companion

FEBRUARY 2013 The essential publication for BSAVA members

Intracranial disease in a Hungarian Vizsla

SAVSNET The next step P4

Nurses and Anaesthesia Results of consultation P6

How To Approach nonhealing supercial corneal ulcers P12

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BSAVA News SAVSNET

Latest from your Association The next stage

Nursing & Anaesthesia Consultation Clinical Conundrum

Whats in

Your comments reviewed A case of intracranial disease in a Hungarian Vizsla Approach non-healing superficial corneal ulcers Big comedy talent for Congress Party Night
Congress Social

811

JSAP

1216

How To

this month?
that are not candidates for conventional multifractionated radiotherapy.

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1819

Slow eaters

Here are just a few of the topics that will feature in your February issue:
Clinical evaluation of a pre-tied ligating loop for liver biopsy and partial liver lobectomy
The authors found that the pre-tied ligating loop is a versatile and safe method for liver biopsy or lobectomy though alternative methods of haemostasis should always be available.

How to get the anorexic tortoise eating The benefits of pre- and posthibernation meetings

Quality of canine spermatozoa retrieved by percutaneous epididymal sperm aspiration

In case of ejaculation failure due to pathological conditions in dogs, the collection of spermatozoa from the cauda of the epididymis could be an option for providing gametes for assisted reproductive technologies.

2021 Tortoise parties

2225 BSAVA Congress Affiliate Meetings

Offering even more CPD for those with special interests Latest fundraising and funding news The World Small Animal Veterinary Association Dr Ruth Cromie
PetSavers

Curettage and diathermy: a treatment for feline nasal actinic dysplasia and supercial squamous cell carcinoma
This study suggests that curettage and diathermy is an eective treatment for feline actinic dysplasia and for supercial squamous cell carcinoma involving less than 50% of the nasal planum. Curettage and diathermy is an easily mastered technique, requiring minimal equipment. Log on to www.bsava.com to access the JSAP archive online. SPECIAL ISSUE OF EJCAP NOW AVAILABLE Dont forget that as a BSAVA member you are entitled to free online access to EJCAP register at www.fecava.org/EJCAP to access the latest issue.

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Doxorubicin/piroxicam combination for transitional cell carcinoma in dogs

Doxorubicin/piroxicam combination therapy is well tolerated in dogs with TCC although PFS, OS, and biological response rates appear modest. The combination with surgery appears to oer a survival advantage however, this may reect tumour location and volume.

2829 WSAVA News

3031 The companion Interview 33 Focus On

An invitation to BSAVA Scottish Congress 2013 Whats on in your area

3435 CPD Diary

Two methods of gastric decompression for management of gastric dilatationvolvulus

The authors found that both orogastric tubing and gastric trocarization are associated with low complication rates. Trocarization had a higher success rate and lower failure rate.

Additional stock photography: www.dreamstime.com

Brianguest; Cynoclub; Ivan Kmit; Michael Flippo

www.stockfreeimages.com

Ecacy of hypofractionated radiotherapy for nasal tumors in dogs

The results suggest that hypofractionated radiotherapy could be a viable option for the treatment of nasal tumours in dogs

Brett Critchley; Colicaranica; Vichaya Kiatying-angsulee

Small Animal Veterinary Association, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB. This magazine is a member-only benet. Veterinary schools interested in receiving companion should email companion@ bsava.com. We welcome all comments and ideas for future articles. Tel: 01452 726700 Email: companion@ bsava.com Web: www.bsava.com ISSN: 2041-2487

companion is published monthly by the British

Editorial Board

Editor Mark Goodfellow MA VetMB CertVR DSAM DipECVIM-CA MRCVS CPD Editor Simon Tappin MA VetMB CertSAM DipECVIM-CA MRCVS Past President Andrew Ash BVetMed CertSAM MBA MRCVS CPD Editorial Team Patricia Ibarrola DVM DSAM DipECVIM-CA MRCVS Tony Ryan MVB CertSAS DipECVS MRCVS Lucy McMahon BVetMed (Hons) DipACVIM MRCVS Dan Batchelor BVSc PhD DSAM DipECVIM-CA MRCVS Eleanor Raffan BVM&S CertSAM DipECVIM-CA MRCVS Features Editorial Team Andrew Fullerton BVSc (Hons) MRCVS Mathew Hennessey BVSc MRCVS Design and Production BSAVA Headquarters, Woodrow House

No part of this publication may be reproduced in any form without written permission of the publisher. Views expressed within this publication do not necessarily represent those of the Editor or the British Small Animal Veterinary Association. For future issues, unsolicited features, particularly Clinical Conundrums, are welcomed and guidelines for authors are available on request; while the publishers will take every care of material received no responsibility can be accepted for any loss or damage incurred. BSAVA is committed to reducing the environmental impact of its publications wherever possible and companion is printed on paper made from sustainable resources and can be recycled. When you have finished with this edition please recycle it in your kerbside collection or local recycling point. Members can access the online archive of companion at www.bsava.com .

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cientific Policy Officer Sally Everitt attended a meeting at the BVA in December which covered a wide range of issues relating to the breeding and the sale of dogs. Subjects raised included puppy farming and the increasing number of puppies coming from abroad, as well as the feasibility of banning sales of puppies from pet shops and introducing controls on Internet sales. There was also discussion about consumer expectations when buying a puppy which may often be driven by convenience and choice rather than the health and welfare of the puppy. The use of puppy contracts, such as those produced by the RSPCA/BVA-AWF and the Kennel Club Assured Breeders Scheme were

BSAVA attends canine welfare meeting

also discussed and it was suggested that these should become mandatory although this is unlikely to happen unless a single format can be agreed. It was also acknowledged that much of the burden for dealing with problems of irresponsible breeding falls on charities and volunteer organisations. If you have any comments or experiences regarding puppy contracts please email Sally Everitt (s.everitt@bsava.com).

Supporting Southern Africa CPD

Special EJCAP issue on

special issue of the online European Journalof Companion Animal Practitioners (EJCAP) focused on diagnostic imaging isavailable now. In the issue, several European experts present their tips and tricks on radiographic, arthroscopic and ultrasound examination of selected joints and abdominal organs. It also provides an insight into the newer tools of CT and MRI to show how these can help to diagnose some more elusive conditions. As the official organ of the Federation of European Companion Animal Veterinary Associations (FECAVA), it is exclusively available to FECAVA members that means BSAVA members. Registration is easy: interested practitioners should simply go to www.fecava.org/ejcap and follow the instructions. Once registered and logged in, all EJCAP online and previous print volumes of EJCAP can be accessed directly.

diagnostic imaging

e recently reported a donation from BSAVA toward the WSAVA CPD initiatives taking place in Southern Africa. The money has been put to good work, as Jill Maddison, Chair of WSAVAs CE committee, told us recently: 2012 was a very good year for WSAVA CE in Southern Africa. Four meetings were run for veterinary surgeons from Mozambique and Swaziland, Botswana, Zambia, and Kenya. All of the 10,000 BSAVA donation was spent on CE activities none was spent on administration. WSAVA is very grateful for the increased support from BSAVA the major sponsor and the level of support is seminal to the success of the programme. Without the increased support in 2012, the final meeting of the year in Kenya, which was arranged at short notice, would not have been possible. Dr Ndurumo M Steven who attended the course in Nairobi wrote to say: Please accept my sincere gratitude for Saturdays course on Small Animal Surgery. I am a vet in charge of over 500 working dogs in East Africa and the insights and training imparted will go a long way in improving my surgical skill and decision making in terms of diagnosing surgical conditions.

Important reminder

Today
March
WEDNESDAY

Practice badge deadline

The deadline for Practice Badge registrations for Congress is 6March. This registration is an excellent way to send as many people from your practice as possible. It provides a four day registration with access to the science (vet or nurse) and exhibition allowing you to send four different people one per day. Purchase of this registration is a privilege of membership. If you have any questions email congress@bsava.com or to book visit www.bsava.com/congress.

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SAVSNET
the next stage
The Small Animal Veterinary Surveillance Network, SAVSNET, was established in 2008 by a team of veterinary scientists at the University of Liverpool, with the aim of monitoring the disease status of the vet-visiting small animal population in the UK. Ina successful pilot scheme, lasting three years, the researchers were not only able to demonstrate the feasibility and validity of the data collection methods but also provided information on common reasons for consultation and antimicrobial prescribing

SAVA and the University of Liverpool have now entered into a partnership to take SAVSNET forward to the next stage, where it will be able to provide surveillance data to the profession, research scientists, the public and policy makers. SAVSNET Ltd has been set up as a charity with clear objectives: 1. To advance the education of the public in general (and particularly amongst scientists) on the subject of diseases of small animals, their diagnosis and management, and to promote research for the public benefit in all aspects of that subject and to publish the useful results. 2. To promote humane behaviour towards animals by providing appropriate education to the public in matters pertaining to animal welfare and the prevention of suffering among animals. 3. To advance the education of the general public in areas relating to human disease and its relationship to animal disease, for example zoonotic disease and antimicrobial resistance, as a result of research carried out on animal disease.

SAVSNET aims to provide information on the frequency of diseases in the small animal vet-visiting population through two parallel surveillance projects.

Project 1: Laboratory data

Project 1 will involve the recruitment and collection ofquarterly data from participating commercial diagnostic labs. The aim of this project is to develop aconsortium of diagnostic laboratories from across the UK, similar to the system established for equine disease by the Animal Health Trust/Defra/British Equine Veterinary Association. Data from each participating laboratory will be collected andcollated centrally. It is hoped that this system will provide insight into the current disease status of the small animal population in the UK, identify temporal and geographic trends in specific disease diagnosis, andallow us to identify the emergence of new strains or new diseases.

Project 2: Practice data

Surveillance

Surveillance is the ongoing measurement, collection,collation, analysis, interpretation and timelydissemination of health-related data, essential for describing disease occurrence and for the planning, implementation and evaluation of disease control measures. Surveillance is already carried out in human medicine, and the farm animal sector as well as for diseases in horses and wildlife. However, there is currently no coordinated small animal surveillance inthe UK.

Project 2 will involve data collection from veterinary practitioners at the end of each consultation, using their existing practice management computer systems. It captures four types of data from consultations in participating veterinary practices:

Routine signalment information such as species, age, breed and sex The reason why the animal was presented to the vet (clinical text field) Treatment prescribed and dispensed, including dose and route of administration Syndromic information on each animal (captured by means of a simple questionnaire appended at the end of consultations).

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The collection of syndromic information will be built into the existing practice computer system, allowing SAVSNET to collect information about particular conditions ranging from specific diagnoses to broad disease syndromes. This is achieved by activating a short series of questions at the end of the consultation. In order to minimise the workload of individual vets the first question will determine whether the consultation is relevant to the subject under investigation and therefore whether the subsequent questions (usually 4or 5) are applicable. The intention is for SAVSNET to collect data that will enable it to:

a. b. c. d. e. f.

Lyme disease (Borrelia burgdorferi ) Erlichia Babesia Leishmania Dirofilaria immitis Angiostrongylus vasorum

3. Antimicrobial resistance this is topical and important, so monitoring the sensitivity profile of some common (e.g. Pseudomonas) and important (e.g. MRSA/MRSP) microorganisms through laboratory submissions would be useful both for practitioners and policy makers.

Monitor disease trends over time and highlight appropriate interventions Identify populations at risk and monitor treatments and outcomes Provide data resources for academics and others Improve general public awareness of small animal diseases and prevention Provide a route to clinical benchmarking for vets in small animal practice.

Possible areas for surveillance Project 2 include:

Summarised reports of the data collected will be provided on the SAVSNET website. They will include:

1. Mortality data: age, breed, medical cause of death / euthanasia 2. Poisoning/Toxicity cases looking at age, breed, toxin, level of treatment and outcome 3. Preventive healthcare e.g. was worming/ parasite control/weight/dental hygiene discussed? Was product/service purchased? 4. Postoperative complications type of operation, type of complication. SAVSNET AT CONGRESS SAVSNET will be on stand 104 in the NIA at BSAVA Congress 2013. Come and meet the sta and researchers and discuss how you can get involved. If you have any questions in the mean time you can contact Suzanna Reynolds, SAVSNET Project Manager, on savsnet@liverpool.ac.uk or visit www.savsnet.co.uk. YOUR CHANCE TO HAVE YOUR SAY

Publically available information in the form of maps and charts providing information about the incidence of disease Benchmarking data for contributing practices (password-protected to ensure practice anonymity) Anonymised summaries of benchmarking data for BSAVA members.

