should be accompanied by a covering letter, nominee CV and list of nominee publications. ■

Nominations invited for 2013 WSAVA AwardsJuly is the deadline for getting in your nominations for these prestigious prizes

28-29 WSAVA NEWS.indd 29 21/05/2012 14:04

30 | companion

the companion interview

Graeme EckfordBVSc

Graeme Eckford is a veterinary surgeon at the People’s Dispensary for Sick Animals in Edinburgh. He started to study at De Montfort University in Lincoln studying Animal Handling as a pre-veterinary course before moving to the University of Liverpool in 2000. On qualifying in 2005, he undertook an internship in small animal medicine and surgery at the University of Edinburgh. As the new Chairman of the BSAVA Scottish Regional Committee, Graeme has been very focused on the up-and-coming Edinburgh Congress.

QWhy choose a veterinary career and has it lived up to what you hoped it would be?

ABeing a vet was an obsession for me from early childhood. We always had a menagerie of small furries at

home when we were kids and interest in all things veterinary developed following the usual trips to the vets at a young age. Although on qualifying the harsh reality was that the ‘James Herriot’ life no longer existed, I’ve found a place in practice that has enough demands and challenges to keep me entertained. Being a vet is nothing like I imagined it would be, I think people looking in from the outside have an over-simplistic view of the profession.

What is your particular area of interest and what is it about that subject/species which fascinates you most?I’m a general practitioner through and through. I love the variety of challenges that come through the door every day. No two cases are the same and you never get the chance to get bored. Some cases are more interesting than others and cardiology in particular never fails to excite me.

How did you decide to take the veterinary career path you chose?At the end of my internship, I was looking for general practice experience. The PDSA was a good bet and after a few weeks settling in it soon became clear that I was

able to gain a huge amount of experience with a close-knit, supportive team around me. Since then I’ve not looked back. I love the work I do and I’m very proud of what I’ve achieved in my career so far.

Tell us about being involved as a regional volunteer.This will be my first Scottish Congress. I’ve been on the Scottish Regional Committee since last year and Chair since April. I’ve been to Birmingham Congress on a regular basis and I’m looking forward to the challenge of making Scottish Congress as successful. The regional committee are a great bunch of people to work with.

30-31 Interview June.indd 30 21/05/2012 14:06

companion | 31

What do you hope delegates at Scottish Congress will take away with them?I’d like to think that we can offer delegates the highest quality training and development which is current, evidence based and, above all, applicable to life in practice. I hope that delegates will leave with a renewed passion for their subject and that they will carry this enthusiasm with them when tackling cases in the future.

What does BSAVA offer the profession in your opinion?BSAVA offers the profession a reliable and trusted source of support and development which I believe is unsurpassed in the profession. Scottish Congress offers much more than just CPD, there is a lively social aspect to the weekend and it is an excellent way to catch up with friends, exchange stories and let your hair down. I’d describe it as a little like Birmingham Congress with a big pinch of the famous Scottish hospitality. Edinburgh is a vibrant and inviting city which is well worth a visit, especially if you have never been before.

What are the highs and lows of veterinary life for you?The highs are seeing patients go home well after treatment, seeing owners happily reunited with their pets and successfully tackling difficult cases/surgeries. The biggest low was on qualifying, the grim realisation that although I had a lot of knowledge, I didn’t always have the practical skills to back it up.

What do you owe your parents?Reward for their support and encouragement all the way through my training. I’d hate to see the bill that my parents could write for me.

Who has inspired you from the veterinary sector?I’ve worked alongside many excellent vets and nurses and I’d like to think I’ve picked up some great tips from them along the way. I’ve learned about empathy, honesty and pragmatism from many great vets over the years and I use these skills every day.

Who would you invite to your dream dinner party?I’d invite the people that have sparked my interest over the years; the photographer Charlie Waite, the engineer Robert Stevenson (builder of lighthouses), the founder of Lotus cars Colin Chapman, the racing driver Ayrton Senna and the whisky writer Michael Jackson (NOT the singer!) Oh, and of course, my wife!

Which words or phrases do you most overuse?‘I’d suggest…’ and ‘…basically…’ although I’m fortunate enough not to have listened to a recording of myself – I’m sure there are many others.

If you could edit your past, what would you change?Nothing. Everything you do you learn from. Sometimes you learn more from your mistakes or failures than you do from your successes. Your past is what makes you who you are and one of the few benefits of getting older is that you do get a little wiser.

What do you consider your greatest achievement career wise?Chairing the Scottish Regional Committee. It’s the biggest single challenge I’ve ever set myself and I’m enjoying it immensely.