Possible areas for surveillance in Project 1

What conditions would you like to see covered by SAVSNET? Would you be prepared to participate in SAVSNET?YesNo Your role in the Practice Practice management system Contact details

1. Endemic diseases which we currently vaccinate against, e.g. distemper, parvovirus, leptospirosis, cat flu, myxomatosis, VHD. Providing information on the occurrence of these diseases will provide evidence for practitioners on disease and the need for vaccination as well as possibly providing information on vaccination failures. 2. Exotic and emerging diseases such as those considered endemic in Europe which may enter or have recently entered the UK as a result of travelling pets. Information on any increase in the incidence of these diseases will be important for veterinary surgeons in practice to alert them to previously rare diseases and enable them to provide clients with advice on preventive healthcare if the incidence of these diseases increases. Infections that could be considered in this category are:

Please send this form to Sally Everitt, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB or email s.everitt@bsava.com

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Review of nursing & anaesthesia consultation

In the October issue of companion we asked for your views on the role of the veterinary nurse in monitoring and maintaining anaesthesia. Sally Everitt, BSAVA Scientific Policy Officer, reports
may have been necessary to cover times when the qualified staff were unavailable, as indicated in this comment from a veterinary surgeon:

nurse is competent to act with this degree of autonomy. The buck should stop with the vet and the nurse should be acting for the vet.
Several veterinary nurses indicated thatthey were already taking on this responsibility, as indicated in the following response:

he consultation at the end of last year was prompted by a motion in the Scottish Parliament which proposed that like humans, animals should only receive care from extensively-trained staff, and calls on veterinary surgeries to only use registered veterinary nurses to monitor anaesthetised animals (John Finnie, August 9th), and the RCVS review of its current guidance. We received 112 responses including 71 from veterinary surgeons and 37 from veterinary nurses.

Yes, because in practice we have more experience altering the vaporiser equipment and animals response.
20 respondents said no, including 3nurses. One respondent went on to say that this is because veterinary inhalation anaesthetics are classified as POM-V. Another replied:

Who is monitoring anaesthesia in veterinary practice?

We have advertised for an RVN for 4 weeks in the Veterinary Times without a single applicant. We are offering above average pay in a busy happy team. Unfortunately there is now a complete dearth of VNs probably as a result of the training process being too much of an onerous paper-chase. We have had no option but to employ 2 unqualified nurses and train them in-house as necessary.

No, the act of varying anaesthesia needs the input from the vet, unless the nurse is anaesthesia qualified.
We also asked if qualified veterinary nurses should be allowed to induce anaesthesia. In total 61 said no to this question, including 48/71 (68%) vets and 13/37 (35%) nurses, while 39 respondents 15/71 (21%) vets and 22/37 (59%) nurses said yes. However, 12 of those that answered yes added a proviso to their answer, for example that there should be a veterinary surgeon present, that the patient had been graded as low risk (American Society of Anaesthesiologists (ASA) Grade 1 or 2 (Table 2)), that this should only apply to drugs given intramuscularly and not incrementally, or that the nurse had undertaken further training.

The results (Table 1) indicate that Registered and Listed Veterinary Nurses are monitoring the majority of anaesthetic in the practices covered by this survey. The variation in results reflects the staff employed in a particular practice, with seven respondents stating that they worked in practices which did not employ an RVN. These practices used a combination of student veterinary nurses and lay staff involved in nursing duties to monitor anaesthesia. Interestingly, of the four respondents who reported sometimes using lay staff not normally involved in nursing duties to monitor anaesthesia, all employed qualified nursing staff, suggesting that this Blank Registered Veterinary Nurse Listed Veterinary Nurse Student Veterinary Nurse Lay staff involved in nursing duties Lay staff not normally involved in nursing duties 6 49 26 19 36

How much responsibility should the veterinary nurse have?

We also asked whether veterinary nurses shouldbe allowed to alter vaporiser settings without authorisation from the veterinary surgeon. This question was answered by 111 respondents: 89 respondents said yes including 53/71 (77%) vets and 33/37 (89%) of nurses. Several respondents answered with provisos about the veterinary surgeon retaining primary responsibility and having confidence in the individual nurse, as indicated in the quote below from a veterinary surgeon:

Yes, but the Vet should be responsible for the anaesthetic and satisfied that the
Always 46 14 6 6 0 Usually 45 9 21 4 0 Sometimes 11 12 48 38 4 Never 4 28 11 45 72

Training for lay staff and qualified veterinary nurses

Table 1: Who assists the Veterinary Surgeon in monitoring anaesthesia in your practice?

We asked respondents if they would encourage lay staff to undertake the City & Guilds Level 2 Certificate in assisting veterinary surgeons with anaesthesia and sedation and monitoring animal patients developed by SPVS and the College of Animal Welfare. Although the majority of respondents replied no to this question, veterinary surgeons were equally divided in their responses, with 33 replying yes, 33 replying no and 3 undecided.

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ASA scale 1 2 3 4 5 E

Physical description Normal patient with no disease Patient with mild systemic disease that does not limit normal function Patient with severe systemic disease that limits normal function Patient with severe systemic disease that is a constant threat to life Patient that is moribund and not expected to survive >24 hours with or without surgery Describes patient as an emergency

Veterinary patient examples Healthy patient for ovariohysterectomy or castration Controlled diabetes mellitus, mild cardiac valve insuciency Uncontrolled diabetes mellitus, symptomatic heart disease Sepsis, organ failure, heart failure Shock, multiple-organ failure, severe trauma Gastric dilatationvolvulus, respiratory distress

(or any) nurse is competent to monitor and adjust anaesthesia. We carry out suitable and sufficient training on the job, which is separate from the official VN training.
Further training in anaesthesia for qualified veterinary nurses, such as the BSAVA Nurse Merit Award in Anaesthesia and Analgesia, while professionally rewarding, may only be appropriate and relevant if the nurse is in a practice where she will be able to use her skills. If you have any further comments relevant to this consultation please email Sally Everitt at s.everitt@bsava.com.

Table 2: American Society of Anesthesiologists (ASA) scale of physical status Nurses on the other hand were more clearly opposed, with 29 replying no, 10 replying yes and 3 undecided. Those who would not encourage lay staff to undertake this course focused on the level of training, as indicated in these quotes, the first from a vet, the second from an RVN:

qualification above and beyond the VN syllabus. It is not a level 2 qualification. Yes, as this field is always progressing. New research, techniques and drugs are always being developed. Nurses have an obligation to keep up-to-date with this new information.

BSAVA VETERINARY NURSE MERIT AWARD The BSAVA Veterinary Nurse Merit Awards provide short structured CPD programmes. Each programme consists of a two-day course and a follow-up one-day practical a couple of months later, two webinars, and an online assessment. All those who complete the programme and assessment satisfactorily will receive a certicate and badge. The programmes are not a formally accredited qualication, but the awards provide recognition of interest and expertise in a particular eld. It is expected that nurses would renew their award with a short refresher course every 5 years. The BSAVA Veterinary Nurse Merit Award programmes are very competitively priced, at just over 400 plus VAT for BSAVA Veterinary Nurse e-Members. This includes registration for both the initial two-day course and the follow-up one-day course a couple of months later, access to both webinars (live and recorded) and the online assessment. Non-members have to pay the full price of 720 plus VAT. The rst group of students completed the anaesthesia course in autumn 2012; provided there is sucient demand the course will be re-run in 2013. For further details or to express an interest in attending the course please contact Jane Greenwood j.greenwood@bsava.com.

No. Without an understanding of the anatomy, physiology and pharmacology involved, this would put staff and patients at risk. No, I would not. Lay staff should not be undertaking such a serious role without adequate training. Anaesthesia is often complicated by many medical factors which require someone with a complete education to understand. Anaesthesia is not something that can simply be separated out of the nursing profession without adversely affecting the outcome for our patients.
In contrast, the respondents were almost unanimous in their support for further training in anaesthesia for qualified veterinary nurses, 63 (89%) vets and 37 (100%) of nurses supporting this proposal, giving reasons such as those below :

Conclusions

This consultation has collected the views of veterinary surgeons and nurses from a wide range of different practices and the responses do, to some extent, reflect the variation in small animal veterinary practice in the UK both in terms of staffing and caseload. Both veterinary surgeons and qualified veterinary nurses are aware of the need to recognise the qualification and role of the qualified veterinary nurse, although not all practices have sufficient qualified nurses for them to monitor all anaesthetic episodes. The position of student veterinary nurses in monitoring anaesthesia is also controversial as many practices rely on student veterinary nurses to do this:

I have been a nurse for over 25 years and still find anaesthesia difficult sometimes. I would like to see a stand-alone anaesthesia

We could not function if student nurses were banned from monitoring. I suspect the number of training places would also drop dramatically. It should be the vet-in-charges decision whether a student

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Clinical conundrum
Alex Gough, SAMSoc committee member invites companion readers to consider a case of intracranial disease in a HungarianVizsla
Case presentation
A 4-year-old neutered male Hungarian Vizsla presented with a 7-day history of progressive neurological signs, including stumbling, bumping into objects, not coming when called, leaning to the left, aimless pacing in both directions and disorientation. The dog was fully vaccinated and there was no history of foreign travel. Heart rate was 120 beats per minute, with a regular rhythm. Body temperature was 38.2C. Blood pressure was 150 mmHg. Hydration status was normal. There was some mild pain on flexion of the neck to the left. Ophthalmological examination was within normal limits. No abnormalities were seen on examination of the external ear canals. There was no evidence of Horners syndrome. No other physical abnormalities were detected. Neurological examination findings are summarised in Table 1. mentation Posture Gait ambulatory? Postural reactions urinary function Cutaneous trunci reex segmental spinal reexes Cranial nerves Palpation Mildly obtunded and disorientated, with compulsive pacing Head tilt to the right Vestibular ataxia and left-sided hemiparesis Yes Reduced/delayed hopping, hemiwalking and paw placing reactions in left pelvic and thoracic limbs Normal Normal Withdrawal intact in all four limbs, patellar reex intact, perineal reex intact No abnormalities detected. No positional nystagmus could be induced Normal muscle tone and size; Neck pain was elicited on manipulation History of otitis externa History of ototoxins Conscious proprioceptive deficits Head tilt Spontaneous nystagmus Positional nystagmus Vertical nystagmus Rotatory nystagmus

What is your problem list?

Obtundation and disorientation Head tilt to the right Vestibular ataxia Hemiparesis on the left with proprioceptive deficits Neck pain

What is your neurolocalisation?

The presence of head tilt implies vestibular disease, which may be peripheral or central. It is important to differentiate between central and peripheral vestibular disease since the differential diagnoses, treatments and prognoses vary greatly between these two forms of the disease. Table 2 lists findings that can be used to differentiate central from peripheral vestibular disease. In this case a head tilt with reduced conscious proprioception is suggestive of central vestibular disease. If the lesion is in the brainstem, the head tilt should be towards the side of the lesion and proprioceptive deficits will be ipsilateral. Paradoxical vestibular syndrome describes a head tilt opposite to the side of a cerebellar lesion. In this case, if the lesion were on the left then the presence of a head tilt to the right would be consistent with paradoxical vestibular disease. However, pure cerebellar lesions do not cause proprioceptive deficits. Central + ++ Peripheral + ++

++ + ++ ++ +

++ ++ +

table 1: neurological examination

table 2: differentiating central from peripheral vestibular disease

= rarely associated; + = sometimes associated

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Delayed placing reactions can be caused by deficits in the forebrain (cerebrum and thalamus), brainstem, spinal cord and peripheral nervous system. As the spinal reflexes were normal, peripheral nervous system involvement is unlikely. Changes in mentation, such as obtundation and disorientation, can be associated with forebrain disease. Neck pain can be due to disease of the cervical spine, or referred pain from intracranial disease. The neurolocalisation therefore is most likely to be multifocal intracranial disease.

Immune-mediated: meningoencephalitis of unknown origin Infectious: toxoplasmosis, neosporosis, canine distemper virus

Can the disease be further characterised by its time course and presentation?
1. 2. 3. 4. 5. Onset Clinical course Pain Lateralisation Neurological localisation

It can be useful to characterise a neurological case according to the following aspects:

Subacute, deteriorating, lateralising/asymmetrical brain disease with associated cervical hyperaesthesia makes an inflammatory/infectious disease process likely. The multifocal nature of the signs mean that neoplasia such as lymphoma or metastatic malignancies are also possible. Degenerative, anomalous and nutritional conditions are unlikely given the age and time course, but some anomalous conditions such as hydrocephalus can remain compensated for some time, then decompensate abruptly, for example with minor, unnoticed trauma. The breed is not typically affected by hydrocephalus. There is no history of trauma, and the lateralisation of the signs makes a metabolic condition directly causing the neurological signs unlikely.

What initial screening tests would be useful in this case?

The characterisation of this disease is therefore: 1. 2. 3. 4. Subacute onset Progressive Painful Right-sided head tilt, left-sided proprioceptive deficits 5. Multifocal intracranial disease

Routine haematology, biochemistry bile acid stimulation and urinalysis were performed to look for possible metabolic diseases causing the clinical signs, and to screen for concurrent disease. These were unremarkable.

What imaging modality would you choose in this case?

What are your differential diagnoses, and which are most likely at this stage?
The DAMNIT-V classification of diseases, (Degenerative; Anomalous; Metabolic; Nutritional; Neoplastic; Infectious; Inflammatory; Idiopathic; Traumatic; Toxic; Vascular) is useful in formulating differential diagnosis lists in neurological cases. The most important differential diagnoses in this case are:

Anomalous: e.g. hydrocephalus Metabolic: hepatic encephalopathy, uraemic encephalopathy, electrolye/acidbase disorders Neoplastic: e.g. lymphoma, metastatic neoplasia

MRI is the imaging modality of choice for the brain. This helps demonstrate space-occupying lesions suchas solid neoplasms, and will often show evidenceof inflammation. MRI scans (Figures 1 and 2) showed multifocal hyperintensities on T2 weighted andFLAIR series throughout the right forebrain and right brainstem. The cerebellum was grossly unaffected. There was shift of the midline from right to left, consistent with a mass effect, but no discrete mass was seen. There was a patchy contrast uptake on T1 scans post gadolinium through the forebrain and brainstem. This is consistent with breakdown of the bloodbrain barrier or an increase in vascularity, which can be associated with inflammation/infection and neoplasia.

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Clinical conundrum

What further tests would you perform at this stage?

Cerebrospinal fluid analysis is often important to make a diagnosis in cases of suspected inflammatory brain disease. It is useful to perform MRI prior to CSF analysis, however, to screen for conditions which might make CSF collection unsafe, such as herniation of the cerebellum through the foramen magnum. CSF analysis from a cisternal puncture showed a moderate mixed lymphoid and monocytoid macrophage leucocytosis (see Table 3), with elevated protein level. Parameter WBC RBC CSF protein Figure 1: t2 weighted transverse mri scan of the brain showing diffuse hyperintensity in the right forebrain result 22/l 0 40.3 mg/dl reference range <5 0 <25

100 cell dierential: 93 lymphoid cells, 7 monocytoid macrophage cells table 3: Cerebrospinal fluid analysis

What is your most likely diagnosis from these findings and what other diseases would you test for at this stage?

Figure 2: t1 weighted transverse mri scan of the brain showing patchy contrast uptake (arrows) in the right forebrain. a mid line shift from right to left is clearly visible, demonstrating a mass effect

The MRI and CSF findings are suggestive of multifocal disease that may be inflammatory or neoplastic in character. Lymphoma cannot be completely excluded on this CSF finding, but the presence of monocyte macrophages makes this less likely; ultimately, response to treatment in this case ruled out lymphoma. A PARR test (PCR for Antigen Receptor Rearrangements), which helps determine whether lymphocytes are derived from one single clone (as inlymphoma) or many (reactive disease) could beperformed, but the results take some weeks to bereceived and so the test was not performed in thiscase. Serology tests for Toxoplasma and Neospora were negative in this case, as was PCR on the CSF for distemper. Retesting to check for rising titres of antibodies to Toxoplasma and Neospora could be useful, but as the disease was already at least 7days into its course, and there was no antibody response at all at this stage, this was not performed.

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The most likely diagnosis was granulomatous meningoencephalitis, but this requires histological confirmation, and other inflammatory brain diseases are possible, so this case may be more correctly classified as a meningoencephalitis of unknown origin(MUO).

Present a case report

at BSAVA Congress SAMSoc meeting
Do you have an interesting or unusual small animal medicine case that you think might be suitable as an oral presentation? SAMSoc is currently inviting submissions for its annual case report session during the pre-BSAVA satellite meeting on 3 April 2013. Suitable cases should have interesting discussion points but need not be so unusual that they would be considered publishable. Three or four case reports will be selected by the SAMSoc committee for presentation at the meeting (presentation duration will be confirmed nearer the time). Successful selection entitles the author to free registration for the satellite meeting. At the end of the session the audience will vote by ballot for their favourite case report. Prizes (kindly donated by Vtoquinol) will then be awarded:

Immunosuppression is the mainstay of treatment in cases of MUO, prednisolone, with or without other immunosuppressive drugs, being most commonly given. Although there are a number of studies demonstrating the treatment of MUO with different immunosuppressive drugs, no direct comparison has been made, so it is unclear whether one regime is superior. In this case prednisolone was prescribed at a dose of 2mg/kg twice daily by mouth for 7 days, followed by a slowly decreasing dose over a 6-month period. Cytarabine (cytosine arabinoside) 50mg/m2 was given subcutaneously, twice daily for 2 days, repeated every 3 weeks for the first 6 weeks. Cytarabine is commonly used in the treatment of inflammatory CNS disease, due to its penetration of the bloodbrain barrier. Cytarabine is a cytotoxic drug and precautions in dosing, handling and administration must be strictly followed.

What treatment would you recommend for this case?

1st place: 300 2nd place: 150 3rd place: 50

How long should treatment be continued?

It is not clear whether these cases generally require lifelong immunosuppressive treatment, or whether therapy can be withdrawn. This case showed a marked improvement on treatment, with all neurological signs resolving over 7 days. Therapy wasdiscontinued after 6 months, and no further treatment has been required in the following 2 years for this condition.

Abstracts should be written in Microsoft Word using Times Roman 12-point font. The first line should contain the title in capitals; the second line all authors; the third the institution(s) the author(s) are affiliated with; followed by the actual abstract starting as a new paragraph. The print must be black, and the abstract should be no more than 500 words in length (including title, author names and institutions). The line spacing should be 1.5. A single diagram, figure or table can be included. Deadline for submission of abstracts is midnight on 17 February 2013. Abstracts should be submitted electronically to kit@vetfreedom.com

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 companion@bsava.com All submissions will be peer-reviewed.

aCknowledgements Thanks to Kate Murphy and Holger Volk for comments on the text.

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How to approach non-healing superficial corneal ulcers

Claudia Busse of the Animal Health Trust helps us look at this problem the rightway

orneal ulcers are commonly encountered in general practice. While most ulcers heal within a few days some fail to do so for an extended period of time, sometimes many months. Corneal ulcers may fail to heal for a variety of reasons. The following article explains the approach and management of non-healing corneal ulcers. Corneal ulcers can be classified depending on their depth, as ulceration can be a surface or stromal defect of the cornea. The cornea consists of three layers: the surface epithelium with its basement membrane, the corneal stroma, and the endothelium with its basement membrane (Descemets membrane). An ulcer is classified as superficial if only the surface epithelium islost (Figure 1). The epithelium is a thin protective layer (making up only about 10% of the corneal thickness) that prevents bacterial invasion of the underlying stroma and is well innervated. It has very little mechanical strength, thus the simple loss of the corneal epithelium does not threaten the integrity of the globe. However, if an ulcer also affects the corneal stroma (about 90% of the corneal thickness) the mechanical strength of the cornea can become compromised, depending on the extent of the lesion. If a lesion results in the full thickness loss of stromal tissue only the single-layered corneal

endothelium and Descemets membrane remain. In this case, the ulcer is called a descemetocele. Cornealendothelium and Descements membrane have very little to no mechanical strength and rupture of the globe is highly likely without adequate surgicalintervention. The healing of corneal ulcers varies depending on their depth. Superficial ulcers should heal within seven to ten days, the length of time needed for the epithelium to renew itself. This is true for the majority of superficial corneal ulcers and these are classified as uncomplicated ulcers. If corneal healing is delayed then a complicated ulcer is present. It is essential to re-assess the patient for underlying causes of the ulceration. Ongoing mechanical trauma caused by lid malformations, an incomplete blink, abnormally placed lashes (distichiasis, ectopic cilia), foreign body material, inadequate tear production (keratoconjunctivitis sicca), etc. have to be excluded.

1. The ulcer has been present for more than two weeks. 2. Underlying causes or factors that might delay healing have been excluded, such as: a. Dry eye (remember to check the tear production in the fellow eye too, as a subclinical dry eye might otherwise be missed) b. Mechanical trauma (entropion, lid tumours, extra lashes: distichiasis, ectopic cilia turn the lid margin out, most ectopic cilia sit in the central upper eyelid, they can be dicult to nd if they are not pigmented) c. Foreign body d. An incomplete blink; this can occur due to conformational issues (brachycephalic breeds), paresis or paralysis of the eyelids or protrusion of the globe. 3. The ulcer has loose epithelial edges. This is demonstrated with a uorescein test. As the dye runs under the loose epithelium and extends further than the ulcer margin outlined by the epithelium (Figures 2 and 3). Make sure you ush excess uorescein dye immediately to avoid false positive results as the dye enters the stroma. 4. The ulcer does not extend into the stroma (the convex contour of the corneal surface remains present). 5. There is no apparent inltration of the corneal stroma. The cornea tends to have a mild bluish tint due to oedema, however there should not be white or yellow densities in the stroma. Table 1: Criteria to identify a non-healing ulcer

Figure 1: A 7-year-old Boxer with a 5-week history of superficial corneal ulceration. Note the lack of corneal vascularisation from the limbus

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Figure 2: The same dog as in Figure 1 after fluorescein staining of the cornea. Note how the fluorescein distributes under the epithelium indicating the poor adhesion between epithelium and stroma Note that the tear production should always be measured in both eyes as subclinical dry eye is easilymissed if the ulcer results in a temporarily increased tear production in the affected eye. The normal tear production in an ulcerated eye is expected to exceed the normal range of the Schirmer tear test (1525mm/minute). Deep (or stromal) corneal ulceration either results from a severe initial trauma (e.g. cat scratch injury) or is due to degradation of the stromal collagen by collagenases. These enzymes can be produced by bacterial and fungal organisms as well as the bodys own cells, particularly neutrophils, but also corneal epithelial cells and fibroblasts. Bacterial involvement should be suspected in cases of stromal ulceration.

Figure 3: A 13-year-old dog with non-healing ulcer following fluorescein staining of the cornea. Note how the fluorescein also extends under the epithelium delineating its loose edges. The prominent corneal oedema of the ageing cornea is likely to contribute to the ulceration ulcer are still frequently used. SCCEDs usually occur in middle-aged dogs. The condition can occur in any breed and a predisposition is described in the Boxer. Presenting signs include a varying degree of ocular discomfort (excessive tear production, blepharospasm, enophthalmos). Loose epithelial edges adjacent to the ulcer margin, indicating the insufficient connection between epithelium and stroma, are a classical feature of the condition (Figures 1, 2 and 3). Patients often present with a reflex uveitis indicated by a slightly miotic pupil, which is easiest to diagnose using distant direct ophthalmoscopy. Other ocular abnormalities are generally absent. After identifying a non-healing ulcer it is important to counsel and educate the owner. Healing of nonhealing ulcers can take weeks to months even with adequate treatment. A treatment plan should address the following three points: Prevention of a secondary bacterial infection Pain relief Encouraging healing.

The non-healing ulcer

An ulcer should only be considered as a true non-healing ulcer if it is superficial and all potential underlying causes have been excluded (Table 1). These ulcers fail to heal due to inadequate adhesion between the corneal epithelium and stroma. The underlying cause is still not fully understood, but a variety of theories attempt to explain the lack of adhesion between the tissues. Abnormalities of the epithelial basal cells and basement membrane, a reduced number of adhesion complexes, a change in the superficial stroma, modified innervation and a lack of growth factors have all been reported. In the ophthalmic literature these ulcers are referred to as Spontaneous Chronic Corneal Epithelial Defects (SCCEDs), but other names like Boxer ulcer or indolent

Prevention of secondary bacterial infection

Prevention of bacterial infection is achieved using topical broad-spectrum antibiotics such as fucidic acid, chloramphenicol or a triple antibiotic combination (neomycin, polymyxin B and bacitracin). Ointments are usually given two to three times daily while drops are given four times daily.

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How to approach non-healing supercial corneal ulcers

Pain relief

Pain relief is provided with atropine eye drops to relax the ciliary muscle spasm (successful if pupil becomes dilated, a single application is usually enough), as well as systemic non-steroidal anti-inflammatories. Remember to use as little topical medication as possible as preservatives (components of most eye drops) can delay healing. Topical steroidal or nonsteroidal anti-inflammatories should also be avoided for the same reason.