What is the most important lesson life has taught you?Always expect the unexpected. Things are never as bad as they seem. The best decision is usually your first decision.

Which living person do you most admire, and why?Mark Reynier, the owner of the Bruichladdich Distillery on Islay. Against the odds, he raised several million pounds in a few short weeks to buy a failing distillery which was unheard of by many. Progressive management and creative marketing have grown the brand over the past 11 years. It’s a great Scottish success story. I have to declare an interest as it’s my favourite whisky.

What single thing would improve the quality of your life?I’m happy with my life at present and there is nothing I’d change immediately. I have many more things I’d like to achieve in life and there is space in the garage waiting for a sports car so I’ve still got lots to aim for.

Will you be enjoying the social events at Scottish Congress?I’ve been known to ceilidh in the past, much to the dismay of everyone else and their trodden-on toes. These days I’m more likely to be found chatting at the bar over a ‘wee dram’.

If you had not been a vet, what other career might you have chosen?I’ve recently taken an interest in architecture and I’ve been building some furniture for my new house so something related to this would have been interesting. Ultimately I think I’ve chosen a vocation I enjoy and I’m suited to, so I’m luckier than many.

If you were given unlimited political power, what would you do? I’d like to say end wars and inequality but if I had to narrow it down, working to protect the environment for future generations would be a good start. ■

…I think people looking in from the

outside have an over simplistic view of the profession…

30-31 Interview June.indd 31 21/05/2012 14:06

32 | companion

PetSavers has been one of the main sources of funding for studies into canine hypothyroidism for the last ten years. Richard Dixon and Carmel Mooney working at Glasgow and Dublin Universities and Ian Ramsey and Michael Herrtage working at

Cambridge University were all given grants to study the best way to diagnose thyroid disease in dogs. Their results significantly altered the way hypothyroidism was diagnosed in dogs throughout the world.

Hypothyroidism is a difficult disease to diagnose in dogs as the clinical signs are subtle. Tests for hypothyroidism are often unreliable as many other disease can affect them. The PetSavers researchers looked at a new test for hypothyroidism and found that it significantly helped and that it could also be used to investigate more unusual thyroid problems such as those associated with dwarfism. The researchers were awarded prestigious awards for their achievements and have gone on to help PetSavers in many different ways.

Josh (pictured) had hypothyroidism. Like many similar dogs he had a ‘tragic’ expression, had become very slow and developed skin changes such as hair loss over his nose. Treatment completely changed Josh’s life.

If you would like to make a donation to PetSavers in order to help continue researching into diseases and illnesses that affect the nation’s pets, please visit the PetSavers website to find out how – www.petsavers.org.uk n

In action on canine hypothyroidismThis short example demonstrates the value in donating to PetSavers and how the good work of the charity ultimately has a direct impact on veterinary practice

Josh before

Josh after

Funding application deadline looms

Qualified veterinary surgeons are invited to apply for funds to support a clinical study in companion animals, the objective of which is to advance the

understanding of the cause and/or management of a clinical disorder.

The projects should not involve experimental animals and should further the knowledge of the small animal practitioner. Joint applications between veterinarians in practice and academia are very welcome.

Funding is available for grants between £1,000 and £8,000. The closing date for applications is 31 August 2012 – with final consideration taking place in March 2013.

Guidelines (terms and conditions) and application forms can be found on the BSAVA website www.bsava.com/petsavers.

Alternatively you can contact PetSavers on 01452 726723 or email [email protected]. n

The deadline for PetSavers Clinical Research Projects is fast approaching – PetSavers welcomes applications for Clinical Research Projects by the end of August

32 PetSavers.indd 32 21/05/2012 14:08

companion | 33

Focus on...BSAVA Scottish Region

Courses coming up

JUNE – Thursday 7Emergency and critical care

■ Andy BrownAft ernoon meeti ngKingsmill Hotel, Inverness

OCTOBER – Sunday 28Diagnostic imaging: interactive abdominal and thoracic imaging