Encouraging healing

Healing of the ulcer is encouraged by removing the loose epithelium and debriding the superficial stroma following the administration of a local anaesthetic. The initial debridement can be performed with a clean cotton bud or ophthalmic stick swab (Figure 4). Make sure you use several cotton buds as they become less effective when wet. Gently rub the loose epithelium off by following the direction of the ulcer margin. This usually leads to a dramatic increase in ulcer size and can sometimes affect the entire cornea (Figure 5 and 6). Note that gentle debridement is not able to remove healthy and well adhered corneal epithelium. The healing rate after debridement alone is thought to be around 60% within two weeks time. To increase the healing rate to 80% within two weeks a keratotomy can be performed (Figure 7). A keratotomy stimulates the superficial stroma and encourages the adhesion between new epithelium and the stroma. The most commonly performed technique is a grid keratotomy; however punctate keratotomies as well as corneal burrs are also successfully used. When performing a grid keratotomy ensure that the patient is well restrained; sedation or general anesthesia may be indicated.

Figure 5: The same eye as in Figure 4 following the debridement. Note the increased size of the superficial ulcer

Figure 6: The same eye as in Figure 3 following debridement. Note the increased size of the superficial ulcer Start by applying a topical anaesthetic and wait for it to work (approximately 5 minutes). Then remove the loose epithelium using cotton buds. The grid keratotomy itself is performed with a 21gauge needle. Use the needle with its bevel up. Avoid turning it on its side as this results in a knife-like effect that results in deep cuts and potentially uncontrolled damage to the corneal stroma. Use the tip of the needle to draw a grid into the superficial stroma (Figure 8). This must be done gently so that it is just visible after flushing the ocular surface. Avoid deep cuts that result in gaping of the corneal tissue. Note that the more prominent the grid the more damage to the corneal stroma occurs and scarring will occur. The use of burrs has increased over the last few years. This technique allows very gentle debridement of the superficial stroma and results in less corneal scarring than a grid keratotomy (Figure 9). Following the procedure, flush the ocular surface with 1 in 50 povidone solution to prevent infection.

Figure 4: Performing debridement of the ulcer shown in Figures 1 and 2 using cotton buds

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Figure 9: Using a purpose-designed diamond ophthalmic burr for the debridement of the epithelium and superficial stroma is becoming more and more popular in veterinary ophthalmology

E
Figure 7: A schematic illustration of a grid keratotomy. (A) The superficial ulcer. (B) Fluorescein staining helps to illustrate the loose epithelium. (C) Debridement of the loose epithelium usually leads to a significant increase of the superficial ulcer. (D) Gentle use of a needle to draw a grid into the superficial stroma (keratotomy). (E) The finished result. Note how the grid extends slightly over the edges of the adhered epithelium

Debridement and keratotomy can be repeated several times depending on the progress of the ulcer, but at least 1014 days should be left between treatments to give the cornea time to heal. Should the ulcer not improve after two or three treatment intervals a superficial keratectomy can be performed. This involves the removal of the most superficial layers of the stroma by performing a superficial lamellar keratectomy. This procedure requires an operating microscope and special instruments, and is better left to the specialist ophthalmologist.

Figure 8: The same eye as in figures 1, 2, 4 and 5 following grid keratomy

Complications of non-healing corneal ulcerations include a secondary bacterial infection or a sterile corneal melt as well as excess granulation tissue formation. Bacterial infection and sterile corneal melt both result in infiltration of the cornea and loss of stromal tissue. Corneal melt results in yellowish (infiltrated) stromal tissue that appears soft and jelly-like. Melting corneal tissue has hardly any mechanical strength. To identify a bacterial infection, corneal swabs for culture and cytology should be taken. The swab should be submitted for culture and sensitivity and the smear for cytology can be stained immediately using Diff-Quik or Gram-staining to give a quicker answer as to the presence of bacteria that may be involved in the melting process. The treatment of the bacterial infection and prevention of further melting of the cornea should be the main objectives in these patients. To prevent progression of the melt undiluted autologous or

Potential complications

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How to approach non-healing supercial corneal ulcers

heterologous serum can be used to inhibit the collagenases that destroy the corneal collagen. Should the ulcer reach more than 50% of the corneal depth, surgical intervention should be discussed. Another common complication is the formation of excess granulation tissue. This is often the result of excessive debridement and resultant dramatic vascularisation of the cornea. This can be very alarming for the owner and is sometimes the reason for referral (Figure 10). When presented with this problem you should initially perform a fluorescein test to check if the corneal ulcer has actually healed or is still present. If the ulcer is healed and the cornea does not stain with fluorescein, no treatment is required. Topical cyclosporine eye ointment or steroids can be used to encourage regression of the blood vessels. If ulceration is still present, extensive loose epithelial edges are often present, too. It seems that the vascular change in the stroma also prevents an adhesion of the epithelium. The treatment should be amended and topical cyclosporine eye ointment can help to reduce the corneal neovascularisation and therefore encourage an adhesion between epithelium and stroma. Severe corneal neovascularisation is a prognostic factor, indicating that significant scarring of the cornea will occur. Re-organisation of the cornea takes several months and the transparency of the tissue may still improve over time. Again cyclosporine eye ointment can encourage regression of the corneal neovascularisation and prevent or reduce corneal pigmentation.

Feline non-healing ulcers

When dealing with non-healing ulcers in the cat the identification of the condition is the same as in dogs (see Table 1). However in most patients the initial involvement of Feline Herpes Virus 1 (FHV-1) has to be suspected. If FHV-1 is identified then the addition of topical or systemic antiviral medication can speed up the healing process in these patients. While loose epithelial edges should also be debrided in cats a keratotomy is contraindicated as it entails a high risk of corneal sequestrum formation, a condition that requires surgical management.

Conclusion

With logical exclusion of potential underlying causes of ulceration and appropriate treatment, most ulcers will eventually heal; however the owner should be made aware that SCCEDs have the potential to recur and may affect the same as well as the felloweye in the future. 1. Give the ulcer enough time to heal, leave at least 1014 days between treatments that encourage healing (debridement, keratotomy). 2. Never perform a grid keratotomy in a cat as it is likely to cause a corneal sequestrum that will then have to be removed surgically. 3. Never perform a grid keratotomy in a stromal corneal ulcer (stromal ulcers are dened by a loss of stromal tissue and impairs the normal convex surface of the cornea, even a very subtle indentation has to be taken very seriously as it might indicate a corneal melt, see above). 4. Do not overuse atropine eye drops: atropine should be given to eect and one drop is usually sucient to dilate the pupil. Its use should be avoided in patients with low tear production or glaucoma. 5. Non-healing ulcers are usually not infected, therefore: a. Use a broad-spectrum antibiotic to prevent infection b. Antibiotics should only be swapped if there is a concern about secondary infection (development of purulent discharge, or white or yellow discoloration of the cornea) c. Use the antibiotic only as often as needed (4x daily for drops; 23x daily for ointment), avoid too much topical medication as the preservatives in it might delay healing Table 2: How to avoid the most common mistakes made when dealing with a non-healing ulcer

Figure 10: Prominent vascularisation following a long-standing healing process of a non-healing ulcer. This is particularly common after too frequent or aggressive debridement, or trauma to the cornea

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Congress 47 APRIL 2013

Big comedy talent

B
SAVA Congress is renowned for its Saturday Party Night, having played host to a variety of top comedy acts such as Michael McIntyre and Jason Manford, along with popular musicacts like Olly Murs and Scouting for Girls. Following in this rich tradition, BSAVA is delighted to announce its top-drawer comedy talent for 2013 and hope that you will join us Birmingham for a night of laughter and dancing.

for Congress Party Night

Headline funny man

Our Comedy Club headliner is Alan Davies. He is one of the UKs best known actors and comedians, having stared in the BBC hit series Jonathan Creek for an incredible 13 years. Indeed, Alan has enjoyed a hugelyvaried acting career with credits including Lewis, Hotel Babylon, Bob and Rose and The Brief. Of course in recent years Alan has become a mainstay of the long-running comedy trivia quiz showQI, where he is an ever-present and much maligned team member. After a brief hiatus, Alan returned to the comedy circuit in 2012 with his hit tour Life is Pain and we are proud to be welcoming him to BSAVA Congress.

More laughs

Supporting Alan will be the exciting and emerging talent that is Chris Ramsey, who is currently on his sell-out tour of Feeling Lucky, the follow-up to his Fosters Edinburgh Comedy Award-Nominated Offermation. Chris has recently been starring in BBC Twos brand-new sitcom Hebburn, alongside Vic Reeves, and is a regular face on Celebrity Juice, Never Mind The Buzzcocks and 8 Out of 10 Cats.

Mister MC

The compre for the evening will be Rhodri Rhys, whose act combines sharp wit and observation with a natural geniality. His material is broad and colourful, drawing on his own experiences in his unusual path to a comedy career, while deftly seaming in religion, business, sport and history. Rhodri has been the subject of a number of TV and radio programmes in Welsh, Czech and English (S4C, TV Nova, BBC Wales) and has done comedy gigs in Warsaw, Moscow, New York, Budapest, Prague and Bahrain. n

COMING TO THE PARTY? You can either order your Party Night ticket at the same time as you register, or you can add it in afterwards email congress@bsava.com or call 01452 726700 if you have any questions. It is sometimes possible to buy tickets at the event from the Birmingham box office, but those whove been disappointed in recent years will testify that the event is often sold out very quickly, so book in advance to secure your place.

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Congress 47 APRIL 2013

Slow eaters
Congress speaker, Kevin Eatwell, to reveal howto get the anorexic tortoise eating

ortoises are famous for taking their time over most things that they do. But if a pet tortoise is slow to regain its appetite after emerging from its winter hibernation, that may not be through its own choice. Delegates attending Congress will be told that post-hibernation anorexia is a common condition in pet tortoises living in British conditions far away from their preferred Mediterranean or tropical climates. Kevin Eatwell, an RCVS-recognised specialist in exotic animal and wildlife medicine, will explain the causes of the problem, how to recognise the key clinical signs and what can be done to get the animal eating again.

Once the owners appreciate that their pet is not eating they will become understandably concerned. Many tortoises may not be ill per se but just cold and dehydrated. When the weather warms up they are able to compensate fully. Others that continue to be anorexic may have an underlying illness such as liver, reproductive or kidney disease and these, of course, do need to see a vet urgently, he warns.

Proper care

Noticing the signs

Kevin, a lecturer at the University of Edinburgh veterinary school, will show that temperature and hydration levels are crucial in bringing ectothermic creatures like the tortoise out of their winter torpor but pet owners may not appreciate just how important they are. Anorexia after hibernation is a huge problem. But many cases are dealt with at home by their owners and do not see a vet until the anorexia becomes prolonged, Kevin explains. A tortoise should be feeding and drinking within a week of coming out of hibernation. However the temperatures in the UK lead to the tortoise being sluggish for too long a period as they are too cold. So many owners will expect their tortoise not to eat for quite some time after hibernation before seeking veterinary advice, he says.

Under appropriate conditions individuals of the most commonly kept tortoise species Testudo graeca and T.hermanni will live for up to 50 years. Yet a failure by the owners either to deal with the underlying management problems or to seek advice from their veterinary practice can certainly reduce a pets life expectancy. Anorexia can be fatal due to metabolic disturbances and dehydration. Renal and liver disease are likely consequences of prolonged anorexia and dehydration, as they are likely to lead to hepatic lipidosis and renal gout. When presented with an anorexic tortoise, the firststep is to get a full history to understand how theanimal has been managed over its hibernation period. If the information is limited, then the clinician willhave to rely solely on their own assessment of theanimals condition. Kevin warns against placing too much faith in the weight ratios that may appear in older textbooks to indicate the extent of the animals weight loss. These were originally created from measurements of wild tortoises of

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two species and can be misleading when examining captive-bred animals. It also does not take into account pathological processes that will make the tortoise weigh more such as coelomic ascites, egg carriage or fatty liver. A full health check in combination with weight records for that tortoise is advised alongside the use of a ratio if the owner or vet wishes to use one. Tortoise parties can perform a useful function see the article that follows on pages 2021. In his presentation, Kevin will highlight the influence of adequate rehydration in helping a tortoise regain its appetite. He will show how blood samples and urinary pH and specific gravity measurements will show the extent of the patients fluid imbalance and give a much clearer insight into its condition. He will also explain how to introduce an oesophagostomy tube in those severe dehydrated animals that fail to respond to more basic treatment. Fortunately, those cases are likely to be in a minority. Ideally, anorexic tortoises should be warmed up and bathed in shallow water to allow them to warm up and rehydrate immediately after hibernation. The main problem is getting the information out to owners and ensuring they have a suitable set-up to do this at home, while waiting for the UK weather to warm up enough for it to occur spontaneously.
Editors note: Readers are also directed to How To Approach the Anorexic Tortoise by John Chitty in July 2012 companion

KEVIN AT CONGRESS Friday 5 April

13.5014.40, Hyatt Ballroom Nursing the exotic patient: introduction to nursing reptiles 14.5015.35, Hyatt Ballroom Nursing the exotic patient: reptile critical care 9.2510.10, Hall 5 ICC Getting to grips with reptiles: the reptile consult 11.0511.50, Hall 5 ICC Getting to grips with reptiles: approach to post-hibernation anorexia in chelonians 12.0012.45, Hall 5 ICC Getting to grips with reptiles: approach to reptile dermatology 14.0514.50, Hall 5 ICC Getting to grips with reptiles: reproductive disease in chelonians 16.5017.35, Hall 10 Pain management: recognising and controlling pain in reptiles

Saturday 6 April

BSAVA MANUAL OF REPTILES, 2nd edition Edited by: Simon Girling and Paul Raiti Reptile medicine has become signicantly more sophisticated, especially in the areas of anaesthesia, diagnosis, nutrition, surgery and therapeutics. This edition provides the same high standards of relevant information as the original Manual, with the important addition of superb full-colour photographs throughout.

Member price: 59.00

Non-member price: 89.00

Buy online at www.bsava.com

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Tortoise parties
RVN Laura Smith of Anton Vets in Hampshire talks about the benefits of pre- and post-hibernation tortoise parties, and offers some tips gained from running her own meetings in the spring and autumn
Due to a high percentage of tortoises carrying a worm burden, de-worming can be carried out at the tortoise party. For larger tortoises such as the Sulcata we carry out a faecal examination in the first instance to establish whether worms are present.

ortoise parties provide many benefits to the practice, the client and the patient. As well as being great fun for all, there are several key advantages to running tortoise parties. An opportunity for the patient to have a clinical examination prior to hibernation can be very beneficial. The patient is weighed and an assessment made of general overall body condition. At this stage, any concerns over poor body condition or ill health can be raised and action taken as necessary, preventing the patient from entering hibernation in a less than optimal condition. Similarly, a clinical examination after hibernation can prove just as useful. Signs of illness or anorexia following hibernation are not always immediately obvious to owners. A clinical examination at this stage can therefore provide information on general health and condition prior to the owner noticing signs of illness, and will facilitate prompt treatment if required.

Ultrasonography

Carrying out an ultrasound scan of all female tortoises during the tortoise party can provide information on their reproductive status. The presence of eggs or follicles are of interest. If eggs are present on ultrasound scanning it is advisable to radiograph the patient to ascertain the number of eggs present and whether the eggs are normal and intact. At this stage, the authors clinic advises induction of egg laying to relieve the egg burden, and to ensure that the weight estimations are accurate. If the eggs are abnormal or damaged surgery is preferred over induction of egg laying. Some older lone females can carry a large number of follicles that do not progress to eggs. In these cases, the option to pair the female with a male to induce ovulation may be taken, or it may be decided to carry out elective ovariectomy if the follicles are static and do not progress over several scans.

Good for owners

The tortoise party provides clients with an opportunity to meet other tortoise owners, to share experiences and ideas, and often to discuss potential tortoise breeding. In grouping a large number of clients together for the tortoise party, we are able to offer a reduction on the usual examination and ultrasound scan fees. Providing a reduction in costs helps to encourage clients to take advantage of the tortoise party, and will ensure client and patient numbers make the event viable. Grouping clients together makes it very convenient to us as a practice, as well as relieving the strain on the appointment system of fitting in more than 200 checks twice yearly! The scan is included in the check price and is essentially free. This is compensated for by the increased pick-up rate of problems and is of huge benefit in training us all to use the scanner.

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One benefit to the practice of running a tortoise party, that must not be underestimated, is the reinforcement of the bond between client and practice. Also, for new members of the veterinary team, attending the tortoise party can provide valuable experience of clinical examinations and the reasoning behind ultrasound scanning in female tortoises, as well as routine husbandry.

Organisation of tortoise parties

Tortoise parties are only for well tortoises; no sick tortoise should be examined due to the risk of spreading infection. Our clinic offers tortoise parties to all of the clients on their database: whether they are experienced owners or first-time tortoise keepers the health check and scan (if appropriate), and de-worming are available for all. The whole family is encouraged to attend, with the aim of providing information and advice to all of those involved in the tortoises care and husbandry. Village halls, community centres and other venues can all be used for holding tortoise parties. Large practice waiting rooms can also be considered, however the timing of the party must be planned well to ensure the party is held during a quiet time, and catering can be quite a challenge in practice. In our experience, village halls work incredibly well. Taking clients and patients out of the clinic setting helps to make the experience less formal, and clients seem more inclined to ask questions. The duration of the party can be as long or as short as desired, with the content dictating how much time isrequired. Our practice sends an invitation through the post to all tortoise owners, and also advertises on the practice website, Facebook and Twitter pages. Once owners have responded to the invitation, a rough timescale is devised and owners planning to attend are given a time to arrive (this prevents all arriving at once!).

examining the tortoise with the client, as each case is discussed as per its individual requirements. A large proportion of the conversation centres around the husbandry and general care of the clientstortoise.

Client support material

What is discussed

Informal interactions are encouraged, with owners asking questions while their tortoise is being examined. There is no set script to follow when

As a green practice, all of our client support material is linked to our website. Clients are encouraged to look at our website for fact sheets and husbandry information, as well as Frequently Asked Questions relating to a variety of topics. A stock of appropriate supplementation, such as vitamins, is taken to the tortoise party so that clients can stock up on whatever they require. With good organisation, advertising and lots of tea and coffee on the day (for clients and practice staff), tortoise parties have many benefits to the client, patient and also the practice. n

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Congress 47 APRIL 2013

BSAVA Congress affiliate meetings

On the Wednesday of Congress BSAVA sponsors meetings for its Affiliate Groups, offering even more CPD for those with special interests. For full details and registration to the affiliated group meetings you need to contact the organisation directly, contact details below
British Association of Veterinary Emergency and Critical Care
Venue: The Crompton Room, Austin Court Website: www.bavecc.org.uk Contact: Toby Birch secretary@bavecc.org.uk BAVECC is a group of veterinary surgeons and nurses who have a common interest in emergency and critical care (ECC) topics. The group consists of university clinicians, emergency vets, nurses and general practitioners with a special interest in ECC. BAVECC will bring nationally and internationally recognised speakers to their BSAVA Congress meeting. One lecture is traditionally delivered by a criticalist from a human ICU/ECC department. The topic this year is anupdate on treating the trauma patient. All vets and nurses with a special interest in ECC are invited to attend the meeting either just out of interest or to get further involved in the development of ECC in the UK. Visit the website or contact the Secretary for more information on membership of BAVECC and course registration.

Association of Veterinary Soft Tissue Surgeons

Venue: Hall 7, ICC Website: www.avsts.org.uk Contact: Alison Young avstsadmin@fsmail.net The AVSTS is thriving, and welcomes all vets and nurses involved with canine and feline soft tissue surgery cases. We aim to provide a thought-provoking discussion forum at our two annual meetings. The spring meeting in Birmingham during BSAVA Congress traditionally covers Whats new and hot? and in 2013 we have a commanding line-up of international speakers including: Karen Tobias, editor of the new surgical bible Tobias and Johnston; Sheila Crispin, chairman of the BVA Advisory Council on the Welfare Issues of Dog Breeding; Alex Reiter, Service Chief of Dentistry and Oral Surgery at the University of Pennsylvania; and David Vail, Professor of Oncology at the University of Wisconsin-Madison. Our autumn meetings, held on a non-half-term Friday-Saturday, allow a theme to be explored with greater depth and breadth, and benefit from inclusion of the comparative aspects from human surgery, as well as from fine food, wine, and laughter. See website for further details and for how to join our happy society.

British Association of Veterinary Ophthalmologists

The Kingston Theatre and Waterside Room, Austin Court Website: www.bravo.org.uk Contact: Claudia Hartley secretary@bravo.org.uk BrAVO is an internationally recognised friendly BSAVA Affiliated Group, consisting of around 200 members from all corners of the United Kingdom, as well as some European and Australian members. We are a sociable group and are always looking to welcome new members to our meetings, whether they have just an interest in ophthalmology or work as full time veterinary ophthalmologists. BrAVO organises two meetings each year, with state of the art lectures covering all aspects of veterinary and human ophthalmology, aiming to educate both at practitioner and specialist level. Our spring meeting is a one-day BSAVA Congress meeting and includes both local and international speakers. The winter meeting is a Venue:

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two-day weekend meeting that is held in locations around the country, usually in the first half of November. Again we include international speakers, and usually a medical speaker for a comparative view in humans. Members are kept informed of all our meetings, enjoy discounts on text books and journal subscriptions, have access to proceedings from the meetings as well as eligibility to apply for one of two travel scholarships to a value of 1000 per year. Additionally we have a range of companies exhibit their products with us each year, making it an ideal place to explore the current ophthalmic equipment on the market. The main speaker for our spring meeting will be Dr Gillian J. McLellan on glaucoma and tonometry.

British Veterinary Dental Association

Venue: Lodges 1 and 2, Austin Court Website: www.bvda.co.uk Contact: Helen Hyde secretary@bvda.co.uk For the BSAVA Congress meeting this year the British Veterinary Dental Association will be having its usual Scientific Day. This will start with Alex Reiter from the University of Pennsylvania, USA, giving two major presentations: Advanced Periodontal Surgery in dogs, including a review of lateral sliding flaps for gingival defect repair; and Surgical Root Canal Therapy in cats and dogs, giving a step by step guide to apicectomy and retrograde filling. There will also be presentations on how to make effective dental impressions so that crowns may be made, and a guide to dental extraction techniques in the horse. Case reports will cover exotics and rabbits. There will be a Q&A session to enable delegates to question the speakers and clarify viewpoints. Refreshments and lunch will be provided and commercial exhibitors will be present all day to help you with your dentistry equipment needs. Delegates may feel free to bring photos and radiographs of cases they may wish colleagues present to give advice on there will always be a committee member available during coffee breaks to help answer any questions. BVDA members are invited to stay for the AGM during the scientific meeting.

British Veterinary Behaviour Association (formerly the CABTSG)

Venue: Hall 8a, ICC Website: www.bvba.org.uk Contact: Jaqi Bunn bvba@btinternet.com The BVBA invites you to attend their annual study day on the 3 April 2013. The topic this year is Pain and Quality of Life Assessment in Relation to the BehaviourPatient. Assessing quality of life and pain in veterinary behaviour patients is frequently difficult and yet it is an essential part of the consultation process. Pain may cause or at least contribute to the behaviours presented to a practitioner and decision making will be influenced by the practitioners belief as to what the quality of life of the patient is likely to be within its current and future environment. For these reasons the BVBA has invited experts in this field to address the meeting with talks ranging from the state of the science of the development and validation of assessment scales, to the practical application of the principles of pain and quality of life assessment with specific reference to the behaviour patient. Invited speakers are all considered leaders in this field and include Professor Xavier Manteca, Prof Jacqueline Reid and Samantha Lindley. In addition the programme will include a range of presentations on other aspects of domestic animal behaviour selected from abstracts submitted.

British Veterinary Dermatology Study Group

Venue: Hall 10, ICC Website: www.bvdsg.org.uk Contact: Filippo De Bellis treasurer@bvdsg.org.uk The BVDSG holds two annual meetings a day meeting prior to BSAVA Congress in April, and a weekend meeting usually in November. Both meetings attract eminent speakers from home and abroad, covering all aspects of veterinary and human dermatology. Members also have an opportunity to present their own work and findings at each meeting in the form of abstracts or short communications.

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Congress 47 APRIL 2013

BSAVA Congress affiliate meetings

The BSAVA Congress event will be an interactive meeting entitled: Interactive Cases: Therapeutic Dilemmas in Dermatology. The BVSDG has secured Dunbar Gram and Kirstin Bergvall as the internationalspeakers.