■ Day meeti ngDunkeld Hilton

NOVEMBER – Thursday 22Seizure management

■ Evening meeti ngGlasgow University Veterinary School

JANUARY – Sunday 27 ■ Day meeti ngs in Edinburgh

Vets ■ Gastrointesti nal disease ■ The approach to vomiti ng and

diarrhoea ■ Medical management and

supporti ve care of GI disease ■ Imaging of GI disease

Nurses ■ Oncology ■ Safe use of cytotoxics in practi ce ■ Overview of lymphoma

chemotherapy ■ Helping clients cope with grief

FEBRUARY – Thursday 21Urinary soft tissue surgery

■ Evening meeti ngHoliday Inn Westhill, Aberdeen

MARCH – Sunday 24Oncology

■ Day meeti ngGlasgow University Veterinary School

MAY – Thursday 30Orthopaedic conditions of young dogs

■ Aft ernoon meeti ngKingsmill Hotel, Inverness

WHAT PEOPLE SAY ABOUT SCOTTISH CONGRESS

“As an exhibiti ng company we feel it is important to have a presence at such an important CPD event. It gives us greater opportunity to meet (and socialise) with members of our vet practi ces in the North. Scotti sh BSAVA is a fantasti c event with a very friendly and welcoming atmosphere and we’re delighted to be involved.”

“Brilliant opportunity for Scotti sh CPD, with great speakers in a good locati on”

“The variety of lectures was great with topics relevant to the practi ce, and the gala dinner was braw!”

“Good talks, friendly atmosphere, the Ceilidh is defi nitely a must”

first opinion practice, or in the out-of-hours sector. Currently she is working for the PDSA. She has a keen interest in orthopaedics and soft tissue surgery.

Barbara-Ann Innes – Scottish Congress CoordinatorBarbara-Ann trained at The Royal (Dick) School of Veterinary Studies, Edinburgh where she worked as a VN for over six years. After spending two years in private practice in Durham, she returned to Scotland as a Lecturer in Animal Care at Oatridge College. Barbara-Ann has a particular interest in internal medicine and emergency medicine and exotics, and also works part time for Vets Now.

Barbara-Ann joined the BSAVA Scottish Region Committee four years ago and as Scottish Congress Coordinator is responsible for organising the event venue and, hopefully, the smooth running of the event.

The committee also includes: ■ Sharon McDonald ■ Val Pate ■ Trevor Black ■ Helen Sutton ■ Alistair Cliff ■ Joanna Hadley ■ Gerard McLauchlan ■ Yvonne McGrotty

BSAVA Scottish Region are in the process of adding the finishing touches to their Congress taking place in Edinburgh, 31 August–2

September. The committee is always keen to hear what you want in your region, so please let us know. Email [email protected] with your suggestions on topics and speakers – and to find out about getting involved and helping to design the delivery of CPD in your area.

Who’s Who on Scottish Committee

Graeme Eckford – ChairGraeme qualified in 2005 from the University of Liverpool, and followed this with an internship at the University of Edinburgh. In 2006 he took up the position of veterinary surgeon at the PDSA in Edinburgh and is currently co-ordinating EMS placements for students and is Chair of the ‘local contributions encouragement working party’ at the PDSA hospital. Graeme started on Scottish Region committee 18 months ago and gradually took up the role of Chair. You can read more about him in his interview on pages 30–31.

Dermot Mullen – SecretaryDermot was raised in rural Northern Ireland and after graduating from Glasgow in 2001 he spent two very enjoyable years in mixed practice in Staffordshire. After a year in small animal practice in Huddersfield he moved to the PSDA in London, and then transferred to the PDSA in Glasgow. Dermot is enrolled on the RCVS Certificate in Small Animal Surgery and his special interest areas are surgery and the medical and surgical management of oncology cases. Dermot is a regular member of the Glasgow University Vet School admissions panel and is also a named author on a paper looking at the effect of weight loss on arthritis management in dogs.

Claire Hughes – TreasurerClaire qualified in 1999. Since then she has worked in and around Glasgow, either in

34 | companion

CPD diary

Day Meeting

thursday 14 JunePhysiotherapy management of the arthritic patientSpeaker: Brian SharpVenue: Dogs Trust, HaresfieldDetails from: [email protected]

evening Meeting – Kent Region

thursday 14 Juneavoiding complications in orthopaedic surgery with particular emphasis on cruciate diseaseSpeaker: Andrew WillsBest Western Russell Hotel, 136 Boxley Road, Maidstone ME14 2AEDetails from [email protected]

evening Meeting – SuRRey anD SuSSex Region

thursday 14 Juneattack of the acronyms: a tour de force of autoimmune diseaseSpeaker: Nat WhitleyThe Leatherhead Golf Club (Park Room), Kingston Road, Leatherhead, Surrey KT22 0EEDetails from [email protected]

evening Meeting – South WeSt Region

Monday 18 JuneSpinal disease in dogs: myths and misconceptionsSpeaker: Noel FitzpatrickCharter Veterinary Hospital, Charter Court, Roundswell, Barnstable, North Devon EX31 3FGDetails from [email protected]

evening Meeting – MiDlanD Region

tuesday 19 JuneRecent advances in cancer management for first opinion veterinariansSpeaker: Stephen BainesYew Lodge Hotel, 33 Packington Hill, Kegworth, Derby DE74 2DFDetails from [email protected]