British and Irish Division of the European Association of Veterinary Diagnostic Imaging
Venue: The Telford Room and Lodge 3, Austin Court Website: www.eavdi.org Contact: Andrew Parry (General) andrew.parry@willows.uk.net Helen Renfrew (Membership) Helenrenfrew@yahoo.co.uk The EAVDI is open to any veterinary surgeon, student, radiographer or nurse with an interest in veterinary diagnostic imaging. The division organises two regular meetings each year: one meeting in Birmingham, on the Wednesday prior to BSAVA Congress, and a further two-day meeting in the following October or November. This year, following the success of last years event, the division will host a satellite meeting on thoracic imaging. This will include a lecture on interpretation of thoracic radiographs given by Ruth Dennis from the Animal Health Trust, how to perform and interpret non cardiac thoracic ultrasound by Allison Zwingenberger, visiting from the University of California, Davis, and current concepts from a human thoracic imaging perspective by Dr Amanda James from Heartlands Hospital, Birmingham, amongst other interesting topics. The meeting will also have a fun film reading session with cases to test your skills. Prices are deliberately kept low to encourage new members: EAVDI member: 100.00 Non EAVDI member: 120.00 Resident: 80.00

The British Veterinary Orthopaedic Association

Venue: Hilton Birmingham Metropole Hotel, NEC Website: www.bvoa.org.uk Contact: Kamila Guilliard k.guilliard@yahoo.com Following the success and popularity of the new location for last years Spring meeting, the BVOA event will again be held in the Hilton Metropole, near Birmingham International Airport. Expect the best mix of international and national experts discussing current options in cruciate surgery, the role of the meniscus and much more. See the website for more information.

British Veterinary Zoological Soceity

Venue: Hall 9, ICC Website: www.bvzs.org Contact: Victoria Roberts editor@bvzs.org The seventh BVZS satellite meeting provides BSAVA delegates and small animal practitioners in general practice the opportunity to undertake world class continuing professional development in non-domestic species medicine and surgery. The programme for the day complements and expands the exotic pet content in the main Congress allowing further development of your skills and understanding. We are again utilising a deeper understanding of exotics, presented by experienced and specialist veterinarians. Each lecture will be around an hour and a quarter in length, followed by time for questions and discussion. The presentations will address the approach to cases seen in small zoo contract work or whilst developing an exotic pet caseload and so will be directly relevant to BSAVA and BVZS members. Speakers include Neil Forbes on avian soft tissue surgery, Anna Meredith on how rabbit nutrition affectshealth and behaviour, Natalie Wissink on the care, diagnostics and common conditions of unusual small mammals, and John Chitty on the care of anorexic tortoises.

International Society of Feline Medicine

Venue: Hall 5, ICC Website: www.isfm.net/conferences Contact: Amanda Dennant conferences@fabcats.org The ISFM provides a feline focus for the veterinary profession worldwide. The high quality of speakers and practical emphasis of all ISFM events has been a formula for success and usually attracts capacity audiences. Aimed at the feline-oriented practitioner, this years ISFM BSAVA Congress symposium

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Congress 47 APRIL 2013

Practical analgesia and anaesthesia for cats, held jointly with the Association of Veterinary Anaesthetists, is likely prove as popular as ever. Pain assessment, analgesia in routine and difficult situations, NSAID therapy, long-term pain management, sedation for the fractious as well as the compromised cat and anaesthesia for the old, the cardiorespiratory patient and in trauma situations, will all be discussed. The itinerary includes wellrespected speakers Liz Leece (Dick White Referrals), Sheilah Robertson (American Veterinary Medical Association), Polly Taylor (freelance consultantin anaesthesia), Sally Polson (University ofLiverpool), Nicki Grint and Pamela Murison (both from the University of Bristol) and Matt Gurney (Northwest Surgeons, UK). ISFM publishes the only peer-reviewed feline veterinary journal, the Journal of Feline Medicine and Surgery, holds an annual European veterinary congress (attended by delegates from over 30 different countries) and, this year, will be hosting the World Feline Veterinary Congress in Barcelona (June 26-30) in conjunction with the American Association of Feline Practitioners and GEMFE (ISFMs Spanish National Partner) under the theme Paediatrics and geriatrics. Early booking is advised for all ISFM events.

Canine diabetes the role of inflammation and autoimmunity and its clinical relevance (Dr Lucy Davidson, University of Oxford) Canine liver disease the role of viruses and the immune system (Dr Nick Bexfield, University of Cambridge).

The programme this year also includes a case report competition with a 300 cash prize open to everyone. The meeting is still ONLY 95 and this includes course notes and lunch. To book your place please contact Yvonne McGrotty. To submit a case report for consideration for inclusion in the programme (maximum 500 words; closing date for submissions 17 February 2013) please contact kit@vetfreedom.com.

Veterinary Cardiovascular Society

Venue: Hall 11, ICC Website: www.bsavaportal.com/vcs Contact: Jan Cormie treasurer@vcsvet.co.uk The VCS BSAVA Congress meeting will focus on methods for measuring the size of the left atrium (arguably the most important echocardiographic measurement made), aspects of arrhythmias, including a panel discussion and some new thoughts on cardiac medications. Our speaker is Mark Rishniw. The meeting will have a practical approach to common issues encountered in General Practice. Please visit our website for access to the full programme and for registration. Fees: Members 125, non-members 150 (includes lunch and proceedings) before 17 March; after this date members 150, nonmembers 175 (last date for registration is 25 March). Membership of the Veterinary Cardiovascular Society is open to any veterinary surgeon or nurse from the UK and abroad with a special interest in cardiology. Annual VCS membership is 20 (standing order), 25 (if paid online or by cheque). The society holds two meetings a year, a one day BSAVA Congress Spring and a two day Autumn meeting, usually in Loughborough in November (89 November 2013). We also offer travel grants annually to younger VCS members to help them attend ECVIM or ACVIM as well as a recently introduced cardiology research grant.

Small Animal Medicine Society

Venue: Hall 8b, ICC Website: www.samsoc.org.uk Contact: Yvonne McGrotty samsoc@vetsurgeon.org or telephone 01412 377676 Members of SAMSoc include specialist internists and general practitioners from the UK and abroad who share a passion and enthusiasm for small animal medicine. New members are always welcome. The society hosts a meeting every year at BSAVA Congress and this is suitable for everybody with an interest in small animal medicine. This year the day will include the following exciting sessions: Acute phase proteins in dogs and cats (Rory Bell, University of Glasgow) Inflammatory bowel disease: Attractive phenotype seeks permissive genotype! (Prof Kenny Simpson, Cornell University, USA) Human inflammatory bowel disease (Prof Yash Mahida, University of Nottingham)

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Practical approach to the diagnostic and management issues in cats with kidney disease
19 February
Bringing the busy practitioner up to date with the issues in diagnosis and treatment, focusing on the main disease presentations
SPEAKER

A clinical dissection of brain disease in dogs and cats

5 March
A day of superb CPD with an engaging expert with the option to add quad biking to your experience
SPEAKER

Pete Smith
VENUE

Jonathan Elliott
VENUE

Wild Park Derbyshire, Brailsford DE6 3BN

FEES WITH QUAD BIKING

Hilton London Stansted Airport

FEES

BSAVA Member: 233.00 Non BSAVA Member: 350.00

BSAVA Member: 250.00 Non BSAVA Member: 375.00

COURSE ONLY

BSAVA Member: 200.00 Non BSAVA Member: 300.00

This wont hurt a bit: simple, safe and effective physiotherapy and rehabilitation
2 May
This course will give you knowledge and skills which you will be able to apply to patients in your practice, supplementing the medical and surgical skills you already use
SPEAKER

Learn@Lunch webinars
These regular monthly lunchtime (12 pm) webinars are FREE to BSAVA members just book your place through the website in order to attend. The topics will be clinically relevant, and particularly aimed at vets and nurses in first opinion practice. There will be separate webinar programmes for vets and for nurses This is a valuable MEMBER BENEFIT

Coming soon

Brian Sharp
VENUE

Dogs Trust, Haresfield

FEES

Vomiting and regurgitation in the dog webinar for vets, 16 January How to tell if your patients are in pain webinar for nurses, 23 January Cruciate disease: which technique when webinar for vets, 13 February Theatre practice webinar for nurses, 20 February

BSAVA Member: 338.00 Non BSAVA Member: 507.00

For more information or to book your course

www.bsava.com
All prices are inclusive of VAT.

Calling for funding applications

E
PetSavers invites applications for a Masters Degree by Research (MDR) grant

A project will be considered by PetSavers to constitute companion animal clinical research if it largely meets each of the following criteria in the reasonable opinion of a majority of the Committee: The study involves only naturally occurring disease in small animals; there must be no experimental or artificial induction of disease The anticipated results of the study will result in a change in diagnosis or management of small animal disease The study is supervised by people with veterinary clinical skills and knowledge Any interventions on animals (including obtaining samples) would be considered part of normal veterinary practice The applicant must state how the results will directly benefit cats, dogs or other companion animals. If the benefit is not direct, they must suggest the number of further steps (and at what cost) they believe it will take before a benefit becomes apparent.

What funding is available?

PetSavers will fund, for a period of one year, the following costs up to a maximum in aggregate of 35,000 (but subject to the individual limitations set out below): a. Postgraduate student stipend (currently 15,00018,000) b. Payment of University fees c. Equipment and consumables (up to 10,000 including VAT) depending on the nature of the project.

ach year PetSavers funds numerous research projects designed to advance our knowledge of conditions affecting small animals and with potential to relieve illness and suffering. In 2012, PetSavers awarded its very first MDR grant to Gina Pinchbeck of the University of Liverpool for her project entitled Prevalence and risk factors for extended-spectrum betalactamase producing bacteria in companion animals.

Guidelines

What is an MDR?

The PetSavers MDR (a recognised degree at Masters level) will fund a postgraduate student to work full time on a specific research project, with or without attendance at some short courses (e.g. statistics, thesis presentation) depending on the nature of the project.

Terms and conditions and application forms can be found at www.bsava.com/ PetSavers/Grants. Alternatively, please contact PetSavers on 01452 726723 or email info@petsavers.org.uk. Written enquiries should be sent to Gemma White, BSAVA, Woodrow House, 1 Telford Way, Waterwells Business Park, Quedgeley, Gloucester GL2 2AB. The deadline for MDR applications is 16August 2013, with the final vote to be taken in March 2014.

DEADLINE FOR CLINICAL RESEARCH PROJECTS (CRP) After introducing the new Masters Degree by Research (MDR) grant in 2012, the decision was taken to alternate the deadlines for applications with the CRPs. Derek Attride, Chair of the PetSavers Grants Awarding Committee, explains, The reason for the shift was to award the MDR in March rather than September so that the MDR start date would t in better with the academic calendar. This gives the universities time to recruit a Masters student for a September/October start date in line with the academic year. Applications for the next round of CRP applications will be March 2014, with the nal vote taken in August 2014. Please check the PetSavers section of the BSAVA website for specic dates for CRP applications which will be updated nearer the time.

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Committee
T
The AWWC was formed in 2009 to help make welfare issues an everyday consideration for small animal practitioners. Dr Karyl Hurley explains more about the role of thiscommittee

COMMITTEE FOCUS: THE WSAVAWALTHAM ANIMAL WELLNESS AND WELFARE COMMITTEE

WHO SITS ON THE AWWC?

mission statement
he role of the Animal Wellness and Welfare Committee (AWWC) is to make welfare issues an everyday consideration for small animal practitioners and to ensure that the WSAVAbecomes a proactive and respected partner within international welfare circles, providing an opinion that balances compassion with science and practical needs. The AWWC was formed in 2009 thanks primarily to the efforts of Drs Roger Clarke of Australia and Ray Butcher, a UK-based vet, who have dedicated their careers to advancing animal welfare and had the foresight to ensure that animal welfare was enshrined as one of the WSAVAs four key pillars. The AWWC works closely with other WSAVA committees in delivering its goals, in particular the CE Committee andthe One Health Committee. The committee brings a great deal of global expertise and experience which can collectively help to support veterinarians all around the world as they strive to increase levels of small animal welfare and wellness. Perhaps the biggest challenge faced by the committee is reaching out to those veterinarians who could most benefit from the support available we want to work in partnership with all veterinarians to achieve our goals. KEY GOALS:

Dr Jolle Kirpensteijn (Acting President of WSAVA and Co-chair) Dr Michael Moyer Past President of the American Animal Hospital Association Dr Karyl J Hurley DVM, DipACVIM, DipECVIM-CA Global Scientic Aairs, Mars Petcare Dr John Rossi VMD MBe (Master of Bioethics) Postdoctoral Research Fellow, Bioethics, Drexel University School of Public Health, USA Dr John M Rawlings BSc MSc PhD Global Science, Welfare and Ethics Advisor, WALTHAM Centre for Pet Nutrition, UK Dr Nienke Endenburg PhD, Assistant Professor, Department of Animals in Science & Society, Faculty of Veterinary Medicine, Utrecht

For further information contact Karyl J Hurley tel: +1 908 619 1044; email: karyl.hurley@eem.com Understanding what the key problems are for veterinarians as they work to improve welfare and wellness, and getting to grips with what we can most usefully provide in terms of support, is the absolute priority for the AWWC. The research we have already conducted (see opposite) has given us a useful starting point but its not complete and we ask more members to get involved and give us their ideas. Should we, for instance, explore providing fellowships in shelter medicine or other training opportunities for students with an interest in animal welfare? What further CE in this area would be most helpful and in what form? Were also interested to know what veterinarians globally sign up to when they qualify, so well be reviewing the oaths we all swear to see how different they are. Please get involved and share your ideas!

To promote advances in animal welfare and wellness around the world through enhanced veterinary care To work with other committees within the WSAVA to provide the resources information, CE, toolkits, etc. to facilitate these advances

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What vets think about

welfare
I
n February 2012, the AWWC issued an online survey to WSAVA member associations to help it start to develop a global picture of the key issues surrounding small animal welfare globally. While more data are needed to make the results more comprehensive, the committee intends to use the initial findings to help prioritise activities into 2013.

Leung Cho Pan | Dreamstime.com

Last year the WSAVAs Animal Wellness and Welfare Committee issued an online survey to help develop a global picture of the key issues surrounding small animal welfare. Here are some of its key findings

Pain management Stray and feral animals Political animal welfare issues Canine, feline and exotic species welfare.

Key findings

When asked to select from a list of issues, the one regarded as most important was zoonoses, followed closely by shelters and re-homing centres (with reference to their welfare and euthanasia policies) and animal behaviour (aggressive dogs, etc). Alarge majority of respondents (81.4%) said that veterinarians in their country would value access to CE on small animal welfare. The following topics were identified as priorities:

When asked how this CE should best be provided, the largest proportion of respondents (75.9%) preferred CE conferences in their region. Access to a central resource for educational materials was also rated highly (53.7%) while WSAVA

Congress lecture streams were suggested by almost half (48.1%). 67.2% of respondents felt it would be helpful for the WSAVA to organise visits in association with Congresses to sites of interest related to small animal welfare. More than half (59.1%) said that they would be interested in participating in voluntary activity programmes with rabies clinics and animal shelters, while passive visits to animal facilities were also suggested by 40.9% of respondents. In a similar vein, more than half (58.2%) of respondents said they would interested in applying for competitive educational grants for student internships in animal welfare that would require the provision of opportunities such as spay/neuter clinics, rescue experience or shelter work. When asked if their national organisation had any documents in Englishthat could be shared within the WSAVA, over a quarter (26.9%) said they had. Almost half (46.3%) of respondents also indicated that their country has an equivalent of a veterinarians oath which could be shared with the AWWC for comparison purposes, while 47.8% said that there were organisations/programmes in place in their country which could serve as models for intervention in particular areas of animal welfare.

More to do at WSAVA World Congress 2013 in Auckland

GOLF DAYS Golf activities have been arranged on Monday 4 and Tuesday 5 March 2013 to allow you time to get a round or two in prior to the Congress. We are pleased to oer golf day packages at category A courses The Grange and Muriwai Golf Club which include green fees, souvenir gift pack, transfers, tour guide, commentary and golf playing partners (if required). Please visit the social functions page at www.wsava2013.org for more information. Accompanying Persons Morning tea will be held on Wednesday 6 March for accompanying persons who are joining delegates in Auckland. A comprehensive programme for accompanying persons will be published on the Congress website soon. If you have any queries about the arrangements for the Congress please contact us by emailing wsava@tcc.co.nz.

Nutrition Shelter welfare Euthanasia Breeding practice

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companion
interview

the

Dr Ruth Cromie
Dr Ruth Cromie was brought up on the coast of rural Northumberland which accounts for her love of eider ducks and big landscapes. Ruth gained a BSc in Biology and PhD in veterinary microbiology from the University of London in 1985 and 1991, respectively. She is currently Head of Wildlife Health at the Wildfowl & Wetlands Trust (WWT) but has worked on a range of wildlife health and welfare research jobs involving various taxa such as waterbirds, raptors and marsupials in UK and overseas. She has never ever been bored in her career and feels blessed to have been able to: perform lion lymphocyte transformation tests, pipette elephant semen, feed 1000s of wild whooper swans, quest for geese in Greenlandic tundra, search Kenyan sewage works for viruses, and both train and learn from passionate conservationists from around the world.
Tell us about how you got interested in science
seal washed up on the beach, or a dead deer in the woods warranted near daily trips to watch their decomposition... As for science, I think an inquiring mind began very early on. I remember at a young age conducting an experiment on what birds eat in my back yard, placing small piles of breadcrumbs/sultanas/apples/crumbled pink wafer biscuits etc. and recording the results from the kitchen window. It wasnt long before it dawned on me that different bird species were confusing the results sheet and, regardless of palatability, the food items next to the window with me looming there were untouched early lessons in defining your hypothesis clearly and designing your experiment properly.

How did you begin your career?

A small advert in the New Scientist directed me to a PhD to develop a vaccine for avian tuberculosis that took me to WWT and into wildlife health. Although Mycobacterium avium remains my adversary, I respect it and owe it a lot for setting me off into a fascinating career.

What jobs have you done?

A
30

I think growing up in the countryside, particularly being on the coast, really sparked (or nurtured) my love of animals and wildlife, and my first pair of binoculars was more memorable than my first bike. I was always keen to get close to wildlife and was particularly intrigued by dead things... any

Ive done a range of mainly research jobs working on health and welfare, including: investigation of mycobacterioses in marsupials in the Smithsonian Institutions National Zoological Park, Washington DC; studying avian immunology at Hong Kong University; and investigating welfare and conservation aspects of raptors in captivity at the Durrell Institute of Conservation and Ecology, Canterbury. Occasionally Ive strayed into other conservation work, such as designing an education exhibit at the National Birds of Prey Centre, Gloucestershire, or tropical forest surveys in Trinidad.

What are you doing now?

I work now for the Wildfowl & Wetlands Trust as Head of Wildlife Health, with responsibilities for some of the health care for the captive animals but mainly working

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you can get an awful lot done with teams of straightforward people

on a range of research, surveillance, advocacy, policy and capacity-building aspects of health in wetlands. Recent projects have included a lot of work on avian influenza and lead poisoning. I also teach on a number of courses, which I find thoroughly rewarding; the conservation benefits feel much more tangible than writing a research paper.

How did you come to be at the WWT?

My first working experience at WWT was as part of my PhD studies, which was a joint WWT/Middlesex Hospital Medical School project. Having left WWT and worked on other jobs, in 1997 I was delighted to accept an invitation to return. The job is wide-ranging, fascinating and challenging. WWT is a truly special place to work, my colleagues are some of the greatest in the world, and to sit at my desk with a stunning wetland reserve just beyond my window makes me feel very privileged. Ioccasionally feel guilty for having not moved on to another job but it would have to be very special indeed to lure me away.

recognising their fundamental importance to life on earth whether wild, domestic or human. Its appropriate then that this convention has championed the One Health approach to managing wetlands, as this recognises the complex interactions between the health of people, livestock and wildlife in these habitats and advocates an approach to health based on maintaining a healthy well-functioning ecosystem. It was a privilege to work on this area for the Convention and a Resolution on taking an ecosystem approach to health was adopted at this years Conference of Parties in Romania in July; 162 countries signing up to what you and your colleagues have written, requesting positive action is very exciting possibly the most significant achievement of my career.

game shot with lead. Its perfect for applying those One Health principles because we can take preventive measures by only shooting with non-toxic shot, which is widely available.

Who has been the biggest influence on your career?

What is your greatest fear in terms of conservation and wildlife welfare?

What are the main challenges facing the vets working at WWT?

Being involved in the health management of the only captive population of critically endangered spoon-billed sandpipers is taking nerves of steel! These diminutive enigmatic waders are crashing towards extinction in the wild at a terrifying rate and in our recently established captive population every single bird is invaluable. However, with such tiny birds, of which we know so little, diagnoses and treatment options are very complex. Thank goodness our great animal carers make the lives of us in the animal health team easy by caring for them so well and preventing problems.

Tell us about the Ramsar Convention on Wetlands

The Ramsar Convention on Wetlands is a multilateral environmental agreement which promotes wise use of wetlands,

My greatest fear is that, despite the many environmental problems to address, as a society we dont act quickly enough in response to what we learn. As a result, were leaving a poorer and more contaminated planet for future generations. That sounds a bit melodramatic but, to give an example, WWT has been trying to address the problem of lead poisoning in waterbirds since the 1980s. Weve recently published a paper which analyses post-mortem data from wild birds going back 40 years. Roughly 10% of wildfowl died of lead poisoning by ingesting spent lead gunshot. This figure may be high but its not new news poisoning from lead shot has long been known as a significant cause of death for waterbirds, raptors and even gamebirds. What is depressing is that despite introduction of laws to restrict its use more than a decade ago, there has been no measureable reduction in lead-related mortality rate. Lead kills wild birds. It affects domestic animals too, if they are exposed to it. It puts human health at risk, for vulnerable groups such as children and those regularly eating

I dont think there is a single person but I have been immensely lucky to work with a number of people who gave me great opportunities and taught me. The training of Dr David Higgins of Hong Kong University in avian immunology in my early career is appreciated to this day. Similarly, Dr Richard (Dick) Montali of Smithsonian Institution went to some lengths to employ me; he is such a great veterinary pathologist and he taught me a great deal. Ive also learnt a massive amount from Martin Brown, WWTs Animal Health Officer; he is a wise, vastly experienced colleague and friend, whom I admire greatly.

Which living person do you most admire, and why?

This might sound a bit parochial but DavePaynter, Reserve Manager at Slimbridge. Hes immensely capable and knowledgeable, yet if he doesnt know something hes honest about it. Hes a great leader or team player, keen to share his passion for wildlife and treats everyone the same, and is always cheerful, positive and helpful. A delight to be with! Imagine if everyone you worked with shared these qualities wouldnt we get a lot done and wouldnt it be fun!

What single thing would improve the quality of your life?

Knowing that there is serious political will to value and look after wildlife. Less hot air, more action.

What is the most important lesson life has taught you?

Be a nice person who is easy to work with you can get an awful lot done with teams of straightforward people.

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New edition includes DVD

Neurology
4th edition

Got this in your practice library?

Endoscopy and Endosurgery

BSAVA Manual of Canine and Feline

BSAVA Manual of Canine and Feline

The latest edition of this best-selling Manual is fully updated to cover all the latest advances in the field. Structured in the same practical way as the previous edition, the new edition includes new chapters on neurological genetic disease testing and counselling, adjunctive therapies, and the importance of providing adequate nutritional support to neurological patients. An accompanying DVD-ROM contains more than 100 videos relating to clinical presentation, examination and diagnosis.

A practical guide for general practitioners wishing to use minimally invasive techniques. Flexible and rigid endoscopy Instrumentation Principles and basic techniques

WHAT THEY SAY

a well-written, concise and useful guide for veterinary practitioners interested in starting out in the eld of endoscopy... JOURNAL OF SMALL ANIMAL PRACTICE

BSAVA Member Price: 55.00

Price to non-members: 89.00

BSAVA Member Price: 49.00

Price to non-members: 75.00

On offer while stocks last

BSAVA Manual of

companion offerof the month

Exclusive offer for companion readers call BSAVA on 01452 726700 and quote companion offer Dentistry

Rabbit Medicine and Surgery

2nd edition
This popular Manual reflects the increased understanding of rabbit health and disease. This edition includes:

Extra 20% discount off member price BSAVA Manual of Canine and Feline

Dentistry
3rd edition
WHAT THEY SAY

Nursing care Cardiovascular disorders

Dentistry Diagnostic imaging

Note: BSAVA Manual of Rabbit Surgery, Dentistry and Imaging due 2013; BSAVA Manual of Rabbit Medicine due 2014

...an excellent addition for a veterinary student or a general practitioner who desires a greater understanding of anatomy, periodontal disease and oral extractions... AUSTRALIAN VETERINARY JOURNAL Offer is available to BSAVA members only. Ends 28 February 2013. Free P&P on telephone orders for UK and Eire delivery, online rates of P&P apply for overseas orders.

WHAT THEY SAY

...provides a large amount of information you will require on a daily basis... JOURNAL OF SMALL ANIMAL PRACTICE

BSAVA Member Price: 49.0035.00

Price to non-members: 75.0055.00

companion offer: 45.0036.00

Price to non-members: 70.00

For more information or to order

www.bsava.com

BSAVA Publications
COMMUNICATING VETERINARY KNOWLEDGE

BSAVA reserves the right to alter prices where necessary without prior notice.