Day/evening Meeting – MetRoPolitan Region

Wednesday 20 June (2–9pm)Fracture fixation: new concepts and new techniquesSpeaker: Michael HamiltonRichmond Gate Hotel, Richmond Hill, Richmond upon Thames, Surrey TW10 6RPDetails from [email protected]

evening Meeting – noRth eaSt Region

Wednesday 20 JuneCanine dental extractions: exodontia – or brutalectomy?Speaker: Bob PartridgeIDEXX Laboratories Wetherby, Grange House, Sandbeck Way, Wetherby, West Yorkshire LS22 7DNDetails from [email protected]

Day Meeting

thursday 21 JunePet loss support in veterinary practiceSpeaker: Julia DandoBSAVA Headquarters, Woodrow House, Gloucester GL2 2ABDetails from [email protected]

evening WebinaR

Wednesday 4 July 20:00–21:00Rehabilitation and physiotherapy webinarSpeaker: Brian SharpOnlineDetails from [email protected]

evening WebinaR

Monday 25 June 20:00–21:00imaging beyond the radiograph webinarSpeaker: Paul MahoneyOnlineDetails from [email protected]

Day Meeting – noRth WeSt Region

Wednesday 13 JuneSimple repairsSpeaker: Turlough O’NeilHoliday Inn, Runcorn, Wood Lane, Beechwood, Runcorn WA7 3HADetails from [email protected]

Day Meeting

tuesday 12 Juneimaging beyond the radiographSpeaker: Paul MahoneyMarston Farm Hotel, Sutton ColdfieldDetails from [email protected]

aFteRnoon Meeting – SCottiSh Region

thursday 7 Juneemergency and critical care: my patient is bleeding, what do i do next?Speaker: Andy BrownKingsmill Hotel, InvernessDetails from [email protected]


Wednesday 18 Julygastrointestinal surgery: principles and pitfallsSpeaker: Ronan DoyleWolverhampton Medical Institute, New Cross Hospital, Wolverhampton, West Midlands WV10 0QPDetails from [email protected]

Day Meeting – eaSt anglia Region

Sunday 12 augustbackyard poultry: problems and solutionsSpeaker: Victoria RobertsThe Cambridge Belfry, Cambourne, Cambridge CB23 6BWDetails from [email protected]

July 2012

august 2012

golF SoCial Day Meeting – noRth WeSt Region

Wednesday 27 JuneRomiley Golf Club, Goosehouse Green, Romiley, Stockport SK6 4LJFurther information available from Michael Gourley (01613 305000, [email protected])

Day Meeting FoR nuRSeS

thursday 28 Juneophthalmology for nursesSpeaker: John MouldBSAVA Headquarters, Woodrow House, Gloucester GL2 2ABDetails from [email protected]

Day Meeting – SuRRey anD SuSSex Region

Wednesday 11 Julyhepatobiliary disease: an interactive surgical and medical experience!Speakers: Ed Friend and Rob FoaleHoliday Inn GatwickDetails from [email protected]

34-35 CPD Diary.indd 34 21/05/2012 14:41

companion | 35

evening WebinaR

Wednesday 3 october 20:00–21:00advanced reptile medicine webinarSpeaker: Joanna HedleyOnlineDetails from [email protected]

Other upcOming BSAVA cpD cOurSeSSee www.bsava.com for further details

■■ Northern Ireland Region Thursday 4 October Canine pancreatitis: an update on causes, diagnosis and treatment

■■ BSAVA Education Thursday 4 October Coughing in the dog and cat

■■ BSAVA Education Tuesday 9 October Canine developmental elbow disease: update of pathogenesis and recent advances in treatment

■■ South West Region Tuesday 9 October Changes to Pet Passport Scheme and imported diseases update

■■ North West Region Thursday 11 October Ears

■■ Surrey and Sussex Region Thursday 11 October Feline endocrinology

Day Meeting

tuesday 4 SeptemberSurgery of the stifle: modern thinking on classic problemsSpeaker: Rob RaywardBSAVA Headquarters, Woodrow House, Gloucester GL2 2ABDetails from [email protected]

Day Meeting

Wednesday 12 SeptemberCanine infectious diseasesSpeaker: Patricia IbarrolaBSAVA Headquarters, Woodrow House, Gloucester GL2 2ABDetails from [email protected]

evening Meeting – Kent Region

Wednesday 12 SeptemberophthalmologySpeaker: Karen CaswellBest Western Russell Hotel, 136 Boxley Road, Maidstone ME14 2AEDetails from [email protected]


Wednesday 12 SeptemberRecent advances in the management of infectious diseasesSpeaker: Susan DawsonWolverhampton Medical Institute, New Cross Hospital, Wolverhampton, West Midlands WV10 0QPDetails from [email protected]

evening Meeting – South WaleS Region

thursday 27 SeptemberCardiologySpeaker: Luca FerasinThe International Legacy Hotel, Cardiff CF15 7LDDetails from [email protected]


tuesday 2 octobernursing reptiles: keeping everything to scaleSpeaker: Matthew RendleBlackpool ZooDetails from [email protected]

WeeKenD Meeting – eaSt anglia Region

Saturday 29 – Sunday 30 SeptemberMedical and surgical emergenciesSpeakers: Dan Brockman and Kate MurphyThe Cambridge Belfry, Cambourne, Cambridge CB23 6BWDetails from [email protected]

evening Meeting – noRtheRn iRelanD Region

thursday 13 SeptemberDermatologySpeaker: Pat HartVSSCo, Enterprise Crescent, Ballinderry Road, Lisburn BT28 2SADetails from [email protected]

Day Meeting – MetRoPolitan Region

Saturday 15 Septembergenitourinary surgerySpeakers: Dan Brockman and Stephen BainesHoliday Inn, ElstreeDetails from [email protected]

WeeKenD Meeting – SuRRey anD SuSSex Region

Saturday 15 and Sunday 16 SeptemberDentistry: focusing on extractions and radiographySpeaker TBCBrooklands College, Weybridge Campus, Heath Road, Weybridge, Surrey KT13 8TTDetails from [email protected]

Day Meeting

tuesday 18 Septemberadvanced reptile medicine: approach to the sick herpSpeaker: Joanna HedleyBlackpool ZooDetails from [email protected]

Day Meeting

thursday 27 SeptemberbSava Dispensing CourseSpeakers: Phil Sketchley, Steve Dean, Fred Nind, John Hird, Pam Mosedale, Mike JessopDe Vere, Village, Daresbury Park, WarringtonDetails from [email protected]

evening Meeting – SuRRey anD SuSSex Region

Wednesday 19 Septemberbackyard poultrySpeaker: John ChittyLeatherhead Golf Club, Kingston Road, Surrey KT22 0EEDetails from [email protected]


tuesday 11 SeptemberDermatology for nursesSpeaker: Natalie BarnardBSAVA Headquarters, Woodrow House, Gloucester GL2 2ABDetails from [email protected]

evening Meeting – South WeSt Region

tuesday 11 September50 things i wish someone had told me about soft tissue surgery beFoRe i attempted itSpeaker: Ed FriendBest Western Lord Haldon Hotel, Dunchideock, Exeter, Devon EX6 7YFDetails from [email protected]

September 2012 october 2012

WeeKenD Meeting – SCottiSh Region

31 august – 2 September

Main lecture speakers: Neil Geddes, Marge Chandler, John Ferguson and C. Louise McLean

Edinburgh Conference Centre, Heriot-Watt, Edinburgh

Details from [email protected] or at www.bsava.com

34-35 CPD Diary.indd 35 21/05/2012 14:41

Veterinary Nurse Merit AwardsNew for Autumn 2012

Structured programmes which develop skills and knowledge in areas of special interest

For more information or to book your course

www.bsava.comBSAVA, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2ABTel: 01452 726700 Fax: 01452 726701 Email: [email protected]

Anaesthesia and AnalgesiaLed by Derek Flaherty at Holiday Inn Glasgow AirportWith a Practical Day at Glasgow Vet School

2 Day Theory Course 7 and 8 September 2012 10:00–17:00

Webinar 10 October 2012 20:00–21:00

1 Day Practical Course 17 November 2012 10:00–17:00

Webinar 28 November 2012 20:00–21:00

2 Day Course 7 and 8 September 2012 10:00–17:00

Webinar 1 October 2012 20:00–21:00

1 Day Course 3 November 2012 10:00–17:00

Webinar 26 November 2012 20:00–21:00

Rehabilitation and PhysiotherapyLed by Lowri Davies at The Smart Veterinary Clinic, Cardiff

Veterinary Nurse Merit AwardsNew for Autumn 2012

36 VN Merit Awards Ad June.indd 36 21/05/2012 14:41

companion june2012

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