2013

Graeme Eckford, Chair of Scottish Congress, invites you to the ever-popular BSAVA Scottish Congress this Summer at the Edinburgh Conference Centre, 30 August 1 September
PROGRAMME HIGHLIGHTS Nurses WOUND MANAGEMENT Kathryn Pratschke Session one: Types of wounds seen in veterinary patients Initial wound management Session two: Primary contact dressings available: when and how to use New methods of wound management including maggots, honey and silver dressings Sub-atmospheric pressure therapy (VAC): when to advise specialist treatment Session three: Wound management case studies

n behalf of the BSAVA Scottish Region Iwould like to invite you to a packed weekend of superb CPD, socialising and ceilidh dancing. We have worked hard to put together a range of topics, delivered by excellent speakers at a great venue, and now that we have released our programme for the weekend its time to mark the date on your calendar and book your place at www.bsava.com/scottishcongress. Thanks to the ongoing support of our sponsors, we have been able to make this years Scottish Congress even better value for money, with BSAVA Vet Member prices starting at just 150 for the whole weekend, along with excellent day delegate rates. Take advantage of the Early Bird offer (available until 31 May) or come and see us on the Scottish BSAVA stand at BSAVA Congress in Birmingham (47 April) for a special registration offer and to meet the team and join us in eating some delicious Scottish tablet.

CLINICAL PATHOLOGY Hayley Henning Session one: Blood smears, staining and cell identication A lecture-based session concentrating on the technique of producing a blood smear of diagnostic quality. Staining technique using Di-Quik, and theoretical instruction on cell identication Session two: Practical urinalysis, microscopy and crystal identication A lecture-based session concentrating on techniques to examine urine samples. The session includes practical instruction on microscopy, staining technique using Sedi-stain, and theoretical instruction on crystal, cast and cell identication Session three: Skin and hair sampling, including parasite identication A theoretical and case study-based session, with some practical identication of parasites. The session involves theoretical instruction on dierent skin and hair sampling techniques, when they would be used, and what could be diagnosed in the in-house laboratory

EARLY BIRD 31 MAY Vet Stream

Vets

BSAVA Member Weekend Rate: 150 BSAVA Member Day Rate: 90 Non Member Weekend Rate: 254.50 Non Member Day Rate: 152.70 Students/1st Year Qualied Weekend Rate: 125 Students/1st Year Qualied Day Rate: 75 BSAVA Member Weekend Rate: 110 BSAVA Member Day Rate: 66 Non Member Weekend Rate: 130 Non Member Day Rate: 78 Students/1st Year Qualied Weekend Rate: 125 Students/1st Year Qualied Day Rate: 75 Gala Dinner 25 for delegates 50 for non delegates Friday CPD/Buet 5 for delegates 20 for non delegates

CARDIOLOGY Ruth Willis Session one: Chest radiography: indications and radiographic interpretation Session two: Cardiology pharmacy: which drug for when Session three: ECG and holter monitoring

Nurse Stream

NEUROLOGY Annette Wessman Session one: Seizures, tremors and twitches Session two: Neurological case management (with video footage) Session three: Feline neurology Joint surgery (interactive) Nacho Calvo The acute abdomen (interactive) Kathryn Pratschke Dog behaviour Sarah Heath Cat behaviour Sarah Heath ECGs for nurses Yolanda Martinez First opinion physiotherapy for nurses Gillian Calvo Urinary tract surgery Sam Woods Pyrexia of unknown origin (interactive) Nicki Reed Diseases of the travelling pet Alix McBrearty Mammary oncology Jo Morris Introduction to clinical coaching in practice Allison Smith Anaesthetic emergencies Fiona Strachan

Afternoon Seminars

Social

Please note, the programme is subject to minor changes. Please visit www.bsava.com or email b.dales@bsava.com for further information and updates

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CPD diary
February 2013
DAY MEETING EAST ANGLIA REGION EVENING MEETING SURREY AND SUSSEX REGION

EVENING MEETING CYMRU/WELSH REGION

Wednesday 13 February Diabetes explained

Speaker: Grant Petrie Carmarthen Veterinary Centre SA31 3SA Details from welsh.region@bsava.com

EVENING MEETING METROPOLITAN REGION

Sunday 3 February Hot topics in feline medicine: an interactive day of case-based lectures
Speaker: Kerry Simpson Animal Health Trust, Newmarket, Suffolk Details from eastanglia.region@bsava.com

Wednesday 6 February Tips, tricks and pitfalls in rigid and flexible endoscopy

Wednesday 13 February AGM

DAY MEETING

Speaker: Philip Lhermette The Holiday Inn, Guildford, Surrey Details from surreyandsussexregion@bsava.com

Venue: TBC Details from metropolitanregion@bsava.com

DAY MEETING

EVENING MEETING WEST MIDLAND REGION

Tuesday 5 February Reptiles: handling and husbandry hands on with lizards, snakes and chelonians
Speaker: Sarah Pellet Animal Care Department, Solihull College, Blossomfield Road, Solihull B91 1SB Details from westmidlands@bsava.com

Thursday 7 February Should I give it steroids? Problems in small animal gastroenterology

Tuesday 19 February Practical approach to the diagnostic and management issues in cats with kidney disease
Speaker: Jonathan Elliott Hilton, Stansted Airport Details from administration@bsava.com

Speaker: Ed Hall Stonehouse Court Hotel, Gloucestershire GL10 3RA Details from administration@bsava.com

EVENING MEETING NORTH WEST REGION

EVENING WEBINAR

Tuesday 19 February Immunology

DAY MEETING

Tuesday 5 February Feeding back to health: clinical nutrition in general practice

Thursday 7 February 20:0021:00 Case presentations: systemic disease and the eye
Speaker: David Gould Online Details from administration@bsava.com

Speaker: Nat Whitley Holiday Inn, Chester Details from northwestregion@bsava.com

LUNCHTIME WEBINAR

Speaker: Isuru Gajanayake and Rachel Lumbis Telford Golf and Spa Hotel Details from administration@bsava.com

Wednesday 20 February 13:0014:00 Theatre practice

AFTERNOON/EVENING MEETING METROPOLITAN REGION

DAY MEETING SOUTHERN REGION

Speaker: Alison Young Online Details from administration@bsava.com

Tuesday 5 February Approach to backyard poultry

Speaker: Steve Smith The Oxford Belfry, Milton Common, Thame, Oxfordshire OX9 2JW Details from metropolitanregion@bsava.com

Sunday 10 February How to solve common problems in small furries, including anaesthesia and post op care
Speaker: John Chitty The Potters Heron Hotel, Ampfield, Romsey, Hampshire SO51 9ZF Details from southernregion@bsava.com

EVENING MEETING SCOTTISH REGION

Thursday 21 February Urinary soft tissue surgery

Speaker: Richard Coe Holiday Inn, Westhill, Aberdeen Details from scottishregion@bsava.com

EVENING MEETING SOUTH WEST REGION

Tuesday 5 February Save that last breath for another day: dealing with a respiratory emergency
Speaker: Dan Lewis The Devon Hotel, Matford, Exeter EX2 8XU Details from southwestregion@bsava.com

EVENING MEETING EAST MIDLANDS REGION

DAY MEETING SOUTH WEST REGION

Tuesday 12 February Exploratory laparotomy: a guided tour

Speaker: Stephen Baines Yew Tree Lodge Best Western Hotel, 33Packington Hill, Kegworth, Derby DE74 2DF Details from eastmidlands@bsava.com

Thursday 21 February Immune-mediated and haematological disease

Speaker: Nat Whitley Kendleshire Golf Club, Henfield Road, CoalpitHeath, Bristol, Avon BS36 2TG Details from southwestregion@bsava.com

EVENING MEETING NORTH EAST REGION

LUNCHTIME WEBINAR

Wednesday 6 February Cat dentals

Speaker: Bob Partridge IDEXX Laboratories Wetherby, Grange House, Sandbeck Way, Wetherby, West Yorkshire LS22 7DN Details from northeastregion@bsava.com

Wednesday 13 February 13:0014:00 Cruciate disease: which technique when

DAY MEETING SOUTH WEST REGION

Friday 22 February Immune-mediated and haematological disease

Speaker: Sorrel Langley-Hobbs Online Details from administration@bsava.com

Speaker: Nat Whitley Kingsley Village, A30, Penhale, Fraddon, Cornwall TR9 6NA Details from southwestregion@bsava.com

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March 2013
EVENING WEBINAR

EVENING WEBINAR

EVENING WEBINAR

Monday 4 March 20:0021:00 Practical approach to diagnostic and management issues in cats with kidney disease
Speaker: Jonathan Elliott Online Details from administration@bsava.com

Monday 18 March 20:0021:00 Case based clinical approach to stifle lameness

Speaker: Toby Gemmill Online Details from administration@bsava.com

Monday 25 March 20:0021:00 Therapeutic exercises: a practical approach to what can be achieved in practice
Speaker: Lowri Davies Online Details from administration@bsava.com

DAY MEETING METROPOLITAN REGION

DAY MEETING

Tuesday 5 March A clinical dissection of brain disease in dogs and cats

Tuesday 19 March Wound management

April 2013

Speakers: Davina Anderson and Kate White Holiday Inn, Crest Road, Handy Cross, High Wycombe HP11 1TL Details from metropolitanregion@bsava.com

Speaker: Pete Smith Wildpark Farm, Ashbourne, Derbyshire DE6 3BN Details from administration@bsava.com

LUNCHTIME WEBINAR

47 April
Practice Badge Deadline Wednesday 6 March
The ICC/NIA, Birmingham, UK Email: congress@bsava.com

EVENING MEETING WEST MIDLANDS REGION

Tuesday 5 March Acute pain management/ peri-operative analgesia

Wednesday 20 March 13:0014:00 Chemotherapy

Speaker: Linda Roberts Online Details from administration@bsava.com

Speaker: Matthew Gurney Wolverhampton Medical Institute, New Cross Hospital, Wolverhampton WV10 0QP Details from westmidlands@bsava.com

DAY MEETING

EVENING WEBINAR

Thursday 21 March BSAVA Dispensing course

EVENING WEBINAR

Wednesday 6 March 20:0021:00 Basic principles of wildlife rescue and first aid
Speaker: Liz Mullineaux Online Details from administration@bsava.com

Speakers: P. Sketchley, F. Nind, J. Hird, P.Mosedale, S Dean, M.Jessop Hawkwell House, Oxford OX4 4DZ Details from administration@bsava.com

Wednesday 10 April 20:0021:00 Are blood transfusions possible in small animal practice?
Speaker: Susana Silva Online Details from administration@bsava.com

DAY MEETING SOUTH WEST REGION

DAY MEETING NORTH EAST REGION

Thursday 21 March Medical and surgical aspects of gastrointestinal disease

Sunday 10 March Smelly ears

Speaker: Sue Patterson Wetherby Racecourse Details from northeastregion@bsava.com

Speakers: Ed Hall and Ed Friend Canalside, Marsh Lane, North Petherton, Bridgwater, Somerset TA6 6LQ Details from southwestregion@bsava.com

OTHER UPCOMING BSAVA CPD COURSES See www.bsava.com for further details

LUNCHTIME WEBINAR

DAY MEETING SOUTH WEST REGION

Wednesday 13 March 13:0014:00 Surgical management of aural disease

Speaker: Alison Moores Online Details from administration@bsava.com

Friday 22 March Medical and surgical aspects of gastrointestinal disease

Speakers: Ed Hall and Ed Friend Lostwithiel Hotel and Country Club, Lower Polscoe Lostwithiel, Cornwall PL22 OHQ Details from southwestregion@bsava.com

EVENING MEETING EAST MIDLANDS REGION

DAY MEETING SCOTTISH REGION

Wednesday 13 March Diagnosis and management of liver disease in cats and dogs

Speaker: Nick Bexfield Yew Tree Lodge Best Western Hotel, 33Packington Hill, Kegworth, Derby DE74 2DF Details from eastmidlands@bsava.com

Sunday 24 March Oncology: top 6 cancers seen in small animal practice, medical and surgical management
Speakers: Kathryn M. Pratschke and JennyR.Helm Glasgow University Vet School Details from scottishregion@bsava.com

BSAVA Education Wednesday 17 April Imaging of the muscloskeletal system BSAVA Education Wednesday 17 April Dealing with specific species: case examples BSAVA Education Wednesday 24 April Geriatric clinics for cats BSAVA Education Wednesday 1 May Diagnosis and management options for elbow dysplasia West Midlands Region Thursday 2 May The coughing dog EXCLUSIVE FOR MEMBERS Extra 10% discount on all BSAVA publications for members attending any BSAVA CPD event.

All dates were correct at time of going to print; however, we would suggest that you contact the organisers for confirmation.

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47 April 2013

The Congress for the whole team

with something for everyone from your practice
Join us in April for the very best in veterinary science, business knowledge, and networking.

Today
March
WEDNESDAY

Practice badge deadline 6 March

More than 300 lectures catering to all career and experience levels Extended management stream Largest small animal exhibition in Europe, with over 250 companies

Register online now

www.bsava.com/congress
The ICC / NIA Birmingham UK